Ocular flutter (OF) is a rare eye movement disorder with horizontal saccadic oscillations without inter-saccadic intervals. The OF can occur in various clinical settings. A 83-year-old female showed the OF in hyperosmolar hyperglycemic state (HHS) following malignant cerebral infarction. The pathophysiology of the OF is still unclear, but this case provides a new information that the OF can occur in the context of toxic-metabolic state such as HHS.

BACKGROUND: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a single-gene disorder caused by mutations in the NOTCH3 gene, located on chromosome 19p13. NOTCH3 encodes a transmembrane receptor which plays a role in cellular differentiation and cell cycle regulation. CASE REPORT: A 71-year-old female showing headache and memory impairment, familial history of stroke and having a missense mutation from proline to serine at codon 167 in the exon 4 on NOTCH3 gene. Five family members revealed the same mutation (c.499C>T), who presented migrainous headache and stroke. In this study, we have uncovered a novel NOTCH3 mutation at the nucleotide position 499 (c.499C>T; p.P167S) in a family with CADASIL. CONCLUSIONS: We suggested a missense mutation of proline to serine at codon 167 in exon 4 of the NOTCH3 gene, which resulted in the substitution of cytosine to thymine (c.499C>T) resulting migraine, stroke and vascular cognitive impairment.
Aged ; CADASIL* ; Cell Cycle ; Codon ; Cognition Disorders ; Cytosine ; Exons ; Female ; Headache ; Humans ; Memory ; Migraine Disorders ; Mutation, Missense* ; Proline ; Serine ; Stroke ; Thymine

BACKGROUND: This study was done to examine the impact of diabetes fear of self-injecting (FSI) and fear of self-testing (FST) on glycemic control and diabetes self-management. METHODS: A questionnaire survey was performed in the form of one-on-one interviews with 100 insulin-treated diabetic patients. The questions included subject traits, FSI/FST, and confidence in diabetes self-care (CIDS). Glycemic control was determined by the measurement of glycated hemoglobin (Hemoglobin A1C). RESULTS: The patients who did not have a spouse and were less well educated showed high FSI/FST scores and low CIDS scores. The patients who had taken high quantities of insulin, had diabetes related complications, and performed self-monitoring of blood glucose less frequently showed high FSI/FST scores. The patients who had received diabetes education, possessed glucometer and performed self-monitoring of blood glucose frequently had high CIDS scores. High FSI/FST scores were positively related to each other, negatively related to low CIDS scores and not significantly related to Hemoglobin A1C. On the other hand, a significant correlation was seen between CIDS scores and Hemoglobin A1C. CONCLUSION: High levels of FSI and/or FST were associated with high diabetes-related distress, poor general well-being, and psychologic comorbidity as well as poorer adherence to the diabetes treatment regimen. It is important in diabetes care to lower injection-related fears and improve diabetes self-management through systematic desensitization, relaxation therapy, the use of pen-type injection device, and proper education such as insulin injection amount adjustment, properties of insulin, and the risk of hypoglycemia for the patients and their families.
Blood Glucose ; Comorbidity ; Diabetes Complications ; Hand ; Hemoglobins ; Humans ; Hypoglycemia ; Insulin ; Relaxation Therapy ; Self Care ; Spouses ; Surveys and Questionnaires

No abstract available.
Respiration ; Thoracic Surgery, Video-Assisted

Objectives: ：This study looked at the effects of chronic IPV on suicide ideation among married women in the country. Methods: ：This study used data from the five-year-old Korea Welfare Panel and analyzed using questions about verbal and physical violence, depression and suicide ideation that were investigated every year. Age, education, and economic levels, drinking, religion, chronic disease, satisfaction with family relationship, satisfaction with social relationship, were included as variables. Results: ：The five-year cumulative score of verbal violence had a statistically significant effect on the depres-sive symptom, and the relative risk was 1.180. The relative risk of five-year-old cumulative score of verbal violence in suicidal ideation was 1.276, and it was also significant even if they exclude the effects of depressive symptom.On the other hand, the five-year cumulative score of physical violence was found to have no significant impact on suicide ideation if they excluded the effects of depressive symptom. Conclusions ：Unlike previous studies, this study found that chronic verbal IPVs increase suicide ideation,even though they do not contain effects of depression. Such findings suggest that intervention in IPV in married women may help reduce the nation's suicide rate.

Objectives: ：This study looked at the effects of chronic IPV on suicide ideation among married women in the country. Methods: ：This study used data from the five-year-old Korea Welfare Panel and analyzed using questions about verbal and physical violence, depression and suicide ideation that were investigated every year. Age, education, and economic levels, drinking, religion, chronic disease, satisfaction with family relationship, satisfaction with social relationship, were included as variables. Results: ：The five-year cumulative score of verbal violence had a statistically significant effect on the depres-sive symptom, and the relative risk was 1.180. The relative risk of five-year-old cumulative score of verbal violence in suicidal ideation was 1.276, and it was also significant even if they exclude the effects of depressive symptom.On the other hand, the five-year cumulative score of physical violence was found to have no significant impact on suicide ideation if they excluded the effects of depressive symptom. Conclusions ：Unlike previous studies, this study found that chronic verbal IPVs increase suicide ideation,even though they do not contain effects of depression. Such findings suggest that intervention in IPV in married women may help reduce the nation's suicide rate.

OBJECTIVES: To investigate clinical and symptomatic differences among motoric subtypes of delirium. METHODS: A total of 256 patients referred to psychiatric consultation services for delirium due to general medical condition were assessed retrospectively. Motoric subtypes were determined according to Lipowski's criteria for hyperactive, hypoactive and mixed subtypes. All patients were evaluated according to Delirium Rating Scale-Revised-98(DRS-98-R) by trained psychiatrists to obtain symptomatic profiles of delirium. RESULTS: Hyperactive subtype were 50.8%(n=130), mixed 46.1%(n=118) and hypoactive 3.1%(n=8). Hyperactive patients were younger than mixed subtype(69.62±13.976 vs. 73.97±11.569, p=0.022) and received antipsychotics to manage symptoms of delirium more frequently(83.8% vs. 57.6%, p<0.001). Hyperactive patients had higher DRS-R-98 scores on both noncognitive(7.14±3.543 for hyperactive, 5.62±3.279 for mixed subtype) and cognitive subscales(10.00±3.574 for hyperactive, 6.38±2.875 for hypoactive, 7.43±3.771 for mixed subtype, p<0.001). CONCLUSION: We demonstrated that clinical and symptomatic profiles were different across motoric subtypes in delirium. Diagnostic and therapeutic approach should be made differently according to motoric subtypes of delirium and special attention is needed not to underestimate or delay treatment in specific motoric subtype of delirium.
Antipsychotic Agents ; Delirium* ; Humans ; Psychiatry ; Retrospective Studies

OBJECTIVES: Delirium of hospitalized patients is common and it is significantly associated with increased mortality rate. Misdiagnosis rates of delirium are reported in a range of 36.7 to 63% in clinical setting. We aimed to identify the clinical features and symptomatic characteristics associated with misdiagnosis of delirium. METHODS: Subjects were 256 inpatients who were referred for psychiatric consultation and diagnosed with delirium by a psychiatrist at a university hospital between January 1 and June 30, 2012. Clinical data were obtained with retrospective chart review. Patients were divided into misdiagnosed group and correct diagnosed group, after reviewing the reason which were described in the consultation request form. RESULTS: Sixty nine(27%) subjects of the 256 patients were referred for other reasons(mood, substance, anxiety, dementia etc.) than "delirium/confusion" by clinician(misdiagnosed group). In misdiagnosed group, use of antipsychotics was more common. There were no differences between the two groups in age, gender, and department of referring clinician. Fluctuation score of DRS-R-98 was higher in the correct diagnosed group. CONCLUSIONS: In this study, the risk of misdiagnosis was higher when the patients have taken antipsychotics or less symptom fluctuation. Careful clinical attention is needed for diagnosis for delirium in these patients.
Antipsychotic Agents ; Anxiety ; Delirium* ; Dementia ; Diagnosis ; Diagnostic Errors ; Humans ; Inpatients ; Mortality ; Psychiatry ; Retrospective Studies

OBJECTIVES: The aim of this study was to clarify the role of alcohol use disorders and acute alcohol consumption in suicide attempts by gender. METHODS: Data of 1,152 suicide attempters(487 males and 742 females) who had visited an emergency center was gathered. Suicide attempts were categorized into three groups according to alcohol use: an alcohol use disorder group(AUD), an acute alcohol use group(AAU), and a no-alcohol use group(NAU). The intent and lethality of suicide attempts were evaluated by Suicidal Intents Scale and Risk-Rescue Rating Scale. RESULTS: For Suicidal Intents Scale score, the male AUD group revealed a significantly lower mean score than the male AAU one. However, there were no statistically significant differences for female subjects across subgroups. With regard to the Risk-Rescue Rating Scale score, there were no significant differences for males, while the AUD group showed both the lowest highest rescue scores and lowest risk-rescue scores within female groups. CONCLUSIONS: AUD in females was more likely regarding impulsive suicide attempts with high rescue chances. Consuming alcohol might have different effect on suicide attempts by gender and our study shows that alcohol use is an important risk factor according to gender, particularly with regard to female suicide attempts.
Alcohol Drinking ; Emergencies ; Female ; Humans ; Male ; Risk Factors ; Suicide