Journal Detail Information

1

Cite

Share

Treatment of One Case of Elderly Manic Episode Developed after Retirement.

Journal of Korean Geriatric Psychiatry.1997;1(1):112-116.

The authers reported one case of manic episode that occured after retirement in a 63 year old male patient. There was no psychiatric past history and family history. Also there was no abnormal finding on laboratory examination. This patient had received small doses of antidepressants anxiolytic and hypnotic (amitriptyline 10 mg, lorazepam 0.5 mg, triazolam 0.25 mg) to control insomnia since 3 months ago before admission. This patient showed manic symptoms such as grandious idea, expansive and irritable mood, increased psychomotor activity and insomnia after retirement. Pharmacotherapy (lithium and chloropromazine) supportive psychotherapy and family therapy were administered. Excessive motivation for work after retirement and small dose of antidepressant were suspected to trigger a manic episode in this elderly patient. We also reviewed literatures about pathophysiology of elderly manic disorder.
Aged* ; Antidepressive Agents ; Bipolar Disorder ; Drug Therapy ; Family Therapy ; Humans ; Irritable Mood ; Lorazepam ; Male ; Middle Aged ; Motivation ; Psychotherapy ; Retirement* ; Sleep Initiation and Maintenance Disorders ; Triazolam

2

Cite

Share

Depressive Symptoms in Elderly Patients with Physical Illness.

Jun Su HAN ; Hyeon Soo LEE ; Seong Keun LEE ; In Kwa JUNG

Journal of Korean Geriatric Psychiatry.1997;1(1):100-111.

OBJECTIVES: This study aimed to evaluate the effects of severity of functional disability, caused by physical illness, on the depressive symptoms and depressive disorders of the elderly patients (above 65 year-old) with physical illness. METHOD: Complete medical and psychiatric evaluations were achieved on 138 patients, except the 12 patients, who were severely cognitively impaired (MMSE-K score;below 19), of the 150 elderly patients (above 65 year-old) with physical illness. Sociodemographic data and health characteristic data were systematically collected, and the severity of functional disability caused by physical illness was evaluated. Depression scales (KGDS, GDS, MADRS) on 138 elderly patients were executed. In addition, based on the 61 patients of the 65 elderly patients (above 65 years old) with physical illness, except 4 patients who were severely cognitively impaired (MMSE-K score;below 19), sociodemographic data and health characteristic data were collected. The clinical diagnosis by DSM-IV diagnostic criteria and KGDS on 61 elderly patients were performed, and their functional disability caused by physical illness was evaluated. RESULTS: The frequency of depressive symptoms showed 50.0%, 36.2%, and 35.5%, respectively in KGDS, GDS, and MADRS. The patients with severe functional disability caused by physical illness-compared with those with mild functional disability-had significantly higher score on the depression scales (KGDS, GDS, MADRS). The correlation between severity of functional disability caused by physical illness and depression scales was highly positive. Severity of functional disability caused by physical illness was the strongest contributor to the depression scales. In the additional study, 19.7% of patients were diagnosed as major depressive disorder, 18% of them as dysthymic disorder, and depressive disorder (major depressive disorder & dysthymic disorder) group-compared with nondepressive disorder group-showed significantly higher score on the FDRPT and KGDS. CONCLUSION: The frequency of depressive symptoms and depressive disorder in elderly patients with physical illness was higher, compared with those in general elderly people. Functional disability caused by physical illness most highly influenced on depressive symptoms. Thus, it is important to discriminate whether the elderly patients with physical illness have depressive symptoms or not. In addition, we assumed that KGDS was not only highly correlated with other depression scales (GDS, MADRS), but also had the high diagnostic power of dis-crimination for depressive symptoms and depressive disorder. This study suggested that KGDS was available in screening depression in the elderly patients with physical illness. It was necessary to study systematically the availability of KGDS in the future.
Aged* ; Depression* ; Depressive Disorder ; Depressive Disorder, Major ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Dysthymic Disorder ; Humans ; Mass Screening ; Weights and Measures

3

Cite

Share

A Preliminary Study on the Risk Factors between Vascular Dementia and Alzheimer's Dementia.

Baik Seok KEE ; Jung Hyun YOON ; Sang Kook KIM

Journal of Korean Geriatric Psychiatry.1997;1(1):96-99.

The authers investigated risk factors between vascular dementia and Alzheimer's dementia patients admitted in Chung-Ang University Hospital and Inchen Eun Hea Hospital from October 1996 to Feburary 1997. Chart review was done and complete those were selected and final disgnoses of dementia for subjects (74) were made by DSM-IV and NINCDS-ADRDA criteria. Risk facters were studied between vascular dementia and Alzheimer's dementia. The results were as follows. 1) Alzheimer's dementia patients were 48 (male 16, female 32), mean age of those was 76.65 (+/-7.47) years and duration of education of those was 3.58 (+/-4.79) years. Vascular dementia patients were 26 (male 7, female 19), mean age and duration of education of those were 73.92 (+/-6.69) years and 5.04 (+/-5.27) years respectively. 2) With respect to risk factors , vascular dementia patients were more likely have a history of hypertension and general anesthesia. 3) We found no difference in history of COPD, diabetes mellitus, alcohol abuse, family history of dementia, closed head trauma and cigarette smoking.
Alcoholism ; Anesthesia, General ; Dementia* ; Dementia, Vascular* ; Diabetes Mellitus ; Diagnostic and Statistical Manual of Mental Disorders ; Education ; Female ; Head Injuries, Closed ; Humans ; Hypertension ; Pulmonary Disease, Chronic Obstructive ; Risk Factors* ; Smoking

4

Cite

Share

Effect of Ethanol on Short-term Memory in Rats:A Mechanism of Alcoholic Dementia.

Jin Sook CHEON

Journal of Korean Geriatric Psychiatry.1997;1(1):81-95.

Chronic and excessive alcohol consumption produces a subtle brain damage, which induces such organic mental disorders as delayed mental processes, abstract thinking impairment, and disturbances in learning and recent memory loss. These phenomena had been known to be caused by malnutrition. However, recent researches showed that it could be caused by mild brain lesions by direct neurotoxic effect of alcohol on the prefrontal cortex, or its related subcortical structures. This study was tried to evaluate the effect of alcohol on the short-term memory function, to compare with the histological changes, and to find out responses to the agonists and antagonists of possibly related neurotransmitters. For experiment 1, 10 aged male Sprague-Dawley rats weighed about 400-500 gm were used. 45 younger adult male Sprague-Dawley rats weighed about 200-300 gm were used for experiment 2 and 3. Therefore, 55 rats were totally used. In experiment 1, T-maze test with 10 nomal aged rats were done first, and then it was divided into 5 atropine-administered group and 5 control group. For the atropine-administered group, T-maze test was repeated on every 30, 60, 120 minute after the atropine injection. After the completion, of behavioral tests, the rats were sacrificed by the intracardiac perfusion with phosphate buffered 10% formaldehyde solution, and the brain specimen was stained with hematoxylin-eosin to count cells in the prefrontal cortex and the hippocampus. In experiment 2, T-maze test with 10 normal younger adult rats were done first, and then it was dividied into five 14% (v/v) ethanol administered group and 5 control group raised with tap water. T-maze test was repeated on every week for a month. After the completion of behavioral tests on the 4th week, histology was done by the same procedure. In experiment 3, T-maze test with 35 normal younger adult rats were done first, and then it was divided into seven groups with five rats each other. 14% (v/v) ethanol was administered ad libitum. In addition, normal saline, fluoxetine, bromocriptine, bethacholine, nimodipine, clonidine, and ketamine were intramuscularly injected on every other day. T-maze test was repeated on every week for a month. After the completion of behavioral tests on the 4th week, histology was done by the same procedure. 1) The reaction time of T-maze test was more delayed on 120 minutes after atropine injection in atropine-administered rats than those in normal aged rats without statistical significance. 2) The reaction time of T-maze test was more delayed in ethanol-treated rats, especially most prominent on the 3rd week, than those in normal younger adult rats without statistical significance. However, cell numbers in the CA1, CA3, dentate gyrus and the prefrontal cortex were significantly reduced in ethanol-treated rats on histology (p<0.05). 3) The reaction time of T-maze test was more shortened in fluoxetine and ketamine-treated rats on the 1st week without statistical significance. It was rather shortened in fluoxetine, ketamine, bromocriptine and nimodipine-treated rats without statistical significance on the 2nd week. On the 3rd week, the reaction time of T-maze test was shortened in every drug-treated rats. It returned to be delayed in all but fluoxetine, clonidine and bethacholine-treated rats on the 4th week without statistical significance. However, cell numbers in the CA1 were significantly increased in bromocriptine-treated rats (p<0.05) and in bethacholine-treated rats (p<0.01). In the CA3 and the dentate gyrus, cell numbers in bethacholine and clonidine-treated rats were significantly increased (p<0.05 respectively). In the prefrontal cortex, cell numbers in bethacholine-treated rats were significantly increased (p<0.005) on histology. 4) While there were no significant difference on the reaction time of T-maze test between ethanol-treated group, normal aged group and atropine-treated group, cell numbers in the prefrontal cortex were significantly different between those of normal aged group and atropine-treated group (p<0.05). Cell numbers in the prefrontal cortex of ethanol-treated group were signifncantly correlated with those of atropine-treated group (r=0.977, p<0.001), and of normal aged group (r=0.448, p<0.05). In conclusion, we should not neglect the risk of memory loss even in the subclinical cases, because neuronal cells in the prefrontal cortex and the hippocampus were significantly reduced on histology, while ethanol-induced short-term memory loss was not functionally significant. The drug responses in this experiments showed that the mechanism of alcohol-induced short-term memory loss might be mainly related with cholinergic system. Otherwise, adrenergic or dopaminergic mechanisms could be involved. Furthermore, we could not exclude the possiblity that pathological aging process might be exerted as an important mechanism underlying alcoholic dementia.
Adult ; Aging ; Alcohol Drinking ; Alcoholics* ; Animals ; Atropine ; Brain ; Bromocriptine ; Cell Count ; Clonidine ; Neurocognitive Disorders ; Dementia* ; Dentate Gyrus ; Ethanol* ; Fluoxetine ; Formaldehyde ; Hippocampus ; Humans ; Ketamine ; Learning ; Male ; Malnutrition ; Memory Disorders ; Memory, Short-Term* ; Mental Processes ; Neurons ; Neurotransmitter Agents ; Nimodipine ; Perfusion ; Prefrontal Cortex ; Rats ; Rats, Sprague-Dawley ; Reaction Time ; Thinking ; Water

5

Cite

Share

Effect of Elderly Leisure Functioning on Depression Scale.

Do Hoon KIM ; Byoung Hoon OH ; Hoo Kyeong LEE ; Kae Joon YOO

Journal of Korean Geriatric Psychiatry.1997;1(1):73-80.

The purpose of this study is to compare the difference of the tendency for depression and leisure functioning between two elderly groups in differnt socio-cultural environment. Also, this study investigated whether the difference of lesiure functioning affected the tendency for depression. The participants are 55 elderly residing in the nursing home in Seoul and 35 Sahalin returning Koreans in KangWon-Do. Leisure Diagnostic Battery (LDB) developed by Witt and Eliss (1987) was used to measure leisure functioning of the elderly and Yesavage (1983)'s Geriatric Depression Scale (GDS measured the tendency of depression. The LDB and GDS were gathered through interviewing. The result of this study reports that the tendency of depreesion in Sahalin returning Koreans was higher than the elderly in Seoul. And the result supports the hypothesis that the elderly in Seoul who have maintained higher leisure functioning showed lower depression level than the Sahalin elderly who had poor leisure functioning. In other words, there were significance between these two groups. This study suggests that education and the leisure program shoud developed and applied for the higher leisure functioning and satisfaction of the elderly (especially elderly in nursing home).
Aged* ; Depression* ; Education ; Gangwon-do ; Humans ; Leisure Activities* ; Nursing ; Nursing Homes ; Seoul

6

Cite

Share

A Study of Standardization of Korean Form of Geriatric Depression Scale(KGDS).

In Kwa JUNG ; Dong Il KWAK ; Sook Haeng JOE ; Hyeon Soo LEE

Journal of Korean Geriatric Psychiatry.1997;1(1):61-72.

This study was aimed to standardize the Korean Geriatric Depression Scale (KGDS). In order to slove the unsatisfied discriminating power of Geriatric Depression Scale (GDS:Yesavage et al. 1983) presented in Korean studies, the authors made KGDs. The preliminary KGDS was costructed of 40 items selected from GDS, BDI, SDS, MMPI-D, CES-S and had satisfied reliability and validity, but had some problems in item contents, number of times, and sampling. Thus by correcting these problems, the authors made new KGDS of 30 item, and tested the reliability and validity of the final version of KGDS. The values of Cronbach's alpha and Split-half reliability were .88 and .79 respectively, and correlational coefficent with GDS was .87. The differences of means was signified at alpha=.001 level (patients group mean=17.82 (10.52), control group mean=10.52 (5.12), t=12.07). On factor anlaysis, 5 factors in KGDS were extracted. They were labeled Emotional discomfort (factor 1), Negative thinking and Unhappinesss feeling (factor 2), Physical weakening and decreased vitality (factor 3), Cognitive dysfunction (factor 4), Decreased social interest and activity (factor 5), which represent depressive features of the elderly in thought, emotional, cognitive, physical, social aspects. The total percentage of variance of 5 factors was 53.72%. The result of discriminatin anlaysis showed that hit ratio of KGDS was 75%, and the score of 14 was suggested as the optimal cut-off score. Additionally, by use percentile score distribution of control group (normal) subjects, each of the score of 14-18, 19-21, over 22 suggested borderline or mild depression, moderate depression, severe depression, respectively. Conclusively, the final version of KGDS not only improved diagnostic discriminatory power approxtimately 10% than GDS, but also showed satisfiable reliability and validity. So the KGDS could be a useful tool for evaluaion of elderly depression.
Aged ; Depression* ; Humans ; Reproducibility of Results ; Thinking

7

Cite

Share

Psychosocial Intervention of Dementia.

Byoung Hoon OH

Journal of Korean Geriatric Psychiatry.1997;1(1):56-60.

Dementia is the most disabling neuropsychiatric disorder of adulthood. Typical dementia-Alzheimer disease (AD) is progressive and irreversible dementia syndrome characterized by loss of intellectual capacity in many domains, altered behavior, inability to care for oneself, and altimately, neurologic abnormalities. But, unfortunately, the exact cause of dementia is still unknown and in the treatment of dementia, the focus is limited to relieve the cognitive and behavioral symptoms. Among treatment modalities of dementia, biomedical intervention has been emphasized on organic cause, individual pathology and cognitive symptomatology. But, for effective management of dementia, both biomedical and psychosocial factors must be included. Because the most fruitful apporach to developing a clinical response to dementia is an interplay between neurologic impairment and the psychosocial experiences of the dementia patients. However, until recently, little attention has been given to the psychosocial implications of the dementia. Psychosocial intervention enable to quality of human interaction and maintain personal identity. Psychosocial intervention should be a guiding principle in the development and implementation of menagement srtategies. Through the psychosocial intervention, problem behaviors might be understood as evidence of promorbid coping styles, searches for security, or activity patterns associated with previous work roles. In fact, psychosocial intervention based on integrated community services because treatment plan of dementia cannot be conducted in isolation. Psychosocial intervention mainly composed of psychotherapy, day care, nursing home, case management and social care. So, to understand and treatment the dementia, all biomedical factors must be examined and simultaneously psychosocial intervention must be considered for patient and family members and other caregivers.
Behavioral Symptoms ; Caregivers ; Case Management ; Day Care, Medical ; Dementia* ; Fruit ; Humans ; Nursing Homes ; Pathology ; Psychology ; Psychotherapy ; Social Welfare

8

Cite

Share

Pharmacological Approach to Demented Patients.

Haingwon WOO

Journal of Korean Geriatric Psychiatry.1997;1(1):48-55.

Of all patients with dementia, 50-60% have dmentia of Alzheimer's type, and vascular dementia represents 17-29% of all cases. Other common causes of dementia include drugs, toxins, intracranial masses, anoxia, infections, neurodegenerative disorders, metabolic disorders, and chronic infalmmatory disorders. Treatment approach to demented patients may account for drug therapy in Al-zheimer's disease, because about 10-23% of patients have coexisting vascular dementia and dementia of Alzheimer's type. Dementia other than Alzheimer's disease also show various degrees of impairment of cognitive and non-cognitive function such as depression, psychosis and other behavioral problems, therefore pharmacological treatment for specific symptoms should be provided and therapy should be directed toward treating the underiying cuases as well. Alzheimer's disease (AD) is the most important of all the degenerative disease with progressive impairment of cognitive function and neuropsychiatric disturbance. Neuropathologic investigations have shown that cholinergic neuronal loss is seen in the nucleus basalis of Meynert, and choline acetyltransferase and acctylcholine esterase are decreased in the cerebral cortex. This hypothesis led to attempts to correct the dificiency with cholinomimetic agents and proved to be effective in some patients. However, there have been no pharmacologic agent proved to be suce-ssful. The most recent of these is the reversible acetyl cholinesterase inhibitor with long half life and high affirnity to CNS, Aricept (donepezil), which produces great improvement in cognitive function in clinical trials in Europe and US without compromized hepatotoxicity. The other pathophysiology of AD includes wide range of neurotransmitter imbalances and cortical atrophy, so that combined treatment apporach such as choinergic/serotonergic drug and cholinergic/somatostatinergic drug should be considered. As a preventive approach, neurotrophic factor, which may delay degenerative process of cholinergic neuron, is clinically valuable when administrated directly into ventricles. In many cases, amyloid deposits are seen as the distinctive neuropathology of AD, and the evidence that amyloid peptide genes found to be on chromosome 21 will lead the gene therapy for this diseases. As the disease advances, various degrees of neuropsychiatric distrubance become so marked that may be helped by treatment of associated depression, anxiety, disruptive behavior, and psychotic symtoms with appropriate psychotropic medication. However, these drugs may make patients confused, requiring reduced ro withdrawal of the medication. therefore, a careful attempt should be made, since demands on enviromental apporach and behavioral therapy are high.
Alzheimer Disease ; Amyloid ; Anoxia ; Anxiety ; Atrophy ; Basal Nucleus of Meynert ; Cerebral Cortex ; Choline O-Acetyltransferase ; Cholinergic Neurons ; Cholinesterases ; Chromosomes, Human, Pair 21 ; Dementia ; Dementia, Vascular ; Depression ; Drug Therapy ; Europe ; Genetic Therapy ; Half-Life ; Humans ; Neurodegenerative Diseases ; Neurotransmitter Agents ; Plaque, Amyloid ; Psychotic Disorders

9

Cite

Share

Symptomatology of Dementia.

Il Woo HAN

Journal of Korean Geriatric Psychiatry.1997;1(1):34-47.

Dementia can be defined as an acquired persistent impairment of intellectual func-tion with compromise in at least three of the mental activities such as language, memory, visuospatial skill, emotion or personality, and cognition. The purposes of diagnosing a dementia syndrome are to search systemically for various etiologies, to differentiate reversible or irreversible dementia, cortical or subcortical dementia, and degenerative or nondegenerative dementia, and to apply to patients neurocognitive rehabilitation or other specific trea-tment strategies. The evaluation of dementia includes neuropsychiatric history taking, neuropsychological assessment, neurologic examination, neuroimaging studies, and laboratory studies. It is impossible to evaluate dementic patients only with clinical signs, symptoms, and neuropsychiatric histories. But I will address specific neurologic or neuropsychiatric symptoms and signs of various dementias to und-erstand them as classification.
Classification ; Cognition ; Dementia* ; Humans ; Memory ; Neuroimaging ; Neurologic Examination ; Rehabilitation

10

Cite

Share

Clinical Evaluation of Dementia Patients.

Doh Kwan KIM

Journal of Korean Geriatric Psychiatry.1997;1(1):23-33.

Dementia is the clinical syndrome characterized by acquired losses of cogn-itive and emotional abilities severe enough to interfere with daily functioning and the quality of life. In Korea, the majority of patients with symptoms of dementia are initially evaluated by a general practitioner, and many do not receive a follow-up assessment by a specialist. Accordingly, general practitioners play a vital role in identifying patients with possible dementia and under-taking additional diagnostic procedures. It is important that tests to confirm the presence of dementia be performed uniformly, irrespective of the specialty of the examining physician. This article will discuss the several issues in the evaluation of dementia which may be raised freq-uently by general practitioners. The infrastructure for dementia assessment team, the evaluation of patients with mild memory complaints, the assessment of cognitive and functional disability, and screening examination to detect the reversibility of dementic symptoms will be reviewed.
Dementia* ; Follow-Up Studies ; General Practitioners ; Humans ; Korea ; Mass Screening ; Memory ; Quality of Life ; Specialization

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share