The current understanding of the neurobioloby of anxiety is generally based on experimental animal model, empirical effective psychopharmacological agents, chemical and naturalistic challenge paradigms, and psychoendocinological assessment. This article focuses on reviewing neuroanantomical, neuroendocinological and neurofunctional research of anxiety disorder. In the decade ahead, we anticipate that extension of current research and the new integrated approach promise novel insight into mechanism of anxiety.
Anxiety Disorders ; Anxiety* ; Models, Animal ; Neuroanatomy ; Neurobiology* ; Neuroendocrinology ; Neuroimaging

The debate about whether depressive disorders should be divided into categories or arrayed along a continuum has gone for decade, without resolution. In our review, there is more evidence consistent with the spectrum concept than there is with the idea that depressive disorders constitute discrete clusters marked by relatively discontinuous boundaries. First, "depression spectrum", "is there a common genetic factors in bipolar and unipolar affective disorder", "threshold model of depression" and "bipolar spectrum disorder" are reviewed. And, a new subtype of depression is so called SeCA depression that is a stressor-precipitated, cortisol-induced, serotonin-related, anxiety/aggression-driven depression. SeCA depression is discussed. But, there is with the idea that depressive disorders constitute discrete subtypes marked by relatively discontinuous boundaries. This subtypes of depressive disorder were reviewed from a variety of theoretical frames of reference. The following issues are discussed ; Dexamethasone suppression test(DST), TRH stimulation test, MHPG, Temperament Character Inventory(TCI), and heart rate variability(HRV).
Depression* ; Depressive Disorder ; Dexamethasone ; Heart Rate ; Methoxyhydroxyphenylglycol ; Temperament

Older persons are at higher risk for suicide than any other age group and elderly suicide is a critical public health problem. Attempted suicide in elderly is very lethal, therefore it's management must be accompanied by prevention. Though, there are few reports about risk factors in elderly suicide, and significant differences in the data between western and eastern world. So, there should be researches about risk factors influenced by peculiar cultural and regional circumstances, and these make it possible to detect elderly suicide early by education and community efforts.
Aged* ; Education ; Humans ; Public Health ; Risk Factors ; Suicide* ; Suicide, Attempted

It has been widely known that the elderly suffer very mild cognitive impairment including memory function that cannot satisfy the criteria of dementia. Koivisti and Hannien et al reported that the prevalences of age-associated memory impairment and age-associated cognitive decline were 38.6% and 26.6%, respectively. The prevalence rate of male was more than that of female and the prevalence rate was increased in younger elderly. The risk factors of age-related cognitive decline were age and myocardiac infarction whereas education and smoking decreased the risk of age-related cognitive decline. The small portion of age-associated memory impairment progressed toward dementia but the most of them were nonprogressive. The probability of progression toward dementia could be predicted by detailed neurocognitive function test. The further epidemiologic studies will reveal the nature of age-associated memory impairment.
Aged ; Dementia ; Education ; Epidemiologic Studies ; Epidemiology* ; Female ; Humans ; Infarction ; Male ; Memory* ; Mild Cognitive Impairment ; Prevalence ; Risk Factors ; Smoke ; Smoking

OBJECTIVE: We analyzed the degree of behavioral and psychic masculinization as well as factors influencing the masculinization in female patients with CAH caused by 21-hydroxylase deficiency. METHODS: We studied 26 patients with salt-wasting (SW) type, 29 patients with simple virilizing (SV) type and 30 control patients, who were older than 10 years of age. Study participants were given a questionnaire containing 55 items (20 masculine items, 20 feminine items, 15 neutral items) in order to evaluate the degree of feminity and masculinity. RESULTS: SW and SV girls revealed significantly higher masculine scores and lower feminine scores than the control groups (P<0.05). Feminine scores were lower in the SW group compared to those in the SV group (P<0.05). Neutral scores showed no significant difference among three groups. Masculine, feminine, bisexual and undifferentiated personality characteristics exhibit 57.6%, 3.8%, 7.6%, and 30.7% in SW group, respectively; 31%, 17.2%, 20.6%, and 30%, respectively in SV group; 3.3%, 50.0%, 20.0% and 26.6%, respectively in control group. Masculine scores were negatively correlated with age at diagnosis and treatment (r=-0.516, P<0.05), but not with the levels of 17-hydroxyprogesterone at the time of diagnosis and study, advancement of bone age, age at clitoplasty, age at onset of puberty and age at menarche. CONCLUSIONS: Female patients with 21-hydroxylase deficiency, who reveal high masculinizing score, should be closely monitored for the adverse effects of high degree of masculinization, such as polycystic ovarian syndrome. Additionally, it is important to treat adequately after early diagnosis to minimize the degree of masculinization and to develop the prenatal mode of treatment to interrupt the secretion of adrenal androgen.
17-alpha-Hydroxyprogesterone ; Adolescent ; Adrenal Hyperplasia, Congenital* ; Bisexuality ; Diagnosis ; Early Diagnosis ; Female* ; Humans ; Masculinity ; Menarche ; Polycystic Ovary Syndrome ; Puberty ; Surveys and Questionnaires ; Steroid 21-Hydroxylase*

Traumatic injury can result not only in physical disability but also in mental and behavioral sequelae. It is very important to properly judge the severity of disability as well as the need for assistance and future medical treatment. It is very difficult to establish objective guidelines for assessing mental and behavioral disabilities due to the inherent peculiarity of the disabilities. This study uses reports generated for court because they need to be more judicious than reports for other types of evaluation. We analyzed reports concerning the facts and problems associated with evaluation of mental and behavioral disabilities. We hope this study will help further our understanding of mental and behavioral disabilities.

STUDY DESIGN: Case study of two cases. OBJECTIVES: The aim of our study is to describe atypical patterns of tuberculous spondylitis. SUMMARY OF LITERATURE REVIEW: Few reports of tuberculous spondylitis have discussed atypical cases, which resulted in a poor prognosis due to the delay in early diagnosis and proper treatment. MATERIALS AND METHODS: A 74-year-old female underwent an incision and drainage, and posterior decompression and fusion (PDF) due to tuberculous epidural abscess after vertebroplasty of a compression fracture at T12. A 52-year-old female underwent interbody fusion and posterior lateral fusion (PLF) because of aggravation of an abscess and neurologic symptoms following non-invasive intervention to treat atypical tuberculous spondylitis. RESULTS: Clinical symptoms and serological tests of the patients were improved at postoperative 6 months. CONCLUSIONS: When a patient presents with focal bony or soft tissue abnormality on an image study, the possibility of non-typical tuberculous spondylitis has to be considered when infective spondylitis or a tumor is detected. Moreover, an invasive diagnosis tool such as biopsy will be needed for proper management.
Abscess ; Aged ; Biopsy ; Decompression ; Diagnosis ; Drainage ; Early Diagnosis ; Epidural Abscess ; Female ; Fractures, Compression ; Humans ; Middle Aged ; Neurologic Manifestations ; Prognosis ; Serologic Tests ; Spondylitis* ; Vertebroplasty

Bisphosphonate is used widely for osteoporosis management. On the other hand, some studies have reported that prolonged use of bisphosphonate without a proper resting period can cause insufficiency fracture and, in rare cases, fractures on the femur neck. This paper reports a case of an elderly patient who suffered bilateral femur neck insufficiency fractures induced by non-stopped long-term bisphosphonate therapy. The patient complained of pain in her buttocks at the first visit. During the admission period, inguinal area pain newly developed. Both a femur neck insufficiency fracture was observed on the hip radiographic image. Hip pinning and postoperative parathyroid hormone treatment were performed. The patient was discharged without specific complications and reported improvement in symptoms on the last follow-up. Several authors have reported one-sided femoral neck insufficiency fractures due to bisphosphonate use, but the present case is uncommon in that it occurred simultaneously in both femur necks. In addition, in the case of bilateral femur fractures, the walking ability after surgery is lower than that of one-sided fracture cases, so active rehabilitation is necessary.

OBJECTIVES: This study aims to confirm the reliability and validity of the GMS-AGECAT(Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy in a Korean elderly population. METHODS: Translation committee developed Korean version GMS translating GMS-A3 after preliminary studies. Few changes from the original English version were necessary. A random sample(N= 1256 of the elderly(65+ years in Asan, community was assessed for diagnostic validity. A two-phase study was designed: Korean version of GMS-AGECAT, MMSE and GDS rated by lay interviewer and clinical assessment by psychiatrists according to DSM-IV. A consecutive hospital sample(N=28 of the elderly(65+ years admitted in Hangang Sacred Heart Hospital was assessed for reliability, concurrent & procedural validity. RESULTS: Reliability coefficients of GMS-AGECAT diagnosis were Inter-rater kappa 0.78 and test-retest kappa 0.56. Correlation coefficients for concurrent validity were 0.76 with MMSE and 0.73 with GDS. Procedural validity of psychiatrist's GMS-AGECAT diagnosis and lay-interviewers' were as follow: case/ no case distinction sensitivity 95.5%, specificity 75%; organicity distinction sensitivity 100%, specificity 83.3% and depression distinction, sensitivity 92.3%, specificity 100%. Diagnostic validity of DSM-IV diagnoses and GMS-AGECAT diagnoses were: case/ no case distinction sensitivity 92.7%, specificity 81%, dementia distinction sensitivity 77.3%, specificity 92.1% and depression distinction sensitivity 83.6%, specificity 84.1%. CONCLUSIONS: This study confirms the reliability and validity of the GMS-AGECAT in Korean elderly. Korean version GMS can be used in the international comparison studies.
Aged ; Chungcheongnam-do ; Classification ; Dementia ; Depression ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Heart ; Humans ; Psychiatry ; Reproducibility of Results* ; Sensitivity and Specificity ; Translating

BACKGROUNDS: Depression in old age has significant negative impact on physical health and social activities, which may greatly burden a society with increased costs of use of health care resources and may seriously hamper individual's quality of life. This study aimed to identify the prevalence and risk factors of depression in older community population. METHOD: By the random sampling, study population(n=1,300) was selected out of total population of the elderly aged 65 years or older in Asan city(N=14,977). Two-phase community survey method was used; the Korean version of the Geriatric Mental State Schedule(GMS-K) was used as a screening instrument to define caseness group by trained interviewers, while board-certified psychiatrists confirmed clinical diagnoses according to the DSM-IV criteria by face-to-face interview of subjects for the Stage 2 study. RESULTS: Of 1,300 subjects, 1,246 elderly completed the stage 1 screening interview(=95.9%). Prevalence of all depressive disorders were 10.5%(male 7.4%, female 12.8%); 8.7% in major depression(male 6.3%, female 10.6%), 0.5% in dysthymic disorder(male 0.4%, female 0.6%), and depressive disorder NOS 0.5%(male 0.2%, female 0.7%). A high risk of depressive disorder was found among elderly women(OR= 1.54, 95% CI 1.08-2.20) and among those with physical illnesses(OR=1.82, 95% CI 1.33-2.48), especially those with vascular risk factors(OR=1.96, 95% CI 1.43-2.69). CONCLUSION: The association between physical health and depression in old age is a consistent finding across world. Systemic efforts to reduce incidence of depression and especially to prevent and treat vascular risk factors may be able to improve mental health in the elderly.
Aged ; Chungcheongnam-do ; Surveys and Questionnaires ; Delivery of Health Care ; Depression* ; Depressive Disorder ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Humans ; Incidence ; Mass Screening ; Mental Health ; Prevalence ; Psychiatry ; Quality of Life ; Risk Factors