• Title/Summary/Keyword: 비약물적 치료

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비만의 약물요법에 대한 최신 지견

  • 이선영
    • Proceedings of the Korean Society of Applied Pharmacology
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    • 2001.04a
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    • pp.3-30
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    • 2001
  • 비만은 고혈압, 제2형 당뇨병, 지방간, 고지혈증, 퇴행성관절염, 일부 암성 질환 등 다양한 만성 퇴행성 질환들을 유발할 수 있으므로 비만을 하나의 질환으로 인식하고 치료할 필요가 있다. 비만은 식사요법, 운동요법과 행동수정요법을 병행해야 최상의 치료효과를 거둘 수 있다고 알려져 왔지만, 비만 치료가 끝나고 4년 후에 빠진 체중의 절반만이라도 다시 늘지 않고 유지하고 있는 사람은 10-30%에 불과하다. 그러나 비만 문제가 중요하고 현재까지의 치료방법이 성공적이지 못함에도 불구하고 비만의 약물 치료의 적절성에 대해서는 논란이 있다. 그러나 최근 비만의 약물 치료에 대해 재평가가 이루어지고 있으며, 식사, 운동, 행동요법과 약물치료의 병합 요법이 효과가 있음을 입증하는 연구결과들이 보고되고 있다. 여기에서는 비만증의 진단기준과 치료원칙을 간단히 설명하고 비만증의 약물요법을 위주로 살펴보도록 하겠다.

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Clinical Efficacy of Clozapine in Refractory Schizophrenia (불응성 정신분열증환자의 Clozapine 치료효과)

  • Lee, Min-Soo;Jung, In-Kwa;Kwak, Dong-Il
    • Korean Journal of Biological Psychiatry
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    • v.2 no.1
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    • pp.131-139
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    • 1995
  • Clozapine, on atypical antipsychotic drug, has been estimated to be a major improvement in the treatment-refractory schizophrenic patients. We evaluated the clozapine efficacy in the treatment of schizophrenic patients who are refractory to classic neuroleptics. The patients were assigned in a prospective, open, comparative trial for 12 weeks. Following an dose titration, 33 inpatients with treatment-refractory schizophrenia diagnosed according to DSM-III-R were given a clozapine(N=17, approximate 300-600mg/day) or haloperidol(N=16, approximate 20-30 mg/day) for 12 weeks. The clinical state was assessed before treatment, and 1st, 4th, 8th and 12th week during treatment using Brief Psychiatric Rating Scale(BPRS) and Positive and Negative Syndrome Scale(PANSS). Assessment of side effects were mode weekly using Simpson-Angus Scale for Extrapyramidal Side Effects and Adverse Events-Somatic Symptoms. Clozapine produces significant improvement than haloperidol on the BPRS and PANSS scores. 77% (13/17) of the clozapine-treated patients were categorized as responders, who showed at least 20% decrease in total BPRS scores, compared with 31% (5/16) of haloperidol-treated patients. Extrapyramidal side effects occurred in only one patient in clozapine group, but nine patients in haloperidol group. Salivation, sleepiness, constipation and hypotension were most frequent adverse effects observed in clozapine group. There was no significant changes in total WBC and neutrophil during clozapine treatment. These findings suggest that clozapine is on effective antipsychotic drug for the Korean treatment-refractory schizophrenic patients, who are nonresponsive to or unable to tolerate classcal antipsychotic drugs due to extrapyramidal side effects.

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Predictors of Persistence and Adherence with Secondary Preventive Medication in Stroke Patients (지역사회 뇌졸중 환자들의 이차 예방을 위한 치료 지속률과 약물 순응도 관련 요인)

  • Kim, Young Taek;Park, Ki Soo;Bae, Sang-Geun
    • Journal of agricultural medicine and community health
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    • v.40 no.1
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    • pp.9-20
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    • 2015
  • Objectives: This study aimed to explore the persistence and adherence to secondary preventive medication of stroke patients after discharge and to assess the reasons for persistence and nonadherence. Methods: Four hundred twenty-nine patients with stroke were surveyed to determine their behaviors from discharge. Reasons for stopping medications were ascertained. Persistence was defined as continuation of all secondary preventive medications prescribed at hospital discharge, and adherence as continuation of prescribed medications according to health care provider instructions. Results: Of the 429 patients, 86.5% were treatment persistent and 41.2%(non-intentional nonadherence=39.4%, intentional nonadherence=19.4%) were adherent. Independent predictors of persistence included having experience about health education. Independent predictors of non-intentional nonadherence were modified Rankin Scale(mRS) (Exp(B)=2.858, p=0.001) and health education experience (Exp(B)=0.472, p=0.032), and independent predictors of intentional nonadherence were mRS (Exp(B)=2.533, p=0.006), depressive symptoms (Exp(B)=1.113, p=0.016), beliefs about medications questionnaire(necessity, Exp(B)=0.879, p=0.011, concern, Exp(B)=1.098, p=0.019). Conclusions: Although up to one-ninth of stroke patients continued secondary prevention medications, nonadherence is common. Several potentially modifiable patient, provider, and system-level factors associated with persistence and adherence may be targets for future interventions. Specially, interventions to improve adherence should target patients' beliefs about their medication.

The Effect of Nonpharmacologic Interventions on Behavioral and Psychological Symptoms of Dementia : A Meta-Analysis (치매환자의 행동심리증상에 비약물적 중재가 미치는 효과 - 메타분석)

  • Kwon, Mi-Hwa;Lee, Jae-Shin
    • The Journal of the Korea Contents Association
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    • v.17 no.6
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    • pp.540-550
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    • 2017
  • To investigate a variety of nonpharmacologic interventions have confirmed what the symptoms and effects, mainly interventions by acting on behavioral and psychological symptoms of dementia was conducted a meta-analysis. Data were collected from online search engines using search words from domestic and foreign article database. The researcher independently and among the pre-post experimental studies published from January 2000 to June 2016, recalled applying for the elderly with dementia presents the effect of treatment group and the control group RCT in this study were included in the study. The results of this meta-analysis showed that, effect size of the nonpharmacologic interventions of total -0.33, occupational therapy - 0.26, multi-sensory stimulation intervention -0.65 was significant beneficial effects to elderly with dementia(p<.05). According to interventions as a major affected the symptoms associated with behavioral problems, mainly aggression, memory-related problem behavior in the home-based program. Also, reminiscence therapy and occupational therapy is generally apathy, multi-sensory stimulation and music therapy was confirmed that there was a major change in behavior anxiety or agitation. The results of this study confirmed that various nonpharmacologic interventions were effective on behavioral psychological symptoms of dementia patients and confirmed the main symptoms of intervention.

Pharmacotherapy for Obesity in Mood Disorders (기분장애 환자의 비만에 대한 약물치료)

  • Sohn, Inki;Lee, Kyu-Hang
    • Korean Journal of Psychosomatic Medicine
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    • v.22 no.2
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    • pp.63-70
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    • 2014
  • The prevalence of obesity and overweight is increasing in mood disorder, and it is connected to an increased cardiovascular mortality. Because of them, treatment for obesity may be an essential part of mood disorder treatment. Similar to the general population, non-pharmacological treatment such as correction of life habits should be considered first of all. If this approaches are fail, pharmacological treatment for obesity would be required as next step. Any drug for obesity is not approved officially in mood disorder. So approved drugs in general population, and drugs supported by several studies are prescribed in clinical settings. Several treatment guidelines for mood disorder and studies support that orlistat, metformin, topiramate and bupropion is effective and safe.

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Metabolic Complications Associated with HIV and Highly Active Antiretroviral Therapy : Overview & A Clinical Case Report (HIV와 HAART 요법과 관련된 대사합병증: 개요 및 임상증례보고)

  • Choi, Eun Joo;Graham, Kathleen K.
    • Korean Journal of Clinical Pharmacy
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    • v.22 no.3
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    • pp.274-282
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    • 2012
  • 현재 HIV(human immunodeficiency virus) 감염에 대하여 보다 많은 효과적인 약물치료법이 가능하다. Highly active antiretroviral therapy (HAART)로 언급되는 이 치료법은 항 HIV치료제의 다양한 병용법으로 구성된다. 그러나, 최근에 이렇게 치료된 환자들에게 중요한 독성들(toxicities)로서 빈번하게 상당한 지질이상과 혈중당의 항상성 조절장애와 연관된 몸의 지방 분포 비정상으로서 나타나는, 광범위한 대사성 합병증(metabolic complications)이 출현해왔다. 이러한 합병증의 관리는 표준적인 치료 중재(interventions)와 연관하여 지질과 당 대사와 관련된 항 HIV치료제의 특성 있는 효과를 이해하면서, 항 HIV 약물들을 조절하는 것을 포함한다. 본 증례는 항HIV 약물요법과정에서 나타난 상당한 지질 이상, 매우 높은 LDL 수치와 높은 TG수치에 따르는 후속 약물요법을 보여주며, 개별화된 항 HIV 약물요법을 수행하면서, 대사성 합병증에 관련된 수치의 검사와 주기적인 약물치료과정의 모니터링을 권하여 HIV에 감염된 환자들의 효과적인 치료를 향상시키기 위한 것이다.

Survey of Insomnia Treatment Status for Doctors (의사 대상 불면증 치료 현황 조사 연구)

  • Choi, Yeonsun;Lee, Mi hyun;Choi, Jae-Won;Kim, Soohyun;Kim, Jichul;Lee, Yu Jin
    • Sleep Medicine and Psychophysiology
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    • v.23 no.2
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    • pp.77-83
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    • 2016
  • Objectives: The present study investigated current practices of insomnia treatment among Korean doctors in clinical settings. Methods: A total of 100 doctors participated in the present study and filled out a series of survey questions regarding their treatment of insomnia patients. Results: The results revealed that the primary type of insomnia treatment was pharmacological and that the most popular medication was zolpidem. The majority of doctors reported that they also utilized non-pharmacological treatments such as sleep hygiene education and cognitive-behavioral therapy. However, these treatments tended to result in low satisfaction. In addition, the doctors perceived that patients largely preferred pharmacological treatments to non-pharmacological ones and did not have sufficient knowledge of non-pharmacological treatments. Conclusion: Many doctors believed that non-pharmacological treatments for insomnia were important, but reported that they were difficult to implement in practice. The results of this study suggest that improved medical conditions for non-pharmacological treatments and education of physicians are necessary to appropriately treat insomnia.

Management of Weight Gain and Obesity Associated With Antipsychotics (항정신병약물 사용과 연관된 체중 증가와 비만의 관리)

  • Lee, Na-Hyun;Lee, Jae-Chang
    • Korean Journal of Psychosomatic Medicine
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    • v.29 no.2
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    • pp.86-94
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    • 2021
  • Objectives : The risk of weight gain is high when using antipsychotic drugs, and the prevalence of obesity in people with mental illness is high. Obesity management in psychiatric patients is important because obesity causes various complications and lowers treatment adherence and quality of life. Methods : In this review, we summarized the management strategies for obesity that can occur when using antipsychotic drugs through a web search. Results : Evaluate obesity-related risk factors and related indicators from the beginning of treatment, and conduct regular monitoring. If an antipsychotic drug is used and obesity is induced, a change to a drug with a low metabolic risk may be attempted. Sufficient interventions are also needed on the need to manage obesity, a healthy diet, and exercises in patients and their families. If weight loss is not achieved and obesity-related complications are associated, the use of anti-obesity drugs may be considered. Pharmacological treatment approaches should be carefully considered. Conclusions : Non-pharmacological and pharmacological therapies can be applied to manage weight gain and obesity caused by the use of antipsychotic drugs. When using anti-obesity drugs, the characteristics of mental disorders, drug safety, and drug interactions should be considered.

비만치료제 개발의 접근 방법

  • 박명환
    • Proceedings of the Korean Society of Applied Pharmacology
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    • 2001.04a
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    • pp.33-42
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    • 2001
  • 최근 수년간 에너지 섭취와 소비의 균형을 유지하는 것과 깨지는 것에 대한 생리적 기전에 대하여 많은 것이 알려졌다. 비만 만연의 사회적 문제점, 치료해야할 필요성, 음식섭취와 에너지 항상성의 조절 기전, 이와 관련된 물질과 수용체의 기능과 가치, 잠재력 있는 조절인자의 대상에 대하여 기술하였다. 비만은 여러 생리과정의 총화이므로 신체의 즉각적, 장기적 에너지 수요를 원활하게 조절하는 다양한 분자신호전달체계에 각각 작용하는 물질을 찾아 함께 사용하도록 하는 것이 새로운 비만치료제를 개발하는 전략이다.

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The Comparison of Intelligence Efficacy According to Methylphenidate Administration in Attention Deficit Hyperactivity Disorder Patients (주의력결핍 과잉행동장애 환자의 약물치료에 따른 지적효율성의 변화)

  • Park, Hyung-Bae;Bai, Dae-Seok;Ha, Jeong-Sang;Seo, Wan-Seok;Song, Chang-Jin
    • Journal of Yeungnam Medical Science
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    • v.18 no.2
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    • pp.253-266
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    • 2001
  • Background: The causes of ADHD(attention deficit hyperactivity disorder) are various, so it is impossible to understand the whole characteristics of ADHD, only with simple intelligence testing scales. We compared cognitive characteristics of ADHD group with normal controls with Korean Kaufman Assessment Battery for Children(K-ABC). It is well known to evaluate neuropsychological and cognitive aspects of the children. Materials and Methods: Age and sex matched 40 ADHD patients and 40 normal controls tested with the K-ABC. Each subscales compared between pre-treatment patients and controls, pre-treatment and post-treatment in patient group, post-treatment patients and controls. Results: Significant differences are observed in sequential processing, simultaneous processing, cognitive processing and achievement between pre-treatment patients and controls, and in gestalt closure between pre-treatment and post-treatment patients group. But there are no significant differences between pre-treatment patients and controls in gestalt closure and reading/decoding. Conclusions: Methylphenidate improved the scores of simultaneous scale, which means improvement of executive functions such as divided attention, analysis and organization. Methylphenidate also reduced distractibility.

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