• Tuberculosis and Respiratory Diseases
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• v.79 no.1
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• pp.22-30
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• 2016

Background: The purpose of this study was to document outcomes following withdrawal of a single inhaler (step-down) in chronic obstructive pulmonary disease (COPD) patients on triple therapy (long-acting muscarinic antagonist and a combination of long-acting ${\beta}2$-agonists and inhaled corticosteroid), which a common treatment strategy in clinical practice. Methods: Through a retrospective observational study, COPD patients receiving triple therapy over 2 years (triple group; n=109) were compared with those who had undergone triple therapy for at least 1 year and subsequently, over 9 months, initiated inhaler withdrawal (step-down group, n=39). The index time was defined as the time of withdrawal in the step-down group and as 1 year after the start of triple therapy in the triple group. Results: Lung function at the index time was superior and the previous exacerbation frequency was lower in the step-down group than in the triple group. Step-down resulted in aggravating disease symptoms, a reduced overall quality of life, decreasing exercise performance, and accelerated forced expiratory volume in 1 second ($FEV_1$) decline ($54.7{\pm}15.7mL/yr$ vs. $10.7{\pm}7.1mL/yr$, p=0.007), but there was no observed increase in the frequency of exacerbations. Conclusion: Withdrawal of a single inhaler during triple therapy in COPD patients should be conducted with caution as it may impair the exercise capacity and quality of life while accelerating $FEV_1$ decline.

• Korean Journal of Psychosomatic Medicine
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• v.5 no.1
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• pp.118-122
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• 1997

We experienced a case of 51-year-old female patient who showed symptoms of persecutory delusion, auditory hallucination and hallucinatory behavior, severe insomnia, psychomotor retardation and social withdrawal, along with some clinical signs of the deficiency of various hormones those gradually progressed after massive postpartum vaginal bleeding 13 years ago. She was admitted to a psychiatric ward under the impression of psychotic depression. However careful history taking and evaluation of clinical feature gave rise to the possibility of underlying medical condition. Laboratory work-up revealed panhypopituitarism, hypoglycemia and hyponatremia. After replacement of thyroid hormone and cortisol for 1 week, her clinical symptoms including psychiatric symptoms were improved. Taken together, these findings were compatible with the diagnosis of Sheehan's syndrome. On reporting this case, we would like to emphasize again the importance of differential diagnosis of medical problems causing psychiatric symptoms those are easily neglected in the clinical approach toward psychiatric patients.

• The Korean Society of Law and Medicine
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• v.10 no.2
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• pp.309-341
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• 2009

According to a case of Supreme Court's Sentence No. 2009DA17417 (May 21, 2009), the Supreme Court judges that 'the right to life is the ultimate one of basic human rights stipulated in the Constitution, so it is required to very limitedly and conservatively determine whether to discontinue any medical practice on which patient's life depends directly.' In addition, the Supreme Court admits that 'only if a patient who comes to a fatal phase before death due to attack of any irreversible disease may execute his or her right of self-determination based on human respect and values and human right to pursue happiness, it is permissible to discontinue life-sustaining treatment for him or her, unless there is any special circumstance.' Furthermore, the Supreme Court finds that 'if a patient who is attacked by any irreversible disease informs medical personnel of his or her intention to agree on the refusal or discontinuance of life-sustaining treatment in advance of his or her potential irreversible loss of consciousness, it is justifiable that he or she already executes the right of self-determination according to prior medical instructions, unless there is any special circumstance where it is reasonably concluded that his or her physician is changed after prior medical instructions for him or her.' The Supreme Court also finds that 'if a patient remains at irreversible loss of consciousness without any prior medical instruction, he or she cannot express his or her intentions at all, so it is rational and complying with social norms to admit possibility of estimating his or her own intentions on withdrawal of life-sustaining treatment, provided that such a withdrawal of life-sustaining treatment meets his or her interests in view of his or her usual sense of values or beliefs and it is reasonably concluded that he or she could likely choose to discontinue life-sustaining treatment, even if he or she were given any chance to execute his or her right of self-determination.' This judgment is very significant in a sense that it suggests the reasonable orientation of solutions for issues posed concerning withdrawal of meaningless life-sustaining medical efforts. The issues concerning removal of medical instruments for meaningless life-sustaining treatment and discontinuance of such treatment in regard to medical treatment for terminal cases don't seem to be so much big deal when a patient has clear consciousness enough to express his or her intentions, but it counts that there is any issue regarding a patient who comes to irreversible loss of consciousness and cannot express his or her intentions. Therefore, it is required to develop an institutional instrument that allows relevant authority to estimate the scope of physician's medical duties for terminal patients as well as a patient's intentions to withdraw any meaningless treatment during his or her terminal phase involving loss of consciousness. However, Korean judicial authority has yet to clarify detailed cases where it is permissible to discontinue any life-sustaining treatment for a patient in accordance with his or her right of self-determination. In this context, it is inevitable and challenging to make better legislation to improve relevant systems concerning withdrawal of life-sustaining treatment. The State must assure the human basic rights for its citizens and needs to prepare a system to assure such basic rights through legislative efforts. In this sense, simply entrusting physician, patient or his or her family with any critical issue like the withdrawal of meaningless life-sustaining treatment, even without any reasonable standard established for such entrustment, means the neglect of official duties by the State. Nevertheless, this issue is not a matter that can be resolved simply by legislative efforts. In order for our society to accept judicial system for withdrawal of life-sustaining treatment, it is important to form a social consensus about this issue and also make proactive discussions on it from a variety of standpoints.

• Journal of Pharmacopuncture
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• v.6 no.3
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• pp.81-86
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• 2003

Recently there has been an increase in annual per capita consumption of alcohol beverage and the incidence of Alcoholic liver disease is steadily and significantly increasing. Alcoholic liver disease includes alcoholic fatty liver, alcoholic hepatitis, alcoholic cirrhosis and it may lead to systemic influence, in a case of CVA. This report is about one case's treatment for ICH with alcoholic liver disease. In this case, we administrated Taeumjowetang and did acupuncture treatment to a patient suffering from ICH with alcoholic liver disease and its withdrawal symptoms. After administration of Taeumjowetang medication, clinical symptoms and liver function were prominently improved. This report showed that Taeumjowetang might be useful for alcoholic liver disease.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.5 no.1
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• pp.184-193
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• 1994

This study was purposed to find out clinical characteristic of intra and extrafamilial sexual abuse, nature of offenders, difference of symptoms describe that sexually abused children and adolescents were experienced. Subjects were 10 sexually abused children and adolescents who visited Seoul National Mental Hospital, from Jan. 1992 to Dec. 1993. In intrafamilial sexual abuse, they had more chronic course than extrafamilial abuse and had more family psychopathology. In symptomatology, The preschool children mainly presented to somatic symptoms and anxiety, and The school children prominently exhibited depressive reaction and withdrawal. Most common reaction of parents was anger and guilt. They were treated with crisis intervention, play therapy, and hospitalization, if needed. The maintenance of treatment was difficult due to parent's avoidance and repression.

• Korean Journal of Biological Psychiatry
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• v.1 no.1
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• pp.31-39
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• 1994

Anxiety and anxiety disorders are one of the most common and most serious psychiatric problems. Anti-anxiety drugs are one of the most effective treatment method for these problems. Benzodiazepines have various side-effects and the risk of overuse and abuse. Therefore, physicians should prescribe benzodiazepines carefully. However, they should not be discouraged from prescribing benzodiazepines when they have a knowledge of the pharmacological characteristics of these drugs and there is a clear indication for their use. Generally speaking, problems of benzodiazepine use such as dependence withdrawal symptoms, and cognitive impairment are more likely to occur with high dose, long-term use(more than 4 months), in geriatric patients and patients with a history of alcohol or other sustance abuse. But long-term or high-dose use can be jusified for patients with panic disorder of agoraphobia, and medically-ill patients with persistent anxiety that cannot be otherwise treated. In summary, there cannot be a general prescribing formulation for benzodiazepine use. Physician should always make their decision based on the individual patient's risk/benefit factors.

• Biomolecules & Therapeutics
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• v.19 no.3
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• pp.274-281
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• 2011

Pharmacological approaches have been included in conventional medical treatment for insomnia or sleep disorders. However, long-term use of frequently prescribed medications can often lead to habituation, critical withdrawal symptoms and/or side effects. Some individuals with insomnia or trouble sleeping have used complementary and alternative medicine (CAM) therapies to treat their conditions. Recently, CAMs or herbs have been attractive alternative medications to many patients with sleep disorders who may be averse to using conventional drugs. We reviewed the most widely available sleep-promoting herbs commonly used in the western and oriental countries.

• The Journal of Korean Society for School & Community Health Education
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• v.14 no.1
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• pp.1-12
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• 2013

Purpose: This study aimed to identify the influencing the effects of emotional characteristics of adolescents on cell phone addiction and to form the basis for the developments of programs to protect addictive cell phone use. Methods: The data of the Korean Child-Youth Panel Survey(KCYPS) was analyzed using the SPSS 18.0 program. Results: The influencing factors of the cell phone addiction were gender, attention, physical symptoms, depression, aggression, social withdrawal, games and entertainment, listening to music, text messages, call family and watching movies. The factors accounted for 30.6% of variance in cell phone addiction. Conclusions: These results suggest that cell phone addiction are influenced by emotional characteristics of adolescents. These results may contribute to development of programs to prevent cell phone addiction.

• Korean Journal of Child Studies
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• v.29 no.4
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• pp.181-197
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• 2008

A mobile phone usage survey was administered to a nationwide sample of 3,617 adolescents. Major motivations of mobile phone usage were mobility/real-time connection, show off, information acquisition, entertainment, dialogue, schedule management, and advice. Maintenance of social relationship with the peer group was most important in mobile phone use. Motivations influenced mobile phone dependency : show off had the strongest influence on anxiety/paranoia followed by dialogue, entertainment, mobility/real-time connection. Without their phones, fashion-oriented adolescents showed mobile phone dependency and anxiety. Stronger dialogue and entertainment motivations were associated with weaker real time connection motivation and stronger paranoia symptoms. Mobile phone dependent adolescents had lower grades, showed lack of attention, had little dialogue with their parents and showed withdrawal from the peer group.

• Sleep Medicine and Psychophysiology
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• v.10 no.1
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• pp.20-25
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• 2003

Many people suffer from chronic insomnia. Inappropriate sleep causes attention difficulties, decreased work efficiency, and increased traffic accidents and disasters. Evaluating the precise causes of insomnia prior to treatment is very important, because chronic insomnia can be a secondary symptom of other medical, psychiatric, and sleep disorders. Medication and behavior therapy are not exclusive of each other, and both treatments are beneficial to some patients, but currently many physicians and patients tend to be dependent only on medication. While long-term medication causes various degrees of dependency, tolerance, and withdrawal symptoms, behavior therapy has a stable effect over a long period. Behavior therapy is one of the most important treatment modalities for chronic insomnia. It shortens sleep latency, and decreases frequency of awakening during sleep. The rationale and practice of currently used behavior therapy and light therapy will be reviewed in this study.