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비정형 항정신병 약물 치료 이후 발생한 비만과 당뇨가 Amisulpride 투여 후 호전된 환자 1예
채정호,정영은,김원,박원명,전태연,김광수 대한정신약물학회 2004 대한정신약물학회지 Vol.15 No.2
Newer atypical antipsychotics have many benefits compared with conventional antipsychotics. However it has been known that atypical antipsychotics are associated with drug-induced weight gain and dibetes mellitus. Obesity and diabetes mellitus may be problematic side effects to patients with schizophrenia because they can cause many medical problems and also drug compliance which is important to prognosis can be reduced by those adverse effects. We present here a male patient, aged 26 year-old, who was treated with risperidone, olanzapine, quetiapine subsequently and gained weight by 32 kilograms (almost 50% increase) during four year-long treatment and diagnosed as having diabetes mellitus. We switched the antipsychotics to amisulpride at the day of admission and increased the dosage to 800mg. At discharge after 34 days after admission, His psychotic symptoms were considerably improved and blood glucose level at fasting time was stabilized within acceptable range. And he also lost weight by 5 kilograms after admission. Amisulpride would be a relatively appropriate choice of drug in patient with atypical antipsychotics induced weight gain and/or diabetes mellitus.
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기분장애를 주소로 내원한 Binswanger씨 병 1례
채정호,전태연,윤수정,최성빈,김대진,김광수 대한생물치료정신의학회 2000 생물치료정신의학 Vol.6 No.1
We report a 70 year-old man with Binswanger's disease associated with mood symptoms. He was apparently well until 15 years ago when the treatment-resistant atypical mood symptoms had been appeared. He showed a fluctuating course in mental disturbance, such as irritable and labile affect, emotional incontinence, and irritable behavior. Two years ago, he was diagnose as hypertension, renal failure, and heart failure. He was admitted to psychiatric ward due to irritable mood, dysarthria, lack of bladder control, gait disturbance, and impulsive behaviors, which had been aggravated during the last 2 months. In physical examination, he had hypertension and both pretibial pitting edema was revealed, and also in neurological examination, exaggeration of deep tendon reflexes and weakness of extremities were found. On mental status examination, he showed irritable and labile mood with mild cognitive disturbances. Brain MRI demonstrated multifocal high signal intensity in periventricular white matter, both basal ganglia, and thalami on the T2 imaging. These findings were compatible with Binswanger's disease with mood symptoms.
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경두개 자기 자극(Transcranial Magnetic Stimulation)의 신경정신과적 응용
채정호,전태연 대한신경정신의학회 2001 신경정신의학 Vol.40 No.1
연구목적: 두부 표면에서 유도시킨 국소 자기장 파동을 이용하여 두뇌 피질을 자극할 수 있도록 하는 새로운 비침습적 시술 방법인 경두개 자기 자극(Transcranial Magnetic Stimulation: 이하 TMS)은 중추 및 말초 신경계의 전도도, 시가 정보 처리, 언어, 기억, 감정 및 운동 등 다양한 두뇌 기능을 국재화하는 데에 널리 사용되고 있으며 특히 두뇌 피질을 국소적으로 자극할 수 있다는 특징으로 인해 여러 신경정신과적 질환의 새로운 치료 방법으로도 이용될 수 있다는 가능성이 대두되고 있다. 본 논문은 TMS의 발달과정, 기전 및 신경정신과적 응용에 대한 광범위한 문헌 검색과 정리를 통하여 그 현황과 미래를 개괄하려는 목적으로 작성되었다. 방법: 현재까지 출간된 영어로 작성된 논문을 검색하여 정리하였으며 TMS를 실제 시행한 경험이 풍부한 전문가들과 논의를 하였다 결과: TMS는 신경정신과적 질환의 행동적 신경심리를 이해하고 두뇌의 병태생리적 회로를 조사하는데에 중요한 도구가 될 것이며 우울증을 비롯한 신경정신과적 질환의 새로운 치료방법이 될 수 있는 가능성이충분하다. 결론: 두되-행동간의 관계를 연구하는 데에 TMS가 매우 유용할 것이며 TMS의 효능과 안정성을 확고하게하는 다양한 향후 연구가 지속적으로 필요할 것이다. Objectives : Transcranial magnetic stimulation(TMS) is a new, noninvasive procedure of a localized pulsed magnetic field to the surface of the head to cause a depolarization of neurons in the brain cortex underneath. The magnetic field(Magnetic) is generated by passing current pulses by conducting coil, held close to the scalp so that the field is passing the skull (Transcranial) and is focused in the cortex(Stimulation). Here we provide a summarized review of the methodology of TMS and its application to research and therapeutics in the field of neuropsychiatry. Methods : We described the history, procedures, basic researches, clinical applications, safety issues, mode of action, and future of TMS using literature review and interview with experts. Results : The earlier clinical uses of TMS had been restricted to the field of neurology where it was used to examine the central and peripheral nervous conduction. However this technology has been widely used to map various brain functions such as visual information processing, language, memory, emotion, and movement. The ability to excite local areas of brain cortex has raised the possibility of the use of TMS as a novel therapeutic tool for various psychiatric disorders. Conclusion : TMS is a relatively new and noninvasive method to investigate regional brain activity and to treat several psychiatric diseases. Further work is necessary to firmly establish the efficacy and safety of this promising tool.
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채정호,박원명,채영래,김제헌 대한신경정신의학회 1994 신경정신의학 Vol.33 No.2
Objects: The authors studied polysomnographic findings of patients with sleep apnea DIMS (disorders of initiating and maintainig sleep) syndrome and anxiety disorders with insomnia related to another mental disorders. Methods : Eight patients with sleep apnea DIMS syndrome and fourteen patients with anxiety disorder with insomnia related to another mental disorder(nonorganic) were studied using computerized polysomnography. Results : 1) The sleep period time were significantly decreased in anxiety disorder group and the sleep latency was prolonged in these patients. 2) The changes in sleep stage and the number of arousals during sleep period time were more frequent in sleep apneic patients group. And using these variables we could discriminate sleep apneic patients group from subjects with anxiety disorder. 3) The stage 1 sleep was significantly increased in sleep apneic patients. 4) The apnea index in sleep apnea patients was 28.1 ±25.7. Conclusion : These results suggested that even though there were similiar clinical presentaion such as insomnia, the sleep features of sleep apnea DIMS syndrome and anxiety disorder with insomnia were different. And though there were no instruments to check respiratory flow or movement, it would be possible to discriminate the sleep apnea DIMS syndrome from the anxiety disorder with insomnia by recording the changes in sleep stage and the number of arousals in overnight electroencephalographic procedure.
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