한국형 양극성 장애 약물치료 알고리듬의 적용 가능성(Ⅲ):치료반응과 내약성

전덕인,박원명,신영철,김찬형,민경준,윤보현,김영기,권준수,조현상 대한정신약물학회 2005 대한정신약물학회지 Vol.16 No.4

Objective : The Korean College of Neuropsychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for bipolar disorder to aid clinical decisions. The purpose of this study was to assess the treatment response and the tolerability in the feasibility testing of Korean Medication Algorithm for Bipolar Disorder(KMAP-BP) in clinical settings. Methods : A total of 126 bipolar patients were enrolled at 17 centers. Among them, 92 patients were treated according to the algorithm. All subjects were assessed over a 4-month period. Prescribing investigators were able to change the recommended treatment strategies of the algorithm if necessary. Results : Most patients showed significant decreases(p<0.001) in symptoms measured by the Young Mania Rating Scale and the 17-item Hamilton Depression Rating Scale for Depression at both assessment point 1(about 2 weeks) and 4 months. No significant changes in adverse events were noted between baseline and endpoint. Conclusion : These results suggest that the treatment based on KMAP-BP can be effective and well tolerated in clinical practices. Further research is planned to revise KMAP-BP. 목 적:임상의사의 적절한 결정을 돕기 위해 개발된 전덕인 등 299 한국형 양극성 장애 약물치료 알고리듬의 적용 가능성을 평가하고자 알고리듬을 임상 상황에 사용하였다. 본 연구는 알고리듬에 따른 치료의 반응과 내약성을 조사하고자 시행되었다. 방 법:연구대상의 포함기준은 DSM-Ⅳ에 의거한 18세 이상의 양극성 장애 환자였다. 원칙적으로 약물의 선택, 교체, 단계의 이동 등은 알고리듬에서 추천하는 방법을 따르도록 했으나 연구자의 판단에 의해 언제라도 바꿀 수 있었다. 치료반응의 평가는 YMRS, HAM-D, CGI, GAF를 이용하였고 내약성은 LUNSERS와 UKU를 사용하였다. 모든 환자들은 정해진 시점과 치료 4개월째에 평가를 받도록 하였다. 결 과:총 126명의 양극성 장애 환자가 등록되어 이중 92명이 알고리듬에 의한 치료를 받았다. 연구대상의 대부분은 제 1 형 양극성 장애 조증 환자였다. 치료에 따라 조증 증상과 우울 증상은 점차 유의하게 호전되었고(p<0.001), 4개월째에 이상반응의 유의한 증가는 없었다. 결 론:본 연구결과는 한국형 양극성 장애 약물치료 알고리듬에 의한 치료가 매우 효과적이며 안전하다고 시사한다. 대상 환자의 진단적 문제나 개방형 연구 등의 제한점들을 비롯하여 여기서 논의된 점들을 참조하여 향 후 알고리듬의 개정이 이루어지기를 기대한다.

한국형 양극성 장애 약물치료 알고리듬 2006(IV):급속순환형

전덕인,박원명,이은,윤보현,정상근,김원,신영철,조현상,권준수,서정석,하규섭,민경준 대한정신약물학회 2006 대한정신약물학회지 Vol.17 No.5

Objective: The development of treatment guidelines has emerged as an important element so as to standardize treatment and to provide clinicians with algorithms. From the previous publication of Korean Medication Algorithm Project for Bipolar Disorder(KMAP-BP): rapid cycling in 2002, we revised that in 2006. Methods: The questionnaire to survey the expert opinion of medication for rapid cycling was completed by the review committee consisting of 53 experienced Korean psychiatrists. It is composed of 7 questions, and each question includes various options. We classified the expert opinion to 3 categories based on the lowest category in which the confidence interval fell (6.5≤ for first-line and 3.5≤ for second-line treatment). Results: Generally, 'treatment of choice' for rapid cycling was not demonstrated. The first-line treatment is the combination of a mood stabilizer and an atypical antipsychotic. Combination of two mood stabilizers was preferred as next strategy. Divalproex and lithium were the first-line choice as mood stabilizer. Compared to the surveys in 2002, the preference for lamotrigine and atypical antipsychotics has increased while that of carbamazepine and antidepressant has decreased. Conclusion: With the result of the survey, the discussion in executive committee, and the evidences from clinical studies, we have revised KMAP-BP for rapid cycling.

양극성 장애 환자의 의학적 공존질환:후향적 챠트 조사

전덕인,석정호,최강,윤형준,조현상,김세주,이은 대한우울조울병학회 2007 우울조울병 Vol.5 No.1

Objectives:Little is known about medical comorbidity in bipolar disorder in Korea. The goal of this study was to determine the prevalence of medical illnesses in bipolar inpatients and the relationship between medical comorbidities and clinical characteristics. Methods:Bipolar patients (n=584) admitted to four training hospitals between 2001 and 2005 were retrospectively investigated. Clinical data, laboratory results, and the presence of medical illnesses were obtained. Results:The most prevalent medical illnesses were cardiovascular diseases (5.8%), thyroid diseases (2.4%), liver diseases (1.9%), and diseases of the central nervous system (1.5%). The most common laboratory abnormalities were anemia, increased AST, hypoalbuminemia, hypoproteinemia, and leukocytosis. Conclusion:Comorbid medical illnesses are common in bipolar patients. Systematic medical evaluation and treatment should be needed for these patients. (J of Kor Soc for Dep and Bip Disorders 2007;5:30-33)

정신분열증의 기억장애

전덕인,Jon, Duk-In 대한수면의학회 1997 수면·정신생리 Vol.4 No.1

Memory disorder is the most consistent neuropsychological finding in schizophrenia and seems to be a stable trait in it. It is suggested that memory dysfunction found in patients with schizophrenia is primary to biological abnormalities, not secondary to attention deficits they have. Although temporal lobe structures including hippocampus and thalamus have traditionally been thought to be implicated regions for memory disorder in schizophrenia, recent studies indicate the possibility of abnormalities in the frontal lobe and the neural circuits between brain regions. Advanced research methods such as functional imaging technique are expected to produce more detailed informations about memory function in schizophrenia.

양극성 장애의 한국형 약물치료 알고리듬(IV) : 급속 순환

전덕인,윤보현,민경준,신영철,권준수,박원명 대한정신약물학회 2004 대한정신약물학회지 Vol.15 No.1

Objective : Treating rapid cycling bipolar disorder has many clinical problems such as recurrence, treatment resistance, and unstable course. Recent developments of medications including atypical antipsychotics and new anticonvulsants make it difficult to choose appropriate pharmacological options. The Korean Society of Psychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for bipolar disorder including rapid cycling to aid clinical decisions. Methods : The first survey was performed with the questionnaire based on ‘The Expert Consensus Guideline Series - Medication Treatment of Bipolar Disorder 2000'. Because of inconsistency among experts in some aspects, we carried out the second survey and discussed with related literature to make a proper algorithm. Results : Generally no ‘treatment of choice' were demonstrated. The first-line treatment is the single mood stabilizer or combination of a mood stabilizer and an atypical antipsychotic. Another mood stabilizer or an antidepressant can be added for the next treatment. Lithium, divalproex, and carbamazepine than the third generation mood stabilizers such as lamotrigine and topiramate are preferred as a mood stabilizer. Conclusion : With the results of two surveys and discussion in executive committee, we developed the algorithm for rapid cycling bipolar disorder.

조증 삽화로 입원했던 환자의 재평가 : 혼재성 삽화 진단의 가능성

전덕인,김경란,이은,손상준 대한신경정신의학회 2006 신경정신의학 Vol.45 No.4

diagnosis of a mixed episode might be too restrictive. The purpose of this study was to investigate the possibility of a mixed episode in bipolar inpatients hospitalized with DSM-IV manic episodes using the Cincinnati criteria, which is a broader criteria compared to DSM-IV. Methods:Inpatient charts of manic patients were carefully evaluated to determine the presence of depressive symptoms in the Cincinnati criteria. The probable mixed patient group was compared with the definitely manic patient group on demographic and clinical variables. The predictability of depressive symptoms for a mixed episode was assessed. Results:Twenty-one out of 101 manic inpatients were possibly diagnosed as mixed episodes. They showed more psychiatric family history, comorbid personality disorder and suicide attempts. Two symptoms (suicidal ideation and helplessness or hopelessness) had good positive predictive value. Conclusion:Diagnosis of a mixed episode can be increased with careful interview and by using a broader diagnostic criteria. The presence of suicidal ideation and helplessness or hopelessness may suggest a mixed state. (J Korean Neuropsychiatr Assoc 2006;45(4):337-342) 혼재성 삽화가 실제 임상상황에서는 조증 삽화로 오인 되어 매우 적게 진단되리라는 가정을 증명하기 위해 한 종 합병원에서 양극성 장애로 입원했던 환자의 입원기록을 조사하였다. 예상대로 혼재성 삽화의 진단은 드물었으며, 조증으로 진단된 환자의 상당수가 Cincinnati criteria에 의해 혼재성으로 변경될 수 있었다. 정신질환의 가족력, 인 격장애의 병존, 자살기도 등의 임상특성이 혼재성 변경군 조증 환자의 혼재성 삽화 가능성 D.I. Jon, et al J Korean Neuropsychiatr Assoc / Volume 45, No 4 / July, 2006 342 에서 흔하게 나타났고 이는 혼재성 환자들에 대한 기존 연구결과와 일치하는 것이다. 우울증상 가운데에서 자살 관련 증상과 절망감(또는 무원감)이 혼재성 변경군에서 특히 흔하였고, 이 두 가지 증상은 혼재성 삽화를 가장 잘 예측하였다. 따라서 적어도 자살관련 증상이나 절망감(또 는 무원감)이 조증 환자에게 있다면 혼재성 삽화일 가능성 을 고려해야 한다고 본다.

조중 삽화로 입원했던 환자의 재평가 : 혼재성 삽화 진단의 가능성

전덕인,김경란,이 은,손상준 大韓神經精神醫學會 2006 신경정신의학 Vol.45 No.4

Objective : Mixed states are difficult to define precisely and to recognize accurately. Moreover, the DSM-IV criteria for diagnosis of a mixed episode might be too restrictive. The purpose of this study was to investigate the possibility of a mixed episode in bipolar inpatients hospitalized with DSM-IV manic episodes using the Cincinnati criteria, which is a broader criteria compared to DSM-IV. Methods : Inpatient charts of manic patients were carefully evaluated to determine the presence of depressive symptoms in the Cincinnati criteria. The probable mixed patient group was compared with the definitely manic patient group on demographic and clinical variables. The predictability of depressive symptoms for a mixed episode was assessed. Results : Twenty-one out of 101 manic inpatients were possibly diagnosed as mixed episodes. They showed more psychiatric family history, comorbid personality disorder and suicide attempts. Two symptoms (suicidal ideation and helplessness or hopelessness) had good positive predictive value. Conclusion : Diagnosis of a mixed episode can be increased with careful interview and by using a broader diagnostic criteria. The presence of suicidal ideation and helplessness or hopelessness may suggest a mixed state.

양극성 장애에서 Ziprasidone의 치료효과

전덕인 대한우울조울병학회 2006 우울조울병 Vol.4 No.-

한국형 기분장애 질문지의 타당화 연구

전덕인,윤보현,정한용,하규섭,신영철,박원명 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.5

Objectives : This study aims to test the validity of the Korean version of Mood Disorder Questionnaire (K-MDQ), a Screening instrument for bipolar disorder. Methods : A total of 238 subjects (126 DSM-IV bipolar outpatients and 112 controls without psychiatric history) completed the K-MDQ. Results : The Cronbach's alpha, used to measure the internal consistency of the scale, was high (0.88). Principal component analysis with varimax rotation revealed three factors, which explained 59.5% of the variance. Individual item correlations with the total score were all statistically significant (p<0.001). The mean total score of the K-MDQ was 8.48 in bipolar disorder and 4.51 in non-clinical participants. A total K-MDQ score of 7 or more excluding further two questions was chosen as the optimal cutoff, as it provided good sensitivity (0.75) and specificity (0.69). Conclusion : The results of this study showed adequate validity of the K-MDQ, suggesting that this instrument is useful for screening of bipolar disorder.

정신장애 연구에서 기능적 자기공명영상검사의 응용

전덕인 대한신경정신의학회 2002 신경정신의학 Vol.41 No.1

연구목적: 최근에 개발된 functional magnetic resonance imaging(fMRI)은 산소화와 연관된 뇌의 활성을 조사할 수 있는 매우 유용한 영상 방법으로 이를 요약 및 소개하고자 한다. 방 법: 본 종설에서는 다양한 정신장애를 대상으로 한 BOLD contrast fMRI 연구를 개괄하였다. 결 과: 비록 fMRI가 일부 제한점을 가지고 있음에도 불구하고 대개의 연구가 정신장애 환자는 정상인과 다른 뇌 활성화 양상을 보인다고 보고하였다. 결 론: 아직은 시작 단계이지만 점차 발전되는 기법과 시설로 fMRI는 정신장애의 신경생물학적 요인에 관한 우 리의 이해를 확충시킬 것이며 뇌의 병태생리를 평가하고 치료함에 있어 훌륭한 기회를 제공할 것이다 Objectives:Functional magnetic resonance imaging(fMRI) is one of the most useful techniques for assessing localized changes in cerebral blood flow and oxygenation using diverse challenge paradigm. This review presents the results of BOLD contrast fMRI studies relating to various psychiatric disorders. Methods:A number of fMRI articles on this subject in psychiatric journals were surveyed. Results:Even with some methodological limitations, most studies showed that BOLD changes appeared with differences between psychiatric patients and control subjects. Conclusions:Undoubtedly, fMRI will extend our understanding of neurobiological basis of psychiatric disorders and offer an unprecedented opportunity for the assessment and management of brain pathology.