• 한국임상약학회지
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• 제22권2호
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• pp.137-142
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• 2012

Background & Purpose: It is well known that Extrapyramidal symptoms (EPS) is induced by atypical antipsychotic agents less frequently than by typical antipsychotic agents. The purpose of this study was to evaluate differences in rates of the use of antiparkinson agent, most commonly prescribed for the management of EPS, between patients with atypical agents and those with typical agents. Methods: This cross-sectional study was conducted in a retrospective way with the Electronic Medical Record (EMR) of the 312 patients for whom the Antipsychotics were prescribed by the Psychiatry Department of the Inje University Ilsan Paik Hospital, from January of 2005 to February of 2011. They received either typical agents (N=15) or atypical agents (N=297) and those 2 groups were compared in terms of antiparkinson agent use. Also, we assessed the difference between individual atypical antipsychotic agents regarding antiparkinson agent use. Results: There was no significant difference in the rates of antiparkinson agent use between the two groups (the typical agent 13.33% vs. the atypical agent 9.76%, p = 0.6512). Meanwhile, the rates of antiparkinson agent use with aripiprazole versus quetiapine (aripirazole 25% vs. quetiapine 3.57%, p = 0.003) were significantly different, Also the rates of antiparkinson agent use with aripiprazole versus risperidone (aripiprazole 25% vs. risperidone 9.52%, p = 0.0216) had a statistical meaning. Conclusions: There was no significant difference in the rates of antiparkinson agent use between patients with atypical agents and those with typical agents. However the rate of antiparkinson agent use was significantly lower with aripiprazole compared with quetiapine or risperidone.

• 생물정신의학
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• 제9권2호
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• pp.129-139
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• 2002

Objective:This study was performed to investigate the prescribing patterns of antimanic agents in the treatment of acute bipolar disorder inpatients in Korea from 1990 through 2000. The results will serve as the basic data for the practice guideline for the pharmacotherapy of bipolar disorder patients in Korea. Method:Retrospective chart review of bipolar disorder inpatients of Soonchunhyang Medical Center in Seoul and Chun-An was conducted for each of the year 1990, 1995, and 2000. The following data are collected ; 1) demographic data, 2) history of bipolar disorder, 3) length of hospital stay, 4) detailed drug titration records of antimanic agents and antipsychotic agents. Results:During the last decade, the frequency of lithium monotherapy was decreased obviously. Instead, more than half of the patients in 2000 were on combination therapy of lithium and anticonvulsants. Lithiumvalproate combination was the preferred strategy and the use rate of carbamazepine has been decreased. In addition, most of the patients were given antipsychotic agents during the last 10 years. And recently, atypical antipsychotics were increasingly prescribed. These changes in the field of pharmacology of bipolar disorder have resulted neither in shorter hospital stays nor lower dosages of concurrent neuroleptics. Conclusions:The results indicate the trends in the prescribing of antimanic agents for the treatment of bipolar disorder in Korea across the past 10 years. Mostly, the change seems to correspond to the international practice guideline. More systematic research is needed to find out the clinical benefits of the anticonvulsants in the real practice of treatment of bipolar disorder.

• 생물정신의학
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• 제1권1호
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• pp.7-16
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• 1994

I will try to serve as the basis for the development of a clinical therapeutic guideline of antipsychotic drugs. Knowing that many patients fail standard treatment recommendations, either because of insufficient efficacy or intolerance to adverse effects, led us to emphasize the importance of the guideline. The clinicians continually assimilate new information about recent advances, including : novel agents targeted to impact specific components of various neurotransmitter systems ; combination strategies ; alternative uses of existing agents ; and specialized requirements of a growing number of identified diagnostic subtypes. The cost to benefit ratio must always be considered when developing a therapeutic guideline.

• 대한약리학회지
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• 제30권3호
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• pp.343-349
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• 1994

정신병치료제들을 장기투여하여 치료를 시도하였을 때에 생기는 여러 부작용은 그 정도 또한 매우 심각하기 때문에 그들의 치료효과와 함께 야기되는 부작용들을 따로 생각할 수가 없게 되었다. 특히 정신병치료는 그 자체에 대한 병인적 원인을 정확히 알 수 없기에 증상에 따른 대중요법이 일괄적으로 사용되므로, 이러한 현재의 치료방법으로는 부작용들이 더 치명적이 될 수 있기 때문에 일차적으로 이들의 공통적약리작용기전들을 연구하는 것은 매우 필요하다. 최근 NO(Nitric oxide)에 대한 많은 연구들에 의하면, 이들이 중추신경계에서 중요한 second messenger 또는 mediator로 신경활동에 영향을 나타내는 것으로 보고되고 있다. 그러므로 저자들은 먼저 이들 약물들과 NO와의 관계를 연구하고자, 중요한 몇종의 정신병치료제들을 택하여 NO생성에 어떤 영향을 미치는 가를 검색하여 다음과 같은 일차 결과를 얻었다 1. 정신병치료제 수종(chlorpromazine, trifluoperazine promazine, pimozide, clozapine, chlorprothixene, haloperidol)을 택하여 쥐의 소내에서 $[^3H]L-arginine$으로부터 $[^3H]L-citrulline$의 생성양을 측정하여 calmodulin antagonist(calmidazolium)와 비교하였다. 2. 이들을 N1E-115 cell에 투여하여 $[^3H]cyclic$ GMP양을 측정하고 그 결과를 calmida-zolium 과 비교하였다. 3. 이들 약물들은 citrulline과 cyclic GMP 모두의 생성양을 의의있게 억제하였으며 그 기전은 calmidazolium과 매우 유사하였다. 위의 일차적 검색결과에 의하면, 정신병치료약물들의 약리작용 기전중에 일부는 중추신경계내의 NO생성 및 cyclic GMP생성에 영향을 나타내는 것으로 사료되며, 이에는 calcium ion이 상당히 중요한 역할을 하는데, 특히 소뇌에서의 NO생성의 감소는 이들 약물들의 치명적 부작용인 tardive dyskinesia와 매우 깊은 관련을 추측할 수 있다. 그러나, 더 많은 약물들의 검색으로 일관적인 기본 결과가 필요 되고 또 각개 약물의 특정적 기전이 연구되기 위하여 현재 실험중이다.

• Bulletin of the Korean Chemical Society
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• 제30권7호
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• pp.1445-1451
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• 2009

New benzotriazoles (5-8) or dibenzodiazepine derivatives (11-18) were synthesized starting from 3-[(2-amino- 4,5-disubstitutedphenyl)amino]-5,5-disubstitutedcyclohex-2-enones (1-4) through internal coupling of their diazonium salts or internal Mannich reaction in the presence of aromatic aldehydes. Pharmacological evaluation of benzotriazole and dibenzodiazepine derivatives for their clozapine-like properties revealed that dibenzodiazepine 11 bearing 4-bromophenyl group exhibited the same antipsychotic activity as the reference drug clozapine while the activity of benzotriazole 7 was 25% lesser than that of clozapine. Moreover, compounds 7 and 11 did not show significant CNS depressant activity as well as no or slight neurotoxicity on contrast to clozapine when tested in mice using forced swim, rotarod and horizontal screen tests.

• Clinical Psychopharmacology and Neuroscience
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• 제16권4호
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• pp.501-504
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• 2018

Autoimmune hemolytic anemia is a disease characterized with destruction of erythrocytes as a result of antibody produce against patient's own erythrocytes and anemia. Autoimmune hemolytic anemia can be roughly stratified into two groups according to serological features and secondary causes including drugs induced hemolytic anemia. Drugs induced autoimmune hemolytic anemia is very rare in pediatric patients. Even though hematological side effects such as leucopenia, agranulocytosis, eosinophilia, thrombocytopenic purpura and aplastic anemia might occur due to psychotropic drug use; to the best of our knowledge there is no autoimmune hemolytic anemia case due to quetiapine, an atypical antipsychotics, in literature. We hereby describe the first child case of autoimmune hemolytic anemia during quetiapine treatment.We also are pointing out that one should keep in mind serious hematological side effects with atypical antipsychotic drug use with this case report.

• 대한조현병학회지
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• 제24권1호
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• pp.1-7
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• 2021

Clozapine is the first and most effective atypical antipsychotic drug for treatment-resistant schizophrenia (TRS). After withdrawal of clozapine due to concerns of agranulocytosis, clozapine was reintroduced with a comprehensive safety monitoring system, the clozapine patient monitoring system (CPMS). The reintroduction was a response to the pressure from psychiatrists and patients with TRS and their families. Clozapine is still the best single agent for the treatment of TRS. However, approximately 30% of patients with TRS still show psychotic symptoms. In patients with clozapine-resistant schizophrenia (CRS), augmentation of other antipsychotic agents could be considered after a thorough evaluation of proper clozapine treatment. In this review, the status of clozapine in patients with TRS and CRS will be discussed.

• Clinical Psychopharmacology and Neuroscience
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• 제16권4호
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• pp.376-382
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• 2018

We reviewed clinical studies investigating the pharmacological treatment of major depressive episodes (MDEs) with mixed features diagnosed according to the dimensional criteria (more than two or three [hypo]manic symptoms+principle depressive symptoms). We systematically reviewed published randomized controlled trials on the pharmacological treatment of MDEs with mixed features associated with mood disorders, including major depressive disorder (MDD) and bipolar disorder (BD). We searched the PubMed, Cochrane Library, and ClinicalTrials.gov databases through December 2017 with the following key word combinations linked with the word OR: (a) mixed or mixed state, mixed features, DMX, mixed depression; (b) depressive, major depressive, MDE, MDD, bipolar, bipolar depression; and (c) antidepressant, antipsychotic, mood stabilizer, anticonvulsant, treatment, medication, algorithm, guideline, pharmacological. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We found few randomized trials on pharmacological treatments for MDEs with mixed features. Of the 36 articles assessed for eligibility, 11 investigated MDEs with mixed features in mood disorders: six assessed the efficacy of antipsychotic drugs (lurasidone and ziprasidone) in the acute phase of MDD with mixed features, although four of these were post hoc analyses based on large randomized controlled trials. Four studies compared antipsychotic drugs (olanzapine, lurasidone, and ziprasidone) with placebo, and one study assessed the efficacy of combination therapy (olanzapine+fluoxetine) in the acute phase of BD with mixed features. Pharmacological treatments for MDEs with mixed features have focused on antipsychotics, although evidence of their efficacy is lacking. Additional well-designed clinical trials are needed.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제24권1호
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• pp.13-20
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• 2013

Neuroleptic malignant syndrome (NMS) is a severe iatrogenic complication of treatment with antipsychotic medication. The aim of this review is to provide the clinical characteristics and treatments of children and adolescents with NMS. Searches were conducted in Medline, Korean studies Information Service System (KISS), and Research Information Service System (RISS). Sixteen case reports and two review articles were selected in Medline, and two Korean cases reported in department of emergency medicine and pediatrics were selected from RISS. Heterogeneous and atypical presentations of NMS were observed in children and adolescents. Some noticeable differences were observed between adult patients and child patients with NMS. In addition, symptom presentations related to atypical antipsychotic agents differed from those of typical ones. In treatment, bromocriptine and benzodiazepine were recommended for management of symptoms. In particular, electroconvulsive therapy (ECT) was a useful treatment option. For prevention and early detection of NMS in children and adolescents, evaluation of risk factors and understanding of diagnostic features of NMS are very important.

• 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.