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A Case of Catatonic Schizophrenia Associated With Proximal Interphalangeal Joint Flexion Contracture in Non-Dominant Hand.

Sang Soo LEE ; Seok Woo MOON ; Beom Woo NAM ; Jeong Seok SEO

Journal of Korean Neuropsychiatric Association.2008;47(2):200-204.

OBJECTIVES: Psychogenic contractures in the hand are a rare topic in the medical literature and psychoflexed hand is rarely mentioned even in orthopedic textbooks. By reporting a case with classic catatonic features of the catatonic type of schizophrenia associated with proximal interphalangeal joint flexion contracture in non-dominant hand, the existence of this rare and almost unknown entity is emphasized and the diagnostic and therapeutic importance facing the clinicians dealing with psychological related symptomatology is suggested. CASE: A 54-year-old, single, right-handed woman who lived alone presented to emergency department in catatonic stupor state, severe dehydration due to refusal of oral intake for about 15 days. She had received a diagnosis of schizophrenia, catatonic type at age 33 and had been hospitalized with catatonic motor and behavioral symptoms for a long time. She was hospitalized in medical intensive care unit and abnormal results of laboratory studies at admission including hypernatremia due to severe dehydration, prerenal azotemia, and hemoconcentration was corrected. Catatonia was confirmed by CRS Catatonia Rating Scale (CRS). Her catatonic and other psychotic symptoms began to resolve with treatment, but the patient was found to have had the psychogenic hand deformity characteristics of proximal interphalangeal joint flexion contractures of left 2nd, 3rd, 4th, 5th finger which started about 20 years ago. She allowed us to try to have a appropriate diagnostic evaluation but as she had experienced a full resolution of catatonic and other psychotic symptoms, she began to resist all the orthopedic treatments. She was discharged by caregiver's request because of economic problems. CONCLUSION: This case highlights the importance of having specific and systemized medical workups for catatonia of schizophrenia in order to prevent the sequelae of severe psychopatholgy such as flextion contractures and other potential complications.
Azotemia ; Behavioral Symptoms ; Catatonia ; Contracture ; Dehydration ; Disulfiram ; Emergencies ; Female ; Fingers ; Hand ; Hand Deformities ; Humans ; Hypernatremia ; Intensive Care Units ; Joints ; Middle Aged ; Orthopedics ; Schizophrenia ; Schizophrenia, Catatonic ; Stupor

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Effects of Structural and Functional Characteristics of Social Network on Social Adjustment in People With Mental Illness.

Sun Hae JUNG ; Jin Hyang LEE ; Mi Kyoung SEO

Journal of Korean Neuropsychiatric Association.2008;47(2):190-199.

OBJECTIVES: The purpose of this study was to investigate effects of structural and functional characteristics of social network on social adjustment in people with mental illness. METHODS: 236 members of the people with mental illness who were enrolled in day hospital, community mental health center and social rehabilitation center participated in the survey. RESULTS: Of structural and functional characteristics of social network, the influenced factors on social adjustment were network size of professional, social support (family, friend and professional) and conflict with professional. When controlling socio-demographic and disorder characteristics, this regression model affected significantly on social adjustment but the power of influence reduced slightly. CONCLUSION: In order to improve the social adjustment of people with mental illness, it is necessary for social network to provide them with more emotional and social resources. Especially, it is important for mental health professionals to build active partnership with the people with mental illness as consumer. For people with mental illness, the economic stability through guaranteed income such as disability benefits, and occupational rehabilitation is very important.
Friends ; Hospitals, Community ; Humans ; Mental Health ; Rehabilitation Centers ; Social Adjustment

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Comparison of Instrumental Activities of Daily Living and Cognitive Functions Among the Elderly Attending Senior Community Centers According to the Presence of Depressive Symptoms.

Dong Bae KIM ; Hyo Jung LEE ; Hong Jin JEON ; Su Jin CHAE ; Maeng Je CHO

Journal of Korean Neuropsychiatric Association.2008;47(2):183-189.

OBJECTIVES: The aim of this study was to evaluate whether or not depressive symptoms were related to differences in the abilities of daily living activities and cognitive functions among the elderly attending senior community centers. METHODS: A total of 304 respondents over 65 years of age completed a set of interviews, which included clinical evaluation, neuropsychological batteries, Short Geriatric Depression Scale (S-GDS), and Instrumental Activities of Daily Living (IADL). RESULTS: Depression was observed in 34.2% respondents (n=105). The depressed group significantly decreased the sum of IADL than that of the non-depressed group (t=3.8, p=0.0002). With logistic analysis, they indicated significant impairment in six items of IADL associated with cognitions, but not in other items with physical functions. The depressed group scored significantly lower in MMSE-K (F=8.56, p<0.01) and delayed recall assessment (F=10.53, p<0.01) despite they showed no difference in immediate memory, compared with the non-depressed group. Among the sociodemographic variables, gender was not a significant risk factor in the depressed elderly, whereas lower income was the only risk factor after adjusting for other variables. CONCLUSION: The depressed elderly attending senior community centers showed impaired functions in their usual daily activities and cognitions. Furthermore, they revealed impairment in cognitive IADLs, whereas they preserved functions in physical IADLs.
Activities of Daily Living ; Aged ; Surveys and Questionnaires ; Depression ; Humans ; Memory, Short-Term ; Risk Factors

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Predictors for Change in Disability in Community-Dwelling Elders.

Hee Young SHIN ; Il Seon SHIN ; Jae Min KIM ; Sung Wan KIM ; Su Jin YANG ; Jin Sang YOON

Journal of Korean Neuropsychiatric Association.2008;47(2):177-182.

OBJECTIVES: This study aimed to identify the predictors for change in disability measured by the Korean version of World Health Organization Disability Assessment Schedule II (WHODAS II-K) in community-dwelling elderly population. METHODS: Of 1204 community participants aged 65 years or over, 717 were reevaluated by WHODAS II-K 2 years later. At baseline, information on demographic characteristics (age, gender, living area, marital status, and religion), socioeconomic status (education, type of accommodation, number of rooms, previous occupation, current employment, and social network), and clinical characteristics (number of physical illness, depression by the Korean version of Geriatric Mental State Schedule B3, and cognitive impairment by Korean version of Mini-Mental State Examination) were collected. RESULTS: Scores on the WHODAS II-K increased by 17.5 in 2 years. Age (B coefficient 0.52, 95% CI: 0.21~0.84), number of rooms (B coefficient -1.92, 95% CI: -3.53~-0.30), and depression (B coefficient 1.84, 95% CI: 0.43~3.25) were independently significant predictors for change in disability. CONCLUSION: Change in the level of disability measured by the WHODAS II-K was mainly affected by age, number of rooms, and depression. These results can be useful for the development of community-based health promotion program for the elderly.
Aged ; Appointments and Schedules ; Depression ; Employment ; Health Promotion ; Humans ; Marital Status ; Occupations ; Social Class ; World Health Organization

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Development of Screening Test for Adolescent Mental Health and Problem Behavior.

Seung Ah JUNG ; Dong Hyun AHN ; Sun Yuo CHUNG ; Youn Gyung JEONG ; Yun Yung KIM

Journal of Korean Neuropsychiatric Association.2008;47(2):168-176.

OBJECTIVES: This study was conducted to develop the screening questionnaire (Adolescent Mental Health and Problem Behavior Questionnaire, AMPQ) for detecting mental health problems and various problem behaviors in adolescents. METHODS: First, six main domains of questionnaire were defined and preliminary sub-items were collected through literature study, consultation data from field mental health experts, and preliminary survey study. Next, with these 52 preliminary items, we conducted nationwide survey on 1,267 middle and high school students of five districts of Korea. RESULTS: Through reliability test and factor analysis 34 items were finally filtered out. The Cronbach's alpha of these 34 items was .88. And correlation with K-YSR and K-CBCL were .34 (p<.01) and .68 (p<.01). CONCLUSION: AMPQ, which is comprised of relatively short list of items and at the same time covers overall mental health and problem behaviors in adolescents can be used by non-professionals as a screening questionnaire in school settings or mental health centers.
Adolescent ; Humans ; Mass Screening ; Mental Health ; Surveys and Questionnaires

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The Reliability and Validity of the Korean Version of Tobacco Craving Questionnaire.

Kyeong Sook CHOI ; Chang Hwa LEE ; Je Chun YU ; Se Jin KIM ; Ho Jin CHOI ; Bum Seok JEONG

Journal of Korean Neuropsychiatric Association.2008;47(2):161-167.

OBJECTIVES: The objective of this study is to assess the reliability and validity of the Korean version of the Tobacco Craving Questionnaire (K-TCQ), a multidimensional, self report instrument evaluating tobacco craving in a population of current smokers. METHODS: The Korean version of TCQ was administered to 216 current cigarette smokers. RESULTS: The Cronbach's alpha coefficient of the K-TCQ was high (0.95) which provided the evidence for the internal consistency. The test-retest reliability of K-TCQ was 0.66 (correlation coefficient, p<0.01). The correlation coefficients between the K-TCQ and each five VAS questionnaires were high (0.50-0.59, p<0.01). Inter-correlations of K-TCQ, VAS, FTQ, BDI, STAI-I and STAI-II were significant (p<0.01). CONCLUSION: The Korean version of TCQ is a valid and reliable scale for evaluating tobacco craving.
Surveys and Questionnaires ; Reproducibility of Results ; Self Report ; Smoking ; Tobacco ; Tobacco Products ; Tobacco Use Disorder

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Reliability and Validity of the Korean Version of Severe Mini-Mental Status Examination (SMMSE-K).

Joon Hyuk PARK ; Jin Yeong CHOE ; Jong Chul YOUN ; Won Hae LEE ; Ji Woon JEONG ; Yeon Ja DO ; Eun Ae CHOI ; Seok Bum LEE ; Jin Hyeong JHOO ; Dong Young LEE ; Ki Woong KIM

Journal of Korean Neuropsychiatric Association.2008;47(2):153-160.

OBJECTIVES: We developed the Korean version of Severe Mini-Mental Status Examination (SMMSE-K) which is a brief cognitive test for the severely demented patients. METHODS: The translation was carried out keeping the basic structure of the English version Severe Mini-Mental Status Examination (SMMSE). The SMMSE-K, Korean version of Mini Mental State Examination (MMSE-KC), and Clinical Dementia Rating (CDR) were administered to 84 Alzheimer's disease (AD) patients and 36 cognitively normal elderly subjects. For evaluating the reliability of the SMMSE-K, Cronbach alpha coefficient, inter-rater reliability, and test-retest reliability were examined. For confirming the validity of the SMMSE-K, the correlations of the SMMSE-K with MMSE-KC and CDR were examined, and factor analysis was performed using principal component analysis with Varimax rotation. RESULTS: SMMSE-K was found to have a high internal consistency (Cronbach alpha coefficient=0.906, p<0.01), inter-rater reliability (Pearson correlation coefficient=0.980, p<0.01) and test-retest reliability (Pearson correlation coefficient=0.940, p<0.01). Performances on the SMMSE-K and MMSE-KC were found to correlate significantly in the subjects with CDR of 2 (Pearson correlation coefficient=0.827, p<0.001) and 3 (Pearson correlation coefficient=0.929, p<0.001). In the subjects with CDR of 3, the MMSE-KC showed a floor effect (2.93+/-3.21), whereas the SMMSE-K did not (11.00+/-8.48). Exploratory factor analysis yielded two factors (automatic informational processing, controlled informational processing) accounting for 76.1% of the total variance. CONCLUSION: The SMMSE-K was found to be a reliable and valid test for assessing the cognition of severely demented patients.
Accounting ; Aged ; Alzheimer Disease ; Cognition ; Dementia ; Deoxycytidine ; Floors and Floorcoverings ; Humans ; Principal Component Analysis ; Reproducibility of Results

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Association Between Suicide Attempts in Patients With Depressive Disorder and Tryptophan Hydroxylase A218C Polymorphism.

Se Hoon SHIM ; Bo Young HWANG ; Young Joon KWON ; Hee Yeon JUNG ; Bun Hee LEE ; Yong Ku KIM

Journal of Korean Neuropsychiatric Association.2008;47(2):142-152.

OBJECTIVES: Several lines of evidence suggest the serotonergic dysfunction involved in the biological susceptibility of suicide. Tryptophan hydroxylase (TPH), the rate-limiting enzyme in the biosynthesis of serotonin, plays a vital role in serotonin metabolism. In a case-control study, we investigated whether the TPH gene was a susceptible factor for suicidal behavior in depressive patients. METHODS: The subjects were 218 depressed patients who attempted suicide and visited emergency rooms in multi-medical centers. One hundred thirty hospitalized non-suicidal depressed patients and the 161 normal controls were matched with the suicidal group. Individuals in all 3 groups were evaluated independently by a Structured Clinical Interview for the purpose of establishing a DSM-IV criteria diagnosis (SCID). The severity of depressive symptoms was evaluated using Hamilton depression rating scale (HDRS). RESULTS: There was no significant difference in genotype distributions and allele frequencies of TPH intron 7 A218C polymorphisms among 3 groups. Furthermore, no significant difference in genotype counts and allele frequencies of the polymorphisms was found among lethal suicidal depressed patients, non-suicidal depressed patients and the normal controls. CONCLUSION: This study suggests that the A218C polymorphism of the TPH gene is unlikely to have a major effect on the susceptibility of suicidal behaviors in depressive patients.
Case-Control Studies ; Depression ; Depressive Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Emergencies ; Gene Frequency ; Genotype ; Humans ; Introns ; Serotonin ; Suicide ; Suicide, Attempted ; Tryptophan ; Tryptophan Hydroxylase

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Neurocognitive Functioning in Bipolar Disorder.

Jinkyung GOH ; Byungsu KIM ; Chang Yoon KIM ; Yeon Ho JOO

Journal of Korean Neuropsychiatric Association.2008;47(2):134-141.

OBJECTIVES: This study was aimed to investigate the neurocognitive functioning of patients with remitted bipolar disorder and compare with schizophrenic patients' neurocognitive functioning. METHODS: This issue was addressed by comparing remitted DSM-IV diagnosed bipolar, schizophrenics patients and controls on several clinical and neurocognitive measures. Clinical state was assessed using the Positive and Negative Syndrome Scale (PANSS), Young Mania Rating Scale (YMRS), and Montgomery-Asberg Depression Rating Scale (MADRS). Neurocognitive measures included the KWIS, WMS-III, Korean California Verbal Learning Test (K-CVLT), Wisconsin Card Sorting Test (WCST), Rey-Osterrieth Complex Test (RCFT), and Color Trails Test (CTT). Thirty-two subjects with remitted bipolar disorder, twenty-four remitted schizophrenia and twelve normal controls were studied. RESULTS: Analysis of variance (ANOVA) revealed no differences across groups on age, education and IQ. With respect to neurocognitive test performance, bipolar disorder patients and schizophrenic patients were similar and both groups were impaired compared to normal controls. Two diagnosed groups have persistent impairments in neurocognitive function, particularly in the domains of declarative memory. CONCLUSION: The results provide support for the view that remitted patients with bipolar disorder suffer cognitive impairment.
Bipolar Disorder ; California ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Schizophrenia ; Sensitivity and Specificity ; Verbal Learning ; Wisconsin

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Association Study of Val158Met Polymorphism of Catechol-O-Methyltransferase Gene and Cognitive Markers in Schizophrenia.

Hae Jung PARK ; Dong Yeon PARK ; Eun Young CHO ; Na Ra KIM ; Hyun Ok JEUN ; Yu Sang LEE ; Dongsoo LEE ; Kyung Sue HONG

Journal of Korean Neuropsychiatric Association.2008;47(2):126-133.

OBJECTIVES: Catechol-O-methyltransferase (COMT) gene has been identified as a positional and functional candidate gene of schizophrenia. Although specific mechanism of increasing schizophrenia susceptibility by this gene has not been well described yet, recent studies suggest that the valine allele of COMT Val158Met polymorphism may contribute to cognitive decline in schizophrenia. The present study investigated the association between this polymorphism of COMT gene and cognitive markers related to schizophrenia in both schizophrenia patients and normal controls. METHODS: The subjects were 78 patients with schizophrenia diagnosed by DSM-IV and 97 normal controls. Comprehensive neurocognitive tests for which performance deficits have been reported in schizophrenia were administered. Genotyping for COMT Val158Met polymorphism was done with SNapShot method. Association analyses between genotype and cognitive functions were performed using ANCOVA and MANCOVA. RESULTS: In the comparison of allele frequencies between patient and control groups, no significant association between the polymorphism and schizophrenia was observed. Significant differences of cognitive performance among genotype groups were not identified in control group. This trend was also observed in the patient group. In the combined analysis of both patient and control groups, there was no significant genotype or genotype-by group effect on any cognitive function measure. CONCLUSION: These findings do not support a major role of COMT gene in the regulation of the cognitive processes of schizophrenia.
Alleles ; Catechol O-Methyltransferase ; Cognition ; Diagnostic and Statistical Manual of Mental Disorders ; Gene Frequency ; Genotype ; Humans ; Schizophrenia ; Valine

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