한국형 양극성장애 약물치료 알고리듬 2014 : 소아 청소년

심세훈,박원명,손인기,김문두,이정구,윤보현,정종현,왕희령,우영섭,전덕인,서정석,신영철,민경준 대한우울조울병학회 2014 우울조울병 Vol.12 No.2

Objectives : Clinicians who treat children and adolescents with bipolar disorder desperately need current treatment guidelines. Therefore, we decided to develop first the algorithms for children and adolescents with bipolar disorder when we revise the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) 2010. Method : We performed the survey using questionnaire comprising 16 questions according to each situation in children and adolescents with bipolar disorder. Twenty-three members of the review committee completed the survey. The executive committee analyzed the results and discussed the final production of algorithm considering scientific evidences. Results : The first-line strategy for manic episode in children and adolescents with bipolar disorder is combina-tion of mood stabilizer and an atypical antipsychotic. There was no first-line strategy including expert consensus for depressive episode in children and adolescents with bipolar disorder and at high risk for bipolar disorder. Conclusion : We developed the algorithm for children and adolescents with bipolar disorder first in KMAP-BP 2014. We expect this algorithm may provide clinicians good information and help about the treatment of children and adolescents with bipolar disorder.

미세호기성 조건에서 Escherichia coli 에놀라아제의 발현에 있어서 RNase G의 역할에 대한 연구

심세훈,김용학,심민지,임보람,이강석,Sim, Se-Hoon,Kim, Yong-Hak,Sim, Min-Ji,Lim, Bo-Ram,Lee, Kang-Seok 한국미생물학회 2010 미생물학회지 Vol.46 No.3

에놀라아제는 대부분의 생명체에서 에너지 대사에 중추적인 기능을 하는 해당과정에 관여하는 효소이며, Escherichia coli에서 RNA 가공 및 분해에 중심적인 역할을 하는 RNase E와 PNPase, Helicase와 함께 RNA 분해 복합체를 형성한다고 알려져 있다. E. coli에서 에놀라아제의 mRNA는 RNase E의 동족체인 RNase G에 의해 잘려서 분해되어 조절 된다고 알려져있다. 산소가 없는 환경에서 과발현되는 것으로 알려진 에놀라아제의 발현에 있어서 RNase G의 역할을 알아보기 위하여, 연구를 수행한 결과, 미세호기성 조건에서는 에놀라아제와 RNase G의 발현양 사이에는 상관관계가 밝혀내었다. 이러한 연구결과는 미세호기성 조건에서는 RNase G 이외에 에놀라아제의 조절에 기여하는 다른 기작이 있을 수 있다는 것을 시사한다. Enolase is one of the glycolytic enzymes, which are involved in a central energy metabolism present in nearly all organisms. In Escherichia coli, enolase constitutes RNA degradosome with RNase E, PNPase and RNA helicase, which are involved in most mRNA degradation and RNA processing. Recently, it has been reported that RNase G, an RNase E homolog, degrades eno mRNA. To examine a functional role of RNase G in enolase expression which is known to be up-regulated under microaerobic condition, we carried out experiments. Here, we report that expression levels of enolase and RNase G are not correlated under microaerobic condition. Based on this observation, we suggest the existence of an unknown factor(s) which regulate the activity of RNase G or enolase mRNA under microaerobic conditions.

Fluoxetine 병용 투여 후 만성 정신분열증 환자에서 혈장 5-Hydroxyindoleacetic Acid 농도에 따른 Hamilton Rating Scale for Depression의 변화

심세훈,정한용,한선호,Shim, Se Hoon,Jung, Han Yong,Han, Sun Ho 대한생물정신의학회 1996 생물정신의학 Vol.3 No.2

Object : The aim of this study was to examine an association between plasma 5-Hydroxyindoleacetic Acid(HIAA) level and the change of depressive symptom after fluoxetine trial in haloperidol-stabilized schizoprenic in-patients. Method : According to plasma 5-HIM level, 32 patients were classified to either group with high 5-HIAA level(N=11) or that with low 5-HIM(N=11). For each patient, fluoxetine(20mg/day) added to stable haloperidol dose for 6 weeks. The authors measured Hamilton Rating Scale for Depression (HRSD) at baseline, the 2nd week, the 4th week, the 6th week of treatment. Result : 1) Age, duration of illness, number of admission, duration of present admission, dosage of haloperidol between high 5-HIAA group and low 5-HIM group were significantly different. 2) As time went on, the association between the change of depressive symptom and plasma 5-HIAA concentration was not significant. 3) Of depressed group, as lime went an, depressive symptoms were improved significantly in high 5-HIAA group, but not in law 5-HIM group. Conclusion : We suggest that the association between plasma 5-HIAA level and the change of depressive symptoms after fluoxetine trial in haloperidol stabilized schizophrenic in-patients was not significant.

한국형 우울장애 약물치료 알고리듬 2017(V) : 소아·청소년/노인/여성

심세훈,박영민,김원,왕희령,우영섭,서정석,정종현,이정구,전덕인,민경준,박원명 대한우울조울병학회 2017 우울조울병 Vol.15 No.2

vision of the previous version. The main purpose of the current study was an amendment of the guidelines for the treatment of major depressive disorder (MDD) for a special population. Methods : The survey consisted of 11 questionnaires for children and adolescents, 7 questionnaires for the elderly, and 8 questionnaires for females. A total of 24 of the 42 experts in pediatric psychiatry, and 79 of the 144 experienced adult psychiatrists answered the survey. Results : As the 1st line of treatment for MDD without psychotic features in children and adolescents, antidepressant (AD) monotherapy was the preferred choice, and AD augmented with atypical antipsychotics (AAP) was preferred for MDD with psychotic features. In geriatric depression, AD monotherapy was recommended as the treatment of choice for mild to moderate episodes and for severe episodes without psychotic features. For the latter, combination of AD and AAP was recommended as the treatment of choice. For MDD in pregnancy, AD monotherapy was as the preferred 1st line in both mild to moderate and severe episodes without psychotic features. In severe episode with psychotic features, a combination of AD and AAP was selected as the 1st line option. Conclusion : We developed the algorithm for special populations with depressive disorders, more specifically than the KMAP-DD 2012. We expect this algorithm will provide clinicians useful information and help the treatment of children and adolescents with depressive disorders

자살을 시도한 우울증 환자에서 혈장 ${\beta}$-Nerve Growth Factor 농도의 변화

심세훈,원성두,이분희,한창수,양종철,권영준,김용구,Shim, Se-Hoon,Won, Seong-Doo,Lee, Bun-Hee,Han, Chang Su,Yang, Jong-Chul,Kwon, Young-Joon,Kim, Yong-Ku 대한생물정신의학회 2006 생물정신의학 Vol.13 No.2

Object : Nerve growth factor(NGF) is a protein involved in neuronal survival and plasticity in the central nervous system, which might play an important role in stress, depression and suicide. This study was performed to determine whether there is an alteration in plasma NGF concentrations in depressed patients with suicidal attempt. Methods : The subjects were 32 depressed patients who attempted suicide and admitted in emergency room. Forty-four hospitalized non-suicidal depressive patients and the 30 normal controls were closely matched with the suicidal group in terms of age and sex. Individuals in all 3 groups were evaluated independently by a semi-structured interview for the purpose of establishing a DSM-IV criteria diagnosis. The severity of depressive symptoms was evaluated using Hamilton depression rating scale(HDRS). The severity of the suicidal behavior was evaluated by Weisman and Worden's risk-rescue rating(RRR) system and the Lethality Suicide Attempt Rating Scale(LSARS). Plasma NGF level was measured by the enzyme linked immunosorbent assay(ELISA) method. Results : There were no statistically significant differences of the plasma NGF levels among groups. LSARS and RRR did not reveal any significant correlation with ${\beta}$-NGF level in suicidal depressive patients. Conclusion : This study do not support an association between ${\beta}$-NGF and suicidal depression. However it is necessary to investigate this association through other route such as postmortem brain.

Adolescent with Tourette Syndrome and Bipolar Disorder: A Case Report

심세훈,권영준 대한정신약물학회 2014 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.12 No.3

Tourette syndrome consists of multiple motor tics and one or more vocal tics. Psychopathology occurs in approximately 90%of Tourette syndrome patients, with attention-deficit/hyperactivity, mood, and obsessive-compulsive disorders being common. Additionally, Tourette syndrome and bipolar disorder may be related in some individuals. However, it is unclear why bipolardisorder may be overrepresented in Tourette syndrome patients, and more research is needed. Herein, we report the caseof a 15-year-old boy diagnosed with both Tourette syndrome and bipolar disorder, whose symptoms improved with aripiprazole,atomoxetine, and valproate. The patient was diagnosed with Tourette syndrome at 8 years of age when he developed tics andexperienced his first depressive episode. The patient had a poor response to a variety of antidepressants and anti-ticmedications. A combination of valproate and aripiprazole stabilized both the patient’s tics and mood symptoms. It is importantto assess individuals with Tourette syndrome for other disorders, including bipolar disorder. The treatment of children and adolescentswith both Tourette syndrome and bipolar disorder is an important clinical issue.

주의력 결핍 과잉행동 장애 아동에서의 집단 프로그램의 치료 효과

심세훈,오창근,권자영,정유숙,홍성도 순천향의학연구소 2003 Journal of Soonchunhyang Medical Science Vol.9 No.1

Background : The authors attempted to introduce group program for improving interpersonal relationship and evaluate the effects of that program. Material and Methods : This program had been held twice a week for 8 weeks for children and parents training had been for times on the treatment and continued from 2001 to 2002. Twenty-five ADHD children in school age were selected as subjects from child psychiatric clinic of a general hospital in Seoul. Treatment outcomes were evaluated by comparing at pre- and post- treatment using the various rating scale. Result : According to the results of statistical analysis, paired t-test, the score of total self-concept including popularity was increased and family environment and parenting stress were improved significantly. These results suggest that this program is useful for its orginal goal. The parents evaluated also that children's total problem behaviors were decreased. Conclusion : These results suggest that the designed and performed group program in this study would be effective in facilitating ADHD children's emotional and interpersonal growth, and decreasing their parents stress. Finally they would have healthy interpersonal reationship.

우울장애 환자에서 자살 시도와 트립토판 수산화 효소(Tryptophan Hydroxylase) A218C 유전자 다형성과의 관련성

심세훈,황보영,권영준,정희연,이분희,김용구 대한신경정신의학회 2008 신경정신의학 Vol.47 No.2

Objectives : Several lines of evidence suggest the serotonergic dysfunction involved in the biological susceptibility of suicide. Tryptophan hydroxylase (TPH), the rate-limiting enzyme in the biosynthesis of serotonin, Plays a vital role in serotonin metabolism. In a case-control study, we investigated whether the TPH gene was a susceptible factor for suicidal behavior in depressive patients. Methods : The subjects were 218 depressed patients who attempted suicide and visited emergency rooms in multi-medical centers. One hundred thirty hospitalized non-suicidal depressed patients and the 161 normal controls were matched with the suicidal group. Individuals in all 3 groups were evaluated independently by a Structured Clinical Interview for the purpose of establishing a DSM-IV criteria diagnosis (SCID). The severity of depressive symptoms was evaluated using Hamilton depression rating scale (HDRS). Results : There was no significant difference in genotype distributions and allele frequencies of TPH intron 7 A218C polymorphisms among 3 groups. Furthermore, no significant difference in genotype counts and allele frequencies of the polymorphisms was found among lethal suicidal depressed patients, non-suicidal depressed patients and the normal controls. Conclusion : This study suggests that the A218C polymorphism of the TPH gene is unlikely to have a major effect on the susceptibility of suicidal behaviors in depressive patients.

한국형 양극성 장애 약물치료 알고리듬 2018 : 소아/청소년

심세훈,박원명,윤보현,전덕인,서정석,김원,이정구,우영섭,정종현,김문두,손인기,송후림,민경준 대한우울조울병학회 2018 우울조울병 Vol.16 No.3

Objectives : The objective of this study was to revise the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) 2014: Children and Adolescents. Methods : We performed the survey, using a questionnaire comprising 22 questions according to each situation, in children and adolescents with bipolar disorder. Results : First-line pharmacotherapeutic strategies for manic episode in children with bipolar disorder were a combination of mood stabilizer (MS) and an atypical antipsychotics (AAP), monotherapy with an AAP, risperidone, and aripiprazole. Aripiprazole was selected as first-line medication for depressive episode in children with bipolar disorder, and aripiprazole, and risperidone were selected as first-line at high-risk children. First-line pharmacotherapeutic strategies for manic episode in adolescents were a combination of MS and an AAP, monotherapy with an AAP valproate, lithium, risperidone (Treatment of Choice, TOC), aripiprazole, and quetiapine. First-line pharmacotherapeutic strategies for depressive episode in adolescents, were a combination of an atypical antipsychotics and lamotrigine, valproate, aripiprazole (TOC), risperidone, and quetiapine. For depressive episodes in adolescents at high risk for bipolar disorder, valproate, aripiprazole (TOC), and risperidone were selected as first-line medication. Conclusion : We expect that the present KMAP-BP 2018-children and adolescents, is useful for clinicians to treat children and adolescents with bipolar disorder.

A Case of Galactorrhea Associated with Excitalopram

심세훈,Yeon-Jeong Lee,Eun-Chan Lee 대한신경정신의학회 2009 PSYCHIATRY INVESTIGATION Vol.6 No.3

Escitalopram is one of the most popular selective serotonin reuptake inhibitors (SSRIs) in current use as a first-line treatment for depression. Escitalopram is well-tolerated and rarely associated with serious side effects. Endocrine and reproductive side effects of serotonergic antidepressants are uncommon and galactorrhea is very rarely mentioned among SSRIrelated side effects. Serotonin-enhancing antidepressants may result in a rise in prolactin levels through suppression of dopamine neurotransmission. In the present study, we report a case of hyperprolactinemic galactorrhea associated with escitalopram. A 36-year-old woman developed galactorrhea after initiation of escitalopram for depression and was found to have an elevated prolactin level. Escitalopram was discontinued with resolution of the patient’s galactorrhea and normalization of her prolactin level.