• Korean Journal of Biological Psychiatry
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• v.22 no.4
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• pp.155-162
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• 2015

Objectives Second-generation antipsychotics (SGAs) are frequently used in the treatment of bipolar disorder. However, there is still no consensus on their risk of tardive movement syndromes especially for first-generation antipsychotics (FGAs)-naïve patients. This study aimed to investigate the prevalence and associated factors of SGAs-related tardive dyskinesia and tardive dystonia in patients with bipolar disorder, in a naturalistic out-patient clinical setting. Methods The authors assessed 78 non-elderly patients with bipolar (n = 71) or schizoaffective disorder (n = 7) who received SGAs with a combined use of mood stabilizers for more than three months without previous exposure to FGAs. Multiple direct assessments were performed and hospital records longer than one recent year describing any observed tardive movement symptoms were also reviewed. Results The prevalence rates of tardive dyskinesia and tardive dystonia were 7.7% and 6.4%, respectively. These patients were being treated with ziprasidone, risperidone, olanzapine, quetiapine, or paliperidone at the time of the onset of the movement symptoms. Tardive dyskinesia was mostly observed in the orolingual area, and tardive dystonia was most frequently detected in oromandibular area. A past history of acute dystonia was significantly associated with presence of both tardive movement syndromes. Conclusions Our findings suggest that SGAs-related tardive movement syndromes occur in a substantial portion of bipolar disorder patients. Acute dystonia, a reported risk factor of tardive movement syndromes in the era of FGAs is confirmed as a risk factor of both tardive dyskinesia and tardive dystonia that were induced-by SGAs.

• Anxiety and mood
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• v.14 no.2
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• pp.53-62
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• 2018

Objective : The Korean Association of Anxiety Disorders developed Korean guidelines for treatment of panic disorder (PD) 2018. In this paper, we discussed the consensus among psychiatrists, regarding initial and maintenance treatment strategies for pharmacological treatment of PD in Korea. Methods : Based on current treatment guidelines published by the American Psychiatric Association, the National Institute for Clinical Excellence, and the Canadian Psychiatric Association, we developed questionnaires pertinent to initial and maintenance treatment strategies for pharmacological treatment of PD. Seventy-two experts in PD answered questionnaires. We classified expert opinions into three categories, first, second, and third-line treatment strategies, by analyzing the 95% confidence interval. Results : Antidepressants, benzodiazepine anxiolytics, and cognitive-behavioral therapy (CBT) were recommended as treatments of choice (ToC), and first-line strategies for initial treatment of PD. Escitalopram, paroxetine, sertraline, and venlafaxine were preferred from among many anti-panic drugs. Mean starting dose of anti-panic drugs for initial treatment of PD was relatively lower, than that for other psychiatric illnesses such as major depressive disorder. In the case of maintenance treatment of PD, antidepressants and CBT were selected as ToC and first-line strategies. Patients were typically examined every four weeks during treatment, to review effectiveness and side effects of the drug. Pharmacotherapy was generally continued for one year or more. Conclusion : This study provides information about consensus among Korean experts regarding pharmacological treatment strategies for patients with panic disorder.

• Korean Journal of Biological Psychiatry
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• v.22 no.2
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• pp.29-33
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• 2015

The brain maintains homeostasis and normal microenvironment through dynamic interactions of neurons and neuroglial cells to perform the proper information processing and normal cognitive functions. Recent post-mortem investigations and animal model studies demonstrated that the various brain areas such as cerebral cortex, hippocampus and amygdala have abnormalities in neuroglial numbers and functions in subjects with mental illnesses including schizophrenia, dementia and mood disorders like major depression and bipolar disorder. These findings highlight the putative role and involvement of neuroglial cells in mental disorders. Herein I discuss the physiological roles of neuroglial cells such as astrocytes, oligodendrocytes, and microglia in maintaining normal brain functions and their abnormalities in relation to mental disorders. Finally, all these findings could serve as a useful starting point for potential therapeutic concept and drug development to cure unnatural behaviors and abnormal cognitive functions observed in mental disorders.

• Journal of The Korean Society of Clinical Toxicology
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• v.6 no.1
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• pp.45-48
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• 2008

A 57-year-old man was transferred to our emergency department with decreased mental status after organophosphate intoxication. He had a four year history of benzodiazepine and hypnotic medication use for chronic insomnia and a depressive mood disorder. He had no previous history of seizures, diabetes mellitus, and hypertension. By hospital day 5, the patient was noted to be awake and to have repetitive jerking movements involving the left upper extremity, and appeared apathetic, depressed and less responsive to external stimuli. A benzodiazepine withdrawal syndrome was subsequently apparent when he developed several generalized tonic clonic seizures and status epilepticus. Using a continuous midazolam intravenous infusion, we successfully controlled the refractory seizure without complications. We present a rare case of status epilepticus from a benzodiazepine withdrawal that developed during the treatment for organophosphate intoxication.

• Anxiety and mood
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• v.3 no.1
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• pp.8-14
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• 2007

Although treatments of anxiety symptom have been available for decades, the biological basis for anxiety disorders in humans is just beginning to emerge. Recently, there is a growing body of literature suggesting that group II metabotrpic glutamate (mGlu) receptors and group I mGlu receptors are important in the physiological and behavioral sequelae associated with stressful stimuli. Moreover, compounds selective for mGlu receptors, particularly mGlu2/3 and/or mGlu5, have proven as effective as classical anxiolytics in various animal models of anxiety without producing many of the unwanted side effects that are typical of current therapies. This article will focus on the emerging preclinical and clinical data that implicate modulation of the mGlu receptors as a potential anxiolytic strategy.

• Anxiety and mood
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• v.5 no.1
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• pp.42-47
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• 2009

Recently, Eye Movement Desensitization and Reprocessing (EMDR) was given the status of an approved form of psychotherapy for the treatment of post-traumatic stress disorder. However, its effectiveness in the treatment of other anxiety disorders such as phobia is yet to be determined given that controlled studies have provided mixed results. This report summarizes the case of a child with a specific phobia (i.e. nighttime fear) which was successfully treated with two sessions of EMDR. This result suggests the further and thorough evaluation of this technique for use in childhood phobic disorders.

• Anxiety and mood
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• v.2 no.2
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• pp.142-146
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• 2006

People who were exposed to chronic interpersonal traumas in their early life consistently demonstrate complex psychological disturbances and many of them meet the criteria for proposed diagnosis of complex posttraumatic stress disorder (complx PTSD). The author reports a case of the successful sequential integrative treatment mainly composed of eye movement desensitization and reprocessing (EMDR) in a complex PTSD patient. The patient did not respond to the previous treatment with psychotropic medications and supportive psychotherapy. Twelve sessions of EMDR and three sessions of supportive psychotherapy were done for the patient. Psychological assessments were performed before starting the treatment and a week after completing the treatment. After the treatment, the patient improved on all the psychological scales and behavioral measures. This case suggests that the sequential integrative treatment mainly composed of EMDR may be effective for complex PTSD patients.

• Anxiety and mood
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• v.10 no.2
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• pp.85-94
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• 2014

Non-pharmacological treatments have long been used for paraphilia or sexual offenders, but few clinical studies were conducted. However, recently there were issued cognitive behavioral therapy of paraphilia or sexual offenders based on the research findings obtained so far. In addition, there were the changes of Diagnostic and Statistical Manual of Mental Disorder by American Psychiatric Association at 2014. The methods of cognitive behavioral therapy for paraphilia or sexual offenders were electric aversion therapy, olfactory aversion therapy, ammonia aversion therapy, covert sensitization, masturbatory reconditioning, directed masturbation, verbal satiation, social skill training, assertiveness training etc. By synthesizing the newly reported foreign guidelines for treatment and review articles, the aim of this study is to investigate the non-pharmacologic therapies used for treatment of paraphilia or sexual offenders.

• Anxiety and mood
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• v.1 no.1
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• pp.37-42
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• 2005

Benzodiazepines are widely used for a variety of conditions in psychiatric field. In this article, the author reviewed the indications, the effects on anxiety and sleep disorders, the side effects, the drug-drug interactions, and the tapering strategies. Benzodiazepines were relatively safe and useful for the treatment of anxiety and sleep disorders. However, used clinically, benzodiazepines can induce many adverse effects (e. g. over-sedation, cognitive impairments, paradoxical effects, dependence and withdrawal symptoms, and so on). Currently available informations about their effects on the developing fetus is controversial. For this reason, pregnant women and nursing mother should be cautioned against the use of benzodiazepines. Drug-drug interactions have to be considered in combination treatments. For the tapering issues, gradual tapering was important to prevent the withdrawal symptoms. Especially, the tapering schedules have to be individualized for the each long-term benzodiapzepine users.

• Proceedings of the EASDL Conference
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• 2010.11a
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• pp.47-47
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• 2010

Chilliness is a complaint among menopausal women in Japan, but increasing evidence indicates that young women also suffer from chilliness. However, neither diagnostic criteria nor drug therapies exist for treating chilliness. We noticed it and recently elucidated methodological issues related to identifying women with chills. Using a discriminant analysis, we demonstrated that four parameters were important determinants of chilliness. On the other hand, after repeated reports of serious adverse effects with hormone replacement therapy, much attention has been given to the development of new remedies to alleviate menopausal depressive state in women, but methods for their preclinical evaluation have not been clarified. We previously developed a procedure to predict the effect of candidate substance on the menopausal depressive-like state in female mice. Since either chilliness or mood disorder is known to disturb a quality of life in women, in this symposium, the efficacy of Korean red ginseng on chilliness in women and depressive-like state will be discussed.