• Korean Journal of Biological Psychiatry
• /
• v.14 no.2
• /
• pp.91-98
• /
• 2007

Objectives : Considering the impact of depressive illness on physical and mental health of both mother and fetus, specification of a treatment algorithm for depressive disorder during pregnancy is legitimated. This article provides a systemic review of treatments for depressive disorder during pregnancy and lactation. Methods : According to the search strategy of the Clinical Research Center for Depression of Korean Health 21 R & D Project, PubMed and EMBASE were searched using terms with regard to the treatment of depressive disorders during pregnancy and lactation. Reference lists of related reviews and studies were searched. In addition, relevant practice guidelines were searched using the PubMed. All identified clinical literatures were reviewed and summarized in a narrative manner. Results : Pharmacotherapy during pregnancy and lactation requires a comprehensive assessment of the risks and benefits of treatment for both mother and fetus or neonate. Recently, there is growing evidence that the use of tricyclic and selective serotonin reuptake inhibitors during pregnancy and lactation does not result in increased risks of teratogenicity. Treatment strategies are described according to the point of time of pregnancy or lactation. FDA categories for antidepressants during pregnancy and lactation are described. In addition, issues regarding to the electroconvulsive therapy and psychosocial treatment are discussed. Conclusion : The treatment option for depressive disorders during pregnancy and lactation depends on the severity of depressive illnesses of the individual patient. For mild to moderate depression, the non-pharmacological treatment should be considered first. For moderate to severe depression, pharmacotherapy should be administered in addition to the psychosocial treatment. ECT is recommended for depressive disorder of severe intensity. As the research knowledge is limited, the recommendations should based on the best judgement of psychiatrists.

• YAKHAK HOEJI
• /
• v.58 no.4
• /
• pp.229-244
• /
• 2014

Background: Antibiotic skin test(AST) is very useful for the diagnosis of drug allergies to prevent immediate allergic reactions. Although it is a safe and widespread method, it is performed very diversely by doctors and nurses without consistency and it also differs from countries and hospitals. This study aims to evaluate the current practice of AST by nurses in Korea and to compare it to the general guidelines. Methods: During January 1, 2013 to May 20, 2013, the study was conducted as questionnaires and case-based survey. The questionnaires were given to the nurses who were randomly selected in various University Hospitals (University Hospitals N=276, and Medical center N=19). The case-based surveys were given to the nurses who were conducting AST at various wards of a University Hospital (N=130). The analysis and evaluations of the responses were carried out. Results: The response rate for the questionnaires was 97.6% and 130 cases of the actual case-based surveys were collected. There were clear differences between the survey results and the general guidelines, such as the method of skin test (skin prick test was not conducted), the method of patient selection for AST, test drugs, concentration, volume and interpretation of AST. AST conducted by nurses was highly variable and inconsistent, even among nurses who worked in the same wards and hospitals. Manufactured standard concentration antibiotic solution of AST showed consistency of concentration to a certain degree. Conclusion: Although the general guidelines have been published by several countries including Korea, these are not a great help to nurses as they lack details for conducting AST, practical consideration for nurses in the clinical setting, propagation and education. Standardized guideline for nurses should be published and it should be a safe, clear, comfortable and easily accessible protocol. Futhermore, additional antibiotic solutions to standardize skin test should be developed and manufactured. Lastly, it would be the pharmacists role to compare their hospitals antibiotic skin test methods with the standard guidelines and develop a protocol within the hospital for patients' safety, and to strive to consistently implement it.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
• /
• v.25 no.2
• /
• pp.89-94
• /
• 2014

Objectives : This study was conducted naturalistically in order to observe the long-term effects of attention-deficit hyperactivity disorder (ADHD) medications on growth rates among Korean school-aged boys with ADHD. Methods : Participants in the study were boys with ADHD aged 6 to 11 years who have taken ADHD medication, methylphenidate (extended release) or atomoxetine. They attended scheduled visits monthly or bimonthly for clinical assessment with measurement of height and weight. In this study, 35 boys with ADHD (mean age at baseline=$7.90{\pm}1.77$ years ; mean age at endpoint= $12.54{\pm}1.91$ years) were included, with a mean follow-up period of 4.64 years (${\pm}1.62$ years), ranging from 2 to 9.7 years. Height, weight, and body mass index (BMI) measurements were converted to "age-corrected Z-scores" using data from Growth Charts provided by the Korean Center for Disease Control and Prevention from 2007. Results : Age-corrected endpoint growth parameters (height, weight, BMI Z-scores) did not differ significantly from the baseline values (height t=0.027 ; weight t=-0.61 ; BMI t=-1.86, in paired t-test). Especially high correlation was observed between the baseline and endpoint height Z-scores (r=0.876, p<.001), for which the coefficient of determination $r^2$ was 0.767, meaning that the amount of variability in endpoint height Z-scores explained by the baseline height Z-scores was 76.7%. Conclusion : Our results suggested that the long-term effects of ADHD medications on growth parameters to be tolerable in Korean school-aged boys with ADHD.

• Korean Journal of Clinical Pharmacy
• /
• v.30 no.1
• /
• pp.51-58
• /
• 2020

Background: Prevention of osteoporosis and bone fracture is one of the important issues for liver transplant recipients because a long history of liver disease and lifelong use of immunosuppressants, including corticosteroids, may cause these diseases. In this study, we aimed to analyze liver recipient bone status, 10-year fracture risk, and medication history. Methods: The electronic medical records of adult patients aged >40 years who received liver transplantation at Seoul National University Bundang Hospital between January 2009 and June 2017 were reviewed retrospectively. On the basis of their bone mineral density and fracture history, their fracture risks were analyzed using the Korean fracture risk assessment tool. Results: A total of 57 liver transplant recipients were treated with corticosteroids during a mean of 8.8 months after transplantation. 30 patients (52.6%) showed bone metabolism dysfunction such as osteopenia or osteoporosis. The 10-year femoral fracture risk was 2.1%, and dual-energy X-ray absorptiometry monitoring was performed, including right before liver transplantation every 27.5±19.2 months. The mean femoral bone mineral density decreased by -7.2%±7.3%. Four patients (7.0%) had a fracture after liver transplantation. Osteoporotic fracture occurred in 3 patients with osteoporosis (25.0%). Among the osteopenia patients with moderate fracture risk who were not treated with bisphosphonate, 1 patient (12.5%) had a history of bone fracture after liver transplantation. Conclusions: Considering the deterioration of bone density and moderate fracture risk, medication for osteoporosis should be prescribed to liver transplant recipients with regular monitoring of bone density after transplantation.

• Korean Journal of Clinical Pharmacy
• /
• v.27 no.1
• /
• pp.22-29
• /
• 2017

Objective: Infection is very common in the elderly, so there is a high prevalence of antibiotics use among this population. Especially, due to the emergence of resistant bacteria, the use of vancomycin is growing. The purpose of this study was to evaluate risk factors associated with vancomycin-induced nephrotoxicity in elderly patients. Methods: The subjects of this study were patients over 18 years old who received intravenous vancomycin in a general hospital located in Gangneung-si, Korea between August 1, 2013 and July 31, 2015. Data collection regarding vancomycin use and baseline characteristics was conducted using computerized hospital database. Logistic regression analysis was used to identify risk factors associated with vancomycin-induced nephrotoxicity. Results: A total of 290 patients were finally included, and 191(66%) out of these patients were age 65 or older. The incidence of vancomycin-induced nephrotoxicity was 11.0%, 12.6%, and 7.0% in the all adult patients, the elderly patients, and the non-elderly patients, respectively. There were significant differences in comorbidities between patients with nephrotoxicity and patients without nephrotoxicity in the all adult patients, and there were significant differences in vancomycin duration, comorbidities, and number of nephrotoxic agents between patients with nephrotoxicity and patients without nephrotoxicity in the elderly patients. However, according to the logistic regression analysis, there was no significant risk factor that increases the incidence of vancomycin-induced nephrotoxicity in all three age groups. Conclusion: There were no differences in risk factors that increase the incidence of vancomycin-induced nephrotoxicity between all adult patients, elderly patients, and non-elderly patients. Further studies with larger sample sizes to identify risk factors associated with vancomycin-induced nephrotoxicity in the elderly to improve the outcome of pharmacotherapy are required.

• Korean Journal of Biological Psychiatry
• /
• v.6 no.1
• /
• pp.96-101
• /
• 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.

• Korean Journal of Psychosomatic Medicine
• /
• v.11 no.1
• /
• pp.36-43
• /
• 2003

Objectives: The purpose of this study was to evaluate the difference of cognitve function among patients with posttraumatic stress disorder according to severity of symptoms. Methods: The subjects were 90 psychiatric inpatients and outpatients with posttraumatic stress disorer(by DSM-IV criteria) after traffic accident. The severity of symptoms was assessed by MMPI subscales; depression, psychasthenia, schizophrenia. The impairment of cognitive function was assessed by Korean Wechsler Intelligence Scale(K-WAIS). Based on scores of the MMPI subscales, the patients were divided into high group(above 70 percentile) and low group(below 30 percentile). We estimated the difference of the K-WAIS score and subtest score in the low group and high group of the MMPI subscales by indedpendent t-test. Results: The scores of high group is significantly higher in the subtests of information, vocabulary, similarity, picture completion, and picture arrangement than the low group for psychasthenia subscale of MMPI. And the score of high group is significantly higher in full scale I.Q., verbal I.Q., performance I.Q., verbal subscales except digit span and simiarity, and performance subscales than low group for schiozphrenia subscale of MMPI. Conclusion: It was found cognitive function was more impaired in the group of PTSD with severe symptom compared to the group of PTSD with mild symptoms. We suggest that psychiatrist should consider various cognitive approaches as well as pharmacotherapy in the management of PTSD.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
• /
• v.6 no.1
• /
• pp.3-17
• /
• 1995

The so-called borderline children are characterised by disturbances in the sense of reality and interpersonal relationships, lack of control, fluctuation of functioning, uneven development and excessive anxiety. But the concept of borderline disorder of childhood is very difficult to define and diagnose in current classification system. The present study adapted the consensus symptoms in borderline children by Bemporad and Vera eight cases aged 7-11 were examined in 37 variables. Results are as follows 1) All subjects are boys and girl hardly be diagnosis n current diagnostic system and have many concurrent diagnoses. Common chief complaints in the sense of reality. 2) In KEDI-WISC test, the borderline children showed average intelligence, but performance IQ tends to be higher than verbal IQ. In Rorscharch test, they showed high thought disorder index, emotional instabilities and aggressive impulses. The results of TOVA suggested attentional deficit in half of the subjects. The organicity is not prominent. 3) Many of the borderline children were unwanted baby. Although primary care takers of all the subjects were their mothers there were moderate problems in caring attitude of their children and marital relationship with their husband. Sccioeconomic status was generally below middle class. Most of all subjects have delayed language development, but have overcome subsequently. Many subjects were rejected by peers because of their aggression. 4) The first visit of the subjects was about 6 years of age. Average duration of treatment was 2 years. All of them were treated in the outpatient basis except one. The effect of pharmacotherapy was doubtful and the necessity of long term play therapy was suggested. Although there were many limitations of method in present study, it was suggested that further research is needed for diagnostic criteria, epidemiology and treatment.

• Korean Journal of Psychosomatic Medicine
• /
• v.12 no.2
• /
• pp.95-102
• /
• 2004

Backgrounds: It was thought that sport was related with mentality. Compared to psychology, psychiatry has so far paid rather little attention to athletes. In this overview, I attempted to introduce the ideas of various observers of sports with the view of clinical psychiatry and summarized basic principle role of psychiatrist. Results and Discussions : To understand the athletic frame of mind, it is helpful to observe athletes in their psychologic development and when we do so we can quickly see trends that are not apparent by observing mature athletes alone. Psychobiology of sport would discuss some of the endogenous neurochemicals(hormone, neurotransmitter) that may be part and parcel of the athlete's psychiatric status. The psychological problems that frequently interfere with training and competition may be divided into five categories 1) choke, 2) slump, 3) injury, 4) interpersonal problem, 5) training dilemma. Psychiatric problem also arise in athletes like general people. various method for psychiatric patients like psychotherapy, group therapy, family systems perspective, and pharmacotherapy could been applied to sports psychiatry. Conclusions Although the contribution of sports psychiatry to sport is clinical one, psychiatrist's interest in role and conflict of athlete would enhance the molding of humanistic athletes who enjoy their life and sports.

• YAKHAK HOEJI
• /
• v.54 no.4
• /
• pp.258-269
• /
• 2010

As people are easy to access the National Health Insurance, medical health service has been increased. It contributed to extend human's average life expectancy and to get better health care. But also increased unnecessary health service or inappropriate drug use. Therefore, DUR (Drug Use Review) is needed to induce appropriate drug use. The purpose of this study is to evaluate outpatient prescriptions by General Practitioner (GP) and Specialized Practitioner, especially indication for ENT referral including common cold which is the frequent indications that have patient see doctor. This study was reviewed retrospectively prescriptions for ENT referral collected at the A pharmacy for ENT Clinic in Cheong-Ju, B pharmacy for GP Clinic in BoEun from Feb 2nd, 2009 to Feb 28th, 2009. Each pharmacy located closed to the each enrolled clinic. The numbers of collected prescriptions were each A pharmacy (n=2501), B pharmacy (n=1343). This study was classified Drug Related Problems (DRPs) those prescriptions had as total 6 groups according to following 6 categories; 1) Unnecessary Drug, 2) Wrong Drug, 3) Low Dose, 4) Overdose, 5) Wrong Instruction, 6) Wrong Combination. In results, Specialized Practitioner's prescriptions had more DRPs than General Practitioner's prescriptions (ENT 155.34% vs GP 130.01%). In detail, Specialized Practitioner's prescriptions had more DRPs in Low Dose (ENT 16.95% vs GP 4.77%), Overdose (ENT 6.72% vs G.P 5.51%), Wrong Instruction (ENT 7.91% vs GP 5.81%), Wrong Combination (ENT 29.31% vs GP 25.09%). These DRPs would be caused from lack of consideration for dosage and drug interaction. General Practitioner's prescriptions had more DRPs in Unnecessary Drug (ENT 70.37% vs GP 78.85%), Wrong drug (ENT 4.12% vs GP 9.98%). These DRPs would be associated with drug selection. This study was assumed that Specialized Practitioner is better prescriber than General Practitioner because Specialized Practitioner complete additional intern and residency training. But, Specialized Practitioner is not always better prescriber than General Practitioner. Furthermore, prescriptions of both Specialized Practitioner and General Practitioner had many problems. In conclusion, It could be cut down the excessive medical expense and expected more efficient medical care by reducing DRPs, thus contributing to the improvement of national health. In order to pharmacist must have good professional ability of pharmacotherapy to help the physician for the drug selection.