Boram Park

Sleeping Pill Administration Time and Patient Subjective Satisfaction

STUDY OBJECTIVES Taking hypnotic agents 30 min before bedtime is the usual suggested administration time, but some patients report dissatisfaction with their sleeping pills. We investigated whether the timing of sleeping pill administration influences patient subjective satisfaction with these drugs. METHODS One hundred twelve patients with primary insomnia currently taking benzodiazepine or nonbenzodiazepine gamma-aminobutyric acid (GABA) agonists as sleeping pills were selected. The time of administration for their sleeping pills, bedtime, sleep onset time, and wake up time were obtained from their medical records. Subjects were also categorized into satisfied or dissatisfied groups. RESULTS Hypnotic agents administration time (p < 0.001) and bedtime (p < 0.001), but not sleep onset or wake up time, occurred later in the night in the satisfied group. The durations from administration of pills to sleep onset (33.6 ± 20.7 min) and to wake up time (7.2 ± 1.2 h) were significantly shorter in the satisfied group when compared to the dissatisfied group (135.9 ± 73.4 min and 9.3 ± 1.5 h for time to sleep onset and wake up, respectively). Logistic regression analysis revealed that patient subjective satisfaction with hypnotic agents could be predicted by a short duration from administration of pills to sleep onset (odds ratio = 0.01; 95% confidence interval [0.001-0.09]) and a short duration from administration of pills to wake up time (0.53; [0.31-0.89], F = 49.9, p < 0.001). CONCLUSIONS Taking sleeping pills at a later time and a shorter interval between pill administration and wake up time may increase patient subjective satisfaction with hypnotic agents. We propose that physicians advise patients to take sleeping pills approximately 7 h before their usual getting-out-of-bed time instead of the current standard of 30 min before bedtime.

Case report: bipolar disorder as the first manifestation of CADASIL

BackgroundCerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebrovascular disease, clinically characterized by variable manifestations of migraine, recurrent transient ischemic attack or lacunar strokes, cognitive decline, and mood disturbances. However, manic episodes have rarely been documented as an initial symptom of CADASIL and bipolar disorder presenting as the first manifestation in CADASIL has not been reported previously from evaluations by psychiatrists or psychological testing by psychologists.Case presentationA 53 year old woman developed symptoms of mania in her 50s leading to a personality change involving a continuously labile mood and irritability over a number of years. Neuropsychological testing revealed an intact memory, but impairment in attention and executive function. In the Rorschach test, she showed a high level of cognitive rigidity. Magnetic resonance imaging findings were very consistent with a diagnosis of CADASIL, which was confirmed by genetic testing for NOTCH3 mutations. Atypical antipsychotics proved to be helpful in treating her manic symptoms and for behavior control.ConclusionWe present a novel case of CADASIL that first presented as bipolar disorder. We contend that when patients show a late onset personality change or chronically irritable mood that deteriorates over many years, an organic cause such as CADASIL must be considered. Further studies are needed to better understand the exact impacts of cerebral tissue lesions and psychiatric symptoms in CADASIL patients.

The Prevalence of Depression among Patients with the Top Ten Most Common Cancers in South Korea

Objective Among the various psychiatric disorders, depression is a common comorbid condition in cancer patients. Due to the distinct and diverse nature of cancer, the prevalence of depression may be assumed to be affected by differences in primary cancer sites. In this study, we explored the prevalence rates of depression among the ten most prevalent cancers in South Korea using a national patient sample. Methods This was a 1-year cross-sectional study using a national patient sample provided by the South Korean National Health Insurance in 2011. We selected all patients who had received ICD-10 codes of the 10 most prevalent cancers and major depressive disorder. Afterwards, the cancer and depression groups were merged and analyzed. Results The MDD prevalence rate was highest in lung cancer (11.0%), followed by non-Hodgkins lymphoma (9.2%), prostate (9.1%), bladder (8.8%), breast (7.8%), cervix (7.8%), colorectal (7.7%), stomach (6.9%), liver (6.5%), and thyroid cancer (5.6%). Within all cancer groups, patients with a MDD diagnosis were significantly older (p<0.05) than non-MDD patients. Colorectal, stomach, and thyroid cancer displayed a higher female proportion in the MDD group than the non-MDD group. In the subgroup analysis, the prevalence rate differed by age and sex. Conclusion The prevalence of depression varied according to cancer types. Patients with lung cancer were the most prone to experience depression. Because clinical and psychological factors may influence MDD prevalence, these factors will need to be studied more closely in the future.

PT657. Take your sleeping pills 7 hours before your wake-up time

Complex sleep behaviors (CSBs) are often associated with hypnotics use. This study aimed to investigate the prevalence and correlates of CSBs among individuals who were taking flunitrazepam from psychiatric outpatient clinics. A total of 268 participants who were administered flunitrazepam for at least 3 months were enrolled from psychiatric outpatient clinics from June 2011 to May 2012. The occurrence of CSBs, demographic characteristics, the dose and duration of flunitrazepam use, psychiatric diagnoses, physical illnesses, and alcohol drinking were collected. Logistic regression analysis was used to examine the clinical correlates of CSBs. In total, there were 66 (24.6%) participants reporting CSBs. Logistic regression analysis showed a high dose (>2 mg) of flunitrazepam (Odd Ratio [OR] = 1.978, 95% Confidence Interval [CI]: 1.066–3.671, p = .031) and alcohol use (OR = 2.034, 95% CI: 1.046–3.955, p = .036) were significantly associated the occurrence of CSBs. Sex, age, duration of flunitrazepam use, psychiatric diagnoses and physical illnesses were not significantly associated the occurrence of CSBs. CSBs should be monitored routinely in flunitrazepam users, especially among those with a high dose of flunitrazepam and alcohol drinking. PT657 Take your sleeping pills 7 hours before your wake-up time Soyoung Youn, M.D., Chi-Won C. Han, B.A., Boram Park, M.D., Suyeon Lee, M.D., Kikyoung Yi, M.D., Seockhoon Chung, M.D., Ph.D. Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea *Corresponding author: Seockhoon Chung, M.D., Ph.D. Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 86, Olympic-ro, 43-gil, Songpa-gu, Seoul, 138–736, Korea Tel: +(82)-2-3010-3411 Fax: +(82)-2-485-8381 E-mail: schung@amc.seoul.kr Abstract Study objectives: The aim of this study is to investigate the effectiveness and practicality of the newly proposed guidance to take hypnotics 7 hours before one’s usual wake-up time, compared to the conventional guidance to do so 30 minutes before bedtime. Methods: Subjects with primary insomnia who were not satisfied with their hypnotics were included in this study. The type of sleeping pill, usual hypnotics administration time, bedtime, sleep onset time, and wake-up time were surveyed. Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Dysfunctional Belief and Attitudes about Sleep (DBAS), and Pre-Sleep Arousal Scale (PSAS) were assessed at baseline. For 2 weeks, patients were instructed to take their own sleeping pills 7 hours before their usual wake-up times. The above questions and sleep scales were assessed again after the end of this period. Results: Among 32 subjects, 23 patients were successfully followed up. Adhering to the said 7-hour instruction, 73.9% (n=17) were satisfied with their sleeping pills. Mean hypnotics administration time was significantly delayed from 9:32 pm ± 0:58 to 10:55 pm ± 0:46 (p<0.001) and duration from pills to wakeup time (PTW) was shortened from 9.0 ± 1.1 to 7.1 ± 0.8 hours (p<0.001). Sleep latency (p=0.023) was significantly shorted, and ISI and PSQI scores significantly improved (p<0.001). The improvements of ISI and PSQI were positively correlated with the shortened sleep latency (r=0.49, p<0.05) and PTW (r=0.54, p<0.05), respectively. Conclusions: Advising patients to take hypnotics about 7 hours before their usual wake-up time could increase the level of satisfaction with their original medication as is. In incorporating concepts of cognitive behavioral therapy, this recommendation may serve as a simple but considerably useful guidance on the proper timing for taking prescribed sleeping pills.

1369PTHE PREVALENCE OF MAJOR DEPRESSIVE DISORDER AMONG PATIENTS WITH TOP 10TH MOST COMMON CANCERS IN S. KOREA : RESULTS FROM HEALTH INSURANCE AND REVIEW AND ASSESSMENT SERVICE - NATIONAL PATIENT SAMPLE

ABSTRACT Aim: Depression is a severe illness which can affect quality of life of cancer patients. The aim of this study is to explore the prevalence of major depressive disorder among patients with top 10th most common cancers in S. Korea. Methods: We analyzed data of 1,375,832 patients from the 2011 Health Insurance and Review and Assessment service - National Patient Sample(HIRA-NPS) of S.Korea. It consisted of records for medical care and medications of 1,375,832 (3% of total records) patients from January 2011 to December 2011. We explored the proportions of patients who had been diagnosed with top 10th most common cancers in S. Korea using the ICD-10 codes. Then, we examined the prevalence of major depressive disorder(F32 and F33) among those patients. Results: Among 1,375,832 patients sampled, thyroid cancer(N = 6688,0.49%) was the most common cancer, and colorectal(0.42%), liver (0.40%), stomach (0.37%), prostate (0.29%), breast (0.26%), lung(0.21%), pancreas(0.14%), non-hodgkin lymphoma(0.05%), and gall bladder/bile duct cancers(0.05%). The prevalence of major depressive disorder was 3.64% among all of patients sampled, but the prevalence was 10.13% among patients with any types of cancers and 10.05% among 32,622 of all patients with any of top 10th most common cancers. The prevalence of major depressive disorder was highest in pancreas cancer (15.19%) and followed by lung(14.7%), prostate (13.21%), gall bladder/bile duct (12.88%), non-hodgkin lymphoma(11.04%), colorectal (10.85%), liver (10.48%), stomach(9.95%), breast (929%), and thyroid cancer( 7.01%). Conclusions: In this study of a nationwide population-based data, the prevalence of major depressive disorder among patients with top 10th most common cancers was higher than that of general population in S.Korea. The prevalence of major depressive disorders varied among patients with different cancer types. Clinical or psychological factors, which can affect the difference in the prevalence, need to be more precisely studied in future research. Disclosure: All authors have declared no conflicts of interest.