• 생물정신의학
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• 제14권1호
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• pp.14-20
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• 2007

Objectives : The diagnosis of depression is based on a highly variable set of symptoms. Therefore, depression should not be viewed as a single disease, but a heterogenous syndrome comprised of different pathophysiologies. There are several subtypes of depression which were already incorporated in DSM-IV. This article provides a systematic review of pharmacological treatments of two recognized subtypes of depression-dysthymic disorder and atypical depression. Methods : Systematic search of relevant literatures on dysthymic disorder and atypical depression was performed by proposed search strategy of the Clinical Research Center for Depression of Korean Health 21 R&D Project. All identified literatures were carefully reviewed and classified according to SIGN grading system and summarized in a narrative manner. Results : For the treatment of dysthymic disorder and atypical depression, selective serotonin reuptake inhibitors( SSRIs) and moclobemide have more evidence than the other antidepressants. SSRIs and moclobemide showed superior tolerability than tricyclic antidepressants. Conclusions : The authors proposed treatment recommendations for dysthymic disorder and atypical depression by the methods of evidence-based medicine(EBM). However, guideline developing methods of EBM also have several inevitable limitations. Therefore, in the absence of clear and significant differences in efficacy, the choice of medication must be individualized for a particular patient based on psychiatrist's own clinical decision.

• 생물정신의학
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• 제9권2호
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• pp.103-111
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• 2002

Neurocognitive research focusing on cognitive deficits in Depression has resulted in several important but yet potentially contradictory findings. Much literature documents the presence of significant neurocognitive impairments in depressive patients. Studies have shown that dysthymic disorder patients demonstrate a diffuse pattern of cognitive impairment which is frequently indistinguishable from that of focal braindamaged patients. Some reports have suggested that there is a focal pattern of deficit, such as anterior cingulate dysfunction, frontal lobe impairment, or dysfunction of the temporal-limbic cortex. The aim of this study is to evaluate the neurocognitive functions in dysthymic disorder patients, and to compare the functions with those of major depressive disorder patients. The subjects are 17 dysthymic disorder patients. And their neurocognitive functions are compared with those of 23 major depressive episode patients. Patients with a history of neurologic disease, alcohol dependence, substance abuse and mental retardation are excluded. They are assessed with a part of Vienna Test System which is computerized neurocognitive function tests and can evaluate attention, eductive ability, reproductive ability, visuoperceptual analysis, vigilance, visual immediate memory, the speed of information-processing, judgement, and fine motor coordinations. There are no other specific difference between two groups, except the result of cognitrone test. This study provides information about the neurocognitive functions and some difference between major depressive disorder patients and carefully diagnosed dysthymic disorder patients.

• 생물정신의학
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• 제3권1호
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• pp.46-50
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• 1996

주요 우울장애 환자와 기분부전장애 환자에서 정상대조군과 비교하여 임파구에 isoproterenol 자극 후 cyclic AMP 생성반응에 차이가 있는지를 알아보고, 이 두 질환군에서 net cyclic AMP levels와 우울정도간의 상관성을 알아보고자 주요 우울장애군 8명, 기분부전장애군 9명, 정상대조군 10명을 대상으로 본 연구를 시행하였다. Cyclic AMP 농도는 방사면역 측정법 (radioimmunoassay)으로 측정하였다. 결과를 요약하연 다음과 같다. 1) HDRS 정수상 주요 우울장애군이 기분부전장애군보다 유의하게 우울정도가 높았다. 2) Isoproterenol 자극전 basal cyclic AMP levels는 정상대조군, 주요 우울장애군, 기분부전장애군간에 차이가 없었다. 3) Isoproterenol $10^{-5}mol/L$ 자극후 net cyclic AMP levels는 정상대조군 주요 우울장애군, 기분부전장애군간에 유의한 차이를 보였다. 4) 주요 우울장애군에서 isoproterenol $10^{-5}mol/L$ 자극후 net cyclic AMP levels와 HDRS 점수간에 유의한 역상관관계를 보였으나, 기분부전장애군에서는 상관관계를 보이지 않았다. 이상의 결과로 저자들은 기분부전장애가 임상적으로는 주요 우울장애의 우울정도가 경미한 한 형태로 보이지만 생물학적으로는 이들 두 질환이 다른 질환일 수 있다고 생각하였다.

• 생물정신의학
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• 제2권1호
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• pp.70-76
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• 1995

A few researchers have reported that major depression may be associated with higher levels of positive acute phase proteins(APPs), such as haptoglobin(Hp), ${\alpha}1$-antitrypsin(${\alpha}1AT$), ceruloplasmin(Cp) and lower levels of negative APPs(visceral proteins), such as albumin(Alb) and transferrin(Tf). Elevated levels of positive APPs and a drop in negative APPs constitute important indicators of immune activation. This study was designed to investigate whether altered serum concentrations of positive APPs and of negative APPs reflect the state of depression. Twenty patients who fulfilled DSM-III-R criteria for major depressive disorder and for dysthymic disorder and twelve normal healthy controls were included. The authors measured positive APPs(Hp, ${\alpha}1AT$, Cp) and negative APPs(Alb, Tf) using rate nephelometry and bromcresol green method. 1) There were significant increases of ${\alpha}1AT$, Cp in major depressed patients as compared with normal controls. Trends towards higher Hp and lower Alb, Tf in major depressed patients were observed. 2) No significant difference of APPs concentrations between dysthymic patients and normal controls was found. 3) Severity of depression(HDRS, BDI score) was related to Hp, Cp, ${\alpha}1AT$ value positively. Our findings are partially compatible with the hypothesis that major depression may be accompanied by acute phase response with higher levels of positive APPs and lower levels of negative APPs.

• 생물정신의학
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• 제4권2호
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• pp.251-258
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• 1997

The dysfunction of either or both noradrenaline and serotonin system are important in the pathophysiology of depression. Previous reports have suggested that there may be an important interaction between these two systems. Recently, some investigators have suggested that the combination of tricyclic antidepressants(TCAs) and selective serotonin reuptake inhibitors(SSRIs) would produce a rapid synergistic effect on down-regulation of either or both of these two systems and that this combination may produce a more rapid and absolute antidepressant effect. We compared the treatment efficacy, treatment associated side effects, treatment satisfaction, and the quality of life between the combination therapy of dothiepin-sertraline as well as the therapy of dothiepin alone in the treatment of major depressive disorder and dysthymic disorder. In our study, the combination therapy of dothiepin and sertraline produced a more rapid and absolute antidepressant effect than dothiepin alone. And the patients with combination therapy experienced relatively high treatment satisfaction than the patients with dothiepin therapy. The patients' quality of life improved more rapidly in the combination therapy, especially, in the health perception, social behavior, and life satisfaction, than dothiepin alone. These results support the hypothesis that the combination of TCA and SSRI may produce a rapid synergistic effect on either or both norepinephrine and serotonin system, and more rapid antidepressant effect and high treatment satisfaction.

• 생물정신의학
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• 제9권1호
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• pp.34-41
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• 2002

Background:Since serotonin neurotrasnmission plays an important role in the pathophysiology of depression, the drug that acts on serotonin transporter can be an effective antidepressant. The aim of this study was to investigate the relationship between serotonin transporter polymorphisms(5-HTTLPR) and the long-term effect of the antidepressant treatment. Method:The 175 depressive patients, who met DSM-IV criteria for major depressive disorder or dysthymic disorder were enrolled into three year study. The genotypes of the patients were investigated by polymerase chain reaction of genomic DNA with promoter regions of the serotonin transporter gene. The patients were assessed by the Clinical Global Impression Scale, at the 1st visit, 8th week, 16th week, 1st year, 2nd and 3rd year after the antidepressant treatment. Result:The genotypes of 138 patients were investigated and 128 of them finished this 1st year study and 107 remained in the study after 2-year treatment, and, 97 completed this 3-year study. The therapeutic response of each subset was not different at 8th, 16th week, but the subset with homozygote(l/l) of long variant showed a better antidepressant therapeutic response than heterozygote(l/s). The heterozygote(l/s) showed a better response than the subset with homozygote(s/s) of short variant at 1st, 2nd and 3rd year after the antidepressant treatment in CGI-global improvement score. Conclusion:This result shows that the serotonin transporter polymorphism may be related to the long-term effect of antidepressant treatment and there may be also ethnic difference.

• 생물정신의학
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• 제6권1호
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• pp.96-101
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• 1999

Background : Since dysthymia begins in late childhood or adolescence and has a chronic course, long-term pharmacotherapy may be required. New generation antidepressant, moclobemide, with more acceptable side effect profiles, is effective in the treatment of dysthymia. The main objective of this study was to determine whether they exhibit comparable efficacy and tolerability in dysthymia to amitriptyline. Method and Materials : The efficacy and tolerability of the moclobemide and amitriptyline, were compared in a eight-week single-centre double-blind study in patients(n=37) with dysthymia using he HAMD-17, the Clinical Global Impression Scale(CGI), the Montgomery-Asberg Depression Rating Scale (MADRS), Efficacy Index-Therapeutic Index(EITE), 4-point Index Side Effect Scale(4-PISES), and Efficacy Index- Side Effect Scale(EISE). Results : A total of 37 patients entered the study, 19 were randomly assigned to the moclobemide group and 18 to be amitriptyline group. Demo-graphic and illness characteristics were similar in both groups. There were no significant difference between two groups at the total 17-HDRS score, the HAMD-17% improvement, the total MADRS score, CGI response, and the EITE. In the comparison of EISE between two groups, the scores of the moclobemide group were relatively lower than the amitriptylinen group in full treatment. And the differences were significant(moclobemide group $1.39{\pm}0.61$ ; amitriptyline group $2.00{\pm}0.85$, p<.001). At the 4-PISE, There was no serious or treatment threatening side effects. And there was no specific difference in side effects between two groups. The moclobemide group reported higher EIR scores than the amitriptyline group at every follow up day, but the differences were not significant. And, there was no significant differences in the scores of five HRQOL subcategories which is compared between two groups at every follow up days. Conclusions : In terms of 17-HDRS and MADRS, moclobemide and amitriptyline are equally effective at least in allevating dysthymic symptoms. But moclobemide tended to be less troubling and better tolerated than amitriptyline. Therefore, moclobemide treatment can be used as a safe, and higher satisfactory treatment strategy for the dysthymia.

• 동의신경정신과학회지
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• 제16권1호
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• pp.1-17
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• 2005

Objective : This empirical research is performed to recognize diagnostic concept, pattern identification, and clinical features of Hwa-byung. In other words, the aims of this research are to examine the differences of the diagnosis between Hwa-Byung and the other psychiatric disorders, and to find out pattern identification, and clinical characteristics of Hwa-Byung for prescriptions of this syndrome. Method : In the experiment, there were participated 30 patients who were met for our criterions according to HBDIS (Hwa-Byung Diagnostic interview Schedule). These patients were diagnosed as Axis1 according to criterions of DSM-IV with administering SCID-I. OMS-prime was utilized for finding out pattern identification of oriental medicine. Symptom Check List-90-Revision(SCL-90-R), Hemilton rating Scale for Depression(HRSD), Heart Rate Variability(HRV), and Digital Infrared Thermographic imaging(D.I.T.I.) were also utilized to discover clinical characteristics of Hwa-Byung Patients. Results : 1. Regarding Sex-ratio, male subjects were 3(10%), and female subjects are 27(90%). The age of subjects ranged from 22 year old to 75 $(51.87{\pm}11.04;\:Mean{\pm}SD)$ 2. In the results of diagnosis on the basis of DSM-IV, the 17(56.67%) patients were MOD (Major Depressive Disorder), the 5(16.67%) patients were USD (Undifferentiated Somatoform Disorder), the 4(13.33%) patients were Dysthymic Disorder, the 3(10%) patients were GAD (Generalized Anxiety Disorder), and the 1(3.33%) was Panic Disorder. Two of the patients who diagnosed as MOD were diagnosed as Panic Disorder too, and one of them was diagnosed as Pain Disorder too. 3. Regarding pattern identification, Hwa-Byung is positively correlated to deficiency of Heart(心). and then to stagnancy of Liver-Gall bladder. Hwa-Byung is correlated deficiency symptom-complex rather than excessiveness symptom-complex. That is also correlated positively to Pathological heat and fire. 4. In SCL90-R, the mean of PSDI was $(75.3{\pm}10.7;\:Mean{\pm}SD)$. The each mean of the other 11 factors was distributed between50-70. 5. The mean of HRSD was $(17.9{\pm}5.6;\:Mean{\pm}SD)$ in the entire subject's group. Then the group of MDD was $20.9{\pm}4.4$ and the group of USD was $12.0{\pm}4.8$ 6. In the results of HRV. the mean of TP is $972.4{\pm}1174(Mean{\pm}SD)$, this is lower than normal range 1000-200. The other factors were within normal range. Then, there were no significant differences between them (p<0.05). 7. The temperatures of each acupoint have significant differences between HNl(印堂) and PC6(內關), between CV17(顫中) and PC6(內關), between HN1(印堂) and CV8(神闕), between CV17(顫中) and CV8(神闕) in comparison with the average of body temperature in the use of D.I.T.I. (p<0.01) 8. In the analysis of correlation between SCL-90-R, HRSD, HRV. and D.I.T.I. there were no significant results. According to results that the correlation was analyzed with only the MDD group as subjects, there was negative correlation between RMSSD of HRV and HRSD, between LF of HRV and PDSIof SCL-90-R, and between LF/HF of HRV and ANX, PSY, and PDSI of SCL-90-R. Conclusion : In the observation of clinical features of 30 cases of Hwa-Byung patients by using diverse structured tests, there could make diverse diagnosis as depressive disorder, anxiety disorder, and Somatoform Disorder. Particularly. MDD was highly distributed. Considering oriental medicine's pattern identification of Hwa-Byung, this syndrome is related strongly to Heart, and there were demonstrated deficiency symptom-complex, and Pathological heat and fire. One of the limits of this study is lack of control subject's group, therefore, in the future study, it requires reexamination through a comparative research with these data to complete this study.

• 대한한방소아과학회지
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• 제12권1호
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• pp.63-76
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• 1998

BACKGROUND : The purpose of this study was to investigate the new effective oriental medical treatments in pediatric diseases and its clinical applicability. METHOD : The study was composed of 1725 new patients who had been treated at the pediatric unit in the Dongguk Bun-Dang Oriental Medicine Hospital for 1 year, from 1 January 1997 to 31 December 1997, and had ages between 0 and 18 years. The chief complaint was mainly categorized by oral examination on patients and their care-givers. RESULT 1. The ratio of male to female was 1.35:1 and the number of each age group and its percentage distribution was 228 patients (13.2%) for the age group between 0 and 1 year, 746 patients (43.2%) between 2 and 6 years, and 751 patients (43.6%) for the age group over 7 years. 2. The chief complaint of the new outpatients was weakness, asthma, common cold, sinustis, skeletal disease, atopic dermatitis, stomach-ache, short stature, diarrhea, nasal blooding, night terror, allergic rhinitis, gastric disorder, enuresis, dermatitis, strabismus in the order of majority.3. The number of patients and its percentage for the most three complaints was 494 patients (28.6%) for weakness, 647 patients (37.4%) for respiratory disease, 144 patients (8.3%) for digestive disease. 4. The digestive disease tended to increase in summer, and appeared mostly in the age group between 0 and 2 years. The respiratory disease increased In inter-season and winter, but decreased significantly in summer. The age group between 1 and 5 years was the largest group of respiratory disease. CONCLUSION 1. The chief complaint in pediatric diseases that needed an oriental medical treatment was mainly the disease that tends to take long time and the weakness, and appeared frequently in digestive and respiratory diseases. 2. The oriental medical treatment was still preferred as a way to improve the weakness by patients, rather than a way to overcome their disease. In particular, the study shows that the oriental medical treatment should be emphasized in terms of preventing the disease. 3. The new diseases, which were developed with the change of human life and environment, (atopic dermatitis, enuresis, short stature, obesity, dysthymic disorder, strabismus), should be investigated as a new field of oriental medical treatment.

• 생물정신의학
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• 제19권2호
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• pp.106-113
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• 2012

Objectives : The purpose of this study is to investigate the relationship between the triallelic serotonin transporter gene and stressful life events to determine their effect on depression with alcohol dependence. Methods : Ninety-five hospitalized patients with alcohol dependence (73 male, 22 female) were enrolled in this study. Thirty-two (33.7%) of the total patients were diagnosed with major depressive disorder and dysthymic disorder by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV. The characteristics of stress were evaluated using the stressful life events scale, and depressive symptoms were assessed using the depression scale (Beck Depression Inventory, BDI). Alcoholism with depression (n = 32) and alcoholism without depression (n = 63) were genotyped for the triallelic serotonin transporter gene ($L_A$ : higher expressing allele, $L_G$/S : lower expressing allele). Results : There was no significant difference in the allele frequency between the depression group and the non-depression group (${\chi}^2$ = 0.345, p = 0.619). $L_G$/S alleles had more comorbid depression in the higher score of stressful life events scale [Mental-Haenszel (MH)-${\chi}^2$ = 4.477, p = 0.034]. But there was no significant difference in the comorbidity according to the scores from the stressful life event scale in the $L_A$ alleles (MH-${\chi}^2$ = 0.741, p = 0.399). In the results, alcohol-dependent individuals with $L_G$/S alleles had more comorbid depression than those with $L_A$ alleles when they had experienced severe stressful life events (MH-odds ratio = 2.699, p = 0.028). Conclusions : These results suggest that there is no direct relationship between triallelic serotonin transporter gene and depression in the alcohol dependent patients. But alcohol dependent individuals with the lower expressing alleles of the serotonin transporter gene were more susceptible to depression than those with the higher expressing alleles in response to stressful life events.