OBJECTIVES: The author tried to find out reasons why and how hysteria(and conversion disorder) patient numbers, which were so prevalent even a few decades ago, have decreased and the phenotype of symptoms have changed. METHODS: The number of visiting patients diagnosed with conversion disorder and their phenotype of symptoms were investigated through chart reviews in a psychiatric department of a University hospital for the last 12 years. Additionally, the characteristics of conversion disorder patients visiting the emergency room for last 2 years were also reviewed. Those results were compared with previous research results even if it seemed to be an indirect comparisons. The research relied on Briquet P. and Charcot JM's established factors of the vicissitudes of hysteria(and conversion disorder) which has been the framework for more than one hundred and fifty years since hysteria has been investigated. RESULTS: The author found decreased numbers and changes of the phenotype of the hysteria patients(and conversion disorder) over the last several decades. The decreased numbers and changes of the symptoms of those seemed to be partly due to several issues. These issues include the development of the diagnostic techniques to identify organic causes of hysteria, repeated changes to the symptom descriptions and diagnostic classification, changes of the brain nervous functions in response to negative emotions, and the influence of human evolution. CONCLUSIONS: The author proposed that the evolutionary brain discord reaction theory explains the causes of disappearance of and changes to symptoms of hysteria(conversion disorder). Most patients with hysteria(conversion disorder) have been diagnosed in the neurological department. For providing more appropriate treatment and minimizing physical disabilities to those patients, psychiatrists should have a major role in cooperating not only with primary care physicians but with neurologists. The term 'hysteria' which had been used long ago should be revived and used as a term to describe diseases such as somatic symptom disorder, functional neurological symptoms, somatization, and somatoform disorders, all of which represent almost the same vague concept as hysteria.
Brain* ; Classification ; Conversion Disorder ; Emergency Service, Hospital ; Humans ; Hysteria ; Phenotype ; Physicians, Primary Care ; Psychiatry ; Somatoform Disorders

Fundamental difficulties in psychiatric nosology lie in the most basic fact that it deals with subjective states of the human mind. Modern instrumental diagnostic classification systems, which amount to lists of symptom inventories, could not provide accurate concepts of psychiatric disorders. This is also true for schizophrenia, a representative mental disorder. Kraepelin's dementia praecox was a collection of controversially proposed diseases, which had some critical similarities in their clinical features, i.e., the course and outcome. Despite initial debates on the adequacy of this concept, dementia praecox was recognized as a disease entity quite early, so that the concept of dementia praecox or schizophrenia proliferated, became diversified, and was then altered. We can now find large discrepancies between Kraepelin's dementia praecox and today's schizophrenia. However, the myth of disease entity was seldom challenged and psychiatrists today implicitly believe that they are dealing with what Kraepelin had proposed. In order to navigate this impasse, we thought that historical studies on the concept of dementia praecox and underlying taxonomic principles established by 19th century alienists including Kraepelin would shed some light. The aim of this article is to comprehensively review the history of concepts of dementia praecox or schizophrenia, and to question critically how much today's schizophrenia has received the conceptual inheritance from original concepts. Through this process, we expect to attain a renewed understanding of schizophrenia.
Classification ; Equipment and Supplies ; Humans ; Mental Disorders ; Psychiatry ; Schizophrenia* ; Wills

The definition of a "good" psychiatrist has varied over the past decades due to changing roles of psychiatrists. Studies on the qualities of "good" psychiatrists have been completed in many countries. However, no such study has been undertaken in Korea. In Korea, recent growing interest in psychiatry demands the identification of qualities for a good psychiatrist. The purpose of this study was to define the qualities of a good psychiatrist in Korea, subsequently facilitating the improvement of psychiatric training programs. The questionnaire was based on a Singaporean survey with the permission from the original authors. Respondents were divided into patient group and psychiatrist group. The 40-item questionnaire contained items grouped into four themes: Professional, Personal Values, Academic Executive and Relationship. Of the four themes, both patient and psychiatrist groups considered Professional as the most important, whereas Academic Executive as the least important. The mean scores for all items of each theme in the patient group were higher than those in the psychiatrist group, reflecting higher expectations for good psychiatrist in the patient group. Patients emphasized Relationship more than psychiatrists did. It is concluded that a good psychiatrist in Korea can be defined as "a good communicator and listener with a professional manner, who respects confidentiality and has good doctor-patient relationships."
Adult ; Aged ; Asian Continental Ancestry Group ; Female ; Humans ; Internship and Residency ; Male ; Middle Aged ; Patients/*psychology ; Physician-Patient Relations ; Physicians/*psychology ; Psychiatry/*classification ; Republic of Korea ; Surveys and Questionnaires ; Translating

Today's diagnostic criteria are based on consensus, however, they are still incomplete and being changed. These unstable but temporarily dogmatic criteria have been constraining the thinking of individual psychiatrists, and invalidating painful scientific achievements based on previous ones. The limitation of the criteria system appears especially clear concerning depression due to the ambiguity of its definition. Therefore, the aim of this article was to review the history of various concepts of depression and to compare this to today's tendency, which attempts to consolidate diversity. In addition to all Diagnostic and Statistical Manual (DSM), Internal Classification of Diseases (ICD)-9, ICD-9-CM, and ICD-10 were centrally discussed. Classic descriptions of depression were extracted from reviews of classic literature, and some salient concepts and the process by which they had been integrated, divided, and newly proposed was traced. The descriptions of depression whose prototype had been melancholia have experienced significant conceptual changes through DSM-IV and the most recent DSM-V ; they impose tasks that are yet to be resolved. Among them, whether various depressive syndromes are diverse phenotypes of one disorder or they all represent different disorders could be regarded as the most fundamental problem. In order to conduct fruitful studies and to ensure proper treatment of every patient, more precise nosologic understanding of depression must be pursued.
Classification ; Consensus ; Depression* ; Depressive Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Fruit ; Humans ; International Classification of Diseases ; Phenotype ; Psychiatry ; Thinking

Today's diagnostic criteria are based on consensus, however, they are still incomplete and being changed. These unstable but temporarily dogmatic criteria have been constraining the thinking of individual psychiatrists, and invalidating painful scientific achievements based on previous ones. The limitation of the criteria system appears especially clear concerning depression due to the ambiguity of its definition. Therefore, the aim of this article was to review the history of various concepts of depression and to compare this to today's tendency, which attempts to consolidate diversity. In addition to all Diagnostic and Statistical Manual (DSM), Internal Classification of Diseases (ICD)-9, ICD-9-CM, and ICD-10 were centrally discussed. Classic descriptions of depression were extracted from reviews of classic literature, and some salient concepts and the process by which they had been integrated, divided, and newly proposed was traced. The descriptions of depression whose prototype had been melancholia have experienced significant conceptual changes through DSM-IV and the most recent DSM-V ; they impose tasks that are yet to be resolved. Among them, whether various depressive syndromes are diverse phenotypes of one disorder or they all represent different disorders could be regarded as the most fundamental problem. In order to conduct fruitful studies and to ensure proper treatment of every patient, more precise nosologic understanding of depression must be pursued.
Classification ; Consensus ; Depression* ; Depressive Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Fruit ; Humans ; International Classification of Diseases ; Phenotype ; Psychiatry ; Thinking

OBJECTIVES : Though both International Classfication of Disease (ICD) and Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV) are currently in use for psychiatric diagnosis in practice, education, research and reimbursement of medical fees in Asian countries, there seem to be few studies about similarities and differences among them in terms of viewpoints on psychiatric classification. METHODS : A questionnaire which has been developed to investigate the views of psychiatrists on their requirements of a classification system, and their opinions on those currently in use was translated into each language and adopted as survey tool in four East Asian countries. The total number of responses obtained was 703 (Korea, n=154;Japan, n=124;China, n=192, and Taiwan, n=233) although the method of data collection varied across all 4 countries. Since the response rate varied in these countries depending upon the convenience of sampling procedures, we compared percentages of responses to each of the questions instead of conducting a statistical analysis across them. RESULTS : The comparison of surveyed data revealed diversity in the utilization, preferences and opinions for further revision of the DSM and the ICD classification systems in East Asia. Psychiatrists in China and Japan routinely used the ICD, while those in Korea and Taiwan favored the DSM. The majority of Asian psychiatrists expressed the view that reliable inter-clinician communication is considered the main purpose of a classification system. Psychiatrists seemed to prefer classifications with 30-100 diagnostic options. CONCLUSION : Though there was limitation in terms of representation due to sampling methods, East Asian psychiatrists showed different pattern on the use of DSM and ICD across countries and had negative viewpoints on current diagnostic classification systems in terms of transcultural use.
Asian Continental Ancestry Group ; China ; Data Collection ; Diagnostic and Statistical Manual of Mental Disorders ; Far East ; Fees, Medical ; Humans ; International Classification of Diseases ; Japan ; Korea ; Mental Disorders ; Psychiatry ; Surveys and Questionnaires ; Taiwan

OBJECTIVES : Though both International Classfication of Disease (ICD) and Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV) are currently in use for psychiatric diagnosis in practice, education, research and reimbursement of medical fees in Asian countries, there seem to be few studies about similarities and differences among them in terms of viewpoints on psychiatric classification. METHODS : A questionnaire which has been developed to investigate the views of psychiatrists on their requirements of a classification system, and their opinions on those currently in use was translated into each language and adopted as survey tool in four East Asian countries. The total number of responses obtained was 703 (Korea, n=154;Japan, n=124;China, n=192, and Taiwan, n=233) although the method of data collection varied across all 4 countries. Since the response rate varied in these countries depending upon the convenience of sampling procedures, we compared percentages of responses to each of the questions instead of conducting a statistical analysis across them. RESULTS : The comparison of surveyed data revealed diversity in the utilization, preferences and opinions for further revision of the DSM and the ICD classification systems in East Asia. Psychiatrists in China and Japan routinely used the ICD, while those in Korea and Taiwan favored the DSM. The majority of Asian psychiatrists expressed the view that reliable inter-clinician communication is considered the main purpose of a classification system. Psychiatrists seemed to prefer classifications with 30-100 diagnostic options. CONCLUSION : Though there was limitation in terms of representation due to sampling methods, East Asian psychiatrists showed different pattern on the use of DSM and ICD across countries and had negative viewpoints on current diagnostic classification systems in terms of transcultural use.
Asian Continental Ancestry Group ; China ; Data Collection ; Diagnostic and Statistical Manual of Mental Disorders ; Far East ; Fees, Medical ; Humans ; International Classification of Diseases ; Japan ; Korea ; Mental Disorders ; Psychiatry ; Surveys and Questionnaires ; Taiwan

This paper reviewed the studies on hwa-byung (HB), which literally means anger disorder and this is known as the culture-related chronic anger syndrome of Koreans. Based on these studies and a review of the literature on the anger syndromes of other cultures, I have proposed a new anger disorder. The rationale for this proposition is first that the clinical correlates of HB, including the epidemiological data, the etiological factors, the symptoms and the clinical course, are unique and different from those of the depressive disorders, which have been postulated to be similar to HB. Second, the symptoms of HB are characterized by pent-up anger and somatic and behavioral symptoms related to the release and suppression of anger. Third, a group of patients with only HB and who visit psychiatrists for treatment have been identified. Fourth, anger is thought to be the basic target of treatment for HB patients. Last, anger syndromes like HB have been identified, with various names, in other cultures. By reducing the cultural variation of HB and integrating the common clinical correlates of the syndromes related to anger, a new anger disorder for the mood of anger can be conceptualized, like that for other mood disorders for the corresponding pathological moods. The research diagnostic criteria for HB and the new anger disorder are also suggested. I propose that the new anger disorder to be included in the new international classification system as a member of the larger family of mood disorders. International collaborative studies are needed not only to identify such anger disorder in various cultures, but also to explore giving better treatment to these patients based on the bio-psycho-social model of anger disorder.
Anger* ; Behavioral Symptoms ; Classification ; Depressive Disorder ; Humans ; Mood Disorders ; Psychiatry

OBJECTIVES: The K-ARS(Korean ADHD Rating Scale) is one of the most important assessment tool of attentiondeficit hyperactivity disorder(ADHD) in Korea. In this study, we presented detailed normative data on the K-ARS for school-aged children in Seoul metropolitan area to put it to practical use. METHODS: The subjects were 2,397 students(1,223 boys and 1,174 girls, aged 6-12) from 4 elementary schools in Seoul, and one caretaker of each child completed the K-ARS for parents. Children who showed high scores of the KARS for parents were screened, and 2 child psychiatrists interviewed them to make a clinical diagnosis. We compared the mean scores of the K-ARS for parents between ADHD and normal group, and examined the percentage of correct classification. RESULTS: There were some differences in score of the K-ARS for parents according to sex and age, so we presented continuous normative data with T score and subdivided cut-off points for ADHD screening. Interviews with child psychiatrists using DSM-IV criteria were performed to test diagnostic validity, and the difference in every the K-ARS for parents index between ADHD and normal group was significant(p<.001). Using 3 different cut-off points(80th, 90th, 93rd percentage), the accuracies of ADHD correct classification were 67.9, 72.2, 71.1% and all 3 canonical discriminants were significant(p<.05) between ADHD and normal group. CONCLUSION: The normative data and cut-off points on the K-ARS for parents are useful in screening ADHD children in Seoul metropolitan area.
Child ; Classification ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Humans ; Korea ; Mass Screening ; Parents* ; Psychiatry ; Seoul

In this paper, we give an overview of the child psychiatry perspectives on developmental disorders and introduce the diagnostic categories of developmental disorders, based on the DSM-IV and ICD-10 classification systems. Pervasive developmental disorders, mental retardation and specific developmental disorders are the three main diagnostic categories of developmental disorders in this article. Pervasive developmental disorders include autistic disorder, Asperger's disorder, Rett disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified. Specific developmental disorders include communication disorder, learning disorder and motor skills disorder. This article discusses the developmental and clinical characteristics of the above mentioned disorders, focusing on the developmental disabilities of each disorder and the differential diagnosis with other disorders. Future directions for diagnosis are also highlighted.
Asperger Syndrome ; Autistic Disorder ; Child ; Child Psychiatry* ; Child* ; Classification ; Communication Disorders ; Developmental Disabilities ; Diagnosis ; Diagnosis, Differential ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; International Classification of Diseases ; Learning Disorders ; Mental Disorders ; Motor Skills Disorders ; Rett Syndrome