We reported two cases of amantadine treatment in traumatic brain injury patients and reviewed the literature of amantadine treatment of those patients. Problems with short-term memory, attention, planning, problem solving, impulsivity, disinhibition, poor motivation, and other behavioral and cognitive dificit could occur following traumatic brain injury or other types of acquired brain injury. this report described results of amantadine using in two patients with this type of symptom profile. Patients received neuropsychiatric examination as well as BPRS and Barthel index. These patients were improved, respectively from 57 point to 82 point(case 1), from 85 to 94(case 2) in Barthel index, and from 66 point to 35 point(case 1), from 55 to 32 point(case 2) in BPRS. These two patients did not reveal any other adverse effect. The rationale for using amantadine were discussed.
Amantadine* ; Brain Injuries* ; Dopamine Agonists ; Humans ; Impulsive Behavior ; Memory, Short-Term ; Motivation ; Problem Solving

No abstract available.
Korea

Recently, sexual violence is rapidly increasing in our society. A sexual assault occurs once every 1 hour and 17 minutes, nowadays. Sexual assault is a violent crime, inducing a life crisis which inflicts major psychological and physical trauma upon the victim. Posttraumatic symptoms occur immediately and leave long-term effects, such as anxiety, depression, sexual dysfunction, and impaired social adjustment. The purpose of the psychiatric intervention after a sexual violence is to assess the patient for it's psychological effects and to provide a proper treatment. Post-traumatic stress response, symptomatology and management of the victim are reviewed in a practical point of view. Adult and child victims are discussed separately.
Adult ; Anxiety ; Child ; Crime ; Depression ; Humans ; Psychopathology ; Sex Offenses* ; Social Adjustment

The purpose of licensing system is to ensure that the medicines are examined for safety, efficacy and quality. Nevertheless, off-label or unlicensed drug usages in pediatric practice is widespread in Korea and worldwide. Psychotropics are one of the most commonly used off-label or unlicensed drugs. The most valid approach to face this dilemma will be to have more evidences from pediatric pharmacological studies. Clinicians, in addition, need to monitor closely their off-label or unlicensed drug prescriptions to minimize the trial and error in practice. Researchers should publish their experiences and provide guidelines. Pharmaceutical companies, regulatory authorities, and consumer organizations should endeavor altogether for the children's right to get safe and efficacious drugs as adults do. Here, the definition as well as the current status of off-label and unlicensed drug prescriptions will be introduced. Critical issues regarding the off label drugs are discussed. In addition, I will describe the present condition as to the off-label and unlicensed drugs in child and adolescent psychiatry and the authorization process of off-label drug prescription in Korea. Lastly, direction we should like to take in this field will be mentioned.
Adolescent ; Adolescent Psychiatry ; Adult ; Child ; Consumer Organizations ; Dietary Sucrose ; Drug Labeling ; Drug Prescriptions ; Humans ; Korea ; Licensure ; Off-Label Use ; Organothiophosphorus Compounds ; Pediatrics ; Psychotropic Drugs

Methylphenidate is a widely used stimulant for treatment of attention-deficit hyperactivity disorder (ADHD). In addition to core symptoms of attention and behavioral symptoms, methylphenidate is even effective for executive functions. However, abuse and misuse of stimulants, including methylphenidate, for the purpose of cognitive enhancement is an issue of concern worldwide. Some prejudices and misunderstandings against methylphenidate are popular ; however, little attention has been given to the neuropsychiatric evidence of methylphenidate for enhancement of cognitive function among healthy populations. In this article, our aim was to conduct a review of previous studies investigating the effect of methylphenidate in healthy populations. Findings from several recent studies have demonstrated the effectiveness of methylphenidate for enhancement of cognitive function in healthy populations. The mechanisms of cognitive enhancement are thought to be associated with motivation and the reward circuit in the brain. However, when considering the risk to benefit, an official discussion of the use of methylphenidate among healthy members of the population would be premature. Instead, investigation of epidemiological studies of the prevalence of misuse of stimulants among healthy members of the population, particularly adolescents and college students, is needed. In addition, based on achievements reported in previous studies, investigation of the effect of an approach using non-pharmacological enhancing motivation, which will in turn result in increased cognitive function would be helpful.
Achievement ; Adolescent ; Behavioral Symptoms ; Brain ; Executive Function ; Humans ; Learning ; Methylphenidate ; Motivation ; Prejudice ; Prevalence ; Reward

OBJECTIVE: Antipsychotic drugs are known to be effective in reducing psychotic symptoms and behavioral disruptions, and are mainly used during the first few days of acute manic phases of bipolar disorders. The purpose of this study was to investigate the use patterns of antipsychotics in the treatment of acute bipolar manic patients in a university hospital in Korea during the last decade. METHODS: To track the use of antipsychotics from 1990 through 2000, a retrospective chart review was conducted by reviewing the medical records of bipolar disorder inpatients at the department of psychiatry, Soonchunhyang Medical Center in Seoul and Chunan. The following data were collected;1) demographic data, 2) history of bipolar disorder, 3) length of hospital stay, and 4) drug titration records of all prescribed antipsychotic medications. RESULTS: Of the 139 total subjects, 98.5% had been treated with more than one antipsychotics combined with a mood stabilizer for at least one week. Chlorpromazine was found to be the preferred antipsychotic between 1990 and 1995. However, preference of high-potency anti-psychotics, such as haloperidol, to low-potency antipsychotics for bipolar disorder patients was observed between 1995 and 2000. The prescription percentage of atypical antipsychotics increased to 16.3% in 2000. The overall mean prescribed daily chlorpromazine equivalents was 669.9 mg/day (SD=514.3). CONCLUSION: In spite of unfavorable side effects and an established guideline for the usage of antipsychotics for bipolar disorder, most bipolar manic inpatients have been prescribed adjunctive antipsychotics at relatively high dosages. The results imply a need to reduce the discrepancy between daily clinical practice and recommended guidelines in the treatment of bipolar patients.
Antipsychotic Agents ; Bipolar Disorder* ; Chlorpromazine ; Chungcheongnam-do ; Drug Therapy ; Haloperidol ; Humans ; Inpatients ; Korea ; Length of Stay ; Medical Records ; Prescriptions ; Retrospective Studies ; Seoul

OBJECTIVE: Antipsychotic drugs are known to be effective in reducing psychotic symptoms and behavioral disruptions, and are mainly used during the first few days of acute manic phases of bipolar disorders. The purpose of this study was to investigate the use patterns of antipsychotics in the treatment of acute bipolar manic patients in a university hospital in Korea during the last decade. METHODS: To track the use of antipsychotics from 1990 through 2000, a retrospective chart review was conducted by reviewing the medical records of bipolar disorder inpatients at the department of psychiatry, Soonchunhyang Medical Center in Seoul and Chunan. The following data were collected;1) demographic data, 2) history of bipolar disorder, 3) length of hospital stay, and 4) drug titration records of all prescribed antipsychotic medications. RESULTS: Of the 139 total subjects, 98.5% had been treated with more than one antipsychotics combined with a mood stabilizer for at least one week. Chlorpromazine was found to be the preferred antipsychotic between 1990 and 1995. However, preference of high-potency anti-psychotics, such as haloperidol, to low-potency antipsychotics for bipolar disorder patients was observed between 1995 and 2000. The prescription percentage of atypical antipsychotics increased to 16.3% in 2000. The overall mean prescribed daily chlorpromazine equivalents was 669.9 mg/day (SD=514.3). CONCLUSION: In spite of unfavorable side effects and an established guideline for the usage of antipsychotics for bipolar disorder, most bipolar manic inpatients have been prescribed adjunctive antipsychotics at relatively high dosages. The results imply a need to reduce the discrepancy between daily clinical practice and recommended guidelines in the treatment of bipolar patients.
Antipsychotic Agents ; Bipolar Disorder* ; Chlorpromazine ; Chungcheongnam-do ; Drug Therapy ; Haloperidol ; Humans ; Inpatients ; Korea ; Length of Stay ; Medical Records ; Prescriptions ; Retrospective Studies ; Seoul

Debates relevant to the etiology of weight gain or obesity, i.e., the dichotomous understandings about whether obesity arises from the genetic predisposition or from the environmental influences, has long existed. This is an important issue because it is related to the therapists's prejudice when treating patients with obesity. In this review, the authors first discuss the environmental and the genetic factors that cause the obesity, and in the latter part, the interactions between genetic and environmental factors will be discussed. This issue is considered and described especially in a conceptual aspect for the therapists ultimately to understand how the genetic and the environmental factors interact to arise obesity. Conclusively, obesity is best understood as a complex, multifactorial, and chronic disabled state, which cause an individual with genetic predispostion to obesity under the environmental influences. In future, in favor of the accumulated knowledge about the genetic and environmental impacts and their interactions in detail, we will be able to provide a client-specific management or prevention of obesity.
Genetic Predisposition to Disease ; Humans ; Obesity* ; Prejudice ; Weight Gain

OBJECTIVES: Several factors, such as biological markers, clinical correlates, and course of the depressive disorders with psychotic symptoms differ from those without psychotic symptoms. Therefore, specification of a treatment algorithm for depressive disorder with psychotic symptoms is legitimated. This article provides a systematic review of somatic treatments for depressive disorder with psychotic symptoms. METHODS: According to the search strategy of the Clinical Research Center for Depression of Korean Health 21 R & D Project, first, PubMed and EMBASE were searched using terms with regard to the treatment of depressive disorders with psychotic symptoms(until July 2006). Reference lists of related reviews and studies were searched. In addition, relevant practice guidelines were searched using PubMed. All identified clinical literatures were reviewed and summarized in a narrative manner. RESULTS: Treatment options, such as a combination of an antidepressant and an antipsychotic versus an antidepressant or an antipsychotic alone are summarized. In addition, issues regarding the electroconvulsive therapy(ECT), combination therapy, and maintenance treatment are discussed. CONCLUSION: In former times, the combination of an antidepressant and an antipsychotic or ECT were recommended as the first line treatment for depressive disorder with psychotic symptoms. Recently, however, there was a suggestion that there was no conclusive evidence that the combination of an antidepressant and an antipsychotic drug is more effective than an antidepressant alone. More evidence regarding the pharmacological treatment for depressive disorder with psychotic symptoms is needed.
Biomarkers ; Depression* ; Depressive Disorder

OBJECTIVES: Considering the impact of depressive illness on physical and mental health of both mother and fetus, specification of a treatment algorithm for depressive disorder during pregnancy is legitimated. This article provides a systemic review of treatments for depressive disorder during pregnancy and lactation. METHODS: According to the search strategy of the Clinical Research Center for Depression of Korean Health 21 R & D Project, PubMed and EMBASE were searched using terms with regard to the treatment of depressive disorders during pregnancy and lactation. Reference lists of related reviews and studies were searched. In addition, relevant practice guidelines were searched using the PubMed. All identified clinical literatures were reviewed and summarized in a narrative manner. RESULTS: Pharmacotherapy during pregnancy and lactation requires a comprehensive assessment of the risks and benefits of treatment for both mother and fetus or neonate. Recently, there is growing evidence that the use of tricyclic and selective serotonin reuptake inhibitors during pregnancy and lactation does not result in increased risks of teratogenicity. Treatment strategies are described according to the point of time of pregnancy or lactation. FDA categories for antidepressants during pregnancy and lactation are described. In addition, issues regarding to the electroconvulsive therapy and psychosocial treatment are discussed. CONCLUSION: The treatment option for depressive disorders during pregnancy and lactation depends on the severity of depressive illnesses of the individual patient. For mild to moderate depression, the non-pharmacological treatment should be considered first. For moderate to severe depression, pharmacotherapy should be administered in addition to the psychosocial treatment. ECT is recommended for depressive disorder of severe intensity. As the research knowledge is limited, the recommendations should based on the best judgement of psychiatrists.
Antidepressive Agents ; Depression* ; Depressive Disorder ; Drug Therapy ; Electroconvulsive Therapy ; Female ; Fetus ; Humans ; Infant, Newborn ; Lactation* ; Mental Health ; Mothers ; Pregnancy* ; Psychiatry ; Risk Assessment ; Serotonin Uptake Inhibitors