• 생물정신의학
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• 제7권1호
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• pp.14-20
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• 2000

Recently atypical antipsychotics have been used as first line agent in the treatment of schizophrenia, and also played a significant role in the treatment of many kinds of psychiatric disorders. The pharmacokinetic and pharmacodynamic properties of these newer antipsychotics are well known through preclinical and early clinical trials. However, it is important to note the limitations of the results due to its relatively short experience. Clozapine is eliminated principally by the hepatic P450 1A2 and 3A4 cytochrome enzymes. 1A2 inducers such as carbamazepine and smoking can reduce its half-life, while 1A2 inhibitors such as SSRIs, especially fluvoxamine can increase its duration of action. Carbamazepine should be avoided in a patient on clozapine because of carbamazepine's potential effects on bone marrow. Benzodiazepines tend to increase the chances of sedation, delirium and respiratory depression. Risperidone is metabolized to 9-hydroxyriperidone by the hepatic P450 2D6 cytochrome enzymes. Fluoxetine and paroxetine, 2D6 inhibitors interfere with metabolism, but 9-hydroxyrisperidone has similar biological activity as parental drug, so it has little affect on the outcome. Olanzapine shows minimal capacity to inhibit cytochrome P450 isoenzymes and shows minimal chance of drug interaction. It is eliminated principally by the hepatic P450 1A2 and 2D6 cytochrome enzymes.

• 생물정신의학
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• 제2권1호
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• pp.57-62
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• 1995

항정신병 약물인 clozapine이 주로 작용하는 도파민 수용체로 알려진 도파민 $D_4$ 수용체는 각각 50 염기쌍에 해당하는 크기의 차이가 있음이 알려져 PCR을 이용해 정신분열증 환자와 정상대조군을 대상으로 도파민 $D_4$ 수용체 유전자의 대립형질 분포를 알아보았다. 정신분열증 환자군과 대조군 모두에 있어 여섯종류의 대립형질의 관찰되었으며 정신분열증 환자에서 네번 반복형태의 대립형질이 수적으로 더 많이 관찰되었지만 통계적으로 유의한 차이는 없었으며 정신분열증과 관련된 도파민 $D_4$ 수용체 유전자의 대립형질은 확인되지 않았다. 그러나 보다 객관적인 정보를 얻기 위해서 clozapine에 대한 반응에 따라 정신분열증 환자의 아형을 분류하고 그 아형에 따른 도파민 $D_4$ 수용체 유전자 대립형질분포의 차이에 관한검증이 필요하며, 나아가 도파민 $D_4$ 수용체 유전자의 발현에 있어 정신분열증 환자와 정상인에 차이가 있는지 여부를 밝히는 추적연구가 필요할 것으로 사료된다.

• 한국산학기술학회논문지
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• 제17권1호
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• pp.152-158
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• 2016

글루탐산염(Glutamate)은 척추동물의 중추신경계에서 중요한 흥분성 신경전달물질 중의 하나이다. 글루탐산염의 대사를 조절하는 사람 글루탐산염 탈수소 효소(hGDH)는 정신분열증(schizophrenia) 환자의 대뇌에서 발현이 증가한다는 연구들이 있었다. 본 연구에서는 정신분열증과 연관된 항정신성약물인 haloperidol, risperidone, (${\pm}$)-sulpride, chlopromazine hydrochloride, melperone, (${\pm}$)butaclamol, domperidone, clozapine에 의한 hGDH의 효소활성변화를 확인하고자 하였다. 우선, 유전자 재조합을 통해 hGDH 동종효소 hGDH1, hGDH2를 합성하였다. 합성된 hGDH1과 hGDH2에 대한 항정신성약물의 억제효과를 효소검사법(enzyme assay)을 통해 확인한 결과, haloperidol, (${\pm}$)-sulpride, melperone, clozapine에 의해 hGDH1과 hGDH2의 효소활성이 억제되었다. 또한, 단백질 인산화 효소 측정법(kinase assay)을 하여 haloperidol이 기질인 알파-케토글루타르산에 대하여는 비경쟁적 저해반응(noncompetitive inhibition)을, NADH에 대하여서는 반경쟁적 저해반응(uncompetitive inhibition)이 나타는 것을 확인하였다. 입체성 다른 자리 작동체(allosteric effector)인 L-leucine이 다른 정신병치료제에서는 hGDH2의 억제를 회복시켰지만 오직 haloperidol에서는 효소의 활성이 회복되지 않았다. 따라서 본 연구는 hGDH1과 hGDH2 에서 항정신성약물에 의한 효소활성 억제를 비교하여 확인하였으며, 중추신경계에서 haloperidol이 GDH 활성 조절과 함께 글루탐산 농도를 조절할 수 있다는 가능성을 제시한다.

• 대한조현병학회지
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• 제22권2호
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• pp.21-33
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• 2019

Objectives: The current study covers a secondary revision of the guidelines for the pharmacotherapy of schizophrenia issued by the Korean Medication Algorithm for Schizophrenia (KMAP-SCZ) 2001, specifically for co-existing symptoms and antipsychotics-related side-effects in schizophrenia patients. Methods: An expert consensus regarding the strategies of pharmacotherapy for positive symptoms of schizophrenia, co-existing symptoms of schizophrenia, and side-effect of antipsychotics in patients with schizophrenia was retrieved by responses obtained using a 30-item questionnaire. Results: For the co-existing symptoms, agitation could be treated with oral or intramuscular injection of benzodiazepine or antipsychotics; depressive symptoms with atypical antipsychotics and adjunctive use of antidepressant; obsessive-compulsive symptoms with selective serotonin reuptake inhibitors and antipsychotics other than clozapine and olanzapine; negative symptoms with atypical antipsychotics or antidepressants; higher risk of suicide with clozapine; comorbid substance abuse with use of naltrexone or bupropion/varenicline, respectively. For the antipsychotics-related side effects, anticholinergics (extrapyramidal symptom), propranolol and benzodiazepine (akathisia), topiramate or metformin (weight gain), change of antipsychotics to aripiprazole (hyperprolactinemia and prolonged QTc) or clozapine (tardive dyskinesia) could be used. Conclusion: Updated pharmacotherapy strategies for co-existing symptoms and antipsychotics-related side effects in schizophrenia patients as presented in KMAP-SCZ 2019 could help effective clinical decision making of psychiatrists as a preferable option.

• 대한임상약리학회:학술대회논문집
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• 대한임상약리학회 1994년도 정기총회 및 추계학술대회
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• pp.24-24
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• 1994

• 생물정신의학
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• 제4권2호
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• pp.162-167
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• 1997

There is no doubt that dopamine plays a critical role in the etiopathogenesis of schizophrenia. However, there appeared some limitations in explaining the complex phenomena of schizophrenia. Recent research data suggest that dysfunction in serotonergic system may be involved. Before the dopamine hypothesis of schizophrenia became established, the interest in serotonin(5-hydroxytryptamine, 5-HT) as an etiological substrate of this illness occurred. Recently the importance and extent of 5-HT's involvement in the pathophysiology and mechanism of action of antipsychotic drug is actively investigated. In recent years, therapeutic success of clozapine and risperidones has increased attention on the interaction between the 5-HT and dopamine systems in schizophrenia. This led to the concept of serotonin-dopamine antagonist for antipsychotics. The authors review the evidence for the role of 5- HT in schizophrenia and serotonin-dopamine interaction.

• 생물정신의학
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• 제3권1호
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• pp.22-29
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• 1996

The introduction of chlorpromazine in the 1950's revolutionized the treatment of schizophrenia and ultimately led to the development of selective $D_2$ antagonists such as haloperidol, a goal in keeping with the prevalent theories at that time. However, limitations in the efficacy of these agents, a growing awareness of their side effects, and theoretical shifts in our understanding of schizophrenia have encouraged ongoing efforts to develop better 'atypical' antipsychotics. Clozapine, and subsequently risperidone, represent examples of these novel compounds, both of which incorporate shared serotonin-dopamine antagonism(SDA). The next years will be dominated by further development of SDA compounds, although a number of other lines of investigation are also being pursued.

• 대한조현병학회지
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• 제23권2호
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• pp.45-50
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• 2020

Schizophrenia is one of serious mental illnesses and is often described as a heterogeneous disorder. Approximately one-third of schizophrenia cases are treatment-resistant schizophrenia (TRS). The aim of this study was to review the definitions and clinical features of TRS. Though it was found that the criteria for TRS were considerably diverse, the Treatment Response and Resistance in Psychosis (TRRIP) consensus criteria were recently introduced. According to the TRRIP criteria, TRS should be suspected if symptoms persist alongside psychotic symptoms despite sufficient treatment for ≥12 weeks, or two or more symptoms persist significantly for ≥6 weeks. The clinical characteristics of TRS includes an earlier age of onset, more severe and familial form, possibly more rural residence, unlikely association with male sex, and an increase in cognitive deficits.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제28권2호
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• pp.132-140
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• 2017

Objectives: Very early-onset schizophrenia (VEOS) is a type of psychosis having a low frequency, insidious onset, and devastating clinical outcome. In this study, the demographic features, information on medication, clinical outcomes, and intellectual capability of patients diagnosed with VEOS in a hospital were analyzed to provide therapeutic strategies for this type of schizophrenia. Methods: Using the electronic medical records of the National Center for Mental Health, 69 patients with VEOS were identified based on the DSM-5 criteria of schizophrenia. The data were summarized and analyzed according to the demographic characteristics, medications used, intellectual strength measured by the full intelligence quotient (FIQ) score, and current clinical status measured by the Clinical Global Impression-Severity (CGI-S) and various combinations of these parameters. Results: The screened study group contained similar numbers of males and females. The younger the onset of psychosis, the lower the frequency. The study population included a significantly higher proportion of births in the winter season than that of the general population. The 3 most frequently used antipsychotic medications were risperidone and its derivatives, clozapine and olanzapine. Valproic acid and divalproex sodium were the most commonly added drugs for outcome augmentation. 53.5% of the study population had received benzodiazepines and/or hypnotics. The average FIQ of the study population was 69.4, which is quite low compared to previous Korean studies with similar populations. There was a weak negative correlation between FIQ and CGI-S, but it was not statistically significant. The average CGI-S score was 4.2, which meant that the patients were moderately ill. Conclusion: This study demonstrated that patients with VEOS showed more frequent intellectual deficits at baseline and poorer outcomes than the control group. Risperidone, clozapine, valproic acid and their combinations were the most preferred medications for the treatment of psychosis. Benzodiazepines were quite commonly added for various reasons.

• 핵의학기술
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• 제16권2호
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• pp.106-109
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• 2012

최근 늘어나는 [$^{18}F$]FDG-PET 검사 증대와 더불어 새로운 방사성의약품으로 [$^{11}C$]아세테이트 검사가 신설되고 다양한 연구용 $^{11}C$-표지 방사성의약품 이용이 증대되고 있다. 본 연구에서는 성공리에 수행한 한국형 사이클로트론의 $^{11}C$-표적시스템을 이용하여, $[^{11}C]CO_2$ 생산 최적화 및 임상에서 사용가능한 $^{11}C$-표지 방사성의약품 생산 적용 연구를 수행하였다.