Education, Clinical Practice, and Research on Psychiatric Illnesses in Korean Traditional Medicine / 신경정신의학

OBJECTIVES: This study was aimed to obtain the basic information on how oriental psychiatric specialists have learned oriental psychiatry, have been trained as a clinician and have conducted recent psychiatric researches. METHODS: We reviewed textbooks, references and annual reports, which have been used and published at the Korean colleges of oriental medicine and the Ministry of Health and Welfare. We also applied detailed questionnaires to 30 oriental physicians for identifying the current situation of local oriental clinics. In addition, we inspected the reports related with oriental psychiatry from 2000 to 2004. RESULTS: The number of oriental hospitals and clinics was 8,638 (12.9% of the total number of hospitals and clinics), and 14,480 oriental physicians have been licensed in 2003 and 16,182 in 2005. Since 2003, 62 oriental psychiatric specialists have been produced. The number of national medical insurance claims for mental disorders from oriental hospitals and clinics in 2002 was 9.0% of the total number of claims. At local oriental clinics, 29.8 patients with psychiatric problems were treated monthly. 2.6% in men and 11.0% in women visited local oriental clinics due to psychiatric symptoms. One hundred fifty-one papers associated with psychiatry have been published during recent 5 years, and 54.7% of them were pertinent to case studies. CONCLUSION: The current status of oriental psychiatric education and training system could be rather inadequate to produce competent oriental doctors who can perform psychiatric practices. In addition, the objective and scientific research data should be accumulated to confirm the hypothesis and effectiveness of psychiatric evaluation and treatment of oriental medicine.

Antipsychotics and the Abnormality of Fasting Glucose, Total Cholesterol in Schizophrenia / 대한정신약물학회지

OBJECTIVE: The concerns about significant weight gain induced by antipsychotics have been recently increased. It raised an issue about the possible effect of antipsychotics on the glucose and lipid metabolism. To address this issue, we investigated the prevalence of abnormal glucose metabolism (impaired fasting glucose (110 mg/dl or= 126 mg/dl)) in patients taking antipsychotics and also compared the prevalence of abnormal glucose metabolism between typical and atypical antipsychotics. METHODS: The subjects included 76 outpatients and 109 inpatients with schizophrenia by DSM-IV diagnostic criteria who had been taking antipsychotics regularly for at least 1 month. We measured fasting glucose, total cholesterol level after midnight NPO. Information about demographic and clinical characteristics of patients was gathered from interview with patients, family members, and the medical records. RESULTS: 24 of 185 schizophrenia patients (13.0%) showed abnormal glucose metabolism. 6 of 47 patients taking olanzapine (12.8%) and 2 of 34 patients taking haloperidol (5.9%) showed abnormal glucose metabolism. The prevalence of abnormal glucose metabolism was higher with olanzapine than with haloperidol, although the difference did not reach statistical significance. However, patients with olanzapine showed higher fasting glucose level than those with haloperidol. There was no significant correlation between medication dose and fasting glucose, total cholesterol level. CONCLUSION: The prevalence of abnormal glucose metabolism was higher in patients with antipsychotics. Olanzapine was more likely to raise fasting blood glucose to higher level than haloperidol.

Course of Patients with Bipolar Disorder after Hospitalization : A 2.5-year Follow-up / 신경정신의학

OBJECTIVES: It has been known that bipolar disorder has diverse courses and complicated factors affecting prognoses. We investigated the 2.5 years course of illness and the predictors of psychosocial outcome of 56 patients who had been hospitalized. As a preliminary step of the prospective outcome study, a retrospective assessment was used. METHODS: At the point of admission and after hospitalization, demographic data, clinical manifestation, duration of illness, numbers and natures of episode, and other clinical variables of the patients were investigated from their psychiatric medical records. The patients' current psychosocial function was assessed using psychosocial items and GAF (Global Assessment of Functioning) score of PSYCH-UP (Psychosocial Symptoms You Currently Have, follow-up version). RESULTS: The patients experienced on average 3.6 times of depressive, hypomanic, manic and mixed episodes during the 2.5 years. The approximately equal numbers of two poles of episodes, depressive and manic including hypomanic, manitested. The premorbid function showed significant difference to GAF score in one way analysis of variance (ANOVA) but not contributed significantly in multiple regression. A stepwise multiple regression revealed that mean duration of admission and numbers of episode recurrence contributed significantly to the GAF score. CONCLUSION: The results of this study suggest that the numbers of episode recurrence and the mean duration of admission are important variables as predictors for psychosocial outcome in patients with bipolar disorder.

Tretment Effect of Bromocriptine on Antipsychotics-induced Amenorrhea / 대한정신약물학회지

Amenorrhea is one of the well-known side effects of antipsychotics in women. It is associated with hyperprolactinemia induced by dopamine blocking effect of antipsychotics. Administration of bromocriptine which belongs to dopamine agonist may reverse amenorrhea and hyperprolactinemia. However dopamine agonist has been reserved in the treatment of antipsychotics-induced amenorrhea because of concern about exacerbation of psychotic symptoms. This case series study was designed to determine whether bromocriptine can be used safely in schizophrenic patients with amenorrhea. We administered bromocriptine to 5 stable schizophrenic outpatients who experienced amenorrhea over 6 months. Bromocrptine dosage was titrated upward from 2.5 mg/day to 7.5 mg/day until menstrual recovery. Patients' menstrual state and side effects of bromocriptine was monitored prospectively for 22 weeks, and clinical symptom were assessed using brief psychiatric rating scale (BPRS) and clinical global impression scale-severity (CGI-S). These were assessed biweekly until 12th week and then every 4weeks thereafter. All five patients resumed menstruation without deterioration of clinical symptoms measured by BPRS and CGI-S. No serious side effect of bromocriptine was reported. Patients with lower baseline prolactin level showed faster recovery and needed lower dose of bromocriptine. These findings suggest bromocriptine may be used safely in the treatment of antipsychotics-induced amenorrhea.

Event-Related Functional Magnetic Resonance Imaging in Post-Traumatic Stress Disorder / 신경정신의학

OBJECTIVE: Symptom provocation paradigms using event-related functional magnetic resonance imaging(fMRI) can be an important tool to visualize neuroanatomic correlates of PTSD symptoms. The purpose of this study is to measure regional changes of brain upon exposure to fear stimulus and elucidate the probable relation between signal changes and fear response in PTSD. METHOD: Event-related fMRI was performed during a task where traffic accident-related photos and checkerboards were presented in 9 women with PTSD and 9 woman normal controls in unpredictable order. MRI data were acquired on a 1.5 T GE vision system with a head volume coil. Stimuli were presented on a mirror mounted on the head coil. A total of 200 functional images were taken during a 10-minute scanning session. TR was 3 seconds and inter-stimulus time was varing 4.5 to 11.5 seconds. Data was analyzed using SPM99. RESULTS: In PTSD group, the fear conditions versus the neutral conditions showed activations in both occipital cortex, both fusiform gyrus, left parietal lobule, both insula, right cerebellar tonsil, right putamen, right claustrum, but deactivations in both prefrontal gyrus(p<0.001). In normal control group, activation were found for the fear conditions as compared with the neutral conditions in left fusiform gyrus, both occipital cortex, left parietal lobule, right frontal lobule(p<0.001). CONCLUSIONS: Emotion provocation paradigm using event-related functional magnetic resonance imaging can be applied to illustrate fear response mechanism in PTSD. The result suggests that insula, limbic lobe, cerebellum may play a role in mediating fear response in PTSD.

Acute Effect of Single Oral Administration of Nefazodone and Trazodone of Psychomotor Performance: A Duble-Blind Cross-Over Comparison in Healthy Volunteers / 대한정신약물학회지

OBJECTIVE: New antidepressant, nefazodone is classified as a serotonin -2 antagonist/reuptake inhibitor like old antidepressant, trazodone. Nefazodone, however, differs from trazodone in that it lacks anti-histaminergic properties and in that it has some norepinephrine reuptake inhibitory properties. These differences may account for the differences between the two drugs in the side effect profiles. This study was conducted to compare the acute effects of nefazodone on the psychomotor performance with those of trazodone. METHODS: The subjects were 12 healthy male volunteers aged between 20-40 years. A single, oral starting dose of nefazodone or trazodone was administered in a double-blind, randomized latin-square design with a 1-week interval between each drug switch. Psychomotor performances were assessed at 1 hour before and at 2 hours after administration of nefazodone 50 mg, nefazodone 100 mg or trazodone 50 mg. The measures of psychomotor performance included Vienna Determination Unit for complex choice reaction time, Critical Flicker Fusion Test, and Grooved Pegboard Test. RESULTS: In the Vienna Determination Unit, when 'within drug effect' (pre- vs. post-medication) was analyzed, nefazodone 100 mg decreased complex choice reaction time in both subtest 2 and subtest 3. Nefazodone 50 mg also decreased the reaction time in subtest 3 but not in subtest 2 which was more difficult and demanding task than subtest 3. On the other hand, no significant changes in the reaction time were observed with trazodone 50 mg in either subtest 2 or subtest 3. When 'between drug effect' was analyzed, however, the differences between drugs were not found to reach statistically significant level. No significant 'between drug effect' or 'within drug effect' was observed in Critical Flicker Fusion Test and Grooved Pegboard Test. CONCLUSION: Although the differences between nefazodone and trazodone did not reach statistically significant level, the results on the complex choice reaction time suggest that al least a single starting dose of nefazodone up to 100 mg does not impair psychomotor performances and it might have a less detrimental effect than trazodone on the psychomotor performance.

A Female Case of Kleine-Levin Syndrome Treated with Amantadine / 신경정신의학

Kleine-Levin syndrome is a rare disorder which usually affects adolescent males and is characterized by periodic hypersomnia, hyperphagia and abnormal behavior. This is an unexplained clinical syndrome for which several etiologies have been entertained with no standard treatment is yet available. A 18-year old woman began suffering from recurrent hypersomnia, hyperphagia, and behavioral disturbances such as irritability, derealization, and amnesia. She was normal between the episodes and diagnosed as Kleine-Levin syndrome. In the course of about two years she had 11 episodes and the mean interval between the episodes was 52.8+/-16.7 days. After application of amantadine, there were two mild episodes and then she had no episodes for more than 6 months. This case suggests the possible role of amantadine in the treatment of Kleine-Levin syndrome.

Association Study between 5-HT2A Receptor and DRD3 Receptor Gene Polymorphism and Clinical Response to Atypical Antipsychotics in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: This study was performed based on the hypothesis that the interindividual differences in clinical response to atypical antipsychotics might be associated with serotonin 2A receptor(5-HT2A) gene and(or) dopamine D3 receptor(DRD3) gene polymorphisms. METHODS: Seventy-five patients(39 men, 36 women) who met DSM-IV criteria for Schizophrenia at the Asan Medical Center were selected for the analysis of the medical records and subsequent interview. A written informed consent was obtained prior to the study and the privacy protection was kept throughout the course. Clinical Global Impression(CGI) Scale was applied after 4 weeks of treatment to assess the response to atypical antipsychotics. All patients in this study were administered olanzapine(n=39), risperidone(n=52) or clozapine(n=4). According to CGI scale, the patients were classified in 7 groups ; very much improvement ; much improvement ; minimal improvement ; no change ; minimal worsening ; much worsening ; very much worsening. The first and second groups were regarded as responders while the other groups were non-responders. Patients were genotyped for 5-HT2A by PCR(Msp I) for detection of T102 and C102 alleles. And they were also genotyped for DRD3 Ser9Gly polymorphism by PCR(Bal I). We conducted the statistical analyses to detect association between responders and non responders with chi-square tests. RESULTS: The patients who were shown no or minimally improved patients were sorted to non-responders(n=42, men 24, women 18) and the other patients shown much or very much improved were grouped as responders(n=33, men 15, women 18). The differences in demographic variables(age, sex), age of onset, and duration of illness were not statistically significant between the two groups. T102 allele is more frequent in non-responders(56.0%) than responders(45.5%), however, this difference is not statistically significant(p=0.20). Gly9 allele is near equal between non-responders and responders (65.5%, 65.2%). Genotype frequencies of the two groups also is not a statistically significant for 5-HT2A T102C(p=0.28) and DRD3 Ser9Gly(p=0.90). CONCLUSION:These results do not show significant associations among 5-HT2A gene, DRD3 gene and clinical response to atypical antipsychotics. On the assumption that responses to atypical antipsychotics are mediated by these two receptors, we can draw two possibilities. First, 5-HT2A and DRD3 genes may not be the functional variants related with responses to atypical antipsychotics. Second possibility is that the unknown variations which might be in linkage disequilibrium with the 5-HT2A T102C polymorphism and DRD3 Ser9Gly polymorphism may be associated with the response to atypical antipsychotics in schizophrenia. However, it is possible that the small number of subjects and ethnic difference of allele frequency of marker polymorphism could induce false negative results.

Prevalence of Mental Disorder and Quality of Life among the Homeless People in a City Shelter / 신경정신의학

OBJECTIVES: Homeless people surged after financial crisis tend to be chronic despite late economic recovery. So we tried to estimate prevalence of mental illness and quality of life of the homeless population living in shelter. METHOD: The study subjects were 220 homeless peoples who stayed at a shelter in Seoul around March 2000. Questionnaires on sociodemographic data were administered to the subjects, and then diagnoses of major DSM-IV Axis I mental disorders were made using Structured Clinical Interview for DSM-IV Axis I Disorders(SCID). And quality of life(QOL) was evaluated by SmithKline Beecham Quality of Life Scale(SBQOL). RESULTS: The lifetime prevalence of major DSM-IV mental disorders(mood disorders, psychotic disorders, and substance use disorders) of 220 homeless people was 73.6%, and current prevalence was 59.1%. The lifetime prevalence of alcohol dependence and abuse was highest, 59.5% and those of mood disorders and psychotic disorders were 39.5%, 3.6% respectively. Quality of life was not significantly correlated with duration of homelessness and unemployment but marital status, self perceive health status, suicidal attempt history were significant factors. The quality of life in the people with mood disorders were estimated to be lower than those with any other diseases(p<0.01). CONCLUSION: Alcoholism was the most prevalent mental disorder in homeless people and mood disorder was negatively related to the quality of life scale.

Epidemiologic Study on Mental Disorders in Urban Homeless People / 신경정신의학

OBJECTIVE: As homeless people increased in urban areas after the economic crisis in Korea, they became a serious social problem. Foreign research showed that many homeless people had chronic mental illnesses which were closely related with the cause and prognosis of homelessness. But very little was known about the prevalence of mental disorders in Korean homeless people. This study tried to capture the overall picture of mental disorders in homeless people. METHOD: The study subjects were 216 homeless people who stayed at two Pusan shelters between late 1998 and early 1999. Questionnaires on sociodemographic data were administered to the subjects, and then diagnoses of major DSM-IV Axis I mental disorders were made using Structured Clinical Interview for DSM-IV Axis I Disorders(SCID). The lifetime and current prevalence of mental disorders in this study were compared to those from other studies in Korean general population and in foreign homeless people. RESULTS: The lifetime prevalence of major DSM-IV mental disorders(mood disorders, psychotic disorders, and substance use disorders) of 216 homeless people was 60.1%, and current prevalence was 35.7%. The lifetime prevalence of major depressive disorders was 22.5% which was higher than that of foreign studies. The lifetime prevalence of alcohol use disorder was 47.4%. The lifetime prevalence of psychotic disorders was 3.8%, and among them the lifetime prevalence of schizophrenia was 1.9% which was lower than that of foreign studies. CONCLUSIONS: In Korean homeless people, mood disorders and substance use disorders were the main mental disorders and psychotic disorders such as schizophrenia were less than in foreign homeless people. The plans to approach and treat homeless people with mental disorders should be made.

Treatment-Seeking Behaviors among Korean University Women with Premenstrual Symptoms / 대한정신약물학회지

OBJECTIVE: The aim of the present study was to determine the treatment-seeking behaviors of Korean university women with premenstrual symptoms. METHODS: Of 1419 subjects who randomly selected in 4 women's university in Seoul, 771 who experienced at least one premenstrual symptom during past three months were included in this study. Treatment-seeking behaviors for relieving premenstrual symptoms were grouped into five categories [doctor's prescription, self-prescription with over-the-counter drug, use of oriental medicine, use of other conservative-alternative medicine (CAM), nonpharmacological treatment]. We investigated what the preferential treatment was and how many subjects were experienced the medical evaluation by doctor. The attitude and knowledge to premenstrual symptoms were evaluated. RESULTS: Subjects who experienced at least one kind of treatment for relieving premenstrual symptoms were 50.2% of women with premenstrual syndrome (PMS) and 63.6% of premenstrual dysphoric disorder (PMDD). Nonpharmacological treatment such as exercise or rest was the most preferential treatment. Only 2.3% of PMDD was examined and prescribed by doctor. Subjects with doctor's or oriental doctor's prescription had more severe premenstrual symptoms and showed functional impairment than others. Only 7% of university women reported to know well about premenstrual symptoms and their treatment. CONCLUSIONS: This study shows that Korean university women prefer self-diagnosis and self-prescription to the evaluation and prescription by doctor for relieving premenstrual symptoms even though they suffer from PMDD. It indicates that the adequate evaluation and treatment for premenstrual symptoms are not carried out because of the lack of knowledge about them. Therefore, the correct information about symptoms and management of PMS and PMDD should be serviced to general population. Also, systematic evaluation of efficacy and safety of oriental medicine and other CAM for premenstrual symptom is needed.

A Multicenter Study on Effects of Nefazodone(Serzone TM) on Depression, Anxiety, Sleep, Sexual Functions, and Quality of Life in Patients with Depression / 대한정신약물학회지

OBJECTIVE: The aim of this study is to determine effects of nefazodone on depression, anxiety, sleep and sexual function in depressive patients. SUBJECTS AND METHODS: This is an open, non-comparative, multi-center study. Antidepressant and other clinical effects of nefazodone were evaluated in 230 patients of 26 centers, aged 14 years or more, who met DSM-IV criteria to major depressive disorder or dysthymic disorder and didn't have other psychiatric disorders and were physically healthy. The clinical efficacy was assessed at week 1, 2, 4 and 8 using Clinical Global Improvement (CGI), Hamilton Depression Scale (HAM-D), Beck Depression Inventory (BDI), State and Trait Anxiety Inventory-State Anxiety (STAI-SA). Other clinical effects were assessed with Weekly Sleep Questionnaire, Sexual Functioning Questionnaire and GHQ-QOL-12, a scale for quality of life. Adverse drug reactions were checked with a questionnaire. Post-treatment effects of drug were compared with pre-treatment baseline condition. RESULTS: The response rates by Clincal Grobal Improvement and HAM-D after 8 weeks treatment were 62.4% and 75.2% respectively. Comparing to baseline, nefazodone was proved to have significantly higher antidepressant and antianxiety effects in depressive patients and it improved also sleep, sexual functions and quality of life. Both patients and physicians satisfied with the effects of drug. Adverse drug reactions were a few and not serious, and most of them disappeared as treatment continued. CONCLUSION: These results suggest that not only nefazodone has antidepressant effects and antianxiety effects, but also it improves sleep disturbance, sexual dysfunction and the quality of life in depressive patients. Adverse drug reactions were a few and not serious.

Sleep Habits and Insomnia-associated Factors in the Urban Elderly: Demographic, Health and Psychobehavioral Correlates / 신경정신의학

OBJECTIVES: The purpose of this study is to analyze sleep habit and investigate the association between insomnia and demographic, health and psycho-behavioral symptomatology in Korean urban elderly. METHOD: A total of 723 community residents aged 65 years or older were surveyed by two stage, random cluster sampling method. The response rate was 76.2%. Interviewers performed door to door visits and administered a questionnaire about sleep, past medical history, and several scales as the Psychogeriatric Assessment Scale (PAS), the short form Quality of Life Scale (SF-36) and etc. RESULTS: The mean scores are as follows: retiring time was ten-sixteen p.m., wake-up time was five twenty two a.m., duration of sleep was seven hours and six minutes. Among the elderly, 11.6% and 14.8% of the subjects reported chronic and intermittent difficulty in sleeping, respectively. The patients with back pain and history of stroke complained of more insomnia symptoms in univariate analysis. In ANCOVA analysis, insomnia symptoms were associated with an old age, depressive symptoms in male. Bodily pain and history of dermatologic disease were additional risk factors in female. CONCLUSIONS: The data suggest insomnia is one of most common health problems among elderly Koreans living in the community. Strong positive relationship between depressive symptoms and insomnia were found. Further research is needed to explore the causal relationship between insomnia and risk factors.

The Patterns of Personality and Anger Expression in the Patients with Colorectal Cancer / 신경정신의학

OBJECTIVES: Although previous studies have suggested that Type 1 or Type C personality may be associated with the development of cancer, the results have not been consistent. There have been some evidences that repression, denial, or non-expression of anger are related with the incidence of colorectal cancer. However, according to the results of recent researches, aggressive hostility was related to the development of colorectal cancer. This study attempted to delineate psychological characteristics or personality patterns of the patients with colorectal cancer based on multidemensions of anger and Type 1 personality for cancer development. METHOD: The subjects were composed of 35 patients with colorectal cancer and 37 normal controls. Grossarth-Maticek personality questionnaire and the Spielberger state-trait anger expression inventory were administered. RESULTS: In comparison with the normal control group, the colorectal cancer patient group showed significantly higher scores on anger experience, angry temperament and state anger but no significant differences on Type 1 personality scale and other subscales. In the discriminant analysis patients and control groups were classified by means of state anger, angry temperament, angry reaction, anger-in, anger-out and anger control variables. When angry temperament variable was selected as a discriminant variable, 65.8% of cases had been correctly classified. CONCLUSIONS: These results suggested the relationship between the disposition to experience and express anger without particular provocation and the development of cancer.

The Influence of IMF-related Economic Stress upon Mental Health / 신경정신의학

This study was designed to investigate the influence of the so-called IMF-related economic stress upon the mental health and to analyze the process of the influence. As the possible variables moderating the stress process, social resource, problem solving style, and hopelessness were included. 221 male and female subjects were recruited according to the intensity of economic stress and classified into four groups(employees of solid companies, employees of the companies at risk, short-term unemployed and long-term unemployed). Relevant measures including economic stress scale, selected SCL-90R subscales(somatization, depression, hostility, anxiety), social support scale, problem-solving scale, and job hopelessness scale were administered. As assumed, it was proved that economic stress had adverse effects on the mental health. In addition to this basic causal relationship, moderating effects of several variables were found as follows: First, social support had the buffering effect upon the economic stress. That is, strong social support played the role suppressing the development of psychiatric symptoms under high stress. Second, men were more vulnerable to the adverse effects of economic stresses than women. Third, economic stresses had influence on the helplessness concerning the problem solving. However other problem solving strategies such as creative style, approach style, avoidance style, etc were proven to have no relationship with the economic stress. Fourth, in the analysis of unemployed group, it was found that hopelessness mediates the relationship between economic stress and mental health. In conclusion, the clinical implications of such findings in economic stress process were discussed and several limitations and the suggestions for future researches were also addressed.

Effect of Sertraline on the Regulation of Serotonin Transporter mRNA Levels in Rat Brain / 신경정신의학

The knowledge of gene regulation of serotonin transporter mRNA may provide clues to understanding how antidepressants affect their therapeutic actions. Recently, the effects of antidepressants on the serotonin transporter have been investigated but yielded controversial results. To study this further, we performed in situ hybridization for serotonin transporter mRNA in rats(treatment group, n=5)receiving long term(14 days)treatment with a selective serotonin reuptake inhibiting antidepressant, sertraline(10mg/kg, i.p) Following sertraline treatment, a significant(p<0.05)ncrease in hybridization of serotonin transporter mRNA was observed compared to that observed in vehicle-treated rats(control group, n=5) This result may be interpreted as a compensatory mechanism to reduce synaptic levels of serotonin which were increased by long term sertraline treatment.

The Effect of Zolpidem on the Psychomotor Performance in Healthy Volunteers / 신경정신의학

OBJECTIVES: Zolpidem is known to have fewer cognitive side effects than older hypnotics. To confirm this objectively, we compared the effects of zolpidem on the psychomotor performance with those of placebo in 10 healthy volunteers. METHOD: Zolpidem and placebo were administered orally in a double-blind, two-way, single dose, cross-over design. Assessments of psychomotor performances were carried out before (1 hour) and 1.5 and 6 hours after the administration of single dose of zolpidem (10mg) or placebo. Each treatment day was separated by 1 week of washout period. The psychomotor performances were measured using Vienna Determination Unit, Vienna Reaction Unit, Vienna Signal Detection, Grooved Pegboard Test and Finger Tapping Test. The data were analyzed using two-way, repeated measures ANOVA on a crossover model. RESULTS: The results showed that 1.5 hours after the administration, zolpidem 10mg produced markedly impaired psychomotor performance but 6 hours after, produced no significant psychomotor performance decrements on most of the psychomotor tests. CONCLUSION: This study confirmed previous findings that zolpidem is generally devoid of adverse side effects on psychomotor performance at the next day after administration.

Acute Effects of Paroxetine and Amitriptyline on the Psychomotor Performancein Healthy Volunteers / 신경정신의학

OBJECTIVES: Paroxetine is known to have fewer cognitive side effects than older antidepressants such as amitriptyline. To confirm this objectively, we compared the effects of paroxetine on the psychomotor performance with those of amitriptyline in 10 healthy volunteers. METHOD: Paroxetine and amitriptyline were administered orally in a double-blind, two-way, single dose, crossover design. Assessments of psychomotor performances were carried out before and 2 and 6 hours after administration of single dose of paroxetine (40mg) or amitriptyline (50mg). Each treatment day was separated by 1 week of washout period. The psychomotor performances were measured using Vienna Determination Unit, Vienna Reaction Time, Vienna Signal Detection, Grooved Pegboard Test and Finger Tapping Test. The data were analyzed using two-way, repeated measures ANOVA on a crossover model. RESULTS: The results showed that paroxetine 40mg produced no significant performance decrements on the every test of psychomotor performances, whereas amitriptyline 50mg produced markedly impaired performance on most of the psychomotor tests. CONCLUSION: This study confirmed pervious findings that paroxetine is generally devoid of adverse side effects on psychomotor performance.

Guidelines for the Adequate Initial Electric Stimuli in Bilateral ECT Using MECTA Device / 대한정신약물학회지

OBJECTIVE: In applying Electro-Convulsive Therapy(ECT) to patients, initial electric stimuli have been often determined without the adequate guidelines. This study was designed to determine adequate numerical value of parameters for initial electric stimuli inducing seizure successfully in ECT. We prepared Asan Medical Center(AMC) guidelines for 4 parameters based on our clinical experiences and MECTA(Monitored Electro-Convulsive Therapy Apparatus, MECTA Crop(R)) instruction manual, and investigated the success rate in the first session of ECT following AMC guidelines for parameters. METHOD: Twenty-two patients(male 10, female 12) treated with ECT using MECTA SR-1 model in Asan Medical Center between september 1996 and october 1998 were included in this study. We carried out bilateral ECT under anesthesia according to AMC guidelines. Seizure that persisted longer than 20 seconds was considered successful. RESULTS: 18 of 22 patients showed successful seizures in the first session (82%). Four patients failed to show successful seizures. One out of the foiled patients received inadequate stimuli due to premature release of switch burton and two patients were taking continuously anticonvulsants and anxiolytics, respectively prior to ECT. But all foiled patients except one, who was thought to have unusually high seizure threshold, demonstrated successful seizures in the second session with the same initial parameters. CONCLUSIONS: The bilateral ECT according to AMC guidelines resulted in the adequate seizures in all patients except one patient who had unusually high seizure threshold. These data show that AMC guidelines can be successfully applied in ECT using MECTA device.

The Psychosocial Characteristics Influencing the Selection of Complementary Medicine / 신경정신의학

This study examined the characteristics of people who have preference for complementary medicine and also the psychosocial factors that are related to the selection of complementary medicine. Two-hunred subjects recruited from the community were included in this study. Demographic variables, medical service characteristics, health locus of control, social support, coping style, and personality charateritics such as self-esteem, neuroticism, and hypochondriasis were measured. It turned out that nearly 80% of the subjects had already experienced at least one alternative therapy in the past. However, past expeiece was not significant in predicting future complementary medicine usage. People who were older in age, had more information about complementary medicine, used active-behavioural coping styles, and had internal locus of control were more likely to use complementary medicine in the future. Recommenations for furthur research is indicated.