Benzodiazepine derivatives, chlordiazepoxide(Librium), diazepam(Valium), nitrazepam(Mogadon) and oxazepam(Serenid-D) are mainly used as hypnotics at present. Diazepam has been used mainly for premedication in anesthesia and as an intravenous anesthetic agent. The pharmacological actions of these drugs are tranquilizing effects for central nervous system, slight depression on the cardiovascular and respiratory system, anticonvulsant, anxiolytic and antidepressant effects. A new benzodiazepine derivative, Flunitrazepam(Ro 5-4200) has strong hypnotic action, is anticonvulsant and antidepressant in spite of slight depression of the cardiovascular and respiratory systems. Furthermore the onset and duration of this drug are shorter than the others. In our clinical study, flunitrazepam in the dosage of 0.005mg/kg was administered intravenously, as an intravenous anesthetic induction agent, for 22 surgical adult patients. In each patient, the blood pressure, pulse rate, respiratory rate, minutes volume and arterial gas study were done, before and after administration of the Ro 5-4200. The results are as follows; 1. Dosage of this flunitrazepam is not constant as other benzodiazepines. 2. The effects of flunitrazepam on the cardiovascular system showed slight depression but no effect by one hour post-operation. 3. In respiratory system, the minute volume was depressed slightly and the respiratory rate was increased but negligibly. 4. Undesirable side effects attributed to this drug were not found, except the developing of cough (one case).
Adult ; Anesthesia ; Benzodiazepines ; Blood Pressure ; Cardiovascular System ; Central Nervous System ; Clinical Study* ; Cough ; Depression ; Diazepam ; Flunitrazepam ; Heart Rate ; Humans ; Hypnotics and Sedatives ; Premedication ; Respiratory Rate ; Respiratory System ; Tranquilizing Agents

The paper summarized the sedative pharmacological effects of CMM, which were reported in the past 10 years. Those sedative CMMs were found in several type of Chinese medicine, such as tranquilizing the mind, calming the liver to stop the wind, general tonic, blood-activating and stasis-resolving drugs, heat-clearing drugs, exterior-releasing drugs, drugs for resuscitation, diuresis-inducing and dampness-draining drugs, ect. Out of them, the general tonic drugs were used in many occasions. Two Chinese herbs, jujube seed and polygala were used popularly as sedative drugs. And their effects have something to do with heart Meridian and liver Meridian. The Locomotor activity, sleeping test and forcing swimming were used commonly to detect the sedative effects. The sedative mechanisms of those CMM were related with neuro-transmitters such as Dopamine (DA), 5-HT and gamma-GABA, etc.
Animals ; Drug Combinations ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Humans ; Hypnotics and Sedatives ; pharmacology ; therapeutic use ; Materia Medica ; pharmacology ; therapeutic use ; Medicine, Chinese Traditional ; Neurotransmitter Agents ; metabolism ; Sleep Wake Disorders ; drug therapy ; metabolism ; Tranquilizing Agents ; pharmacology ; therapeutic use

Adolescent ; Adult ; Asthma ; drug therapy ; Czechoslovakia ; History of Medicine ; Humans ; Injections, Subcutaneous ; Isoquinolines ; administration & dosage ; Mental Disorders ; drug therapy ; Psychiatry ; history ; Terbutaline ; administration & dosage ; therapeutic use ; Tranquilizing Agents ; history ; therapeutic use ; Tretoquinol ; administration & dosage ; therapeutic use

OBJECTIVE: Early treatment choice is critical in first-episode schizophrenia-spectrum disorders. The purpose of this study was to describe prescribing trends of antipsychotics use in patients with first-episode schizophrenia in 2005 and 2010, respectively. METHODS: We reviewed the medical records of newly treated patients with schizophrenia from a university psychiatric hospital in 2005 (n=47) and 2010 (n=52). We defined patients as receiving a high antipsychotic dose if their ratio of prescribed daily dose (PDD) to defined daily dose (DDD) was greater than 1.5. RESULTS: The rates of high-dose antipsychotic prescription were 61.7% and 53.8% in 2005 and 2010, respectively. The rates of antipsychotic polypharmacy were 34.6% in 2005 and 34.0% in 2010. The most common first-prescribed antipsychotics were (in descending order of prescription frequency) olanzapine, risperidone, aripiprazole, and haloperidol in 2005 and risperidone, quetiapine, paliperidone, and olanzapine in 2010. High-dose antipsychotics were significantly associated with antipsychotic poly-pharmacy (odds ratio=23.97; p<0.01). More individuals were treated with mood stabilizers in 2010 than in 2005 (p=0.003). CONCLUSION: The practice of prescribing high-dose antipsychotics and associated antipsychotic polypharmacy were common even for initial treatment of first-episode schizophrenia in 2005 and 2010. In 2010, the list of the most common first-prescribed antipsychotics changed, and the use of mood stabilizers increased in non-affective schizophrenia.
Antimanic Agents ; Antipsychotic Agents ; Haloperidol ; Hospitals, Psychiatric ; Humans ; Medical Records ; Polypharmacy ; Prescriptions ; Risperidone ; Schizophrenia* ; Aripiprazole ; Quetiapine Fumarate

OBJECTIVE: This study was performed to investigate the prescribing patterns of antimanic agents in the treatment of acute bipolar disorder inpatients in Korea from 1990 through 2000. The results will serve as the basic data for the practice guideline for the pharmacotherapy of bipolar disorder patients in Korea. METHOD: Retrospective chart review of bipolar disorder inpatients of Soonchunhyang Medical Center in Seoul and Chun-An was conducted for each of the year 1990, 1995, and 2000. The following data are collected ; 1) demographic data, 2) history of bipolar disorder, 3) length of hospital stay, 4) detailed drug titration records of antimanic agents and antipsychotic agents. RESULTS: During the last decade, the frequency of lithium monotherapy was decreased obviously. Instead, more than half of the patients in 2000 were on combination therapy of lithium and anticonvulsants. Lithiumvalproate combination was the preferred strategy and the use rate of carbamazepine has been decreased. In addition, most of the patients were given antipsychotic agents during the last 10 years. And recently, atypical antipsychotics were increasingly prescribed. These changes in the field of pharmacology of bipolar disorder have resulted neither in shorter hospital stays nor lower dosages of concurrent neuroleptics. CONCLUSIONS: The results indicate the trends in the prescribing of antimanic agents for the treatment of bipolar disorder in Korea across the past 10 years. Mostly, the change seems to correspond to the international practice guideline. More systematic research is needed to find out the clinical benefits of the anticonvulsants in the real practice of treatment of bipolar disorder.
Anticonvulsants ; Antimanic Agents* ; Antipsychotic Agents ; Bipolar Disorder ; Carbamazepine ; Drug Therapy ; Humans ; Inpatients* ; Korea ; Length of Stay ; Lithium ; Pharmacology ; Retrospective Studies ; Seoul

To examine the double-faced thymoleptic(antidepressant and antimanic) effects of risperidone in mood disorders, this article reviews the psychotropic-induced mania, thymoleptic effects of antipsychotics, therapeutic effects of risperidone(RIS)-induced mania(RIM) in mood disorders, risk factors of RIM, possible neurochemical mechanism of these thymoleptic effects, pathophysiological and clinical significance of thymoleptic effects, and suggestive clinical guideline of RIS in mood disorders. RIS appeared effective for bipolar disorder at a lower dose than that recommended for schizophrenia, especially in the cased of maintenance of mood stabilizers, and gradual titration from low doses. Manic induction/exacerbation can occur by chance during RIS treatment in mood disorders, schizoaffective disorders, and schizophrenias. The possible risk factors for RIM are refractory mood disorder, especially in bipolar I disorder with poor initial response ; refractory chronic schizophrenias, especially with initial response ; psychotic features ; higher initial doses ; rapid titration ; combined therapy with antidepressants in refractory depression ; and RIS monotherapy in mania/hypomania. RIS is a drug that preferentially block 5-HT2 receptors. The effect of low dose are due mainly to the blockade of 5-HT2 receptors. There are more gradual increase in D2 blockade with increasing dose and the D2 blocking properties become apparent at higher doses. This may be related to a modulation of dopaminergic transmission by 5-HT2 antagonism at lower doses with the direct action of RIS on DA receptors coming into play at higher dose. The serotonergic antagonistic effect may be important for its effects on depressive symptoms. This, together with adequate blockade of D2 receptors, may not necessarily lead to destabilization of mood disorder, but rather to more therapeutic effects. Therefore, this dose-receptor affinity relationship with both antidepressant and antimanic effects according to treatment duration can explain a continuum of antidepressant effect, antimanic effect, behavioral stimulation, and manic/hypomanic induction/exacerbation. It was the recognition of a useful psychiatric side effects by a thoughtful observer with fertile minds that led to their ultimate utilization as psychotropic drugs, i.e., phenothiazine, MAOI, TCA, and lithium. And, in vivo pharmacological challenge by novel psychotropics, as a neruochemical probe, with more specific actions is a useful tool to select pharmacologically homogeneous subgroup of the same phenotypical(clinical) condition, to further study the unknown underlying pathogenesis of various mental illnesses. Finally, RIS may be a useful alternative or adjunctive drug for patients with mood disorders without psychotic features or refractory to treatment with standard antipsychotic drugs. The more conservative doses(tirated slowly from 1-3mg/d) of RIS, and maintenance of mood stabilizer in the cases. with risk factors of RIM are recommended in mood disorder.
Antidepressive Agents ; Antimanic Agents ; Antipsychotic Agents ; Bipolar Disorder ; Depression ; Depressive Disorder, Treatment-Resistant ; Humans ; Lithium ; Mood Disorders* ; Psychotic Disorders ; Psychotropic Drugs ; Risk Factors ; Risperidone* ; Schizophrenia

Acquired perforating dermatosis (APD) is a skin disorder occurring in the patients with chronic renal failure (CRF), diabetes mellitus (DM) or both. The purpose of this study was to clarify the clinical and histopathological features of APD, and evaluate role of scratching in the pathogenesis of APD. Twelves patients with APD associated with CRF and DM were enrolled in the study. In six patients who required hemodialysis, the lesions appeared 2-5 yr (mean 3 yr) after the initiation of dialysis, 18-22 yr (mean 19.3 yr) after the occurrence of DM. The other patients who did not receive hemodialysis noted the lesions 4-17 yr (mean 9.5 yr) after the onset of DM. All patients had an eruption of generally pruritic keratotic papules and nodules, primarily on the extensor surface of the extremities and the trunk. The histologic features of our cases showed a crateriform invagination of the epidermis filled by a parakeratotic plug and basophilic cellular debris. The period of treatment for patients who suffered from severe (7 cases) or very severe (3 cases) on the pruritus intensity was longer than that of patients who had mild pruritus (2 cases). These data showed that scratching appear to play a critical part in the pathogenesis of APD.
Adult ; Aged ; Diabetes Mellitus, Type I/*complications ; Diabetes Mellitus, Type II/*complications ; Female ; Histamine H1 Antagonists/therapeutic use ; Human ; Kidney Failure, Chronic/*complications ; Male ; Middle Aged ; Phototherapy ; Pruritus/drug therapy/etiology ; Skin Diseases/drug therapy/*etiology/pathology ; Tranquilizing Agents/therapeutic use

OBJECTIVES: This study investigated the patterns of psychotropic medications prescribed to patients admitted to an open psychiatric ward. METHODS: We reviewed 4282 medical records of patients who were discharged from an open psychiatric ward from May 2003 through April 2014. Data were collected on each patient's age, sex, length of hospital stay, number of past admissions, discharge diagnosis, and kinds and dosages of psychotropic medications at discharge. RESULTS: Among the 1384 male and 2898 female patients, 3.56 psychotropic medications were prescribed on average, with the number increasing across years, from 3.30 in 2003-2008 to 3.76 in 2009-2014. Prescription rates of antipsychotics, anxiolytics, and hypnotics significantly increased in patients with depressive disorders, bipolar disorders, anxiety disorders, delirium, dementia, and amnestic and other cognitive disorders. Only lithium prescription rates decreased significantly. Prescriptions for two or more anxiolytics and antipsychotics increased during the survey years, while antidepressant polypharmacy rates decreased. CONCLUSIONS: Recently, there has been a significant increase in the number of psychotropic medications prescribed, including antipsychotics, anxiolytics, and hypnotics. Caution should be exercised when prescribing medications to avoid cost increases and the risk of side effects, with uncertain gains in the quality of care.
Anti-Anxiety Agents ; Antipsychotic Agents ; Anxiety Disorders ; Bipolar Disorder ; Delirium ; Dementia ; Depressive Disorder ; Diagnosis ; Female ; Gyeonggi-do* ; Humans ; Hypnotics and Sedatives ; Length of Stay ; Lithium ; Male ; Medical Records ; Polypharmacy ; Prescriptions*

OBJECTIVE: This study examines the risk factors of the falls of the dementic elderlies in the nursing home. Especially we investigated how the psychotropics affect them in the aspect of the falling tendency. METHODS: We investigated the falls of the 262 patients living in the Seoul JungGae Nursing Home for six month since March 1 1999. Among these we recruited 182 patients whom the exclusion criteria was applied to, and then we measured the relative risks of risk factors known from the previous studies. RESULTS: The incidence rate of falls is 40.1/100person year. The relative risk of gender, age, disease of central nervous system, chronic illness, cognitive function, antipsychotics, antidepressants and anxiolytics had no significance (p>0.05). BADL, mobility, mood stabilizers were related with the falls significantly, and the relative risks were 0.904 (95%CI 0.840-0.973), 1.744 (95%CI 1.064-2.858), 4.683 (95%CI 1.412-15.532) relatively. CONCLUSIONS: The average rate of falling was 40.1/100person year showing less frequent accidents than that of other foreign studies, which was assumed the large number the care-givers and sitting life style on the floor helped preventing the elderlis' falling. Although The gender, age, disease of central nervous system, chronic illness, cognitive function, antipsychotics, antidepressants and anxiolytics did not influence the rate of the falling tendendy of the elderlies, the mobility and impaired activity of daily living increased the rate of their falling. The elderlies taking psychotropics more fell than others not taking pills. The imbalance between the mobile potency and imposed real activity causes the falls. When the psychotropics affect negatively on the mobility, it increases the falling rate of the elderlies. On the other hands, when these affect positively, these prevent elderlies falling.
Anti-Anxiety Agents ; Antidepressive Agents ; Antipsychotic Agents ; Central Nervous System ; Chronic Disease ; Dementia ; Hand ; Humans ; Incidence ; Life Style ; Nursing Homes* ; Nursing* ; Risk Factors* ; Seoul

Although pain is not only a physical but also an emotional and cognitive distress, psychiatric management of pain has commonly been overlooked. In this article the author will review the psychiatric assessment and treatment of patients with chronic pain. Pain is not a simple sensory process but a complex perception involving higher levels of the central nervous system, emotional states, and highorder mental processes. Thus the psychosocial aspect should be underscored in patients with chronic pain, and a multidisciplinary approach is necessary in the treatment of chronic pain. Tricyclic antidepressants are most widely used and have proven effective in patients with chronic pain. Anticonvulsants/mood stabilizers, anxiolytics, antipsychotics, and opioid analgesics are beneficial in some cases. Non-Pharmacological and psychological therapy of chronic pain includes cognitive-behavioral therapy, relaxation techniques, biofeedback, hypnosis, psychotherapy, and family therapy. New psychotropic agents and various psychological therapies need to be developed and be proven to be effective and tolerable in patients with chronic pain through well-controlled and long-term follow-up studies. Psychiatric treatments, both pharmacological and non-pharmacological, are helpful in patents with chronic pain.
Analgesics, Opioid ; Anti-Anxiety Agents ; Antidepressive Agents, Tricyclic ; Antipsychotic Agents ; Biofeedback, Psychology ; Central Nervous System ; Chronic Pain* ; Family Therapy ; Humans ; Hypnosis ; Mental Processes ; Psychotherapy ; Relaxation Therapy