There are numerous drug interactions related to many psychotropic and cardiovascular medications. Firstly, the principles in predicting drug interactions are discussed. Cytochrome P (CYP) 450 plays a significant role in the metabolism of these drugs that are substrates, inhibitors, or inducers of CYP450 enzymes. The two most significant enzymes are CYP2D6 and CYP3A4. The ability of psychotropic drugs to act as inhibitors for the enzymes may lead to altered efficacy or toxicity of co-administered cardiovascular agents as a substrate for the enzymes. The following is also a review of the known interactions between many commonly prescribed cardiovascular agents and psychotropic drugs. Most beta blockers are metabolized by CYP2D6, which may lead to drug toxicity when they use in combination with potent CYP2D6 inhibitors including bupropion, chlorpromazine, haloperidol, selective serotonin reuptake inhibitors, and quinidine. Concomitant administration of lithium with angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and diuretics may increase serum lithium concentrations and toxicity. Calcium channel blockers and cholesterol lowering agents are subject to interactions with potent inhibitors of CYP3A4, such as amiodarone, diltiazem, fluvoxamine, nefazodone, and verapamil. Prescribing antiarrhythmic drugs in conjunction with medications are known to prolong QT interval and/or inhibitors on a relevant CYP450 enzyme is generally not recommended, or needs watchful monitoring. Digoxin and warfarin also have warrant careful monitoring if co-administered with psychotropic drugs.
Amiodarone ; Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Anti-Arrhythmia Agents ; Bupropion ; Calcium Channel Blockers ; Cardiovascular Agents ; Chlorpromazine ; Cholesterol ; Cytochrome P-450 CYP2D6 ; Cytochrome P-450 Enzyme System ; Cytochromes ; Digoxin ; Diltiazem ; Diuretics ; Drug Interactions ; Drug Toxicity ; Fluvoxamine ; Haloperidol ; Lithium ; Psychotropic Drugs ; Quinidine ; Serotonin Uptake Inhibitors ; Triazoles ; Verapamil ; Warfarin

A pair of eyes of a 18 year-old girl with advanced congenital glaucoma was examined by light and electron microscopy. Results were as follows: 1. Trabecular meshwork and iris root showed fibrosis. 2. Schlemm's canal was absent. 3. Endothelium of the trabecular meshwork was degenerated. 4. Ciliary body was atrophied. 5. Inner layer of retina showed degeneration with the loss of nerve fiber layer and ganglion cell layer, which was replaced by Mueller cells. 6. Optic nerve showed atrophy from a loss of nerve fibers and there was proli feration of collagen tissue.
Adolescent ; Atrophy ; Ciliary Body ; Collagen ; Endothelium ; Female ; Fibrosis ; Ganglion Cysts ; Glaucoma* ; Humans ; Iris ; Microscopy, Electron ; Nerve Fibers ; Optic Nerve ; Retina ; Trabecular Meshwork

Each year many people are exposed to life-threatening disaster and traumatic events that put them at risk for trauma- and stressor-related disorders such as posttraumatic stress disorder. This report reviews research on the psychosocial interventions currently employed for the prevention and treatment of trauma- and stressor-related disorders. Cognitive behavioral therapy, including cognitive therapy and prolonged exposure, has been shown to improve several outcomes. Considerable progress has also been made in the use of eye movement desensitization and reprocessing. Trauma- and stressor-related disorders are associated with complex outcomes and multiple comorbid emotional, social, and physical health difficulties. Further advances are required in the intervention for populations with complex and chronic forms and in the development of integrated and well-related systems of care.
Adult* ; Cognitive Therapy ; Disasters ; Eye Movements ; Humans ; Stress Disorders, Post-Traumatic

OBJECTIVES: Somatic symptoms after the exposure of psychological trauma frequently developed. However, the somatic symptoms are not covered under the diagnostic criteria of posttraumatic stress disorder(PTSD) in detail, although they are often associated with social and occupational functioning and patient-doctor relationships. The aim of this article is to highlight the potential mechanisms, the common manifestations, and the treatment of the somatic symptoms. METHODS: This article studied the somatic symptoms searched using academic search engines like PubMed, Scopus, Google Scholar, KoreaMed and KISS from the earliest available date of indexing to March 31, 2016. RESULTS: The mechanism of somatic symptoms after the exposure was described as psychological and physiological aspects. Psychological mechanism consisted of psychodynamic theory, cognitive behavioral theory, and others. Physiological mechanism involved changes in neuroendocrine and immune system, autonomic nervous system and central nervous system. Somatization associated with psychological trauma manifested various health conditions on head and neck, chest, abdominal, musculoskeletal, and dermatological and immune system. Few studies described the standardization of treatment for the somatic symptoms. CONCLUSIONS: Clinicians and disaster behavioral health providers should think of the accompanying somatic symptoms during intervention of psychological trauma and PTSD. Further studies are needed on the somatic symptoms seen in psychological trauma and PTSD.
Abstracting and Indexing as Topic ; Autonomic Nervous System ; Central Nervous System ; Disasters ; Head ; Immune System ; Neck ; Psychological Trauma* ; Search Engine ; Stress Disorders, Post-Traumatic ; Thorax

We experienced a complication of brachial plexus palsy secondary to operative position during thoracoscopic thoracic sympathectomies. His general health was excellent and no previous histories vulnerable to peripheral nerve systems were observed. The thoracic sympathectomies were done under general anesthesia. The patient was placed left lateral position with his right arm abduced 150o on padded arm board. An operation was lasted 2 hours and 30 minutes at this position because of severe right apical lung adhesion. The controlateral side was performed same procedure and lasted 20 minutes. After the patient recovered from the anesthesia, the patient had a complete paralysis of right arm. There was also slightly diminished sensation to pinprick on the arm and hand. Neurologic examination and EMG study revealed brachial plexus palsy. Nerve blocks and physiotherapy were performed to treat brachial plexus injuries. His motor functions were improved day by day and he was discharged with a complete range of motion against gravity on 14th. postoperation day. However, there were loss of muscle powers against some resistances and tingling sensations of fingertips. Two months later, he was recovered completely and there was no residual disabilities.
Anesthesia ; Anesthesia, General ; Arm ; Brachial Plexus* ; Gravitation ; Hand ; Humans ; Lung ; Nerve Block ; Neurologic Examination ; Paralysis* ; Peripheral Nerves ; Range of Motion, Articular ; Sensation ; Sympathectomy*

OBJECTIVES: This study was conducted to quantify the six dimensions of obstacles to disaster behavioral health (DBH), which was explored through the previous Qualitative Content Analysis of field workers' experiences after the Sewol Ferry accident and to determine the preference and significance of the details of every dimension. METHODS: Based on the six dimensions and their details, structured questionnaires were devised. The field workers as DBH service providers were requested to choose not only the most urgent item but also the reason for their choice. For the statistical analysis, the field workers were grouped by age, employment period, place of employment, occupation, mental health professional certificate, and experience and education of DBH interventions. Differences of the groups were analyzed using chi-square test. RESULTS: The questionnaires were distributed to 284 field workers for DBH, and a total of 79 usable questionnaires were collected and analyzed. Out of six dimensions, 43% of the field workers primarily suffered from difficulties in vertical relations of the administration system. Vague policy on DBH was the most challenging in difficulties in vertical relations of administration system (32.9%). The details of the other 5 dimensions were also discovered. Several significant differences were identified among groups according to the structured questionnaires. CONCLUSION: This study identifies the six dimensions and their significance as obstacles to DBH services. It may make a contribution to improving laws and systems when deciding on related policies and sorting out urgent problems.
Disasters* ; Education ; Employment ; Health Personnel ; Health Services* ; Humans ; Jurisprudence ; Korea* ; Mental Health ; Occupations

OBJECTIVES: MDM-2 is an oncoprotein that inhibits p53 tumor suppressor protein. Amplication and over- expression of its protein have been observed in human malignancies, and these abnormalities have a role in tumorigenesis through inactivation of p53 function. To elucidate the role of p53 and MDM-2 protein in cervical neoplasia we investigated the expression rates of MDM-2 and p53 protein in surgically resected specimens. METHEDS: Immunohistochemical studies using anti-p53 and anti-MDM-2 protein in the paraffin embedded section of 62 cases including cervical intraepithelial neoplasm(CIN) and invasive cervical cancer were performed. RESULTS: Expression rates of p53 protein were 25% in CIN I& CINII, 20% in CINIII, and 44% in invasive carcinoma, respectively. The MDM-2 protein were 33% in CIN I & CIN II, 16% in CIN III, and 48% in invasive carcinoma, respectively. There was no evident correlation between p53 positivity and MDM-2 positivity(p>0.05). However, correlation between MDM-2 negativity and p53 negativity was statistically significant(p=0.002) CONCLUSION: These data suggest that the expression of p53 protein is presumed to be necessarily correlated with MDM-2 protein expression in cervical neoplasia.
Carcinogenesis ; Humans ; Paraffin ; Proto-Oncogene Proteins c-mdm2* ; Tumor Suppressor Protein p53 ; Uterine Cervical Neoplasms

No abstract available.
Eosinophilic Granuloma* ; Eosinophils*

OBJECTIVES: Previons studies reported altered beta-adrenergic receptor (betaAR) responsiveness in panic disorder, but few studies reported to see the effect of pharmacotherapy on betaAR function in panic patients. This investigation examined betaAR responsiveness in patients with panic disorder before and after pharmacotherapy with paroxetine. METHODS: After assessment using the Anxiety Disorder Interview Schedule for DSM-IV, 27 acute panic patients whose illness duration did not exceed 1 year were assigned to 12 weeks of paroxetine treatment. Twenty seven normal control subjects with no previous history of major medical and psychiatric illnesses were matched by age, sex, exercise, and body mass index. The Hamilton rating scale for anxiety (HAM-A), Hamilton rating scale for depression (HAM-D), Spielberger state-trait anxiety inventory-State (STAI-S) and Trait (STAI-T), acute panic inventory (API), anxiety sensitivity index (ASI), and Beck depression index (BDI) were performed to assess clinical states in the panic patients before and after treatment. The HAM-A, HAM-D, STAI-S and STAI-T, and BDI were also performed in the normal control subjects. We measured the betaAR density (Bmax), affinity (1/Kd), and sensitivity (cyclic AMP ratio of isoproterenol-stimulated cAMP to basal cAMP) in all subjects. RESULTS: Panic patients showed much lower scores of the HAM-A, STAI-S, STAI-T, API, ASI, HAM-D, and BDI after 12 weeks of paroxetine treatment than those before the treatment. There was no significant difference in the means of Bmax and cAMP ratio between control subjects and panic patients before and after the treatment. However, pretreatment Kd (R2=0.314, beta=-0.876, p=0.001) and Bmax (R2=0.230, beta=-0.575, p=0.019) significantly accounted for API scores after the treatment and change of Bmax according to the treatment accounted for the improvement of anxiety sensitivity (R2=0.353, beta=0.594, p=0.015). The pretreatment Kd value was significantly higher in the panic patients compared with that of control subjects (78.35+/-26.20 vs. 59.15+/-29.33, p=0.014), which was significantly reduced after the treatment (79.43+/-26.83 vs. 56.38+/-28.79, p=0.002). The pretreatment Kd value significantly accounted for the improvement of API scores (R2=0.316, beta=0.562, p=0.029) and the decrease in trait anxiety (R2=0.246, beta=-0.513, p=0.025). CONCLUSION: In acute panic patients, only betaAR affinity was reduced before the treatment, which was contrary to our expectation. Decreased betaAR affinity was normalized after paroxetine treatment. Decreased betaAR affinity and increased betaAR density before the treatment predicted good treatment response in acute panic patients. Thus, betaAR affinity and density could be useful biological markers that predict the treatment response of paroxetine in panic disorder.
Anxiety ; Anxiety Disorders ; Appointments and Schedules ; Biomarkers* ; Body Mass Index ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Drug Therapy ; Humans ; Panic Disorder* ; Panic* ; Paroxetine* ; Receptors, Adrenergic, beta

OBJECTIVES: We aimed to evaluate the efficacy of biofeedback-assisted autogenic training for chronic tension-type headache, and to determine the relationship among the changes in electromyography (EMG) activity, headache activity, and mood states according to the psychophysiological treatment. METHODS: Chronic tension-type headache patients aged from 20 to 40 years (n=35) were randomized to the treatment group receiving biofeedback-assisted autogenic training (8 sessions) or the monitoring-only control group. EMG activities, headache index, and various psychological variables were examined. RESULTS: We found greater treatment response rate (> or =50% reduction in headache index) in patients with biofeedbackassisted autogenic training than in the monitoring group (61% vs. 18%; chi-square=6.882, df=1, p=0.01). There were no significant changes in the mean values of the pretreatment EMG activities across the sessions in either group (all p's>0.1). Mood states including anxiety and depression improved over time in the both groups, with the improvements being more prominent in the treatment group. Moreover, the reduction in depression level predicted treatment outcome in terms of headache index (95% confidence interval: 0.272-0.966, p=0.039). CONCLUSION: These results show that biofeedback-assisted autogenic training is effective for the treatment of chronic tension-type headache in a Korean population. Changes in mood states may be closely associated with the clinical outcome in the treatment of chronic tension-type headache using biofeedback-assisted autogenic training.
Aged ; Anxiety ; Autogenic Training ; Biofeedback, Psychology ; Depression ; Electromyography ; Headache ; Humans ; Tension-Type Headache ; Treatment Outcome