Carbamazepine과 Phenobarbital이 항정상태의 혈청 Haloperidol 농도에 미치는 영향

정경화,김영훈,엄용섭 大韓神經精神醫學會 1989 신경정신의학 Vol.28 No.2

To investigate the effect of adding carbamazepine or phenobarbital on the steady-state haloperidol levels, we selected 15 chronic psychotic patients who had been in the same psychiatric ward for a minimum of 3 months. All were maintained daily 20㎎ of haloperidol for at least 2 weeks before adding carbamazepine or phenobarbital. Either of these two agents was added to the ongoing haloperidol medication and rapidly increased to therapeutic dosage within 3 days. After plateau dosage was achieved, it was maintained for the next 4 days. The serum haloperidol levels of 7 patients on carbamazepine plus haloperidol and 8 patients on phenobarbital plus haloperidol were determinded with high-performance liquid chromatography before and after the 7 days of concomitant medication. Additionally the clinical changes noted during this period were rated on the Brief Psychiatric Rating Scales. The percent decrease in the steady-state haloperidol levels due to adding carbamazepine for 7 days was between 18% and 64%, and was between 5% and 52%, due to adding phenobarbital. Based upon this study's preliminary findings, the effects of these two agents on serum haloperidol levels were noted to occur within one week. Clinical worsenings found in some patients on carbamazepine plus haloperidol, but it was difficult to document whether carbamazepine-induced reductions of serum haloperidol were the significant factors in the clinical change.

Identitia Psychiatrica

金鍾海,嚴龍燮 大韓神經精神醫學會 1974 신경정신의학 Vol.13 No.1

We several Korean psychiatrists who have been worked in the field more this ten year long, again deliberate their whole situations, specially in relation with their object, that is psychiatric patients, psychiatrists themseves, psychiatric method as proper and psychiatric tradition. 1. psychiatric patient-we psychiatrists may preoccupy ourselves to the negative feature of the human psyche becouse of this specific situation in which they always encounter first with negatives. But also we often wonder the flush of splended featurs of the human psyche which is concealed behind psychopathology. Those are poly to pology, integrity & transcendency of the human psyche. When we consider the psychopathology in relation with their positives, we are oblised to think the patient, as its name, being "with patience." In other words, he is a novice in his life course by his own specific life problems so when he insighted & worked through his problems, he subtly become something better formed who profit himself & the groups of various degree, he belongs. The psychiatric patients may be respected as Bodhisattva, that is, a novice who enthusiastically is learning & training for becoming Budha, who is insighed & worked throwgh his own life problem & his nature. 2. Subject-on the other hand, the psychiatrist himself also "with patience" for his own life problem & now after insighted, worked throwgh & solved his problem, he can dare to help his decessors by his own knowledge, technique & personality power which has been gained through his novice period, that is trainage. Here is the situation of psychinatrist previously mentioned, in relation not only toward the patient, but also toward himself & same situation in relation with the psychiatric trainese. 3. psychiatric method-when, we think about psychiatric method proper, past & present, east and west, we are obliged to use the conception of "trance" which we adopted from the field of hypnotics and is used in more broadened sense when we consides transference of psychoanalytic psychotherapy, trance of hyponotics, tranquilization of tranquilizers, the relaxing mood in which behavior therapy is done, Saimadhi of Budhism, praying of christianism, and ecstatic state of shamanism there are exactly something same fundameutally and ideutically. That state which declined much to emotion from intellectuale and rationale is the matrix of human psyche in the sense that it mollifies and extincts any harmness, appea fromred inner and outer side of the body, which threat human psye or human existence. Heree briefly we estimate the conditioning of trance, physiology of trance and action of trance. After estimate them detailly we conclnded that the psychiatric method proper may be trance. 5. Tradition of psychiatric practice- traditinally psychiatric practice has heen done not only for prevention & treatment of individual but for that of various groups. From such a view point we are oblized to think of something beyond the modern psychiatry as medicine or modern science, for our tradition of psychiatric practice, Beyond its modern psychhiatry, which is imported from western, that is derived from christianism through praying, trance of hypnotics and transference of psycho analysis we think Badhism, and at last to the shamanism. The shamanism is originated and inherited here in the far north east Asia for the prevention and treatment of individual and group psychic crises. So after overviewing detail about shamanism trance, the fundamental basis of shamanism has been based for indiudual & various group lives in relation with the prevention and treatment of human psyche. In the Badhism and christianism of our nation there also we see the dynamic activities of shamanism as their bases. Here as the great decessors of shamanism, we psychiatrists consisder what shall do in modern psychiatric practice present and future.

Klein-Levin Syndrome 1례의 Lithium carbonate 치료경험

곽태섭,김영훈,엄용섭 大韓神經精神醫學會 1985 신경정신의학 Vol.24 No.1

The Klein-Levin syndrome, first named by Cuitchley and Hoffman, consists of periodic hypersomnia, morbid hunger and unusual mental symptoms. Recently the authors treated a 16-year-old male patient who had suffered from 10 to 15day periods of hypersomnia and intermittent episodic pathological hunger. Therapeutic trials on Carbamazepine and Methylphenidate were unsuccessful. Next we treated him with a daily dose of 900㎎ Lithium carbonate for 5 months. Soon after treatment was discontinued against medical advise, one short period of somnolence reappeared. But reinstitution of Lithium carbonate prevented him from more somnolence for next 8 months. Lithium carbonate seemed to suppress the reemergence of somnolence sufficiently in this case, therefore we report this therapeutic experience with a case of Klein-Levin syndrome.

憂鬱病의 發病前 社會環境的 要因에 대한 考察

오세원,엄용섭 大韓神經精神醫學會 1980 신경정신의학 Vol.19 No.3

This clinical study was made to investigate the socio-environmental stressors occurring prior to the onset of severe depression in 85 patients who were hospitalized in the Neuro-Psychiatric Department of Chosun University Hospital from September, 1976 until December, 1979. The result were as follows: 1. According to the diagnostic distribution, 54 were cases of "nonendogenous" depression and 31 were cases of "endogenous" depression. Among them, 71% of the endogenous depressives and 28% of the nonendogenous depressive had a past history of deprission. 2. Frequency of the socio-environmental stressors prior to the onset of depressive illness were (1) financial problems(55.3%) (2) conflict among family members(42.4%) (3) failure of patient's children to meet parental expectations(27.1%) (4) failure in job performance or increased responsibities(27.1%) (5) made to face denied reality(25.9%) (6) threat to sexual identity(23.5%) (7) physical illness(22.4%) (8) change in marital relationship(22.4%) (9) damage to social status(12.9%) (10) death of important person(12.9%). 3. Of the patient, 27 cases were male and 58 were fomale. Most of the cases were distributed in the late adulthood range. The more frequent stressors in male patients were financial problems aned failure in job performance or increased responsibilities. In female patients, financial problems, conflict among family members and failure of patient's children to meet parental expectations were the most frequent stressors. 4. The frequency and type of socio-environmental stressors were similar in both the endogenous and nonendogenous groups. Frequency of stressors in the endogenous group was in the order of financial problems(58.0%), failurein job performance or increased reaponsibilities(38.7%), made to face denied reality(35.5%), conflict among family members(25.8%), failure of patient's children to meet parental expectations(25.8%), physical illness(25.8%), threat to sexual identity(25.8%). The frenquency of stressors in the nonendogenous group was in the order of financial proplems(53.7%), conflict among family members(51.8%), failure of patient's children to meet parental expectations(29.4%), threat to sexual identity(22.2%), change in marital relationship(22.2%). 5. Internal psychological reactions to socio-enviromrntal exteranl events seemed to be determined by individual psychopathology and internally-underlying psychological conflict.

고압액체 크로마토그래피(HPLC)를 이용한 혈청 Haloperidol정량분석

김영훈,엄용섭 大韓神經精神醫學會 1987 신경정신의학 Vol.26 No.3

The method for determination of haloperidol in serum is based on high-performance isocratic liquid chromatography with the use of ?? bonded reversed-phase column at room temperature. The mobile phase is a 40/60 (by Vol.) mixture of acetonitrille and 0.05M phosphate buffer (pH 4.3). Degassing is performed for 5 min. in ultrasonic cleaner. Haloperidol and the internal standard (Amitriptyline) are extracted from alkalized serum into isoamylalcohol/hexane (2/98 by Vol.) and back-extracted into HCl and then 40 ul of these samples were injected on the column. The authors used a high-performance liquid chromatography with a fixed wave length (214nm) ultraviolet detector. A graph of ratio of the peak height of haloperidol to that of amitriptyline against drug concentration was linear and passed through the origin. The detection limit of this method was 2 ng/ml of haloperidol and the coefficient of variation at 10 ng/ml was 5.5% and at 20 ng/ml it was 10.4%. According to the results, this method appears to be suitable for monitoring haloperidol serum levels in chronic schizophrenc patients and also for the investigation of the correlation between serum levels and pharmacological effects.

靑年期의 精神力動學的發達과 그 精神病理

嚴龍燮 조선대학교 학생지도연구소 1979 生活指導硏究 Vol.- No.-

간질성 정신병의 임상적 연구

박태수,엄용섭 大韓神經精神醫學會 1986 신경정신의학 Vol.25 No.1

A clinical study of psychoses in epilepsy was performed on 352 patients with epilepsy, who visited at Neuropsychiatry Department, Pusan Paik Hospital, In-Je medical college, from January 1982 to December 1984 for 3 years. Among the patients, 23 cases(6.5%) manifested psychotic states. The psychotic states could be classified into the following 5 types; Schizophrenia like state, DElusional-hallucinatory state, Paranoid state, Manic depressive state, Transient psychotic state. Two cases showed schizophrenia like state which was difficult to differentiate from schizophrenia. There were 12 cases(52.5%) of delusional-hallucinatory state, 4 cases(17.4%) of paranoid state, 3cases(13%) of manic depressive state, and 2 cases(8.7%) of transient psychotic state. Some clinical factors appeared to correlate closely with the psyshotic state. Of the cases with delusional-hallucinatory state, 58% had complex partial seizure and showed temporal spike foci on electroencephalography. However, in the other types of psychoses, there were no significant findings in clinico-electroencephalographic aspect. In 14 cases of the subjects, obvious adhesive perdsonality trait was found, particularly in paranoid state and delusional-hallucinatory state, all of the cases showed the trait and their ability of adaptation to environment was disturbed apparently by the trait. In 13 cases, on the other hand, some psychological precipitating factors were found at onset of the psychotic states. The authors concluded that there were different types of the psychotic state in so-called epileptic psychosis, and there appeared to be different clinical factors, probably relating to occurrence of the psychotic state. Importance of adhesive personality trait and psychological factors at onset was stressed in the psychosis.

15명의 정상 성인 남자에 대한 근육주사 및 경구투여후 Haloperidol의 약력학적 연구

김용관,김영훈,엄용섭 大韓神經精神醫學會 1987 신경정신의학 Vol.26 No.3

Pharmacokinetics of haloperidol were studied after intramuscular and oral administration in 15 healthy male volunteers. 10 mg of haloperidol were administered intramusculary to 9 subjects and the remainders received the same dose of haloperidol orally. In nine subjects, venous blood was sampled at 45, 90, 180, 360, 720, 1440 min. after intramuscular dosing and in six subjects it was done at 90, 180, 360, 720, 1080, 1440 min. after oral dosing. Serum haloperidol levels were determinded by high-performance liquid chromatography with ultraviolet detection. The detection limit of that method was 2ng/ml of haloperidol and the coefficient of variation was 5.4% at 10ng/ml and it was 10.4% at 20ng/ml of heloperidol. In all subjects, data were analyzed by model-independant approaches. Elimination half-life was determined in a model-independant manner by linear regression of the postdistribution. The linear trapezoidal rule was used to calculate area under the curve (AUC). In nine intramuscular subjects, mean elimination half-life was 19.8±8.4 hr and it was 19.8±8.4 hr in six oral subjects. Our results do not demonstrate any differences between the two. Relative bioavailability(F) of oral haloperidol against intramuscular dosing was 47.2%. Because intravenous data were not available in our study, we used ?? and ?? to calculate the value for clearance and volume of distribution. The mean steady-state volume of distribution/?? was 6.8±1.7L/kg and the mean clearance/?? was 5.1±1.5 ml/kg/min. The mean steady-state volume of distribution/?? was 14.3±3.6 L/kg and mean clearance/?? was 5.1±1.5 ml/kg/min.

알콜精神病患者에 對한 臨床的 硏究 : 幻覺內容을 中心으로

尹昌範,高診富,嚴龍燮 大韓神經精神醫學會 1976 신경정신의학 Vol.15 No.2

The author studied mainly the hallucinated phenomena of the 15 alcoholic psychotics who were hospitalized in Dept. of Neuro-Psychiatry, of Medical college, Chosun University, from October of 1972 to October of 1975. The following conclusions were obtained from the studies. 1) In general distribution of age, the average of the alcoholic psychotics was 40.5 years, with a range from 35 to 43 years. The range of age is significant, the alcoholic psychotics being a much more homogenous group. The rate of males to females among the alcoholic psychotics was 15 to 0. 2) This report will concern data from a group of 9 patients (60%) who were diagnosed as Delirium tremens and from 4 patients who were diagnosed as having Alcoholic Hallucinosis (25%) without schizophrenia and from 2 Patients (13%) of Korsakoff's psychosis who is less than others. 3) Alcoholic psychosis is the special disease of men in Korean society but not less and it is the most part in the lower class of the educational, socio-cultural level and the lower income class. 4) Their average of drinking capacity of a day is the 2 bottles (which is filled with 2 HOB) of SOJU (spirits) and 2-3 DOI of MAKOULLI, howerever they used not to get some eatables. 5) I found the light tremulousness (80%), insomnia (93%), night-mare or vivid dreams (53%), itching (47%), retching (33%), sweating (13%), seizure (27%) and blurred vision (20%) to be part of the alcoholic withdrawal syndrome. 6) The most frequent incidence was in the formed visual hallucinations (80%), followed by the formed auditory hallucinations (60%) and haptic hallucinations (58%). 7) In the contents of visual hallucinations, the bug, flea and snake are the most part but few seen the case of a rat. The contents of visual hallucinations in western people is the snake and rat which is the most part, such a difference between western and oriental people should be taken into account of the comparative cultural aspects. 8) Alcholic psychotics gave more responses regards as persecutory and every day affairs. 9) Alcoholic psychotics perceived the phenomena externally to any extent. 10) Alcoholic psychotics frequently thought that the hallucination was real at the time of it's appearance but later in the recovery period expressed recgnition of it's unreality and alcoholic psychotics behaved negatively or ambivalently in majority of cases.

일반화된 가우시안 분포를 이용한 신호 준공간 기반의 음성검출기법

엄용섭,장준혁,김동국,Um, Yong-Sub,Chang, Joon-Hyuk,Kim, Dong Kook 한국음향학회 2013 韓國音響學會誌 Vol.32 No.2

본 논문에서는 신호준공간(signal subspace) 영역에서 통계적 모델을 이용한 향상된 음성검출기법을 제안한다. 이를 위해 EP(Embedded Prewhitening) 기법에 의해 비상관적인 (uncorrelated) 신호준공간을 생성하고, 이 영역에서 잡음음성과 잡음에 대한 통계적 특성을 파악하였다. 이러한 통계적 특성에 근거하여 GGD (Generalized Gaussian Distribution)을 사용하여 보다 효율적인 음성검출 알고리즘을 제안한다. 실험을 통해 제안된 기법이 0-15dB SNR의 시뮬레이션 환경에서 기존 Gaussian을 사용한 신호준공간 기법보다 향상된 음성검출 결과를 보여준다. In this paper we propose an improved voice activity detection (VAD) algorithm using statistical models in the signal subspace domain. A uncorrelated signal subspace is generated using embedded prewhitening technique and the statistical characteristics of the noisy speech and noise are investigated in this domain. According to the characteristics of the signals in the signal subspace, a new statistical VAD method using GGD (Generalized Gaussian Distribution) is proposed. Experimental results show that the proposed GGD-based approach outperforms the Gaussian-based signal subspace method at 0-15 dB SNR simulation conditions.