OBJECTIVE: The purpose of this study is to evaluate the efficacy and safety of mirtazapine treatment in multicenter population consisting of Korean patients suffering from moderate-to-severe depression. METHODS: Total 163 of in and outpatients with a diagnosis of major depressive disorder (DSM-IV) and 18 or over scores of 17-items Hamilton Rating Scale for Depression (HAMD) received treatment with mirtazapine (15-45 mg/day) for 6 weeks. Efficacy was assessed by HAMD, Montgomery and Asberg Depression Rating Scale (MADRS), Beck's Depression Inventory (BDI), and Clinical Global Impression (CGI) scales and statistical analyses were performed on the intent-to-treat sample (143 patients) using the last-observation-carried-forward method. In addition, reported adverse events, routine laboratory parameters, and vital signs were investigated to evaluate the safety of mirtazapine. RESULTS: Mean daily dose of mirtazapine was 28.4 mg. At the end of the study, the response rate (50% or more reduction from baseline in HAMD scores) was 75.5% and the remission rate (7 or less in HAMD score) was 42.7%. Mirtazapine treatment induced significant reduction in depressive symptoms at the 4(th) day and substantial reduction along the treatment period, as assessed by changes in HAMD, MADRS, BDI, and CGI scales. At the 4(th) day and first week of mirtazapine treatment, the mean HAMD-17 total score was significantly reduced compared that of the baseline and the response rates were 11.9% and 28.7%, respectively. Mirtazapine was well tolerated in general, and somnolence and sedation were the most common adverse events reported. In addition, there were no clinically relevant changes in laboratory parameters and vital signs, although body weight was increased. CONCLUSION: Although this trial had many limitations of open non-comparative study, mirtazapine was demonstrated to an effective treatment for moderate to severe major depressive disorder and was well tolerated. A potentially rapid onset of overall therapeutic efficacy of mirtazapine was suggested by significant changes in all major variables of efficacy after 4(th) day of treatment.
Body Weight ; Depression ; Depressive Disorder, Major ; Diagnosis ; Humans ; Outpatients ; Vital Signs ; Weights and Measures

PURPOSE: The purpose of this study is to evaluate the psychometric properties of the Korean version of the King's Health Questionnaire(KHQ) in patients with stress urinary incontinence. MATERIALS AND METHODS: Multicenter prospective study was undertaken in 106 patients with stress urinary incontince. Psychometric properties including discriminant validity, convergent validity were evaluated and the Cronbach's alpha coefficients were calculated. Test-retest analysis was performed and the sensitivity to clinical change before and after treatment was also evaluated. RESULTS: The psychometric properties and clinical validity of the KHQ Korean version were confirmed in 106 study population. The KHQ's good reliability was evidenced by Cronbach's alpha coefficients of>0.60, indicating to change in patients' perception of bladder condition in all domains. CONCLUSION: Our analyses confirm excellent psychometric properties for the Korean version of KHQ, which appears to provide a valid and reliable instrument for clinical usages in Korea.
Female ; Humans ; Korea ; Prospective Studies ; Psychometrics* ; Surveys and Questionnaires* ; Translations ; Urinary Bladder ; Urinary Incontinence* ; Urination

OBJECTIVES: A great deal of attention has been paid to comorbid personality disorders in obsessive-compulsive disorder not only from the theoretical perspectives but also from the clinical aspects related to the prediction of the treatment response. The purpose of the current study was to investigate the relations of the symptoms dimensions in OCD to the comorbid personality pathology. METHODS: One-hundred thirty subjects with OCD completed Yale-Brown Obsessive Compulsive Scale (YBOCS) and Personality Disorder Questionnaire-4+ (PDQ-4+). Factor scores of symptom dimensions yielded from a factor analysis of 13 categories in YBOCS symptom checklist were inspected how to be related with the presence of any personality disorder and the PDQ scores for cluster A, B, and C personality pathology. RESULTS: The PDQ total score was significantly correlated with aggressive/sexual/religious obsessions, hoarding, and symmetry/ordering dimensions. The hoarding and repeating/counting dimensions were correlated with cluter A pathology, the symmetry/ordering dimension was with cluster B pathology, while the obsessions dimension was globally related to personality disorders of all the clusters. CONCLUSION: These findings add the evidence of the heterogeneity of OCD. The presence of pure obsessions, hoarding, and symmetry/ordering dimensions may need a close screening for comorbid personality disorders and individualized therapeutic strategies.
Checklist ; Mass Screening ; Obsessive Behavior ; Obsessive Hoarding ; Obsessive-Compulsive Disorder* ; Pathology* ; Personality Disorders ; Population Characteristics

This study examined the relationship between anger expression or alexithymia and coronary artery stenosis in patients with coronary artery diseases. 143 patients with coronary artery diseases (104 males and 39 females) were enrolled in this study. The severity of their coronary artery stenosis was measured by angiography. The Anger Expression Scale and the Toronto Alexithymia Scale were used to assess the level of anger expression and alexithymia. The more stenotic group (occluded by 75% or more) exhibited a significantly higher level of alexithymia than the less stenotic group (occluded by less than 25%). Multiple regression anaylsis on the extent of stenosis also revealed that regardless of gender and age, the coronary artery disease patients with higher alexithymia were likely to show a greater level of stenosis. However, no significant differences were found on either the anger-in or anger-out subscale scores between the two groups. These results suggest that alexithymia is associated with the severity of coronary artery stenosis in patients with coronary artery disease. However, both anger expression and anger suppression were not shown to be associated with the severity of coronary artery stenosis.
Adult ; Affective Symptoms/*epidemiology ; Aged ; *Anger ; Coronary Stenosis/*epidemiology/*psychology ; Female ; Human ; Male ; Middle Aged ; Risk Factors ; Severity of Illness Index

OBJECTIVE: The introduction of new psychiatric medications with better efficacy and tolerance seems to increase the frequencies of co-prescriptions of various psychotropic agents. We investigated the frequencies of the combined treatments of atypical antipsychotics and selective serotonin reuptake inhibitors (SSRIs) that are supposed to be common in clinical practice. METHODS: Data on 2783 outpatients from March 1, 2002 through June 31, 2002 in Seoul National University Hospital were collected. The number of cases with a co-prescription of atypical antipsychotics with SSRIs were counted and compared by diagnoses. The relations of diagnosis and age to the combined treatment were explored. RESULTS: 499 (17.4%) patients took co-prescriptions of antipsychotics with antidepressants, and 393 (13.7%) patients those of atypical antipschotics with SSRIs. Patients with obsessive compulsive disorder and schizophrenia took the combinations of atypical antipsychotics and SSRIs more frequently than patients with other diagnoses, as 41.6% and 20.8%, respectively. Controlling for diagnostic categories, age was significantly correlated with the presence of those co-prescriptions. CONCLUSION: The findings of the current study reflect evidence-based prescriptions in an educating hospital and provide basic data for further pharmaco-epidemiological studies. The co-prescription of atypical antipsychotic agents with SSRIs seems to occur only in proper indications, under the consideration of the risk of drug-drug interactions and adverse effects.
Antidepressive Agents ; Antipsychotic Agents* ; Diagnosis ; Humans ; Obsessive-Compulsive Disorder ; Outpatients* ; Prescriptions ; Schizophrenia ; Seoul ; Serotonin Uptake Inhibitors*

OBJECTIVE: The introduction of new psychiatric medications with better efficacy and tolerance seems to increase the frequencies of co-prescriptions of various psychotropic agents. We investigated the frequencies of the combined treatments of atypical antipsychotics and selective serotonin reuptake inhibitors (SSRIs) that are supposed to be common in clinical practice. METHODS: Data on 2783 outpatients from March 1, 2002 through June 31, 2002 in Seoul National University Hospital were collected. The number of cases with a co-prescription of atypical antipsychotics with SSRIs were counted and compared by diagnoses. The relations of diagnosis and age to the combined treatment were explored. RESULTS: 499 (17.4%) patients took co-prescriptions of antipsychotics with antidepressants, and 393 (13.7%) patients those of atypical antipschotics with SSRIs. Patients with obsessive compulsive disorder and schizophrenia took the combinations of atypical antipsychotics and SSRIs more frequently than patients with other diagnoses, as 41.6% and 20.8%, respectively. Controlling for diagnostic categories, age was significantly correlated with the presence of those co-prescriptions. CONCLUSION: The findings of the current study reflect evidence-based prescriptions in an educating hospital and provide basic data for further pharmaco-epidemiological studies. The co-prescription of atypical antipsychotic agents with SSRIs seems to occur only in proper indications, under the consideration of the risk of drug-drug interactions and adverse effects.
Antidepressive Agents ; Antipsychotic Agents* ; Diagnosis ; Humans ; Obsessive-Compulsive Disorder ; Outpatients* ; Prescriptions ; Schizophrenia ; Seoul ; Serotonin Uptake Inhibitors*

BACKGROUND: In order to decide on a strategy of the treatment against gastric cancer, an accurate preoperative evaluation of the depth of tumor invasion is essential. We have studied the depth of invasion in early gastric cancer by endoscopic findings.METHODS: The preoperative endoscopic diagnosis of the depth of invasion was compared with pathologic findings in a total of 108 cases with early gastric cancers (EGC) which were confirmed pathologically in resected specimen. RESULTS: Of one hundred eight EGCs, forty-one were elevated type, others were flat-depressed type. There was no relationship between the depth of invasion and macroscopic type of EGC. All of the elevated typed EGCs were differentiated carcinoma. In the depressed typed EGCs, Forty-five percent was differentiated carcinoma and fifty-five percent was undifferentiated carcinoma. The incidence of lymph node metastasis in submucosal cancers (14.8%) was significantly more than in mucosal cancers (1.6%). Among the submucosal cancers, the incidence of nodal metastasis in double lesions (100%) was significantly more than in single lesions (14.8%). In the elevated typed EGCs, mucosal cancers were small in size less than 3.0 cm (83%), and contained whitish patches, and showed uneveness and erosion. Submucosal cancers were large in size, and contained ulcers, and showed submucosal tumor-like shapes and bridging folds. In the depressed typed EGCs, it was difficult to determine endoscopically the depth of invasion. Submucosal cancers showed the fusion of converging folds and unevenness of the depressed base. The regularity of the depressed base without ulcer was primarily found in mucosal cancer. CONCLUSION: When the tumor was elevated, the endoscopic diagnosis for the depth of invasion was determined easily by size of the lesion and features of the elevated surface. For the depressed tumor, diagnostic clues were the pattern of the base of the depression and the converging fold, and the endoscopic diagnosis of the depth of invasion was much more difficult than the elevated type EGC.
Carcinoma ; Depression ; Diagnosis* ; Gastroscopy ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Stomach ; Stomach Neoplasms* ; Ulcer

BACKGROUND/AIMS: From the review of Korean literature most fatal mushroom poisonings have been due to amatoxins with high mortality. So far there have never been investigations on the amatoxins poisonings such as annual incidence, mortality, common causal species, and endemic areas. This study was carried out to develop some basic statistics as part of studies for an effective management of amatoxins intoxications. METHOD: For the year 1999 authors collected cases of mushroom poisonings which had been mainly gathered from hospitals nation-wide. All of the cases with suggestive amatoxins poisonings were screened by symptomatology and laboratory findings. The causal species of mushrooms were identified grossly and microscopically. RESULTS: A total of 54 victims with mushroom poisonings were evaluated. The causal mushroom toxins were diagnosed or strongly suggested as amatoxins in 43 of 54 victims. Eleven of 54 victims did not conform to the category of amatoxins intoxication due to absent or minimal elevation of aminotransferase. Mean age of the victims was 44.3 23.3 (range: 7-78) with male predominance (1.2 : 1). The causal species were confirmed, or strongly suggested, as Amanita virosa in 25 victims, Amanita subjunquillea in 14, and unknown species in 4. Thirty-five out of a total of 43 were regarded as moderate to severe intoxication (AST or ALT >1,000 IU/L) with 20% mortality. Most fatal victims showed marked thrombocytopenia (40,000 19,000/mm3) compared to non-fatal victims (109,066 42,245/mm3). A total of 88.4% of victims was developed in the Kangwon and Kyungpuk provinces. Both are west of the Taebaek Mountains (38/43). CONCLUSIONS: Although the common causal species for amatoxins poisonings in Korea are different from European countries and North America, the mortality is similar to that of those areas. In order to further reduce the mortality, bedside diagnostic methods using biological fluids and more effective therapy for liver failure should be established.
Agaricales ; Amanita ; Gangwon-do ; Humans ; Incidence ; Korea* ; Liver Failure ; Male ; Mortality ; Mushroom Poisoning ; North America ; Poisoning* ; Thrombocytopenia

Continuous ambulatory peritoneal dialysis(CAPD) is now the most important and effective therapeutic modality as well as hemodialysis(HD) and renal transplantation in patients with chronic renal failure. It is frequently recommended to diabetic renal failure patients because of poor, athersclerotic vascularity of them. Hyperglycemia and obesity are not uncommon complications of CAPD therapy. But there were only few reports of very severe hyperglycemia or hyperosmolar coma in CRF patients on CAPD therapy, especially with 7% dextrose CAPD dialysate in foreign countries in the past. Moreover, no specific management for hyperosmolar coma is established in those situations yet. In Korea, only three cases of hyperosmolar coma in non diabetic renal failure patient on CAPD therapy have been reported in one case report. And only one case among them whose CAPD therapy was changed to HD survived. Authors also experienced a case of diabetic hyperosmolar coma treated successfully with conversion to HD in chronic renal failure patient on CAPD therapy. So we report this case with a review of literature. Taken together with this case and review of literature, changing CAPD therapy to HD is regarded to be an important part of treatment when hyperosmolar coma develops in chronic renal failure patients.
Coma* ; Glucose ; Humans ; Hyperglycemia ; Kidney Failure, Chronic* ; Kidney Transplantation ; Korea ; Obesity ; Peritoneal Dialysis, Continuous Ambulatory* ; Renal Dialysis* ; Renal Insufficiency

Continuous ambulatory peritoneal dialysis(CAPD) is now the most important and effective therapeutic modality as well as hemodialysis(HD) and renal transplantation in patients with chronic renal failure. It is frequently recommended to diabetic renal failure patients because of poor, athersclerotic vascularity of them. Hyperglycemia and obesity are not uncommon complications of CAPD therapy. But there were only few reports of very severe hyperglycemia or hyperosmolar coma in CRF patients on CAPD therapy, especially with 7% dextrose CAPD dialysate in foreign countries in the past. Moreover, no specific management for hyperosmolar coma is established in those situations yet. In Korea, only three cases of hyperosmolar coma in non diabetic renal failure patient on CAPD therapy have been reported in one case report. And only one case among them whose CAPD therapy was changed to HD survived. Authors also experienced a case of diabetic hyperosmolar coma treated successfully with conversion to HD in chronic renal failure patient on CAPD therapy. So we report this case with a review of literature. Taken together with this case and review of literature, changing CAPD therapy to HD is regarded to be an important part of treatment when hyperosmolar coma develops in chronic renal failure patients.
Coma* ; Glucose ; Humans ; Hyperglycemia ; Kidney Failure, Chronic* ; Kidney Transplantation ; Korea ; Obesity ; Peritoneal Dialysis, Continuous Ambulatory* ; Renal Dialysis* ; Renal Insufficiency