항정신병약물 사용 중인 정신분열병 환자에서 올란자판으로의 교체 방법에 관한 연구(II) : Comparison of Safety 안전성 비교

안용민,권용실,권준수,민성호,박두병,양문정,소형석,송종호,신윤식,우행원,유범희,이홍석,정한용,한창환,김용식 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.5

연구목적: 이 다기관 공동임상연구는 사용 중인 항정신병약물을 ’직접 교체 방법’또는 ’시작-감량 교체 방법’중 한 가지 방법으로 올란자핀으로 교체한 후, 안정성 측면에서 두 교체 방법 간의 비교와 교체후의 변화를 관찰하기 위한 것이다. 방법: 국내 13개 병원의 입원 및 외래에 내원한 환자들 중 ICD-10 지단기준으로 정신분열병에 해당되며, 임상적으로 항정신병약물 교체가 필요한 환자를 대상으로 하였다. 두 가지 교체 방법 중 한 가지를 무작위로 피험자에 적용하였으며, ’직접 교체 방법’에 배정된 경우에는 사용중인 항정신병약물을 일시에 중단하고 10㎎의 올란자핀을 바로 투여하였고, ’시작-감량 교체 방법’에 배정된 경우는 10㎎의 올란자핀 투여하고 2주에 걸쳐서 기존 약물을 감량하여 중단하였다. 올란자핀 사용기간은 총 6주이며, 용량은 5∼20㎎ 범위로 제한하였다. 한정성 평가를 위해서 체중, 생명징후, 자발적인 이상반응 복, 실험실 검사 그리고 Simpson-Angus Scale(SAS), Barnes akathisia rating scale(BARS), Abnormal involuntary movement scale(AIMS). Liverpool University neuroleptic side effect rating scale(LUNSERS)등을 이용하였다. 결과: 총 103명의 정신분열병 환자를 대상으로 하였다. 사용한 올란자핀의 용량, 벤조디아제핀의 병용률, 탈락률과 탈락 사유, 자발적인 이상반응 보고, 생명징후, 실험실 검사 그리고 대부분의 부작용 척도 상에서 임상적으로 의미 있는 차이를 두 교체 방법간에 발견하지 못하였다. 다만 AIMS의 감소는 ’직접 교체 방법’군에서 보다 적었고, 항콜린제의 병용률은 ’시작-감량 교체 방법’군에서 보다 많았다. 기저 상태에서 전체 피험자의 SAS와 BARS 점수는 각각 3.5점과 1.8점이었으며 70% 이상의 피험자가 고프로락틴 혈증을 보였다. 올란자핀으로 교체한 후, SAS, BARS, AIMS 점수의 유의한 감소가 있었으며 고프로락틴 혈증을 보인 피험자 분율도 약 30%이하로 감소하였다. 그러나 교체 방법과 상관없이 올란자핀 교체 후 유의한 체중 증가가 있었다. 결론: 이 연구를 통해 교체 방법에 관계없이 비교적 안전하고 용이하게 올란자핀으로 교체 할 수 있음을 알 수 있었다. 그리고 기존 항정신병약물을 올란자핀으로 교체함으로써 일부 부작용들을 줄일 수 있음을 간접적으로 관찰할 수 있었다. 하지만 이 연구는 여러 제한점과 문제점을 지니고 있기 때문에 보다 체계적인 연구를 통해 검정이 필요하리라 생각된다. Objectives: This multicenter clinical trial involving 13 hospital sites compared the safely of switching to olanzapine between ’direct switching method’ and ’start-tapering switching method’. Method: This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For ’direct switching method’group, previous antipsychotics were abruptly discontinued and 10㎎ of olanzapine was administered, and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20㎎. The safety of switching to olanzapine was measured with vital sings including body weight, adverse events reported spontaneously, laboratory tests, and various scales such as Simpson-Angus Scale(SAS), Barnes Akathisia Rating Scale(BARS). Abnormal Involuntary Movement Scale(AIMS), and Liverpool University Neuroleptic Side Effect Rating Scale(LUNSERS). Results: 103 patients were switched to olanzapine in this study. The comparison between two switching methods did not show any significant difference in the dosage of olanzapine used, the concomitant use of benzodiazepine, the rate and reasons of drop-out, the adverse events, vital signs, laboratory tests, and most scales for measuring side-effects. However, the decrease in AIMS scores was significantly lower in ’direct switching method’ group, and the concomitant use of anticholinergics was comparatively greater in ’start-tapering switching method’ group. At baseline, SAS and BARS scores were 3.5 and 1.8 points respectively, and more than 70% of the subjects showed hyperprolactinemia. After switching to olanzapine, SAS, BARS, and AIMS scores were significantly decreased and the proportion of the patients with hyperprolactinemia was also decreased to less than 30%. However significant weight gain after the treatment of olanzapine was observed regardless of switching method. Conclusion: This study may suggest that switching to olanzapine can be done with relatively high safety regardless of switching methods and olanzapine can significantly decrease some side-effects induced by other antipsychotics.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

지난 4년간 학회지 "신경정신의학" 심사 평가보고

오병훈,권준수,남궁기,김승현,지익성,김창윤,하규섭,박원명,김성곤,오강섭,김정범,이수정,정한용,이창욱,박용천,이영문,김세주,이병욱 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.5

Four Years Reports of "Journal of Korean Neuropsychiatric Association" during 2001 to 2005 were evaluated by 18 Editorial Board of Korean Neuropsychiatric Association. We investigated the articles to specific fields and rejection rate etc. by different section chiefs. Although several problems concerning review time duration and rejection guideline issues indicated but generally all reviewer processes proved relatively clear and concise criteria. Through these objective and systematic evaluation Processes, "Journal of Korean Neuropsychiatric Association" will develop a good journal.

DSM-Ⅲ에 의한 불면증에 관한 연구 : 정신과 외래환자를 대상으로 Based on Psychiatric Outpatients

정한용,이대희,신동균 大韓神經精神醫學會 1985 신경정신의학 Vol.24 No.3

This investigation was based on the study of 247 Psychiatric patients with insomnia of at least 1 month’s duration, who had visited at the Department of Neuropsychiatry, Korea University Hae wha Hospital from January 1983 to December 1983. The results were as follows; 1. There were 101 men and 146 women with the mean age of 38.9 years. They had occupied 40.4 percent of all psychiatric patients in the same period. 2. The most common diagnoses were, in order, affective, somatoform, anxiety, schizophrenic, compulsive personality, and passive-aggressive perscalnity disorder. Also about one half of them were in the anxious of fearful cluster. 3. In the duration of insomnia, more than one half had been suffering from insomnia for at least 12 months and there were no statistical significances among diagnoses except subtypes of affective disorder. 4. Difficulty falling asleep was the most common type in this investigation. Difficulty falling asleep was more common in bipolar disorder, mania; V codes; schizophrenic; dysthymic; and compulsive personality disorder, whereas difficulty staying asleep was more common in major depression and bipolar disorder, depressed. 5. Twenty-one patients had axis Ⅲ diagnoses and also they had axis Ⅰ diagnosis as principal diagnosis. 6. In the MMPI results, the scales most elevated were, in order, hypochondriasis, conversion hysteria, depression and psychasthenia. These findings suggested that various factors such as somatic concern, depression, anxiety, fear, and obsession were correlated with insomnia.

산화아연계 무기질과 솔잎추출물 첨가에 의한 농산물 포장 필름의 광 및 미생물 열화능 개선

한신,나현정,강용구,박찬영 전남대학교 촉매연구소 2001 觸媒硏究 論文集 Vol.22 No.-

To invent environmentally friendly materials for packaging of agricultural produce, morphological and mechanical properly changes after daylight exposure and soil deposit for LDPE films composed of different incorporation substances have been investigated. Silver coated ceramic, zinc oxide, fine particle of ferrofluid and pine needle's extract were the incorporated substances. The pine needle's film degrades fast in soil while the silver coated ceramic's film shows daylight decay more on the morphological view. The mechanical strength keeps almost same. But turndown of elongation is explicit on the pine needle's film and silver coated ceramic's film.

토오크 양에 따른 세라믹 브라켓의 파절 저항성

한정흠,장민희,임용규,이동렬 대한치과교정학회 2007 대한치과교정학회지 Vol.37 No.4

鹿茸藥鍼液의 DNA chip을 利用한 遺傳子 發顯 分析

한상원,서정철,이윤호,최제용 大韓鍼灸學會 2003 대한침구의학회지 Vol.20 No.3

Objective : Bone homeostasis is maintained by balance of bone formation and resorption. Therefore, bone related diseases arose by disturbance of this balance between osteoblast and osteoclast activities. To develop a successful screening system the therapeutic components based on oriental medicine is essential to set up systematic approach for that purpose. The purpose of this study is to the know the gene expression using cDNA microarray assay. Methods : Cervi Pantotricuhum Cornu Herbal-acupuncture extract was prepared by boiling. human osteosarcoma cells(HOS) were treated with Cervi Pantotricuhum Cornu Herbal-acupuncture solution. Then mRNA was extracted and cDNA microarray assay was performed. Results : Human osteosarcoma cells(HOS) treated with Cervi Pantotricuhum Cornu Herbal-acupuncture solution(500㎍/㎖) showed that thioredoxin, TAFII31 and two novel genes were increased. However many genes decreased their expression by Cervi Pantotricuhum Cornu Herbal-acupuncture. Conclusions : This type of approach will give a good chance to explore the favorable effects of Cervi Pantotricuhum Cornu Herbal-acupuncture. Futher study is needed for investigating the effect of Cervi Pantotricuhum Cornu Herbal-acupuncture.

정신과 입원환자의 정신사회적 스트레스 요인에 관한 연구

한선호,권영준,정한용 大韓神經精神醫學會 1989 신경정신의학 Vol.28 No.6

The psychosocial stressors experienced in the 6 months prior to the admission were studied in 249(140 male and 109 female) psychiatric inpatients who were hospitalized in the Neuropsychiatric department of Soonchunhyang University Hospital from January 1987 to December 1988. The results were as follows : 1) Among the 249 cases, 120(48.2%) cases had the psychosocial stressors prior to admission. 2) 37.9% of male cases and 61.5% of female cases had the psychosocial stressors prior to admission. Female cases had significantly higher occurrence of the psychosocial stressors. 3) By the educational level, there was a significant difference in occurrence of psychosocial stressors prior to admission. Middle school graduates had the highest, no education had the lowest occurrence of the psychosocial stressors. 4) By the occupation, there was a significant difference in occurrence of the psychosocial stressors prior to admission. Housewives had the highest, unemployed had the lowest occurrence of the psychosocial stressors. 5) 90.0% of the cases with adjustment disorder, 81.9% of the cases with anxious disorders, 66.7% of the cases with depressive disorders. 66.7% of the cases with somatoform disorders, 60.0% of the cases with paranoid disorders, 58.1% of the cases with bipolar disorders, 56.1% of the cases with psychotic disorders not elsewhere classified, 27.8% of the cases with organic mental disorders, 27.5% of the cases with schizophrenic disorders, 15.4% of the cases with personality disorders, and 8.3% of the cases with substance use disorders had the psychosocial stressors prior to admission. When cases were grouped into neurosis and psychosis, there was no significant difference between two groups in occurrence of the psychosocial stressors. 6) Major psychosocial stressors with theirs frequency were occupational problems(21.7%), physical illness or injury(20.0%), other interpersonal problems(18.3%), and conjugal problems(16.7%).

프레탈정 (실로스타졸 100mg)에 대한 실로스탄정 (한국유나이티드 제약)의 생물학적 동등성

용철순,이경희,최진석,박병주,정세현,김용일,박상만,유봉규,이종달,최한곤 한국병원약사회 2003 병원약사회지 Vol.20 No.2

Bioequivalence of one cilostazol tablets, the Pletaal^(R)(Korea Otsuka Pharmaceutical Co., Ltd.) and Cilostan^(R)(Korea united Pharmaceutical Co., Ltd.), was evaluated according to the guideline of KFDA. Sixteen normal male volunteers(age 20~30 years old)were divided into two groups and a randomized 2×2 cross-over study was employed. After one tablet containing 100㎎ of cilostazol were orally administered, blood was taken at predetermined time intervals and the concentration of cilostazol in plasma was determined with an HPLC method using UV detector. The pharmacokinetic parameters(C_(max), T_(max) and AUC_(t)) were calculated and ANOVA was utilized for the statistical analysis of parameter. The results showed that the differences in C_(max), T_(max) and AUC_(t) between one tablet were 16.08%, 18.88% and 17.57%, respectively. The powers (1-β) for C_(max), T_(max) and AUC_(t) were 85.03%, 83.92% and 80.12%, respectively. Detectable differences(Δ) and confidence intervals were all less than 20%, and confidence interval of all the parameters were also less than 20% at the significance level(α) of 0.05. All of these parameters met the criteria of KFDA for bioequivalence, indicating that Cilostan^(R) tablet is bioequivalent to Pletaal^(R) tablet.

철근콘크리트 보에 대한 CFRP의 정착길이

한상훈,최만용,조홍동,박중열,황선일 충북대학교 건설기술연구소 2002 建設技術論文集 Vol.21 No.1

A failure mode in the beam strengthened with a high modulus plate appears as a interface debonding failure or ripping-off failure. This failure mode means that plate is separated from adhesive or concrete before displaying its own ability. Therefore, as a method for controlling a premature failure, it is need to use a general anchorage implement. We conducted bending tests for reinforced concrete beams strengthened with CFRP. The experimental variables were a concrete strength, reinforcement ratio, cover thickness of concrete and length ratio of CFRP for a pure span. A failure load, failure mode, load-deflection curve and strain response at different distances from a cut-off of CFRP and strain distribution curve were measured to determine the bond development length. Also, the bond development length was compared with Nguyen’s model and British Standard specification.