OBJECTIVES: There is increasing evidence of an association between suicide and psychiatric disorders. This is the first report in Korea that investigated the differences of clinical and demographic characteristics between suicide completers and suicide attempters who had visited emergency room. METHODS: For this study, we enrolled patients who had visited the emergency rooms of university-affiliated medical centers or hospitals, due to psychiatric problems, between January 2003 and December 2006. In October 2007, we used the Korea national statistical office to identify the suicide completers among these enrollees. We then conducted a retrospective chart review comparing clinical and demographic characteristics between suicide attempters and completers. RESULTS: During the study period, 1106 subjects visited the emergency room of a university affiliated medical center or hospital. Among these subjects, the number of suicide attempters and suicide completers was 162 and 13, respectively. The proportion of suicide completion in the suicide related behavior was higher in patients with schizophrenia (27.3%) and anxiety/somatoform disorder (50.0%) compared with those with other psychiatric disorders. Suicide completers used more violent methods of suicide. CONCLUSION: These results suggest that patients with schizophrenia and anxiety/somatoform disorder make more fatal suicide attempts. The proportion of suicide completion within the suicide-related behaviors of these patients was higher than found in other psychiatric disorders. A greater number of risk factors should be elucidated to provide effective suicide prevention programs in Korea.
Emergencies ; Humans ; Korea ; Retrospective Studies ; Risk Factors ; Schizophrenia ; Suicide

OBJECTIVES: The purpose of this study was to examine the performance and electrophysiological characteristics of drug-naive children with attention-deficit/hyperactivity disorder (ADHD) during the Go/NoGo task. METHODS: Twenty-three boys with ADHD and 18 age-matched normal boys were recruited at a child psychiatric outpatient clinic in Seoul. All subjects were assessed by the Kiddie Schedules for Affective Disorders and Schizophrenia -Present and Lifetime version. The investigator also assessed all subjects using the ADHD Rating Scale-IV (ADHDRS). Event-related potentials were recorded from 8 scalp electrodes during the visual Go/NoGo task. RESULTS: Children with ADHD showed a larger mean of standard deviation of response time during the Go/NoGo task than normal children. The temporal N200 and P300 amplitudes were larger in children with ADHD relative to controls. The parietal N200 and P300 latencies were more prolonged in children with ADHD compared to normal controls. CONCLUSION: These results suggest that psychotropic-naive children with ADHD may have more variable performance ability, more difficulty in discriminating visual stimuli, and slower information processing speed than their normal agematched counterparts.
Ambulatory Care Facilities ; Appointments and Schedules ; Automatic Data Processing ; Child ; Electrodes ; Evoked Potentials ; Humans ; Mood Disorders ; Neuropsychological Tests ; Reaction Time ; Research Personnel ; Scalp ; Schizophrenia

OBJECTIVE: We aimed to examine the rates, correlates, methods, and precipitating factors of suicide attempts among adolescent patients admitted for psychiatric inpatient care from 1999 to 2010 in a university hospital in Korea. METHODS: The subjects consisted of 728 patients who were admitted for psychiatric inpatient care in a university hospital over a 12-year period and who were aged 10-19 years at the time of admission. We retrospectively investigated the information on suicidal behaviors and other clinical information by reviewing the subjects' electronic medical records. Whether these patients had completed their suicide on 31 December 2010 was determined by a link to the database of the National Statistical Office. RESULTS: Among 728 subjects, 21.7% had suicidal ideation at admission, and 10.7% admitted for suicidal attempts. Female gender, divorced/widowed parents, and the presence of mood disorders were associated with a significantly increased likelihood of suicide attempts. Most common method of suicide attempts was cutting, and most common reason for suicide attempts was relationship problems within the primary support group. A diagnosis of schizophrenia was associated with increased risk of death by suicide after discharge. CONCLUSION: These results highlight the role of specific psychosocial factor (e.g., relational problems) and psychiatric disorders (e.g., mood disorders) in the suicide attempts of Korean adolescents, and the need for effective prevention strategies for adolescents at risk for suicide.
Adolescent* ; Diagnosis ; Electronic Health Records ; Female ; Humans ; Inpatients* ; Korea ; Mood Disorders ; Parents ; Precipitating Factors* ; Psychology ; Retrospective Studies ; Risk Factors ; Schizophrenia ; Self-Help Groups ; Suicidal Ideation ; Suicide*

BACKGROUND: Although case reports have suggested that the erector spinae plane block (ESPB) may help analgesia for patients after breast surgery, no study to date has assessed its effectiveness. This retrospective observational study analyzed the analgesic effects of the ESPB after total mastectomy. METHODS: Forty-eight patients were divided into an ESPB group (n = 20) and a control group (n = 28). Twenty patients in the control group were selected by their propensity score matching the twenty patients in the ESPB group. Patients in the ESPB group were injected with 30 mL 0.375% ropivacaine, followed by catheter insertion for further injections of local anesthetics every 12 hours. Primarily, total fentanyl consumption was compared between the two groups during the first 24 hours postoperatively. Secondary outcomes included pain intensity levels (visual analogue scale) and incidence of postoperative nausea and vomiting (PONV). RESULTS: Median cumulative fentanyl consumption during the first 24 hours was significantly lower in the ESPB (33.0 μg; interquartile range [IQR], 27.0–69.5 μg) than in the control group (92.8 μg; IQR, 40.0–155.0 μg) (P = 0.004). Pain level in the early postoperative stage (<3 hr) and incidence of PONV (0% vs. 55%) were also significantly lower in the ESPB group compared to the control (P = 0.001). CONCLUSIONS: Intermittent ESPB after total mastectomy reduces fentanyl consumption and early postoperative pain. ESPB is a good option for multimodal analgesia after breast surgery.
Acute Pain ; Analgesia ; Anesthesia, Conduction ; Anesthetics, Local ; Breast ; Catheters ; Fentanyl ; Humans ; Incidence ; Mastectomy ; Mastectomy, Simple ; Nerve Block ; Observational Study ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Propensity Score ; Retrospective Studies ; Ultrasonography

Background: Commonly used epidural or systemic analgesics for pain control after hip surgery carry risk for potential adverse effects. In contrast, the quadratus lumborum block (QLB) utilizes a simple and easy fascial plane technique and provides a wide area of sensory blockade. Thus, the QLB may be beneficial as analgesia after total hip arthroplasty. CaseHere, we report the case of an 83-year-old man who received a continuous transmuscular QLB as part of a multimodal analgesia after hardware removal and total hip arthroplasty. The patient received a continuous infusion of 0.2% ropivacaine at 8 ml/h through an indwelling catheter in addition to patient-controlled analgesia with intravenous fentanyl and oral celecoxib. The patient’s pain scores did not exceed 4, and no additional analgesics were required until postoperative day 5. Conclusions Transmuscular QLB may be a suitable option for multimodal analgesia after total hip arthroplasty.

OBJECTIVES: This study was aimed to obtain the basic information on how oriental psychiatric specialists have learned oriental psychiatry, have been trained as a clinician and have conducted recent psychiatric researches. METHODS: We reviewed textbooks, references and annual reports, which have been used and published at the Korean colleges of oriental medicine and the Ministry of Health and Welfare. We also applied detailed questionnaires to 30 oriental physicians for identifying the current situation of local oriental clinics. In addition, we inspected the reports related with oriental psychiatry from 2000 to 2004. RESULTS: The number of oriental hospitals and clinics was 8,638 (12.9% of the total number of hospitals and clinics), and 14,480 oriental physicians have been licensed in 2003 and 16,182 in 2005. Since 2003, 62 oriental psychiatric specialists have been produced. The number of national medical insurance claims for mental disorders from oriental hospitals and clinics in 2002 was 9.0% of the total number of claims. At local oriental clinics, 29.8 patients with psychiatric problems were treated monthly. 2.6% in men and 11.0% in women visited local oriental clinics due to psychiatric symptoms. One hundred fifty-one papers associated with psychiatry have been published during recent 5 years, and 54.7% of them were pertinent to case studies. CONCLUSION: The current status of oriental psychiatric education and training system could be rather inadequate to produce competent oriental doctors who can perform psychiatric practices. In addition, the objective and scientific research data should be accumulated to confirm the hypothesis and effectiveness of psychiatric evaluation and treatment of oriental medicine.
Education* ; Female ; Humans ; Insurance ; Male ; Medicine, East Asian Traditional ; Medicine, Korean Traditional* ; Mental Disorders ; Surveys and Questionnaires ; Specialization

OBJECTIVES: The objective of this study was to examine the perinatal and developmental risk factors of attention-deficit hyperactivity disorder (ADHD) diagnosed with a structured interview among Korean children. METHODS: The current study included 924 children (6-15 years) recruited from schools in five Korean cities or a child psychiatry outpatient clinic of Seoul National University Children's Hospital. The parents of the children completed the structured diagnostic interview for attention-deficit hyperactivity disorder, as well as questionnaires on perinatal and developmental risk factors. RESULTS: Preterm delivery, severe maternal stress during pregnancy, change in primary care taker during the first three years, postpartum depression, and delayed first sentence showed a significant association with ADHD diagnosis. CONCLUSION: These findings suggest that perinatal and developmental factors contribute to development of ADHD in Korean children. Conduct of future research using a prospective design is needed in order to identify the causal relationship between observed risk factors and development of ADHD.
Ambulatory Care Facilities ; Child ; Child Psychiatry ; Depression, Postpartum ; Female ; Humans ; Parents ; Pregnancy ; Primary Health Care ; Risk Factors ; Surveys and Questionnaires

OBJECTIVE: We aimed to investigate the neurocognitive and behavioral endophenotypes of premorbid mood disorder. We compared intelligence, neuropsychological functioning, and behavioral problems among three groups: 1) a high-risk group [attention-deficit hyperactivity disorder (ADHD) children of parents with a history of a mood disorder], 2) a low-risk group (ADHD children of parents without a history of a mood disorder), and 3) normal comparison subjects. METHODS: We used the Korean Educational Development Institute Wechsler Intelligence Scale for Children-Revised (KEDI-WISC-R), the Stroop Color Word Interference Test (Stroop), the Wisconsin Card Sorting Test (WCST), and the Rey-Osterrieth Complex Figure Test (RCFT) as neurocognitive measures, and we used the Child Behavior Checklist (CBCL) as a behavioral measure. Performance on these neuropsychological tests and score on the CBCL of 18 high-risk children were compared to those of 20 low-risk children and 24 healthy children. We also assessed the children's current mood state and familial functioning to control for the confounding effects of these variables. RESULTS: Compared to low-risk and healthy children, high-risk children were impaired on the Picture Completion and Stroop Word subtest and showed higher scores on the CBCL subscales representing internalizing symptoms. These significant group differences persisted even after adjustment for the children's current mood state and familial functioning. CONCLUSION: Neuropsychological deficits in the offspring of parents with a mood disorder may be associated with the current mood state rather than with innate characteristics, while their internalizing symptoms may partially stem from innate characteristics that are endophenotypes of a premorbid mood disorder.
Attention Deficit Disorder with Hyperactivity ; Checklist ; Child Behavior ; Child* ; Endophenotypes ; Humans ; Intelligence ; Mood Disorders* ; Neuropsychological Tests ; Neuropsychology ; Parents* ; Pilot Projects* ; Wisconsin

OBJECTIVES: This study was aimed to examine the efficacy and safety of bupropion in methylphenidate-inapplicable children with attention deficit hyperactivity disorder (ADHD) due to insufficient treatment response or intolerable adverse effects. METHODS: Twelve children (8.8+/-2.1 years, 10 boys, total IQ 105.3+/-10.7) were recruited for this study from September 2004 to August 2005. ADHD was confirmed by K-SADS-PL. The efficacy was assessed by ADHD rating scale (ADHDRS) for investigator, Conner's parental rating scale-revised (CPRS-R), ADHDRS school version, clinical global impression (CGI), and computerized neurocognitive function test. 168.8 mg (SD=85.4 mg) of bupropion was medicated for 37.4 days (SD=8.7 days). RESULTS: Total score of ADHDRS assessed by investigator (p=0.018), CGI-S score (p=0.026), CPRS-R score (p=0.018), total score (p=0.027) and inattentive score (p=0.041) of ADHDRS school version were significantly decreased after bupropion application. Six subjects (50%) were assessed as "very much improved" or "much improved" by CGI-Improvement in the end of trial. Response time of word color test was also significantly decreased after medication (p=0.043). Decreased appetite (2 subjects), weight loss (1 subject), insomnia (1 subject), anxiety (1 subject), and nausea (1 subject) were observed during this study period. CONCLUSION: Bupropion was effective and well-tolerated for the methylphenidateinapplicable children with ADHD.
Anxiety ; Appetite ; Attention Deficit Disorder with Hyperactivity* ; Bupropion* ; Child* ; Humans ; Nausea ; Parents ; Reaction Time ; Research Personnel ; Sleep Initiation and Maintenance Disorders ; Weight Loss

OBJECTIVES: We compared the clinical presentations of manic and depressive episodes and the treatment response among children and adolescents with bipolar disorder (BD) types I and II and BD not otherwise specified (NOS). METHODS: The sample consisted of 66 patients, aged between 6 and 18 years, who were admitted for BD to a 20-bed child and adolescent psychiatric ward in a university hospital located in Seoul, Korea. RESULTS: Patients with BD type I were more likely to have lower intelligence quotients and exhibit violent behaviors during manic episodes than patients with BD type II or BD NOS and to show better treatment responses during manic episodes than patients with BD NOS. Patients with BD NOS were more likely to have an irritable mood rather than a euphoric mood during the manic phase than patients with BD type I or II and to exhibit violent behaviors during the depressive phase and chronic course than patients with BD type II. CONCLUSION: Pediatric BD patients are heterogeneous with respect to their clinical characteristics. Implications for the usefulness of the current diagnostic subtype categories should be investigated in future studies.
Adolescent ; Bipolar Disorder* ; Child ; Humans ; Inpatients* ; Intelligence ; Irritable Mood ; Korea ; Seoul