• Journal of Neurogastroenterology and Motility
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• 제24권4호
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• pp.512-527
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• 2018

This review provides a comprehensive overview of brain imaging studies of the brain-gut interaction in functional gastrointestinal disorders (FGIDs). Functional neuroimaging studies during gut stimulation have shown enhanced brain responses in regions related to sensory processing of the homeostatic condition of the gut (homeostatic afferent) and responses to salience stimuli (salience network), as well as increased and decreased brain activity in the emotional response areas and reduced activation in areas associated with the top-down modulation of visceral afferent signals. Altered central regulation of the endocrine and autonomic nervous responses, the key mediators of the brain-gut axis, has been demonstrated. Studies using resting-state functional magnetic resonance imaging reported abnormal local and global connectivity in the areas related to pain processing and the default mode network (a physiological baseline of brain activity at rest associated with self-awareness and memory) in FGIDs. Structural imaging with brain morphometry and diffusion imaging demonstrated altered gray- and white-matter structures in areas that also showed changes in functional imaging studies, although this requires replication. Molecular imaging by magnetic resonance spectroscopy and positron emission tomography in FGIDs remains relatively sparse. Progress using analytical methods such as machine learning algorithms may shift neuroimaging studies from brain mapping to predicting clinical outcomes. Because several factors contribute to the pathophysiology of FGIDs and because its population is quite heterogeneous, a new model is needed in future studies to assess the importance of the factors and brain functions that are responsible for an optimal homeostatic state.

• 한국심리학회지ㆍ건강
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• 제14권2호
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• pp.277-292
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• 2009

급성 스트레스 상황에 따른 Type D 성격의 자율신경계 반응을 심박률 변동성을 중심으로 조사하였다. Type DS-14의 점수에 근거하여 Type D 집단(n=23명)과 non-Type D 집단(n=23명)을 구성하였다. 심박률 변동성(heart rate variability, HRV)을 이용하여 기저선, 스트레스 단계 및 회복 단계 동안의 심박활동을 측정하였으며 스트레스 과제로는 Stroop 색채단어 검사가 사용되었다. 반복측정 변랑분석을 통해 두 집단의 심박활동을 비교하였으며, 회귀분석을 통해 Type D 척도와 스트레스 취약성 척도가 기저선 상태에서의 심박활동의 변화를 예측할 수 있는지를 알아보았다. 연구 결과, Type D 집단은 non-Type D 집단보다 고주파수(high frequency, HF) 활성화가 더 낮았고 저주파수(low frequency, LF) 활성화는 더 높았다. 스트레스 과제 수행 시, non-Type D 집단에서는 교감신경계 활성화 지표(LF component, LF/HF)가 증가하고 부교감신경계 활성화 지표(HF component)가 감소하는 것이 관찰된 반면, Type D 집단에서는 심박활동 비율상의 유의한 변화가 나타나지 않았다. 또한, Type D 척도의 총점수, 부정적 정서 소척도와 사회적 억제 소척도는 기저선 상태에서의 심박활동 반응에 대한 유의한 예측인자로 나타났다. 이러한 결과는 Type D 성격이 non-Type D 성격에 비해 교감신경계 활성화 비율이 높거나 또는 부교감신경계 활성화비율이 낮음을 시사한다. 즉, Type D가 스트레스에 취약한 성격임을 시사하며, Type D에서 관찰된 심박 활동 양상, 즉 높은 교감신경계 혹은 낮은 부교감신경계 활성화는 Type D 성격이 심장혈관 장애 등을 포함한 정신신체 질환과 관련될 수 있음을 시사한다.

• 대한간호학회지
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• 제43권5호
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• pp.579-586
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• 2013

Purpose: This article provides an update and overview of a nursing research program focused on understanding the pathophysiology and management of irritable bowel syndrome (IBS). Methods: This review includes English language papers from the United States, Europe, and Asia (e.g., South Korea) from 1999 to 2013. We addressed IBS as a health problem, emerging etiologies, diagnostic and treatment approaches and the importance of a biopsychosocial model. Results: IBS is a chronic, functional gastrointestinal disorder characterized by recurrent episodes of abdominal pain and alterations in bowel habit (diarrhea, constipation, mixed). It is a condition for which adults, particularly women ages 20-45, seek health care services in both the United States and South Korea. Clinically, nurses play key roles in symptom prevention and management including designing and implementing approaches to enhance the patients' self-management strategies. Multiple mechanisms are believed to participate in the development and maintenance of IBS symptoms including autonomic nervous system dysregulation, intestinal inflammation, intestinal dysbiosis, dietary intolerances, alterations in emotion regulation, heightened visceral pain sensitivity, hypothalamic-pituitary-adrenal dysregulation, and dysmotility. Because IBS tends to occur in families, genetic factors may also contribute to the pathophysiology. Patients with IBS often report a number of co-morbid disorders and/or symptoms including poor sleep. Conclusion: The key to planning effective management strategies is to understand the heterogeneity of this disorder. Interventions for IBS include non-pharmacological strategies such as cognitive behavior therapy, relaxation strategies, and exclusion diets.

• 대한한방체열의학회지
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• 제2권1호
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• pp.1-5
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• 2003

Dysmenorrhea is one of the common gynecologic disorders of menstruation women. Primary dysmenorrhea is menstrual pain without pelvic pathology. whereas secondary one is painful mestruation with underlying pathology. The cause of primary dysmenorrhea is increased endometrial prostaglandin. The mechanisims underlying secondary dysmenorrhea are not eluciated. There are many blood vessels under the skin and they play a very important role in the thermal control of peripheral part. The control of blood circulation is mainly controlled by autonomic nervous system and it is known that D.I.T.I. (digital infra-red thermographic imaging) is an objective method showing the body temperature. I observed the abdominal themerature of 49 patients complaning of dysmenorrhea who visited the gynecologic department of Pundang Oriental Medical Hospital during 1997. In order to rule out thermal abnormality due to obesity. the causes whose obesity index were above I. were excluded in this study. The mean temperature of lower abdomen of the dysmenorrhea group was $35.22{\pm}1.33^{\circ}C$ and control group was $36.01{\pm}0.74^{\circ}C$.

• 대한불안의학회지
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• 제3권1호
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• pp.26-31
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• 2007

Object : This study was designed to assess the change of heart rate variability (HRV) during stimulation test among the patients with major depressive disorder. Methods : 15 patients with major depressive disorder (MDD) and 15 normal controls were enrolled in this study. We sequentially measured HRV at baseline, during cognitive stimuli and emotional stimuli. Results : There are significant differences between the two groups in HRV index, TINN on baseline state and under cognitive stimulus. Conclusion : Stimulation protocol using HRV can be useful in estimating autonomic nervous function.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제3권2호
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• pp.188-194
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• 2000

반복되는 구토로 인한 폐렴 증세로 내원하여 분문무이완증, 무루증, 신경인성방광 등의 소견을 보여 Triple A 증후군으로 진단받고, 식도하부 괄약근의 반복 확장술(pneumatic dilatation)로 증상이 소실된 환아 1례를 경험하였기에 이에 보고하는 바이다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제18권4호
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• pp.224-229
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• 2015

Cyclic vomiting syndrome (CVS) is a functional disorder characterized by stereotypical episodes of intense vomiting separated by weeks to months. Although it can occur at any age, the most common age at presentation is 3-7 years. There is no gender predominance. The precise pathophysiology of CVS is not known but a strong association with migraine headaches, in the patient as well as the mother indicates that it may represent a mitochondriopathy. Studies have also suggested the role of an underlying autonomic neuropathy involving the sympathetic nervous system in its pathogenesis. CVS has known triggers in many individuals and avoiding these triggers can help prevent the onset of the episodes. It typically presents in four phases: a prodrome, vomiting phase, recovery phase and an asymptomatic phase until the next episode. Complications such as dehydration and hematemesis from Mallory Wise tear of the esophageal mucosa may occur in more severe cases. Blood and urine tests and abdominal imaging may be indicated depending upon the severity of symptoms. Brain magnetic resonance imaging and upper gastrointestinal endoscopy may also be indicated in certain circumstances. Management of an episode after it has started ('abortive treatment') includes keeping the patient in a dark and quiet room, intravenous hydration, ondansetron, sumatriptan, clonidine, and benzodiazepines. Prophylactic treatment includes cyproheptadine, propranolol and amitriptyline. No mortality has been reported as a direct result of CVS and many children outgrow it over time. A subset may develop other functional disorders like irritable bowel syndrome and migraine headaches.

• The Korean Journal of Pain
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• 제25권1호
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• pp.28-32
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• 2012

Background: Primary hyperhidrosis is a disorder of excessive sweating, which shares several features with anxiety disorders and has a negative impact on a patient's quality of life. Oral glycopyrrolate is one of the treatments available. There are a few published studies on the use of glycopyrrolate given orally in the treatment of hyperhidrosis. Methods: Thies is study was a review of case notes in a series of 36 patients with primary hyperhidrosis. We made a comparison between the Keller's scale score of a pre-glycopyrrolate medication group and the Keller's scale score f a post-glycopyrrolate medication group. The Milanez de Campos score, Short Form_36 (SF-36) score, Beck Depression Inventory (BDI) score, Beck Anxiety Inventory (BAI) score, and autonomic nervous system (ANS) scale score were also compared between the two groups. Results: In the post-glycopyrrolate medication group, there were declines in Keller's scale, and Milanez de Campos scale score and BAI score (P < 0.001). In addition, there were increases in SF_36 score in the post-glycopyrrolate medication group (P = 0.03) However, no changes were seen in, BDI score and ANS score in the post-glycopyrrolate medication group (P < 0.001). Conclusions: Glycopyrrolate is an effective initial method of treating primary hyperhidrosis that, reduces anxiety and improve patients' quality of life.

• The Korean Journal of Pain
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• 제26권1호
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• pp.89-93
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• 2013

Compensatory hyperhidrosis or reflex hyperhidrosis is the increase in sweating in the postoperative stage of thoracic sympathectomy or lumbar sympathectomy. It shares several features with anxiety disorders and has a negative impact on a patient's quality of life. Oralglycopyrrolate is one of the treatment options available. This study reviewed case notes in a series of 19 patients with compensatory hyperhidrosis. We made a comparison between the Milanez de Campos score of a pre-glycopyrrolate medication group and the Milanez de Campos score of a post-glycopyrrolate medication group. The Beck Depression Inventory (BDI) score, Beck Anxiety Inventory (BAI) score, and autonomic nervous system (ANS) scale score were also compared between the pre-medication and post-medication groups. In the post-glycopyrrolate medication group, there was decrease in the Milanez de Campos score, BAI score, and BDI score (P < 0.05). But no meaningful change was seen in the ANS score in the post-glycopyrrolate medication group (P > 0.05). Glycopyrrolate is an effective medication in the treatment of compensatory hyperhidrosis that, can alleviate anxiety and improve patients' quality of life.

• Clinical and Experimental Pediatrics
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• 제64권6호
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• pp.251-259
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• 2021

Psychogenic nonepileptic seizures (PNES) is a neuropsychiatric condition that causes a transient alteration of consciousness and loss of self-control. PNES, which occur in vulnerable individuals who often have experienced trauma and are precipitated by overwhelming circumstances, are a body's expression of a distressed mind, a cry for help. PNES are misunderstood, mistreated, under-recognized, and underdiagnosed. The mind-body dichotomy, an artificial divide between physical and mental health and brain disorders into neurology and psychiatry, contributes to undue delays in the diagnosis and treatment of PNES. One of the major barriers in the effective diagnosis and treatment of PNES is the dissonance caused by different illness perceptions between patients and providers. While patients are bewildered by their experiences of disabling attacks beyond their control or comprehension, providers consider PNES trivial because they are not epileptic seizures and are caused by psychological stress. The belief that patients with PNES are feigning or controlling their symptoms leads to negative attitudes of healthcare providers, which in turn lead to a failure to provide the support and respect that patients with PNES so desperately need and deserve. A biopsychosocial perspective and better understanding of the neurobiology of PNES may help bridge this great divide between brain and behavior and improve our interaction with patients, thereby improving prognosis. Knowledge of dysregulated stress hormones, autonomic nervous system dysfunction, and altered brain connectivity in PNES will better prepare providers to communicate with patients how intangible emotional stressors could cause tangible involuntary movements and altered awareness.