한국정신병리진단분류학회

DOI:

Abstract

Key Words

Joo Yun Song , Kee Jeong Park , Young Tak Jo , Su Jeong Seong , Jae Yeon Hwang

DOI:10.36430/kjp.2023.27.2.001

Abstract

With the increasing burden of dementia as a prevalent health concern, national-level policy responses in the form of dementia management programs have become crucial. Dementia management involves multiple stakeholders, with the dementia management system representing the organizational structure responsible for implementing these programs. This research aims to examine the history and role evolution of the dementia management system, which includes National Institute of Dementia, Regional Dementia Centers, and Dementia Reasurance Centers. The roles of the dementia management system have been articulated in various policies, such as the Elderly Welfare Act, Dementia Management Act, Dementia Elderly 10-Year Plan, and the 1st to 4th National Dementia Plans. The role of the National Institute for Dementia began with a focus on research and statistical management, while the role of the Regional Dementia Center started with an emphasis on education and technical support. However, both are undergoing a transformation in their roles, moving towards strengthening policy support functions. The Dementia Reasurance Centers, initially focused on early detection program due to infrastructure limitations, have evolved to perform additional roles as nationwide infrastructure has been secured. These centers are now expanding their roles, and strengthening functions related to service coordination and integration.

Key Words

Dementia, Policy, Dementia management

Myeong Hyeon Mun

DOI:10.36430/kjp.2023.27.2.002

Abstract

Patients with schizophrenia are advised to take antipsychotic drugs for at least two years in the first onset, and to maintain antipsychotic drugs for at least two to five years in the event of recurrence. Patients with schizophrenia often take antipsychotics for a long time, and some second-generation antipsychotics have anticholinergic effects. Pathophysiological mechanisms by which anticholinergic action increases the risk of glaucoma development or exacerbates glaucoma are known. On the other hand, open-angle glaucoma has no subjective symptoms in more than 50% of patients until the middle of visual field damage, so if clinically suspected and not treated, it is overlooked and there is a risk of missing the treatment period, leading to blindness. Considering that the number of elderly schizophrenia patients is increasing due to the development of schizophrenia treatment strategy, and glaucoma has a higher prevalence in the elderly population, It can be expected that the number of cases of glaucoma among schizophrenia patients will increase. Psychiatrists should check for glaucoma predispositions, such as the family history of glaucoma, and increased intraocular pressure, when treating elderly schizophrenia patients, and pay attention to the possibility of a link between the anticholinergic action of the second-generation antipsychotics and glaucoma.

Key Words

Glaucoma, Atypical Antipsychotics, Anticholinergic agents, Schizophrenia

Hyunjung Lee , Jung-woo Son , Ji-eun Kim , Jeonghwan Lee

DOI:10.36430/kjp.2023.27.2.003

Abstract

Objectives: Neuroimaging studies have revealed structural abnormalities in the brains of adolescents with attention deficit hyperactivity disorder(ADHD). However, few studies have focused on the volumes of amygdala nuclei. We aimed to determine whether there are volumetric differences in the amygdala and its nuclei between ADHD adolescents and a healthy control group. Methods: Twenty four ADHD adolescents undergoing stimulant medication and healthy controls underwent high resolution 3 Tesla Magnetic Resonance Imaging. All participants were assessed using the Korean ADHD Rating Scale. We analyzed the volumes of the amygdala and its nuclei based on a 1 mm thickness sagittal T1-weighted image using the FreeSurfer program. We compared the volume of each nucleus across groups using an analysis of covariance, controlling for the effects of age and gender. Results: ADHD group demonstrated volumetric increment of bilateral amygdala(left: F=5.76, p=0.021, effect size 0.12 ; right: F=5.64, p=0.022, effect size=0.11). Among the eighteen amygdala nuclei, left accessory basal nucleus (F = 9.13, adjusted p-value = 0.019, effect size = 0.18), left cortical nucleus (F = 6.93, adjusted p-value = 0.035, effect size = 0.15), and left corticoamygdaloid transition (F = 11.55, adjusted p-value = 0.013, effect size = 0.21) showed an increase in volume in the ADHD group compared with the control group. Conclusions: Unlike previous studies on medication-naive ADHD, we observed an increase in the volume of the bilateral amygdala and several nuclei in adolescents with ADHD undergoing stimulant treatment. Further research is required to confirm the effect of stimulant medication on the volumetric change of amygdala and its behavioral manifestation.

Key Words

ADHD, Amygdala, Amygdala nuclei

Su Jeong Seong , In Hye Kim , Suhyeon Lim , Nuri Min , Myung Ju Lee , Jae Hyun Han , Soonhyun Kwon , Ka Hee Yoo , Hyun Jun Jo , Kee Jeong Park , Young Tak Jo , Joo Yun Song , Jae Yeon Hwang

DOI:10.36430/kjp.2023.27.2.004

Abstract

Objectives: The burden on caregivers of dementia patients is a crucial factor in the quality of life and disease management for both the patient and the caregiver. However, research on caregiver burden at the time of initial dementia diagnosis is lacking. This study aims to investigate the factors related to caregiver burden in caregivers within three months of dementia diagnosis. Methods: A total of 85 caregivers, whose care recipients were aged 65 or older and had been diagnosed with dementia within the past three months, were surveyed. Caregivers whose care recipients were institutionalized were excluded from the study. The Caregiver Burden Inventory was used to measure caregiver burden. Socio-demographic factors of the patient and caregiver, clinical characteristics of the patient, caregiver's depressive symptoms, attitudes toward dementia, coping skills, and social support were examined. Results: Higher severity of dementia in the patient, female gender of the caregiver, cohabitation of caregiver and patient, and more severe depressive symptoms in the caregiver were significantly associated with higher caregiver burden. Additionally, caregivers using negative coping strategies, having negative attitudes toward dementia, and receiving less social support experienced higher caregiver burden. Multivariate regression analysis results showed that only caregiver's gender and depressive symptoms were significantly related to caregiver burden. Conclusions: Caregiver depressive symptoms at the time of initial dementia diagnosis were found to increase caregiver burden. It is essential to identify risk factors for caregiver burden from the early stages of diagnosis and implement interventions to reduce caregiver burden.

Key Words

Dementia, Caregiver, Caregiver burden, Depression