• 생물정신의학
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• 제27권2호
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• pp.58-63
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• 2020

Depressive disorder is a very common disease, clinical manifestations vary, and the mechanism is not clear. Therefore, a pharmacotherapy is very important to achieve sufficient therapeutic effect, but the choice of drug is not easy due to the occurrence of side effects of treatment and confusion with clinical features. It is easy to overlook the side effects of weight gain with antidepressants compared with antipsychotics, but they are frequently observed in clinical settings. The first-generation antidepressants have higher weight gains than selective serotonin reuptake inhibitors. Serotonin norepinephrine reuptake inhibitors are observed to have less weight gain, and dopamine norepinephrine reuptake inhibitors have weight loss effect due to decreased appetite. Mirtazapine, an atypical antidepressant, has a strong histamine H1 blockade, and gains weight gain from short-term use. The effects of desvenlafaxine, vortioxetine, and agomelatin on weight, which have recently been increasing in use, have not been largely identified. For better compliance, studies on weight gain due to the use of antidepressants are needed.

• 생물정신의학
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• 제30권1호
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• pp.1-6
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• 2023

Many psychiatric disorders are associated with brain functional dysfunctions and neuronal degeneration. According to the research so far, enhanced brain plasticity reduces neurodegeneration and recovers neuronal damage. Brain-derived neurotrophic factor (BDNF) is one of the most extensively studied neurotrophins in the mammalian brain that plays major roles in neuronal survival, development, growth, and maintenance of neurons in brain circuits related to emotion and cognitive function. Also, BDNF plays an important role in brain plasticity, influencing dendritic spines in the hippocampus neurogenesis. Changes in neurogenesis and dendritic density can improve psychiatric symptoms and cognitive functions. BDNF has potent effects on brain plasticity through biochemical mechanisms, cellular signal pathways, and epigenetic changes. There are pharmacological and non-pharmacological interventions to increase the expression of BDNF and enhance brain plasticity. Non-pharmacological interventions such as physical exercise, nutritional change, environmental enrichment, and neuromodulation have biological mechanisms that increase the expression of BDNF and brain plasticity. Non-pharmacological interventions are cost-effective and safe ways to improve psychiatric symptoms.

• 생물정신의학
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• 제26권1호
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• pp.14-21
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• 2019

Objectives Thyroid hormone deficiency during the neurodevelopmental period can impair brain development and induce psychiatric symptoms. This study examined the association between thyroid dysfunction and the severity of symptoms in schizophrenia patients, and the treatment response of patients with schizophrenia. Methods Three hundred thirty-eight schizophrenia patients, with no prior history of thyroid disease or taking medication associated with it, were studied. We assessed the blood thyroid hormone level, the Brief Psychiatric Rating Scale (BPRS) scores on the day of admission and discharge, admission period, dose of administered antipsychotics, and the number of antipsychotic combinations. The collected data were subsequently analyzed using the Kruskal-Wallis test and Pearson's chi-square test. Results The percentage of schizophrenia patients who presented with abnormal thyroid hormone level was 24.6%. High total triiodothyronine (TT3) (p = 0.003), low TT3 (p = 0.001), and high free thyroxine (fT4) (p < 0.001) groups showed a higher BPRS score on admission than did the normal thyroid hormone group, while thyroid stimulating hormone (TSH) levels were not significantly correlated with the severity of symptoms. Furthermore, thyroid hormone was not associated with the treatment response assessed by the rate of BPRS score reduction, admission days, use of clozapine, and dose of antipsychotics. Conclusions The TT3 and fT4 hormone levels were significantly associated with the severity of symptoms in schizophrenia patients. These relations suggested that thyroid dysfunction may be associated with the severity of schizophrenia. And hence, further analysis of the results of the thyroid function test, which is commonly used in cases of psychiatric admission, is required.

• 생물정신의학
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• 제3권2호
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• pp.156-161
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• 1996

Many pregnant women have to receive psychotropic medication during pregnancy and lactation period, despite the proven and assumed risks to the fetus ar neonate. A brief summary of drug metabolism and pharmacodynamics is given. Principles and quidelines of using psychotropic agents during pregancy and lactation period are presented for psychotic disorders, bipolar affective disorders. depression and anxiety disorders, with due consideration for relative benefits and risks of choosing among psychotropic drugs and alternative treatments.

• 생물정신의학
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• 제28권2호
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• pp.50-57
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• 2021

Objectives Clozapine is the most effective atypical antipsychotic agent for the treatment-resistant schizophrenia (TRS), however, only 40%-70% of TRS patients respond to clozapine. Moreover, TRS encompasses various symptom dimensions. Therefore, augmentation with other medications for clozapine is frequently applied. However, the prescription pattern of clozapine and combined medications in Korea is yet to be examined. This study aims to investigate the maintenance treatment pattern of clozapine and augmentation agents in one Korean tertiary hospital. Methods The patients with schizophrenia spectrum disorders under clozapine maintenance, defined as one-year clozapine continuation, were subjected for analysis. Medication data at one-year time-point after clozapine initiation was extracted and analyzed. Results Among total 2897 patients having clozapine prescription experience from January 2000 to December 2018, 1011 patients were on clozapine maintenance. The mean age of clozapine initiation was 30.2 ± 11.3 years, and the maintenance dose of clozapine was 217.8 ± 124.3 mg/day. Combination rate of antipsychotics, mood stabilizers, and antidepressants were 43.5%, 25.3%, 38.6%, respectively. Most frequently prescribed drugs in each category were aripiprazole, valproate, and sertraline. Olanzapine equivalent dose of combined antipsychotics was 10.4 ± 7.7 mg/day. Male patients were prescribed higher dose of combined antipsychotics and higher rate of antidepressants. Female patients had later onset of clozapine prescription. Patients with two or more combined antipsychotics were prescribed higher dose of clozapine and higher rate of antidepressants compared to patients with one combined antipsychotic. Conclusions Taken together, among the patients taking clozapine, a substantial rate of patients were under polypharmacy. The present findings based on the real-world prescription pattern could provide the valuable clinical information on the treatment of TRS-related conditions.

• 생물정신의학
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• 제31권1호
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• pp.1-6
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• 2024

Objectives Alcohol is metabolized to acetaldehyde by alcohol dehydrogenase enzyme in the liver and then acetaldehyde is metabolized to acetone by aldehyde dehydrogenase (ALDH) in the liver. There are two main ALDH enzymes which metabolize the acetaldehyde produced during ethanol oxidation. In particular, in the presence of the ALDH2 1^*2 allele, the activity of the ALDH 2 enzyme is lowered. As a result, acetaldehyde metabolism is slowed down and acetaldehyde accumulates in the body compared to the ALDH2 1^*1 allele. There are many studies that have investigated the blood acetaldehyde concentration according to the ALDH2 genotype, but there are few studies to compare this with age. So we investigated the blood acetaldehyde concentration according to ALDH2 genotype, age and gender. Methods According to the ALDH2 genotype, we divided the group by gender and age. We divided the age group in to three groups which ranged from 20 to 34 years old, from 35 to 49 years old, and lastly from 50 to 64 years old. And then we collected blood samples after 15 min, 30 min, 1 hr, 2 hr, 3 hr, 4 hr, 5 hr and 15 hr of after drinking to measure the blood acetaldehyde concentration. Results In ALDH2 1^*2 allele group, there are significant differences of the blood acetaldehyde concentration between the age groups. In ALDH2 1^*2 allele and male group, there are significant differences of the blood acetaldehyde concentration between the age groups. Conclusions There are significant differences of the blood acetaldehyde concentration between the age groups according to ALDH2 genotype. Also, there are significant differences of the blood acetaldehyde concentration between the age groups with male gender and ALDH2 1^*2 allele. Studies about other factors that may influence the blood acetaldehyde concentration are needed.

• 생물정신의학
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• 제28권2호
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• pp.58-69
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• 2021

Objectives The aim of this study was to examine the association between the sleep pattern, chronotype (midpoint of sleep on free days) and the depressive symptoms in adults aged 19 years and over in Korea. This study also investigated the mediating effect of perceived usual stress (PUS) and self-rated health (SRH) on the association between chronotype and depressive symptoms. Methods Among the subjects of the 7th Korea National Health and Nutrition Examination Survey (KNHANES) 2016 and 2018, 16142 adults aged 19 or over responded to the survey and finally 8604 were analyzed according to the exclusion conditions. Logistic regression analysis was conducted to see the risk of depressive symptoms, suicidal ideation over sleep pattern, chronotype. Finally, mediation analysis was performed in order to clarify how PUS and SRH are associated to chronoytpe and depression. Results After controlling for potential covariates, weekly sleep duration < 5 hours, ≥ 10 hours was associated with depressive symptoms. And late bed time sleeping after am 1:00 and later midpoints of sleep was associated with a higher level of depressive symptoms. Additionally, the PUS and SRH between chronotype and depressive symptoms showed a serial multiple mediation effect. Conclusions Short or long sleep duration, late bed time and later midpoints of sleep on free days are associated with depressive symptoms. Furthermore, the mechanism between chronotype and depressive symptoms needs to be further clarified by identifying the serial multiple mediation effects of PUS and SRH.

• 정신신체의학
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• 제8권2호
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• pp.149-164
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• 2000

신체화는 진단보다는 오히려 일종의 과정으로 간주된다. 따라서 단순히 진단명을 선택하기보다는 정신병리를 알아 보려는 노력이 더 중요하다. 신체형장애의 진단 및 치료의 어려움은 환자의 질병행동 즉 정신사회적 문제를 부정하여 정신과적 접근을 기피하는 것과 밀접한 관계가 있다. 신체증상 이면에 있는 정신사회적 문제에 대한 단서를 포착하는 것은 정신과의사의 중요한 역할이다. 이런 점에서 신체화 환자들에 대한 치료적 접근은 정신과적 치료에 대한 수용을 촉진할 수 있는 특정 기술과 전략이 요구된다. 신체화 환자의 치료목표는 완치가 아니라 관리에 있다. 치료는 환자의 반응과 필요성에 따라 융통성을 두어야 한다. 평가 및 치료 초기부터 여러 과가 공동으로 접근하는 것이 효과적이다. 결론적으로 신체화의 평가 및 치료는 통합적인 접근 즉 생물정신사회적인 접근이 필요하다. 특히 다른 신경증 환자에서보다는 생물의학적 접근이 더 강조될 필요가 있다. 따라서 이런 환자들을 조기에 발견하고 환자의 정신과적 치료의 수용을 촉진시키기 위해서는 신체형환자에게 적절한 접근 즉 면담기술을 개발해야 함은 물론 다른과 의사들을 교육시키는 것도 정신과의사가 해야 할 중요한 역할에 속한다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제1권1호
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• pp.5-26
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• 1990

• 생물정신의학
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• 제22권3호
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• pp.113-117
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• 2015

Psychiatry has progressed with neurobiological basis, providing individually tailored treatment, preventing mental illness, and managing public mental health. Foundational knowledge that may contribute to the development of psychiatry and neuroscience has been attained through continual national and international investment in research. However, this knowledge obtained from neurobiological research is not being applied to clinical practice proactively. This may be due to a lack of support for translational research connecting neuroscience with clinical practice, and a lack of development and availability of educational programs for clinical psychiatrists. To solve these problems, it is essential to support translational research conducted by clinicians and to establish an appropriate reward system. Considering the direction of progress in psychiatry and the demand from clinicians, appropriate investment in research and education programs that provide neurobiological knowledge applicable to clinical practice is required. Researchers and educators must also communicate and collaborate to deliver neurobiological findings effectively.