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.

성모병원에서의 정신과 자문 현황

권용실,유태열,한진희 大韓神經精神醫學會 1991 신경정신의학 Vol.30 No.4

To obtain relevant data on current trends of psychiatric consultation in a general hospital, the authors reviewed 194 cases of inpatients who were referred for psychiatric consultation from January 1. 1989 to December 31. 1989 at the St. Mary's Hospital. The results were as follows : 1) The overall consultation rate was 1.4% of all inpatients, and age distribution was heavily concentrated at the age of 30's and 50's. 2) A majority of referrals came from the department of internal medicine(48%) and from the department of neurosurgery(16.5%). 3) The most common reason of psychiatric consultation were to evaluate physical symptoms with no laboratory abnormalities(26.8%), while the most frequent symptoms of the referred patients were those related to head and central nervous system(20.6%). 4) The rate of psychotropic drugs use prior to psychiatric consultation was 44.3% and the most frequently prescribed ones were antianxiety drugs(56.2%). 5) Depressive disorders(22.6%) and organic mental disorders(20.6%) were the most common diagnoses given after psychiatric consultation. 6) Use of psychotropic drugs was the most frequent recommendations given after psychiatric consultation.

주요 우울증을 동반한 신경성 식욕과항진증 1례

신석호,권용실,김보연,이정태,이성필 한국의학사 1992 診斷과治療 Vol.12 No.7

정신과 입원환자의 공격행동 특성

전태연,권용실,도규영,장계호 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.3

저자들은 1994년 1월 1일부터 1995년 6월 31일까지 가톨릭대학교 의과대학 의정부성모병원 정신과에 입원했던 환자들 중세서 공격행동을 보인 환자(공격군) 72명과 공격행동이 없었던 환자(비공격군) 215명의 임상적 특성에 관한 조사를 하여 다음과 같은 결과를 얻었다. 1) 공격행동을 보인 환자는 72명으로 전체 조사 환자의 25.1%이었다. 2) 성별, 연령, 종교, 결혼 상태와 정신과 질환의 가족력 등에 따른 공격행동의 발생비율의 차이는 유의하지 않았다. 3) 교육 정도와 직업에 따른 공격군의 비육에 유의한 차이가 있었다(p<.05). 4) 진단별로는 공격군에서 조증, 기질성 정신장애, 정신분열증의 빈도가 높았으나 진단에 따른 의미 있는 차이는 없었다. 5) 공격행동의 기왕력은 공격군에서 더 많았고 비공격군과 비교시 의미 있는 차이를 보였으며(p<.001), 입원 형태는 공격군에서 타의 입원의 빈도가 유의하게 높았다(p<.005). 7) 입원시 정신병리는 초조-흥분과 적대감-의심에서 공격군의 빈도가 높았으며 정신병리에 따른 의미 있는 차이를 보였다(p<.001). 8) 총 재원 일수는 공격군에서 평균 59.3일이었고 비공격군이 평균 38.4일로 유의한 차이를 보였다(p<.001). 9) 공격행동의 유형은 말로한 경우가 가장 많았고 물건을 대상으로한 행동, 타인을 대상으로 하는 행동의 순으로 나타났다. 10) 공격행동 직전 행동 특징은 활동증가, 시끄러움, 욕설, 분노, 적대적이었던 경우가 가장 많았다. 11) 공격행동은 정오에서 오후 6시 사이, 휴식시간에 가장 많이 나타났다. 12) 입원 후 1주일 이내에 공격행동의 62.3%가 나타났다. 13) 총공격 점수에 의미 있게 영향을 주었던 변인들로는 종교(p<.05), 교육 정도(p<.05), 직업(p<.05), 입원형태(p<.005), 진단(p<.001), 입원시 정신 병리(p<.001), 공격행동의 기왕력(p<.001) 등으로 나타났다. To evaluate the characteristics of violent behavior of psychiatric inpatients the authors reviewed clinical records of psychiatric patients who had admitted at UiJong Bu St. Mary's Hospital from January 1994 to June 1995. We divided the 287 subjects into violent and nonviolent group according to the presence of violent behaviors in psychiatric ward. We assessed demographic variables, clinical characteristics and violent behaviors using Overt Aggression Scale and compared these variables of violent group with nonviolent group. The results were as follows : 1) The number of violent patients was 72(25.1% of the total). 2) In terms of demographic variables, the differences between two groups in education and occupation were significant(p<.05). 3) In psychiatric diagnoses, violent group were more likely to have mania, schizophrenia and organic mental disorder in sequence but there were no differences between violent and nonviolent group. 4) The history of violent behavior was greater in violent group(p<.001) and the mode of admission was significantly different between two groups(p<.005). 5) In cluster of psychopathology on admission, more frequently found clusters of psychopathology in violent group were agitation-excitement and hostile- suspiciousness and there were significant differences between two groups(p<.001). 6) The length of stay in violent group(59.3 days)was significantly longer than nonviolent group(38.4 days)(p<.001). 7) The types of violent behavior were verbal aggression, physical aggression against objects and physical aggression against other people in frequency sequence. 8) The most frequent type of behavioral clue before violent behavior was hyperactive, loud, verbally abusive, angry, hostile(68.1%). 9) Most of violent behaviors were presented between midday and 6 pm. in resting time. 10) 62.3% of total violent behaviors were occurred within first week following admission. 11) The variables which showed significant effects on total aggression score were religion, educational status, occupation, mode of admission, psychiatric diagnosis, psychopathology on admission and history of violent behavior before admission. In summary, these results showed similar trends compared to previous studies on characteristics of psychiatric inpatients. And we found that more important predictors of violent behavior in practice were likely to be history of violent behavior, psychopathology on admission and behavioral cue before violent behavior.

정신과 입원환자에서의 혈청 콜레스테롤 농도와 공격행동

전태연,도규영,정종현,권용실,김석범 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.5

목 적 : 혈청 콜레스테롤 농도와 자살 등의 공격행동간의 연관성에 관한 여러 연구가 있었으나 일치된 결과를 보이고 있지 못하다. 이에 저자들은 다양한 진단의 정신과 입원 환자들 중 공격행동을 보인 환자의 콜레스테롤 농도를 정상 한국 성인에서의 혈청 총 콜레스테롤의 성별, 연령별 평균 및 표준편차와 percentile분포에 맞추어 공격행동 및 자살시도와 혈청 콜레스테롤 농도간의 연관성을 알아보기 위하여 본 연구를 시행하였다. 방 법 : 본 연구는 1994년 1월 1일부터 1995년 6월 31일까지 18개월간 카톨릭대학교 의정부성모병원 정신과 병동에 입원하였던 환자 중 콜레스테롤 농도를 얻을 수 있었던 127명을 대상으로 하였다. 대상 환자는 공격행동의 유무에 따라 공격군과 비공격군으로 분류하여 공격군 35명과 비공격군 92명의 자료를 얻었으며, 공격군은 Overt Aggression Scale을 사용하여 평가하였다. 측정된 각 환자의 콜레스테롤 농도는 정상 한국 성인에서의 혈청 총 콜레스테롤의 성별, 연령별 평균 및 표준편차와 percentile분포에 맞추어 4개의 군으로 나눈 후 공격행동 발생비율, 자살시도간의 차이를 알아보았다. 또한 공격행동을 보인 군에서도 각 콜레스테롤군 간의 총 공격 점수를 비교하였다. 결 과 : 1) 각 콜레스테롤군 간의 공격행동 발생비율에는 유의한 차이가 없었다. 2) 공격군에서 각 콜레스테롤군 간의 총 공격 점수는 유의한 차이를 보이지 않았다. 3) 각 콜레스테롤군 간의 자살시도 빈도는 유의한 차이가 없었다. 결 론 : 정신과 입원 환자의 혈청 콜레스테롤 농도를 정상 한국 성인에서의 혈청 총 콜레스테롤의 성별, 연령별 평균 및 표준편차와 percentile분포에 맞추었을 때 혈청 콜레스테롤 농도와 공격행동 및 자살시도에 유의한 연관이 없었다. Objectives : An association between serum cholesterol concentration and violent behavior has been suggested, but has not been consistently demonstrated. This study was conducted in order to evaluate the relation between serum cholesterol concentration and violent behavior in psychiatric inpatients who had been admitted at Uijongbu St. Mary's Hospital, the Catholic University of Korea from January 1994 to June 1995. Methods : We divided the 127 subjects into violent(35 subjects) and non-violent group(95 subjects). According to the percentile distribution of serum total cholesterol in healthy Korean adults, the subjects were classified into four subgroups : Group 1, subjects Whose cholesterol concentrations were below 26% of percentile distribution, Group 2, from 26% to 50%, Group 3, 51% to 75% and Group 4, above 75%. In the four cholesterol subgroups, the authors examined the incidence of violent behaviors and suicidal attempts. Within the violent group, total aggression score of four cholesterol subgroups was compared. Results : 1) Among the four cholesterol subgroups, there were no significant differences in the violent behavior. 2) Within the violent groups, total violent score of the four cholesterol subgroups showed no significant difference. 3) Among the four cholesterol subgroups, there were no significant differences in suicidal attempt. Conclusion : When the serum cholesterol concentrations of psychiatric inpatient applied to the percentile distribution of serum total cholesterol in healthy Korean adult, no association was found between serum cholesterol concentration and violent behavior and suicide attempt.

노인에서 정서 인식의 저하

이경욱,채정호,최인철,이해국,권용실,이정태 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.2

Objectives : The purpose of this study was to investigate whether elderly and young adults differ in their recognition of facial expressions of emotion. Methods : A total of 120 (elderly group 53, young group 67) subjects participated in this study. Korean facial expressions of emotion including happiness, sadness, fear, anger, disgust, surprise and neutral were used as stimuli for facial affect recognition test. Computerized facial affect recognition test that consists of facial affect discrimination test and facial affect intensity test was performed. Results : For facial affect discrimination test, there was a significant difference between two groups (F==3.986, P<.01) after controlling the effect of education. Elderly participants showed significantly less correct recognition rate with sadness, anger and disgust (p<.05). For facial affect intensity test, there was no significant difference between the groups in recognition of emotional intensity. Chi-square test or t-test was done according to the clinical variables. Multivariate analysis of covahance was done to test group differences of correct recognition rate and emotional intensity. Conclusion : This is the first report of differential decrease of facial affect recognition in elderly using Korean facial expressions. This study suggests that the decrement of facial affect recognition maye be a part of normal aging process.

의료보험 고액진료비 환자의 특성연구

문옥륜,강선희,이은표,좌용권,이현실 韓國保健行政學會 1993 보건행정학회지 Vol.3 No.1

A small number of high cost patients usually spend a larger proportion of scarce health resources. Korea is no exception. Under the national health insurance, 12% of the insured persons have consumed approximately half of the national health insurance expenditures. Therefore, it is necessary to identify the characteristics of the high cost patient group, if we would like to reduce them. This study has defined high cost patients as those who have spent one and half million won and over Per 6 months. The study reveals that high cost users are those who have a longer length of stays(LOS), 40 days of LOS in the 6 months, have multiple admissions, 2 to 3 admissions per 6 months and are the eiderly patients. They have Spent 814, 126won per day on the average, and commonly suffered from malignant neoplasms, circulatory diseases, fracture, diabetes mellitus, etc. Unlike the case of western developed countries, early readmissions are not the major causes of high cost spending in Korea. Undoubtedly, a lengthy admission is the main cause of large spending. Health policies should vigorously be explored to respond appropriately. There are evidences that hospital beds are often misused. As the Korean health care system is lacking in a mechanism of patient evaluation under the fee-for-service remuneration system, an idea of progressive patient care needs to be tested. The Government should set up health policy to diversify the role of long-term care facilities and encourage people to establish them. Further studies are needed to identify factors influencing large medical bills necessary for formulating the health policy on cost containment.

School-Based Suicide Prevention Strategy: Evidence-Based Data and Challenges

Yong-Sil Kweon 대한소아청소년정신의학회 2020 소아청소년정신의학 Vol.31 No.4

Characteristics of Drug Overdose in Young Suicide Attempters

Yong-Sil Kweon,Sunyoung Hwang,Bora Yeon,최경호,오영민,Hae-Kook Lee,이정태,이경욱 대한정신약물학회 2012 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.10 No.3

Objective: Few studies have focused on the characteristic features of drug overdose in children and adolescents who have attempted suicide in Korea. The present study examined the characteristics of drug overdose in children and adolescents who visited the emergency room following drug ingestion for a suicide attempt. Methods: The medical records of 28 patients who were treated in the emergency room following a drug overdose from January 2008 to March 2011 were analyzed. Demographic and clinical variables related to the suicide attempts were examined. Results: The mean age of the patients was 16.6±1.7 years (range 11-19 years), and 20 of the patients (71.4%) were female. Most of the patients (n=23, 82.1%) overdosed on a single drug; acetaminophen-containing analgesics were the most common (n=12, 42.9%). Depression was the most common psychiatric disorder (n=22, 78.6%), and interpersonal conflict was the most common precipitating factor of the suicide attempts (n=11, 39.3%). This was the first suicide attempt for approximately 80% of the patients. About one fourth of the patients (n=7, 25%) had follow-up visits at the psychiatric outpatient clinic. Conclusions: Early screening and psychiatric intervention for depression may be an important factor in preventing childhood and adolescent suicide attempts. Developing coping strategies to manage interpersonal conflicts may also be helpful. Moreover,policies restricting the amount and kind of drugs purchased by teenagers may be necessary to prevent drug overdose in this age group.

한국형 비행 청소년 정신병리 선별척도인 MAYSI-2K(Massachusettes Youth Screening Instrument-2Korean)의 표준화를 위한 예비연구

권용실(Yong Sil Kweon),이지현(Ji-Hyun Yi),이해국(Hae Kook Lee),이정태(Chung Tai Lee),김선경(Sun Kyung Kim) 대한소아청소년정신의학회 2003 소아청소년정신의학 Vol.14 No.2