• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.9 no.2
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• pp.247-252
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• 1998

Neuroleptic malignant syndrome(NMS) is an acute, potentially fatal, idiosyncratic reaction to neuroleptic medication. Early recognition and intensive care are crucial. An important issue is whether NMS will recur after initial recovery and subsequent use of neuroleptic medication. The authors presented with a male adolescent who had suffered a bipolar disorder manic episode and been taking clozapine after recovering from MNS. He had been admitted into a psychiatric ward once before and similarly diagnosed. On the second admission, he showed muscle rigidity, autonomic instability, mild fever, severe diaphoresis, and altered mental status on the fourth hospital day following a haloperidol injection. He was diagnosed with NMS, according to the clinical signs and laboratory data. After the use of antipsychotics was discontinued, he was moved to intensive care unit and given dantrolene. His condition began to improve about 48 hours after the onset of NMS. Due to manic behavior, he returned to the psychiatric ward. On the 21 st hospital day, clozapine was administered to counter the manic symptoms. The final dose was 350mg and showed good remission signs without further recurrence of NMS.

• Korean Journal of Psychosomatic Medicine
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• v.20 no.1
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• pp.40-49
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• 2012

Objectives : To examine emotional and psychological characteristics associated with suicide attempts in depressed patients. Methods : A sample of 37 inpatients diagnosed with major depressive disorder or depressive disorder NOS was divided into two groups : lifetime suicide attempters(N=15 ; 40.54%), non-attempters(N=22 ; 59.46%). Beck Depression Scale(BDI), Beck Anxiety Scale(BAI), Hamilton Depression Rating Scale(HDRS), Hamilton Anxiety Rating Scale(HARS), and MMPI-2 were used to evaluate symptoms severity and psychological characteristics. Results : Suicide attempters scored higher on the BDI though there were no group differences on the HDRS and on the both anxiety scales. Also they showed higher scores on the F, Fb, Pa, RC1, DEP, HEA, PK, AAS among MMPI-2 subscales. Our findings suggest that suicide attempters among depressed patients undergo more severe subjective distress and difficulties in adjustment than non-attempters. Also they were more hostile to others and showed lower trust. Lastly, they showed more somatic complaints and substance related problems. Conclusion : The present study showed that suicide attempters among depressed patients have distinct emotional and psychological characteristics. MMPI-2 would be helpful to assess suicidal risk of depressed patients.

• Korean Journal of Biological Psychiatry
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• v.24 no.3
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• pp.95-109
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• 2017

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique which can change cortical excitability in targeted area by producing magnetic field pulses with an electromagnetic coil. rTMS treatment has been used to treat various neuropsychiatric disorders including depression. In this review, we evaluate the literature on rTMS for depression by assessing its efficacy on different subtypes of depression and different technical parameters. In particular, we focus on the results of randomized clinical trials and meta-analyses for depression after the US Food and Drug Administration approval in 2008, which acknowledged its efficacy and acceptability. We also review the new forms of rTMS therapy including deep TMS, theta-burst stimulation, and magnetic seizure therapy (MST) that have been under recent investigation. High frequency rTMS over left dorsolateral prefrontal cortex (DLPFC), low frequency rTMS over right DLPFC, or bilateral rTMS is shown to be effective and acceptable in treatment for patients with non-psychotic, unipolar depression either as monotherapy or adjuvant. Deep TMS, theta-burst stimulation and MST are promising new TMS techniques which warrant further research.

• Journal of Oriental Neuropsychiatry
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• v.31 no.3
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• pp.213-223
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• 2020

Objectives: To determine treatment effects of a combination of interpersonal and social rhythm therapy and Korean medicine for a patient with major depressive episode of bipolar II disorder. Methods: A patient was treated with Korean medicine (acupuncture, herbal medicine, etc.) and interpersonal and social rhythm therapy (IPSRT) for four months. Pattern identification for depressive mood and sleep associated symptoms was evaluated using Patient Health Questionnaire-9 (PHQ-9) and Social rhythm metric II-5 (SRM II-5). Results: At the end of the treatment, depression and delayed sleep symptoms were improved and social rhythm was recovered to the regular range. The patient acquired an insight to his interpersonal tensions and conflicts. Conclusions: Korean medicine in combination with interpersonal and social rhythm therapy can be used to treat patients with major depressive episode of bipolar II disorder. More cases are needed to develop guidelines for treating bipolar disorder.

• Korean Journal of Biological Psychiatry
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• v.2 no.2
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• pp.205-217
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• 1995

In comparison with tricyclic antidepressants(TCAs), one of the most interesting characteristics of selective serotonin reuptake inhibitors(SSRIs) is its structural differences, reveals different pharmacological properties. The applications at the moment are most effective in clinical applications to depression. The limited result of the research to date on the various applications of SSRIs has not revealed the total potential and applicability of SSRIs. Therefore, attending physicians utilizing SSRIs do not know the full capabilities of the drug on patients and what the patients may reap in terms of benefit from its curing elements. Physicians must first try to understand the full potential of SSRIs and its potential applications for it to be effective on patients. recently, it has been determined that SSRIs and other drugs when administered together may be more effective in the healing process because SSRIs complements and aids in the enhancement and effect of the other drugs. This article is written to give attention to the reader of the pharmacological properties and the clinical use of SSRIs. It is the authors's hope that continuous research on the particular aspects of SSRIs can aid the clinicians in the use of this SSRIs.

• Korean Journal of Psychosomatic Medicine
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• v.28 no.1
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• pp.29-35
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• 2020

Objectives : Evidence regarding the association between untreated depression in adolescence and suicidal risk in male young adults is scarce. We aimed to assess the effect of untreated illness during adolescence on the suicidal risk and attempt after that first episode. Methods : As part of a cross-sectional study, between May 2017 and April 2018, a total of 260 patients with currently unipolar or bipolar depression were included in the final analysis. Multiple linear and logistic regression analysis were performed to evaluate the association between untreated mood disorder in adolescence and its effect on the suicidal risk and attempt. Results : In total 260 patients, 189 were classified as untreated group. The proportion of suicide attempts, total depression score, suicidal risk and number of suicide attempts were significantly higher in the untreated group. The most predictive factors of suicide attempts were history of untreated depression [Adjusted Odds Ratio (AOR)=4.19, 95% Confidence Interval (CI)=2.25-7.81, p<0.001] and diagnosis of bipolar depression (AOR=2.60, 95% CI=1.52-4.46, p<0.001). Conclusions : Although the untreated depression suggests higher rates of suicidality, a significant proportion (86.7%) of adolescent depression in this study did not receive psychiatric treatment. Future research should be needed to find better ways to decrease barriers in using mental health treatment and its contribution to reduction and prevention of adverse outcome.

• Korean Journal of Psychosomatic Medicine
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• v.26 no.2
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• pp.194-200
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• 2018

Objectives : The significance of leukoaraiosis on brain magnetic resonance imaging (MRI) is uncertain, but it is often seen with vascular risk factors or in the context of cognitive impairment. We aimed to investigate the effect of leukoaraiosis on the severity and course of delirium. Methods : Periventricular hyperintensity and deep white matter hyperintensity on brain MRI were rated in 42 patients with delirium by semiquantative visual rating scale. Correlations between their grades and the scores of Korean version of Delirium Rating Scale-Revised-98 (K-DRS-R-98) were analyzed, and the interaction effects between the groups according to the levels of leukoaraiosis and two evaluation points were also analyzed. Results : The grade of deep white matter hyperintensity in the occipital lobe was positively correlated with the scores on the total, severity items, cognitive items, and non-cognitive items of K-DRS-R-98. The cognitive items scores of K-DRS-R-98 in the low grade group of periventricular hyperintensity showed significantly steeper decrease than the high grade group. Conclusions : A difference in severity or recovery speed of delirium according to the level of leukoaraiosis may result from disruption in brain functional connectivity. Our results have a clinical implication in that the severity and course of delirium can be possibly predicted using the level of leukoaraiosis.

• The Journal of the Korea Contents Association
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• v.14 no.12
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• pp.639-654
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• 2014

What is noticeable in Changgeuk Madame Ong is that for "narrativization," a main character is replaced with Madame Ong and her mother and a reinvented story as a result thereof is the female liberation from oppression. The director sought for the completeness of the narrative with a plot line created (i) by daringly deleting the latter half (episode relating to Gangsoe's death), which was a persistent problem unsolved both in the original and its derivative contents, (ii) by diluting Gangsoe's patriarchal authority and thereby creating the ending of endless love and the fruition of love, and (iii) by severing the link between Madame Ong's doomed fate of widowhood and Gangsoe's doomed fate of death by the violation of a taboo (the key factors of the original story) and at the same time, thereby inserting the doomed fate of death by Jowang (god of fire), declaring a war against jangseung (Korean traditional totem pole), the aesthetic structure representing "fictionization," and enabling a female character to gain love, fame and life through free will and spirit of resistance. The director achieved a remarkable success in terms of composition by (i) taping into a variety of genres of music, (ii) by maximizing the effect of Madame Ong's solo, (iii) by strengthening the "uniqueness of each part" through chorus, (iv) by creating a dramatic atmosphere for the change of scene, (v) by applying a dual variation of tension (resistance theme) and relaxation (freedom theme), etc.

• Sleep Medicine and Psychophysiology
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• v.10 no.2
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• pp.100-107
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• 2003

Objectives: Periodic leg movements in sleep (PLMS) might be subdivided based upon whether or not they are associated with visible EEG microarousals (MA). MA is considered to be responsible for nonrestorative sleep and daytime fatigue. The American Sleep Disorders Association's (ASDA) scoring rules for MA based on visual analysis of the EEG changes suggest that MA should last more than 3 seconds. However, it has been suggested that visual analysis may not detect some changes in EEG activity. This study is aimed at measuring changes in EEG spectra during PLMS without MA in order to better understand the arousing response of PLMS. Methods: Ten drug-free patients (three men and seven women) diagnosed with PLMS by polysomnography were studied. Spectral analysis of the EEG was performed in each patient on 30 episodes of PLMS without MA, chosen randomly across the night in stage 2 non-REM sleep. We applied stricter criteria for MA compared to ASDA, by defining it as a return to alpha and theta frequency lasting at least 1 second. Results: The mean PLMS index was $16.7{\pm}10.0$. The mean PLMS duration was $1.3{\pm}0.7$ seconds. Comparison of 4-second EEG activity both before and after the onset of PLMS without MA using independent t-test showed that the movements were associated with significant increase of relative activity in the delta band (p=0.000) and significant decrease of activity in the alpha (p=0.01) and sigma (p=0.000) bands. No significant decrease in the theta (p=0.05), beta (p=0.129), or gamma (p=0.062) bands was found. Conclusion: PLMS without MA was found to be associated with EEG change characterized by increase in the delta frequency band. This finding seems to be compatible with the hypothesis of an integrative hierarchy of arousal responses of Sforza's. Considering that the subjects had lower PLMS index and shorter PLMS duration than those of the previous study, it is suggested that an even less severe form of PLMS without MA could induce neurophysiologic change, which may potentially be of clinical significance.