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      • KCI등재후보

        신경내분비계 조절 기전의 새로운 항우울제들: 시상하부-뇌하수체-부신 축을 중심으로

        우영섭,박원명 대한우울조울병학회 2010 우울조울병 Vol.8 No.1

        Despite the availability of numerous options for the treatment of depression, most depressed patients fail to achieve remission and a substantial minority show minimal improvement. Although the monoaminergic neurotransmitters are undoubtedly involved, it is now recognized that changes in the levels of monoamines produced are not sufficient on their own to explain the mechanism of action of antidepressants. Many studies have gathered substantial evidence that hypothalamic-pituitary-adrenal (HPA) system dysregulation plays an important role in the pathophysiology of depressive disorder. According to the corticoid receptor hypothesis of depression, hyperactivity of the HPA is one of the major pathophysiological factors. CRH1 Receptor antagonist has a huge amount of preclinical data suggesting antidepressant effect, but failed to show significant differences between this drug and placebo in the only controlled trial. There is some evidence from animal studies that vasopressin V1b receptor antagonist may have anxiolytic and antidepressant properties. Cortisol synthesis inhibitor (metyrapone) has significant AD effect as augmentation. Glucocorticoid receptor antagonist (mifepristone) significantly reduce psychotic symptom in psychotic major depression but showed no significant effect in depressive core symptoms. DHEA has antiglucocorticoid properties and significant antidepressant efficacy.

      • KCI등재

        Tianeptine은 고유한 기전의 항우울제인가? - Tianeptine의 약물학적 특성과 임상적 적용 -

        우영섭,박원명 대한정신약물학회 2010 대한정신약물학회지 Vol.21 No.4

        Tianeptine is an antidepressant effective in reducing depressive symptoms and combined anxiety symptoms. Tianeptine has drawn much attention, because this compound challenges traditional monoaminergic hypothesis of depression. The involvement of glutamate in the mechanism of action of tianeptine is consistent with glutamate hypothesis of depression which demonstrating the key function of glutamate in the mechanism of altered neuroplasticity that underlies the symptoms of depression. This article reviews the evidence of tianeptine’s mechanism of action with a focus on the glutamatergic system in an attempt to provide a possible explanation for the observed beneficial clinical profile of tianeptine in patients with depression. 전통적인 신경전달물질 불균형 가설 외에도 스트레스, 신체적 질환, 유전적 소인 등이 우울증의 발생에 영향을 준다는 사실은 최근 널리 알려졌다. 다양한 요인들이 신경전달물질, 호르몬, 성장인자(growth factor) 등의 변화를 유발하여 우울증의 발병에 영향을 주며, 해마와 편도와 같은 뇌의 구조 변화 또한 동반되어 나타난다. 이러한 측면들을 종합하면 우울증은 스트레스와 같은 외부 자극에 뇌가 기능적, 구조적으로 적응하기 위한 능력인 신경가소성의 변화와 관련된 것으로 생각할 수 있다. 비록 여러 방면에서의 전임상 연구들이 우울증에서의 신경가소성 변화 가설을 지지하지만, 아직까지 불분명한 부분도 많이 남아있다. 우울증에 대한 monoamine 이론은 tianeptine이 항우울 효과를 보이는 기전을 설명하지 못한다. Tianeptine은 항우울 약물의 작용기전과 관련되어 새로운 관점들을 제공하고 있다. 첫째, 우울증에서 나타나는 뇌 일부 부위의 기능 변화를 막는 기전, 둘째 뇌에서 우울증과 관련된 구조적 그리고 세포 변화의 예방과 회복, 셋째, glutamate계 신경전달의 안정화가 그것이다. 결론적으로 tianeptine은 경도에서 중증에 이르기까지 다양한 우울 증상의 치료에 효과적이며 gluta-mate에 대한 tianeptine의 작용이 항우울, 항불안 효과를 설명할 수 있는 바탕이 될 수 있을 것이다.

      • KCI등재

        Cognitive Deficits as a Mediator of Poor Occupational Function in Remitted Major Depressive Disorder Patients

        우영섭,Joshua D. Rosenblat,Ron Kakar,박원명,Roger S. McIntyre 대한정신약물학회 2016 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.14 No.1

        Cognitive deficits in major depressive disorder (MDD) patients have been described in numerous studies. However, few reports have aimed to describe cognitive deficits in the remitted state of MDD and the mediational effect of cognitive deficits on occupational outcome. The aim of the current review is to synthesize the literature on the mediating and moderating effects of specific domains of cognition on occupational impairment among people with remitted MDD. In addition, predictors of cognitive deficits found to be vocationally important will be examined. Upon examination of the extant literature, attention, executive function and verbal memory are areas of consistent impairment in remitted MDD patients. Cognitive domains shown to have considerable impact on vocational functioning include deficits in memory, attention, learning and executive function. Factors that adversely affect cognitive function related to occupational accommodation include higher age, late age at onset, residual depressive symptoms, history of melancholic/psychotic depression, and physical/psychiatric comorbidity, whereas higher levels of education showed a protective effect against cognitive deficit. Cognitive deficits are a principal mediator of occupational impairment in remitted MDD patients. Therapeutic interventions specifically targeting cognitive deficits in MDD are needed, even in the remitted state, to improve functional recovery, especially in patients who have a higher risk of cognitive deficit.

      • KCI등재

        Blonanserin Augmentation of Atypical Antipsychotics in Patients with Schizophrenia-Who Benefits from Blonanserin Augmentation?: An Open-Label, Prospective, Multicenter Study

        우영섭,박주언,Do-Hoon Kim,Inki Sohn,Tae Yeon Hwang,박영민,Duk-In Jon,정종현,박원명 대한신경정신의학회 2016 PSYCHIATRY INVESTIGATION Vol.13 No.4

        '스콜라' 이용 시 소속기관이 구독 중이 아닌 경우, 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

        ObjectiveaaThe purpose of this study was to investigate the efficacy and tolerability of atypical antipsychotics (AAPs) with augmentation by blonanserin in schizophrenic patients. MethodsaaA total of 100 patients with schizophrenia who were partially or completely unresponsive to treatment with an AAP were recruited in this 12-week, open-label, non-comparative, multicenter study. Blonanserin was added to their existing AAP regimen, which was maintained during the study period. Efficacy was primarily evaluated using the Positive and Negative Syndrome Scale (PANSS) at baseline and at weeks 2, 4, 8, and 12. Predictors for PANSS response (≥20% reduction) were investigated. ResultsaaThe PANSS total score was significantly decreased at 12 weeks of blonanserin augmentation (-21.0±18.1, F=105.849, p<0.001). Moreover, 51.0% of participants experienced a response at week 12. Premature discontinuation of blonanserin occurred in 17 patients (17.0%); 4 of these patients dropped out due to adverse events. The patients who benefited the most from blonanserin were those with severe symptoms despite a treatment with a higher dose of AAP. ConclusionaaBlonanserin augmentation could be an effective strategy for patients with schizophrenia who were partially or completely unresponsive to treatment with an AAP.

      • KCI등재후보

        정신과적 질환에 대한 새로운 약물요법

        우영섭,박원명 대한의사협회 2011 대한의사협회지 Vol.54 No.10

        Psychopharmacology has developed over approximately the past five decades. The remarkable proliferation of information in this area has made it difficult for clinicians to understand the characteristics of various psychotropic agents. Atypical antipsychotics including amisulpride, asenapine, aripiprazole, blonanserin, clozapine, iloperidone, lurasidone,olanzapine, paliperidone, quetiapine, risperidone, ziprasidone, and zotepine cause fewer extrapyramidal problems and have many clinical applications, but they can cause metabolic disturbances. Mood stabilizers and lamotrigine are widely used for bipolar disorder. Other novel anticonvulsants such as topiramate, oxcarbazepine, gabapentin, tiagabine, pregabalin, vigabatrin,levetiracetam, and riulzole have also been tested with diverging or inconclusive results. Antidepressants are commonly used in the clinical treatment of depression and anxiety disorder. However, the mechanism of action of medications used in the treatment of psychiatric disorders remains unclear. Understanding the mechanisms of action and clarifying the diagnosis may enhance the treatment outcome in psychiatry. In this review, we analyzed clinical pharmacology data for each drug within a class and discussed clinical strategies for administering currently available antipsychotics, mood stabilizer/anticonvulsants, and antidepressants widely used for various psychiatric indications.

      • KCI등재

        Metformin을 투여하여 항정신병약물 유발 무월경이호전된 여성 조현병 환자 2예

        우영섭,박원명 대한정신약물학회 2013 대한정신약물학회지 Vol.24 No.4

        본 증례들은 항정신병약물의 투여 이후 발생한 무월경에 대하여 metformin을 500~1,000 mg/day 투여한 후 월경이 회복된 증례이다. 두 증례 모두에서 metformin을 투여한 이후 4~10주 이내에 월경이 회복되었으며, metformin 투여와 관련하여 신체적, 정신과적 부작용은 발견되지 않았다. 본 논문에서 보고된 2예만을 근거로 metformin의 무월경에 대한 효과를 입증하기는 어려우나, 많은 여성 조현병 환자에서 항정신병약물 치료에 문제를 유발하는 무월경 증상에 대한 치료적 대안으로 metformin을 고려할 수 있을 것으로 생각한다. 향후 잘 계획된 연구를 통하여 metformin의 무월경에 대한 효과와 그 기전의 규명이 필요할 것으로 생각한다. Amenorrhea is a common adverse event in female patients treated with antipsychotics. Because amenorrhea can produce difficulties for women suffering from schizophrenia, attempts should be made to alleviate antipsychotic-induced amenorrhea. We report two cases of female schizophrenic patients whose antipsychotic-induced amenorrhea were treated with metformin. Two patients who treated with metformin resumed their menstruation within three months. There was no adverse event reported during metformin treatment. This paper presents the rationale for the use of metformin for female patients who suffered from antipsychotic-induced amenorrhea through a literature review

      • KCI등재

        Effect of Initial Ziprasidone Dose on Treatment Outcome of Korean Patients with Acute Manic or Mixed Episodes

        우영섭,박원명,조수현,윤보현,이정구,김원,정종현,서정석,민경준,전덕인 대한신경정신의학회 2011 PSYCHIATRY INVESTIGATION Vol.8 No.3

        '스콜라' 이용 시 소속기관이 구독 중이 아닌 경우, 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

        Objective We investigated the efficacy and tolerability of ziprasidone combined with divalproex to determine the relationship between the initial dose of ziprasidone and the treatment effect among Korean patients with acute bipolar manic or mixed disorders. Methods This study was a 6-week, open-label, prospective investigation of Korean patients with an acute manic or mixed episode of bipolar disorder. Sixty-five patients were recruited. The patients were categorized based on the initial dose of ziprasidone as follows: low (20-79 mg/day) and standard (80 mg/day). Ziprasidone was given in combination with divalproex in flexible doses, according to the clinical response and tolerability. Results The response and remission rates were significantly higher in the standard-dose group than the low-dose group. The combination of ziprasidone and divalproex was well-tolerated and adverse events were mostly mild with no statistically significant increase in body weight. Conclusion The results of this study showed that a standard starting dose of ziprasidone in combination with divalproex for bipolar disorder is more effective than a low starting dose.

      • KCI등재

        Bioequivalence of Generic and Brand Name Clozapine in Korean Schizophrenic Patients: A Randomized, Two-Period, Crossover Study

        우영섭,왕희령,윤보현,이상열,이광헌,서정석,박원명 대한신경정신의학회 2015 PSYCHIATRY INVESTIGATION Vol.12 No.3

        '스콜라' 이용 시 소속기관이 구독 중이 아닌 경우, 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

        ObjectiveaaClozapine is the treatment of choice for refractory schizophrenia. The aim of this study was to compare the pharmacokinetics of the brand name (Clozaril) formulation and a generic formulation (Clzapine) of clozapine in Korean schizophrenic patients. MethodsaaA prospective, randomized, crossover study was conducted to evaluate the steady-state pharmacokinetic profiles of Clozaril and Clzapine. Schizophrenic patients were randomized to receive either the brand name or generic formulation (100 mg twice daily) for 10 days, followed by the other formulation for 10 days. Plasma samples were collected on the last day of each treatment period. ResultsaaTwenty-two of 28 patients (78.6%) completed the study. The mean Cmax,ss values for Clzapine and Clozaril were 524.62 and 551.18 ng/mL, and the mean AUC0-12 values were 4479.90 hr·ng/mL and 4724.56 hr·ng/mL, respectively. The 90% CI values for the natural logarithmically transformed Cmax,ss and AUC0-12 ratios (Clzapine to Clozaril) after a single oral dose (100 mg) were 0.934 (0.849–1.028) and 0.936 (0.869–1.008), respectively. Five patients (20.8%) among 24 patients who took Clzapine reported 11 adverse events and six adverse events were reported by four patients (15.4%) among 26 who took Clozaril; there were no significant differences on physical examination or in vital signs, ECG, and laboratory tests between groups. ConclusionaaGeneric clozapine (Clzapine) appears to be bioequivalent to brand name clozapine (Clozaril).

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