알쯔하이머병 환자에서 백질 변화와 혈중 호모시스테인 및 엽산 농도의 상관관계

김신겸(Shin Gyeom Kim),정한용(Han Yong Jung),이소영(So Young Lee),신은영(Eun Young Shin),정우열(Woo Yeol Jung),박준호(Jun Ho Park) 대한노인정신의학회 2009 노인정신의학 Vol.13 No.2

Objectives : To explore the relationship of white matter changes (WMC) on magnetic resornance imaging (MRI) with plasma homocysteine and folate levels in Alzheimer's disease (AD) patients. Methods : Forty-one patients with probable AD were evaluated on WMC on brain MRI, plasma homocysteine and folate levels, and cerebrovascular risk factors. Subjects were divided into two groups according to WMC scores (lower group with <5 and higher group with ≥5). WMC were assessed by a scale of the European Task Force on Age-Related WMC. Results : Plasma homocysteine levels were correlated with right frontal WMC and have a tendency of correlation with left frontal WMC. When subjects were divided into two groups: higher plasma homocysteine group (≥14 μmol/L) and lower plasma homocysteine group (<14 μmol/L), the former was significantly higher than the latter in both frontal WMC. In a logistic regression analysis, higher plasma homocysteine were not a significant risk factor for higher WMC. Increasing age was a only significant risk factor for higher WMC and correlated with both frontal WMC. There was no relationship folate with any WMC. Conclusion : It is possible that plasma homocysteine levels have a region-specific correlation with frontal WMC in AD. However, it is important that effect of age on the relationship should be considered.

노인에서의 약물 유도성 섬망

김신겸(Shin Gyeom Kim),정한용(Han Yong Jung) 대한노인정신의학회 2008 노인정신의학 Vol.12 No.2

The elderly is accompanied by an increased likelihood of illness, and old people take a disproportionate amount of self-administered and prescribed medications. They are more likely to develop delirium as a result of taking medications than younger patients. Psychoactive drugs such as narcotics, long acting benzodiazepines, and tricyclic antidepressants are important causes of delirium. Drug induced confusion with nonpsychoactive drugs is often idiosyncratic in nature, and the diagnosis is easily missed. Anticholinergic medications are the most common causes of drug induced delirium in the elderly. Successful treatment of delirium depends on identifying the contributing factors, and drugs are the most common reversible cause of delirium. This article provides an clinical approach to prevent, recognize, and manage drug induced delirium.

치매 개념의 역사적 변천

김신겸(Shin Gyeom Kim),정한용(Han Yong Jung) 대한노인정신의학회 2008 노인정신의학 Vol.12 No.1

Most histories of senile dementia begin with Alois Alzheimer's description in 1906 of the first case of Alzheimer's disease. However, the history of senile dementia is quite rich, dating back to the ancient Greek and Roman philosophers and physicians, so the history of dementia is probably as old as mankind itself. Although senile dementia has been recognized as a condition of aged individuals since at least the time of Pythagoras in the 7th century B.C., because it was dismissed as an inevitable feature of aging, it remained largely an uninvestigated disorder until the 19th century. An introduction of a scientific approach to clinical observation and the systematized classification of mental disorders in the mid-19th century that senile dementia began to be differentiated from other dementias, and was established as its own defined class of mental disorder. The identification of Alzheimer's disease at the onset of the 20th century was a turning point for the understanding of senile dementia, and the concepts and histological findings presented by the early researchers of Alzheimer's disease remain relevant still today. Here the author traces the history of the evolution of our current conceptualization of Alzheimer's disease from the Greek-Roman concept of age-associated dementia.

루이체 치매

김신겸(Shin Gyeom Kim),정한용(Han Yong Jung) 대한노인정신의학회 2007 노인정신의학 Vol.11 No.2

Here the author reviews the clinical and pathologic characteristics of dementia with Lewy bodies (DLB). DLB took many years to crystallize into a recognizable clinico-pathologic entity. Based on sensitive immunostaining technique, DLB is now considered the second most commonest cause of neurodegenerative dementia in the elderly. It is part of the range of clinical presentations that share a neuritic pathology based on abnormal aggregation of the synaptic protein α-synuclein. Lewy body pathology is found from the brainstem to the cortex and, in many cases, associated with concurrent Alzheimer' disease pathology. A recent international consortium on DLB has resulted in revised criteria for the clinical and pathological diagnosis of DLB incorporating new information about the clinical features and improved methods for their assessment. Neuropathologic diagnosis now assigns a weight to both α-synuclein and Alzheimer tangle pathology. Accurate identification of patients is important because they have specific symptoms, impairments, and functional disabilities that differ from those of other dementing illness including Alzheimer's disease.

뇌졸중에서 우울증과 실행기능부전에 대한 고찰

나경세,김신겸,이소영,정한용,Na, Kyoung-Sae,Kim, Shin-Gyeom,Lee, Soyoung Irene,Jung, Han-Yong 대한생물정신의학회 2012 생물정신의학 Vol.19 No.4

Depression and executive dysfunction are common neuropsychiatric sequelae of stroke. Patients with stroke are more predisposed to depression and executive dysfunction compared to patients with similar degree of physical disability. Both depression and executive dysfunction are also associated with poor prognosis such as high mortality and delayed recovery after stroke. Complex neurobiological and anatomical mechanisms are associated with the development of depression and executive dysfunction after stroke. Activation of pro-inflammatory cytokines is thought to be associated with onset of depression, whereas injuries in frontal-subcortical circuit are thought to be a link between depression and executive dysfunction. Early detection of depressive symptoms and both pharmacological and non-pharmacological treatment would be helpful. In this review paper, the authors investigated 1) biological and neuroanatomical substrate for poststroke depression and executive dysfunction, 2) the relationship and common etiopathology for poststroke depression and executive dysfunction, and 3) pharmacological and non-pharmacological treatment for poststroke depression. The contents of the paper are as follows : the prevalence, clinical manifestation, and biological etiology for poststroke depression, neuroanatomical abnormalities as a common etiological factor for depression and executive dysfunction, pharmacotherapy and non-pharmacological approach.

Venlafaxine에 의한 급성 독성 간염 1예

나경세,황희성,김신겸,이소영,정한용,Na, Kyeong-Sae,Hwang, Hee-Sung,Kim, Shin-Gyeom,Lee, So-Young-Irene,Jung, Han-Yong 대한생물정신의학회 2011 생물정신의학 Vol.18 No.3

Venlafaxine is among the most widely prescribed antidepressants. It is extensively metabolized to O-desmethylvenlafaxine via cytochrome P450 (CYP) 2D6. We report a case of acute toxic hepatitis resulting from venlafaxine in a 54-year-old woman with pain disorder. During venlafaxine treatment, laboratory tests revealed elevated liver enzymes with a maximum of 169 IU/L for aspartate transaminase (AST) and 166 IU/L for alanine transaminase (ALT). AST and ALT levels returned to normal after 6 days of discontinuation of venlafaxine. The patient was finally diagnosed with acute toxic hepatitis through liver biopsy. This case indicates the importance that clinicians should be aware of the hepatotoxicity of venlafaxine in practice.

섬망 환자에서 Quetiapine과 Haloperidol의 치료 효과 비교 : 전향적, 무작위 연구

이유진,정한용,이소영,김신겸,박준호,Lee, Yu-Jin,Jung, Han-Yong,Lee, Soyoung Irene,Kim, Shin Gyeom,Park, Joon Ho 대한생물정신의학회 2009 생물정신의학 Vol.16 No.1

Objectives : The purpose of this study is to examine the efficacy and side effects of quetiapine and haloperidol for the treatment of symptoms of delirium. Methods : One hundred and seven patients with delirium were recruited and randomly assigned to receive a flexible-dose regimen of quetiapine or haloperidol over 7days and seventy-seven patients completed the study(quetiapine group N=40, haloperidol group N=37). The severity of delirium was assessed by using Memorial Delirium Assessment Scale(MDAS) scores, the psychiatric and behavioral symptoms were assessed by Neurobehavioral Rating Scale(NRS) scores, and the cognitive status was measured by Mini-mental state examination Korean version(MMSE-K) scores. The side effects were measured by Drug Induced Extrapyramidal Symptoms Scale(DIEPSS) scores. Results : MDAS scores significantly improved in both treatment groups. NRS scores also significantly improved in both treatment group, but the group-by-time effect approached significance, likely caused by the greater decrease in scores of the quetiapine group. MMSE-K scores significantly improved only in the quetiapine group. Side effects associated with treatment were not significant in either treatment groups. Conclusion : This study suggests that quetiapine is as efficacious as haloperidol in the treatment of delirium. In particular, quetiapine seems to improve psychiatric and behavioral problems of delirium and was more effective than haloperidol in cognitive improvement.

국내학술지 문헌고찰을 통해 나타난 치매의 진단 및 평가방법의 변화

정한용(Han Yong Jung),김신겸(Shin Gyeom Kim),전용호(Yong Ho Jun) 대한노인정신의학회 2005 노인정신의학 Vol.9 No.2

Objectives : The purpose of the present study was to investigate what aspects of evaluation was ordered for diagnosis of dementia up to the present in Korea. Methods : Article review was performed via web searching. We searched the Korean Medical Database (KMbase) for title words containing 'dementia'. Only original articles were used for the analysis. According to the published year, all articles were divided into three stage (1990-1994, 1995-1999, 2000-2003). The data was collected for what instruments were used and what clinical diagnostic criteria for the diagnosis of dementia. Results : 97 studies were identified through a KM base search of all Korean-language publications between 1 January 1990 and 31 December 2003. Mini-Mental State Examination was not only most commonly applied screening test for dementia in all three stage, also mainly employed as a standard test for validating other screening test. The trends that the DSM clinical diagnotic criteria was soley used were changed in later stage, and then much more studies used NINCDS-ADRDA and NINDS-AIREN criteria in conjunction with DSM diagnostic criteria. Variable instruments to assess functional impairment and behavioral problem were more widely used in three stage than before. In addition, usage of the neuroimage was significantly increased in the 3rd stage. Conclusion : This results show increasing trend in study on dementia in Korea with the aid of systematic diagnosis of dementia including specific clinical diagnosis, screening test, cognitive function test, functional and behavioral assessment.

주관적 기억감퇴를 가진 노인에서 백질 변화와 인지기능 장애의 관련성

신은영,정한용,김양래,이소영,김신겸,Shin, Eun-Young,Jung, Han-Yong,Kim, Yang-Rae,Lee, So-Young-Irene,Kim, Shin-Gyeom 대한생물정신의학회 2011 생물정신의학 Vol.18 No.3

Objectives The purpose of this study is to evaluate the relationship between the severity of white matter changes (WMC), risk factors and cognitive domains, including executive function profiles. Method Forty nine subjects over 55 years with subjective memory complaints were assessed with MRI and neuropsychological tests. The WMC were assessed by MRI T2-FLAIR images and divided into 3 groups of mild vs. moderate vs. severe and 2 groups of mild-moderate vs. severe by using Mantyla's criteria and Fazeka's criteria. The risk factors were examined in hypertension, heart disease history and chemistry Lab. Medical conditions which affect to cognitive dysfunction and definite dementia were also excluded. Results Comparing 3 groups, hypertension was identified as a risk factor of the WMC. Comparing 2 groups, total cholesterol and LDL were identified for as the risk factor of WMC. The severity of WMC was significantly associated with cognitive disturbances and their main effect on cognition was working memory and inhibition. Conclusion The risk factors of the WMC in the elderly were hypertension, hyperlipidemia. The severity of WMC appears to be associated with executive dysfunction in the elderly.

부천시 노인 인구의 자살에 대한 허용적 태도와 자살 인식에 관한 연구

이도은(Doeun Lee),이소영(Soyoung Irene Lee),이지원(Jeewon Lee),김신겸(Shin-Gyeom Kim),정한용(Han-yong Jung) 대한신경정신의학회 2018 신경정신의학 Vol.57 No.3

Objectives The aim of this study was to investigate the variables influencing acceptability and perception towards suicide among the elderly in Bucheon city, South Korea. Methods A total of 1099 elderly over 65 years old participated in this study. The subjects completed a self-questionnaire including their demographic characteristics, psychiatric characteristics, factor 1 and 4 of the Attitudes Towards Suicide-20, and Geriatric Depression Scale Short Form Korea Version. One-way analysis of variance was performed to identify the variables associated with the acceptability and perception towards suicide. Results As result of this study, the demographic characteristics (older age, lower education level, lower economic state, bereavement, divorce or separated marital status, and life without spouse) and psychiatric characteristics (psychiatric past history, treatment history, and suicidal attempt history) were found to be associated with a more acceptable attitude toward suicide. In addition, a lower education level, no psychiatric history, and no psychiatric treatment history influenced the lack of perception to suicide. Conclusion For public services to prevent suicide of the elderly population who lack spontaneity and accessibility to suicidal evaluations, it would be important to focus on the variables identified in this study for enhancing the effectiveness of the services.