양극성장애와 성격장애의 경계

하태현(Tae Hyon Ha) 대한신경정신의학회 2018 신경정신의학 Vol.57 No.4

The concept of bipolar spectrum disorder (BSD) has developed to include affective temperaments such as cyclothymia and hyperthymia. This has greatly helped clinicians to differentiate depressed patients, who would potentially benefit from mood stabilizing treatment, from those with unipolar depression. Cyclothymia, however, has significant similarities with personality disorders, especially with borderline personality disorder (BPD). All the diagnostic items for BPD are frequently found in patients with BSD as well, which presents diagnostic challenges. There are no clear guidelines on how to differentiate BSD from BPD. Featuring borderline pathology for clinical purposes, it may be useful to rely on psychodynamic approaches to identify primitive defense mechanisms of splitting and projective identification suggesting borderline personality organization. Based on new findings on common features between BSD and BPD, some authors have proposed a renewal of the classification system of mental disorders. The dichotomy of bipolar and unipolar depression has gestated a new concept of BSD. Currently, the BSD concept forced us to formulate the border of BSD and personality disorders.

임상연구의 설계 및 연구윤리

장재승,이선이,하태현,윤인영,하규섭,Chang, Jae Seung,Lee, Sunny,Ha, Tae Hyon,Yoon, In-Young,Ha, Kyooseob 대한생물정신의학회 2012 생물정신의학 Vol.19 No.4

Data from clinical studies are needed for psychiatrists to make quick and scientific decisions based on the best available evidence in clinical settings. Various methods of clinical studies are useful for clinicians to have reliable answers to unmet clinical needs. Although randomized controlled trials may provide high-quality information about major issues, well-designed, naturalistic and observational studies often give us unbiased explanation for real-world phenomena. Adequate selection of clinical variables and appropriate number of participants are key factors of well-designed clinical studies. Statistical methods can add an extra dimension to initial design of clinical studies. Given ethical issues in clinical studies on psychiatric disorders, special regards should be paid to participants' ability to provide informed consents. New strategies of clinical studies need to be developed to meet clinical needs and protect the rights and welfare of study participants.

정신건강의학과 개방병동 입원 환자의 진단군별 약물 처방 경향 변화 : 경기도 소재 일 대학병원에서의 11년 비교 연구

변선정,김의태,유희정,하태현,윤인영,김기웅,Byun, Seonjeong,Kim, Euitae,Yoo, Hee Jeong,Ha, Tae Hyon,Yoon, In-Young,Kim, Ki Woong 대한생물정신의학회 2015 생물정신의학 Vol.22 No.4

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.

우울증에 대한 예측모형

김재용,민병주,이재훈,장재승,하태현,하규섭,박태성,Kim, Jaeyong,Min, Byungju,Lee, Jaehoon,Chang, Jae Seung,Ha, Tae Hyon,Ha, Kyooseob,Park, Taesung 한국통계학회 2014 응용통계연구 Vol.27 No.2

양극성 장애는 조증 삽화(manic episode)와 주요 우울삽화(major depressive episode)를 특징으로 하는 정신질환이다. 주요 우울삽화 시기에는 양극성 장애 환자들의 810%가 자살하는 것으로 알려져 있다. 그러므로 양극성 장애 환자를 치료할 때, 우울증상의 정도를 측정하는 것이 중요하다. 우울증상의 정도를 측정하기 위해 가장 많이 사용하는 검사법은 해밀턴 우울평가 척도(Hamilton depression rating scale)이다. 본 논문에서는 해밀턴 우울평가척도 점수를 이용하여 환자들의 치료 효과를 예측하기 위해 선형혼합효과모형(linear mixed effects model)과 전이모형(transition model)을 제시하였다. 예측을 위해 사용된 자료는 분당서울대학교병원을 방문하여 초진일 당시의 해밀턴 우울평가 척도 점수가 8 점 이상인 환자들의 정보를 사용하였다. 첫 조사시점부터 6개월, 12개월 후 세 차례에 걸쳐 관측된 해밀턴 우울평가 척도 점수를 선형혼합효과모형과 전이모형에 적합시켰다. 그 결과를 토대로 특정시점의 해밀턴 우울평가 척도 점수를 예측하였다. 첫 조사시점부터 6개월, 12개월 후의 해밀턴 우울평가 척도 점수를 사용해 선형혼합효과모형과 전이모형에 적합 시켰다. 이 모델들을 이용해 조사시점부터 24개월 후의 해밀턴 우울평가 척도 점수를 예측한다. 이 예측모델은 조사된 24개월 후의 점수와 예측된 24개월의 후의 점수를 비교하여 평가하였다. Bipolar disorder is a psychopathy characterized by manic and major depressive episodes. It is important to determine the degree of depression when treating patients with bipolar disorder because 810% of bipolar patients commit suicide during the periods in which they experience major depressive episodes. The Hamilton depression rating scale is most commonly used to estimate the degree of depression in a patient. This paper proposes using the Hamilton depression rating scale to estimate the effectiveness of patient treatment based on the linear mixed effects model and the transition model. Study subjects were recruited from the Seoul National University Bundang Hospital who scored 8 points or above in the Hamilton depression rating scale on their first medical examination. The linear mixed effects model and the transition model were fitted using the Hamilton depression rating scales measured at the baseline, six month, and twelve month follow-ups. Then, Hamilton depression rating scale at the twenty-four month follow-up was predicted using these models. The prediction models were then evaluated by comparing the observed and predicted Hamilton depression rating scales on the twenty-four month follow-up.

리튬 또는 발프로산으로 치료받은 양극성장애 환자의 무증상 갑상선저하증

최현만,장재승,김자연,김정현,최정은,하태현,하규섭,Choi, Hyeon Man,Chang, Jae Seung,Kim, Jayoun,Kim, Jeong Hyun,Choi, Jung Eun,Ha, Tae Hyon,Ha, Kyooseob 대한생물정신의학회 2013 생물정신의학 Vol.20 No.4

Objectives To investigate the pattern of subclinical hypothyroidism (SCH) in patients with bipolar disorders managed by lithium or valproic acid. Methods The study participants were 106 patients with DSM-IV bipolar disorders receiving planned maintenance treatment at the Mood Disorders Clinic of Seoul National University Bundang Hospital (aged between 17 and 64, mean duration of follow-up = 875.65 days). Using the bipolar disorder registry, thyroid function data were analyzed to assess the frequency of and the risk factors for SCH in patients managed by lithium (n = 64) or valproic acid (n = 42) for more than 5 months. Results Overall frequencies of SCH were 20.3% (13/64) in the lithium group, 14.3% (6/42) in the valproic acid group, and between the two groups there is no difference (p = 0.43). No differences were observed in the potential risk factors for SCH between the two groups including age, sex, subtype of bipolar disorder, baseline TSH, and concomitant antipsychotic use. In cases with SCH, thyroid-stimulating hormone (TSH) showed a tendency to increase at 3 month after the initiation of lithium or valproic acid. A gradual increase in the number of patients showing SCH was found within the first 3 years of medication. Conclusions With regular monitoring and careful assessment, there was no difference in the risk of SCH between lithium and valproic acid maintenance. The risk of mood stabilizer-associated SCH may gradually increase within 3 years following the commencement of medication, thereby mandating close monitoring for the first 3 years of treatment. Further studies with large sample size would be needed to confirm these findings.

강박장애 환자에서의 안와전두피질 용적의 2년 추적 연구

김성년,강도형,유소영,노규식,장준환,최정석,하태현,권준수,Kim, Sung-Nyun,Kang, Do-Hyung,Yoo, So-Young,Roh, Kyu-Sik,Chang, Joon-Hwan,Choi, Jung-Seok,Ha, Tae-Hyon,Kwon, Jun-Soo 대한불안의학회 2006 대한불안의학회지 Vol.2 No.2

Objective : This study was designed to examine the volumetric abnormality of orbitofrontal cortex (OFC) and its change after 2 years of pharmacotherapy in obsessive compulsive disorder (OCD) patients. Method : Volumetric magnetic resonance imaging studies were conducted in 15 OCD patients and 13 normal volunteers. For 2 years, all patients took at least one serotonin reuptake inhibitor and atypical antipsychotics were used as an augmentation therapy in most patients. The follow-up MRI studies were conducted after the pharmacotherapy and OFC volumes were measured by the manual region of interest method. Results : Bilateral OFC volumes of 15 OCD patients were significantly greater than those of the normal volunteers before the treatment. After 2 years of the treatment, significant decrease was observed in bilateral OFC volumes of OCD patients to the extent that left OFC volume of OCD patients was not different from that of the normal volunteers. Conclusion : This finding suggests that OFC is directly related to the pathophysiology of obsessive compulsive disorder.

한국 20세 남자 일반인의 인격 장애 유병율에 관한 연구

윤탁 ( Tak Youn ),류인균 ( In Kyoon Lyoo ),유소영 ( Soh Young Yu ),하태현 ( Tae Hyon Ha ),권준수 ( Jun Soo Kwon ) 한국정신병리진단분류학회 2002 精神病理學 Vol.11 No.1

강박장애환자의 Rey-Osterrieth Complex Figure Test에서의 정보처리유형과 회상율에 관한 연구

박수진 ( Soo Jin Park ),이영호 ( Young Ho Lee ),권준수 ( Jun Soo Kwon ),김창윤 ( Chang Yoon Kim ),고진경 ( Jin Kyung Goh ),하태현 ( Tae Hyon Ha ) 한국정신병리진단분류학회 2003 精神病理學 Vol.12 No.1

강박장애의 증상차원과 공존 인격병리의 관련성에 관한 연구

하태현,윤탁,노규식,김명선,권준수 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.1

만화 과제를 이용한 정신분열병 환자의 사회인지 능력의 측정

오정은,나명현,하태현,신용욱,노규식,홍순범,이경진,신민섭,이영호,권준수 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.3

Objectives : This study is to investigate the hypothesis that schizophrenic patients have difficulty in inferring mental state of others. Methods : Twenty schizophrenic patients and twenty normal subjects were administered to the Cartoon Task required inferring the character's intention in a given context. Results : The schizophrenic patients showed a statistically significant impairment in the Cartoon Task. Both groups chose the card depicting a frequent everyday action significantly more rather than the similar card to the last picture in each story for wrong answers. Conclusion : These preliminary results suggest that schizophrenia is associated with a specific deficit of the cognitive ability referred to as social cognition, and this deficit can be detected not only in the acute phase as found in previous research studies, but also in remission. Also when subjects fail to appreciate what is going on in the minds of other people, they seem to rely on a socially familiar experience.