Complete Heart Block due to Lithium Toxicity / 대한정신약물학회지

Lithium treatment has been associated with a wide range of cardiac complications. We observed a 53-year-old female patient who presented with complete heart block due to lithium toxicity. The patient had been diagnosed as schizoaffective disorder and had been taking a stable dose of lithium, 1,500 mg/day since January 2007. Recently, she begun a strict diet and experienced muscle weakness and lethargy a few days later. While receiving fluid therapy, she lost her consciousness and was transferred to an emergency medical center. An electrocardiogram revealed that she had complete heart block, so a temporary pacemaker was inserted immediately. After 4 days of intensive care, her heartbeat recovered spontaneously and the temporary pacemaker was removed. On the 11th day, she had sufficiently recovered and could ambulate by herself. Lithium levels were measured at 5.22 mEq/L and 0.66 mEq/L on the 1st and 4th day of treatment, respectively. This case illustrates the importance of educating patients and their relatives about the possible lithium toxicity caused by a strict diet.

Complete Heart Block due to Lithium Toxicity / 대한정신약물학회지

Lithium treatment has been associated with a wide range of cardiac complications. We observed a 53-year-old female patient who presented with complete heart block due to lithium toxicity. The patient had been diagnosed as schizoaffective disorder and had been taking a stable dose of lithium, 1,500 mg/day since January 2007. Recently, she begun a strict diet and experienced muscle weakness and lethargy a few days later. While receiving fluid therapy, she lost her consciousness and was transferred to an emergency medical center. An electrocardiogram revealed that she had complete heart block, so a temporary pacemaker was inserted immediately. After 4 days of intensive care, her heartbeat recovered spontaneously and the temporary pacemaker was removed. On the 11th day, she had sufficiently recovered and could ambulate by herself. Lithium levels were measured at 5.22 mEq/L and 0.66 mEq/L on the 1st and 4th day of treatment, respectively. This case illustrates the importance of educating patients and their relatives about the possible lithium toxicity caused by a strict diet.

Treatment of Persistent Hiccups with Risperidone Quicklet / 대한정신약물학회지

Hiccups are due to involuntary contraction of the diaphragm and intercostals muscles. Most hiccups are self-limiting, but sometimes intractable hiccups can lead to multiple problems including exhaustion. Persistent or intractable hiccups may be related to the presence of serious underlying system disease. A 52-year-old male who had suffered from gastric cancer was consulted from surgical department due to persistent hiccups. Initially, he was unsuccessfully managed using conservative method, i.e., breath holding, induced gag reflex, and the oral administration of chlorpromazine. We administered risperidone quicklet, and then the hiccups disappeared. We conclude that risperidone quicklet is one of the useful treatment methods for persistent hiccups.

Ziprasidone Induced Neutropenia / 대한정신약물학회지

Neutropenia and agranulocytosis are dangerous conditions seldom caused by antipsychotics. We report the case of a 35-year-old female patient who presented with neutropenia following ziprasidone administration. Ziprasidone was gradually increased to 160 mg/day in combination with escitalopram 10 mg/day. Following ziprasidone administration, her neutrophil count fell to 1700x10(3)/mm3, on day 45 and to 1500x10(3)/mm3 on day 57. Ziprasidone was immediately stopped, and quetiapine 25 mg was given from the next day onward, along with the escitalopram. Her neutrophil count rose to 2700x10(3)/mm3 2 days later, and was maintained at 2,900x10(3)/mm3 at 17 days after changing medication. To the best of our knowledge, this case represents the first report of ziprasidone - induced neutropenia in Korea. Further study is necessary to determine the incidence of neutropenia and its relationship with agranulocytosis secondary to ziprasidone.

Genetic Polymorphism of Endothelial Nitric Oxide Synthase in Korean Schizophrenic Patients / 신경정신의학

OBJECTIVES: Although genotype of endothelial nitric oxide synthase has been investigated in many neuropsychiatric disorders, results were controversial and even contradictory. The purpose of this study was to investigate the nature of endothelial nitric oxide synthase in Korean schizophrenic patients, and compare it with healthy control group in terms of distribution of e genotype and allele frequency of endothelial nitric oxide synthase. METHODS: Using polymerase chain reaction and amplified refractory mutation system, endothelial nitric oxide synthase genotypes were identified in 77 schizophrenics and 121 healthy controls. RESULTS: 1) When genotypes of endothelial nitric oxide synthase were classified as a/a, a/b, b/b, there was no statistical difference in genotypes between the two groups. 2) In terms of allele frequency, there was also no statistical difference between the two groups. CONCLUSION: These results suggest that endothelial nitric oxide synthase gene seem to be unrelated to the pathogenesis of schizophrenia in Korean population.

Genetic Polymorphisms of Apolipoprotein E in Korean Schizophrenic Patients

OBJECTIVES: Although polymorphisms of apolipoprotein E have been investigated in many neuropsychiatric disorders, results were controversial and even contradictory. The purpose of this study was to investigate the genotypes of apolipoprotein E in schizophrenia and healthy controls, and to compare them in two groups in terms of distribution of apolipoprotein E genotype and allele. METHOD: Using polymerase chain reaction and amplified refractory mutation system, apolipoprotein E genotypes were identified in 77 schizophrenics and 115 healthy control persons. RESULTS: The results were as follows 1) When genotypes of apolipoprotein E were classified into epsilon2/2, epsilon2/3, epsilon2/4, epsilon3/3, epsilon3/4, epsilon4/4 according to phenotypes, there were no statistical differences in genotypes between two groups 2) In terms of allele frequency, there were also no statistical differences between two groups CONCLUSION: These results suggest that genotypes and alleles of apolipoprotein E seem to be unrelated to the pathogenesis of schizophrenia.

Effects of Acute and Chronic Treatment of Olanzapine and Risperidone on the Extracellular Dopamine Concentrations of the Prefrontal Cortex in Rats / 신경정신의학

OBJECT: It is reported that the effect of antipsychotics on the extracellular dopamine levels in the prefrontal cortex is related to the their effect on the negative symptoms. Therefore, we investigated the acute and chronic effects of olanzapine and risperidone on the extracellular dopamine concentrations in the prefrontal cortex of rat. Samples were obtained using in vivo brain microdialysis. METHOD: Dopamine levels in the samples were measured by high pressure liquid chromatography with electrochemical detection. RESULTS: 1) Both the acute treatment of olanzapine and risperidone increased the extracellular dopamine concentrations in the prefrontal cortex, dose-dependently. 2) There was a no significant difference in the maximal change of the extracellular dopamine concentrations in the prefrontal cortex induced by the acute treatment of olanzapine and risperidone. 3) Both the chronic treatment of olanzapine and risperidone also increased the extracellular dopamine concentrations in the prefrontal cortex, but they showed the tolerance effect that the degree of increase was smaller than that of the acute treatment. 4) As for the maximal changes of the extracellular dopamine concentrations in the prefrontal cortex induced by the chronic treatment of olanzapine and risperidone, the effect of the former was greater than that of the latter. CONCLUSION: These results suggest that the effects of olanzapine and risperidone on the negative symptoms are related to the increased extracellular dopamine concentrations in the prefrontal cortex induced by these drugs.

Treatment of Obsessive Symptoms in Schizophrenic Patient with a Risperidone-Fluoxetine Combination / 대한정신약물학회지

Recent studies have reported that obsessive-compulsive (OC) symptoms are highly prevalent in schizophrenia, and schizophrenic patients with OC symptoms have a poorer clinical course compared to those without OC symptoms. In spite of many previous case reports, treatment of OC symptoms in schizophrenia has not been systematically studied. We report a patient with chronic schizophrenia who had obsessive symptoms such as bizarre, stereotyped behaviors. Treatment with olanzapine and risperidone, resulted in partial response for his psychotic symptoms, respectively. The obsessive symptoms, however, persisted and fluoxetine was added to the risperidone regimen. After 4 weeks of combination treatment, fluoxetine was titrated up to 80 mg/day and his obsessive symptoms became less in frequency and intensity. After 7 weeks on combination treatment of risperidone and fluoxetine, obsessive symptoms resulted in a significant reduction. On the 20 months of following, he remained in a recovered state and had been treated with risperidone 4 mg/day, and fluoxetine 20 mg/day.

Comparison of the Dopamine Response in the Rat Prefrontal Cortex Induced by Irregular and Regular Electrical Stimuli / 대한정신약물학회지

OBJECTIVE: In general, it is known that repetitive regular stimuli induce tolerance and repetitive irregular stimuli induce sensitization. We sought to determine the dopamine response in the rat prefrontal cortex under the repetitive regular and repetitive irregular stimuli. METHODS: After giving irregular and regular electrical stimuli repetitively to rats, we measured the dopamine levels of prefrontal cortex. We compared these results with the dopamine levels of prefrontal cortex of rats which were given just one electrical stimulus. Samples were obtained using in vivo brain microdialysis. Dopamine levels in the samples were measured by high pressure liquid chromatography with electrochemical detection. RESULTS: 1) Dopamine levels of prefrontal cortex of both repetitive regular stimuli group and repetitive irregular stimuli group increased after electrical stimuli. 2) Dopamine levels of prefrontal cortex also significantly increased after just one electrical stimulus. 3) Among the repetitive regular stimuli group, repetitive irregular stimuli group and one stimulus group, the dopamine response was most significant in the repetitive irregular stimuli group. CONCLUSIONS: Repetitive irregular electrical stimuli induce sensitization of prefrontal cortex and repetitive regular electrical stimuli don't induce tolerance of prefrontal cortex.

Effect of Pretreatment of (-)-3-PPP on the Haloperidol-Induced Extracellular Dopamine Concentraions in the Nucleus Accumbens of Rats

OBJECTIVES: To investigate the effects of (-)-3-PPP(0.5, 2, and 10mg/kg, s.c.) and haloperidol(0.1, 0.5, and 2mg/kg, s.c.) on the extracellular dopamine concentrations, and the effect of pretreatment with (-)-3-PPP(2mg/kg) on the haloperidol(2mg/kg)-induced extracellular dopamine concentrations in the nucleus accumbens(NAS) of free moving rats. METHODS: Dopamine levels in dialysate were determined with high pressure liquid chromatography(HPLC) with electrochemical detection(ECD). RESULTS: (1) (-)-3-PPP had dual actions depending on the doses : at 2mg/kg, it decreased and at 10mg/kg, increased extracellular dopamine concentrations ; (2) haloperidol at all doses increased dopamine levels with higher dose having a greater icrease ; and (3) pretreatment of (-)-3-PPP reduced the increase in dopamine levels elicited by acute treatment with haloperidol. CONCLUSIONS: These findings suggest that pretreatment of (-)-3-PPP in low dose could accelerate the onset of therapeutic effect of haloperidol by diminishing the haloperidol-induced dopamine release in the limbic system.

Effect of Cognitive-Behavioral Therapy on the Delusion in Schizophrenic Patients / 신경정신의학

OBJECTIVE: The effect of cognitive-behavioral therapy on the delusion in schizophrenic patients was evaluated. METHOD: The patients admitted to a psychiatric ward from September 1999 to June 2000 and diagnosed as schizophrenia, schizophreniform disorder, and schizoaffective disorder by DSM-IV were randomly assigned to cognitive-behavioral therapy(CBT) group(n=9) and supportive psychotherapy (ST) group(n=8). During the 10 weeks' treatment period, conviction, preoccupation, and anxiety on delusion, mode of explanation about symptom, and recovery style were regularly measured and compared between groups. RESULTS: 1) As for conviction and anxiety on delusion, the patients from both groups showed gradual reduction over time, but there was no significant difference between groups. 2) As for preoccupation of delusion, patients from both groups showed gradual reduction over time, and the patients on CBT group had a significantly more reduction than ST group. 3) As for mode of explanation and recovery style, CBT group had more marked positive changes than ST group did. CONCLUSION: Cognitive-behavioral therapy is more effective on preoccupation of delusion, explanatory mode about symptom, and recovery style than supportive psychotherapy.

Stress Perception, Coping Behavior, Depression and Anxiety in Infertile Women / 신경정신의학

OBJECTIVE: The purpose of this study was to investigate psychological impacts of infertility-related stress in Korean infertile women. METHODS: Both the 34 infertile women group and the control group(34 married women) were evaluated by using Semistructured Questionnaire, Stress Perception Scale, Coping Behavior checklist, Beck Depression Inventory(BDI), Hamilton Anxiety Scale(HAS), Hamilton Rating Scale for Depression(HRSD), SCL-90-R and State Trait Anxiety Inventory(STAI). RESULTS: Perceived financial stress, frequency of negative and neutral life events and frequency of passive coping(especially, emotion-focused coping) were significantly higher in infertile women than control group. In infertile women, totally perceived stress was positively correlated with BDI, SCL-90-R(depression) and STAI. Passive coping behavior was positively correlated with BDI, HAS and STAI. CONCLUSION: Above results suggest that infertile women would have a tendency to passive coping and high level of depression and anxiety, and should be considered for psychiatric intervention.

The Psychophysiologic Response in Korea Patients with Generalized Anxiety Disorder / 수면정신생리

OBJECTIVES: The psychophysiologic response pattern between healthy subjects and patients with generalized anxiety disorder, and the relationship among anxiety rating scales and those patterns in patients were examined. METHODS: Twenty-three patients with generalized anxiety disorder(AD) and 23 healthy subjects were evaluated by Hamilton Rating Scale for Anxiety(HRSA)and State- Trait Anxiety Inventory before baseline stressful tasks, Subjective Units of Distress were evaluated just before baseline period, immediately after stressful tasks, at the end of the entire procedure, and psychophysiologic measures, i.e., skin temperature(ST), electromyographic activity(EMG), heart rate(HR), electrodermal response(EDR) during baseline & rest and during two psychologically stressful tasks (mental arithmentic, TM; talk about a stressful event, TT) were also evaluated. RESULTS: 1) AD group showed significantly higher EMG level during rest after stressful tasks and higher HR level during all period except TM compared to control group. 2) AD group showed lower change in the startle response(SR) of ST, in the SR & the recovery response(RR) of EMG during TM, and in the RR of EDR immediately after TM than control group. AD group showed that the RR of EDR was significantly lower than the SR during stressful tasks. 3) We found that there was significantly negative correlation between state anxiety and the RR of EDR after TT in AD group. We also found that there were significantly positive correlations between HRSA score and the SRs of EDR during stressful tasks, and between state anxiety and the SR of EDR during TT. CONCLUSION: Our results suggest that patients with generalized anxiety disorder show higher autonomic arousal than healthy subjects and decreased physiologic flexibility or reduced autonomic flexibility.

Depression, Anxiety, Stress Perception and Coping Strategy in Male Sexual Dysfunctional Patients / 신경정신의학

Thirty-one male sexual dysfunctional patients were selected to investigate their depression, anxiety, stress perception, and coping strategy. They were examined by Beck's Depression Inventory, State-Trait Anxiety Inventory, Symptom Checklist-90-Revised, Global Assessment of Recent Stress Scale and Coping Strategy. Twenty-seven healthy normal adults were selected as control group. The results were as follows: 1) Depression and anxiety scores were significantly higher in the patients. 2) Stress perception of usual life, especially work, job and change in relationships, was significantly higher in the patients. Frequency of negative life events was significantly higher in the patients. 3) As coping strategy, intellectualisation, redefinition and compliance were most frequently used by the patients. Most of the patients showed tendency to deny their vulnerabilities. Patients who lived with spouse showed more active confrontation and less emotional turmoil, anxiety and fear than patients who lived without spouse.

A Study of Medical Education System in Korea / 한국의학교육

There is a trial to increase as four years of the premedical course to make doctors with better humanities and variable educational backgrounds and good researchers in basic medicines. We studied the trial in the present situation of the Korean in scvcral vicwpoints There will be a confusion between doctor in a origanization and there are many problems expected with two different educational system in a countury Moreover, two years of premedical course and four years of medical course are enough to a clinician, especially a primary care doctor and there will be increased costs and late age to be a doctor if premedical course are increased as four years. It is not real reason for the lack of applicants to be good researchers in basic medicines that shot premedical course and lack of non-medical educational backgrouds. Also situation of medical school in Korea is not suffice to extend their facilities and faculties. Finally advantages from the extension of the premedical course can be gained with introductions of the limeted bachelor`s admission and or dual major system. The most important things is the single educational system to be a doctor and leaving the system to the discretion of the medical schools or universities

The relationship between clinical response and urinary MHPG and plasma cortisol level in major depressives treated with tricyclics / 신경정신의학

No abstract available.

A study of cold agglutinin titer in schizophrenia / 신경정신의학

No abstract available.

Is It Necessary to Evaluate Clerkship? / 한국의학교육

No abstract available.