• The Korean Journal of Physiology and Pharmacology
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• 제22권5호
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• pp.525-538
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• 2018

Post-traumatic stress disorder (PTSD) is a trauma-induced psychiatric disorder characterized by impaired fear extermination, hyperarousal, and anxiety that may involve the release of monoamines in the fear circuit. The reported pharmacological properties of tetramethylpyrazine (TMP) include anti-cancer, anti-diabetic, anti-atherosclerotic, and neuropsychiatric activities. However, the anxiolytic-like effects of TMP and its mechanism of action in PTSD are unclear. This study measured several anxiety-related behavioral responses to examine the effects of TMP on symptoms of anxiety in rats after single prolonged stress (SPS) exposure by reversing the serotonin (5-HT) and hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Rats were given TMP (10, 20, or 40 mg/kg, i.p.) for 14 days after SPS exposure. Administration of TMP significantly reduced grooming behavior, increased the time spent and number of visits to the open arm in the elevated plus maze test, and significantly increased the number of central zone crossings in the open field test. TMP administration significantly reduced the freezing response to contextual fear conditioning and significantly restored the neurochemical abnormalities and the SPS-induced decrease in 5-HT tissue levels in the prefrontal cortex and hippocampus. The increased 5-HT concentration during TMP treatment might be partially attribute to the tryptophan and 5-hydroxyindoleacetic acid mRNA level expression in the hippocampus of rats with PTSD. These findings support a role for reducing the altered serotonergic transmission in rats with PTSD. TMP simultaneously attenuated the HPA axis dysfunction. Therefore, TMP may be useful for developing an agent for treating psychiatric disorders, such those observed in patients with PTSD.

• 대한불안의학회지
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• 제6권1호
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• pp.65-70
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• 2010

Objectives : Indirect contact with trauma may occur when a person empathically listens to detailed descriptions, exposing the person to intense emotional pain from trauma victims. Although less severe than direct trauma, indirectly traumatized persons may experience the same fear, rage, and despair as direct trauma victims. This phenomenon has been variously termed vicarious trauma, traumatic countertransference, burnout, compassion fatigue, and secondary traumatic stress. Using a psychiatric symptoms questionnaires, this study investigated the effects of indirect exposure to co-worker's trauma on the mental health of firefighters who had not directly experienced traumatic events in the previous year. Methods : We administered self-report questionnaires, such as the Impact of Event Scale-Revised (IESR) and Alcohol Use Disorder Identification Test (AUDIT), to firefighters working at two fire stations in a metropolitan city. We analyzed 188 of 232 collected surveys, after excluding falsely entered data (28 cases) and questionnaires by directly-traumatized victims (16 cases). Results : Alcohol consumption and posttraumatic stress disorder (PTSD) symptoms, as determined by the AUDIT and IES-R, were significantly higher in the indirectly-traumatized group. The ratio of high-risk members scoring higher than 23 in IES-R was larger in the indirectly traumatized group, although this was not statistically significant. Conclusion : Alcohol consumption was significantly higher in the indirectly traumatized group. This group also included more members at high risk for PTSD. Further research, with a larger group of indirectly traumatized firefighters and ongoing investigation of PTSD development and other psychiatric symptoms, is needed.

• Annals of Clinical Neurophysiology
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• 제23권2호
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• pp.108-116
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• 2021

Background: Nitrous oxide (N₂O) is used in surgery and dentistry for its anesthetic and analgesic effects. However, neurological and psychiatric manifestations of N₂O abuse have been increasingly reported among Korean adults. The aim of this study was to demonstrate laboratory findings of N₂O abuse in Korean patients. Methods: Patients diagnosed with N₂O-induced neuropathy or myelopathy from August 2018 to December 2019 were enrolled. Their clinical presentations and laboratory and imaging findings were analyzed. Results: Sensory changes and limb weakness were present in nine of the enrolled patients. The laboratory findings revealed that seven patients had high homocysteine levels and five had high methylmalonic acid levels in their blood. Nerve conductions studies indicated that axonal neuropathy was present in four cases and longer F-wave and Hoffman's-reflex latencies were present in two cases. Signal changes in cervical spine imaging occurred in five patients, while two had normal results. Conclusions: Chronic N₂O abuse can cause neurological damage or psychiatric problems. Because N₂O is illegal for recreational use in Korea, patients tend to hide their history of use. Even though the spinal imaging results were normal, clinicians should consider the possibility of N₂O use, and further electrophysiological tests should be applied for precise evaluations.

• 대한한의학회지
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• 제43권4호
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• pp.102-130
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• 2022

Objectives: The persistence and unpredictability of coronavirus disease (COVID-19) and new measures to prevent direct medical intervention (e.g., social distancing and quarantine) have induced various psychological symptoms and disorders that require self-treatment approaches and integrative treatment interventions. To address these issues, the Korean Medicine Mental Health (KMMH) center developed a field manual by reviewing previous literature and preexisting manuals. Methods: The working group of the KMMH center conducted a keyword search in PubMed in June 2021 using "COVID-19" and "SARS-CoV-2". Review articles were examined using the following filters: "review," "systematic review," and "meta-analysis." We conducted a narrative review of the retrieved articles and extracted content relevant to previous manuals. We then created a treatment algorithm and recommendations by referring to the results of the review. Results: During the initial assessment, subjective symptom severity was measured using a numerical rating scale, and patients were classified as low- or moderate-high risk. Moderate-high-risk patients should be classified as having either a psychiatric emergency or significant psychiatric condition. The developed manual presents appropriate psychological support for each group based on the following dominant symptoms: tension, anxiety-dominant, anger-dominant, depression-dominant, and somatization. Conclusions: We identified the characteristics of mental health problems during the COVID-19 pandemic and developed a clinical mental health support manual in the field of Korean medicine. When symptoms meet the diagnostic criteria for a mental disorder, doctors of Korean medicine can treat the patients according to the manual for the corresponding disorder.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제18권2호
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• pp.138-144
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• 2007

Objectives: The aim of this study was to evaluate the reliability and validity of the Korean Version of the Diagnostic Interview Schedule for Children Version IV(DISC-IV), a highly structured diagnostic interview used to assess more than 30 psychiatric disorders in children and adolescents. Methods: A total of 91 study subjects, including 67 subjects who visited the child and adolescent psychiatry outpatient clinic at our institution and 24 community-based subjects, were assessed using the Korean Version of the DISC-IV. Clinical diagnosis was used as a gold standard for the examination of the validity of the DISC-IV. Forty-four of the study subjects were randomly selected for test-retest reliability measurement. Results: The validity of the Korean Version of the DISC-IV showed kappa values ranging from 0.25 to 0.40 in the clinical sample and 0.65 to 1.00 in the community sample. The sensitivities varied according to the diagnostic categories, but the specificities were excellent for all diagnostic entities. Conclusion: The Korean Version of the DISC-IV showed good reliability and validity in Korean children and adolescents. The Korean Version of the DISC-IV might be a useful tool for assessing psychiatric disorders in children and adolescents.

• 대한불안의학회지
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• 제9권1호
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• pp.31-37
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• 2013

정신장애 진단선별 질문지(PDSQ)는 임상에서 흔하게 진단되는 DSM-IV 축 1의 장애를 평가하기위해 고안된 최초의 자기보고식 질문지이다. PDSQ는 포괄적인 평가가 가능하고, 공존질환을 평가 할 수 있으며 신뢰도와 타당도가 높은 것으로 알려져 있다. 이 연구는 K-PDSQ의 표준화를 위한 연구로서, K-PDSQ와 M.I.N.I.-Plus의 비교를 통해 K-PDSQ의 진단적 타당성과 유용성을 검증하고자 하였다. 계명대학교 동산병원 정신건강의학과를 방문한 외래와 입원환자 640명을 대상으로 K-PDSQ와 M.I.N.I.-Plus의 진단적 일치도, K-PDSQ의 시행시간, 민감도 및 특이도를 산출하였다. K-PDSQ와 M.I.N.I.-Plus의 Cohen's kappa계수는 .66로 일치도가 높게 나타났고, K-PDSQ의 시행 소요시간은 $18.2{\pm}11.80$분이었다. 타당도에 있어 국내 환자군 대상으로 산출된 절단점을 적용하였을 때 높은 수준의 민감도와 특이도를 나타냈다. 대부분의 하위척도에서 수용자 작업특성 곡선(ROC)이 대각선 위에 있었고 곡선아래 영역(AUC) 값이 .80 이상으로 선별검사로서 유용성이 입증되었다. K-PDSQ는 M.I.N.I.-Plus와 상당한 진단적 일치도를 보였고, 시행시간이 짧고, 민감도와 특이도에서 높은 수준을 보였다. 따라서 K-PDSQ는 외래 진료환경에 적용하여 임상면담 이전에 환자에 대한 진단적 평가와 공존질환을 선별해내는데 큰 도움이 될 것으로 생각된다.

• 동의신경정신과학회지
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• 제21권4호
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• pp.219-231
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• 2010

Objectives : School refusal is usually considered as individual's behavioral problem. These days. however. the adolescents' school refusal needs some kind of medical approaches because it is related to mental disorder of the adolescents. Due to too much pressure and stress from the competition between classmates and from good performance in school. the number of adolescents who refuse to go to school is increasing. Despite this circumstance. school refusal is neither regarded as a single independent disorder nor endorsed as an officially classified disease. which makes difficult to conduct research on this issue and to establish standardized treatment for it. In addition. there is a lack of research on this topic. especially in oriental medicine. so there is no a case report or study on school refusal. This study is trying to comment on school refusal from the perspective of oriental medicine. Methods : We tried to examine the effect of oriental medicine treatment for school refusal with four adolescent cases. The patients commonly have at least more than one mental disorder (including depression disorder. anxiety disorder. and anorexia nervosa). have some problem with the relationship with their family. in particular with mother. do not have father or not be loved by their father. and have irregular eating habits. Thus. we diagnosed them as qi transforming into fire (氣鬱化矢) spleen-stomach deficiency cold (脾胃虛寒) and heart blood deficiency (心血虛) due to stress from the family issues and unhealthy eating habits. The patients received supportive therapy. family therapy. etc among many oriental mental treatments and their progress had been observed through hospitalization and outpatient treatment. Results : All four cases were reported positive progress on their symptoms and started coming back to school. We also examined whether they were well fitting into the school while they received outpatient treatment. and the results show that all four patients continue to settle down in normal school life. Conclusions : This study closely reviewed the mental disorder of school refusal cases and showed that the Oriental medical treatment was effective in helping the patients come back to school. More future research is required to better treatment for school refusal cases in oriental medicine.

• Journal of Ginseng Research
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• 제46권1호
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• pp.62-70
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• 2022

Background: Maternal Toxoplasma gondii (T. gondii) infection during pregnancy has been associated with various mental illnesses in the offspring. Ginsenoside Rh2 (GRh2) is a major bioactive compound obtained from ginseng that has an anti-T. gondii effect and attenuates microglial activation through toll-like receptor 4 (TLR4)/nuclear factor-kappa B (NF-κB) signaling pathway. GRh2 also alleviated tumor-associated or lipopolysaccharide-induced depression. However, the effects and potential mechanisms of GRh2 on depression-like behavior in mouse offspring caused by maternal T. gondii infection during pregnancy have not been investigated. Methods: We examined GRh2 effects on the depression-like behavior in mouse offspring, caused by maternal T. gondii infection during pregnancy, by measuring depression-like behaviors and assaying parameters at the neuronal and molecular level. Results: We showed that GRh2 significantly improved behavioral measures: sucrose consumption, forced swim time and tail suspended immobility time of their offspring. These corresponded with increased tissue concentrations of 5-hydroxytryptamine and dopamine, and attenuated indoleamine 2,3-dioxygenase or enhanced tyrosine hydroxylase expression in the prefrontal cortex. GRh2 ameliorated neuronal damage in the prefrontal cortex. Molecular docking results revealed that GRh2 binds strongly to both TLR4 and high mobility group box 1 (HMGB1). Conclusion: This study demonstrated that GRh2 ameliorated the depression-like behavior in mouse offspring of maternal T. gondii infection during pregnancy by attenuating the excessive activation of microglia and neuroinflammation through the HMGB1/TLR4/NF-κB signaling pathway. It suggests that GRh2 could be considered a potential therapy in preventing and treating psychiatric disorders in the offspring mice of mothers with prenatal exposure to T. gondii infection.

• 우울조울병
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• 제10권1호
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• pp.13-21
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• 2012

자살은 다양한 신경생물학적, 심리사회적 요인들이 모두 관여하고 있는 복합적인 행동으로, 유전적 요인과 가족력, 신경생물학적인 특성, 발달 단계에서의 요인들과 성격적 특성 등의 취약한 체질적 소인을 가진 사람들에게서 환경적인 스트레스와 물질남용, 정신질환, 신체질환 등의 영향을 통해 최종적으로 발생하게 된다. 신경생물학의 발달로 인해 자살에는 정신질환과 무관하게 독립적으로 작용하는 유전적 소인이 있으며, 이와 관련된 신경전달물질, 신경호르몬, 신경영양인자, cytokine, 지질 대사의 이상 등이 신경회로의 신호 전달을 교란시켜 자살에 취약하도록 만든다는 사실이 밝혀졌다. 또한 그 중 가장 주된 역할을 하는 인자는 5-HT와 HPA 축의 기능부전인 것으로 생각할 수 있다. 이러한 소견들은 향후 자살의 생물학적 표지자를 설정하고, 임상적으로 자살 고위험군에 대한 조기 개입을 하는 한편 새로운 치료 방법을 개발하는데 많은 도움을 줄 수 있을 것이다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제15권2호
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• pp.143-151
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• 2004

연구목적：소아·청소년기 발병 강박장애는 낮은 약물반응, 높은 공존장애율, 강한 유전적 경향성을 가진다고 알려져 왔다. 그러나 현재까지 국내에서 소아·청소년기 발병 강박장애에 대한 연구는 극히 미미하다. 이에 본 연구에서는 서울대학교병원 소아·청소년 정신과 병동에 입원한 강박장애 아동들을 대상으로 임상양상, 유전부하, 약물 반응양상, 퇴원후의 경과등을 조사하여, 심각한 증상을 보이는 소아·청소년 강박장애 군의 특성을 파악하려 하였다. 방 법：최근 9년사이에 서울대병원 소아·청소년 정신과에 입원한 환아 20명(남 16, 여 4)의 자료를 조사하였고 이를 대상으로 임상적 특성을 조사하였다. 진단 및 임상 상의 정확성을 유지하기 위해 의무기록지, 심리학적 보고서, 가족 면담 자료, 간호 보고서를 모두 고려하였고, 퇴원시 확정된 진단을 일차진단으로 하였다. 결 과：1) 환아의 성비는 남성이 4：1로 우위였다. 2) 강박사고에 있어서 가장 흔한 형태는 병적의심이었고, 이어서 더러움에 대한 공포, 공격적 사고, 대칭에의 요구, 성적 강박 사고였다. 강박행동에서 가장 흔한 내용은 확인, 씻기, 숨쉬기, 움직임, 대칭, 반복적 질문, 물건수집, 정신적 강박행동 등이었다. 3) 가장 흔한 공존 장애는 우울증이었고, 그 다음으로는 다른 불안장애, 틱장애, 품행장애, 반항장애였다. 드물게 강박사고에 대한 현실검증력이 손상된 것으로 판단되는 아동도 발견되었다. 4) 정신과 질환에 대한 가족력을 살펴본 결과, 17 가족(85%)에서 2차 친척 중 정신과 장애를 앓는 사람이 발견되었다. 그리고, 강박 스펙트럼 장애로 의심되는 친척을 둔 아동이 전체의 45%(9명)이었다. 5) 약물치료로서 사분의 삼 정도의 환아들(75%)이, SSRI와 항정신병약물을 함께 복용하고 있었고, 치료 반응상 CGI에서 중등도 호전(moderate improved) 이상을 보이는 경우가 75%로 파악되었다. 6) 퇴원 후의 외래 추적 결과, 지속적인 증상의 관해를 보인 경우는 5명(25%)이었고, 부분적인 증상을 가진 채 만성적으로 지속되는 경우가 10명(50%)이었다. 결 론：심각한 소아·청소년 강박장애약물 환아들의 임상상을 국내에서는 최초로 체계적으로 조사하였다. 그 결과, 높은 공존장애율, 높은 정신과장애의 가족력, 높은 항정신병약물 복용을 보이는 것으로 조사되었다. 증상면에서도 공격적-성적 강박사고의 비율이 높았으며, 숨쉬기, 움직이기 등의 특이한 강박행동이 발견되었다. 치료로서 사분의삼 정도의 환아들(75%)이, SSRI와 항정신병약물을 함께 복용하고 있었고, 치료 반응상 CGI에서 중등도 호전(moderate improved) 이상을 보이는 경우가 75%로 파악되었다.