• 대한임상독성학회지
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• 제12권2호
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• pp.54-62
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• 2014

Purpose: The purpose of this study was to compare prescription patterns and clinical features according to clinical departments in sedative-hypnotic intoxication. Methods: This was a retrospective study of histories, substances of poisoning, acquisition routes, clinical courses, and outcomes of patients treated for acute intoxication in a single emergency medical center from January, 2011 to December, 2013. Results: A total of 769 patients were treated for acute intoxication, 281 patients ingested sedative hypnotics during the study period. Among 281 patients, 155 patients were prescribed by psychiatric department and 80 patients were prescribed by non-psychiatric department. Benzodiazepines were more likely to be prescribed by psychiatrists, and zolpidem was preferred by non-psychiatrists (p<0.001). Non-psychiatrists were more likely to prescribe short acting benzodiazepines than psychiatrists (p<0.001). However, there was no statistically significant difference in the clinical outcomes, including prevalence of admission to ICU, ventilator care, and length of stay in ICU. In patients prescribed by non-psychiatrists, there were more patients prescribed without psychiatric diagnosis and diagnosed as major depression disorder after hospitalization. Conclusion: To promote rational prescribing of sedative hypnotics, proper psychiatric evaluation should be performed before prescribing, and educational programs including the contents of interactions and side effects of sedative hypnotics are needed.

• 정신신체의학
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• 제28권2호
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• pp.116-125
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• 2020

연구목적 자살시도로 응급실에 내원한 환자들 중 음독이 가장 높은 빈도를 보이고 있다. 본 연구에서는 음독 의약품에 따른 자살 시도자들의 특성을 분석하여 향후 임상 진료 현장에서 도움이 될 제언과 자살 예방 정책을 마련하는데 기초자료를 제공하고자 하였다. 방 법 2011년부터 2019년까지 서울 소재 1개 종합 병원 응급실에 음독 자살 시도 후 내원한 환자 574명의 의무기록을 후향적으로 검토하였다. 의무기록을 통해 인구통계학적 정보 및 자살 과거력, 정신건강의학과 과거력, 정신질환 외 기저질환력, 음독 약물의 종류 및 양, 획득 경로, 단일 혹은 혼합 음독여부 등에 대해서 조사 후 카이제곱 검정 및 독립표본 t-검정을 사용하여 통계 분석하였다. 유의한 결과에 대해서는 위험률 산출을 위해 오즈비를 구하였다. 결 과 일반의약품 음독군이 전문의약품 음독군에 비해 연령은 유의하게 낮았으며 국민건강보험 외 비율은 낮고 배우자가 있는 비율은 유의하게 높았다. 전문의약품 음독군은 일반의약품 음독군에 비해 비자발적 응급실 내원, 정신질환력 및 정신질환 외 기저질환력에서 높은 비율을 보였다. 전문의약품 중 벤조디아제핀 음독군은 비음독군에 비해 본인 처방 비율이 높은 반면 졸피뎀 음독군은 타인처방 비율이 높았다. 벤조디아제핀, 졸피뎀, 항우울제 단독 음독군이 복합 음독군에 비해 유의하게 정신질환력이 없는 비율이 높았다. 결 론 일반의약품 판매 규제에 대한 가이드라인이 필요할 것이며 임상 현장에서 자살 고위험군의 특성을 유념한 면담이 필요하다. 또한 자살 위험성이 높은 환자들에게 전문의약품 처방 시 추적 관찰 기간 및 처방 기간, 포장 방식에 대한 적극적인 고려가 필요할 것으로 보인다.

• 수면정신생리
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• 제26권2호
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• pp.86-103
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• 2019

목 적 : 본 연구는 대한수면의학회로부터 수면에 대한 전문가로 구성된 집단을 모집하여 델파이 기법을 통해 수면진정제의 안전사용지침을 개발하고자 한다. 방 법 : 대한수면의학회 소속 수면 전문가 15인을 모집하였으며, 전문가들을 대상으로 웹 기반의 3차 델파이 조사를 시행하였다. 첫 델파이 조사는 39개의 문항으로 구성되었으며 한국에서 수면진정제 사용의 문제점을 환기하고, 안전사용지침에 포함되어야 할 항목들에 대한 조사를 시행하였다. 두번째 델파이 조사는 21개의 문항으로 구성되었으며 수면진정제 처방에 있어서 임상적으로 중요한 문제들에 대한 구체적인 의견을 수집하였다. 세번째 델파이 조사는 Likert 척도를 이용하여 1, 2차 조사를 통해 도출한 수면진정제 안전사용지침에 대한 의견 동의율을 구하고 이를 바탕으로 수면진정제 안전사용지침을 개발하였다. 결 과 : 17개 항목에 대한 전문가들의 의견 동의율이 중앙값 4점 이상이었으며 평균 4.12, 표준편차 0.32를 보였다. 본 연구를 통해 개발된 수면진정제 안전사용지침은 수면진정제의 처방, 유지, 그리고 감량 및 중단에 대한 총 13개의 지침을 제안한다. 결 론 : 증가하는 불면증 환자와 수면진정제 처방에도 불구하고 한국 임상 현실에 맞는 안전사용지침이 부재하였는데, 본 연구를 통해 개발된 수면진정제 안전사용지침을 통해 한국 임상에서 수면 비전문가들이 수면진정제를 처방할 시에 안전하고 효과적인 처방을 위해 유용하게 사용될 수 있을 것이다.

• 동의신경정신과학회지
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• 제20권3호
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• pp.65-88
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• 2009

Objectives : There has not been the comparison research of medication on the Insomnia as the complementary significance of the Oriental-Western Cooperative Therapeutic Viewpoint so far. The aim of this preliminary research is to study Eastern and Western Medication Model for the Insomnia through the comparison of Oriental Medication based on "Sang Han Lon" and "Dong yui bo gam". Methods : The author researched oriental-western viewpoints and the present treatment condition of Sleep and Sleeping Pills with reference to Korean articles issued since 1975, dissertations, journals registered or candidated on KCI, alternative medicine journals on Pubmed, and books concerning Neuropsychiatry. In the field of Oriental medical study, this study was demonstrated on "The Oriental Medical textbook of neuropsychiatry", "Sang han lon", "Dong yui bo gam" and the present research trend. Results : In Oriental Medicine, Insomnia is treated according to si-jie-bu-shui-zung (思結不睡證) type, rong-xie-bu-zu-zung (榮血不足證) type, yin-her-nae-re-zung (陰虛內熱證) type, xin-dan-her-qie-zung (心膽虛怯證) type, dam-xian-yu-jie-zung (痰涎鬱結證) type, and wei-zhong-bu-he-zung (胃中不和證) type etc. In Western Medicine, Insomnia has been treated by Barbiturate over 60's and BZ over 70's. According to recent treatment on Insomnia, Zolpidem or Zaleplon, which is short-lived and has less side effects, is used much, and tri-cyclic antidepressants are prescribed on a chronic psycho-physiological insomnia. Conclusions : Generally, Insomnia is being treated by controlling whole ways. The oriental medication is less effective for sleep induction. On the contrary, that of western medication is very effective for sleep induction, but there are many possibilities of side effects. If this two mutual therapy is conducted cooperatively, more effective medical care might be expected. Therefore, it is considered that not only the oriental medical study for sleep induction, but the study of Oriental-Western Cooperative Therapy should be preceded to treat Insomnia from now on.

• 수면정신생리
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• 제23권2호
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• pp.77-83
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• 2016

목 적 : 본 연구는 1차 및 2차, 3차 의료기관에 종사하는 의사 102명을 대상으로 설문조사를 통해 불면증 환자의 치료 실태를 조사하고자 하였다. 방 법 : 총 102명의 정신건강의학과 및 타과 전공 의사들이 설문에 참여하였고, 분석에 포함된 설문조사 대상자는 100명이었다. 결 과 : 실제 치료 장면에서 가장 자주 사용되고 있는 치료는 약물학적 치료였으며, 수면위생 교육과 인지행동 치료 등의 비약물학적 치료도 시행이 되고 있는 것으로 나타났다. 그러나 비약물학적 치료를 시행하더라도 그 효과에 대한 만족도는 높지 않았다. 의사가 보기에 불면증 환자들의 비약물학적 치료에 대한 관심은 일정 수준 있는 것으로 나타났으나 이에 대한 식견이나 의식 수준은 아직 미흡한 것으로 보고되었고, 치료의 실행도 충분히 적절하게 이루어지고 있지는 않은 것으로 보고되었다. 본 연구에서는 추가적으로 의료진이 생각하는 불면증 환자의 적정 진료를 위해 요구되는 점에 대해서도 탐색하였다. 결 론 : 본 연구는, 치료적 개입에 대한 보다 구체적인 정보를 획득하지는 못했다는 점, 환자를 대상으로도 설문을 실시하지는 못했다는 점 등의 제한점을 지니고 있으나, 그럼에도 불구하고 불면증 치료의 개선과 변화를 위해 필요한 현황 조사를 면밀히 실시했다는 점에서 그 의의가 있다. 결론적으로 다수의 의사들이 불면증의 비약물학적 치료가 중요하다고 생각하고 있었으나 진료 현실에서 적용하기 힘든 부분이 있다고 보고하였다. 본 연구 결과는 불면증에 대한 적정 치료를 위해 비약물학적 치료를 위한 진료 여건 개선 및 의사대상 교육이 필요함을 제시하였다.

• 한국임상약학회지
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• 제22권4호
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• pp.304-315
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• 2012

Today, suicide by self-poisoning of prescribed or non-prescribed drugs on purpose has been increasing and is a major cause of mortality. It is very important to treat promptly and properly for saving the lives from those suicides. There is neither an organization such as poison control center nor measurement in S. Korea, though. The object of this study was to evaluate information of frequently used substances for suicide attempt in S. Korea. Our results also can provide healthcare provider including pharmacists and doctors, etc and contribute to increasing health and welfare for Korean. From June $1^{st}$ 2006 to April $30^{th}$ 2012, we retrospectively studied patients visiting emergency room due to suicide attempt. We collected information of underlying disease, history of past medical condition and suicide attempt, ingredient and getting route of ingesting substances, emergency treatment, and outcome by reviewing electronic medical record. We also evaluated actual treatment of self-poisoning and made guide information about antidote medication for S. Korean healthcare provider. Among total 242 cases of suicidal attempts, cases ingesting substances including prescription, non-prescription drugs and agricultural chemicals were 86.4%. The most frequently used drugs for suicide attempt were sedatives-hypnotics (53.6%), followed by analgesics (16.7%) and antidepressants (12.4%). Analgesics including acetaminophen and aspirin were most in teenagers but sedatives-hypnotics including benzodiazepines, non-benzodiazepine (zolpidem) and antihistamine were most in other ages including elderly people. Most frequently used antidote was activated charcoal (62.7%) and specific antidotes for some substances (acetaminophen, aspirin, agricultural chemicals) were also treated properly, accompanying with medication for supportive care. In conclusion, the most used substances for suicide attempt were sedatives-hypnotics and treatments for self-poisoning in emergency room were appropriate based on existing references. Therefore, information of frequently used substances and antidote reflecting these results will be useful for South Korean healthcare provider.

• 동의신경정신과학회지
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• 제30권4호
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• pp.341-355
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• 2019

Objectives: The purpose of this study was to check the therapeutic effect of the Dendropanax morbifera Pharmacopuncture for insomnia and cognition caused by psychosocial stress. Methods: We separated Wistar rats (older than age 10 weeks, 300 g) into normal, control, positive control (Zolpidem administered, PC), and Dendropanax morbifera Pharmacopuncture experimental groups (DPA). Psychosocial stress such as circadian rhythm change, clammy straw, predator stress, restraint stress, noise bursts, and flashing lights were applied to the control, PC, DPA groups. The Dendropanax morbifera Pharmacopuncture group was given 0.5×, 1× and 2× amount concentration of Dendropanax morbifera Pharmacopuncture, respectively. The levels of Melatonin, Serotonin, Corticosterone, GABA, BDNF and CREB were measured, and the Y-maze test, weight and blood test were performed. Results: In all of the DPA groups, the Melatonin level showed no noticeable difference. In the DPA-2x group, Serotonin increased significantly. In all the experimental groups, Corticosterone decreased significantly and GABA showed increasing tendency. The DPA-1x and DPA-2x groups showed remarkable increase in BDNF and DPA-0.5x and the DPA-2x groups showed significant increase in CREB. The DPA-2x group showed remarkable increase in the Alternation behavior category of the Y-maze test. In all of the experimental groups the weight change showed increasing tendency, whereas no noticeable differences were found among all experimental groups regarding AST, ALT, BUN, Creatinine and CBC. Conclusions: Dendropanax morbifera Pharmacopuncture increases levels of serotonin and GABA, decreases corticosterone, increases levels of BDNF and CREB, and increases the ratio of alternation behavior in the Y-maze test. Thus, I suggest that Dendropanax morbifera Pharmacopuncture has the effect of treating insomnia caused by psychosocial stress, activating the brain, and improving cognition.

• 동의신경정신과학회지
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• 제30권4호
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• pp.357-369
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• 2019

Objectives: This study was designed to examine the effect of Hominis Placenta Pharmacopuncture on the change in behavior, sleep-related hormones, inflammatory cytokines, anti-oxidants, weight, blood, and serum on rats given chronic physical stress. Methods: Wistar rats older than age 10 weeks were used in this experiment. They were divided into six groups. The normal group was not given stress. The control group was given only chronic physical stress and no treatment. The positive control group was given chronic physical stress and treated with zolpidem. Three Hominis Placenta Pharmacopuncture (HPP) groups were given chronic physical stress, then treated with different concentrations of HPP; HPP-0.5× (0.5 times diluted), HPP-1× (undiluted) and HPP-2× (2 times condensed). The changes of values of Nestlet Shredding results, weight, Melatonin, Gamma-aminobutylic Acid (GABA), Tumor Necrosis Factor Alpha (TNF-α), Interleukin-6 (IL-6), Superoxide dismutase (SOD), glutathione peroxidase (GPx), AST, ALT, BUN, Creatinine, and leukocytes were observed during the experiment. Results: The changes in chronic physical stress of the rat model were as follow. The Nestlet Shredding result increased in the control group compared to the normal group (p<0.05), and decreased in the HPP-1× and HPP-2× compared to the control group (p<0.05). The amount of weight gain showed increasing tendency in the HPP-2× compared to the control group since the second week. The GABA increased (p<0.05) and Melatonin also showed certain increasing tendency in the HPP-1× and HPP-2× compared to the control group. The TNF-α and IL-6 increased in the control group compared to the normal group (p<0.01), and decreased in all the HPPs compared to the control group (p<0.05). The SOD level decreased in the control group compared to the normal group (p<0.01), and increased in all the HPPs compared to the control group (p<0.05). GPx, AST, ALT, Bun, Creatinine and leukocytes showed no noticeable difference among all groups. Conclusions: Hominis Placenta Pharmacopuncture was effective in increasing weight, GABA, Melatonin, SOD, and decreasing Nestlet Shredding and inflammatory cytokines, suggesting that it consequently facilitates in relieving physical stress.

• 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.