Research on Psychiatric Treatment by Psychiatrists of Chosun-Governor Hospital and Keijo Imperial University Hospital in Korea during Japanese Colonial Rule / 신경정신의학

This review describes the types of psychiatric treatment studied during the Japanese colonial period of 1910–1945 in Korea, known at the time as Chosun. Twenty-nine research papers and abstracts on psychiatric treatment were reviewed, which were published in the Shinkeigaku-zassi (Neurologia), the Seishin-shinkei-gaku zassi (Psychiatria Et Neurologia Japonica) and the Journal of Chosun Medical Association, by faculty members of the department of neuropsychiatry, Chosun-Governor Hospital and Keijo (Seoul) Imperial University School of Medicine. The major research area was biological psychiatry and biological treatment, as Japanese pioneers in psychiatry at that time had introduced German psychiatry into Japan. Professor Kubo published the most papers, followed by Dr. Hattori, Dr. Hikari, and Professor Suits. In Chosun-Governor Hospital, research on prolonged sleep therapy was an active field. In the Imperial University Hospital, malarial fever therapy, sulphur-induced fever therapy, and insulin shock treatment were the most frequent research topics. Some were tried for the first time in the Japanese Empire, which reflected the pioneering position of the university. These achievements are attributed to Professor Kubo. Six papers on psychotherapy were published. Among them, two papers were on persuasion therapy, three papers were case reports of psychoanalytic therapy, and one paper on Freud. However, this psychoanalytic therapy research seemed to be limited trials conducted following literal guidance, and no further development was noted. Generally, research was characterized by simple design, small numbers of subjects, lack of objective evaluation method, lack of statistical treatment, and especially lack of ethical consideration comparing with today's standard.

Research by Psychiatrists of Chosun Chongdokbu Hospital and Keijo Imperial University in Korea during Japanese Colonial Rule / 신경정신의학

Eighty-three of 114 original articles and abstracts of research published by neuropsychiatrists of Chosun Chongdokbu Hospital (the Japanese colonial government hospital in Korea) and Keijo (Seoul) Imperial University Hospital during the Japanese colonial period (1910-1945) in journals including Shinkeigaku-zassi (Neurologia), Seishin-shinkei-gaku zassi (Psychiatria Et Neurologia Japonica), and The Journal of Chosun (Korea) Medical Association were reviewed. Most articles were on clinical research based on descriptive and biological psychiatry while only 4 articles were on dynamic psychiatry, probably because Japanese pioneers in psychiatry had introduced German psychiatry into Japan during the 1880s. The first paper was written by Dr. Shim Ho-sub. Professor Kubo of Keijo (Seoul) Imperial University published most articles, followed by Dr. Hikari, Dr. Hattori, and Dr. Sugihara. There were more articles on symptomatic psychosis and morphine addiction, followed by general paralysis, schizophrenia, neurological diseases, narcolepsy, epilepsy, and neurasthenia. The meaningful articles even for today were comparative studies between Japanese and Koreans and articles on opioid use disorder in Korea. Authors reported a markedly lower rate of psychotic inpatients in the population of Koreans compared with Japanese. Japanese researchers argued that, because of simpleness in social life in Korea and less violence or excitement in symptoms, Korean mental patients could be cared for by family or members of the community, or be treated by shamanism rather than bringing them to a public mental hospital, and poverty also prohibited hospital care. Finding of higher ratio of schizophrenia to manic-depressive psychosis among Koreans than Japanese was discussed in relation to delayed cultural development of Korea compared to Japan. In addition, traditional customs prohibiting marriage between relatives in Korea was related to low prevalence of manic-depressive psychosis, local endemic malaria was related to low prevalence of general paresis, and poor general hygiene was related to high prevalence of epilepsy. Unclear (undifferentiated) form of psychotic symptoms including hallucination and delusion was reported in more Koreans than Japanese. Also Korean patients showed a more atypical form in diagnosis. Authors added that they had found no culture-specific mental illness in Korea. However, no Korean psychiatrists were included as author in such comparative studies. Comparative studies on constitution between Koreans and Japanese mental patients and prisoners were also unique. However, no Korean psychiatrists participated in such comparative studies. In studies on morphine addiction in Koreans, Japanese researchers argued that such studies were necessary to prevent introduction of morphine-related criminal phenomena to Japan. Meanwhile, Dr. Kubo had left a notion on adaptation problems of Japanese living in the foreign country, Korea. Nevertheless he reported nothing about psychosocial aspects of mental illness in relation to political, cultural, and economic difficulties Koreans were experiencing under the colonial rule of Japan. These general trends of studies based on German biological and descriptive psychiatry and policies of colonial government to isolate "dangerous" mental patients in hospital appeared to reflect colonial or ethnopsychiatry of those days. These policy and research trends seem to have worsened stigma attached to mental disorders. Japanese tradition of psychiatric research was discontinued by return home of Japanese scholars with the end of WWII and colonial rule.

Professor McLaren (2). His Theories of Psychiatry / 신경정신의학

Professor Dr. Charles I. McLaren (1882-1957) of the Department of Psychiatry, Severance Union School of Medicine in Seoul, Korea had introduced not only Christianity but medicine and psychiatry of his time with his own theories to Korea while he had served as a Christian missionary from Australia to Korea from 1911 to 1941. Based on his view of Christianity and knowledge of modern science and medicine, he tried to explore the etiology, symptoms, treatment and spiritual meaning of mental disorders including general paresis, dementia praecox, mania, melancholia, paranoia, neurasthnenia, hysteria, hypochondriasis, and even psychophysiological disorder. Though he accepted that mental disorders are related to disrupted functions of brain or neurons, he believed that fundamental causes of insanity is spiritual. Regarding etiology, he suggested that people's choice not to follow God's logos by their free-will and consequent disharmony with nature or human society or failure of self to adapt to reality causes mental disorders. And he explained psychotic phenomena in view of Christian spirituality. In addition, he argued "psychic" (psychological or spiritual) conflict, sensitivity and guilt feeling as a possible etiology of psycho-neurosis including neurasthenia, hysteria and hypochondria. Conflict includes not only sexual conflicts but social conflicts related to family, job, money, or guilt feeling. He also emphasized the meaning and purpose of life in relation to development of mental illness. Remarkably, he introduced idea of "spill-over" to explain how emotional problems influence autonomic dysfunction resulting in psycho- physiological symptoms. He can be recognized as a psychiatrist who integrated bio-medical descriptive psychiatry with psycho-social approach, dynamic psychotherapy and even spiritual approach as a fundamental one. Though many scientific criticism can be given to his theories of psychaitry, he is deserved to be rediscovered and recognized as a pioneer who had shown another apprach to mental disorders to present psychiatrists who are lost in confusion with so many uncertainties in regard to understanding and treating mental disorders.

Professor Charles I. McLaren, MD (1) : His Life and Medical Philosophy / 신경정신의학

Professor Charles I. McLaren (1882-1957) was an Australian Christian missionary and a professor of psychiatry in Korea. As the first psychiatrist from a Western country, he accomplished tremendous achievements in clinical, teaching and writing activities as well as in his missionary work. He graduated from the University of Melbourne in 1906 and, after residency training under Professor Dr. Sir Richard Stawell at the Royal Melbourne Hospital, he and his wife came to Korea in 1911. He practised medicine at Margaret Whitecross Paton Memorial Hospital in Chinju, Korea and later was appointed as a professor of psychiatry at the Severance Union Medical School in Seoul, Korea. He left Korea for a while to participate in WWII as a military doctor and he also once traveled to Vienna to learn new skills, including fever therapy and psychoanalysis. Because of his love for the Korean people, Dr. McLaren not only introduced into Korean society modern Western psychiatry and a humanitarian approach to patients with mental disorders, but he also practised medicine according to his own unique medical philosophy drawn from Christian spirituality and he educated Korean native students in psychiatry and Christianity. He and his wife also made efforts to improve old customs in Korean society. Because he argued against Japan's enforcement of emperor-worship, he had to resign from the Severance Medical College in 1939, and he returned to Chinju. Immediately after the bombing of Pearl Harbour, he was arrested, imprisoned, interned, and subequently expelled to Australia in 1942. In Melbourne, received wide press coverage and great controversy. He lectured widely and contributed to various professional and other publications, covering not only subjects in Christianity and medicine/psychiatry, but also his opinions about the war and Japan, communism and the White Australia policy. As a Christian me-dical doctor and scientist, he was interested in the "nature of man", the relationship or interaction between body (brain and/or material) and mind/spirituality, the origin of human consciousness in relation to time-space energy, the healing of disease, and the etiology of mental illness and spiritual treatment. He was passionate in his stated belief that God's Word applied to the whole spec-trum of human relationships, from personal to international, as well as to the natural world. Dr. McLaren kept his conservative Christian beliefs, but he respected traditional Asian philosophies. His thoughts and experiences were publically expressed through lectures, journals and books, not only in Korea but also in China and Australia. He was a man of compassion, courage and ceaseless intellectual activity, a pioneer of psychiatry and a lifelong explorer of the Bible. Korean psych-iatrists, who may feel confused by the many complicated new medical theories and advanced technologies, still find Dr. McLaren's simple and clear teachings on science, medicine, and human nature and his practice of caring for mental patients with a compassionate, humanitarian and Christian attitude a challenging example to emulate.

Korean Traditional Medicines as Novel Drugs for Neuropsychiatric Disorders / 대한정신약물학회지

This paper reviews history of new drug development in Korea as well as researchs on development of new psychotherapeutic drug from traditional medicines or natural products in Korea. Korea has a long history of traditional medicine and accumulated knowledge of natural resources. However, only a few new drug have been developed from those natural products. Now many researchers in Korea are devoting themselves to test the possibility of natural products as antipsychotic drugs, antidepressants, anxiolytic drugs and cognitive enhancers. However, only a few graduates from traditional medical schools in Korea are engaging in research on developing new drug from natural products and they are not familiar to research methods of western medicine and pharmacology. For research and development of new drug from natural products or traditional medicines, many researchers should be trained for methodology of basic medicine, pharmacology, pharmacognosy, and oriential pharmacy. Government and pharmaceutical companies need to provide more investment for R & D for new drug from natural products including establishment of data base for component of traditional medicines and natural products, system development integrating information technology, bio-technology and nanotechnology, and international collaboration with advanced countries which have common interest in new drug development from natural products.

Past, Present and Future of Psychopharmacology in Korea / 대한정신약물학회지

History of psychopharmacology in Korea since 1885 was reviewed, when western medicine was firstly introduced to Korea. Barbiturates and fever therapy had been main therapies for mental patients until 1940s. The true era of psychopharmacology started around 1960 with introduction to Korea of chlorpromazine followed by other phenothiazines and meprobamate. Since then, Korean psychopharmacology has developed following international development in psychopharmacology and neuroscience. Around 1990s, second generations of antidepressants and antipsychotic agents had been introduced to Korea. These days, most major psychotherapeutic drugs have become available in Korea soon after they appeared in world market. Meanwhile most researches were clinical ones until 1990s. However basic researches have been limited due to not only lack of financial support but poor conditions for research. Recently general condition for research are improving with general economical development of Korea. Many young researchers have returned to Korea after years of training abroad and are leading researches and international activities. Future directions for researches in psychopharmacology and for activities of Korean College of Neuropsychopharmacology (KCNP) are discussed related to future social changes and especially focused on integration of drug treatment with psychosocial treatment.

Effects of Ginseng Saponin on the Stress-Induced Plasma Corticosterone Levels in Mice / 신경정신의학

OBJECTIVES: The present study was designed to investigate the effect of ginseng saponin and its major active metabolite on the HPA axis under acute stress-i.c.v. injection stress, and immobilization stress, and to examine whether nitric oxide is involved in the mechanism of ginseng saponin on the HPA axis under acute stress. METHODS: In the experiment to study the effect of ginseng on HPA axis during stress, various dose of GTS were injected intracerebroventricularly(i.c.v.) or intraperitoneally(i.p.). Plasma corticosterone levels were measured 30 min after the i.c.v. injection stress. Immobilization stress was applied for 30 min and then blood was cellected for the assays of plasma corticosterone levels immediately after the completion of immobilization stress. To determine the active ginsenosides that can affect the stressinduced plasma corticosterone levels, various dose of each gisendosides(Rb1, Rb2, Rc, Re, Rf, Rg1, 20(S)-Rg3, and 20(R)-Rg3) were injected i.c.v. or i.p.. In the experiment to determine the involvement of the nitric oxide in the inhibitory effect of ginseng on the HPA, NG-Nitro-L-arginine methyl ester(L-NAME) and ginsenosides were coadministered i.c.v. or i.p., and plasma corticosterone levels were measured 30 min after stress was applied. RESULTS: First, the present study showed that ginseng total saponin, ginsenoside Rg3(S form), and ginsenoside Rc administered i.c.v. attenuated the intracerebroventricular injection stress-induced increase in plasma corticosterone levels, and these effects were removed by nitric oxide co-injection. Second, ginseng total saponin and ginsenoside Rc administered i.p. attenuated the immobilization stress-induced increase in plasma corticosterone levels, but ginsenoside Rg3(S form) did not attenuate the immobilization stress-induced increase in plasma corticosterone levels. The attenuative effects of ginseng total saponin and ginsenoside Rc in the immobilization stress-induced increase in plasma corticosterone levels were not affected by L-NAME co-injection. CONCLUSION: This study suggests that ginseng saponin attenuated stress-induced increase in plasma corticosterone levels and these effects were mediated by different mechanisms according to the components of ginseng saponin, and routes of administration.

Relationship between First-Episode Schizophrenic Psychopathology and 99m-Tc-ECD SPECT Regional Cerebral Blood Flow and Plasma Homovanillic Acid / 대한정신약물학회지

OBJECTIVE: The purpose of this study was to examine the relative blood flow differences of brain regions between first-episode schizophrenic patients and normal controls and the relationships between these regions and the changes of psychopathology scores, the treatment response, after serotonin dopamine antagonist (SDA) risperidone treatment. Another purpose of this study was to investigate SPECT relative blood flow index as the treatment response predictor of SDA treatment under control of the influences of homovanillic acid (HVA). We hypothesize that there is differences in the brain blood flows examined by SPECT between first-episode schizophrenic patients and normal controls. Relative blood flow index examined by SPECT will be the response predictors of SDA treatment of schizophrenia under control of influences of metabolites. METHODS: The relative blood flows of seventeen first-episode schizophrenic patients and ten normal controls were examined by 99m-Tc ECD SPECT before drug treatment. The patients group was treated for 6 weeks with SDA. The psychopathology was assessed at baseline just before SDA trial and then at 2 weeks and 6 weeks after SDA treatment. At the same time plasma HVA was evaluated by HPLC (high performance liquid chromatography). RESULTS: The cerebral blood flow of first-episode schizophrenic patients was decreased in thalamus and left basal ganglia and the relative blood flow index of schizophrenic patient's left thalamus was significant therapeutic predictor of SDA treatment of positive symptoms under control of the HVA influnences. CONCLUSION: These results suggest that the relative blood flow examined by SPECT will be a therapeutic index of SDA treatment in schizophrenia.

The Effect of Haloperidol on Regional Cerebral Blood Flow Assessed with 99m-Tc-ECD SPECT In Schizophrenic Patients / 신경정신의학

OBJECTIVES: Regional cerebral blood flow(rCBF)in schizophrenics is confounded by various factors including medication status. Previously, there have been numerous studies regarding the effects of antipsychotics on rCBF. However, these works have shown contradictory and inconsistent findings due to the different of type, dose and exposed duration of antipsychotics. The aim of this study was to observe the effect of antipsychotic medication on rCBF and exposed duration of antipsychotics under control. METHODS: Eighteen drug-naive schizophrenics and 19 schizophrenics medicated with haloperidol were included in the study. Regional cerebral blood flow was assessed with the singlephoton emission computed tomography(SPECT)under a resting state. Relative rCBF was compared between two groups. Haloperidol was selected as the antipsychotic drug as it has relatively selective action at the D2 receptor and less active metabolites. Exposed duration was limited from one to three weeks. RESULTS: Haloperidol-medicated schizophrenic patients had a significantly greater increase of relative cerebral perfusion in the right inferior temporal lobe, left inferior frontal lobe, both basal ganglia, left thalamus, both parieto-occipital lobes, and right parietal lobe than drug-naive schizophrenic patients. Haloperidol-medicated schizophrenic patients had a significant decrease of relative cerebral perfusion in left inferior temporal lobe. However, no significant differences in relative rCBF were found between drug-naive and haloperidol-medicated schizophrenic patients in right inferior frontal lobe, right thalamus, both superior temporal lobes, both superior frontal lobes, and left parietal lobe. CONCLUSION: These findings suggest that antipsychotics affect regional cerebral blood flow, and antipsychotic medication status must be considered in the relative rCBF studies of schizophrenic patients.

99m-Tc-ECD SPECT Study of Differences on Relative Cerebral Blood Flow between Drug-Naive and Drug-Free Schizophrenic Patients / 신경정신의학

OBJECTIVES: In schizophrenics, regional cerebral blood flow(rCBF) are affected by various confounding variables, i.e., age, sex, duration of illness, and clinical status. The pharmacological condition of patients is also a particular important variable to be taken into consideration. However, few data are available regarding the differences between the relative rCBF findings in drug-free and drug-naive schizophrenic patients. Currently, numerous studies have included drug-free and drug-naive schizophrenic patients in the same 'unmedicated' group under the assumption that the rCBF is identical between drug-free and drug-naive cases. Therefore, the aim of this study was to compare the rCBF between a group of drug-free schizophrenic patients and a group of drug-naive schizophrenic patients about the effects of age, sex, duration of illness, and clinical status(positive and negative symptoms) under control. METHODS: Eighteen drug-naive schizophrenics and fifteen drug-free schizophrenics were in-cluded in the study. Regional cerebral blood flow was studied with the single-photon emission computed tomography(SPECT) under resting state. Symptoms were assessed with Positive and Negative Syndrome Scale(PANSS). Regions of interest were both inferior temporal lobe, inferior frontal lobe, superior temporal lobe, thalamus, basal ganglia, parieto-occipital lobe, superior frontal lobe, and parietal lobe. RESULTS: No significant differences of relative rCBF were found between drug-free and drug-naive schizophrenic patients in left inferior temporal lobe, right inferior frontal lobe, both superior temporal lobe, both thalamus, both basal ganglia, right parieto-occipital lobe, and both superior frontal lobe. But, drug-free schizophrenic patients had a significant increase of perfusion in the right inferior temporal lobe and left inferior frontal lobe and a significant decrease of perfusion in both parietal lobes and left parieto-occipital lobe. CONCLUSIONS: Relative rCBF in drug-free schizophrenic patients is different from that in drug-naive schizophrenic patients. So, in the relative rCBF studies of schizophrenic patients, it must be considered whether the patients were previously medicated or not.

Relationship between Regional Cerebral Blood Flow in 99m-Tc-ECD SPECT and Symptom Profiles in Unmedicated Patients with Schizophrenia / 신경정신의학

Symptom profiles in schizophrenia consists of positive and negative symptom dimensions which are considered to be related to different underlying pathophysiologies and neural substrates. The purpose of the study was to identify the possible relationship between relative regional cerebral perfusion and positive and negative symptom dimension in unmedicated patients with schizophrenia. Twenty-seven unmedicated patients with schizophrenia(13 patients who were antipsychotic drug-naive and 14 patients who had been drug-free for at least 1 week) were included in the study. Regional cerebral perfusion was studied with the single-photon emission computed tomography(SFECT). Symptom dimensions were assessed with positive and negative syndrome scale(PANSS). The scores of each symptom dimension were correlated with regional cerebral perfusion. The results were 1) positive symptom dimension score was significantly related to decreased perfusion in the medial temporal lobe and increased perfusion in the frontal lobe, 2) negative symptom dimension score was significantly related to decreased perfusion in the basal ganglia, thalamus and increased perfusion in the frontal lobe. These results suggest that positive symptom dimension is associated with the dysfunction of the link between the frontal lobe and the medial temporal lobe and that negative symptom dimension is related with the impairment of frontal-basal ganglia circuit.

Quantitative EEG Changes during Verbal Memory Task Performance in Schizophrenia / 대한정신약물학회지

OBJECTIVE: Under the hypothesis that activated brain regions of patients with schizophrenia differ from those of normal subjects during memory task performance, this study was aimed to investigate topographic changes related to memory functions in schizophrenia. METHOD: Subjects of this study consisted of 20 unmedicated patients with schizophrenia and 19 normal controls who were matched for age, sex, and handedness. Quantitative EEG(QEEG) with 32 channels was recorded with eyes closed(EEG0) and open(EEG1) in a resting condition and during computerized verbal encoding(EEG2) and recognition(EEG3) tasks. RESULTS: During EEG1, 2, and 3, there was a decrease in alpha activity in both groups compared to EEG0 and the change in alpha activity of patients was significantly lesser than normal controls in the occipital region. Pairwise comparison showed that the alpha activity of normal controls significantly increased from EEG1 to EEG2 in the parietal region and from EEG1 to EEG3 in all regions except both frontal regions while those of patients did not change. The beta activity of normal controls significantly increased from EEG1 to EEG2 in both temporal regions and from EEG1 to EEG3 in the frontal, temporal, and parietal regions while those of patients significantly increased only in the parieto-occipital region. CONCLUSION: These results indicate that the frontal lobe, temporal lobe, and thalamus are not appropriately activated during memory tasks in schizophrenia. It may be proposed that the learing of visually presented words in patients with schizophrenia depends on distinct memory process such as priming.