Disruptive mood dysregulation disorder (DMDD) is a DSM-5 diagnosis for children and adolescents characterized by persistent irritability and severe temper outbursts. Due to overlapping symptoms with other disorders, DMDD is frequently misdiagnosed. This study presents two clinical cases. The first case involves a 14-year-old male patient with chronic irritability, temper outbursts, and impulsive aggression, resulting in significant academic and social impairment. The second case involves a 14-year-old female patient who initially presented with pathological gambling and emotional instability. These cases illustrate the diagnostic complexity of DMDD and its potential progression to mood disorders, such as bipolar disorder. Careful clinical observation and comprehensive assessment of irritability and mood dysregulation are essential for an accurate diagnosis. This study underscores the importance of continuous follow-up in DMDD patients to monitor disease progression and optimize treatment strategies. Understanding the developmental trajectory, comorbidities, and treatment responses in DMDD can help improve clinical outcomes and prevent long-term psychiatric complications.

Disruptive mood dysregulation disorder (DMDD) is a DSM-5 diagnosis for children and adolescents characterized by persistent irritability and severe temper outbursts. Due to overlapping symptoms with other disorders, DMDD is frequently misdiagnosed. This study presents two clinical cases. The first case involves a 14-year-old male patient with chronic irritability, temper outbursts, and impulsive aggression, resulting in significant academic and social impairment. The second case involves a 14-year-old female patient who initially presented with pathological gambling and emotional instability. These cases illustrate the diagnostic complexity of DMDD and its potential progression to mood disorders, such as bipolar disorder. Careful clinical observation and comprehensive assessment of irritability and mood dysregulation are essential for an accurate diagnosis. This study underscores the importance of continuous follow-up in DMDD patients to monitor disease progression and optimize treatment strategies. Understanding the developmental trajectory, comorbidities, and treatment responses in DMDD can help improve clinical outcomes and prevent long-term psychiatric complications.

Disruptive mood dysregulation disorder (DMDD) is a DSM-5 diagnosis for children and adolescents characterized by persistent irritability and severe temper outbursts. Due to overlapping symptoms with other disorders, DMDD is frequently misdiagnosed. This study presents two clinical cases. The first case involves a 14-year-old male patient with chronic irritability, temper outbursts, and impulsive aggression, resulting in significant academic and social impairment. The second case involves a 14-year-old female patient who initially presented with pathological gambling and emotional instability. These cases illustrate the diagnostic complexity of DMDD and its potential progression to mood disorders, such as bipolar disorder. Careful clinical observation and comprehensive assessment of irritability and mood dysregulation are essential for an accurate diagnosis. This study underscores the importance of continuous follow-up in DMDD patients to monitor disease progression and optimize treatment strategies. Understanding the developmental trajectory, comorbidities, and treatment responses in DMDD can help improve clinical outcomes and prevent long-term psychiatric complications.

Disruptive mood dysregulation disorder (DMDD) is a DSM-5 diagnosis for children and adolescents characterized by persistent irritability and severe temper outbursts. Due to overlapping symptoms with other disorders, DMDD is frequently misdiagnosed. This study presents two clinical cases. The first case involves a 14-year-old male patient with chronic irritability, temper outbursts, and impulsive aggression, resulting in significant academic and social impairment. The second case involves a 14-year-old female patient who initially presented with pathological gambling and emotional instability. These cases illustrate the diagnostic complexity of DMDD and its potential progression to mood disorders, such as bipolar disorder. Careful clinical observation and comprehensive assessment of irritability and mood dysregulation are essential for an accurate diagnosis. This study underscores the importance of continuous follow-up in DMDD patients to monitor disease progression and optimize treatment strategies. Understanding the developmental trajectory, comorbidities, and treatment responses in DMDD can help improve clinical outcomes and prevent long-term psychiatric complications.

Disruptive mood dysregulation disorder (DMDD) is a DSM-5 diagnosis for children and adolescents characterized by persistent irritability and severe temper outbursts. Due to overlapping symptoms with other disorders, DMDD is frequently misdiagnosed. This study presents two clinical cases. The first case involves a 14-year-old male patient with chronic irritability, temper outbursts, and impulsive aggression, resulting in significant academic and social impairment. The second case involves a 14-year-old female patient who initially presented with pathological gambling and emotional instability. These cases illustrate the diagnostic complexity of DMDD and its potential progression to mood disorders, such as bipolar disorder. Careful clinical observation and comprehensive assessment of irritability and mood dysregulation are essential for an accurate diagnosis. This study underscores the importance of continuous follow-up in DMDD patients to monitor disease progression and optimize treatment strategies. Understanding the developmental trajectory, comorbidities, and treatment responses in DMDD can help improve clinical outcomes and prevent long-term psychiatric complications.

objectives: ：Far-infrared (FIR) lights have been investigated for sleep quality intervention. We sought to measure the advantageous effects of FIR in sleep using polysomnographic data as the objective outcomes. Methods: ：The ten healthy volunteers were enrolled in a single-center, prospective, patient-blind, single-arm trial. Individuals slept on a sham mattress and a FIR emitting mattress with polysomnography for one night each. Results: ：Sleep efficiency showed an increasing trend but was not statistically significant. PSQI-K significantly decreased (p=0.013). The latency to REM of the baseline was shorter than that of the intervention (p=0.008). Though there was no statistical significance, Stage N1 and N2 were shortened, and Stage N3 was prolonged after the intervention compared to the baseline. Conclusions ：The FIR-emitting mattresses improved sleep quality on self-reported insomnia. We suggested the candidate for the markers altered by the FIR therapy, such as the normalization of REM latency and increased N3 sleep.

enuresis nocturia is more prevalent in children than in adults. Using polysomnography (PSG), we investigated the causes of adult enuresis nocturia in a 20-year-old female patient with nighttime bedwetting. In spite of normal urological examinations, her detailed medical history disclosed frequent sleep paralysis and urination during dreams. During PSG, two electromyograms were attached to her anus to assess the tone of her bladder's sphincter while she slept. During REM sleep, the EMG tone of the mandible decreased, but the anal and bladder sphincter tones did not. The polysomnogram revealed moderate obstructive sleep apnea. Consequently, she was diagnosed with adult parasomnia (nocturnal enuresis) overlap syndrome with OSA. This study demonstrates the value of PSG with simultaneous anal tone EMG for diagnosing NREM parasomnia and nocturnal enuresis.

Ludwig’s angina is a rapidly progressive and gangrenous cellulitis in the submandibular, sublingual spaces, and neck. It is characterized by an elevated tongue and laryngeal edema, resulting in airway compromise and, rarely, in sudden death. The most common cause is an odontogenic infection of a molar tooth. Infection can spread to the superior mediastinum and buccal area through anatomical structures. Herein, we report the sudden death of a 45-year-old male who was not diagnosed with Ludwig’s angina. He died in the emergency room 20 minutes after loss of consciousness. Intubation was impossible owing to severe laryngeal edema. The C-reactive protein level was 33.81 mg/dL. On autopsy, a diffuse light green abscess of the submandibular space was detected, along with severe edema of the epiglottis, aryepiglottic fold, and vocal cords. Subsequently, we confirmed that the airway obstruction was caused by Ludwig’s angina based on a literature review. In conclusion, this report emphasizes the need to identify the infection source and perform a detailed dissection according to the anatomical structure in the autopsy procedure for Ludwig’s angina.

Objective: This study evaluated the effectiveness of a virtual reality (VR) based stress reduction program tailored for healthcare and information technology (IT) professionals during the coronavirus disease-2019 pandemic. Methods: The 2-week program, based on forest healing principles, was designed to alleviate occupational stress and improve sleep quality. Participants (n=54; 46 healthcare, 8 IT professionals) underwent pre- and post-intervention assessments using validated psychological scales and physiological measurements. Results: Results showed significant reductions in stress (Perceived Stress Scale [PSS], p=0.001) and anxiety (Hospital Anxiety and Depression Scale [HADS] anxiety, p=0.002) across all participants. Healthcare professionals demonstrated significant decreases in depression (Patient Health Questionnaire-9, p=0.015), anxiety (HADS anxiety, p<0.001), and stress (PSS, p=0.001). Unexpectedly, weekday sleep quality (Pittsburgh Sleep Quality Index) worsened in the healthcare group (p=0.013). The IT group showed no significant changes, possibly due to the small sample size. Physiological measurements revealed significant differences between groups post-intervention, including melatonin levels (p=0.001) and electrocardiogram values (p=0.031), suggesting occupation-specific responses to VR interventions. Conclusion Despite limitations such as unequal sample sizes, this study provides valuable insights into the potential of VR-based stress management programs. The findings underscore the need for occupation-specific approaches and further research with larger, balanced samples to validate these results and explore long-term effects.

Spontaneous coronary artery dissection (SCAD) is a condition in which an intramural hematoma within the coronary artery leads to acute coronary syndrome without atherosclerosis, trauma, or iatrogenic causes. It predominantly affects middle-aged women and is associated with several predisposing conditions, including fibromuscular dysplasia, systemic inflammatory disorders, connective tissue diseases, and coronary artery spasms. We report the case of a 64-year-old male with a history of hypertension who died of SCAD. His death occurred suddenly and without preceding trauma while the decedent was working overtime at a construction site. On gross examination, a thrombus-like material was identified in a branch of the left anterior descending artery and was initially presumed to be a postmortem clot. However, microscopic examination revealed an intramural hemorrhage, medial dissection, and formation of a false lumen within the coronary artery. This case report highlights the importance of a thorough histopathological examination of the coronary arteries during autopsy, even in the absence of atherosclerosis.