• 생물정신의학
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• 제19권4호
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• pp.205-210
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• 2012

Objectives The purpose of this study was to investigate clinical profile, efficacy, and safety of long-term treatment with selective serotonin reuptake inhibitors (SSRIs) in Korean autism spectrum disorders (ASDs) patients. Methods Effectiveness was assessed through a retrospective review of self-reported target symptom improvement at the last follow-up visit. Changes in illness severity and improvement were measured using the Clinical Global Impression-Severity (CGI-S) of illness and Clinical Global Impression-Improvement (CGI-I) Scales. Tolerability was assessed through a review of the reason for discontinuation of SSRI and documented adverse events. Results A total of 21 ASDs patients (aged 9 to 19 years) treated with SSRI during July 2010 to July 2011 in department of child and adolescent psychiatry of Seoul National Hospital were identified. The mean duration of SSRI treatment was 47.9 (standard deviation = 36.9) months (range 0.7-114.5), and the mean fluoxetine equivalent dosage of SSRIs was $27.1{\pm}10.8$ mg. Nineteen (90.5%) patients were using concomitant medication. We found that SSRIs were prescribed for symptoms of agitation, stereotyped behavior, aggression, depression, impulsivity and self-injury in ASDs. Ten patients (47.6%) reported improvement in their target symptom after SSRI treatment based on CGI-I scores (CGI-I ${\leq}$ 2). The side effects were reported in 5 patients (23.8%) ; vomiting (n = 2, 9.5%), excessive mood elevation (n = 1, 4.8%), insomnia (n = 1, 4.8%), somnolence (n = 1, 4.8%) and decreased appetite (n = 1, 4.8%). Self-injurious behavior was reported in one patient (4.8%). Conclusions The results of this study suggest that SSRIs may be used effectively in children and adolescents diagnosed with ASDs. However, safety issues need to be considered carefully when choosing SSRIs for treatment. Future controlled trials are needed to confirm these findings.

• 대한불안의학회지
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• 제13권2호
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• pp.66-73
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• 2017

우울증은 높은 유병률을 가지며 심각하고 만성화 될 수 있는 질병이다. 환자가 증상 없이 기능적 회복이 되어 일상을 영위하기 위해 임상가는 단독요법 이상의 치료 전략이 필요하다. 본 연구에서 SSRI와 aripiprazole 또는 bupropion 부가 요법은 우울증의 증상 호전을 보였다. SSRI와 aripiprazole 부가 요법은 우울증의 전반적 점수의 호전뿐 아니라 세부척도의 핵심 증상에서 bupropion 병합 요법에 비해 더 의미 있는 변화를 보였다. 또한 두 약제 모두 핵심 우울증상이라 할 수 있는 개별증상(우울한 기분, 일과 활동, 정신적 불안)에서 가장 큰 변화를 보였다

• Toxicological Research
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• 제32권3호
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• pp.207-213
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• 2016

Although propolis is one of the most popular functional foods for human health, there have been no comprehensive studies of herb-drug interactions through cytochrome P450 (CYP) inhibition. The purpose of this study was to determine the inhibitory effects of propolis on the activities of CYP1A2, 2A6, 2B6, 2C9, 2C19, 2D6, 2E1 and 3A4 using pooled human liver microsomes (HLMs). Propolis inhibited CYP1A2, CYP2E1 and CYP2C19 with an $IC_{50}$ value of 6.9, 16.8, and $43.1{\mu}g/mL$, respectively, whereas CYP2A6, 2B6, 2C9, 2D6, and 3A4 were unaffected. Based on half-maximal inhibitory concentration shifts between microsomes incubated with and without nicotinamide adenine dinucleotide phosphate, propolis-induced CYP1A2, CYP2C19, and CYP2E1 inhibition was metabolism-independent. To evaluate the interaction potential between propolis and therapeutic drugs, the effects of propolis on metabolism of duloxetine, a serotonin-norepinephrine reuptake inhibitor, were determined in HLMs. CYP1A2 and CYP2D6 are involved in hydroxylation of duloxetine to 4-hydroxy duloxetine, the major metabolite, which was decreased following propolis addition in HLMs. These results raise the possibility of interactions between propolis and therapeutic drugs metabolized by CYP1A2.

• Journal of Korean Neurosurgical Society
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• 제61권4호
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• pp.427-433
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• 2018

Obsessive compulsive disorder is a debilitating condition characterized by recurrent obsessive thoughts and compulsive reactions. A great portion of the obsessive compulsive disorder (OCD) patients are managed successfully with psychiatric treatment such as selective serotonin-reuptake inhibitor and cognitive behavioral psychotherapy, but more than 10% of patients are remained as non-responder who needs neurosurgical treatments. These patients are potential candidates for the neurosurgical management. There had been various kind of operation, lesioning such as leucotomy or cingulotomy or capsulotomy or limbic leucotomy, and with advent of stereotaxic approach and technical advances, deep brain stimulation was more chosen by neurosurgeon due to its characteristic of reversibility and adjustability. Gamma knife radiosurgery are also applied to make lesion targeting based on magnetic resonance (MR) imaging, but the complication of adverse radiation effect is not predictable. In the neurosurgical field, MR guided focused ultrasound has advantage of less invasiveness, real-time monitored procedure which is now growing to attempt to apply for various brain disorder. In this review, the neurosurgical treatment modalities for the treatment of OCD will be briefly reviewed and the current state of MR guided focused ultrasound for OCD will be suggested.

• 정신신체의학
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• 제20권2호
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• pp.135-138
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• 2012

기능성 위장관 장애(functional gastrointestinal disorder, FGID)의 생물학적 병태생리는 아직 명확하지 않은 실정이나 최근에 뇌-장관 축(brain-gut axis, BGA) 모델이 각광받고 있다. BGA 모델은 중추신경계(CNS)와 장관신경계(ENS)가 신경계, 신경내분비계, 신경면역계 등으로 밀접하게 연계되어 양방향성으로 항상성을 유지한다는 이론이다. 또한 BGA는 FGID에 대한 항우울제 효과의 이론적 근거를 제공한다. 저자들은 세로토닌 노르에프네프린 재흡수 차단제인 duloxetine이 목 이물감, 우울감을 보이는 환자와 상부 위장관 팽만감, 건강염려증적 불안을 보이는 환자에서 위장관 증상 및 정신의학적 증상에 효과적이었음을 경험하였다. 이에 두 증례보고를 통하여 BGA에 대해서 간략히 검토하고 duloxetine의 효과를 BGA의 측면에서 고찰하였다. 이 두 증례에서 duloxetine의 장관에서 뇌로의 영향(bottom-up regulation)으로는 세로토닌 수용체, 노르에피네프린 수용체 그리고 부신피질자극호르몬방출인자(CRF) 길항효과를 통해서 내장과민성(visceral hypersensitivity) 및 정신의학적 증상을 호전시키고, 뇌에서 장관으로의 영향(top-down regulation)으로는 우울과 불안을 호전시킴으로 위장관 증상에 영향을 미친 것으로 추정해 볼 수 있다.

• The Korean Journal of Pain
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• 제25권4호
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• pp.228-237
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• 2012

Background: Milnacipran is a balanced serotonin norepinephrine reuptake inhibitor with minimal side effects and broad safety margin. It acts primarily on the descending inhibitory pain pathway in brain and spinal cord. In many animal studies, intrathecal administration of milnacipran is effective in neuropathic pain management. However, there is no study for the neurological safety of milnacipran when it is administered neuraxially. This study examined the neurotoxicity of epidural milnacipran by observing behavioral and sensory-motor changes with histopathological examinations of spinal cords in rats. Methods: Sixty rats were divided into 3 groups, with each group receiving epidural administration of either 0.3 ml (3 mg) of milnacipran (group M, n = 20), 0.3 ml of 40% alcohol (group A, n = 20), or 0.3 ml of normal saline (group S, n = 20). Results: There were no abnormal changes in the behavioral, sensory-motor, or histopathological findings in all rats of groups M and S over a 3-week observation period, whereas all rats in group A had abnormal changes. Conclusions: Based on these findings, the direct epidural administration of milnacipran in rats did not present any evidence of neurotoxicity in behavioral, sensory-motor and histopathological evaluations.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제18권2호
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• pp.109-116
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• 2007

The objective of this review is to establish practice parameters for pharmacological treatment of children and adolescents with pervasive developmental disorders. We performed a detailed review of the literature, including a wide range of controlled clinical trials, open trials, case reports, and side-effect profiles of related drugs. Few medications have a treatment indication for pervasive developmental disorders, and few studies with well-controlled methodology are available for evaluating treatment results. Pharmacological treatments focus on associated target symptoms because symptom reduction may improve educational and social ability and enhance quality of life. Well-controlled trials have been conducted for some SSRI(selective serotonin reuptake inhibitor) antidepressants, risperidone, and methylphenidate, and showed reduction of some target symptoms. Since the medications are not specific to autism and do not treat core symptoms of the disorder, their potential side effects should be carefully considered. Family education is necessary to give proper information on target symptoms, limitation of drug treatments, and risks.

• 대한불안의학회지
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• 제2권2호
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• pp.94-100
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• 2006

Objective : This study was designed to examine the volumetric abnormality of orbitofrontal cortex (OFC) and its change after 2 years of pharmacotherapy in obsessive compulsive disorder (OCD) patients. Method : Volumetric magnetic resonance imaging studies were conducted in 15 OCD patients and 13 normal volunteers. For 2 years, all patients took at least one serotonin reuptake inhibitor and atypical antipsychotics were used as an augmentation therapy in most patients. The follow-up MRI studies were conducted after the pharmacotherapy and OFC volumes were measured by the manual region of interest method. Results : Bilateral OFC volumes of 15 OCD patients were significantly greater than those of the normal volunteers before the treatment. After 2 years of the treatment, significant decrease was observed in bilateral OFC volumes of OCD patients to the extent that left OFC volume of OCD patients was not different from that of the normal volunteers. Conclusion : This finding suggests that OFC is directly related to the pathophysiology of obsessive compulsive disorder.

• 대한본초학회지
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• 제30권3호
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• pp.13-17
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• 2015

Objectives : Taraxacum platycarpum H. Dahlstedt has been reported to have several biological properties such as skin hydration and antiinflammation. The purpose of this study was to examine the antidepressive effects of water extract of T. platycarpum (WTP) on an animal model of depression. Methods : In the present study, normal ICR mice (4 weeks) were used, and orally administered with WTP (25, 50 and 100 mg/kg). Depression-like behavior was monitored the forced swimming test (FST) and tail suspension test (TST) in mice. The locomotor activity was evaluated to eliminate the false-positive activity in the open field test (OFT). Fluoxetine, the selective serotonin reuptake inhibitor, as a positive control was intraperitoneally administered at a dose of 15 mg/kg at 30 min before starting the behavioral test. Moreover, we evaluated the effects of WTP on the expression of brain-derived neurotrophic factor (BDNF) and the extracellular signal-regulated kinase (ERK)/ cyclic AMP response-element binding protein (CREB) signaling pathway in the hippocampus using Western blot. Results : The administration of WTP (50 and 100 mg/kg) significantly (P < 0.05, respectively) reduced the immobility time during FST and TST without accompanying changes in locomotor activity by OFT. Furthermore, WTP at dose of 100 mg/kg increased the BDNF expression and the phosphorylation of ERK and CREB in the hippocampus region. Conclusions : These results suggest that WTP has a useful anti-depressant effect through the regulation of BDNF/ERK/CREB signaling pathway.

• 한방재활의학과학회지
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• 제23권2호
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• pp.185-191
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• 2013

본 증례에서는 절식치료 중인 환자에 있어 글리세린 관장을 실시한 직후 발생한 허혈성 대장염 1례에 대해 고찰하여, 관장으로 인한 장관 내압 상승, 상온의 체온보다 낮은 관장액으로 인한 혈관 경련, 선택적 세로토닌 재흡수 억제제에 의한 출혈 경향 증가 및 글리세린 용액의 화학적 삼투작용으로 인한 점막 손상 가능성 등을 제시하였다. 관장으로 인한 이와 같은 부작용을 예방하기 위하여 임상의들의 주의가 요구된다.