• Korean Journal of Biological Psychiatry
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• v.2 no.1
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• pp.20-27
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• 1995

Therapeutic montitoring of drugs is a well established clinical 1001. However, the state of art is somewhat less advanced for psychotrpoic agents than it is for other classes of drugs, for several reasons. Most psychotropics have large volumes of distribution and achieve relatively low plasma concentrations following therapeutic doses. Many have one or more active metabolites. As a consequene, the analytical methodologies are often complex and not always reliable; well-controlled clinical studies are difficult to perform; and therapeutic ranges have been difficult to establish. Despite these limitations, prudent and selective monitoring of serum drug concentrations, particularly of the tricyclic antidepressants can be helpful in clinical management. This paper presents an overview of clinical and mothodological issues surrounding the utility of blood level measurement.

• Korean Journal of Psychosomatic Medicine
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• v.1 no.1
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• pp.25-34
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• 1993

The author reviewed the general principle in the use of psychotropics for patients with renal diseases. who have psychiatric problems. Durgs which are dialyzable and metabolized or eliminated by kidney should not be used for patients with renal failure. However, lithium can be effectively used in a single dose$(300{\sim}600 mg/day)$ after each dialysis. though lithium has the double negative components. It is recommended that serum lithium level should be frequently monitored and the dose of lithium should be gradually increased to minimize its side effect Most of other psychotropics such as benzodiazepine anxiolytics tricyclic or tetracyclic antidepressants, and neuroleptics are metabolized in the liver, and they can be used in renal patients. The dose of these drugs should be reduced in two-thirds of the standard dose. In addition. it is necessary for liaison psychiatrists and other physicians to understand the interactions between psychotropics and drugs often used for treatment of renal diseases in order to prescribe psychotropics safely and effectively in renal patients.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.22 no.2
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• pp.74-80
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• 2011

Attention-deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder with an onset of symptoms before 7 years of age, often starting as early as the preschool years. The off-label use of methylphenidate (MPH) for 3- to 6-year-old preschool children with ADHD is being more common, although MPH is not licensed for use in children younger than age 6 years, in most countries. Despite the limited data, the review of the literature suggests that MPH meets evidence based criteria as beneficial and safe for carefully diagnosed ADHD preschool children. Carefully monitored administration of evidence-based psychotropic medication in preschool children with ADHD may be indicated if psychosocial treatments are ineffective.

• Korean Journal of Biological Psychiatry
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• v.23 no.1
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• pp.1-11
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• 2016

Development of various antidepressants such as monoamine oxidase inhibitors, tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, and noradrenergic and specific serotonergic antidepressant has led to a tremendous progression of pharmaceutical treatment for depression, but still there are some limitations of current antidepressants, such as treatment-resistant depression and delayed onset of antidepressants. The pathogenesis of depression is unclear because depression is a heterogeneous disease state, and the mechanisms of antidepressants remain uncertain as well. Nevertheless, in an attempt to develop novel antidepressants, some trials have been conducted based on the potential biological mechanism discovered in the numerous research results. This review will provide information about the potential novel antidepressants and the current states of clinical studies using them. In particular, some potential novel antidepressants anti-inflammatory agents, antioxidants, anticholinergics, modulators of Hypothalamic Pituitary Adrenal Axis, glutamate, and opioid systems, as well as some neuropeptides such as susbstance P, neuropeptide Y, and galanin will be discussed.

• Korean Journal of Biological Psychiatry
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• v.5 no.1
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• pp.46-55
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• 1998

Any compound which disrupts the integrity of psychological aspects of performance, in particular, cognitive ability and psychomotor function analogous to the psychological behaviors of routine life, is known to be behaviorally toxic. A significant level of behavioral toxicity will interfere with patient safety and quality of life, and also may be counter-therapeutic by exacerbating the condition that the drug was prescribed for. Now, behavioral toxicity of psychotropic drugs has become one of the main growth areas of psychopharmacological research. Evaluation of the potential of drug-induced behavioral toxicity is important not only to the experimental researcher involved in human psychopharmacology, but also to the clinical practitioner treating psychiatric patients. This article attempts to describe behavioral toxicity of the three classes of psychotropic drugs - benzodiazepines, antidepressants and neuroleptics. After a brief discussion of some methodological issues arising in the investigation of behavioral toxicity, each of these drug classes is reviewed in the context of practical importance rather than purely scientific concern. The last session summarizes some suggestions for future studies on drug-induced behavioral toxicity.

• Korean Journal of Biological Psychiatry
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• v.5 no.2
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• pp.155-161
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• 1998

Mood disorder is a medical illness resulting from the disorder of CNS neurotransmission and its principal therapeutic tool is pharmacotherapy. Psychotherapeutic drugs for mood disorder have some clinical limitations which are due to no or partial response, decreased compliance for drug by the side effects, and delayed therapeutic effects. So, general hope of all clinicians that mood diorder will respond to a single psychotherapeutic agent may be the exception rather than the rule. Recently, combined drug treatments have become increasingly popular to overcome the clinical limitations of individual agent in mood disorder. Combined treatments are usually used for augmenting or initiating rapidly the effect of drug, and for treating different target symptoms or drug side effects. When combined treatments being tried, knowledge of the action mechanism, pharmacokinetics, and pharmacodynamics is crucial to cope with the possible adverse reactions of drugs.

• Korean Journal of Biological Psychiatry
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• v.7 no.1
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• pp.34-45
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• 2000

Pharmacotherapy of bipolar disorder is a rapidly evolving field. Mood stabilizers and anticonvulsants have varying biochemical profiles which may predispose them to different adverse effects and drug-drug interactions. Several of the new anticonvulsants appear less likely to have the problems with drug-drug interaction. To provide more effective combination pharmacotherapies, clinicians should be allowed to anticipate and avoid pharmacokinetic and pharmacodynamic drug-drug interactions. We reviewed the role of cytochrome P450 isozymes in the metabolism of the drugs and their interactions. The drug-drug interactions of several classes of drugs which used as mood stabilizers and new anticonvulsants, some of which may have psychotropic profiles, are discussed mainly in this article. Finally, potential pharmacokinetic interactions between the benzodiazepines and other coadministered drugs are discussed briefly.

• Korean Journal of Psychosomatic Medicine
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• v.7 no.2
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• pp.274-280
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• 1999

A variety of mechanism may generate pain resulting from injury to the central and peripheral nervous system. None of these mechanism is disease-specific, and several different pain mechanism may be simultaneously present in anyone patient, independent of diagnosis. Diagnosis of neuropathic pain is often easily made from information gathered on neurologic examination and from patient history. Although treatment of neuropathic pain may be difficult, optimum treatment can be achieved if the neurologist has a complete understanding of therapeutic options, the mainstay of which is pharmacotherapy. Selection of an appropriate rharmacologic agent is by trial and error since individual responses to different agents, doses, and serum levels are highly variable. An adequate trial for each agent tried is key to pharmacologic treatment of neuropathic pain. Tricyclic antidepressants are first-line agents, although other drugs, including anticonvulsants, local anesthetic antiarrhythmics, clonidine, opiates, and certain topical agents, also offer pain relief in some patient populations. The novel antidepressants venlafaxine and nefazodone are potentially useful new drugs that are better tolerated than tricyclic antidepressants. Also Gabapentine seems an interesting and promising drug for the treatment of neuropathic pain.

• Korean Journal of Biological Psychiatry
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• v.14 no.2
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• pp.91-98
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• 2007

Objectives : Considering the impact of depressive illness on physical and mental health of both mother and fetus, specification of a treatment algorithm for depressive disorder during pregnancy is legitimated. This article provides a systemic review of treatments for depressive disorder during pregnancy and lactation. Methods : According to the search strategy of the Clinical Research Center for Depression of Korean Health 21 R & D Project, PubMed and EMBASE were searched using terms with regard to the treatment of depressive disorders during pregnancy and lactation. Reference lists of related reviews and studies were searched. In addition, relevant practice guidelines were searched using the PubMed. All identified clinical literatures were reviewed and summarized in a narrative manner. Results : Pharmacotherapy during pregnancy and lactation requires a comprehensive assessment of the risks and benefits of treatment for both mother and fetus or neonate. Recently, there is growing evidence that the use of tricyclic and selective serotonin reuptake inhibitors during pregnancy and lactation does not result in increased risks of teratogenicity. Treatment strategies are described according to the point of time of pregnancy or lactation. FDA categories for antidepressants during pregnancy and lactation are described. In addition, issues regarding to the electroconvulsive therapy and psychosocial treatment are discussed. Conclusion : The treatment option for depressive disorders during pregnancy and lactation depends on the severity of depressive illnesses of the individual patient. For mild to moderate depression, the non-pharmacological treatment should be considered first. For moderate to severe depression, pharmacotherapy should be administered in addition to the psychosocial treatment. ECT is recommended for depressive disorder of severe intensity. As the research knowledge is limited, the recommendations should based on the best judgement of psychiatrists.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.22 no.2
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• pp.67-73
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• 2011

The purpose of licensing system is to ensure that the medicines are examined for safety, efficacy and quality. Nevertheless, off-label or unlicensed drug usages in pediatric practice is widespread in Korea and worldwide. Psychotropics are one of the most commonly used off-label or unlicensed drugs. The most valid approach to face this dilemma will be to have more evidences from pediatric pharmacological studies. Clinicians, in addition, need to monitor closely their off-label or unlicensed drug prescriptions to minimize the trial and error in practice. Researchers should publish their experiences and provide guidelines. Pharmaceutical companies, regulatory authorities, and consumer organizations should endeavor altogether for the children's right to get safe and efficacious drugs as adults do. Here, the definition as well as the current status of off-label and unlicensed drug prescriptions will be introduced. Critical issues regarding the off label drugs are discussed. In addition, I will describe the present condition as to the off-label and unlicensed drugs in child and adolescent psychiatry and the authorization process of off-label drug prescription in Korea. Lastly, direction we should like to take in this field will be mentioned.