• Korean Journal of Psychosomatic Medicine
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• v.20 no.2
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• pp.135-138
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• 2012

The pathophysiology of functional gastrointestinal disorder(FGID) is not completely understood, but the importance of the 'Brain-Gut Axis(BGA)' model in FGID is being increasingly recognized. The BGA model is a bidirectional, hard-wired and homeostatic relationship between the central nervous system(CNS) and the enteric nervous system(ENS) via neural, neurohormonal and neuroimmunological pathways. In addition, the BGA model would provide a rationale for the use of psychotropics on FGID. The authors experienced two cases in which duloxetine, a serotonin-norepinephrine reuptake inhibitor, was effective in relieving FGID symptoms as well as psychiatric symptoms such as depression and hypochondriacal anxiety. Therefore we discuss the vignettes from the perspective of BGA theory. Duloxetine showed efficacy in these two patients by reducing visceral hypersensivity (bottom-up regulation) and by relieving depression and anxiety(top-down regulation).

• Korean Journal of Biological Psychiatry
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• v.5 no.1
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• pp.34-45
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• 1998

We provide the reader with a brief introduction to the neurobiology of neuropeptides. Several comprehensive reviews of the distribution and neurochemical, neurophysiological, neuropharmacological and behavioral effects of the major neuropeptides have recently appeared. In reviews of the large number of neuropeptides in brain and their occurance in brain regions thought to be involved in the pathogenesis of major psychiatric disorders, investigators have sought to determine whether alternations in neuropeptide systems are associated with schizophrenia, mood disorders, anxiety disorders, alcoholism and neurodegenerative disease. There is no longer any doubt that neuropeptide-containing neurons are altered in several neuropsychiatric disorders. One of the factors that has hindered neuropeptide research to a considerable extent is the lack of pharmacological agents that specifically alter the synaptic availability of neuropeptides. With the exception of naloxone and naltrexone, the opiate-receptor antagonists, there are few available neuropeptide- receptor antagonists. Two independent classes of neuropeptide-receptor antagonists has been expected to be clinically useful. Naltrexone, a potent ${\mu}$-receptor antagonist, has been used successfully to reduce the need for alcohol consumption. And cholecycstokinin antagonists are now in development as a new class of anxiolytics, which would be expected to be free from tolerance and physical dependence and lack of sedation. In this review, we deal with these two kinds of neuropeptide system, the opioid system and cholesystokinins in the brain. The role of opioid systems in the reinforcement after alcohol consumtion and that of cholesystokinins in the pathogenesis of anxiety will be discussed briefly. As we know, the future for neuropeptides in psychiatry remains bright indeed.

• Clinical and Experimental Pediatrics
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• v.51 no.12
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• pp.1324-1328
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• 2008

Purpose : Attention deficit hyperactivity disorder (ADHD) is a syndrome characterized by inattention, impulsive disruptive behavior, impaired concentration, and motor restlessness. This study examined the relationships among electroencephalographic (EEG) findings, stimulant use, and seizure occurrence in children with ADHD. Methods : We retrospectively studied 308 children with ADHD who visited the neuropsychiatric clinic of our hospital from January 2001 to December 2005. We retrospectively analyzed age distribution, etiology, abnormal EEG findings, and use of CNS stimulants. Among these children, brain waves was recorded in 84 patients. Results : Eighty-four children (72 males, 85.7%, 9.3 years mean age; 12 females, 14.3%, 8.0 years mean age) with ADHD had electroencephalograms (EEGs) performed at our institute. Nineteen patients (22.6%) demonstrated epileptiform abnormalities, and 65 (77.4%) demonstrated normal EEGs. Stimulant therapy was applied to 59 of 84 patients (70.2%). Seizures occurred in 1 of 65 patients with a normal EEG (incidence, 1.5%) and 3 of 19 treated patients with epileptiform EEGs (incidence, 15.7%). Conclusion : These data suggest that patients with normal EEGs have minor risk for seizure. In contrast, patients with epileptiform EEGs have higher risk for seizure than patients with normal EEGs.

• Korean Journal of Psychosomatic Medicine
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• v.16 no.2
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• pp.69-74
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• 2008

Delirium is an organic psychiatric syndrome characterized by an acute onset, prominent disturbance of consciousness and cognitive impairment with fluctuating course. Although there is not a clear consensus concerning the optimal classification system for delirium subtypes, Lipowski(1983) firstly classified delirium by psychomotor activity, namely hyperactive, hypoactive, and mixed. According results of several following studies, prevalence of hypoactive delirium were not less than that of hyperactive delirium. But a diagnosis of hypoactive delirium often missed, which is most frequently misdiagnosed as depression and dementia. Hyperactive delirium can be caused by alcohol or benzodiazepine withdrawal, would be related with excessive dopamine and cholinergic deficiency, and is more responsive to high-potency antipsychotics therapy. Hypoactive delirium would be caused by metabolic encephalopathy, and tends to present a less responsiveness to antipsychotics and poorer overall prognosis with a prolonged duration of admission than hyperactive delirium. Delirium is not a homogenous syndrome. Because of different subtypes, it may have dissimilar underlying pathogenetic pathways. So different treatment strategies between various subtypes may be needed.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.13 no.1
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• pp.129-138
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• 2002

Objectives：In order to treatment guideline of ADHD, present clinical practise of child psychiatrists and their opinion of optimal intervention were evaluated. Methods：Structured questionnaire items about diagnostic workup, drug choice of 5 different situations according to different co-morbid disorders, and non - pharmacological treatment were applied to 32 child psychiatrists working at university and general hospital. we compared the data with Texas Algorithm Project guideline. Results：(1) Intelligence Test, Sentence Completion Test, sustained attention test, and Conner's questionnaire were the basic routine test that must be performed. (2) Main trend of medication in this study was not different from TAP guideline. (3) In case of co-morbid tic disorder, first recommending drug is still psychostimulant in the TAP guideline. But in this study initial psychostimulant prescription was not main trend. (4) In case of MPH non-response co-morbid disruptive behavior disorder, MPH medication combined with other drug were more common than switching to other drug as suggested the TAP guidelines. (5) In non-pharmacological treatment, most child psychiatrists reported the importance of parent management. Conclusion：There were some difference in medication trend in this study compared with TAP guideline. Further study and conference are needed for experts consensus in Korea.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.9 no.2
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• pp.218-226
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• 1998

This study aims at investigating the effects of psychostimulant on functional cerebral localization during the attentional tasks in ADHD. Inclusional subjects were 13 boy between 6-12 years old who met the DSM-IV criteria for ADHD. In each patient, there was a drugfree period(without methyphenidate) and a drug-loaded period(with oral methylphenidate administration), and within each period there was a resting state and a stimulated state with TOVA. Comparisons were made by measuring the amplitudes of four bands(${\alpha}$, ${\beta}$, ${\delta}$, ${\theta}$) of quantitative EEG to see if there were any differences between the drug-free period(resting and stimulated) and the drug-loaded period(resting and stimulated). In the resting state, there was no difference between the drug-free and drug-loaded periods. In the stimulated state with TOVA, the presence of methylphenidate induced significant changes in the theta to beta ratio(${\theta}/{\beta}$) in the right frontal, right parieto-occipital, and left temporal-parietal areas in contrast to the drugf-ree period. These data suggest that methylphenidate shows electrophysiological influences on cerebral topographical activities during the attentional tasks in ADHD.

• Journal of Oriental Neuropsychiatry
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• v.19 no.2
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• pp.223-230
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• 2008

소합향원 (蘇合香元) 가감방(加減方) 정유향기의 진통효과가 투여방법에 따라 어떤 차이가 있는지를 비교, 검토함으로서 본 약재의 새로운 적용방법을 탐색해 보고자 한다. 방법 : 가감소합향원에서 추출한 정유향기를 실험동물을 대상으로 7일간 경구 (50mg/kg, 100mg/kg), 흡입 (매일 3시간씩 1일 2회), 또는 피부도찰 (10mg) 방법으로 투여하여 페닐퀴논-유도 writhing test, 아세트산-유도 writhing test 및 hot-plate test를 실시하였다. 결과 : 가감소합향원 정유향기는 페닐퀴논-유도 writhing test에서는 피부도찰이 가장 효과적 이었으며 그 효과는 양성 대조약물인 아세트아미노펜 보다 약간 더 우수하였다 (p<0.05). 아세트산-유도 writhing test에서도 피부도찰법이 가장 좋은 효과를 나타내었으며 양성대조 약물인 아미노피린보다는 좀 더 좋은 효과를 보여주었다 (p<0.05). 그러나 hot-plate test에서는 경구투여가 가장 좋은 진통효과를 나타내었는데 고용량 (100mg/kg)에서는 양성 대조약물인 아세트아미노펜보다 유의적으로 더 효과적이었으나 저용량 (50mg/kg )에서는 이보다 다소 약하였다. 이상의 연구결과, 가감소합향원의 정유향기는 피부도찰시에는 비특이적 화학자극제인 페닐퀴논이나 아세트산에 의한 통증의 완화에 보다 효과적이며, 경구투여시에는 중추신경계에 영향을 미치는 hot plate에 의한 열자극성 통증에 더 유효함을 의미한다. 결론 : 가감소합향원의 정유향기액은 향기흡입보다는 피부흡수나 경구투여방법으로 진통의 목적으로 응용될 수 있을 것으로 사료된다.

• The Korean Journal of Physiology
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• v.1 no.1
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• pp.7-22
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• 1967

인간(人間)의 감각(感覺), 운동(運動), 사고등(思考等)에 직접관여(直接關與)하는 체성신경원(體性神經元)이 인체내(人體內)에 있어서 단일세포동물(單一細胞動物)과 비체성신경원(非體性神經元)과 같이 각종(各種)의 자극(刺戟)에 직접응(直接應)하므로써 기능적(機能的) 활동(活動)을 개시(開始)한다는 한연(漢然)한 예상하(豫想下)에서 말초(末梢)에서는 혹종(或種)의 통소(痛素)를, 중추(中樞)에서는 어떤 묘(妙)한 화학적(化學約)인 흥분전달물질(興奮傳達物質)을 탐구(探求)하고 있으며 말초(末梢)의 통흥분시발(痛興奮始發)과 대뇌피질(大腦皮質)의 기능발생(機能發生)같은 중요(重要)한 제기전(諸機轉)이 해명(解明)될 가능성(可能性)조차 보이지 않는 것이 체성신경생리학(體性神經生理學)의 현상(現狀)이다. 저자(著者)는 생태분리(生態分離)한 단일신경섬유실험(單一神經纖維實驗)과 임상적연구(臨床的硏究)로서 인체내(人體內)의 체성신경섬유(體性神經纖維)와 그 구심성종말(求心性終末)은 최종(最終) 공통기계적자극(共通機械的刺戟)을 받는 점(點)을 입증(立證)하고 뇌피질내(腦皮質內)의 입사(入射)에 의(依)한 Synapse 전달(傳達)이 기계적(機械的)인 점(點)과 모세혈관확대(毛細血管擴大)에 의(依)한 Glial Satellite 부(部)의 기계적전달(機械的傳達)과 Spine Koph 에서는 입사(入射) 없이도 Massage에 의(依)하여 초발탈분극(初發脫分極)이 발생(發生)될 필연성(必然性)을 지적(指摘)하는 동시(同時)에 저자(著者)가 부르는 ${\ulcorner}$체성신경계(體性神經系)의 기계적생리학(機械的生理學)${\lrcorner}$에 의(依)하면 난간(難間)에 속(屬)하는 대다수(大多數)의 신경현상(神經現象)과 정신현상(精神現象)이 구체적(具體的)이며 합리적(合理的)이요 또 실용적(實用的)으로 해명(解明)됨을 실례(實例)를 들어서 예시(例示)한다. 본연구(本硏究)는 습수만예(拾數萬例)의 단일신경섬유관찰(單一神經纖維觀察)과 수백예(數百例)의 임상적연구(臨床的硏究)와 최근고도(最近高度)로 발달(發達)된 기술(技術)에 의(依)한 징소생리학적(徵少生理學的) 제연구업속(諸硏究業續)과 전자현미경적형태학성과(電子顯徵鏡的形態學成果)를 종합(綜合)하므로써 성립(成立)된 것이요 하등(何等)적 무리(無理)한 억측(憶測)을 내포(內包)하지 않음을 확신(確信)한다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.21 no.3
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• pp.174-181
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• 2010

Objectives: To identify the factors affecting long-term adherence to methylphenidate treatment in children with attention-deficit hyperactivity disorder (ADHD). Methods: A retrospective medical record review of 239 ADHD patients (mean age $9.3{\pm}2.6$ years, range 6.0-17.4 years) who had visited the child and adolescent psychiatry clinic at a university hospital, in Seoul, Korea from March 2005 to February 2008. Subjects were diagnosed as ADHD based on the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision version (DSM-IV-TR) and underwent neuropsychological tests including the continuous performance test (CPT). Treatment discontinuation was defined as the last prescription date when the medication possession rate (MPR) became less than 0.80. Subjects were divided into three groups and labeled as Group I, non-adherence without pharmacotherapy, Group II, non-adherence with short-term pharmacotherapy, and Group III, adherence with long-term pharmacotherapy. Results: Ninety (37.7%) patients were grouped as non-adherent (Groups I+II) and 149 (62.3%) as adherent (Group III). The adherence group exhibited lower intelligence, higher symptom severity, and a higher number of comorbid psychiatric disorders than controls. The use of stimulants was significantly associated with long-term adherence to treatment. Additionally, the duration of interval between the date of the first visit and the date of the first prescription was positively associated with long-term adherence. Conclusion: About two-thirds of patients diagnosed as ADHD adhered to the treatment six months after the first visit. With respect to patient evaluation and the development of treatment strategies, factors affecting early drop-out and longer follow-up must be considered.

• Sleep Medicine and Psychophysiology
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• v.13 no.2
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• pp.67-74
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• 2006

Introduction: Excessive daytime sleepiness and cataplexy are key features of narcolepsy. Modafinil is psychostimulant used in the treatment of narcolepsy. In this study, we evaluated effects of modafinil on nocturnal sleep structure and sleep latency in multiple sleep latency test and clinical features. Methods: Twelve narcoleptic patients (7 male, age: $22.9{\pm}2.6\;yrs$) were participated in the study. All of them had done nocturnal polysomnography (nPSG), multiple sleep latency test (MSLT), clinical symptoms scales and have repeated same procedure after taking 200 mg of modafinil. We have done linear mixed model analysis to describe effects of group, medication and nap time on these measures. Results: Modafinil did not affect clinical scales except PSQI which had been reduced after medication. In this study, Modafinil reduced total sleep time, sleep efficiency and increased wake after sleep onset and percent of arousal during sleep in nocturnal polysomnography and prolonged mean sleep latency in multiple sleep latency tests in both group. Discussion: Modafinil has stimulant effect of central nervous system but its effect on night sleep is less than other psychostimulants such as methylphenidate. We ascertained that modafinil affected total sleep time, sleep efficiency and percent of wake during sleep but did not effect on sleep structure. Modafinil was effective in the management of day time sleepiness. Modafinil can enhance alertness of control group without day time sleepiness.