• 정신신체의학
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• 제21권2호
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• pp.81-92
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• 2013

새로운 항우울제가 개발되고 임상에서 정신과적 질환뿐만이 아니라 만성통증증후군, 섬유근통증증후군, 두통 등의 많은 정신신체질환 그리고 신체질환자의 적응장애 및 우울증 등의 자문조정정신의학 영역에서도 다양하게 자주 사용되고 있다. 다양한 정신의학적 질환을 치료하기 위해 처방하는 새로운 항우울제의 사용 시 치료중단의 가장 큰 원인은 약물부작용이다. 이 논문은 현재 우리나라에서 널리 사용되고 있는 새로운 항우울제 사용 시 나타나는 부작용들 중 정신신체의학과 자문조정정신의학영역에서 관심을 가져야 할 매우 빈번하게 나타나는 세 가지 부작용인 오심과 구토, 체중증가, 성기능장애에 대한 발생기전, 발생빈도, 그리고 약물학적 처치를 위주로 한 해결방안을 알아보았다. 저자는 이 논문을 통하여 정신건강의학과 의사만이 아니라 정신신체의학 영역에 관심을 가지거나 자문조정정신의학과 연계되는 타과 영역의 의사들이 새로운 항우울제를 사용할 때 빈번하게 나타나서 삶의 질을 떨어뜨리고 치료중단을 일으킬 수 있는 이 약물들의 부작용을 잘 인지함으로써 이를 조기에 발견하고 적절히 해결하여 환자 치료에 도움을 주고자 하였다.

• The Korean Journal of Physiology and Pharmacology
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• 제20권4호
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• pp.379-385
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• 2016

TWIK-related $K^+$ channel-2 (TREK-2) and TWIK-related spinal cord $K^+$ (TRESK) channel are members of two-pore domain $K^+$ channel family. They are well expressed and help to set the resting membrane potential in sensory neurons. Modulation of TREK-2 and TRESK channels are involved in the pathogenesis of pain, and specific activators of TREK-2 and TRESK may be beneficial for the treatment of pain symptoms. However, the effect of commonly used analgesics on TREK-2 and TRESK channels are not known. Here, we investigated the effect of analgesics on TREK-2 and TRESK channels. The effects of analgesics were examined in HEK cells transfected with TREK-2 or TRESK. Amitriptyline, citalopram, escitalopram, and fluoxetine significantly inhibited TREK-2 and TRESK currents in HEK cells (p<0.05, n=10). Acetaminophen, ibuprofen, nabumetone, and bupropion inhibited TRESK, but had no effect on TREK-2. These results show that all analgesics tested in this study inhibit TRESK activity. Further study is needed to identify the mechanisms by which the analgesics modulate TREK-2 and TRESK differently.

• 약학회지
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• 제57권4호
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• pp.289-292
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• 2013

A total of 2,080 forensic autopsies in Seoul, Incheon and Gyeonggi province were performed by the National Forensic Service (NFS) in 2010. After analysing blood samples collected at autopsies by GC-MS and LC-MS/MS, the types and prevalence of drugs and poisons in blood were investigated using our laboratory information management system. Among 2,080 cases, 1,061 cases (51%) were positive for drugs and poisons. Surprisingly, antidepressants were identified in 137 cases which comprised 13% of the positive cases. Twelve different kinds of antidepressants were determined: Amitriptyline, fluoxetine, nortriptyline, trazodone, imipramine, mirtazapine, citalopram, venlafaxin, clomipramine, paroxetine, sertraline and bupropion. Amitriptyline was the most frequently detected antidepressant and was identified in 39 cases. Moreover, amitriptyline, fluoxetine, and nortriptyline were included in the list of the 20 most commonly encountered drugs or poisons in the analysis of blood collected at autopsies from 2007 to 2009, indicating the prevalence of their use. In this study, the 137 antidepressant-related deaths were classified by the mode of death to predict the prevalence of these drugs. As a result, those deaths were divided into four groups based on the cause and mode of death: 56 cases of suicide with fatal concentrations of antidepressant drugs in blood, 6 homicidal cases directly or indirectly related to antidepressants, 59 natural deaths with antidepressants detected in blood and 16 deaths caused by fire or other accidents with antidepressants detected in blood. Because incidents involving antidepressants have been increasing, especially in suicides or homicides, it is necessary for the health authorities and law enforcement administrations to cooperate and share the statistical data for curbing the abuse of antidepressants. This report is expected to provide the reference data related with antidepressants for the investigation of the deaths.

• 한국응용약물학회:학술대회논문집
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• 한국응용약물학회 1998년도 Proceedings of UNESCO-internetwork Cooperative Regional Seminar and Workshop on Bioassay Guided Isolation of Bioactive Substances from Natural Products and Microbial Products
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• pp.170-170
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• 1998

In order to discover new types of 5-hydroxytryptamine antagonists, we have devoted our attention to investigating naturally occurring compounds having anti-5HT activity in vitro. Recently, ${\gamma}$-mangostin [1,3,6,7-tetrahydroxy-2,8-bis(3-methyl-2-bytenyl)-9H-xanthen-9-one] from the fruit hull of Garcinia mangostana Linn has been shown to be a selective antagonist for 5-hydroxytryptamine$_{2A}$ receptors in smooth muscle and platelets. It is of interesting that y-mangostin which does not have a nitrogen atom, possesses marked 5-$HT_{2A}$ receptor blocking activity. The present study was undertaken to investigate the effects of ${\gamma}$-mangostin on central 5-HT receptors by using animal behavioural models. Intracerebronventricular injection of ${\gamma}$-mangostin (10-40n mol/mouse) inhibited 5-fluoro-${\alpha}$-methyltryptamin (5-FMT) (45 mg kg$^{-1}$, i.p.)-induced head-twitch response in mice in the presence or absence of citalopram (5-HT-uptake inhibitor). Neither the 5-FMT- nor the 8-hydroxy-2-( di-n-propylamino )tetralin (5-HT$_{1A}$-agonist)-induced 5-HT syndrome (head weaving and hindlimb abduction) was affected by ${\gamma}$-mangostin. The locomotor activity stimulated by 5-FMT through the activation of at-adrenoceptors did not alter in the presence of ${\gamma}$-mangostin. 5-HT-induced inositol phosphates accumulation in mouse brain slices was abolished by ketanserin. ${\gamma}$-Mangostin caused a concentration-dependent inhibition of the inositol phosphates accumulation and the binding of [$^3H$]-spiperone, a specific 5-$HT_{2A}$ receptor antagonist, to mouse brain membranes. Kinetic analysis of the [$^H3$]-spiperone binding revealed that ${\gamma}$-mangostin increased the $_{d}$ value without affecting the $B_{max}$ value, indicating the mode of the competitive nature of the inhibition by ${\gamma}$-mangostin. These results suggest that ${\gamma}$-mangostin inhibits 5-FMT-induced head-twitch response in mice by blocking 5-$HT_{2A}$ receptors not by blocking the release of 5-HT from the central neurone. ${\gamma}$-Mangostin is a promising 5-$HT_{2A}$ receptors antagonist in the central nervous system.m.

• 대한임상독성학회지
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• 제20권1호
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• pp.1-7
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• 2022

Purpose: In patients with acute drug overdose, identification of drugs ingested is crucial to make a precise diagnosis. In most cases, the diagnoses are made on the medical history and physical examination findings. This study was undertaken to determine the concordance of diagnosis made on the basis of patient history by comparing it with urine toxicology analysis. Methods: This was a retrospective study of drug intoxicated patients over 18 years old who presented to the emergency center from 2017 to 2019. Specimens from urine were tested using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-TMS). The test results were compared with information obtained from patients. Diagnostic concordances for drug detection in intoxicated patients were calculated. Logistic regression analysis was used to examine the association between clinical characteristics and diagnostic discrepancy. Results: Totally, 370 patients were included in the analysis. Overall, 66 types of drugs were detected by UPLC-TMS. The drugs detected most frequently were zolpidem (104, 27.8%), citalopram (70, 18.7%), and paracetamol (66, 17.6%). The mean diagnostic concordance of patients was 52.7%. There were statistically significant diagnostic discrepancies in patients with underlying depression and patients intoxicated with multiple types of drugs. Conclusion: In ED patients with acute drug overdose, the diagnoses made on history alone were often inaccurate. It is essential to perform urine toxicology tests such as UPLC-TMS as a confirmatory instrument to improve accuracy in evaluating patients with drug intoxication.

• 정신신체의학
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• 제14권2호
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• pp.94-101
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• 2006

연구목적 : 본 연구는 불안장애 환자들과 정상대조군을 대상으로, 심박변이도(heart rate variability, HRV)를 이용해서 자율신경계의 심장조절기능을 비교하고 그 생리학적 의미를 살펴보고자 한 것이다. 또한 불안장애 환자들에게 세로토닌재흡수억제제 (selective serotonin reuptake inhibitor, SSRI)를 투여한 뒤 투여전과 투여후를 비교해보고 치료효과를 판정하여 임상적 적용가능성을 고찰해보고자 하였다. 방법: DSM-IV의 진단기준에 의하여 불안장애로 진단받은 환자 30명과 정상대조군 30명을 대상으로 연구를 수행하였다. 불안증상의 심각도를 평가하기 위하여 Hamilton Anxiety Scale을 사용하였으며 정상대조군은 학생과 의사, 간호사 그리고 병원에 근무하는 직원들이었다. 검사는 불안장애 환자군과 정상대조군의 HRV를 측정한 후 시영역과 주파수 영역별로 분석하였다. 그리고 불안장애 환자들을 대상으로 SSRI 투여전과 투여 뒤 4주후 HRV를 측정하였다. SSRI 약물로는 fluoxetine, paroxetine, citalopram, sertraline을 사용하였다. 통계적 검증은 SPSS-Windows (version 10.0)을 이용하여 independent t-test, chi-square test, 그리고 paired t-test를 사용하였다. 결과: 불안장애 환자군과 정상대조군의 연령, 성별의 유의한 통계적 차이는 없었으며, 치료 후의 Hamilton Anxiety Scale 점수는 치료전과 비교하여 유의하게 감소되었다.(p<0.05). 정상대조군과 치료전 불안장애군을 비교하였을 경우, 치료전 불안장애군이 시간영역변수들인 RMSSD, SDNN에서 유의한 감소를 나타내었다. 또 주파수 영역 변수들을 살펴보면, 치료 전 불안장애 환자군이 정상대조군에 비해 TP, VLF, LF, HF에서 유의한 감소를 나타내었으며 LF/HF는 유의한 차이가 없었다. 그리고 불안장애 환자군에서 SSRI 치료 전과 치료 후의 HRV 변인들은 통계적으로 유의한 차이가 없었다. 결론: 치료전 불안장애군이 정상대조군에 비하여 감소된 HRV를 나타내었고, 불안장애 환자군을 대상으로 한 SSRI 치료전후 비교에서는 두 군간에 유의한 차이가 없었다. SSRI제제들이 자율신경의 활성을 반영하는 HRV의 인자에 영향을 미치지 않는 것으로 결과가 나타난 것이지만, 향후 더 많은 환자를 대상으로 한 연구가 진행되어야 할 것이다.