PT729. Dance-like Movement of An Attempted Murderer? A Case Report

s | 65 In psychological aspect, average BDI scale was reduced by 4 points. Average FACT-G scale was increased in all categories including physical well being, social wellbeing, emotional wellbeing, functional wellbeing. In QLQ – C30, patients reported much less fatigue, nausea & vomiting, dyspnea, loss of appetite, constipation symptoms. In QLQ – BR23, patients expressed their body images more proud. During rehabilitation programs, there were no remarkable changes in circumferences between initial assessment and final assessment. Conclusion: Our results showed that compared to the healty group, breast cancer patients had lower cardiopulmonary exercise capacity (METs, peak O2 consumption). When patients went on exercise rehablilitation programs, there were significant changes in cardiopulmonary function, muscle strength, quality of life. Although patients performed muscle strengthening exercise, there were no aggravations of lymphedema in both patients. PT727 Factors influencing quality of life in women with breast cancer treated with initial neoadjuvant chemotherapy Kwang-Min Lee, M.D. 1, Dooyoung Jung, M.D. 2, Kyung-Hun Lee, M.D., Ph.D. 3, Bong-Jin Hahm, M.D., Ph.D. 1, 4 1 Department of Psychiatry, Seoul National University Hospital, Seoul, Seoul, Korea, 2 School of Design and Human Engineering, Ulsan National Institute of Science and Technology, Ulsan, Korea 3 Department of Internal Medicine, Seoul National University Hospital, Seoul, Seoul, Korea 4 Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Seoul, Korea Abstract Neoadjuvant chemotherapy has been increasingly recommended to women with large or locally advanced breast cancer to improve surgical outcomes and to raise the opportunities for breast-conserving therapy. While the women with breast cancer are treated with neoadjuvant chemotherapy, they could have several distress symptoms diminishing their quality of life (QOL) and positive psychosocial factors maintaining their QOL. This study explored the QOL and related factors in women with breast cancer undergoing initial neoadjuvant chemotherapy.Neoadjuvant chemotherapy has been increasingly recommended to women with large or locally advanced breast cancer to improve surgical outcomes and to raise the opportunities for breast-conserving therapy. While the women with breast cancer are treated with neoadjuvant chemotherapy, they could have several distress symptoms diminishing their quality of life (QOL) and positive psychosocial factors maintaining their QOL. This study explored the QOL and related factors in women with breast cancer undergoing initial neoadjuvant chemotherapy. The participants were 114 women with stage II or III breast cancer treated with their neoadjuvant chemotherapy. Initial evaluation was conducted before first neoadjuvant chemotherapy and second evaluation was conducted before second neoadjuvant chemotherapy. Self-report instruments used to assess QOL and related factors included the Functional Assessment of Cancer Therapy-Breast (FACT-B), the Pittsburgh Sleep Quality Index (PSQI), the Hospital Anxiety and Depression Scale (HADS), the Fatigue Severity Scale (FSS), the M.D. Anderson Symptom Inventory, the Multidimensional Scale of Perceived Social Support, the Adult Dispositional Hope Scale, and the Perceived stress scale. Between before and after initial neoadjuvant chemotherapy, there is no significant difference in FACT-B total scores. But in the FACT-B subscales, emotional well-being domain (P<0.001) was significantly lower after initial chemotherapy. HADS (P<0.001) and FSS (P=0.001) score were higher after initial chemotherapy. Whereas PSQI score was no significant difference between before and after initial chemotherapy. In a multivariate analysis, most powerful predictor of QOL after initial chemotherapy was anxiety. Altogether perceived stress, social support and fatigue were also related to the variance of QOL in the participants. These result suggest that women with breast cancer undergoing neoadjuvant chemotherapy are at higher risk for diminished QOL, especially in emotional domain. Those at high risk for lower QOL, may need interventions that specifically target related anxiety, stress, social support and fatigue. PT728 Potentially inappropriate medications in the elderly in Korean long-term care facilities Kang Soo Lee, MD, PhD3** Abstract Objective: We evaluated the frequency of potentially inappropriate medications and factors influencing their frequency. Methods: A retrospective cross-sectional study was conducted in 20 long-term care facilities which located in northwest regions of the south Korea for 824 patients aged 65 years and over who were assessed between January and February of 2012. Potentially inappropriate medications were identified using the 2012 American Geriatric Society’s Beers Criteria. We assessed the relationship between the frequency of potentially inappropriate medications prescribed and patient age, sex, co-medications, comorbidity, activities of daily living, length of stay, grade of long-term care insurance for seniors and the bed size and business type of the long-term care facility. Results: Of the 529 participants who satisfied our inclusion criteria, 308 (59.2%) had received at least one inappropriate medication according to the 2012 Beers Criteria. The most frequently prescribed classes of inappropriate medications were central nervous system drugs (58.5%), anti-cholinergics (21.5%) and cardiovascular medications (10.8%). The most common drugs involved were quetiapine (28.4%), chlorpheniramine (15.8%), risperidone (6.5%), and zolpidem (5.8%). Inappropriate medication use was associated with the number of co-medications and long-term care insurance grade 3 which means lesser dependency and the requirement for low level care. Conclusion: Central nervous system (58.5%) was the most prescribed class of inappropriate medication. Quetiapine was the drug most often given inappropriately (28.4%). There was a relationship between inappropriate medication use and the number of co-medications. The frequency of inappropriate medication prescriptions was higher among patients whose long-term care insurance for seniors was grade 3 which means lesser dependency and the requirement for low level care.Objective: We evaluated the frequency of potentially inappropriate medications and factors influencing their frequency. Methods: A retrospective cross-sectional study was conducted in 20 long-term care facilities which located in northwest regions of the south Korea for 824 patients aged 65 years and over who were assessed between January and February of 2012. Potentially inappropriate medications were identified using the 2012 American Geriatric Society’s Beers Criteria. We assessed the relationship between the frequency of potentially inappropriate medications prescribed and patient age, sex, co-medications, comorbidity, activities of daily living, length of stay, grade of long-term care insurance for seniors and the bed size and business type of the long-term care facility. Results: Of the 529 participants who satisfied our inclusion criteria, 308 (59.2%) had received at least one inappropriate medication according to the 2012 Beers Criteria. The most frequently prescribed classes of inappropriate medications were central nervous system drugs (58.5%), anti-cholinergics (21.5%) and cardiovascular medications (10.8%). The most common drugs involved were quetiapine (28.4%), chlorpheniramine (15.8%), risperidone (6.5%), and zolpidem (5.8%). Inappropriate medication use was associated with the number of co-medications and long-term care insurance grade 3 which means lesser dependency and the requirement for low level care. Conclusion: Central nervous system (58.5%) was the most prescribed class of inappropriate medication. Quetiapine was the drug most often given inappropriately (28.4%). There was a relationship between inappropriate medication use and the number of co-medications. The frequency of inappropriate medication prescriptions was higher among patients whose long-term care insurance for seniors was grade 3 which means lesser dependency and the requirement for low level care. PT729 Dance-like Movement of An Attempted Murderer? A Case Report Dae-Bo Lee1, Won-Myong Bahk2, Jong-Hyuk Choi1, Seon-Gyeong Kim3, Sang-Yeol Lee4, Mi Kyung Lyu1 1National Forensic Hospital, Republic of Korea, 2The Catholic University of Korea, Republic of Korea, 3Sinsegye Hospital, Republic of Korea, 4Wonkwang University, Republic of Korea Abstract Huntington’s disease (HD) is a rare, fatal inherited disorder that results from excessive repetition of the trinucleotide sequence CAG (cytosine-adenine-guanine) in the Huntington’s disease gene on the short arm of Chromosome 4. HD is characterized by neurodegenerative disorders of cognition, movement, behavior, and functional capacity. We here present a case of a criminal psychiatric evaluation which was requested by a court. Ms. P, a 48-year-old Korean womanHuntington’s disease (HD) is a rare, fatal inherited disorder that results from excessive repetition of the trinucleotide sequence CAG (cytosine-adenine-guanine) in the Huntington’s disease gene on the short arm of Chromosome 4. HD is characterized by neurodegenerative disorders of cognition, movement, behavior, and functional capacity. We here present a case of a criminal psychiatric evaluation which was requested by a court. Ms. P, a 48-year-old Korean woman 66 | International Journal of Neuropsychopharmacology, 2016 with no prior criminal and psychiatric history, was arrested for attempted murder, interference with a government official in the execution of his duties, and violation of domicile. Forensic psychiatrist found that she had chorea in all limbs, dysarthria, and dysphagia, all suggesting HD. But our neurologist’s impression was malingering. We conducted neurological and psychiatric evaluations. A Magnetic Resonance Imaging (MRI) examination of her brain revealed mild atrophy of both caudate nuclei and diffuse cortical atrophy. Finally, genetic analysis identified abnormal CAG expansion(allele 1: 48 CAG repeats and allele 2: 20) and full-penetrance. Despite we used clonazepam and procyclidine for chorea management, both was ineffective. But Lorazepam was more effective. In this case, we aimed to discuss the criminal behavior of HD patient, and the diagnostic consideration and treatment during procedure of forensic psychiatric evaluation of the HD case. PT730 The association between the number of prescription medications and mental status in a communitybased elderly population Ki Hyeok Nam, MD1 Jung Jae Lee, MD, PhD2 Seok Bum Lee, MD, PhD2 Joon Hyuk Park, MD, PhD3 Yoonseok Huh, MD4 Ki Woong Kim, MD, PhD5 Ki Chang Park, MD, PhD1 Tae Hui Kim, MD1 1. Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, South Korea 2. Dankook University Hospital, Cheonan, South Korea, 3. Jeju National University Hospital, Jeju, South Korea, 4. Jeesang Clinic, Bundang, South Korea, 5. Seoul National University Bundang Hospital, Seongnam, South Korea Abstract Objective: We evaluated the association between prescribed medications and mental status such as sleep, mood, and cognition in Korean elderly. Method: We investigated the number of medications of 604 individuals (281 men and 323 women) who taken prescriptionObjective: We evaluated the association between prescribed medications and mental status such as sleep, mood, and cognition in Korean elderly. Method: We investigated the number of medications of 604 individuals (281 men and 323 women) who taken prescription without major depressive disorder and dementia. They were enrolled in the Korean Longitudinal Study on Health and Aging (KLoSHA), a community-based cohort of aged ≥65 year. The daily total average number of medications used at least once a month including oral, injections, and external preparations except eye drops was calculated. The Pittsburgh Sleep Quality Index (PSQI), Korean version of the Geriatric Depression Scale (GDS-K), Subjective Memory Complain Questionnaire (SMCQ) were evaluated for subjective mental status. Results: The mean age of men and women was 76.10 ± 8.33 and 75.20 ± 7.86 years. The average number of medications used in men was 6.16 ± 5.98 and in women was 5.53 ± 5.77. The number of medications significantly correlated with PSQI score(r=0.14, 95% confidence interval (CI), 0.14 to 0.26) and GDS score (r=0.13, 95% CI, 0.02 to 0.25) in men but not in women. However it was not significant after adjusting for the illness burden of any comorbid illnesses. Conclusion: In elderly men, an increasing number of prescription medications have a relation to sleep quality and mood, unlike elderly women. PT731 A study of clinical factors related to intelligence diminution after onset of mental disorders Kenichi Oga, Yosuke Fujita, Kei Itagaka, Yoshio Kawashita, Hironori Kobayashai, Hanae Minami, Kenichiro Nishimura, Wataru Omori, Minoru Takebayashi, Saki Tamiya National Hospital Organization Kure Medical Center, Japan Abstract Background: The presence and degree of cognitive function and intelligence diminution is important for diagnosis of mental disorders. The National Adult Reading Test (NART) is widely used as a measure of premorbid IQ of English-speaking patients with mental disorders. The Japanese Adult Reading Test (JART) is Japanese version of NART uses kanji (ideographic script) compound words. In this study, we examined clinical factors related to intelligence diminution after onset of mental disorders using the estimated premorbid IQ by JART and present IQ by WAIS-III. Methods: We retrospectively reviewed the records of 46 patients who have taken JART and WAIS-III. We examined the relation of intelligence diminution after onset and clinical factors such as age, sex, clinical diagnosis, duration of disease and amount of drugs for remitted 29 patients diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder and anxiety disorder. Results: In the schizophrenia group including schizophrenia and schizoaffective disorders, the estimated premorbid IQ was 97.8 ± 8.2, and present IQ was 79.3 ± 13.3. In the non-schizophrenia group including bipolar disorder, major depressive disorder and anxiety disorder, the estimated premorbid IQ was 104.9 ± 8.1, and present IQ was 98.0 ± 13.6. Degree of intelligence diminution was significantly larger in the schizophrenia group. Multivariate analysis revealed that only diagnosis (schizophrenia group) was significantly related to intelligence diminution after onset. Conclusion: Degree of intelligence diminution may be an auxiliary useful for diagnosis of schizophrenia. However, this was preliminary study for a small number of patients, and it is necessary to examine a larger number of patients and to look specifically at each disorder.Background: The presence and degree of cognitive function and intelligence diminution is important for diagnosis of mental disorders. The National Adult Reading Test (NART) is widely used as a measure of premorbid IQ of English-speaking patients with mental disorders. The Japanese Adult Reading Test (JART) is Japanese version of NART uses kanji (ideographic script) compound words. In this study, we examined clinical factors related to intelligence diminution after onset of mental disorders using the estimated premorbid IQ by JART and present IQ by WAIS-III. Methods: We retrospectively reviewed the records of 46 patients who have taken JART and WAIS-III. We examined the relation of intelligence diminution after onset and clinical factors such as age, sex, clinical diagnosis, duration of disease and amount of drugs for remitted 29 patients diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder and anxiety disorder. Results: In the schizophrenia group including schizophrenia and schizoaffective disorders, the estimated premorbid IQ was 97.8 ± 8.2, and present IQ was 79.3 ± 13.3. In the non-schizophrenia group including bipolar disorder, major depressive disorder and anxiety disorder, the estimated premorbid IQ was 104.9 ± 8.1, and present IQ was 98.0 ± 13.6. Degree of intelligence diminution was significantly larger in the schizophrenia group. Multivariate analysis revealed that only diagnosis (schizophrenia group) was significantly related to intelligence diminution after onset. Conclusion: Degree of intelligence diminution may be an auxiliary useful for diagnosis of schizophrenia. However, this was preliminary study for a small number of patients, and it is necessary to examine a larger number of patients and to look specifically at each disorder. PT732 Successful treatment with a combination of thyrotropin-releasing hormone (TRH) and hyperbaric oxygen (HBO) for an interval form of carbon monoxide (CO) poisoning Waturu Omori, Yosuke Fujita, Kenichi Oga, Kei Itagaka, Yoshio Kawashita, Hironori Kobayashai,, Kenichiro Nishimura, Minoru