• The Korean Journal of Pain
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• v.32 no.1
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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.

• Korean Journal of Schizophrenia Research
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• v.20 no.2
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• pp.55-60
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• 2017

Objectives : Severe mental illness is a major risk factor for suicide. This study aimed to identify characteristics of patients who died by suicide among subjects who had been received service from a community mental health center. Methods : We searched individuals who had committed suicide in Gwangju Bukgu Community Mental Health Center since 2006. Sociodemographic and clinical data were gathered from medical records and their case managers and they were compared with those of general members in the center. Characteristics of schizophrenia patients who died by suicide were particularly summarized. Results : Twelve person committed suicide between 2006 and 2016. The characteristics of those who died by suicide were male (67%), diagnosis of schizophrenia (75%), aged below 50 (83%), unemployed (92%), past history of psychiatric hospitalization (100%), recent admission within 3 months (67%), past history of suicidal attempt (78%), family history of schizophrenia (58%), poor adherence to medication (58%), and use of daily rehabilitation program (42%). Ten out of twelve (83%) showed warning sign for suicide. All identified method of suicide in patients with schizophrenia was jumping from high building. Many patients with schizophrenia, who committed suicide, suffered from comorbid depressive symptoms (67%) and auditory hallucination (78%). Conclusion : Case managers should pay attention to and carefully manage individuals who showed suicidal warning, particularly with risk factors for suicide, such as unemployment, admission state or recent discharge from psychiatric hospital, poor adherence to medication, family history of schizophrenia, and a history of suicidal attempt.

• Knowledge Management Research
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• v.25 no.2
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• pp.1-18
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• 2024

With the increasing demand for and utilization of large language models (LLMs), the risk of user sensitive information being inputted and leaked during the use of LLMs also escalates. Typically recognized as a tool for mitigating the hallucination issues of LLMs, knowledge graphs, constructed independently from LLMs, can store and manage sensitive user information separately, thereby minimizing the potential for data breaches. This study, therefore, presents a knowledge graph-based chatbot that transforms user-inputted natural language questions into queries appropriate for the knowledge graph using LLMs, subsequently executing these queries and extracting the results. Furthermore, to evaluate the functional validity of the developed knowledge graph-based chatbot, performance tests are conducted to assess the comprehension and adaptability to existing knowledge graphs, the capability to create new entity classes, and the accessibility of LLMs to the knowledge graph content.

• Journal of Physiology & Pathology in Korean Medicine
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• v.38 no.2
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• pp.49-58
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• 2024

The rapid advancement of generative large language models has revolutionized various real-life domains, emphasizing the importance of exploring their applications in healthcare. This study aims to examine how generative large language models are implemented in the medical domain, with the specific objective of searching for the possibility and potential of integration between generative large language models and East Asian medicine. Through a comprehensive current state analysis, we identified limitations in the deployment of generative large language models within East Asian medicine and proposed directions for future research. Our findings highlight the essential need for accumulating and generating structured data to improve the capabilities of generative large language models in East Asian medicine. Additionally, we tackle the issue of hallucination and the necessity for a robust model evaluation framework. Despite these challenges, the application of generative large language models in East Asian medicine has demonstrated promising results. Techniques such as model augmentation, multimodal structures, and knowledge distillation have the potential to significantly enhance accuracy, efficiency, and accessibility. In conclusion, we expect generative large language models to play a pivotal role in facilitating precise diagnostics, personalized treatment in clinical fields, and fostering innovation in education and research within East Asian medicine.

• Journal of the Korean Society of Radiology
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• v.85 no.5
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• pp.861-882
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• 2024

Large language models (LLMs) have revolutionized the global landscape of technology beyond the field of natural language processing. Owing to their extensive pre-training using vast datasets, contemporary LLMs can handle tasks ranging from general functionalities to domain-specific areas, such as radiology, without the need for additional fine-tuning. Importantly, LLMs are on a trajectory of rapid evolution, addressing challenges such as hallucination, bias in training data, high training costs, performance drift, and privacy issues, along with the inclusion of multimodal inputs. The concept of small, on-premise open source LLMs has garnered growing interest, as fine-tuning to medical domain knowledge, addressing efficiency and privacy issues, and managing performance drift can be effectively and simultaneously achieved. This review provides conceptual knowledge, actionable guidance, and an overview of the current technological landscape and future directions in LLMs for radiologists.

• Sleep Medicine and Psychophysiology
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• v.18 no.1
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• pp.40-44
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• 2011

Narcolepsy is a sleep disorder, which is characterized by excessive daytime sleepiness (EDS) that is typically associated with cataplexy, sleep fragmentation and other REM sleep-related phenomenon such as sleep paralysis and hypnagogic hallucination. Narcoleptic symptoms can be developed from various medical or neurological disorders. A 17-year-old male patient admitted for the evaluation of EDS which started three-month ago. He slept more than 18 hours a day with cataplexy and hypnagogic hallucination. He was obese with body mass index (BMI) of 30.4 kg/$m^2$. After admission he was newly diagnosed to the thyrotoxicosis. T3 391.2 ng/dL (60-181), free T4 4.38 ng/dL (0.89-1.76), TSH <0.01 ${\mu}IU$/mL (0.35-5.5) were measured. His pulse rate ranged 70-90 beats per minute and blood pressure ranged 150/100-120/70 mmHg. Polysomnography revealed many fragmentations in sleep with many positional changes (81 times/h). Sleep onset latency was 33.5 min, sleep efficiency was 47.9%, and REM latency from sleep onset was delayed to 153.6 min. REM sleep percent was increased to 27.1%. Periodic limb movement index was 13.4/h. In the multiple sleep latency test (MSLT), average sleep latency was 0.4 min and there were noted 3 SOREMPs (Sleep Onset REM sleep period) on 5 trials. We couldn't discriminate the obvious sleep-wake pattern in the actigraph and his HLA DQB1 $^*0602$ type was negative. His thyroid function improved following treatment with methimazole and propranolol. Vital sign maintained within normal range. Cataplexy was controlled with venlafaxine 75 mg. Subjective night sleep continuity and PLMS were improved with clonazepam 0.5 mg, but the EDS were partially improved with modafinil 200-400 mg. Thyrotoxicosis might give confounding role when we were evaluating the EDS, though sleep fragmentation was one of the major symptoms of narcolepsy, but enormous amount of it made us think of the influence of thyroid hormone. The loss of sleep-wake cycle, limited improvement of EDS to the stimulant treatmen, and the cataplexy not supported by HLA DQB1 $^*0602$ should be answered further. We still should rule out idiopathic hypersomnia and measuring CSF hypocretin level would be helpful.

• The Korean Journal of Archival Studies
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• no.79
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• pp.5-32
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• 2024

The Korean government ranked 3rd among 193 UN member countries in the UN's 2022 e-Government Development Index. Korea, which has consistently been evaluated as a top country, can clearly be said to be a leading country in the world of e-government. The lubricant of e-government is data. Data itself is neither information nor a record, but it is a source of information and records and a resource of knowledge. Since administrative actions through electronic systems have become widespread, the production and technology of data-based records have naturally expanded and evolved. Technology may seem value-neutral, but in fact, technology itself reflects a specific worldview. The digital order of new technologies, armed with hyper-connectivity and super-intelligence, not only has a profound influence on traditional power structures, but also has an a similar influence on existing information and knowledge transmission media. Moreover, new technologies and media, including data-based generative artificial intelligence, are by far the hot topic. It can be seen that the all-round growth and spread of digital technology has led to the augmentation of human capabilities and the outsourcing of thinking. This also involves a variety of problems, ranging from deep fakes and other fake images, auto profiling, AI lies hallucination that creates them as if they were real, and copyright infringement of machine learning data. Moreover, radical connectivity capabilities enable the instantaneous sharing of vast amounts of data and rely on the technological unconscious to generate actions without awareness. Another irony of the digital world and online network, which is based on immaterial distribution and logical existence, is that access and contact can only be made through physical tools. Digital information is a logical object, but digital resources cannot be read or utilized without some type of device to relay it. In that respect, machines in today's technological society have gone beyond the level of simple assistance, and there are points at which it is difficult to say that the entry of machines into human society is a natural change pattern due to advanced technological development. This is because perspectives on machines will change over time. Important is the social and cultural implications of changes in the way records are produced as a result of communication and actions through machines. Even in the archive field, what problems will a data-based archive society face due to technological changes toward a hyper-intelligence and hyper-connected society, and who will prove the continuous activity of records and data and what will be the main drivers of media change? It is time to research whether this will happen. This study began with the need to recognize that archives are not only records that are the result of actions, but also data as strategic assets. Through this, author considered how to expand traditional boundaries and achieves reterritorialization in a data-driven society.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.1 no.1
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• pp.130-147
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• 1990

This study intended to investigate the characteristics of adolescent drug user in Korea. A questionnaire on adolescent drug use was administered to 1st or 2nd grade 898 students (465 males, 433 females) from 9 senior high schools in Seoul area. The extent of current using six representative drugs such as cigarettes, alcohol, chemical substance inducing hallucination(e,g., thinner, bond etc.), psychostimulant, hypnotic and minor tranqulizer was self-reported. Also their psychological distress, self-concept and individual-related variables such as academic grade, deviant behavior, drug-using peers, the perceived availability of drugs, the degree of family discipline, and the perceived parents' attitude for drinking and smoking were surveyed. Subjects were grouped into six(male) or five(female) subgroups (nonuser, simple experiencer, one kind of drug user, two kinds of drugs user, three kinds of drugs user(male only), minor tranqulizer user) to their extent of drug use. Then ANOVA procedure performed for group comparison of their psychological distress, self-concept and individual-related variables. The results showed that the most popular drugs among adolescents in Korea were cigarettes and alcohol. Minor tranqulizer was used by about 2.8% of male and 7.41% of female subjects. In general abusers showed lower academic grade, more deviant experiences, having more drug-using peers, higher degree of psychological distress, and lower postitive self-concept than nonuser group. According to the results of discriminant analysis, hostility and deviant behavior were reliable predictive variables that distinguished abuser group from nonuser group among the associated variables in this study. These results suggest that some common factors affect drug use of Korean high school students : high school students who have many common risk factors could be abusers more easily. These findings supported risk factor theory that the extent of drug use of adolescents might be associated with general maladjustment in everyday life.

• Sleep Medicine and Psychophysiology
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• v.7 no.2
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• pp.115-119
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• 2000

Objectives Summary: A 20-year-old man was presented with a history of difficult waking for 10 years. He suffered from morning headache, chronic fatigue and mild daytime sleepiness but had no history of irresistible sleep attack, cataplexy, hypnagogic hallucination or sleep paralysis. Methods: Night polysomnography (PSG), multiple sleep latency test (MSLT) and HLA-typing were carried out. Results: The PSG showed short sleep latency (4.0 min) and REM latency (2.5 min), increased arousal index (15.7/hour), periodic limb movements during sleep (PLMS index=8.1/hr) with movement arousal index 2.1/hr and normal sleep efficiency (97.5%). The MSLT revealed normal sleep latency (15 min 21 sec) and 4 times sleep-onset REM (SOREM). HLA-typing showed DQ6- positive, that corresponded at the genomic level to the subregion DQB1*0601, which was different from the usual locus in narcolepsy patients (DQB1*0602 and DQA1*0102). Conclusion: Differential diagnosis should be made with circadian rhythm disorder and other causes of primary waking disorder. The possibility of a variant type of narcolepsy could be suggested with an unusual clinical manifestation and a new genetic marker.

• Korean Journal of Psychosomatic Medicine
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• v.20 no.2
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• pp.105-111
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• 2012

Objectives : We investigated the prevalence and composite score of the neuropsychiatric symptoms in patients with mild cognitive impairment(MCI), and dementia of Alzheimer's type(AD). The aim of this study is to analyze the correlation between the result of Korean Neuropsychiatric Inventory(K-NPI) and cognitive function. Methods : A total of 163 patients diagnosed with MCI or AD was divided into three groups(55 MCI patients, 56 dementia patients with mild stage, and 52 dementia patients with moderate, severe stage). We examined neuro-psychiatric symptoms by K-NPI and compared the prevalence and composite score of each subdomain in K-NPI among three groups. Results : The most common symptoms in the MCI group were depression/dysphoria, sleep/night-time behavior, anxiety, and irritability/lability. In mild AD group, the most frequent disturbance was agitation/aggression, depression/dysphoria, anxiety, apathy/indifference, and sleep/night-time behavior. In moderate to severe AD group, the most frequent disturbance was apathy/indifference, depression/dysphoria, agitation/aggression, and delusion. The frequencies of delusion, hallucination, agitation/aggression, apathy/indifference, aberrant motor behavior, appetite/eating change were statistically significant. The total NPI score showed a negative correlation with MMSE-KC and a positive correlation with GDS. Conclusions : Neuropsychiatric symptoms are common features of MCI and AD. These symptoms observed in MCI are similar to those of mild AD. Psychosis is most common in moderate to severe AD, leading to a faster rate of cognitive decline. Therefore, proper management according to the neuropsychiatric symptoms of MCI and three stages of dementia is needed.