Children with autism are often medicated to manage emotional and behavioral symptoms; yet, data on such pharmacotherapy is insufficient. In this study, we investigated the Korean National Health Insurance Claims Database (NHICD) information related to autism incidence and psychotropic medication use. From the 2010–2012 NHICD, we selected a total of 31,919,732 subjects under 19 years old. To examine the diagnostic incidence, we selected patients who had at least one medical claim containing an 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) code for pervasive developmental disorder, F84, not diagnosed in the previous 360 days. Psychotropics were categorized into seven classes. Then, we analyzed the data to determine the mean annual diagnostic incidence and psychotropic prescription trends. Diagnostic incidence was 17,606 for the 3 years, with a mean annual incidence per 10,000 population of 5.52. Among them, 5,348 patients were prescribed psychotropics. Atypical antipsychotics were the most commonly used, followed by antidepressants. An older age, male sex, and the availability of medical aid were associated with a higher rate of prescription than observed for a younger age, female sex, and the availability of health insurance. Psychotropic drugs were used for less than one-third of patients newly diagnosed with autism, and prescription differed by sex and age. Increased diagnostic incidence is associated with an increased prescription of psychotropic drugs. Therefore, medication-related safety data and policies for psychotropic drugs in autism should be prepared.
Adolescent* ; Antidepressive Agents ; Antipsychotic Agents ; Autistic Disorder* ; Behavioral Symptoms ; Central Nervous System Stimulants ; Child* ; Drug Therapy ; Drug Utilization ; Female ; Humans ; Incidence ; Insurance, Health* ; International Classification of Diseases ; Male ; National Health Programs ; Prescriptions* ; Psychotropic Drugs

OBJECTIVES: We developed the short form of the Mentalization Improvement Program for Adolescent-Community Model (MIPAdo-CM-S), based on the concept of the mentalization. METHODS: The MIPAdo-CM was composed of 6 sessions and was applied to 133 students in the 1st grade of a middle school for six weeks during their regular school hours. After 6 weeks, we compared the endpoint changes of Adolescent Mental Problem Questionnaire-Revised (AMPQ-R), Emotional Empathy Test, Peer Aggression Scale, Peer Bullying Scale, School Adjustment Scale, Test Anxiety Inventory and Visual Analogue Scale between the subject and the control group. RESULTS: On the Visual Analoge Scale, students in the trial classes reported an increased understanding and respect for others, as well as themselves. CONCLUSION: The efficacy of MIPAdo-CM was subjective improvement of understanding and respect for both others and themselves. To prove objective usefulness of this program, further studies should be administered in the form of long-term, regular and structured courses.
Adolescent ; Aggression ; Bullying ; Child ; Empathy ; Humans ; Mental Health ; Test Anxiety Scale

OBJECTIVES: Understanding the emotions, thoughts, feelings and behaviors of others, as well as oneself, is part of the mentalizing function. We developed a new school-based community model for mental health, called the Mentalization Improvement Program for Adolescent-Community Model (MIPAdo-CM), based on the concept of mentalization. METHODS: The MIPAdo-CM was composed of 12 sessions and was applied to 403 students in the 2nd grade of a middle school. Every session was conducted after the regular school hours for 6 weeks. After 6 weeks, we compared the endpoint changes of Adolescent Mental Problem Questionnaire-Revised (AMPQ-R), Emotional Empathy Test (EET), Peer Aggression Scale (PAS), Peer Bullying Scale (PBS), School Adjustment Scale (SAS), Test Anxiety Inventory (TAI) and Visual Analogue Scale between the subject and the control group. RESULTS: There was no significant difference between two groups in AMPQ-R, EET, PAS, PBS, SAS, and TAI. On the Visual Analoge Scale, however, students in the trial classes reported more increase in understanding and respect for both others and themselves. CONCLUSION: The efficacy of MIPAdo-CM was subjective improvement of understanding and respect for both others and themselves, erence between two groups in AMPQ-R, Empathy test, To prove objective usefulness of this program, further studies with more structured design will be needed.
Adolescent ; Aggression ; Anxiety ; Bullying ; Child ; Empathy ; Humans ; Mental Health ; Phenothiazines ; Theory of Mind

OBJECTIVES: Recently, Korean psychiatrists have noticed the complaints from probands and family members that private health insurance companies do not pay for most psychiatric disorders. Furthermore, probands cannot even apply for insurance because of their medical record of psychiatric disorders. Authors investigated and reviewed contracts of Korean private insurance companies to find reasons for banning psychiatric disorders from insurance policies. METHODS: Authors reviewed more than 800 contracts from 48 insurance companies. RESULTS: Among all the psychiatric diagnoses, few of them-dementia and some other organic mental disorders-are guaranteed to be paid from insurance companies. Less then 10 contracts say they pay for psychiatric illnesses. Most insurance companies have contracts prohibiting F codes ; however, there are not enough reasons in these contracts. CONCLUSIONS: In the private health insurance system, psychiatric illnesses have almost no rooms. It is very urgent to add space for patients with psychiatric illnesses and psychiatrists in the insurance policies.
Diagnosis ; Humans ; Insurance* ; Insurance, Health ; Korea* ; Medical Records ; Psychiatry

OBJECTIVES: This study was conducted to evaluate the reliability and the validity of the Korean version of the Scale to Assessment Unawareness of Mental Disorder (SUMD-K). METHODS: The subjects were 55 schizophrenic patients between ages of 26 and 58 who were recruited from the psychiatric unit of the university hospital and the out-patient clinic. The SUMD-K and insight scale of PANSS were applied to the patients. RESULTS: The range of inter-rater (Spearman's rho) of the general items of SUMD-K were .97-. 98 on the current illness and .58-.98 on the past illness. The correlation coefficient between the sum and the general items of the SUMD-K showed high scores. The concurrent validity between SUMD-K and insight item of PANSS was high (scores between .59-.96). However, the reliability and the validity of the attribution items of symptoms showed low scores compared to the current symptoms. CONCLUSION: The SUMD-K was confirmed in its reliability and validity. It can be a useful clinician-rating scale for evaluating insight in schizophrenic patients as well as patients with other neuropsychiatric conditions.
Humans ; Mental Disorders* ; Outpatients ; Reproducibility of Results*

BACKGROUND: Despite the clinical clues of bronchial asthma, some chronic coughers fail to be diagnosed due to negative test results. This study was aimed at evaluating the diagnostic performance of routine objective tests and identifying a cost-effective approach for asthmatics with a chronic cough. METHODS: Patients with a chronic cough of more than 3 weeks duration, and showing normal chest radiograph and spirometry were enrolled. On the first visit, objective tests, composed of serum total IgE, peripheral blood eosinophil count, spontaneous sputum eosinophil count, methacholine bronchial provocation test (MBPT) and paranasal sinus radiograph, were performed, with the simultaneous administration of oral prednisolone (0.5mg/kg) for one week. The final diagnoses were made on the basis of the test results, and the patients grouped according to their steroid responsiveness. The role of the etiologic diagnosis tests was evaluated, and the medical costs of the final management plan simulated with respect to three assumed models. RESULTS: Sixty chronic coughers were finally analyzed. The final diagnoses were as follows: bronchial asthma 21.7%, eosinophilic bronchitis 6.7%, paranasal sinusitis 18.3%, presumptive allergy 8.3% and non-diagnostic case 45.0%. Ninety percent were steroid responder. With the bronchial asthma cases, the positive rate of MBPT was 38.5%, with sputum eosinophil count in 84.6%, serum total IgE in 38.5%, and a peripheral blood eosinophil count rate of 30.8%. When the test results and steroid responsiveness data were applied to the 3 models, the chest radiograph, spirometry, sputum eosinophil count and paranasal sinus radiograph test results, and simultaneous short term steroid treatment seemed to have acceptable diagnostic performances, which could be used as a further guide to cost-effective planning. Conclusion:Objective tests, composed of chest radiograph, spirometry, paranasal sinus radiograph and sputum eosinophil count, with simultaneous short term steroid treatment, are suggested as cost-effective approaches for asthmatics with a chronic cough.
Asthma ; Bronchial Provocation Tests ; Bronchitis ; Cough* ; Diagnosis ; Eosinophils ; Humans ; Hypersensitivity ; Immunoglobulin E ; Methacholine Chloride ; Prednisolone ; Radiography, Thoracic ; Sinusitis ; Spirometry ; Sputum

Chemical pneumonitis is caused by the inhalation of noxious chemical substances and is a cause of occupational lung disease. Nitric acid, which is a one of the common air pollutants and a potential oxidant for refining and cleansing of metals, has a chance for occupational and environmental exposure. A 52-year-old man visited our hospital due to coughing and dyspnea after the inhalation of nitric acid fumes at his workplace. He had conditions of tachypnea (respiratory rate 26 /min) and hypoxemia (PaO2 42.6 mmHg, SaO2 80.2% in room air) in our emergency department. The chest radiographs showed diffuse interstitial infiltrates and ground glass opacity in both lungs. The patient made improvements in clinical symptoms and chest radiography after being given a supply of oxygen, antibiotics, and bronchodilator therapy without systemic glucocorticoid therapy. On his follow up visit after 4 weeks, he showed no symptoms and sequelae, and the pulmonary function test showed a normal pulmonary function.
Air Pollutants ; Anoxia ; Anti-Bacterial Agents ; Cough ; Dyspnea ; Emergency Service, Hospital ; Environmental Exposure ; Follow-Up Studies ; Glass ; Humans ; Inhalation* ; Lung ; Lung Diseases ; Metals ; Middle Aged ; Nitric Acid* ; Oxygen ; Pneumonia* ; Radiography ; Radiography, Thoracic ; Respiratory Function Tests ; Tachypnea ; Thorax

Pulmonary gangrene is a rare and severe complication of bacterial pneumonia, where a pulmonary segment or lobe is sloughed due to parenchymal devitalization of the parenchyma, with secondary anaerobic infection and necrosis caused by pulmonary vascular thrombosis. Prior to the antibiotic era, massive pulmonary gangrene was potentially fatal. Herein, a case of pulmonary gangrene in a 67-year-old man is reported. He complained of fever, chills, dyspnea and purulent sputum of 5 days duration. The plain chest radiograph showed well-marginated right upper lobe consolidation, with bulging minor fissure, suggestive of a Klebsiella infection. A contrast CT scan demonstrated consolidation of the right upper lobe, with a central necrotizing portion. Klebsiella species was confirmed from both sputum and blood cultures. After appropriate antibiotics, the chest X-ray and CT scan 3 weeks later showed a large cavity with an air-fluid level, sloughing-off and extrusion of necrotic lung tissue, suggestive of pulmonary gangrene. Seven months later, the right gangrenous lung showed severe volume loss on a chest radiograph. The management of pulmonary gangrene has been somewhat controversial. Herein, it was managed without surgical drainage or resection. If the antibiotic therapy had failed, then a surgical approach would have been considered.
Aged ; Anti-Bacterial Agents ; Chills ; Drainage ; Dyspnea ; Fever ; Gangrene* ; Humans ; Klebsiella Infections ; Klebsiella* ; Lung ; Necrosis ; Pneumonia* ; Pneumonia, Bacterial ; Radiography, Thoracic ; Sputum ; Thorax ; Thrombosis ; Tomography, X-Ray Computed

OBJECTIVE: This multicenter clinical trial was carried out to investigate the efficacy and the safety of olanzapine for the treatment of Korean patients. METHOD: 105 patients with schizophrenia and schizophreniform disorder, visited at 10 mental or university hospitals, had received an open and non-comparative treatment with olanzapine for 8 weeks. Patients had psychotic or depressive symptoms with the severity above moderate degree or intolerable side effects to previous antipsychotics. After a wash-out period of 2-7 days, 10mg olanzapine was prescribed initially to all the patients, and then the dosage could be adjusted within the range of 5-20mg/day of olanzapine by 3-7 days. RESULTS: 90(85.7%) of 105 patients completed the 8-weeks trial and the mean modal dose of olanzapine was 16.1(+/-4.7)mg/day. At the end of the trial, 73 patients(69.5%) were classified as responder, which was defined as 40% or more improvement in BPRS(Brief Psychiatric Rating Scale) score comparing to baseline. There was a significant reduction in the scores of PANSS(Positive and Negative Syndrome Scale) and subscales including negative symptom scores and CGI. Also weekly analysis showed that the reductions in scores were kept on for the whole period of the trial. 43.8% of all the patients had depressive symptoms at the baseline and total scores of MADRS(Montgomery-sberg Depression Rating Scale) and HAM-A(Hamilton Rating Scale for Anxiety) were also reduced after the trials. Vital signs revealed no clinically significant changes but continuous weight gain was observed during the treatment with olanzapine. The scores of SAS(Simpson-Angus Scale) and AIMS(Abnormal Involuntary Movement Scale) for assessing the EPS(extrapyramidal symptoms) and tardive dyskinesia respectively were significantly decreased and only a few patients reported EPS as adverse events. Although mild and clinically non-significant elevation of ALT/SGPT was observed, most laboratory parameters including plasma prolactin level showed no significant changes during the trial. CONCLUSIONS: Although this trial had many limitations because it was a non-comparative and open study, olanzapine showed high efficacy on the positive, negative and depressive symptoms in schizophrenia and schizophreniform disorder. In addition to that, olanzapine showed a substantially favorable safety profile, such as low incidence of EPS and hyperprolactinemia.
Antipsychotic Agents ; Depression ; Dyskinesias ; Hospitals, University ; Humans ; Hyperprolactinemia ; Incidence ; Movement Disorders ; Plasma ; Prolactin ; Psychotic Disorders* ; Schizophrenia* ; Vital Signs ; Weight Gain

OBJECTIVES: This study was designed to evaluate differences in the quality of life(QOL) according to insight in patients with schizophrenia. The author speculated that insight might have an effect on individual's QOL, especially subjective QOL. METHOD: The study group consisted of patients with schizophrenia(N=55). Subjects were divided into two groups, patients with insight(N=22)and without insight(N=15), based on Scale of Unawareness of Mental Disorders(SUMD). All of the patients were administered the Quality of Life Interview (QOLI)by Lehman and compared in objective and subjective QOL between two groups. Additionally, they completed BDI and F scale on MMPI. RESULTS: The patients with insight showed a tendency of lower scores in total subjective QOLI scores and the safety issues compared to the patients without insight although not significant statistically. And they showed significantly less satisfaction with social relations. In objective QOL, there are no statistically significant differences between two groups. CONCLUSION: Such differences support the notion that schizophrenic patients with insight are less satisfied with their lives, especially in the aspect of interpersonal relations. It reflects the awareness of functional decline due to lifetime disability, disconnection from social relations, poor resources and supports, social stigma, and also depressive or anxiety symptoms. The authors propose that the treatment strategies for schizophrenia must include concern and support for domains of life with which patients feel themselves least satisfied, to increase effectiveness and efficacy of treatment and improve QOL.
Anxiety ; Humans ; Interpersonal Relations ; MMPI ; Quality of Life* ; Schizophrenia* ; Social Stigma