Objectives : Treatment for bipolar disorder is often complicated by various clinical situations. We undertook a survey of expert opinions to facilitate clinical decisions in special situations such as weight gain, metabolic syndrome, hyperprolactinemia, genetic counseling, and treatment adherence. Methods : A written survey that asked treatment strategies related to safety and tolerability, was prepared focused on weight gain, antipsychotic related hyperprolactinemia, lamotrigine related skin rash, treatment non-adherence and genetic counseling. Sixty-one experts of the review committee completed the survey. Results : In the case of weight gain related to medications, experts preferred exercise and education for diet-control. First chosen medications were lamotrigine, aripiprazole and ziprasidone. Recommendations based on expert survey results for treatment of bipolar patients in other special situations are outlined. Conclusion : With limitation of expert opinions, authors hope that results of this study provide valuable information to make clinical decisions about treatment of bipolar disorder in complicated situations.
The purpose of this study is to investigate the current status of work performance of public health doctors(PHDs) involved in quarantine of COVID-19, and to suggest a plan to support PHDs for effective national epidemic prevention and control in the future. As a result of the study, it was found that PHDs mainly performed sample collection, interview, and treatment. 39% of PHDs worked in places without negative pressure facilities, and personal protective equipment and welfare support were poor. In addition, it was investigated that they experienced high-risk infectious diseases, mental distress, exclusion from the decision-making process, conflicts with officials, problems with work guidelines, and lack of prior education. For effective infectious disease management, it is necessary to assign appropriate ranks and to participate in the decision-making process for quarantine, to specify appropriate compensation and regulations, to education, and to support mental health.
This study was conducted to compare the cardiovascular-metabolic risk and mental health according to physical activity in postmenopausal women, in order to present basic data for health promotion of postmenopausal women. 4,453 postmenopausal women among the raw data of the 7th period (2017-2019) of the National Health and Nutrition Examination Survey were used for the final analysis. Cardiovascular-metabolic was measured by waist circumference, systolic blood pressure, diastolic blood pressure, HDL -cholesterol, fasting blood sugar and triglycerides, and mental health was measured by depression and stress perception. As a result of the study, it was found that Korean postmenopausal women were more physically active as their waist circumference was smaller, systolic blood pressure was lower, diastolic blood pressure and HDL-cholesterol were higher. However, there was no difference in depression and stress perception. Consequently, it is considered that waist circumference, blood pressure, and HDL-cholesterol management are necessary to improve cardiovascular and metabolic functions in postmenopausal women.
In Korea, modern art therapy was developed in the 1960s and 1970s in the form of supplementary activities for patients in psychiatry. Along with the foundation of the Korean Association for Clinical Art in 1982 by psychiatric doctors, the therapy involved more various arts forms such as music, art, dance, poetry therapy, and psychodrama. More organizations with specific expertise opened such as the Korean Art Therapy Association, Korean Art Therapy Association, etc. in the 1990s and the Korea Arts Therapy Institute in 2001. As of April 2015, the members of the Korean Art Therapy Association total 15,000, including 6,200 regular members. The arts in integrative arts therapy (IAT) is an individual's creative activity which is related to his inner world, and the forms of IAT include music, drawing, dance and poetry therapy. From the aspect of phenomenology, IAT is psychophysical therapy involving the arts that helps patients recognize and perceive their experiences with an aim of at a recovery of the body and creativity from the phenomenological aspect. It is also a therapeutic activity that targets growth and development of the body and mind. Meta-analysis of the effects of art therapy with a focus on that involving music, drawing, dance movement and IAT in recent years in Korea, significant effects were observed in all factors but physical function. The biggest effect was mentality adaptation followed by activity adaptation and physiology. In the run up to the implementation of the daily flat-rate system for the health insurance reimbursement for palliative care in July 2015, the Ministry of Health and Welfare is reviewing the coverage of music therapy, drawing therapy and flower therapy, which are currently practiced by 56 hospice institutes in Korea. This is a meaningful step because the coverage of hospice and palliative care came after that of art therapy for psychiatric patients was approved in 1977. Still, there is a need clarify the therapeutic mechanism by exploring causality among the treatment media, mediation type and treatment effects. To address the issue of indiscriminately issued licenses, more efforts are needed to ensure expertise and identity of the licensed therapists through education, training and supervision.
This article investigates 170 mental health social workers in order to find out the current status and influencing factors on linking services. The social workers of this study work at different kinds of mental health organizations(mental hospitals, mental health centers, mental rehabilitation facilities, mental residential facilities). The result from the research were 1) the degree of linking services is low, and the primary type of coordination is sharing of information and client referrals. The fund-raising and joint project cases are very poor. 2) based on personal and organizational characteristics, there arc significant differences between respondents' sex, education level, job-related status, experience in mental health field, mental health licence(personal factors), location, type of organization, and type of primary client(organizational factors). 3) the factors affecting service coordination among mental health social workers are experience in mental health field, current job-related experience(personal factors), education, location of organization, type of organization, and history of organization(organizational factors). Finally, the research recommends that establishment of cooperation system, service delivery system, and information network is needed in order to enhancing the function of service coordination among mental health social workers. Also, mental health professional associations and agencies should provide opportunity of discussion and training for mental health social workers, and develop the institutional devices to expand the content and type of service coordination.
Objectives : The objective of this study was to revise the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) 2014: Children and Adolescents. Methods : We performed the survey, using a questionnaire comprising 22 questions according to each situation, in children and adolescents with bipolar disorder. Results : First-line pharmacotherapeutic strategies for manic episode in children with bipolar disorder were a combination of mood stabilizer (MS) and an atypical antipsychotics (AAP), monotherapy with an AAP, risperidone, and aripiprazole. Aripiprazole was selected as first-line medication for depressive episode in children with bipolar disorder, and aripiprazole, and risperidone were selected as first-line at high-risk children. First-line pharmacotherapeutic strategies for manic episode in adolescents were a combination of MS and an AAP, monotherapy with an AAP valproate, lithium, risperidone (Treatment of Choice, TOC), aripiprazole, and quetiapine. First-line pharmacotherapeutic strategies for depressive episode in adolescents, were a combination of an atypical antipsychotics and lamotrigine, valproate, aripiprazole (TOC), risperidone, and quetiapine. For depressive episodes in adolescents at high risk for bipolar disorder, valproate, aripiprazole (TOC), and risperidone were selected as first-line medication. Conclusion : We expect that the present KMAP-BP 2018-children and adolescents, is useful for clinicians to treat children and adolescents with bipolar disorder.
Objectives : The fourth revision of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was performed in 2018, to provide newer guidelines for clinicians. In this section, we examined expert opinions to facilitate clinical decisions relative to treating bipolar disorder with medical comorbidity. Methods : The survey was completed by the review committee, consisting of 61 experienced psychiatrists. This part of the survey constitutes treatment strategies, under major medical comorbidities. The executive committee analyzed results, and discussed the final production of algorithm. Results : Aripiprazole was the first-line medication for bipolar patients with metabolic syndrome, cardiovascular, hepatic, renal, and cerebrovascular comorbidities. Ziprasidone also was recommended as the first-line medication in case of metabolic syndrome. Lithium also was regarded as the first-line medication, in case of hepatic problems. Valproate also was considered as the first-line medication, in case of cerebrovascular problems. Conclusion : This study provided the most recent consensus among experts, for treatment of bipolar disorder with physical problems.
Journal of the Korean Applied Science and Technology
/
v.35
no.4
/
pp.1285-1294
/
2018
The purpose of this paper was to identify the relationship between the characteristics of community mental health, and to identify if mediatable contextual property acts as factor influencing community mental health. Data of 229 municipal population groups were collected from KNSO and The 6th Community Health Plan. The data were analyzed using ANOVA, Spearman correlation, and multiple regression analysis. The perceived stress showed significant difference depending on health budget, mental health budget, number of mental health personnel, and was negatively correlated with proportion of the elderly, employment rate, percentage of NBLS recipients, health budget, and number of mental health personnel. The depressive mood differed depending on the number mental health personnel, and was negatively correlated with percentage of NBLS recipients and number of mental health personnel. Mental health budget and number of mental health personnel were respectively influencing factor of perceived stress and depressive mood. Following the above result, in order to reduce the gap between the mental health of communities, the researcher suggests that mental health budget as well as overall health budget and the number of mental health personnel be enforced.
Kang, Jino;Kim, Hye Ri;Min, Kyungjoon;Kim, Na Ryoung;Heo, Yoon Kyung;Kim, Sun Mi
Korean Journal of Psychosomatic Medicine
/
v.27
no.2
/
pp.130-137
/
2019
Objectives : When a patient who attempts suicide visits the emergency room, it is important that the departments of emergency medicine, internal medicine, and psychiatry communicate with each other and prioritize treatment. This study was conducted to verify the effectiveness of the multidisciplinary emergency consultation system (ECS) for drug intoxicated patients. Methods : We retrospectively analyzed the data from medical records prior to the ECS, from July 2017 to May 2018, and after the ECS, from July 2018 to May 2019, to verify the effectiveness of the system. Results : After the ECS, admission to open wards was significantly higher than to the intensive care units (χ2=8.567, p=0.014). In addition, the proportion of consultations to the department of psychiatry among patients admitted to other departments tended to increase (χ2=4.202, p=0.053), and the time required for consultation response decreased (Z=-2.031, p=0.042). As a result of the consultation, the proportion of the patients who had been transferred to the department of psychiatry was increased (χ2=4.692, p=0.043), and the time spent to transfer tended to decrease (Z=-1.941, p=0.052). Conclusions : After implementing the ECS for drug intoxicated patients, unnecessary intensive care unit admissions, consultation response time, and the time spent to transfer were reduced, and the rate of consultation referrals and transfer rates increased. This means that the multidisciplinary consultation system rapidly provided essential medical services to patients at lower medical costs.
The patient population of U. S. state mental hospitals has changed drastically since the 1960s, when the deintstitutionalization movement began. This paper is designed to look at what happened to the number of inpatients of state hospitals in California during the last 150 years and, from this, to explore implications for the future of the mental health system in Korea, especially for the viability of mental hospitals. The data had been collected by field research(visits to state hospitals and State Department of Mental Health, and interviews with mental health administrators) and accessing statistical publications and various reports. Since the first state hospital opened in 1851 the statewide inpatient population of individuals who were mentally disabled has grown and peaked at 37,489 in 1959. The number of patients in state hospitals, however, began declining in the early 1960s and was reduced to 10,874 by 1971, and to 4,973 by 1986. As of 1997, there were only 4, 263 inpatients remaining in the state hospital system. This dramatic decrease slowed down somewhat in 1980s and 1990s, but this trend seems irreversible except for the inpatients referred by the court. Now the beds in state hospitals are filled with more and more forensic patients, which constitutes nearly 70% of the total inpatient population. Based on these findings, it is well expected that the number of inpatients of mental hospitals in Korea will also be reduced in a significant way as the community-based mental health care system is gradually replacing the traditional one. Mental hospitals need to introduce more diversified programs for the care of the mentally ill, and concurrently more vigorous aftercare programs are required in the community.
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