• 생물정신의학
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• 제1권1호
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• pp.40-59
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• 1994

The introduction of lithium salts for the treatment of mood disorder by Code in 1949 was a major therapeutic breakthrough. Yet it is far from the universal therpeutic agent in the treatment of mood disorders. Indeed, some acutely manic patients do not respond adeqately to lithium and some individuals experience breakthrough affective episodes during lithium maintenance. In the last decode, it has become c1ear that a significant number of patients with more highly recurrent disorders may require alternative or enhanced forms of prophylactic treatment. For these reasons, a variety of other drugs hove been employed for the treatment and prophylaxis of mood disorders. Efforts to develop new pharmacologic strategies for mood disorder hove included a diverse array of medications, ranging from potent benzodiazepines to novel neuroleptics and from anticonvulsants to calcium channel blockers. The anticonvulsants appear particularly useful in cases of dysphoric mania and rapid cycling state, subforms of bipolar disorder that respond quite poorly to conventional treatments. Among all of these new pharmacologic strategy, carbamazepine and sodium valproate have received the broadest clinical applications as maintenance therapies. The data documenting the short-term antimanic effectiveness of the calcium channel blocker verapamil and benzodiazepins such as clonazepam and lorazepam appear also promising. A number of other theoretically interesting, as well as clinically relevant therapies, which are not presently employed routinly, hove also been studied, including 2 blocker clonidine, atypical antipsychotic clozapine, cholinomimetics, 5-HT enhancers, thyroid and magnesium preparations. Now prophylaxis in mood disorder remains a considerable therapeutic challenge. Controlled testing of the prophylactic efficacy of compounds such as carbamazepine, valproic acid, and the calcium channel blockers represent important next step in the clinical trials for mood disorder.

• 생물정신의학
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• 제3권2호
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• pp.262-268
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• 1996

It has been known that clozapine is more selective mesolimbic dopamin $D_2$ receptor antagonist and related to 5-HT receptor. In this study, we wxamined the plasma homovanillic acid(HVA), serotonin(5-HT), and 5-hydroxyindoleacetic acid(5-HIM) levels in refractory schizophrenics during clozapine treatment. And we assessed the effects of clozapine on these plasma monoamine metabolites and their association with psychopathology and treatment response. Eight refractory schizophrenic patients(DSM-IV) have entered the study for 3 months during clozapine treatment. Patients were admitted to the inpatient sevice and withdrawn from all neuroleptics for 7-14 days but exceptionally occasional doses of lorazepam was given if needed for behavioral control. The dose of clozapine was titrated as tolerated to 800mg/day. The plasma HVA. 5-HIM and 5-HT levels were measured before treatment and following 2nd week, 4th week, 8th week, and 12th during treatment. Psychopathology was assessed with Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Synrome Scale(PANSS) before and during clozapine treatment. During clozapine treatment, no statistically significant changes were found in plasma HVA, 5-HIM, 5-HT levels, and HVA/5-HIM ratio between baseline and following 2nd week, 4th week, 8th week, 12th week. However, the change in plasma 5-HIAA/5-HT ratio from baseline to 4th week was statistically significant. Generally, changes of plasma HVA, 5-HIAA, 5-HT levels and HVA/5-HIAA ratio were not associated with psychopathology but 5-HIAA was associated with in positive symptoms and general psychopathology of PANSS. These results suggest that clozapine has been found to have relatively weak dopaminergic blokade and stronger serotonergic antagonism.

• 한국환경보건학회지
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• 제9권2호
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• pp.55-65
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• 1983

This survey was carried out to investigate the pattern of taking psychotropic drugs for 618 cases who visited 48 drugstores located as such four types of areas as business sections, gay quarters, residential sections and quasi-industrial areas from May, 1982 to March, 1983. The results are summarized as follows: I. The age distribution: The age group of 20-29 showed the highest distribution covering 35.6% as 220 out of 618 cases. The age groups of thirties and forties covered 23.0% and 19.0% respectively. The sex ratio was estimated as 1:1.86. 2. The occupational distribution: The unemployees composed the largest portion covering 53.7% as 332 out of 618. Above all the class of the housewives was 32.7%. 3. The marital status: The degree of distribution was higher on the sides of the group of married people than that of single and its percentage was 30.1. 4. The educational level: Most of the people who purchased the drugs had no knowledge of the effect of the drugs, and they covered 80.9%. 5. As for the motives, the twenties took psychotropic drugs in order to relief insomnia and that was the biggest major motive at the portion of 59.1%, 130 out of 618. 6. The age group of twenties who took the drugs for about 6 months showed the highest percentage of 52.7%. 7. The highest distribution appeared in the case that takes one or two tablets a day for less than 6 months. 8. The dosage distribution by the number of times taking the drugs The group of people that took the drugs more than 3 to 4 tablets a day as the number of 1 to 3 times covered 41.7\ulcorner0 of 187. 9. The most favorite psychotropic drugs: Lorazepam was showed to be the most favorite drugs by either male or female covered 50.9o70, 54.2\ulcornero respectively. 10. The motives of selecting drugs: The optional motives of selecting psychotropic drugs were showed 269 (43.5%) out of 618 cases that chose the drugs for themselves.

• 대한한방내과학회지
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• 제39권5호
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• pp.1061-1067
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• 2018

A patient had central fever following pontine hemorrhage. Central hyperthermia caused by stroke is a rare case, and it is difficult to control. There are few case reports about central hyperthermia in Korean medical treatment (KMT). The patient suffered central hyperthermia accompanied by tachycardia, dyspnea, and irritability. However, there was no evidence of infection. Thus, hypnotics, sedatives, and a minor tranquilizer (Lorazepam and Midazolam) was prescribed. Despite a temperature peak of $39.9^{\circ}C$, most of the symptoms were alleviated. The patient's average body temperature was about $37^{\circ}C$, which is higher than most people at $36.5^{\circ}C$. His symptoms were diagnosed as ascendant hyperactivity of liver Yang (肝陽上亢), and the patient was prescribed Shihogayonggolmoryo-tang. During the 44 days of KMT, there was no change in his average body temperature and no central hyperthermia over $39^{\circ}C$. This case report demonstrates the possibility of controlling central hyperthermia caused by pontine hemorrhage using KMT.

• 대한한방소아과학회지
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• 제21권3호
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• pp.189-203
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• 2007

Objectives The prognosis, recurrence rate and treatment of febrile seizure were studied through the research of recent western medicine and Chinese oriental medicine paper. Methods Recent western medicine paper of internal and external and chinese oriental medicine paper from 1999 to 2007 were investigated. Results and Conclusions The prognosis of febrile seizure was good in most cases, but children with febrile seizure who developed epilepsy range between 2 and 10%. The risk factors developed epilepsy including complex febrile seizure, focal and prolonged seizure, pre-existing neurodevelopmental abnormalities and recurrent febrile seizure. Recurrence rate of febrile seizure ranges between 30 and 50% was high. The risk factors can be predicted by their age at first febrile seizure happened, family medical history of febrile seizure and epilepsy, complex febrile seizure, and neurodevelopmental abnormalities. However, the most important factor of those is the age when they have first febrile seizure. Diazepam or Lorazepam was administrated for a child with prolonged seizure but only Diazepam was used for reducing recurrence of febrile seizurein febrile illness. However, there were some side effects such as lethargy, ataxia, and irritability. The study of chinese oriental medicine demonstrates that the acupuncture and venesection were used for seizure attack and reduced of recurrences and second attack. To reduce recurrence of febrile seizure, herbal medicine was also used for febrile illness or after seizure attack within a certain period of time, so reduce the recurrence, frequency of seizure and febrile illness. The most of herbs in prescription were used for removing heat and toxic meterials(淸熱解毒), extinguishing wind and to stopping the convulsion(熄風止痙)

• 대한한방부인과학회지
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• 제35권3호
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• pp.56-73
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• 2022

Objectives: This study was aimed to review the effect of acupuncture for insomnia in climacteric syndrome. Methods: Researchers searched data through 5 online databases up to December 2021. The data was limited to randomized controlled trial studies on patients diagnosed with insomnia in climacteric syndrome. Results: 8 Randomized controlled trials were included in this study. 6 of studies were published in Chinese, in China. 2 were published in English. Intervention of treatment group were composed of simple acupuncture. Intervention of control group were made up with Estazolam, Alprazolam, Lorazepam and sham-acupuncture. Outcome measurements were Total effective rate, Pittsburgh Sleep Quality Index (PSQI), Kupperman index, Menopause Quality of Life scales (Men-QoL), the level of hormones (E2, FSH, LH) etc. In all outcome measurements, treatment group were more effective than control group and it was statistically significant. Conclusions: Acupunture therapy is effective for treating insomnia in climacteric syndrome. Pittsburgh Sleep Quality Index (PSQI) is most frequently used for sleep assessment indicator. 神門 (HT7) is the most frequently used acupoint for treatment group. However because insomnia in climacteric syndrome is easy to recur, additional long-term research is needed.

• Pediatric Infection and Vaccine
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• 제31권1호
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• pp.147-152
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• 2024

기저 질환 없이 평소 건강하던4세 남아에서 COVID-19와 연관된 열성 경련이 발생하였다. SARS-CoV-2 양성으로 확인되어 음압격리병동에 입원한 당일 발열과 함께 25분간 전신 간대성 발작이 있었고 산소흡입, 항경련제 투여 후 소실되었다. 말초혈액, 혈액화학, 전해질, 혈액기체분석, 급성기반응물질, 면역혈청, 특수화학 검사 결과들은 참고치 내에 있었으나, 소변검사에서 케톤이 검출되었다. 가슴X선 영상검사에서 활동성 폐병변이 관찰되지 않았고, 뇌파 검사에서 이상 소견 없었다. 뇌 자기공명영상 검사에서 뇌실질 내외의 병변은 없었다. 발작은 재발하지 않았고 입원 12병일째 퇴원하였으며 신경학적 후유증은 없었다.

• The Korean Journal of Pain
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• 제6권2호
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• pp.231-236
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• 1993

Clonidine, a centrally-acting antihypertensive agent known to reduce central sympathetic outflow and modulate presynaptic transmitter's release, has shown to suppress central noradrenergic hyperactivity induced by immobilization stress in animals, by decreasing the MAC of halothane and the dose of narcotics required to prevent reflex cardiovascular response to noxious stimuli, and to have potent analgesic properties in humans. These characteristics suggest that clonidine might be a useful adjunct to the anesthetic management of patients with preexisting hypertension. Accordingly, we determined the clinical efficacy and safety on analgesia, sedation and hemodynamic stability in the perioperative period. Thirty patients(ASA physical status II-III) with a history of arterial hypertension, scheduled for elective orthopedic surgery were randomly assigned to two groups. We applied CPA-clonidine patch($6.9\;mg/cm^2$, 0.2 mg delivered daily) or placebo patch to each groups, 48 hours prior to induction of anesthesia. Antihypertensive medication was continued until the morning of the scheduled surgery. All patients received premedication of atropine and lorazepam, and induced anesthesia with thiopental and succinylcholine, and maintained with enflurane and 50% nitrous oxide, while sustaining the BP and pulse rate at acceptable range. For the relief of pain postoperatively, diclofenac and fentanyl were administered intramuscularly on demand. The results were as follows: 1) The change of hemodynamic responses in clonidine group was less compared to the placebo group. 2) Intraoperative anesthetic requirement for enflurane in clonidine group were significantly lower than placebo group. 3) Postoperative analgetic requirement in clonidine group were significantly lower than placebo group. In clonidine group, 5 cases out of 15 cases were required no analgetics, and the incidence of administration of additional fentanyl was decreased to 5 cases, comparing with 10 cases in placebo group.

• 약학회지
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• 제52권2호
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• pp.137-146
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• 2008

Even though driving under the influence of drug (DUID) is a worldwide problem, we, Korea has no regulation system yet except for alcohol, and there are little cases reported related to DUID. In order to investigate the type of abused drugs for drivers in Korea, we tried to analyze controlled and non-controlled drugs in alcohol-positive blood samples. 275 whole bloods, which were positive for alcohol on the roadside test, were collected from the police for two months ($Nov.{\sim}Dec.$ 2006). The analytical strategy was constituted of three steps: First, alcohol in blood samples were confirmed and quantified by gas chromatography. Second, controlled drugs were screened by $Evidence_{investigator}\;^{TM}$ (Randox, U.K.) as preliminary test. It was based on immunoassay by biochip array analyzer. Nine groups of drug abuse were screened: amphetamines, methamphetamines, cannabis, cocaine, opiates, barbiturates, methadone, benzodiazepines I (oxazepam) & II (lorazepam). Finally, confirmation of these drugs was performed by GC-MS. Blood samples were extracted by solid-phase extraction by $RapidTrace^{TM}$ (Zymark, U.S.A.). After trimethylsilyl (TMS) derivatization, eluates were analyzed to GC-MS. Total 49 drugs were investigated in this study including controlled drugs, antidepressants, 1st generation antihistamines, dextromethorphan, nalbuphine, ketamine, etc. For rapid detection, we developed the automated identification system. It was made up a new software, "DrugMan", modified Chemstation data analysis menu and newly developed macro modules. A series of peak selection, identification and reporting of the results were performed automatically by this system. Concentrations of alcohol in 275 blood samples were ranged from 0.011 to 0.249% (average, 0.119%). Among 149 blood samples, just six samples (4.0%) were showed positive results to the immunoassay: one methamphetamine and five benzodiazepines group I. By GC-MS confirmation, only benzodiazepines were detected and methamphetamine was not detected from immunoassay positive blood sample. Besides these drugs, 5 chlorpheniramines, dextromethorphan, diazepam, doxylamine, ibuprofen, lidocaine and topiramate were also detected in whole bloods by GC-MS. Conclusively, the frequency of drug abuse for Korean drivers was relatively low. There was none case which illegal drug was detected. However these results were limited to alcohol positive blood samples, so it is necessary to analyze more samples including alcohol negative blood.

• Journal of Hospice and Palliative Care
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• 제19권2호
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• pp.119-126
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• 2016

목적: 본 연구의 목적은 섬망이 있는 말기암환자에 있어 진정제의 투약 투약 관련 특성을 파악하고, 진정제 투약군과 비투약군 간의 생존기간의 차이를 확인하기 위함이다. 방법: 본 연구는 2012년 1월부터 2013년 12월까지 B 광역시 소재 P대학교병원에서 응급실과 수술실, 중환자실을 제외한 병동에서 임종한 암환자 900명 중 경과기록지, 간호기록지를 통해 섬망선별 도구인 Nu-DESC를 이용하여 섬망이 있었던 말기암환자 240명을 대상자로 선정하였다. 투약기록지를 통해 진정제인 haloperidol, diazepam, lorazepam을 정맥 또는 근육주사로 규칙적이거나 필요 시 투여한 횟수를 조사하였다. 결과: 연구 대상자의 섬망기간은 최소 1일에서 최대 61일까지 나타났고, 중앙값은 5일이었다. 연구 대상자에게서 나타난 섬망 특성은 부적절한 행동이 35.0%로 가장 많았다. 연구 대상자의 연령(F=3.96, P=0.021), 원발암의 종류(F=3.31, P=0.010), 항암치료 여부(t=-3.44, P=0.001)에 따른 섬망기간이 유의한 차이가 있었다. 연구 대상자가 진정제를 복용한 경우는 72.1%이었고, 투약된 진정제의 종류는 haloperidol이 59.6%로 가장 많았다. 진정제 투약군의 생존기간은 평균 16.85일, 비투약군은 9.37일로 나타났으나 이는 통계적으로 유의하지는 않아(t=1.766, P=0.079) 진정제 투약이 생존기간에 영향을 미치지는 않았다. 결론: 말기암환자의 섬망 발생 시 진정제 투약이 생존기간에 미치지 않았다. 이러한 결과를 바탕으로 생명단축의 윤리적 문제로 인해 진정제 사용을 꺼려하기 보다는 증상완화를 위한 진정제 치료를 적극적으로 권유할 수 있다. 또한 섬망은 가족이나 의료진과의 의사소통 장애를 유발할 뿐 아니라 환자나 가족들에게 스트레스로 작용하며 돌봄에 대한 부담감을 가중시키므로, 적절한 진정제의 투여는 말기암환자와 가족의 안위를 위해 적극적으로 추천하는 바이다.