OBJECTIVES: Clinical studies have shown cognitive dysfunctions and soft neurological signs in schizophrenic patients and these findings have been suggested as evidence of organic bases in the pathophysiology of schizophrenia. This study was intended to investigate the characteristics of cognitive deficits and soft neurological signs in schizophrenia and, to determine whether any abnormality in these functions can be regarded as a trait marker of the illness which is independent of antipsychotic treatment and clinical improvement. We also investigated the correlation between cognitive deficits and soft neurological signs reflecting cognitive dysmetria, respectively. METHODS: Twenty schizophrenic patients were assessed for the soft neurological signs and cognitive functions before and after neuroleptic treatment. The patients had been medicated for at least 3 weeks with one of the atypical neuroleptics. Cognitive functions were evaluated by Trail making A, B, Stroop test and Word fluency test. Soft neurological signs were assessed by Cambridge Neurological Inventory(Part 2). Positive and Negative Syndrome Scale(PANSS) and Clinical Global Impression(CGI) were used to assess the clinical severity and Extrapyramidal Symtoms Rating Scale was used to estimate the extrapyramidal symptoms. Cognitive functions and soft neurological signs of twenty normal controls were assessed with the same scale. RESULTS: Before treatment, schizophrenic patients showed significant impairments on cognitive function tests(Trail Making A, B, Stroop Test) and soft neurological sign tests(8 items:Grasp reflex, Go/no-go, Finger thumb opposition, Rhythm tapping, Finger agnosia, Fist-edge-palm, Left-right orientation, Extinction). Although significant clinical improvements were observed after the treatment, there were no significant changes in cognitive functions and soft neurological signs(except for Go/no-go test and Finger agnosia). Among the soft neurological signs of the patients, abnormality in Rhythm tapping was significantly correlated with cognitive deficits. CONCLUSION: Schizophrenic patients showed characteristic cognitive deficits and soft neurological signs which were independent of medication and clinical symptoms. And these two characteristics were partly correlated with each other.
Agnosia ; Antipsychotic Agents ; Cerebellar Ataxia ; Fingers ; Humans ; Reflex ; Schizophrenia ; Stroop Test ; Thumb

OBJECTS: We developed the Korean version of Hasegawa Dementia Scale(HDS-K) by translating the revised Hasegawa Dementia Scale(HDS-R) which is known to be a useful brief screening instrument for dementia. MATERIALS AND METHODS: The translation was carried out keeping the basic structure of Revised Hasegawa Dementia Scale(HDS-R). HDS-K, along with MMSE-KC, SBT-K and CDR, were administered to 174 dementia patients and 160 elderly control subjects. Cronbach alpha coefficient, inter-rator reliability, and test-retest reliability of HDS-K were examined. The correlations of MMSE-KC, SBT-K and CDR with HDS-K were also examined to confirm the validity of HDS-K. Cut-off scores for dementia were estimated by Receiver Operator Characteristic(ROC) curve anslyses. By comparing Area Under Curve(AUC), the diagnostic efficiency of HDS-K was compared with those of MMSE-KC and SBT-K. RESULTS: 1) HDS-K was found to have significantly high internal consistency(Cronbach alpha coefficient=0.948, <0.01), inter-rater reliability(Pearson correlation coefficient=0.999, <0.01) and test-retest reliability(Pearson correlation coefficient=0.848, <0.01). 2) All the correlations of HDS-K with MMSE-KC, SBT-K and CDR were significant indicating that HDS-K has good concurrent validity. Its optimal cut-off point for dementia was estimated as 15/16, where the sensitivity and specificity were 0.950 and 0.902, respectively. 3) The ROC curve analysis indicated that the diagnostic efficiency of HDS-K(AUC=0.972) was comparable with MMSE-KC(AUC=0.951) and SBT-K(AUC=0.963). CONCLUSION: We conclude that HDS-K is a reliable, valid, and useful screening instrument for dementia.
Aged ; Dementia* ; Humans ; Mass Screening* ; Reproducibility of Results* ; ROC Curve ; Sensitivity and Specificity ; Translating

Objectives: This study analyzed the current state of community mental health programs in Korea to develop evidence-based criteria for these programs. Methods: Seventy community mental health facilities nationwide were surveyed about the scope of their operated mental health programs. Details, including program structure, staff expertise, standardization, and quality management, of the 511 programs submitted by the facilities as their representative programs were also analyzed to evaluate their efforts for evidence-based practice. Results: The average number of programs operated by community mental health welfare centers was 15.9. The most common programs were those related to serious mental illness (SMI), followed by child/adolescent mental health programs, early psychosis programs, and non-SMI adult mental health programs. In the case of community addiction management centers, there were 7.2 different addiction-related programs per center. Among the psychiatric rehabilitation facilities for SMI, the average number of programs for SMI was 13.1, with some programs for early psychosis. Of the 511 programs submitted as representative programs in their facilities, only 12.3% were judged to be good evidence-based programs. Conclusion More efforts by mental health professionals and governments are needed to implement evidence-based programs in Korea.