만성 조현병 환자에서 대사증후군과 인지기능과의 연관성

김경윤,김신겸,변원탄,이덕기,정봉주,박영민,서재원,Kim, Kyung-Yoon,Kim, Shin-Kyum,Byun, Won-Tan,Lee, Duk-Ki,Jung, Bong-Joo,Park, Young-Min,Seo, Jae-Won 한국정신신체의학회 2014 정신신체의학 Vol.22 No.2

연구목적 이 연구는 만성 조현병 조현병 환자에서 대사증후군과 인지기능과의 연관성을 알아보기 위해 시행하였다. 방 법 일 병원에서 입원중인 만성 조현병 환자 105명(대사증후군 40명, 비대사증후군 65명)을 대상으로 A Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet(CERAD-K)의 인지기능 검사 항목들을 시행하였다. 결 과 대사증후군에 이환된 만성 조현병 환자들에서 구성실행 검사 항목에서 대사증후군에 이환되지 않은 군에 비해 유의하게 낮은 점수를 나타냈으며, 그 외 다른 검사항목에서는 차이점이 나타나지 않았다. 결 론 만성 조현병 환자에서 대사증후군이 구성실행 검사 항목에서의 인지기능 저하를 나타내었다. 조현병 환자에서 대사증후군의 적절한 치료가 필요할 것이며 향후 장기추적연구가 필요할 것으로 보인다. Objectives : The aim of this study was to investigate the relationship between metabolic syndrome and cognitive functions among chronic schizophrenia patients. Methods : The survey participants were 105(40 metabolic syndrome and 65 non-metabolic syndrome) chronic schizophrenia patients at Yang-san Hospital. Each score of cognitive test(A Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet, stroop test), Positive and Negative Syndrome Scale, Hamilton rating scale for Depression were assessed. Statistical analysis of the relationship between various tests of A Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet and metabolic syndrome were performed using ANCOVA and logistic regression. Results : Schizophrenia patients with lower score on construction praxia were likely to be included in Metabolic syndrome group. However, there were no significant relationships in other tests between the two groups. Conclusions : This study found metabolic syndrome caused cognitive decline in chronic schizophrenia patients, especially Construction praxia. This study could be a basis to show metabolic syndrome has to be treated appropriately in schizophrenia patients and suggests the necessity of following longitudinal designed study.

정신건강복지법 제 50조 응급입원에 대한 COVID-19의 영향

박필섭(Pil Seop Park),변원탄(Won Tan Byun),주새한(Sae Han Joo),김세훈(Se Hoon Kim),박현우(Hyun-Woo Park),정재웅(Jae Woong Jeong),김휘곤(Whi Gon Kim),박영민(Young Min Park) 대한사회정신의학회 2022 사회정신의학 Vol.27 No.1

목 적 : COVID-19가 정신건강증진 및 정신질환자 복지서비스 지원에 관한 법률(정신건강복지법) 제 50조에 의한 응급입원(이하 ‘응급입 원’) 대상자들의 인구학적, 임상적 변인에 어떤 영향을 끼쳤는지 알아보고자 하였다. COVID-19 이후 응급입원 대상자들의 응급입원 에서 비자발적 요소가 있는 보호입원 또는 행정입원으로의 전환, 야간 및 새벽 시간에 내원, ICD-10 분류 체계에 따른 진단명 중 조현병, 분열형 및 망상장애(F2)의 비율 증가를 예상하고 연구를 진행하였다. 방 법 : 2019년 1월 20일에서 2020년 1월 19일까지 일 정신병원에서 응급입원 한 군(‘COVID-19 이전 입원 군’) 과 2020년 1월 20일에서 2021년 1월 19일까지 응급입원 한 군(‘COVID-19 이후 입원 군’)으로 나누었고, 각각 100명, 96명이 포함되었다. 대상자들의 나이, 재원일수, 입원 사유, 성별, 의료보험 종류, 응급입원기간 후 입원 전환 유무와 종류, 주 진단명/부 진단명, 일 병원 초/재진 구분, 퇴원후 정신건강복지센터연계 의향, 퇴원 결과, 입원 시간, 응급입원 3일 내 처치(격리, 강박, 진정), 이전 정신건강의학과 입원력 유무, 결혼 유무, 교육 정도, 종교 유무 등의 변인을 평가하였으며 독립표본 t 검정(independent t-test), 카이제곱 분석(Chi-square test) 을통해 두 군의 특성을 비교, 분석하였다. 결 과 : COVID-19 이전 입원 군이 COVID-19 이후 입원 군에 비해 응급입원 후 72시간 내에 퇴원한 비율이 통계적으로 유의미하게 높았다(n=48 [48.0%] vs. n=24 [25.0%], p<0.001). 그리고 09-18시에 내원한 비율이 통계적으로 유의미하게 높았다(n=61 [61.0%] vs. n=28 [29.2%], p<0.01) COVID-19 이후 입원 군은 COVID-19 이전 입원 군에 비해, 응급입원에서 행정입원으로 전환된 비율이 통계 적으로 유의미하게 높았다(n=13 [13.0%] vs. n=28 [29.2%], p=0.005) 진단명에서는 ICD-10 분류 체계에 따른 진단명 중 조현병, 분열형 및 망상장애(F2) 비율이 통계적으로 유의미하게 증가하였다(n=21 [21.0%] vs. n=33 [34.4%], p=0.036) , 입원 시간에서는 18-24시 (n=23 [23.0%] vs. n=36 [37.5%], p=0.027), 00-09시 (n=16 [16.0%] vs. n=32 [33.3%], p=0.005)에 내원한 비율이 통계적으로 유의미 하게 높았다. 결 론 : 연구 결과 COVID-19 에 의한 영향으로 COVID-19 이후 입원 군에서 응급입원에서 행정입원으로의 전환 증가, ICD-10 분류 체계에 따른 진단명 중 조현병, 분열형 및 망상장애(F2)의 증가, 야간 및 새벽인 18-09시 내원한 비율의 증가가 나타났다. 이는 COVID-19에 의해 병원 방문을 꺼리게 된 환자들이 증상 악화 후 야간 및 새벽에 응급입원을 위해 일 병원을 많이 방문하였고, 질병인식 불능증(병식의 부족) 등을 겪는 조현병 환자들이 증가하였고, 행정기관, 보건소에서 방역의 문제로 정신응급환자에 대한 치료에 동의를 많이 하여 응급입원에서 행정입원으로의 전환 증가가 일어났을 가능성을 생각해 볼 수 있다. 본 연구의 결과가 응급입원의 현황을 확인할 수 있는 지침으로 사용될 수 있길 기대한다. Objectives : The objective of this study was to determine the effect of COVID-19 on patients admitted by emergency hospitalization in accordance with the Article 50 of Act on the improvement of mental health and the support for welfare services for mental patients. Methods : A retrospective cross-sectional study was conducted on data from Yangsan psychiatric hospital from January 20, 2019 to January 19, 2021. Pre-COVID-19 group included 100 patients who were hospitalized emergently from January 20, 2019 to January 19, 2020. Post-COVID-19 group included 96 patients who were hospitalized emergently from January 20, 2020 to January 19, 2021. The study compared sociodemographic and clinical characteristics between the two groups using independent sample t-test and Chi-square test. Results : The number of patients who were discharged after emergency hospitalization in 72 hours and the frequency of visits during 09-18 hour were significantly higher in the pre-COVID-19 group. However, transition from emergency hospitaliza-tion to hospitalization by special self-Governing City Mayor, Special self-governing Province Governor, or Head of Si/Gun/ Gu, F2-type diagnosis, and the frequency of visits during 18-24 hours were significantly higher in the post-COVID-19 group. Conclusion : This study revealed increased rates of transition from emergency hospitalization to hospitalization by special self-Governing City Mayor, Special self-governing Province Governor, or Head of Si/Gun/Gu, F2(Schizophrenia, schizotypal and delusional and other non-mood psyhotic disorders) diagnosis, and visits during 18-09 hour in the post COVID-19 group. These results can be used as a guideline to extend current understanding of emergency admission amid a crisis.

범죄 이력 여부에 따른 알코올 사용 장애 환자의 음주 특성, 정서적 특성 및 특성간 상관관계의 비교

정현수(Hyeon Soo Jeong),변원탄(Won Tan Byun),박영민(Young Min Park),김세훈(Se Hoon Kim),박현우(Hyun-Woo Park),정재웅(Jae Woong Jeong),김휘곤(Whi Gon Kim),주새한(Sae Han Joo) 대한생물치료정신의학회 2021 생물치료정신의학 Vol.27 No.3

Objectives:In this study, socio-demographic, drinking and emotional characteristics, and their correlations were compared among patients with alcohol use disorder (AUD) according to the presence or absence of any type of criminal record. Methods:Among patients admitted to the hospital with AUD, 27 with and 31 without criminal records were included. Socio-demographic data and drinking characteristics such as first drinking age, average daily alcohol consumption were collected. In addition, the severity of alcohol problems, the degree of change readiness for drinking alcohol, depressive symptoms, anxiety symptoms, and impulsivity were evaluated using scales and statistically analyzed. Pearson’s correlation test was applied to reveal the differences in correlation of the characteristics according to the presence or absence of criminal records. Results:The first drinking age was significantly earlier in the AUD group with criminal records. Interestingly, the degree of change readiness regarding alcohol problem as shown in SOCRATES-K was significantly higher in the AUD group with criminal records. Anxiety symptoms were statistically significantly higher in the AUD group with criminal records. In AUD with criminal records, first drinking age negatively correlated with the degree of change readiness. In AUD without criminal records, first drinking age correlated negatively with the severity of alcohol problem, and the degree of change readiness, and the degree of change readiness negatively with age, and the degree of change readiness positively with the severity of alcohol problem. In Both groups, anxiety symptoms positively correlated with depressive symptoms. Conclusions:This study showed that AUD patients with criminal record had a faster first drinking age and the higher degree of change readiness regarding alcohol problem. Significantly higher symptoms of anxiety were also presented in AUD patients with criminal record than AUD patients who have no criminal records. Some differences were identified in correlations among characteristics between the two groups.

알코올 진전섬망 발생에 관련이 있는 위험요인과 대처방안

김은도(Eun Do Kim),변원탄(Won Tan Byun),박영민(Young Min Park),김세훈(Se Hoon Kim),정재웅(Jae Woong Jeong),주새한(Sae Han Joo),정일근(Il Geun Jung) 대한사회정신의학회 2023 사회정신의학 Vol.28 No.1

목 적 : 본 연구의 목적은 알코올 사용장애 환자에서 알코올 진전섬망 발생에 관련이 있는 위험요인을 분석하고 대처방안을 모색하는 것이다. 방 법 : 본 연구는 정신건강의학과 전문병원에 2019년 1월부터 2022년 12월까지 입원하였던 알코올 사용장애 환자들을 대상으로 전자의무기록을 검토하여 후향적으로 분석하였다. 로지스틱 회귀분석으로 알코올 진전섬망 발생에 관련이 있는 위험요인을 분석하였고, 다중회귀분석으로 알코올 진전섬망 지속시간에 관련이 있는 변인을 분석하였다. 결 과 : 알코올 진전섬망 발생에 관련이 있는 위험요인으로 알코올 진전섬망 과거력이 있는 경우(p=0.012), 내과질환이 있는 경우(p=0.008), 아스파테이트아미노전이효소(AST) 수치가 높은 경우(p=0.032)가 해당하였다. 알코올 진전섬망 지속시간에 관련이 있는 변인으로 시간당 벤조디아제핀계 약물 투여량이 적은 경우(p<0.001) 진전섬망이 오랜 시간 동안 지속되는 것으로 나타났다. 결 론 : 알코올 사용장애 환자 입원시 시행 가능한 간단한 문진(알코올 진전섬망 과거력 유무, 내과질환 유무)으로 어떤 환자에서 진전섬망의 발생을 특별히 더 주의해야 하는 지 알 수 있다. 의료진의 세심한 관찰과 벤조디아제핀계 약물의 적극적인 투여로 진전섬망의 기간을 감소시키는 것이 필요하겠다. Objectives : The aim of this study was to analyze the risk factors of developing alcohol withdrawal delirium and to find a solution. Methods : We conducted a retrospective analysis of the electronic medical records of alcohol use disorder inpatients admitted to a psychiatric hospital between January 2019 and December 2022. Results : The risk factors for developing alcohol withdrawal delirium included an alcohol withdrawal delirium history (p=0.012), medical illness (p=0.008), and higher aspartate aminotransferase levels (AST) (p=0.032). In the variable associated with the duration of alcohol withdrawal delirium, the longer the duration of alcohol withdrawal delirium, the less use of a benzodiazepine during alcohol withdrawal delirium (p<0.001). Conclusion : The simple history-taking (previous alcohol withdrawal delirium history and medical illnesses) that can be performed when a patient with alcohol use disorder is hospitalized can reveal which patients need special attention for the occurrence of alcohol withdrawal delirium. Careful observation by medical staff and the active administration of a benzodiazepine drug are necessary to reduce the duration of alcohol withdrawal delirium.

알코올 의존 환자에서 한국어판 알코올 충동 척도(Korean Alcohol Urge Questionnaire, AUQ-K)의 신뢰도와 타당도 연구

김철민,김성곤,김민정,김호찬,오광욱,김효정,김세훈,이덕기,변원탄,강철중,Kim, Cheol Min,Kim, Sung Gon,Kim, Min Jeong,Kim, Ho Chan,Oh, Kwang-Ook,Kim, Hyo Jeong,Kim, Se Hoon,Lee, Duk Ki,Byun, Won Tan,Kang, Cheol Joong 대한생물정신의학회 2008 생물정신의학 Vol.15 No.3

Objectives : The Alcohol Urge Questionnaire(AUQ) has been used in alcohol dependence treatment and research. The goal of this study is to develop of the Korean Alcohol Urge Questionnaire(AUQ-K). Methods : To examine the AUQ-K's psychometric properties, responses from 104 patients admitted in alcohol dependence treatment facility were investigated. Results : The internal consistency of the 8-item AUQ-K, measured by coefficient ${\alpha}$, was high(Cronbach's ${\alpha}$=0.78). AUQ-K scores showed significant correlation when the retest interval was 1 day(p<0.01). The AUQ-K's validity was investigated using correlational analyses with two other craving scales[the Obsessive Compulsive Drinking Scale(OCDS) and the Visual Analogue Scale(VAS)]. The high correlations were obtained between total AUQ-K scores and total OCDS scores, and between total AUQ-K scores and the VAS scores(p<0.01, respectively). Conclusion : The AUQ-K is a reliable and valid short scale for measurement of self-reported alcohol craving. This scale may offer significant advantages over existing single-item measures of alcohol craving in the fields of alcohol dependence treatment and research.

조현병 환자에서 당뇨와 수면의 질 사이의 연관성

권기태(Ki Tae Kwon),김신겸(Shin Kyum Kim),변원탄(Won Tan Byun),이덕기(Duk Ki Lee),정봉주(Bong Ju Jung),박영민(Young Min Park),서재원(Jae Won Seo),김세훈(Se Hoon Kim) 대한생물치료정신의학회 2017 생물치료정신의학 Vol.23 No.1

Objectives:We aimed to investigate the relation between poor quality of sleep and clinical characteristics in patients with schizophrenia. Methods:Using the Korean version of the Pittsburgh Sleep Quality Index(PSQI-K), the sleep quality was evaluated in 118 patients with schizophrenia. Demographic and clinical variables were compared between schizophrenia patients with and without poor quality of sleep. Laboratory variables, clinical and sociodemographic characteristics were compared between PSQI-K score higher than 5 points group(PSQI-H) and PSQI-K score lower than 4 points group(PSQI-L). Results:The prevalence of diabetes mellitus(DM) was higher in PSQI-H patients. In patients with DM, sleep duration was shorter and use of sleeping medication was more frequent than patients without DM. In logistic regression analysis, DM was associated with higher score of PSQI-K. Conclusion:We have found that presence of DM can be associated with poor quality of sleep in patients with schizophrenia. Further studies with more objective assessment on sleep quality and mediation are needed to clarify these relationships between sleep quality disorder and diabetes mellitus.

Alcohol Use Inventory를 이용한 입원한 알코올 의존환자의 인지행동적 특성과 유형 분류

이덕기(Duk-Ki Lee),최혜선(Hye-Sun Choi),변원탄(Won-Tan Byun),하미영(Mi-Young Ha) 한국중독정신의학회 2004 중독정신의학 Vol.8 No.1

Objectives:This study was performed to evaluate cognitivebehavioral characteristics of alcohol dependent patients by AUI. And, the data of AUI analyzed using cluster analysis in order to identify the subtypes of alcohol dependence. Methods: Subjects served for the study were 402 alcoholic patients in Korea from a mental hospital. The data were mainly collected through several questionnaires including Korean version of Alcohol Use Inventory. Results:1) Among the AUI scales, HELPBEFR, GREGARUS, MENTALIM were relatively higher and RECPAWAR, AWARENES were relatively lower. 2) In the correlation analysis, there was a significant correlation among the scales associated with benefits of drinking, consequences of drinking and concerns about drinking and psychopathology variables. But, there was no significant correlation among the scales associated with drinking style, amount of drinking and psychopathology variables. 3) Alcohol dependence were classified into 4 subtypes. Subtype 1 was relatively higher in benefits of drinking, consequences of drinking and concerns about drinking. Subtype 2 was relatively lower in benefits of drinking and relatively higher in consequences of drinking and concerns about drinking. Subtype 3 was relatively lower in benefits of drinking, consequences of drinking and concerns about drinking. Subtype 4 was relatively higher in benefits of drinking and relatively lower in consequences of drinking and concerns about drinking. 4) Among the 4 subtypes, there is no significant difference in demographic variables. Conclusion:In order to prescribe cognitive-behavioral treatment effectively for alcohol dependent patients, first of all, the evaluation of cognitive-behavioral characteristics of the patients must be done. Next, on the basis of cognitive-behavioral characteristics, appropriate cognitive-be-havioral treatment strategy should chosen.

팔리페리돈 장기 지속형 주사제 사용 후 정신과적 증상 및순응도 변화

박홍준(Hong Jun Park),김신겸(Shin Kyum Kim),변원탄(Won Tan Byun),정봉주(Bong Ju Jung),박영민(Young Min Park),서재원(Jae Won Seo),김세훈(Se Hoon Kim),임종길(Jong Gil Lim) 대한사회정신의학회 2019 사회정신의학 Vol.24 No.1

연구목적 : 조현병 환자에서 저하된 약물 순응도는 증상 재발의 주요한 원인 중 하나이다. 팔리페리돈 장기 지속형 주사제를 사용한 이후 환자의 정신과적 증상 및 약물 순응도의 변화를 측정하였다. 방 법 : 팔리페리돈 장기 지속형 주사제를 시작한 64명의 환자들을 대상으로, 한국형 양성 및 음성 증상 척도(Positive And Negative Syndrome Scale, 이하 PANSS) 및 약물 태도 척도(Drug Attitude Inventory-10, 이하 DAI)를 사용하여, 시작 전과 6개월 후의 정신과적 임상 증상과 약물 순응도 및 경구용 항정신병 약물 용량을 측정하였다. 또한 팔리페리돈 장기 지속형 주사제 사용 후 나타난 치료 효과와 임상적 요인의 관련성을 분석하였다. 결 과 : 팔리페리돈 장기 지속형 주사제 사용 후 정신 증상 및 약물 순응도가 개선된 것으로 나타났다. 로지스틱 회귀 분석 결과, 초기 경구용 항정신병 약물 용량이 낮을 수록, 6개월 간 경구용 항정신병 약물 감소량이 높을 수록 정신 증상의 호전과 연관성을 보였다. 6 개월 후 낮은 PANSS-P 점수는 약물 순응도의 호전과 연관성을 보였다. 결 론 : 팔리페리돈 장기 지속형 주사제 사용은 경구용 항정신병 약물을 감량하면서도 정신 증상의 악화를 최소화하며 약물 순응도를 개선시키는 결과를 나타내었다. Objectives : Poor drug adherence is a major cause of symptom relapse in the overall course of schizophrenia. We investigated the change of psychiatric symptoms and drug adherence following paliperidone palmitate long acting injection (PLAI) in patients with schizophrenia. Methods : Psychiatric symptoms and drug adherence were evaluated in 64 patients with schizophrenia at baseline and after 6-month use of PLAI. Korean version of Positive And Negative Syndrome Scale (PANSS) was used to evaluate the change of symptoms and Drug Attitude Inventory-10 (DAI) to estimate their drug adherence. We assessed concurrent dose of oral antipsychotics over time and associated treatment effectiveness with clinical variables. Results : Psychiatric symptoms and drug adherence were improved after use of PLAI. Logistic regression analysis showed treatment effectiveness of psychiatric symptoms was associated with lower dose of initial oral antipsychotics and higher decrement of oral antipsychotics dose. And the improvement of drug adherence was associated with lower score of end-point PANSS-P. Conclusion : PLAI is expected to be a promising strategy to reduce the dose of oral antipsychotics without worsening of psychiatric symptoms and drug adherence in schizophrenic patients.

알코올 의존 환자에서 치료 서비스 조사(Treatment Service Review)의 신뢰도, 타당도에 대한 예비적 연구

조현기(Hyun-Kee Cho),주동식(Dong-Sik Joo),조웅제(Woong-Je Cho),변원탄(Won-Tan Byun) 한국중독정신의학회 2004 중독정신의학 Vol.8 No.1

Objectives:The purpose of this study was to evaluate the reliability and validity of Korean version of Treatment Service Review (TSR) in alcohol dependence patient Methods:Forty patients for the reliability test and forty four patients for the validity test were choosen, all of whom were diagnosed as alcohol dependence according to DSM-IV criteria and forty four patients for the validity test had treated for 8 weeks or more. Results:In the reliability test, Test-retest study and Interrater reliability were satisfactory in medical, alcohol, psychiatric problem areas. In the validity test, 1) Alcohol area of TSR problem showed between-level difference, but the other areas did not show significant between-level difference in Alcohol ward admission patients and General psychiatric ward admission patients. 2) Comparing TSR with chart record showed high correlation. 3) Correlations of treatment need with treatment provided were positive in the medical problem area but negative in the other problem areas. Conclusion:The results suggests that several Korean version of TSR problem areas showed reasonable reliability and validity, but this study is just initial step for the development of Korean version of TSR. Further study is indicated to evaluate general application.

알코올 의존 환자에서의 한국어판 알코올의존 척도의 신뢰도와 타당도 연구

이덕기(Duk-Ki Lee):신진규(Jin-Kyu Shin):윤세민(Se-Min Yun),변원탄(Won-Tan Byun) 한국중독정신의학회 2000 중독정신의학 Vol.4 No.1

For the purpose of testing the utility of the Alcohol Dependence Scale (ADS) in Korea, the authors evaluated the reliability and validity of a Korean version of the ADS in 180 Korean alcoholic inpatients. The results were as follows: 1) The means of ADS was 16.94±8.23 and the scores of the ADS in 180 subjects conformed quite closely to a normal distribution. 2) The test-retest reliability for the ADS showed significant reliability. 3) The internal consistency analysis of the ADS showed significant reliability. 4) The item-analysis for each of the 25 items revealed a moderate correlation to the total score for the majority of the items. 5) In the correlation analysis for the test of concurrent validity, ADS scores had significant negative correlation with the age of first admission due to drinking and positive correlation with drinking amount and frequency, alcohol-induced sequelae and 6 secondary scales of AUI (such as drinking benefits, ob-ssessive drinking, direct complication, indirect complication, anxiety about drinking, insight). 6) The ANOVA analysis among 3 groups according to the severity of ADS scores revealed statistically significant differences in drinking frequency and alcoholinduced sequelae among the 3 groups and in drinking amount between mild group and moderate and severe groups. Based on these results, Korean version of the Alcohol Dependence Scale showed reasonable reliability and validity, and it may be useful in the evaluation of alcoholic patients.