• 대한불안의학회지
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• 제2권2호
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• pp.101-107
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• 2006

Object : Since autonomic nerve system dysfunction was known as the mechanism of panic disorder, many researchers used heart rate variability (HRV) as means of measuring autonomic nerve function of patients with panic disorder. We aimed to examine the effect of paroxetine medication for 3 months on symptom improvement and change of heart rate variability of the patients with panic disorder. Methods : The subjects were patients with panic disorder who visited the psychiatric outpatient clinic of Samsung Medical Center in Seoul. We included panic disorder patients who were aged from 20 to 50 and in normal BMI range (from 18 to 30) to minimize the effect of age and weight on HRV data. We excluded the patients with EKG abnormalities, hypertension or other major psychiatric disorders. They took 20-40 mg paroxetine medication a day for 3 months. Alprazolam was used only during the first month to control the acute panic symptoms and was tapered off after that. We measured the acute panic inventory (API), Hamilton rating scale for anxiety and depression (HAM-A & HAM-D), Spielberger state-trait anxiety inventory (STAIS, STAIT), and Beck depression inventory (BDI) in order to assess clinical improvement of the patients. And we measured time and frequency domain HRV in the resting, standing and cognitive stress states to assess the change of HRV. All measurements were done before and after paroxetine treatment. Result : After paroxetine medication, patients showed significant improvement in all psychiatric scales. In time domain of HRV, standard deviations of all R-R intervals (SDNN) were significantly increased in all states. In frequency domain of HRV, the ratio of high frequency to total power (HF/TP) in the standing state was significantly increased. Conclusion : After 3 months paroxetine medication, panic disorder patients showed significant clinical improvement and change in HRV data such as SDNN in all states and HF/TP ratio in the standing state. This result suggests that paroxetine medication is effective for the improvement of autonomic nerve system dysfunction in panic disorder patients.

• 대한불안의학회지
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• 제4권1호
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• pp.28-33
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• 2008

Objective : A working group of psychiatrists from the Korean Academy of Anxiety Disorders was established to determine the appropriate medication algorithm for treating patients with panic disorder. In this article, we discussed the consensus among psychiatrists regarding the use of cognitive behavior therapy (CBT) in the development of a treatment algorithm for panic disorder in Korea. Methods : Based on the guidelines or algorithms published by the American Psychiatric Association, National Institute for Clinical Excellence, and Canadian Psychiatric Association, we constructed questionnaires regarding the core components and contents of CBT for patients with panic disorder. Fifty-four experts in panic disorder completed the questionnaires. Results : There was statistically significant consensus among the experts in the belief that cognitive reconstruction and psychological education are the core components of CBT for the treatment of patients with panic disorder. However, there was some inconsistency between the opinions of some experts regarding the content and frequency of CBT and the results of studies published outside of Korea. Conclusions : CBT, especially the psychological education and cognitive reconstruction components, should be considered when treating patients with panic disorder. However, further consideration needs to be put into the design of a more detailed treatment guideline for the use of CBT in the treatment of patients with panic disorder.

• 신경정신의학
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• 제57권4호
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• pp.287-300
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• 2018

Of the different phases of bipolar disorder, bipolar depression is more prevailing and is more difficult to treat. However, there is a deficit in systemic research on the pharmacological treatment of acute bipolar depression. Therefore, consensuses on the pharmacological treatment strategies of acute bipolar depression has yet to be made. Currently, there are only three drugs approved by the Food and Drug Administration for acute bipolar depression : quetiapine, olanzapine-fluoxetine complex, and lurasidone. In clinical practice, other drugs such as mood stabilizers (lamotrigine, lithium, valproate) and/or the other atypical antipsychotics (aripiprazole, risperidone, ziprasidone) are frequently prescribed. There remains controversy on the use of antidepressants in bipolar depression. Here, we summarized the evidence of current pharmacological treatment options and reviewed treatment guidelines of acute bipolar depression from recently published studies.

• 생물정신의학
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• 제24권3호
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• pp.134-141
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• 2017

Objectives A retrospective case series study was conducted to investigate the clinical characteristics of psychotic disorders induced by appetite suppressants, phentermine and phendimetrazine. Methods A retrospective electronic medical record review identified 5 admitted patients who had psychotic symptoms after taking phentermine or phendimetrazine. Clinical information was reviewed and summarized in each case. Results Hallucinations were reported in all cases, including auditory, visual, olfactory and somatic hallucinations. After discontinuation of phentermine or phendimetrazine, the symptoms rapidly improved with low dose of antipsychotics. Patients tended to have less prominent negative symptoms and higher insight into illness, and often showed depressive mood. These clinical characteristics were similar to psychosis induced by amphetamines. Two patients developed stimulant use disorder while using phentermine. Conclusions These findings call for awareness of the risks associated with use of appetite suppressants. Prescription of phentermine or phendimetrazine should be accompanied by close monitoring of mental status, and suspicion for substance/medication-induced psychotic disorder.

• 대한불안의학회지
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• 제3권1호
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• pp.26-31
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• 2007

Object : This study was designed to assess the change of heart rate variability (HRV) during stimulation test among the patients with major depressive disorder. Methods : 15 patients with major depressive disorder (MDD) and 15 normal controls were enrolled in this study. We sequentially measured HRV at baseline, during cognitive stimuli and emotional stimuli. Results : There are significant differences between the two groups in HRV index, TINN on baseline state and under cognitive stimulus. Conclusion : Stimulation protocol using HRV can be useful in estimating autonomic nervous function.

• 대한불안의학회지
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• 제3권2호
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• pp.69-76
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• 2007

Anorexia nervosa is a physical and psychosocial disorder that occurs most frequently in adolescent girls and young adult women. A decade ago, anorexia nervosa was rare outside of the developed western countries. However, it is now becoming a common clinical problem among young women in Korea. It is not enough to merely focus on relieving patients from the symptoms of "not eating," which is a practice that has been adopted by some forms of hospital care. The evidence base to guide treatment is limited. Nevertheless, there is the hope that a better understanding of the factors that play a role in the initiation and maintenance of disordered eating behaviors may be lead to more sophisticated treatments. This review aims to look beyond the overt "not eating" phenotype of anorexia nervosa and considers eating disorder endophenotypes based on Treasure's model. The first part of the review sets the basis for a framework of potential eating disorder endophenotypes. A description of the evidence of disordered eating behaviors as well as the clinical and psychopathological features associated with the central control of appetite follow. Finally, we describe how endophenotypes can be translated into treatments.

• 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.

• 대한불안의학회지
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• 제16권2호
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• pp.57-75
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• 2020

Particular matter is steadily increasing due to environmental factors at domestic and abroad such as industry and economy. Recently, the exposure particular matters has been reported to increase the risk not only for morbidity and mortality, but also for diseases of the respiratory system, cardiovascular system and central nervous system/neuropsychiatric disorder. Although the causes of neuropsychiatric diseases are genetic and environmental factors, it is necessary to pay more attention to environmental factors in terms of prevention. We mainly describe environmental factors that affect neuropsychiatric disorders, mainly on particular matter, which is one of harmful environmental substances. In the current study, we reviewed evidence for the presence of particular matter or particular matter related harmful air pollutants-O₃, SO₂, NO₂/NOx, traffic related air pollution, that may represent risk factors for the development of neuropsychiatric disorder.

• 동의신경정신과학회지
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• 제23권4호
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• pp.229-242
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• 2012

Objectives : This case report presents a 68-year-old female patient. Her chief complaint was fatigue and depressed mood. During the therapeutic period, she experienced a sudden onset of unconsciousness. After two days, she became alert. We diagnosed her with conversion disorder. Methods : We treated her with Korean traditional herbal medicine (Chungsimyeonja-eum, Soum-In Bojungyikgi-tang, Hyeongbangjiwhang-tang) and oriental psychotherapy for 21 days. The effects of treatment were measured by Beck Depression Inventory (BDI), Zung Depression Rating Scale (SDS), and State-Trait Anxiety Inventory (STAI-X-1). Results : After treatment, the chief complaint and accompanying symptoms have been subsided and improved. Further, BDI, SDS, STAI-X-1 score were decreased. Conclusions : In this case, we recognized that Korean traditional herbal medicine and oriental psychotherapy could be effective for clinical symptoms of conversion disorder.

• 대한불안의학회지
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• 제8권2호
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• pp.161-166
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• 2012

Though infanticide, killing the baby after birth of the neonate and denial of pregnancy, are very rare psychiatric disorder, they have been receiving a lot of social concerns. We report and review infanticide and denial of pregnancy administration in a 19 year-old adolescent with bipolar disorder and borderline personality disorder. Patients with a young age, cognitive immaturity, an unwanted child, hid the pregnancy facts were consistent with the results of previous studies. In addition, the patient's impulsivity and emotional instability is affecting infanticide. After inpatient care with pharmacotherapy (escitalopram 20mg, alprazolam 1.5 mg, clonazepam 0.5 mg, valproate sodium 1,100-1,300 mg, and quetiapine 100-400 mg) and supportive psychotherapy, and there were significant improvement of clinical symptoms.