Atypical Symptoms in Patients With Gastroesophageal Reflux Disease

( Chih Hsun Yi ),( Tso Tsai Liu ),( Chien Lin Chen ),( Manoj Kumar ) 대한소화기기능성질환·운동학회 2012 Journal of Neurogastroenterology and Motility (JNM Vol.18 No.3

Background/Aims Atypical symptoms are common in gastroesophageal reflux disease (GERD). Patients with non-erosive reflux disease (NERD) and erosive reflux disease (ERD) exhibit different clinical characteristics and responses to acid suppression treatment. We aimed to compare atypical characteristics in patients with NERD and ERD. We also investigated the presence of histological esophagitis in patients with NERD and ERD. Methods Eligible patients completed a questionnaire regarding reflux symptoms and concomitant atypical symptoms. Endoscopic biopsies with histological examination were performed. Results Of the 210 patients with GERD, 90 patients with ERD and 120 patients with NERD were studied. ERD patients were characterized by higher prevalence of hiatal hernia (P = 0.001) and smoking (P = 0.047). The prevalence of GERD was greater in the age group between 41 and 60 years regardless of endoscopic finding. There was no difference in the prevalence of atypical symptoms or histological esophagitis between NERD and ERD. In all subjects, heartburn was associated with dysphagia (r = 0.16, P = 0.01), dyspepsia (r = 0.22, P = 0.008) and hiccup (r = 0.19, P = 0.003), whereas acid regurgitation was associated with dyspepsia (r = 0.21, P = 0.014), belching (r = 0.15, P = 0.018) and hiccup (r = 0.19, P = 0.002). Conclusions Atypical symptoms did not correlate with the presence of histological esophagitis. Atypical symptoms were equally prevalent in patients with NERD and ERD. The existence of atypical symptoms appears to be associated with the presence of typical reflux symptoms irrespective of endoscopic and histological reflux esophagitis. (J Neurogastroenterol Motil 2012;18:278-283)

Relationship between improvements of subjective well‐being and depressive symptoms during acute treatment of schizophrenia with atypical antipsychotics

Kim, J.‐,H.,Ann, J.‐,H.,Kim, M.‐,J. Blackwell Publishing Ltd 2011 Journal of clinical pharmacy and therapeutics Vol.36 No.2

<P><B>Abstract</B></P><P><B>What is known and Objective: </B> It has been suggested that atypical antipsychotics may exert beneficial effects on subjective well‐being as well as depressive symptoms in schizophrenia. However, the relationship between the two remains to be clarified. The authors examined the relationship between subjective well‐being and depressive symptoms across the course of acute treatment with atypical antipsychotics in patients with schizophrenia.</P><P><B>Methods: </B> Thirty‐five inpatients with schizophrenia were examined for subjective well‐being, psychopathology, and extrapyramidal side effects before and 8 weeks after the initiation of new treatment with atypical antipsychotics.</P><P><B>Results and Discussion: </B> Significant improvement was observed in subjective well‐being, psychotic symptoms, and depressive symptoms. No change was observed in the severity of extrapyramidal side effect. The subjective well‐being score had significant negative correlations with depressive symptom score both at baseline and at week 8. The mean change in subjective well‐being score was significantly correlated with that in depressive symptom score. The severity of depressive symptoms at baseline was significantly correlated with the subsequent change in subjective well‐being score and the change in depressive symptom score was the only predictor of change in subjective well‐being score.</P><P><B>What is new and Conclusion: </B> Depressive symptoms were significantly associated with subjective well‐being in patients with schizophrenia and may moderate the acute effects of atypical antipsychotic treatment on subjective well‐being. Further investigations are necessary to fully define the place of depressive symptoms in the conceptualization of subjective well‐being in schizophrenia and the optimal use of atypical antipsychotics.</P>

계절성 정동장애에 관한 임상적 연구

이경규,윤도준,장환일 大韓神經精神醫學會 1992 신경정신의학 Vol.31 No.1

The purpose of this study was to investigate : (l) whether seasonal affective disorders (SADs) exist among affective disorders in Korea ; (2) if there were SADs in Korea, whether they would be different from other countries' reports describing SAD as having atypical depressive symptoms ; and (3) Is there any difference between winter depression and summer depression as shown in the studies from other countries ; ie. WD shows atypical depressive symptoms and SD shows typical depressive symptoms ? The 76 subjects, having had suffered relapses for at least 2 years in succession, were selected from 375 patients with affective disorder who had been admitted to the Department of Neuropsychiatry of Kyung Hee University Hospital during the 10 years, from 1 January 1980 to 31 December 1989. This study was done by reviewing their records, making a comparison between SAD with depression (n=23) and nonseasonal affective disorder (NSAD) with depression(n=25). Also, another comparison was made between SD(n= 14) and WD(n=9) in SAD. They were analyzed according to sex, age of onset, season of birth, occupation, premorbid personality. family history of psychosis, and atypical depressive symptoms-hypersomnia. hyperphagia. carbohydrate craving, and irritability. The results were as follows : 1) There indeed were patients with SAD in Korea. The prevalence of SAD in this study was 10.9%. 2) Comparison between SAD and NSAD with depression : There was a significantly higher number of patients with NSAD with depression among those with indoor occupations and in families with a history of psychosis compared with patients with SAD with depression (p<0.05). There were no significant difference between them in other factors. 3) Comparison between SD and WD in SAD : There were no significant difference between them in all factors. In conclusion, SAD exists in Korea. But, there are no significant differences in depressive symptoms between SAD and NSAD with depression, or between SD and WD as is the case in the previous studies from other countries.

근로자의 고용형태와 스트레스 유형별 우울상태

김진현(Jinhyun Kim) 충남대학교 사회과학연구소 2017 사회과학연구 Vol.28 No.4

Labor market insecurity has widened the gap between the typical worker and atypical worker in terms of health disparity as well as economic inequality. This study aims to identify the impact of various types of employment on mental health, particularly depressive symptoms, by focusing on the mediating effect of stress. This study classified types of employment into three different categories including typical or atypical worker, full or part time, and direct or indirect employment. Three dimensions of stress such as mental and physical stress, anxiety regarding future insecurity, and task related stress were considered. Data analysis included survey data from the Korean medical panel in 2012. 4,317 participants were included in the final sample. Data analysis results showed that the direct impacts of employment on depressive symptoms were weaker, but the indirect effects of stress between employment types and depressive symptoms were more significant. In particular, atypical and indirect workers suffered more from mental and physical stress, anxiety regarding future insecurity, and these in turn significantly predicted higher levels of depressive symptoms. Based on the results of this study, it is important to manage various job stresses and improve insecure employment types for mitigating depressive symptoms.

Clinical and imaging features of multiple system atrophy: Challenges for early and clinically definite diagnosis

Hirohisa Watanabe,Yuichi Riku,Kazuhiro Hara,Kazuya Kawabata,Tomohiko Nakamura,Mizuki Ito,Masaaki Hirayama,Mari Yoshida,Masahisa Katsuno,Gen Sobue 대한파킨슨병및이상운동질환학회 2018 Journal Of Movement Disorders Vol.11 No.3

Multiple system atrophy (MSA) is an adult-onset, progressive neurodegenerative disorder. Patients with MSA show various phenotypes during the course of their illness, including parkinsonism, cerebellar ataxia, autonomic failure, and pyramidal signs. Patients with MSA sometimes present with isolated autonomic failure or motor symptoms/ signs. The median duration from onset to the concomitant appearance of motor and autonomic symptoms is approximately 2 years but can range up to 14 years. As the presence of both motor and autonomic symptoms is essential for the current diagnostic criteria, early diagnosis is difficult when patients present with isolated autonomic failure or motor symptoms/signs. In contrast, patients with MSA may show severe autonomic failure and die before the presentation of motor symptoms/signs, which are currently required for the diagnosis of MSA. Recent studies have also revealed that patients with MSA may show nonsupporting features of MSA such as dementia, hallucinations, and vertical gaze palsy. To establish early diagnostic criteria and clinically definitive categorization for the successful development of disease-modifying therapy or symptomatic interventions for MSA, research should focus on the isolated phase and atypical symptoms to develop specific clinical, imaging, and fluid biomarkers that satisfy the requirements for objectivity, for semi- or quantitative measurements, and for uncomplicated, worldwide availability. Several novel techniques, such as automated compartmentalization of the brain into multiple parcels for the quantification of gray and white matter volumes on an individual basis and the visualization of α-synuclein and other candidate serum and cerebrospinal fluid biomarkers, may be promising for the early and clinically definitive diagnosis of MSA.

2019 Novel Coronavirus (COVID-19) Pneumonia with Hemoptysis as the Initial Symptom: CT and Clinical Features

Fengxia Shi,Quanbo Yu,Wei Huang,Chaochao Tan 대한영상의학회 2020 Korean Journal of Radiology Vol.21 No.5

Recently, some global cases of 2019 novel coronavirus (COVID-19) pneumonia have been caused by second- or third-generation transmission of the viral infection, resulting in no traceable epidemiological history. Owing to the complications of COVID-19 pneumonia, the first symptom and imaging features of patients can be very atypical and early diagnosis of COVID-19 infections remains a challenge. It would aid radiologists and clinicians to be aware of the early atypical symptom and imaging features of the disease and contribute to the prevention of infected patients being missed.

Atypical Clinical Presentation of Geriatric Syndrome in Elderly Patients With Pneumonia or Coronary Artery Disease

정유진,윤종률,김학선,이애영,김미영,조정진 대한노인병학회 2017 Annals of geriatric medicine and research Vol.21 No.4

Background: Atypical symptoms often occur in elderly patients due to impaired homeostasis associated with age-related physiological changes and multiple pathologies. These atypical symptoms make diagnosis difficult and may partially increase morbidity and mortality. This study aimed to determine the incidence of atypical clinical presentation and to identify the effects of age and comorbidities on illness presentation in the elderly. Methods: Medical charts of 6,057 elderly patients (≥60 years) with pneumonia or coronary artery disease (CAD) admitted to 4 university hospitals were retrospectively reviewed. Determinants of atypical symptom presentation was evaluated using logistic regression analysis. The definition of atypical presentation was adapted from a previous study on atypical symptoms of pneumonia and CAD. Results: Among the 6,057 participants, 4,773 (78.8%) and 1,284 (21.2%) presented with typical and atypical symptoms, respectively. Among the participants, 24.8% CAD and 18.8% pneumonia patients had atypical presentations. Logistic regression analysis showed that factors associated with atypical presentation in CAD patients were age (≥85 years; odds ratio [OR], 2.7; 95% confidence interval [CI], 1.81-4.03), higher pulse rate (OR, 1.01; 95% CI, 1.00-1.01), and number of comorbidities ≥4 (OR, 1.62; 95% CI, 1.13-2.32). In pneumonia patients, age (≥85 years; OR, 2.22; 95% CI, 1.49-3.31), body mass index (OR, 0.97; 95% CI, 0.94-0.99), and 1 comorbidity (OR, 1.53; 95% CI, 1.01-2.36) were statistically significant factors that increased atypical presentation. Conclusion: This study suggested that older patients frequently present atypical geriatric syndrome with acute illness, and age and comorbidity are statistically significant factors associated with atypical symptoms in CAD or pneumonia patients.

입원한 여성의 급성 정신증과 월경관련 증후군

신정호,안정숙,노현송 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.6

Objects : The authors have clinically observed that many reproductive female patients whose psychiatric admissions or onset/recurrence of the psychiatric symptoms were related to their menstrual cycle. And in a few cases, their significant symptoms were not properly to be diagnosed with DSM-Ⅲ-R system only, particularly in acute psychotic patients. So this study was designed to examine the possibility that such atypical symptoms would be considered as a specific syndrome or disorder related to menstrual cycle, menstruation-related syndrome. Methods : 1) The authors re-diagnosed 112 reproductive female patients with acute psychosis hospitalized in a psychiatric ward of Wonju Christian Hospital during two years period(1991.1.1-1992.12.31) according to DSM-Ⅲ-R criteria, and identified their with the Sibergeld's classification to determine in what phase they were admitted to. 2) A group of patients with atypical symptoms, in which the diagnoses were not agreed by more than two authors, was selected, and the symptoms were listed and scored on the severity(1-moderate, 2-severe). 3) The symptom list of an atypical patient group was compred to the Premenstrual Assessment From(PAF) and Menstrual Distress Questionnaire(MDQ) to illuminate its relation to the menstrual cycle. Results : 1) Most of the reporductive female patients with acute psychosis were admitted in premenstrual(38.9%), ovulation(27.8%), or menstrual phases(18.1%), respectively. 2) Eleven patients showed regressed behavior, perplexity, confusion, hostility, negativistic behavior, poor impulse control, psychomotor agitation, and emotional lability. 3) All of the atypical patient group was in premenstrual(72.4%) or ovulation phase(27.3%) on admission. Conclusion : If acute psychotic state was full-blown on the premenstrual or ovulation phase and the main symptomatology met the above 8 characteristic symptoms, those patients would be considered as a menstruation-related syndrome.

알츠하이머 치매의 행동심리증상에서 비정형 항정신병약물

한명일(Myeong-Il Han),황태영(Tae-Young Hwang),이지은(Jieun Lee) 대한노인정신의학회 2015 노인정신의학 Vol.19 No.2

AD 환자의 치료에서 BPSD를 조절하는 것은 매우 중요하다. 이를 통하여 환자의 삶의 질을 향상시키고 가족과 수발자 의 부담을 경감시키며 요양시설 등에의 입소를 지연시켜 의료비의 감소를 유도할 수 있다. AD 환자에서 빈발하는 정신증, 초조증상, 그리고 공격성 등의 BPSD 치료에 공인된 약물은 아직 없다. 다만 임상 지침서와 전문가의 의견을 토대로 AAP 가 일차적 선택 약물로 추천된다. AD 환자에서 정신증을 비롯한 BPSD의 치료에 사용되는 risperidone과 aripiprazole의 치료적 효과는 분명하지만 효 과의 정도는 크지 않다. Olanzapine의 치료 효과는 앞의 두 가지 약물에 비해 다소 부족하고, quetiapine은 고용량에서 어느 정도 효과가 있을 것이라고 기대된다. AAP의 사용과 관련하여 흔히 발현되는 부작용으로는 졸림, EPS, 말초 부종 등이 있다. AAP는 인지기능 저하, CVAEs 증가, 그리고 사망률 증가 등의 심각한 부작용을 발생시킨다. 치료 효과는 크 지 않고 부작용은 심각하기 때문에 AD 환자의 BPSD를 치료하기 위해 AAP를 사용하는 경우에는 약물 사용에 따른 편익(benefits)과 위험(harms)을 충분히 비교하면서 접근하 는 것이 중요하다. In addition to cognitive and functional decline, various behavioral and psychological symptoms in dementia (BPSD) are mani-fested in the patients with Alzheimer’s dementia (AD). Some of BPSD, especially psychosis, agitation, and aggression could be challenges to caregivers and clinicians. Atypical antipsychotic drugs (risperidone, olanzapine, quetiapine, and aripiprazole) are widely prescribed to manage complicated neuropsychiatric symptoms associated with AD. It is known that atypical antipsychotics (AAP) have modest and significant beneficial effects in the short term treatment of BPSD. However their safety of AAP has been concerned with potentially increased adverse events. This article reviewed the treatment outcomes and adverse effects of AAP when managing BPSD in the patients with AD. The effects of risperidone and aripiprazole are obvious on psychosis and aggres-sion, but with small effect size. AAP could exacerbate cognitive decline, and it could increase the rate of cerebrovascular accidents and mortality rate in the patients with AD.

Subjective Well-being in Patients with Schizophrenia Treated with Atypical Antipsychotics: The Impact of Psychopathology and Adverse Drug Effects

Yeon-Woo Lee,김종훈,Jun-Hyung Ann,Seo-Eun Cho,Jinyoung Lee,Min-Jung Kim,Seong-Jin Cho,조인희,Seog Ju Kim,Yu-Jin Lee,배승민 대한정신약물학회 2010 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.8 No.3

Objective: According to a conceptual clinical model of subjective well-being in schizophrenia, subjective well-being is viewed as the subject’s perception of the outcome of an interaction between psychotic symptom severity and adverse drug effects. However, data are lacking for patients receiving atypical antipsychotics. The purpose of the present study was to evaluate the impact of psychopathology and adverse drug effects on subjective well-being in schizophrenic patients receiving atypical antipsychotics. Methods: One hundred and thirteen outpatients with schizophrenia receiving atypical antipsychotics were evaluated. Subjective well-being was assessed using the Subjective Well-being under Neuroleptics Scale (SWN). The patients' psychopathology and adverse drug effects were evaluated using the Positive and Negative Syndrome Scale (PANSS) and the Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS), respectively. Correlation analysis and multiple regression analysis were performed. Results: The SWN score had significant negative correlations with the PANSS depression/anxiety factor score and the LUNSERS scores. Multiple regression analysis revealed that depression/anxiety and akathisia contributed significantly to the SWN score. The best-fit regression model showed that these variables accounted for 29% of the total variance. Conclusion: The results of our study suggest that depressive/anxiety symptoms and akathisia contribute significantly to subjective well-being, indicating the necessity to develop strategies to control these variables effectively. These results also suggest that akathisia continues to be a major adverse effect associated with low subjective well-being in patients receiving atypical antipsychotics. Further studies are required to investigate the multidimensional predictors of subjective well-being in schizophrenia and to determine their relative contributions