Objectives The aim of this study was to explore trends associated with the amendment of The Mental Health Welfare Act by comparing involuntary admission processes in Asian countries.Methods We obtained copies of the Mental Health Acts for four East Asian countries -Korea, Japan, Singapore, and Taiwan (China).We then analyzed the contents of the acts including their definitions of mentally ill patients, the types of hospitalization, and the procedures for involuntary admission. ResultsThe Japanese provision for involuntary admission was the prototype used for the Korean system prior to the total revision of the Korean system in 2016.Regardless, Korea and Japan still regard family members as pivotal in deciding on involuntary admission.Taiwan and Singapore acts are characterized by the involvement of government or government-designated medical practitioners, not caregivers, in the hospitalization process.In Taiwan, involuntary admission is decided by a judgment of a review committee and is a task of the government.In Singapore, the opinions of experts are considered when making the initial decision on involuntary hospitalization, whereas a judicial decision is essential for extension of that hospitalization.Conclusion Despite cultural and historical similarities, the systems of involuntary admission were considerably different across the countries.We observed a reduction in the role of family guardians and an increase in the use of more objective screening processes.All four countries were in the process of applying those recommendations from international organizations that were in accordance with their society/culture.There may be a need to partially amend The Mental Health Welfare Act in Korea in order to protect the human rights of psychiatric patients while maintaining a stable therapeutic environment.
Objectives : We hypothesized that the polymorphisms of ADH1B and NQO2 could effect on the onset of alcohol dependence and withdrawal symptoms. Methods : PCR (polymerase chain reaction) and RFLP (restriction fragment length polymorphism) were used to analyze the genetic polymorphisms of ADH1B and NQO2 in 194 male patients with alcohol dependence (AD) and 152 healthy comparisons. The AD were classified into the early and late onset groups with the onset age of 25. Alcohol withdrawal symptoms were measured by Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar). Results : 1) Alcohol dehydrogenase 1B gene : There was no difference in genotype distribution between the patients group and the control group. However the frequency of ADH1B*2 allele in late-onset alcohol dependence was higher group than early-onset group. 2) NRH-quinone oxidoreductase 2(NQO2) : The patients group had higher frequency of D allele than the healthy comparisons. In patients group, the frequency of the D allele in the late-onset group was higher than he early-onset group. 3) CIWA-Ar scale : There was no difference in the CIWA-Ar scale between the genetic polymorphisms of ADH1B. However, the patients with D allele of NQO2 showed significantly higher scores in the CIWA-Ar scale than those with I/I allele. Conclusion : With current results, we suggested that ADH1B*2 and D allele of NQO2 would have a possible association with the alcohol withdrawal symptoms and play a protective role in the onset of alcohol dependence.
Objectives ： In this study, we comprehensively investigated the factors that affect the nationwide clinical services used by patients diagnosed with alcohol use disorder and have received outpatient care. Methods ： Patient with alcohol use disorder(n=305, aged 19 to 65 years) were recruited nationwide. They were tracked through clinical follow-up for 6 months following registration at different medical and community centers for mental health and addiction. Using the assistance of on-site personnel, self-reported questionnaires were administered to patients, and the responses were analyzed by logistic regression. Results ： The following factors were found to significantly affect clinical service use: lack of religion, lower economic status, onset of alcohol use disorder at or after the age of 25 years, low levels of depression, prior experience with case management, and higher quality of life. Conclusion : The findings of this study contribute to the development of measures for the continued use of medical facilities and community centers for the treatment of alcohol use disorder
The purpose of this study was to investigate regional cerebral blood flow (rCBF) changes using 1110 MBq of Tc-99m ECD SPECT in alcohol-related dementia (ARD) patients. Twenty-five patients with ARD and 22 healthy control subjects were included in the study. Mini-Mental Status Examination was applied to the patients and controls. The ARD patients showed drastically reduced rCBF in the frontal cortices, basal ganglia, and thalami. The results indicate that ARD is associated with hypoperfusion in both cortical and subcortical regions. These findings support previous studies suggesting the association with both cortical and subcortical neuropathology in ARD patients.
Nicotine is the major substance that accounts for the addictive nature of smoking. Nicotine induces neurobiological and behavioral responses through diverse neurochemical mechanisms over the central nervous system. The brain reward system, particularly the dopaminergic pathway from the ventral tegmental area to nucleus accumbens, is central to understanding the behavioral reinforcement underlying substance addictions such as the addiction to nicotine. Nicotine acts as an agonist provoking activation or desensitization of nicotinic acetylcholine receptors in different brain areas including the brain reward system. Nicotine also indirectly influences the glutaminergic, GABAergic, noradrenergic, and serotonergic neurotransmission that lead ultimately to activation of the dopaminergic pathway in the brain reward system. Chronic exposure to nicotine activates neuroadaptation and associative learning with the nicotine-related stimulus through dopaminergic or cholinergic systems, which can lead to nicotine dependence or withdrawal. In sum, the neurobiological processes described above are deeply involved in the basis of nicotine dependence and underlie the frequent failure of attempts to quit smoking. In this review we discuss the neurobiological mechanisms of nicotine addiction focusing on the roles of the nicotinic acetylcholine receptor.
Background Web‐based alcohol screenings and brief interventions have been shown to be effective methods for changing drinking behavior. This study evaluated the efficacy of the online‐based Brief Empowerment Program for Alcohol‐Use Monitor (on‐ BEAM ) , a brief intervention applying personalized normative feedback ( PNF ) and components of motivational interviewing ( MI ) techniques. Methods A community‐based, double‐blind, parallel‐group randomized controlled trial with individual randomization was conducted in Korea (registered at Clinical Research Information Service— KCT 0003050). An e‐mail about participating in a survey on drinking behavior was sent to 5,684 individuals, aged 20 to 40, that were registered as part of a research panel. Male and female participants with AUDIT ‐C scores of ≥4 and ≥3, respectively, were randomly assigned to either an intervention (received a drinking behavior assessment and the results with normative feedback) or control group (assessment and results without normative feedback). To evaluate the effects of the intervention with 2 sessions over the course of a month, a follow‐up assessment was performed online 4 weeks after completion of the intervention. The main outcome was the number of standard drinks consumed during the past week measured using the timeline followback method. The rate ratios ( RR s) were calculated to test the effects of the intervention. Results In total, 1,496 participants were randomized and 93% of them followed up. The intervention group reported consuming less alcohol during the past week ( RR = 0.13; p = 0.012) than the control group. Additionally, the intervention group had fewer binge drinkers ( RR = 0.69; p < 0.001) and a lower AUDIT ‐C score ( RR = 0.59; p = 0.009) than the control group. Conclusions The web‐based intervention, on‐ BEAM , which applies PNF and MI components related to high‐risk drinking reduced the amount of alcohol consumption in our study population. Further research is needed to determine the duration of on‐ BEAM 's effects and evaluate its effectiveness in the real world.
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