• 생물정신의학
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• 제6권2호
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• pp.189-192
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• 1999

The genetically determined CYP2D6 activity may be considered to be associated with antipsychotic induced extrapyramidal side effects with interindividual variation. Genetic polymorphism of CYP2D6 was determined by polymerase chain reaction(PCR) and MspI restriction fragment length polymorphisms(RFLP) for 194 schizophrenics. Subjects with a 334bp band were classified a1a1, those with 229bp and 105bp bands a2a2, and those with all three bands a1-a2. We did not identify schizophrenic subject with poor metabolizer. 194 schizophrenic patients previously treated neuroleptic medication, were assessed by Extrapyramidal Symptom Rating Scale(ESRS).The cases were composed of 33 akathisia, 47 parkinsonism, 21 tardive dyskinesia. These results are similar to the previous understanding that the poor metabolizer is very rare in Orientals compared to Caucasians, therefore, it considered that CYP2D6 genotypes have maybe no association with schizophrenia and extrapyramidal side effects in Koreans.

• 생물정신의학
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• 제8권1호
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• pp.147-152
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• 2001

Objective : It has been thought that estrogen has neuroleptic like effect in women schizophrenic patients. This study aimed to investigate neuroleptic side-effects severity in women with schizophrenia and to investigate their putative association with variations in sex steroids over menstrual cycle. Based on the estrogen theory, The author hypothesized that parkinsonian side-effects would be exacerbated when estrogen levels were high. Method : 26 schizophrenic women were assessed using the ESRS(Extrapyramidal Symptom Rating Scale) and estrogen analysis. Tests were conducted twice, in the mid luteal and mid follicular phase. Result : It was hypothesized that high level of estrogen would lead to an exacerbation of parkinsonian side-effects but the results indicated that parkinsonian side effects decreased overall when estrogen levels were high. This effects were more marked for the group taking typical neuroleptics than those taking atypical neuroleptics. Conclusion : The results of this study suggest that estrogen and progesteron may reduce the severity of neuroleptic induced extrapyramidal side effects over menstrual cycle in women with schizophrenia. It was concluded that estrogen has different effects on dopamine dynamics in the mesolimbic and mesostriatal pathways according to estrogen, progesteron, catecol estrogen, prolactine.

• The Korean Journal of Pain
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• 제4권1호
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• pp.20-25
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• 1991

During the past decade the use of epidural opioids for treatment of chronic as well as postoperative pain has increased Epidural droperidol significantly reduced the side effects of epidural morphine without any appreciable toxicity, except possibly sedation. The purpose of this study was to assess the side effects and potentiation of analgesia of epidural morphine by dose-related droperidol. The results were as follows: 1) Duration of analgesia and pain score: There was no significant difference between morphine and dose-related droperidol groups. 2) Pruritus: Droperidol did not affect the incidence of pruritus with epidural morphine (P>0.05). 3) Nausea and vomiting: Significantly fewer patients experienced nausea and vomiting (16.7%) with droperidol 2.5mg(P<0.001). 4) Hypotensive episode Hypotension occurred in the groups with droperidol 1.25 mg (27. 8%) and 2.5mg(33.3%). 5) Sedation: It there was increased severity and incidence of sedation with dose related epidural droperidol. 6) Respiratory depression: There was no patient with respiratory depression in the morphine or droperidol group. 7) Extrapyramidal symptoms and others: There was no extrapyramidal symptom in the group with morphine and 0.25 mg droperidol, but 3 patients in the group with l.25 mg droperidol and 5 patients in the group with 2.5 mg droperidol how extrapyramidal symptoms. One patient in droperidol 2.5 mg developed suspicious NMS. It is suggested that the use of epidural droperidol to reduce the side effects of morphine may not be appropriate.

• 생물정신의학
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• 제2권2호
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• pp.281-286
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• 1995

Objects : Manic phase of bipolar disorder is treated with a combination of mood stabilizer and antipsychotic drug, especially in the acute phase. Such combined treatment is often required for the clinical management of manic symptoms until therapeutic effects of mood stabilizer become evident. The present study was the first open trial to evaluate the efficacy of risperidone, and safety of the combination of mood stabilizer and risperidone in the treatment of acute manic patients. Method : This study was performed as an open clinical study. The subjects of this study were 42 patients who had been admitted with first manifestations or acute exacerbations of illness were selected, using DSM-III-R criteria for bipolar disorder, manic episode. Patients were rated using the the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI), Extrapyramidal Symptom Rating Scale(ESRS). Other adverse events were assessed by a symptom checklist and by observation by medical personnel. Vital signs were monitored in a standard way and electrocardiography, routine laboratory analysis were performed. Results : Thirty patients(67%) completed the 12-week trial period. The CGI showed a good therapeutic effect with a minimal incidence or severity of side effects. The majority of patients showed a continuos reduction in their BPRS scores. The extrapyramidal symptoms assessed on ESRS generally showed mild to moderate degree. laboratory porameters showed no significant changes during the course of treatment. Conclusion : The results of the study showed a good efficacy of the risperidone in manic patients and further controlled studies are warranted.

• 생물정신의학
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• 제5권2호
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• pp.263-277
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• 1998

Conventional high-dose antipsychotics tend to result in more side effects, negative symptoms and dysphoria, and at the same time lower the cognitive function which is already impaired in most schizophrenics. Florid psychotic symptoms, negative symptoms and cognitive impairment greatly impede psychosocial performance and eventual reintegration into society. The reduction of symptom and the improvement of cognitive funtions and social skills are therefore central to the psychiatric rehabilitation process. The purpose of this study was to evaluate the dose-reduction effects of antipsychotics on chronic schizophrenics prescribed conventional high-dose antipsychotics more than 1,500mg equivalent of chlorpromazine. Fifty-one chronic schizophrenics who maintained high-dose antipsychotics for more than three months were randomly assigned to two groups : 20 patients comprised the dose-maintaining group and 31 patients made the dose-reduction group. Over a sixteen weekperiod Positive and Negative Syndrome Scale(PANSS), Extrapyramidal Symptom(EPS), Nurses' Observation Scale for Inpatient Evaluation(NOSIE-30), Continuous Performance Test(CPT), Quality of Life(QOL), and haloperidol/reduced haloperidol blood levels were determined at the base line and after 2, 4, 6, 8, 12, 16 weeks to evaluate the dose reduction effects of high-dose antipsychotics. The results were as follows : 1) Dose-reduction is highly effective in reducing positive and negative symptoms, and general psychopathology. Effects were most prominent at 8, 12, 16 weeks. Among the dose reduction group, positive symptoms in positive symptom group and negative symptoms in negative symptom group were more reduced. 2 Extrapyramidal symptoms showed no significant difference between two groups. But the EPS was reduced time after time within two groups. 3) Hit rates of Continuous Performance Test, which indicate attentional capacity, increased significantly after dose reduction. 4) Haloperidol and reduced haloperidol blood levels decreased until the 4th week, after which they were constant. 5) Total scores of Nurses' Observation Scale for Inpatient Evaluation were unchanged between the two groups. But among the indices, social interest and personal neatness were improved in the dose-reduction group and retardation was aggrevated in the dose-maintaining group. 6) Total quality of life scores were unchanged between two groups. But in the dose maintaining group, satisfaction scores of attention, autonomy, and interpersonal relationship decreased progressively. These findings suggest that the dose reduction of antipsychotics for chronic schizophrenics on programs of high-dose antipsychotics were effective. Dose reduction should therefore be implemanted to spread the rehabilitation and improve quality of life for chronic schizophrenics.

• The Korean Journal of Pain
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• 제32권1호
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• pp.3-11
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• 2019

Going back to basics prior to mentioning the use of antipsychotics in patients with pain, the International Association for the Study of Pain (IASP) definition of pain can be summarized as an unpleasant experience, composed of sensory experience caused by actual tissue damage and/or emotional experience caused by potential tissue damage. Less used than antidepressants, antipsychotics have also been used for treating this unpleasant experience as adjuvant analgesics without sufficient evidence from research. Because recently developed atypical antipsychotics reduce the adverse reactions of extrapyramidal symptoms, such as acute dystonia, pseudo-parkinsonism, akathisia, and tardive dyskinesia caused by typical antipsychotics, they are expected to be used more frequently in various painful conditions, while increasing the risk of metabolic syndromes (weight gain, diabetes, and dyslipidemia). Various antipsychotics have different neurotransmitter receptor affinities for dopamine (D), 5-hydroxytryptamine (5-HT), adrenergic (${\alpha}$), histamine (H), and muscarinic (M) receptors. Atypical antipsychotics antagonize transient, weak $D_2$ receptor bindings with strong binding to the $5-HT_{2A}$ receptor, while typical antipsychotics block long-lasting, tight $D_2$ receptor binding. On the contrary, antidepressants in the field of pain management also block the reuptake of similar receptors, mainly on the 5-HT and, next, on the norepinephrine, but rarely on the D receptors. Antipsychotics have been used for treating positive symptoms, such as delusion, hallucination, disorganized thought and behavior, perception disturbance, and inappropriate emotion, rather than the negative, cognitive, and affective symptoms of psychosis. Therefore, an antipsychotic may be prescribed in pain patients with positive symptoms of psychosis during or after controlling all sensory components.

• 한국음향학회지
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• 제41권3호
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• pp.367-374
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• 2022

본 논문은 항정신병 약물의 복용량에 따른 음성 특징의 상관관계 분석을 수행하였다. 항정신병 약물의 대표적 부작용 중 하나인 추체외로 증상(ExtraPyramidal Symptoms, EPS) 발생에 따른 음성 특징의 패턴을 알아보기 위하여, 문장 개발을 통해 한국어 기반 추체외로 증상 음성 코퍼스를 구축하였다. 수집된 자료는 추체외로 증상 군과 비 추체외로 증상 군으로 나누어 음성 특징 패턴을 조사하였으며, 특히 추체외로 증상 군의 높은 음성 특징 상관관계를 보였다. 또한, 발화 문장의 종류가 음성 특징 패턴에 영향을 미친다는 것을 확인할 수 있었으며, 이를 통해 음성 특징을 기반한 추체외로 증상의 조기 발견 가능성을 기대해볼 수 있었다.

• 한국임상약학회지
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• 제11권2호
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• pp.89-96
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• 2001

Ziprasidone is equally effective as haloperidol in treating schizophrenia with fewer side effects and drug interactions. Ziprasidone is an atypical antipsychotic agent and works by blocking serotonin and dopamine receptors in the central nervous system, specifically 5-HT2A and D2 receptors. Low anticholinergic side-effects and low EPS would recommend the drug for use in the elderly. Ziprasidone inhibits reuptake of norepinephrine and serotonin at neurojunction sites in vitro, indicating a potential efficacy for depression and negative symptoms which often follow after exacerbation of schizophrenia. Patients with recent acute myocardial infarction and uncompensated heart failure are contraindicated to the drug due to a possibility of QT prolongation. Although ziprasidone is metabolized by cytochrome P450 3A4, there is no significant drug interaction with the drugs that induce or inhibit the isoenzyme. Ziprasidone is safe with coadministration of lithium and there has been no significant drug interaction reported with oral birth control pills.

• 생물정신의학
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• 제2권1호
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• pp.131-139
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• 1995

Clozapine은 정형적 항정신병약물에 반응하지 않는 불응성 정신분열증 환자에게 효과적이며, 추체외로부작용이 적은 비정형적 향정신병약물로 보고되고있다. 따라서 저자들은 불응성 정신분열증환자를 대상으로 clozapine의 항정신병효과 및 부좌용에 대해 대표적 전형적 항정신병약물인 haloperidol과 비교연구하였다. 대상환자를 clozapine투여군(17명) 과 haloperidol 투여군 (16명)으로 나누어 12주 동안 각각의 약물을 투여하는 전향적 개방대조연구를 하였다. 두가지 약물의 치료효과와 부작용은 BPRS, PANSS, Simpson-Angus Rating Scale 및 Adverse Events-Somatic Symptoms를 사용하여 평가하였다. 약물투여 12주후 clozapine투여군이 76.5% 에서 치료반응을 보인데 비해 haloperidol투여군은 31.2%의 치료반응을 보임으로써 두약물 투여군간에 유의한 차이가 있었다. BPRS와 PANSS 척도상 clozapine투여군이 haloperidol투여군에 비하여 BPRS, PANSS 양성증상 및 일반증상 척도는 약물투여 8주후부터, PANSS 음성척도는 약물투여 4주후부터 12주까지 일관성있게 지속적으로 의미있는 호전을 보였다. Clozapine투여군에서는 타액분비(70.6%), 졸리움(52.9%), 변비(29.4%) 및 저혈압(23.4%)이, haloperidol투여군은 진전(37.5%), 정좌불능(25.0%), 강직(18.8%) 및 무운동(18.8%)이 흔히 보고되었다. 하지만 두약물 투여군 모두에서 대부분 경미하고 환자가 견딜 정도였다. Clozapine투여군에서 약물투여 전에 비해서 약물투여 12주후 백혈구와 호중구의 유의한 변화는 없었다. 이상의 결과를 종합해볼 때, clozapine은 정형적 항정신병약물에 치료효과가 없거나 추체외로부작용 때문에 약물투여가 어려운 경우의 한국인 불응성 정신분열증환자에게 효과적인 비정형적 항정신병약물이다.

• 대한한방소아과학회지
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• 제18권2호
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• pp.143-160
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• 2004

Objective: There were few reports on the treatment of Hypoxic ischemic encephalopathy. We treated a hypoxic ischemic encephalopathic patient after accident with Oriental medical approach, and get a significant result. this treatment shows the possibility of healing Hypoxic ischemic encephalopathy, So we are reporting that case. Method : The acupuncture, herb medication. rehabilitation therapy was applied for treting patient's chife symptom(involuntary movement, dystonia, aphasia, dysuria, constipation) Results : 1. Generally patients with Hypoxic ischemic encephalopathy show language impairment and cognition disorder for several weeks to months. After coma stage, first they recover consciousness but have various degree of confusional mentality, visual agnosia, extrapyramidal stiffness and motor disturbance. 2. Consciousness loss in acute stage of Hypoxic ischemic encephalopathy can be considered as Mental Confusion due to Phlegm(Dammisimgyu) in veiw point of Oriental medicine. 3. After oriental medical treatment, patient's chief symptoms were improved. Conclusion: We treated a hypoxic ischemic encephalopathic patient with Oriental medical approach and patient's chief symptoms were improved. this treatment shows the possibility of healing Hypoxic ischemic encephalopathy.