We report a case of a 34-year-old woman who was in temporary delirium and hyperammonemia during treatment of bipolar affective disorder with valproate. Patient showed delirium after 20 days of treatment, while the serum valproate level was within the therapeutic range without any sign of hepatic insufficiency. However, the patient had increased serum ammonia level (121 microg/mL), and valproate was discontinued due to suspicion of valproate-induced hyperammonemic encephalopathy (VHE). Serum valproate level was normalized with reduced delirium after valproate has been discontinued. Few VHE in psychiatric literature has been documented, because of possible confusion between VHE and preexisting psychiatric symptoms. Clinicians should be cautious about the potential risk for hyperammonemic encephalopathy caused by valproate medication.
Adult ; Ammonia ; Delirium ; Female ; Hepatic Insufficiency ; Humans ; Hyperammonemia ; Mood Disorders ; Valproic Acid

Objectives: ：Zolpidem is a common drug used in insomnia. However, there are several reports of side effects of the central nervous system or sleep related behavior in patients who took zolpidem. This study was conducted to investigate risk factors affecting sleep related behavior after taking zolpidem in inpatients. Methods: ：From January 1, 2019 to December 31, 2019, medical records of patients who took zolpidem hospitalized at Inha University Hospital were reviewed retrospectively. Results: ：907 patients who took Zolpidem, 102 (11.2%) showed sleep related behavior, and if they were 65years of age or older, men, taking antipsychotics, and taking antipsychotics and benzodiazepines at the same time, they were significantly more likely to show sleep related behavior. Conclusions ：Risk factors for sleep-related behavior after use of zolpidem are estimated gender, elderly, antipsychotics, and combination of antipsychotics and benzodiazepines.

OBJECTIVES: Study aimed to identify factors that may affect family burden and quality of life (QOL) of primary caregivers in schizophrenia family. METHODS: Among outpatients with schizophrenia undergoing treatment at the psychiatric department of a university hospital, 72 patients and their primary caregivers were investigated. Sociodemographic and clinical data were collected and analyzed. RESULTS: As a result of multiple regression of primary caregivers’ family burden (R²=0.284), primary caregiver’s income (p=0.001) and patient’s delusional symptoms (p=0.001) significantly explained the total family burden of primary caregivers. In multiple regression on QOL (R²=0.515), primary caregiver’s income (p=0.033) and education level (p=0.006), patient’s sex (p=0.006), treatment duration (p<0.001), degree of disorganized speech (p=0.008), negative drug attitudes (p=0.026) and the attitude of overcoming stigma against mental patients (p=0.029) all significantly explained the average QOL score. CONCLUSION: Various factors determining primary caregiver’s QOL, including Clinical symptoms such as patient’s disorganized speech and clinically correctable factors such as negative drug attitude and insight into disease. Therefore, provision of education regarding drug and disease for patients and caregivers will be helpful to effectively reduce burden and improve the QOL of primary caregivers.
Caregivers ; Delusions ; Education ; Humans ; Mentally Ill Persons ; Outpatients ; Quality of Life* ; Schizophrenia*

Objectives: The purpose of the present study was to examine the relationship between the chronotype and the burnout, so we investigated the mediating effects of the mediators such as perceived stress, stress response, and depression. Methods: Employees working at Incheon Customs conducted a mental health self-examination through the internet. Among them, 174 people who agreed to the mental health survey participated in the study. Participants completed questionnaires including Composite Scale of Morningness (CSM), Center for Epidemiological Studies-Depression Scale (CES-D), Perceived Stress Scale (PSS), Stress Response Inventory (SRI), Maslach Burnout Inventory-General Survey (MBI-GS). Results: Our results showed a higher degree of CES-D, SRI, exhaustion, and cynicism in evening and intermediate type compared to morning type, and a higher degree of professional efficacy in morning type compared to intermediate type. CSM was shown to have a direct effect on exhaustion and indirect effect through CES-D and SRI. CSM also had a direct effect on professional efficacy and had an indirect effect through the CES-D. However, CSM was found to have only indirect effects through the SRI for Cynicism. Conclusions In this study, individuals with evening type tend to experience a high degree of burnout (exhaustion, cynicism and professional efficacy) through the mediation effect of depression and stress response. Further study is necessary to reveal the effect of management of the depression and stress response in the employee with evening type.

Objectives: The purpose of the present study was to examine the relationship between the chronotype and the burnout, so we investigated the mediating effects of the mediators such as perceived stress, stress response, and depression. Methods: Employees working at Incheon Customs conducted a mental health self-examination through the internet. Among them, 174 people who agreed to the mental health survey participated in the study. Participants completed questionnaires including Composite Scale of Morningness (CSM), Center for Epidemiological Studies-Depression Scale (CES-D), Perceived Stress Scale (PSS), Stress Response Inventory (SRI), Maslach Burnout Inventory-General Survey (MBI-GS). Results: Our results showed a higher degree of CES-D, SRI, exhaustion, and cynicism in evening and intermediate type compared to morning type, and a higher degree of professional efficacy in morning type compared to intermediate type. CSM was shown to have a direct effect on exhaustion and indirect effect through CES-D and SRI. CSM also had a direct effect on professional efficacy and had an indirect effect through the CES-D. However, CSM was found to have only indirect effects through the SRI for Cynicism. Conclusions In this study, individuals with evening type tend to experience a high degree of burnout (exhaustion, cynicism and professional efficacy) through the mediation effect of depression and stress response. Further study is necessary to reveal the effect of management of the depression and stress response in the employee with evening type.

Objectives: ：In this study, elderly hospitalized patients aged 65 years or older who were admitted to a university hospital and referred to the department of psychiatry were classified into youngest-old, middle-old, and oldest-old. It was conducted to find out what factors contribute to the agitation pattern by age group, wheth-er there is a difference in the factors, and whether there is a difference in the severity of the agitation pattern. Methods: ：From July 1, 2021 to December 31, 2021, the medical records of patients aged 65 years or older who were referred to the department of psychiatry were retrospectively reviewed. Age, gender, route of hospitalization, department of referral, reason for referral, treatment method, presence of internal and surgical diseases, and hematological test data were investigated. Results: ：There was a significant correlation with the RASS score in cases of surgery referral and high CRP levels for youngest-old aged 65 to 74 years, in cases of surgery referral, dementia and hyponatremia for middleold aged 75 to 84 years, in case of dementia for oldest-old aged 85 years old or older. In addition, there were differences in the severity of agitation patterns between age groups. Conclusions ：As the age group increases, the agitation of delirium patients becomes more severe, and vari-ous factors contributing to the agitation pattern also differ by age group. Therefore, when treating elderly pa-tients with delirium, attention should be paid to factors that may affect agitation depending on age.