• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제9권2호
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• pp.247-252
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• 1998

신경이완제 악성증후군(NMS)은 치사율이 높은 관계로 집중적인 치료를 요하는 부작용이며, NMS 에서 회복된 후에도 NMS 발생 이전의 기존 정신증상이 지속될 경우에 언제, 어떤 항정신병 약물을 투여할 것인가 하는 문제가 있다. 본 증례는 조증 증세를 보인 18세 남자 청소년에서 NMS에서 회복된지 약 2주경부터 clozapine을 사용하여 NMS의 재발없이 조증의 호전을 경험하였기에 보고하는 바이다. 환아는 1995년 11월경 발병한 양극성 정동장애, 경조증삽화로 1996년 2월 13일부터 동년 3월 29일까지 서울대학교 병원 소아정신과에 입원하였다. 퇴원후 약물치료를 계속하였고, 1998년 3월말부터 엉뚱하고 난폭한 행동이 나타나 1998년 3월 31일 재 입원하였다. 입원후 일일 haloperidol 8mg까지 투여하였고, 입원 4일째 근육경직과 의식혼탁이 나타났다. 임상증상과 혈액검사 소견상 NMS로 판단되어 항정신병 약물 투여를 중단하였고, dantrolene과 bromocriptine을 투여하였다. 입원 6일째부터 혈액 검사소견이 호전되기 시작하였고 임상적으로도 호전되었다. 이후 전형적인 조증증세가 나타나기 시작하였다. Thioridazine을 최대 일일 50mg까지 투여하였으나 증상조절이 되지 않아서 기존 사용약물을 모두 끊고 입원 21일째부터 clozapine을 투여하기 시작하였다. 입원 46일째 clozapine 투여량은 일일 350mg 이었다. 이후 동량을 유지하였고 NMS 증상의 악화나 재발없이 조증 증세 호전되어 입원 58일째 퇴원하여 현재까지 외래 통원치료중이다.

• 한국임상약학회지
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• 제30권2호
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• pp.92-101
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• 2020

Background: Delirium is a neuropsychiatric disorder characterized by sudden impairments in consciousness, attention, and perception. The evidence of successful pharmacological interventions for delirium is limited, and medication recommendations for managing delirium are not standardized. This study aimed to provide evidence of antipsychotics for symptomatic treatment of delirium in cancer patients receiving palliative care. Methods: We retrospectively reviewed adult cancer patients in palliative care who received antipsychotic delirium treatment at Severance Hospital between January 2016 and June 2019. The efficacy was evaluated primarily by resolution rates. The resolution of delirium was defined as neurological changes from drowsiness, confusion, stupor, sedation, or agitation to alertness or significant symptomatic improvements described in the medical records. The safety was studied primarily by adverse drug reaction incidence ratios. Results: Of the 63 enrolled patients, 60 patients were included in the statistical analysis and were divided into three groups based on which antipsychotic medication they were prescribed [quetiapine (n=27), haloperidol (n=25) and co-administration of quetiapine and haloperidol (n=8)]. The resolution ratio showed quetiapine to be more effective than haloperidol (p=0.001). No significant differences were seen in adverse drug reaction rates among the three groups (p=0.332). Conclusions: Quetiapine was considered the most effective medication for delirium, with no significant differences in adverse drug reaction rates. Therefore, quetiapine may be considered a first-line medication for treating delirium in cancer patients receiving palliative care. However, further studies comparing more diverse antipsychotics among larger populations are still needed.

• 생물정신의학
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• 제26권1호
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• pp.14-21
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• 2019

Objectives Thyroid hormone deficiency during the neurodevelopmental period can impair brain development and induce psychiatric symptoms. This study examined the association between thyroid dysfunction and the severity of symptoms in schizophrenia patients, and the treatment response of patients with schizophrenia. Methods Three hundred thirty-eight schizophrenia patients, with no prior history of thyroid disease or taking medication associated with it, were studied. We assessed the blood thyroid hormone level, the Brief Psychiatric Rating Scale (BPRS) scores on the day of admission and discharge, admission period, dose of administered antipsychotics, and the number of antipsychotic combinations. The collected data were subsequently analyzed using the Kruskal-Wallis test and Pearson's chi-square test. Results The percentage of schizophrenia patients who presented with abnormal thyroid hormone level was 24.6%. High total triiodothyronine (TT3) (p = 0.003), low TT3 (p = 0.001), and high free thyroxine (fT4) (p < 0.001) groups showed a higher BPRS score on admission than did the normal thyroid hormone group, while thyroid stimulating hormone (TSH) levels were not significantly correlated with the severity of symptoms. Furthermore, thyroid hormone was not associated with the treatment response assessed by the rate of BPRS score reduction, admission days, use of clozapine, and dose of antipsychotics. Conclusions The TT3 and fT4 hormone levels were significantly associated with the severity of symptoms in schizophrenia patients. These relations suggested that thyroid dysfunction may be associated with the severity of schizophrenia. And hence, further analysis of the results of the thyroid function test, which is commonly used in cases of psychiatric admission, is required.

• 한국임상약학회지
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• 제31권4호
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• pp.268-277
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• 2021

Background: Most antipsychotic drugs studies have been mainly conducted on side effects, randomized clinical trials, utilization rates, and trends. But there have been few studies on the influencing factors in elderly patients. The purpose of this study was to analyze the influencing factors on the outpatient prescription of antipsychotic drugs in the elderly patients. Methods: Active ingredients of antipsychotic drugs in Korea were selected according to the Korean Pharmaceutical Information Center (KPIC)'s classification. Data source was Korean Health Insurance Review and Assessment Service (HIRA) claims data in 2020 and target patient group was the elderly patient group. We extracted patients who have been prescribed one or more antipsychotic drugs and visited only one medical institution. Data were analyzed using descriptive statistics, chi-square, t-test, negative binomial regression. Results: A number of outpatients were 245,197 and prescriptions were 1,379,092. Most characteristics of patients were 75-85 year's old, female, health insurance type, no disease (dementia, schizophrenia), atypical drugs, cci score (>2) and characteristics of medical institution were neurology in specialty, rural region, general hospitals. Results of regression showed that patient's characteristics and medical center characteristics had significant effect on the outpatient prescription of antipsychotic drugs in the elderly patients. Conclusion: This study suggests that national policy of antipsychotic drugs in the elderly patients, with the consideration of the patients' and medical institutions' characteristics, is needed.

• 대한핵의학회지
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• 제31권1호
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• pp.9-18
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• 1997

목 적 : 본 연구에서는 정량적 자가방사선사진법을 이용하여 비정형 항정신병 약물의 하나인 risperidone 이 백서 뇌의 신경수용체에 어떻게 작용하는지를 알아보고자 하였다. 대상 및 방법 : 급성투여군은 백서 30마리를 6군으로 나누어 0, 0.1, 0.25, 0.5, 1, 2mg/kg의 risperidone을 복강내 투여하고 2시간후에 단두하였고, 만성투여군은 0, 0.1, 1mg/kg의 risperidone을 21일간 복강내 투여후 단두하여 정량적자가 방사선사진법으로 $5-HT_2$과 $D_2$ 수용체에 대한 [$^3H$]spiperone 결합을 측정함으로써, 선조체, 측좌핵, 전두엽피질 각각의 $5-HT_2$과 $D_2$ 수용체의 분포변화를 측정하고 투여량에 따른 수용체의 영향을 ANOVA 검정으로 분석하였다. 결 과 : 급성투여군에서 $5-HT_2$ 수용체는 전두엽 피질에서 risperidone 투여후 0.1-2mg/kg의 투여 범위전체에서 [$^3H$]spiperone 결합이 대조군에 비하여 32% 이하로 감소하여 통계적으로 유의한 차이를 보였으며, 선조체와 측좌핵의 피질하 수용체에서는 거의 결합을 보이지 않았다. $D_2$ 수용체는 risperidone 투여량의 증가에 따라 선조체와 측좌핵의 [$^3H$]spiperone 결합이 감소하였으며, 1-2mg/kg의 투여량을 준 경우에는 대조군에 비해 57% 이하로 감소하여 통계적으로 유의한 차이를 보였다. 만성투여군에서는 피질의 $5-HT_2$ 수용체가 대조군에 비하여 저용량투여군과 고용량투여군에서 각각 51%와 46%로 감소하였다. 결론 : Risperidone은 $D_2$ 수용체를 약하게 차단하며 $D_2$ 수용체에 영향을 주는 양보다 적은 양을 투여해도 $5-HT_2$ 수용체를 차단하는 효과를 보임으로써 $5-HT_2$ 수용체에 강력히 작용하는 비정형 항정신병 약물임을 알 수 있었다.