OBJECTIVES: Type D personality was originally introduced to study the role of personality in predicting outcomes of heart disease. However, researches showed that other medical conditions are also affected by this personality. The purpose of this study was to evaluate the relationship between type D personality and somatic symptom complaints in depressive patients. METHODS: Eighty-two individuals diagnosed with depressive disorder were included. Type D personality was measured with DS14. Patient Health Questionnaire(PHQ) 9 and 15 were used to measure depression severity and somatization tendencies. For alexithymia, TAS-20 was used. Student T-test and linear regression analysis were performed. The best regression model was determined by stepwise variable selection. RESULTS: More than half of the subjects(56%) complained at least medium degree somatic symptoms according to PHQ-15 criteria. Two-thirds of the subjects were classified as Type D personality(63.4%). The mean PHQ-15 score of the Type D individuals was significantly higher than the remaining subjects(PHQ-15 mean=12.7, p=8.2x10-7). The best regression model included age, PHQ-9 score and NA subscale score as predictor variables. Among these, only the coefficients of age(p=1.5x10(-3)) and NA score(p=1.5x10(-7)) were found to be statistically significant. CONCLUSIONS: The result showed that Type D personality was one of the strong predictors of somatic complaints among depressive individuals. The finding that negative affectivity rather than social inhibition was more closely associated with somatization tendencies does not fully agree with the traditional explanation that inability to express negative emotion predispose the individuals to somatic symptoms. The finding that alexithymia was not shown to be a significant predictors also substantiated this discrepancy. However, it might be possible that the high correlation between NA and SI subscore(r=0.65) and between NA and TAS-20 score(r=0.44) hid the additional effects of social inhibition and alexithymia. Further research with a larger sample would be needed to investigate the effects of the latter two components over and above the effect of negative affectivity on the somatic complaints in depressive patients.
Affective Symptoms ; Depression ; Depressive Disorder ; Heart Diseases ; Humans ; Linear Models

Congenital smooth musele hamartomas appear at birth as hypertrichotic patches or plaques with or without hyperpigmentation. Histologic characteristic is hyperplasia of dermal smooth muscle bundles. We report a case of congenital smooth muscle harnartoma in 5-year-old female, who showed localized excessive-hairy, skin-colored patch on the lateral surface of left. elbow, which were found at birth. Biopsy specimen showed hyperpigmentation of the basal layers of epidermis, melanophages in upper dermis, and hyperplasia of smooth muscle bundles in lower dermis.
Biopsy ; Child, Preschool ; Dermis ; Elbow ; Epidermis ; Female ; Hamartoma* ; Humans ; Hyperpigmentation ; Hyperplasia ; Hypertrichosis ; Muscle, Smooth* ; Parturition

No abstract available.
Decompression, Surgical* ; Exophthalmos*

The relationship of mind and body has stimulated extensive discussion for a long time. However, answers are ambigous and not forthcoming yet. Meanwhile, after the western medicine had embraced materialistic paradigm, conditions which cannot be substantiated by organic change were pushed out to periphery under the banner of "Medically Unexplained Symptoms". Medical experts endeavored to understand these mysterious illnesses based on the mind-body relationship and provided a frame of interpretation called Psychosomatic Medicine. This frame of interpretation had influenced not only the communication practice but also the health-seeking behavior and even the subjective experience of patients regarding their illnesses. The frame of interpretation had been drastically changed many times keeping pace with the socio-economic situation and the new scientific discoveries. Accordingly, body or mind was given differential importance by medical experts. For instance, when treatment modalities were lacking, mind was given excessive importance and patients were blamed for their unconscious motives, characterological weaknesses and for their lack of responsibility. In contrast, after the discovery of effective drug, mind was given no more attention and patients were no longer blamed for their contribution to suffering. In this paper, the historical change of the frame of interpretation for understanding migraine and headache was presented as an example. By this, it can be demonstrated how the frame of interpretation has modified the subjective experience of patients, and how the patients' responsibilities were viewed differently. This observation can help to realize the enormous influence of the frame of interpretation provided by medical experts.
Headache* ; Humans ; Migraine Disorders* ; Psychosomatic Medicine

OBJECTIVES: Considerable variations in the contents of clinical practice are the natural consequences of the fact that so many factors can have influences on each clinical decision making processes in the psychiatric treatment, let alone the pharmacotherapy of schizophrenia. To attain the goal of rational treatment, it is needed to examine the actual contents of clinical practices and the degree of variations among diverse hospitals. In addition, it is also needed to look into the unique situations in which each hospital is situated. For this purpose, this study tried to investigate the degree of variations in several aspects of the treatment of schizophrenia with atypical antipsychotics currently practiced in Korea. METHODS: This study is based on the data from RODOS (Risperidone Olanzapine Drug Outcome Study) in Korea. This study had been designed as a multi-center naturalistic study, therefore, had many advantages for the survey study of actual clinical practices. The subjects of the study were the in-patients who had been given risperidone or olanzapine for the control of their psychotic symptoms. Clinical data had been gathered by retrospective chart review. The degree and the characteristics of the variations were examined by comparing the patient-characteristic variables and the treatment-related variables among each hospital. RESULTS: The differences in the baseline characteristics of the patients including the duration of illness and the past history of psychiatric treatment were substantial among each hospital, and these differences seemed to explain a great portion of the variations in the contents of treatment. The variations in the dosage of risperidone and olanzapine were not conspicuous among each hospital. However, the variations in other treatment-related variables, including duration of admission, proportion of combined therapy with other antipsychotics, usage of anticholinergics, detection rate of extrapyramidal symptoms, remained statistically significant after adjusting the baseline patient characteristics as covariates. Although no significant correlation among each variable was found, a couple of unique practice patterns common to several hospitals could be observed. CONCLUSIONS: Considerable variations in the diverse treatment-related variables were observed in the treatment of schizophrenic patients with risperidone and olanzapine. It seemed that the major portion of these variations could be explained by the characteristic of patient group. However, the possibility remained that the other factors including the socio-cultural environment of the community and the disposition of the clinician themselves were still the major contributing factors to these variations. It is expected that the future clinical practice surveys like this study can help the clinicians to reevaluate their current practices, and can help to accumulate the basic data needed to establish the more rational and customized treatment practices.
Antipsychotic Agents ; Cholinergic Antagonists ; Decision Making ; Drug Therapy ; Humans ; Korea ; Linear Energy Transfer ; Retrospective Studies ; Risperidone* ; Schizophrenia

Imipramine(Tofranil(R)) is one of the tricyclic antidepressants commonly used in depressive symptoms or enuresis. An accidental or nonaccidental poisoning of imipramine is common today. A 16 years old girl was admitted to Seoul National university Hospital because of unocnsciousness and frequent attacks of seizure after the impulsive ingestion of 1.4gm of imipramine. She showed variable arrhythmias such as complete RBBB, secod degree AV block and ventricular tachycardia and recovered from poisoning without residual myocardial damage. We present a case of imipramine poisoning with cardiac arrhythmias with review of literatures.
Adolescent ; Antidepressive Agents, Tricyclic ; Arrhythmias, Cardiac* ; Atrioventricular Block ; Depression ; Eating ; Enuresis ; Female ; Humans ; Imipramine ; Poisoning* ; Seizures ; Seoul ; Tachycardia, Ventricular

In order to find the disease susceptibility gene in these complex genetic trait, there have been much interests in association study using single nucleotide polymorphism (SNP). Association study can be divided into two approaches candidate gene approach and linkage disequilibrium mapping. Recently, the candidate gene approach also has attracted much attention with the possiblity of whole genome wide scan being widely discussed. In genome wide scan, the amount of information that a locus can provide about the other adjacent loci becomes an important matter. When a locus was found not to be associated with a trait, it is questionable that closely situated adjacent loci can also be excluded as disease susceptible loci. To approach this problem theoretically, this study tried to find a method to calculate power in case-control association study, and aimed to investigate the influence of hypothesized inheritance model to the obtainable power. In addition, this study investigated the implication of negative association results in other adjacent loci. METHOD: The power of associatiation study was calculated applying non-centrality chi-distribution approximated by Poisson distribution. Using this method, the powers in each inheritance model were calculated in candidate gene approach. The power of chi-square test in linkage disequilibrium mapping was also algebraically obtained. This method was applied to simulation data to verify the validity of the method. RESULT: The proportion of phenocopy and the allele frequency of candidate locus exert substantial influence to the power of the study rather than penetrance matrix or inheritance model. The power in linkage disequilibrium mapping exponentially decreased according to the degree of linkage disequilibrium as anticipated, however, the marker allele frequency exert enormous influence to the power. Without any a prior knowledge about which marker allele had linked with disease susceptibility allele, the marker with equal distribution of each allele showed the highest power. CONCLUSION: The implication of negative results obtained in association study can only be determined by power analysis. In linkage disequilibrium mapping, if favorable power had been obtained, exclusion analysis of specific gene segment could be attempted. Taking into account the probable inheritance model and the marker allele frequency in designing association study, more efficient and rigorous study can be possible.
Alleles ; Case-Control Studies ; Disease Susceptibility ; Gene Frequency ; Genome ; Linkage Disequilibrium ; Penetrance ; Polymorphism, Single Nucleotide* ; Wills

STUDY OBJECT: Clozapine has been known to induce variety of side effects. Amongst of all, the hematological abnormalities, especially agranulocytosis, has prohibited the wide-spread use of this drug. There have been a lot of efforts to predict the hematological abnormalities based upon the demographical and clinical characteristics. In addition, although only a few, prediction by the initial hemodynamic change was also attempted. This study was carried out as an attempt to find a reliable predictor of clozapine-induced hematological abnormalities based upon the baseline hematological status and the initial hemodynamic change by clozapine. METHOD: Regardless of the diagnosis, the complete blood count data of every patient who had received clozapine in Seoul National University Hospital from 1996 to the present were analyzed. The risk group was defined as the patient whose absolute neutrophil count(ANC) had dropped below 1500mm3 equal or more than 3 times during the one year after clozapine trial. The occurrences of future clozapine-induced hematological abnormalities were predicted by the baseline ANC and the initial ANC change. RESULT: The baseline ANC immediately before clozapine trial, the degree of ANC declining during the first week, and that of ANC rising during the 2nd and 3rd week all showed significant difference between the risk group and the safe group. The likelihood ratio of risk was 7.75(95% confidence interval: 2.77-21.3) implying significant risk of hematological abnormalities when the baseline ANC was below 2000mm3, and the likelihood ratio of risk was 0.372(0.159-0.798) when the baseline ANC was above 4000mm3. In likewise manner, the interval likelihood ratios of risk associated with the ANC rising during the first 3 weeks were calculated. These two predictor variables contributed mutually independent information in predicting future hematological abnormalities. CONCLUSION: The baseline ANC and the initial hemodynamic change after clozapine trial could help predicting future clozapine-induced hematological abnormalities. If the more reliable predictors can be found, prescreening high risk patients using these predictors and the close hematological monitoring of these patients may not only decrease the risk associated with clozapine usage, but also widen the indication of clozapine by relieving much of the burden currently imposed upon the doctors.
Agranulocytosis ; Blood Cell Count ; Clozapine ; Diagnosis ; Hemodynamics* ; Humans ; Neutrophils ; Schizophrenia ; Seoul

Development of new drugs using the incrementally modified drug (IMD) technique is becoming increasingly popular in the pharmaceutical industry. The technique addresses the critical need of pharmaceutical companies to reduce the astronomical budget required to develop a new drug. Incremental drug modification can encompass modification of the structure, formulation, or indication of existing drugs. Typical examples of the technique include modification of chemical structure, changes to formulation, and development of compound drugs. While some large pharmaceutical companies use the technique as a strategic tactic to prolong patent rights and maintain a profitable brand, it can also offer many health benefits, such as the discovery of new uses for the same compound, improved safety, and raised patient compliance. Several incrementally modified drugs have already been marketed for psychiatric use, and many more are waiting for approval. This new trend may expand the options available to clinicians; the usefulness of chiral and long-acting drugs has already been proven in clinical practice. This review presents an overview of the incrementally modified drug technique and its current status in psychopharmacology. It also discusses the economic and clinical implications of the current popularity of this technique.
Budgets ; Drug Industry ; Human Rights ; Insurance Benefits ; Patient Compliance ; Psychopharmacology*

Development of new drugs using the incrementally modified drug (IMD) technique is becoming increasingly popular in the pharmaceutical industry. The technique addresses the critical need of pharmaceutical companies to reduce the astronomical budget required to develop a new drug. Incremental drug modification can encompass modification of the structure, formulation, or indication of existing drugs. Typical examples of the technique include modification of chemical structure, changes to formulation, and development of compound drugs. While some large pharmaceutical companies use the technique as a strategic tactic to prolong patent rights and maintain a profitable brand, it can also offer many health benefits, such as the discovery of new uses for the same compound, improved safety, and raised patient compliance. Several incrementally modified drugs have already been marketed for psychiatric use, and many more are waiting for approval. This new trend may expand the options available to clinicians; the usefulness of chiral and long-acting drugs has already been proven in clinical practice. This review presents an overview of the incrementally modified drug technique and its current status in psychopharmacology. It also discusses the economic and clinical implications of the current popularity of this technique.
Budgets ; Drug Industry ; Human Rights ; Insurance Benefits ; Patient Compliance ; Psychopharmacology*