• 대한불안의학회지
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• 제11권2호
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• pp.143-148
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• 2015

Objective : This study examined benzodiazepine prescription patterns of outpatients visiting the psychiatry department in a single general hospital in Korea. Methods : A retrospective descriptive analysis of benzodiazepine prescriptions was performed on a database from 2014 in a general hospital in Korea. We analyzed the following factors of adult outpatients: demographic factors such as sex and age, amount of benzodiazepine prescribed, treatment duration, and diagnosis based on the ICD-10. Results : In 2014, benzodiazepines were prescribed to 46.4% of the outpatients. Percentage of benzodiazepine prescription increased with age and was highest in the age group 40-59 years. Prescription was more prevalent in women and the prescription percentage increased by treatment duration. Patients with the F4 diagnosis (neurotic, stress-related and somatoform disorders) were the most highly prescribed group. For all diagnosis groups, prescription was more prevalent in females or similar for both sexes except for patients with F5 diagnosis (behavioral syndromes associated with physiological disturbances and physical factors), with males being more predominant. Conclusion : Despite the concern regarding the rate of benzodiazepine prescription and administration to geriatric patients, long-term prescription and usage among older patients is still prevalent.

• 대한불안의학회지
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• 제5권2호
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• pp.75-79
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• 2009

In this article, we review the efficacy of early interventions after traumatic incidents and during acute stress disorder (ASD). There are some evidences that psychopharmacological medications such as propronolol, morphine, and hydrocortisone are effective in the prevention of posttraumatic stress disorder (PTSD). Considering the role of selective serotonin reuptake inhibitors in hippocampal neurogenesis and an animal model of PTSD, early administration of selective serotonin reuptake inhibitors is also fairly promising. Other pharmacological treatments including benzodiazepines did not treat ASD nor prevent PTSD. There are good evidences that cognitive behavioral therapy including cognitive therapy and prolonged exposure is a valuable intervention for ASD and the most effective prevention for PTSD. No contolled researches on eye movement desensitization&reprocessing, psychodynamic psychotherapy and hypnotherapy have performed. Recent randomized controlled studies using psychological debriefing did not prove as a useful intervention for the prevention of PTSD until now, although the efficacy of debriefing has been at the centre of controversy.

• 대한족부족관절학회지
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• 제23권3호
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• pp.131-134
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• 2019

Stiff-person syndrome is a rare disorder, and the natural history of the syndrome has not been completely ascertained. The symptoms range from mild to severe and can progress over time: the final result can be significant disability. However, this syndrome is often misdiagnosed due to a lack of understanding of the clinical manifestations. We report the case of a patient who presented with slowly progressing gait disturbance and lower extremity pain and was later diagnosed as suffering from stiff-person syndrome. The patient experienced symptomatic improvement after the administration of benzodiazepines. No recurrence of symptoms has been reported. If the characteristic clinical features and electromyography findings of the syndrome are accurately interpreted, diagnosis of patients with abnormal muscle tension can be effectively done.

• 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.

• 한국임상약학회지
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• 제29권1호
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• pp.25-32
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• 2019

Objective: South Korea made a list of potentially inappropriate medications (PIMs) for elderly patients in 2015 and has prompted medical professionals to prescribe proper medication by using the drug utilization review (DUR) system. It has been three years since the system was introduced, but related studies have rarely been conducted. This study aimed to evaluate the effect of the DUR system on the prescription of PIMs for elderly patients. Methods: The data on the prescription of PIMs for elderly patients (${\geq}65$ years) who received medical treatment between March 1st and May 31st in 2015 (before introduction of the DUR system) and who received medical treatment between March 1st and May 31st in 2018 (after introduction of the DUR system) were retrospectively collected from electronic medical records. Results: The prescriptions of PIMs decreased from 3,716 (7.7%) to 3,857 (6.9%) (p < 0.001). The prescription of escitalopram and paroxetine, among selective serotonin reuptake inhibitors, increased significantly, and that of short-acting benzodiazepines also increased significantly from 454 (0.93%) to 624 (1.2%). Conclusion: Prescription of PIMs for elderly patients significantly decreased (p < 0.001) after the DUR system was introduced. Further expanded studies of PIMs need to be conducted for the safety of elderly patients.

• 정신신체의학
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• 제31권1호
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• pp.19-24
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• 2023

Objectives : Biofeedback is a useful non-pharmacological treatment for panic disorder (PD), but no studies have identified physiological markers related to the treatment response. This study investigated predictors of the treatment response for biofeedback in patients with PD. Methods : A retrospective study based on the electronic medical records of 372 adult patients with PD was performed. Patients received biofeedback treatment at least once, and physiological markers including heart rate, heart rate variability, respiratory rate, skin conductance, skin temperature, and electromyography were collected before the treatment began. The patients were classified as responders or non-responders based on the change in Clinical Global Impression-Severity (CGI-S) score. Results : The response rate to biofeedback treatment was 30.4%. Multivariable logistic regression analysis revealed that a higher CGI-S score at baseline and fewer benzodiazepine prescriptions were associated with a better response to biofeedback treatment. According to subgroup analyses, the baseline CGI-S score, dose of benzodiazepines, and skin conductance are candidate predictors of the response to biofeedback treatment in men, while only baseline disease severity was associated with the treatment response in women. Conclusions : The present results suggest that skin conductance may be target marker and predictor for biofeedback in male patients with PD.

• 대한임상독성학회지
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• 제14권2호
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• pp.92-99
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• 2016

Purpose: The use of flumazenil administration in the emergency department is still controversial because of concerns about adverse effects. The present study was conducted to re-evaluate the risk-benefit ratio associated with flumazenil administration to patients suspected of having acute hypnotics and sedatives poisoning in the emergency department. Methods: A retrospective chart review study was conducted for patients whose final diagnoses were "poisoning" and "benzodiazepine" or "sedatives-hypnotics" from Mar. 2006 to Feb. 2015. The basal characteristics of the patients, including past medical history, ingredients and dose of ingested drug and co-ingested drugs were investigated. For patients administered flumazenil, responsiveness and time from admission to flumazenil administration were investigated with supplement. All collected data were analyzed in aspect terms of risk/benefit. Results: A total of 678 patients were included in our study. Benzodiazepine was the most common sedative/hypnotic drug prescribed, and the frequency of prescription continuously increased. The proportion of TCA as co-ingestion decreased from 13.1% to 3.9% in patients with acute sedative/hypnotic poisoning. Flumazenil was administered to 55 patients (8.1%), of which 29 patients (52.7%) were applied to contraindications. Fifty-three patients (96.4%) showed positive responsiveness, including partial responsiveness after flumazenil administration. No severe adverse events were identified. Conclusion: Based on the current trends in prescription patterns for sedative/hypnotic drugs, increased use of non-TCA antidepressants, and responsiveness to administration of flumazenil, benefit seemed weighted more in this study, although the observed benefits were based on limited results. Further prospective multicenter studies will be needed to optimize benefit-risk ratio.

• 한국임상약학회지
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• 제25권4호
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• pp.254-263
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• 2015

Objectives: The present study assessed the prevalence of the potentially inappropriate medication (PIM) use in Korean elderly patients with Parkinson's disease. In addition, this study examined risk factors that affect PIM use. Method: A retrospective, observational study was conducted using Korean National Health Insurance claims database of 2009. PIM use in Parkinson's disease patients aged 65 years or older was examined based on 2012 Beers Criteria. Multivariable logistic regression was conducted to identify risk factors for PIM use. Results: Among 5,277 elderly patients with Parkinson's disease, 88.9% of patients used PIM(s) at least once. The average number of PIM items used per patient was 4.2. PIM use ratio, the proportion of total amount of PIMs to all medications per patient, was 12.6%. Frequently used PIM therapeutic classes were benzodiazepines (32.7%), first-generation antihistamines (19.2%), and prokinetics (17.5%). Individual PIMs most commonly used included chlorpheniramine (11.4%), levosulpiride (10.9%), diazepam (9.0%), and alprazolam (7.6%). Women (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.11-1.16), medical aid (OR 1.18, 95% CI 1.15-1.21), and long-term facilities (OR 2.43, 95% CI 2.22-2.65) were shown to be risk factors associated with PIM use. Of particular, wide variation in PIM use was associated with the types of healthcare facility. Conclusion: The PIM prevalence was very high in elderly Parkinson's disease patients. Nationally effective and systematic efforts to identify and prevent PIM use should be made to ensure patient safety and to improve quality of care in the elderly.

• 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.

• 대한소아치과학회지
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• 제25권4호
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• pp.811-824
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• 1998

The purpose of this study was to compare the clinical sedation effect of chloral hydrate and hydroxyzine combination, midazolam, triazolam when young children were sedated for dental treatment. The uncooperative 22 children aged, 25 to 52 months of age(ASA class I) and weighting between 11 and 17kg, participated in the study. Each patient was assigned randomly to receive chloral hydrate(50mg/kg) and hydroxyzine HCl(25mg), midazolam(0.5mg/kg), and triazolam(0.25mg) oral administration : alternative regimens were administered at next appointment. According to rating scale, sleep, crying, movement, and overall behavior response were checked for evaluation of the clinical sedation effect. Pulse rate and oxygen saturation were also measured for monitoring the patients during treatment period by pulse oximeter. The results were as follows: 1. In the evaluation of sedation effect, 90.9% in chloral hydrate and hydroxyzine combination and midazolam, and 77.3% in triazolam were rated "good" or "very good". 2. Sleep was demonstrated to be statistically significant increase in chloral hydrate and hydroxyzine combination group. Despite the fact that chloral hydrate and hydroxyzine group was in a deeper state of sleep, all the children were easily aroused. 3. There were no statistically significance among the three regimens with regard to cry ing, movement, overall behavior. 4. The adverse side effect was vomiting in one patient of chloral hydrate and hydroxyzine combination. There were no clinical sign of respiratory depression.