• 생물정신의학
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• 제2권1호
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• pp.77-90
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• 1995

The Purposes of this study were to examine plasma homovanillic acid(pHVA) levels and 5-hydroxyindoleacetic acid(pHIAA) levels in schizophrenics during haloperidol treatment, and to assess the association of pHVA and pHIM levels with their psychopathology and treatment responses. Fourteen patients entered the study and pHVA, pHIAA levels were measured at baseline, first week, second week and fourth week during treatment. Also, plasma haloperidol levels were measured at first week, second week and fourth week. Psychopathology was evaluated with Brief Psychiatric Rating Scale(BPRS) at baseline, 1st week, 2nd week and 4th week. 1) There were significant differences on the duration of illness and total BPRS scores at baseline between higher pHVA group(baseline pHVA level >7.72ng/mL) and lower pHVA group(baseline pHVA level <7.72ng/mL). 2) There was no significant difference on the duration of illness between higher pHIM group(baseline pHIAA level >3.18ng/mL). and lower pHIAA group(baseline pHIAA level <3.18ng/mL). 3) The Means of pHVA levels at 1 st week and 2nd week after treatment decreased significantly in the higher pHVA group and did not change in the lower pHVA group. 4) In the higher pHIAA group, the mean of pHIAA levels at 4th week after treatment decreased significantly, but did not change in the lower pHIAA group. 5) Between the higher pHIVA group and lower pHVA group, the response rates(percentile improvement) after treatment were not different from each other, but there was significant difference on the response rate between the lower pHIAA group and higher pHIM group at 2nd week. 6) There was significant correlation between total BPRS scores and pHVA levels in the higher pHVA group during treatment. The results suggest that repeated measurement of pHVA levels and pHIAA levels following antipsychotic treatment have prognostic significance for response. Also, shcizophrenics whose have relatively nigh levels of pHVA, or relatively low levels of pHIAA before treatment will show a favorable early responses to antipsychotics.

• 대한약리학회지
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• 제30권3호
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• pp.291-297
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• 1994

이 연구에서는 선조체에서 opioid 신경계와 dopamine 신경계의 상호 관계를 알아보기 위해서 morphine을 5m/kg, 20 mg/kg로 10일간 복강내 투여한 후 chlorpromazine, thioridazine, haloperidol, sulpiride, pimozide를 투여하였다. Opioid ${\mu},\;{\delta},\;{\kappa}$ 수용체의 binding의 변화를 관찰하고자 $[^3H]\;DAGO$, $[^3H]\;DPDPE$, 및 $[^3H]\;DPN$ binding assay를 하였으며, 그 결과 morphine (20 mg/kg) 장기 투여된 실험군에서 $[^3H]\;DAGO$, $[^3H]\;DPDPE$, 및 $[^3H]\;DPN$ 결합이 감소되었다. Morphine 20 mg/kg 장기 투여군에 chlorpromazine, thioridazine 주사시에는 morphine 5mg/kg 투여군에 비하여 $[^3H]\;DAGO$ 결합의 감소와, $[^3H]\;DPDPE$, 및 $[^3H]\;DPN$ 결합의 증가를 나타내었고, haloperidol 주사군은 $[^3H]\;DAGO$, $[^3H]\;DPN$ 결합의 감소, 및 $[^3H]\;DPDPE$ 결합의 증가를 나타내었다. Sulpiride, pimozide 주사군은 morphine 5 m/kg 투여군에 비하여 20m/kg 투여군에서 $[^3H]\;DAGO$, $[^3H]\;DPDPE$, 및 $[^3H]\;DPN$ 결합의 증가를 나타내었다. 이상의 결과로 보아 각 약물간의 opioid 결합에 대한 차이점은 있었으나, morphine 5mg/kg 투여군보다 20m/kg 투여군에서 $[^3H]\;DPDPE$ 및 $[^3H]\;DPN$의 결합이 증가의 경향을 보임으로써, 다량의 morphine을 투여했을 때 ${\mu}\;opioid$ 수용체에 비하여 ${\delta}와 ${\kappa}\;opioid$ 수용체가 더 활성화되는 것을 알 수 있었다.

• 생물정신의학
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• 제5권2호
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• pp.263-277
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• 1998

Conventional high-dose antipsychotics tend to result in more side effects, negative symptoms and dysphoria, and at the same time lower the cognitive function which is already impaired in most schizophrenics. Florid psychotic symptoms, negative symptoms and cognitive impairment greatly impede psychosocial performance and eventual reintegration into society. The reduction of symptom and the improvement of cognitive funtions and social skills are therefore central to the psychiatric rehabilitation process. The purpose of this study was to evaluate the dose-reduction effects of antipsychotics on chronic schizophrenics prescribed conventional high-dose antipsychotics more than 1,500mg equivalent of chlorpromazine. Fifty-one chronic schizophrenics who maintained high-dose antipsychotics for more than three months were randomly assigned to two groups : 20 patients comprised the dose-maintaining group and 31 patients made the dose-reduction group. Over a sixteen weekperiod Positive and Negative Syndrome Scale(PANSS), Extrapyramidal Symptom(EPS), Nurses' Observation Scale for Inpatient Evaluation(NOSIE-30), Continuous Performance Test(CPT), Quality of Life(QOL), and haloperidol/reduced haloperidol blood levels were determined at the base line and after 2, 4, 6, 8, 12, 16 weeks to evaluate the dose reduction effects of high-dose antipsychotics. The results were as follows : 1) Dose-reduction is highly effective in reducing positive and negative symptoms, and general psychopathology. Effects were most prominent at 8, 12, 16 weeks. Among the dose reduction group, positive symptoms in positive symptom group and negative symptoms in negative symptom group were more reduced. 2 Extrapyramidal symptoms showed no significant difference between two groups. But the EPS was reduced time after time within two groups. 3) Hit rates of Continuous Performance Test, which indicate attentional capacity, increased significantly after dose reduction. 4) Haloperidol and reduced haloperidol blood levels decreased until the 4th week, after which they were constant. 5) Total scores of Nurses' Observation Scale for Inpatient Evaluation were unchanged between the two groups. But among the indices, social interest and personal neatness were improved in the dose-reduction group and retardation was aggrevated in the dose-maintaining group. 6) Total quality of life scores were unchanged between two groups. But in the dose maintaining group, satisfaction scores of attention, autonomy, and interpersonal relationship decreased progressively. These findings suggest that the dose reduction of antipsychotics for chronic schizophrenics on programs of high-dose antipsychotics were effective. Dose reduction should therefore be implemanted to spread the rehabilitation and improve quality of life for chronic schizophrenics.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제10권2호
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• pp.244-251
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• 1999

자해행동은 정신지체에서 자주 나타나며, 특히 자폐증에서 더욱 많이 나타난다. 자해행동은 질환이라기보다는 하나의 증상군으로 다루어져왔지만, 사망률에 직접적인 영향을 줄만큼 응급인 임상적 상황이다. 본 증례는 반복적으로 머리를 때리는 자해행위를 보이는 난치성 자폐증 장애 환아가 입원한 상태에서 약물요법과 행동치료를 병행하여 치료하였기에 임상경험을 문헌고찰과 함께 보고하는 바이다. 환아는 7세된 남아로 99년 4월 20일 자해행동을 주소로 OO대학교 어린이병원 소아정신과에 내원하였으며 7월 10일까지 12주간 입원치료를 받았다. 약물치료로는 입원 4주경부터 haloperidol 0.5mg에서 1.0mg으로 증량하였고, naltrexone을 $25{\sim}50mg$을 입원기간중에 병합 투여하였다. 행동치료로는 차등강화(Differential Reinforcement of Other behavior)를 이용하여 정규적인 놀이학습을 수행하였고, 초기에 사용했던 신체적 강박을 해제하기 위해서 머리 보호대와 팔거리를 이용하였다. 현재 외래 통원치료중이며 약물은 haloperidol 0.5mg 및 naltrexone 50mg을 유지하고 있고, 환아 모를 교육하여 집에서 놀이학습을 한시간씩 수행하고 있다. 퇴원당시 자해행동은 중등도 이상 감소되었으며 외래에서도 호전된 상태를 계속 유지하고 있다.

• 대한임상약리학회:학술대회논문집
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• 대한임상약리학회 2001년도 제10차 추계학술대회
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• pp.40-40
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• 2001

• 생물정신의학
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• 제4권1호
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• pp.127-131
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• 1997

Objective : To evaluate the clinical efficacy of adjuvant sertraline treatment in chronic schizophrenic patients, we carried out a double-blind, placebo controlled study. Method : Thirty six inpatients who fulfilled DSM-III-R criteria for chronic schizophrenia were randomly assigned to sertraline and placebo groups in a double-blinded fashion. A history of at least 2 years of illness and at least six months of hospitalization were prerequisities for inclusion in the study. Patients were received sertraline 50mg or placebo for 8 weeks in addition to their routine haloperidol regimen. Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression(CGI), Simpson-Angus Scale(S-A) were evaluated at 5 points ; baseline, 2, 4, 6, and 8 weeks of treatment. Results : The groups were controlled for age, gender, and length of illness. There were no significant differences in three PANSS factros(positive, negative, general), CGI, and S-A scale scores at any between sertaline and placebo treatment. Conclusion : This placebo controlled study showed no significant effects of sertraline on negative and positive symptoms in chronic schizophrenic patients.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제6권1호
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• pp.116-122
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• 1995

목적 : 다음과 같은 fluoxetine으로 유발된 조증 증례를 보고한다. 이와 함께 fluoxetine사용이후 보고된 조증 증례보고를 모아서 정리하고 함께 문헌고찰을 하였다. 증례요약 : 가족력상 기분장애의 병력이 없었으며, 다른 주요 정신과적 질환의 병력은 없었다. 환아는 개인력상 5세경에 주의력 결핍, 과잉행동의 양상을 보였던 병력이 있었고, 13세때에 피해 망상, 환청이 지속되어 haloperidol로 치료받기 시작하였다. 이후 피해 망상의 내용을 언급하거나 환청에 영향받는 행동은 없어졌고 간혹 우울감을 호소하였다. 이후 정신분열증의 진단 하에 haloperidol만으로 3년간 유지하였다. 1994년 환아는 18세때 고3이 되면서 대입에 대한 걱정과 신체적인 허약감을 자주 호소하며, 우울증상이 두드려져 fluoxetine 20mg를 3일간 투여하던 중 갑자기 조증의 임상적 양상을 보이기 시작하여 본원의 입원치료를 받게 되었는데, 입원당시 보인 임상양상은 앙양된 기분, 이자극성(irritability), 사고의 비약, 연상의 이완과 지리멸렬, 과대망상, 피해망상, 관계망상, 환청 등이었고 사람, 장소, 시간에 대한 지남력까지 일시적으로 상실되는 심헌 정신병적 조증상태였다. 토의 : fluoxetine 사용이후 현재까지 세계적으로 문헌상 보고된 14개의 증례보고를 모아서 정리하였다. fluoxetine-induced mania의 병태생리학적인 기전은 명확하지 않지만 가능한 기전에 대해 토론하였다. 이 약물의 중대한 부작용중의 하나인 조증을 예방하기 위해, 이 약물을 다루는 의사는 가능한 조증 발병의 위험인자들에 대하여 인식하고, 약물의 용량조절시에도 주의를 하여야 한다. 가능한 발병 위험인자들에 관해서도 검토하였다.

• 한국독성학회:학술대회논문집
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• 한국독성학회 2001년도 International Symposium on Signal transduction in Toxicology
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• pp.149-149
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• 2001

Cytochrome P450 (CYP) 2D6 and CYP3A4 have been reported to be involved in the major metabolic pathways and formations of neurotoxic metabolites (HPP$\^$+/, RHPP$\^$+/) from haloperidol (HAL). However, no in vivo study has been addressed to the involvement of both CYP isoforms on the formation of toxic HAL metabolites.(omitted)

• 생물정신의학
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• 제5권1호
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• pp.129-133
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• 1998

Objective : Base on clinical practice, the authors report a case of tardive dyskinesia arising during the course of treatment with resperidal. Methods : This article was review and analysis of a case on risperidone-induced tardive dyskinea. Results : Mrs K, a 51-year-old woman with a 1-year history of schizophrenic disorder, gradually developed tardive dyskinetic movement of the mouth, lip, and tongue over a 4 month period(From July, 1996 to June, 1997) while taking risperidone. Initially she was treated with haloperidol and alprazolam. However, the haloperidol was subsequently discontinued because of EPS developed. From 11th March, 1997, she was observed to have a severe form of tardive dyskinesia involving her tongue, lip, and mouth. After risperidone was withdrawn at 9th May 1997, her tardive dyskinetic movement was disappeared. Conclusions : This is, to our knowledge, the first report of the onset of tardive dyskinesia in a patient taking risperidone. However, additional controlled studies of specific questions are needed ; e.g., the dose-response curves for produce tardive dyskinesia and the mechanism of producing risperidone-induced tardive dyskinea and so on.

• Archives of Pharmacal Research
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• 제26권11호
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• pp.951-959
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• 2003

A series of typical (chlorpromazine, haloperidol and thioridazine) and atypical (risperidone, quetiapine, clozapine and olanzapine) antipsychotics were tested for effects on integrated bioenergetic functions of isolated rat liver mitochondria. Polarographic measurement of oxygen consumption in freshly isolated mitochondria showed that electron transfer activity at respiratory complex I is inhibited by chlorpromazine, haloperidol, risperidone, and quetiapine, but not by clozapine, olanzapine, or thioridazine. Chlorpromazine and thioridazine act as modest uncouplers of oxidative phosphorylation. The typical neuroleptics inhibited NADH-coenzyme Q reductase in freeze-thawed mitochondria, which is a direct measure of complex I enzyme activity. The inhibition of NADH-coenzyme Q reductase activity by the atypicals risperidone and quetiapine was 2-4 fold less than that for the typical neuroleptics. Clozapine and olanzapine had only slight effects on NADH-coenzyme Q reductase activity, even at 200 $\mu$ M. The relative potencies of these neuroleptic drugs as inhibitors of mitochondrial bioenergetic function is similar to their relative potencies as risk factors in the reported incidence of extrapyramidal symptoms, including tardive dyskinesia (TD). This suggests that compromised bioenergetic function may be involved in the cellular pathology underlying TD.