신경아교세포와 조현병

원승희,Won, Seunghee 대한생물정신의학회 2015 생물정신의학 Vol.22 No.2

In the past decade, structural, molecular, and functional changes in glial cells have become a major focus in the search for the neurobiological foundations of schizophrenia. Glial cells, consisting of oligodendrocytes, astrocytes, microglia, and nerve/glial antigen 2-positive cells, constitute a major cell population in the central nervous system. There is accumulating evidence of reduced numbers of oligodendrocytes and altered expression of myelin/oligodendrocyte-related genes that might explain the white matter abnormalities and altered inter- and intra-hemispheric connectivities that are characteristic signs of schizophrenia. Astrocytes play a key role in the synaptic metabolism of neurotransmitters ; thus, astrocyte dysfunction may contribute to certain aspects of altered neurotransmission in schizophrenia. Increased densities of microglial cells and aberrant expression of microglia-related surface markers in schizophrenia suggest that immunological/inflammatory factors are of considerable relevance to the pathophysiology of psychosis. This review describes current evidence for the multifaceted role of glial cells in schizophrenia and discusses efforts to develop glia-directed therapies for the treatment of the disease.

사회인구학적 요인이 CERAD-K의 15항목 단축형 보스톤 이름대기 검사의 각 항목별 결과에 미치는 영향

김혜림(Hyerim Kim),원승희(Seunghee Won),이승재(Seung Jae Lee),장성만(Sung Man Chang),김병수(Byung-Soo Kim) 대한생물치료정신의학회 2016 생물치료정신의학 Vol.22 No.1

Objectives:The purpose of this study was to investigate the influence of sociodemographic factors on the results of each item of the 15-item Modified Boston Naming Test in the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet(BNT-KC) in a clinical sample. We also explored the usefulness of each item in BNT-KC for the diagnosis of Alzheimer’s disease(AD). Methods:Data of BNT-KC from 261 outpatients aged over 60 years, including 150 diagnosed with AD and 111 with normal cognitive function, were analyzed. Logistic regression analyses were performed to investigate the association of age, gender, and education with the results of each item in BNT-KC controlling for cognitive function. The relationship between each item of BNT-KC and the diagnosis of AD were examined using logistic regression analyses controlling for age, gender, and education. Results:Failing to answer ‘Mermaid’ was associated with low education level(≤6 years). Failing to answer ‘pomegranate’ was associated with the male gender, whereas failing to answer ‘compass’ or ‘dinosaur’ was associated with the female gender. Four items(‘hand’, ‘red pepper’, ‘wind-bell’, and ‘monk’s hat’) were not associated with the diagnosis of AD in this sample. Conclusions:Several items of BNT-KC are affected by sociodemographic factors and some items are not useful for the diagnosis of AD. This finding will help to develop a revised edition of BNT-KC to improve the accuracy of dementia diagnosis.

조현병 환자와 발병하지 않은 일차친족에서 신경인지의 결함

김도훈,김지우,황선영,김병수,원승희,Kim, DoHoon,Kim, Jiwoo,Hwang, Sunyoung,Kim, Byungsoo,Won, Seunghee 대한생물정신의학회 2014 생물정신의학 Vol.21 No.2

Objectives This study aimed to identify the differences and the profiles of cognitive deficits in remitted patients with schizophrenia and first-degree relatives of schizophrenic probands. Methods A total of 26 remitted states of schizophrenia patients were included in the study and the same number of unaffected first-degree relatives of schizophrenic probands and healthy controls were matched for age, sex, years of education. Cognitive function of all participants was measured by using the Digit span test, the Continuous performance test, the Rey auditory & visual learning test, the Complex figure test, the Verbal fluency test, the Wisconsin card sorting test and the Finger tapping test. The effects of subsyndromal symptomatology and general intelligence score were controlled. Results Schizophrenia patients' group showed more significant impairment than other groups in verbal memory (learning, immediate recall, delayed recall), visual memory (copy, immediate recall, delayed recall) and cognitive flexibility domains. The family group and the patient group commonly performed significantly worse than healthy controls in working memory and verbal fluency (category) tests. There were no differences in sustained attention, psychomotor performance. Conclusions Our research shows that the deficit in working memory and verbal fluency could be strong candidates of endophenotypic marker in schizophrenia.

대학병원 응급실을 내원한 자살 시도자들의 특성

이광헌(Kwanghun Lee),원승희(Seunghee Won),김희철(Hee-Cheol Kim),이종훈(Jong Hun Lee),서완석(Wan Seok Seo),김지우(Jiwoo Kim) 대한생물치료정신의학회 2015 생물치료정신의학 Vol.21 No.2

Objectives:This study aimed to investigate the demographic and psychosocial characteristics and suicide-related clinical variables of suicide attempters and provide empirical data to establish a suicide prevention program. Methods:The subjects were 279(122 male and 157 female) suicide attempters who were admitted to the emergency centers of 4 university hospitals in a large city between June 2011 and March 2014. Their psychosocial and demographic characteristics and suicide-related clinical variables were studied through interviews, questionnaires(on suicide intention, lethality, risk, and rescue) and their electronic medical records. Results:The main findings were as follows : among subjects in their 20s, there was a significantly higher proportion of women, while among subjects older than 60 years, there was a significantly higher proportion of men. The rate of attempting suicide in autumn was significantly higher in females while that in summer was significantly higher in males. The rate of attempting suicide in the morning was significantly higher in older(≥60 years) subjects while that at night and dawn was significantly higher in subjects below 60 years. Among interpersonal relationship problems, couple relationship problems were the most common motive for suicide attempt. Depressive disorders were the most common psychiatric illness. Conclusion:This study indicates the necessity of suicide prevention measures, tailored to several psychosocial factors(place, time-of-day, season, and so on) according to age and gender, are suited to the regional characteristics. It also reveals the necessity of intervention for couple relationship problems and appropriate psychiatric treatment for depression in order to prevent suicide

기억성 경도인지장애환자의 우울증상 특성

이지민(Jimin Lee),원승희(Seunghee Won),이승재(Seung Jae Lee),장성만(Sung Man Chang),김병수(Byung-Soo Kim) 대한생물치료정신의학회 2017 생물치료정신의학 Vol.23 No.1

Objectives:Patients with mild cognitive impairment(MCI) are known to be commonly accompanied by depression. The aim of this study was to investigate the characteristics of depressive symptoms in patient with amnestic MCI(aMCI). Methods:Three hundred and thirty two individuals were included in this study. They completed a comprehensive assessment, including the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet(CERAD-K), and a past psychiatric/medical history interview. Depressive symptoms were assessed using the revised Korean version of the Geriatric Depression Scale(GDS-KR). All patients were divided into three groups, aMCI group, non-amnestic mild cognitive impairment(naMCI) group, and cognitively normal group. We defined factor based score as total score of items belonging to each factor of GDS-KR. We compared depressive symptoms among three groups based on factor based score. Results:The GDS-KR was meaningfully factored into five clearly separated factors(sad mood and agitation, positive mood, lack of energy, cognitive inefficiency, social withdrawal). In the factor of ‘lack of energy’, there was a significant difference among the three groups(p=0.048). In post-hoc analysis, the ‘lack of energy’ factor based score of aMCI was higher than that of the cognitively normal group(p=0.044). Conclusion:These findings suggest that the pathophysiology of depression in aMCI may differ from that of depression in cognitively normal group. It is important to focus on lack of energy in treating depressive symptoms in aMCI.

한국 조현병 환자에서 검지-약지 길이비와 발병 연령 및 대사 장애와의 연관성

김홍래,이중선,주연호,원승희,류승형,홍경수,권준수,이승연,오홍석,최준호,이유상,Kim, Hong Rae,Lee, Jung Sun,Joo, Yeon Ho,Won, Seunghee,Ryu, Seunghyong,Hong, Kyung Sue,Kwon, Jun Soo,Lee, Seung Yeoun,Oh, Hong Seok,Choi, Joon Ho,Lee, Yu Sa 대한생물정신의학회 2017 생물정신의학 Vol.24 No.3

Objectives The ratio of second to fourth digit length (2D : 4D) could be a potential epigenetic marker of sexual dimorphism reflecting prenatal testosterone exposure. Testosterone is known to affect the development of the brain through an epigenetic mechanism. The purpose of this study was to investigate the effects of exposure to fetal testosterone on the metabolic syndrome based on 2D : 4D of schizophrenia patients and the relationship with the age of onset of schizophrenia. Methods A total of 214 schizophrenia patients participated in this study. The participant's physical and blood tests were performed according to the American National Cholesterol Education Program's Third Amendment of the Metabolic Syndrome Diagnostic Criteria, and the 2D : 4D was measured by the method designed by McFadden. Data were statistically analyzed by t-test, Pearson's correlation analysis and multiple regression model analysis. Results 2D : 4D was significantly higher in female than male in both hands, and there was a statistically significant negative correlation between 2D : 4D and the age of onset of schizophrenia in male. However, 2D : 4D did not show statistically significant correlation with metabolic factors. Conclusions Fetal testosterone suggests the possibility of affecting the age of onset of schizophrenia through the epigenetic mechanism, but there is no clear relationship with metabolic factors.

정신분열병 입원환자의 우울증상 유병 률 및 예측인자

정재훈(Jaehoon Jeong),원승희(Seunghee Won),장성만(Sungman Chang) 대한생물치료정신의학회 2011 생물치료정신의학 Vol.17 No.1

본 연구의 목적은 정신보건시설에 입원 중인 정신분열병 환자의 우울증상에 대한 유병률을 알아보고 이에 영향을 미치는 요인들을 알아보기 위한 것이다. 이를 위해 대구경북지역 및 인천경기지역의 정신보건시설에 입원 중인 정신분열병 환자 141명을 대상으로 Center for Epidemiologic Studies-Depression scale(CES-D)을 시행하였다. 정신분열병 환자의 우울증상 유병률은 전체46.8%, 남자 43.7%, 여자 50.0%였다. 가족이 없는 경우, 보호자들이 면회를 잘 오지 않는 경우, 지남력의 손상이 있는 경우, 통증이나 불편감이 있는 경우에서 우울 증상이 높게 나타났다. 본 연구의 결과를 바탕으로 정신분열병 환자에서 우울장애의 발생과 진행을 예방하기 위해 이러한 예측인자들에 대한 특별한 주의가 필요함을 제시한다. Objectives : This study was performed to evaluate the prevalence and to identify predictors of depressive symptoms among inpatients with schizophrenia. Methods : One hundred and forty-one schizophrenic patients were included. Sociodemographic characteristics were obtained by questionnaire. Depressive symptoms were evaluated using Center for Epidemiologic Studies Depression scale(CES-D). A cutoff score 16 or above was used to indicate depressive symptoms. Results : Prevalence of depressive symptoms was 46.8% in this sample, 43.7% in male and 50.0% in female. No familial support, six or more numbers of admission, infrequent visit of caretaker over the last month, impaired orientation and presence of pain or discomfort were predictors of depressive symptoms. Conclusion : Depressive symptoms were highly prevalent in inpatients with schizophrenia. The predictors of depressive symptoms should be given special attention to prevent the onset and progression of depressive disorder in this group of patients.

한국어 개정판 친밀관계경험 척도의 단축형 개발

윤혜림,이원기,배금예,이상원,우정민,원승희,Yun, Hyerim,Lee, Won-Kee,Bae, Geumye,Lee, Sang-Won,Woo, Jungmin,Won, Seunghee 대한불안의학회 2017 대한불안의학회지 Vol.13 No.2

Objective : The experiences in close relationships questionnaire-revised (ECR-R) (Fraley, Waller & Brennan, 2000) is a valuable tool for measuring adult attachment, and its Korean version, the ECRR-K (Kim, 2004), is widely used in Korea. However, given its substantial length, this study was aimed to develop and validate a short version of the ECRR-K called the ECRR-K14. Methods : Two hundred and ninety-four medical students participated in this study in 2016. They completed the ECRR-K, the Perceived Stress Scale (PSS), the Rosenberg Self-Esteem Scale (RSES), and the UCLA Loneliness Scale (UCLA-LS). The study authors applied the Rasch rating scale to check each item's model fit and then performed confirmatory factor analyses (CFAs) to test the new scale's validity. Results : The authors selected seven items each for the anxiety and avoidance subscales, and the ECRR-K14 showed fair to good internal consistency (Cronbach's ${\alpha}=0.93$ and 0.92 for anxiety and avoidance, respectively). The anxiety subscale showed concurrent validity with the PSS and the RSES while the avoidance subscale showed concurrent validity with the UCLA-LS. The CFAs also demonstrated the validity of the model with a goodness-of-fit index of 0.916. Conclusion : The ECRR-K14 showed excellent reliability and validity and appears to be a promising instrument for measuring the two attachment dimensions in adults.

항정신병약물로 유발된 고프로락틴혈증을 가진 조현병 환자의 삶의 질

우선진(Seonjin Woo),진보현(Bo-Hyun Jin),원승희(Seunghee Won) 대한생물치료정신의학회 2018 생물치료정신의학 Vol.24 No.3

Objectives:Antipsychotic-induced hyperprolactinemia causes physical symptoms, such as amenorrhea, galactorrhea, gynecomastia, sexual dysfunction, and bone density loss, as well as psychiatric symptoms, such as depression and cognitive impairments. This study aimed to clarify the associations among hyperprolactinemia caused by antipsychotics in patients with schizophrenia, psychiatric pathology, and psychosocial factors. Methods:Ninety-nine patients with schizophrenia in the psychiatry department of a university hospital were registered between 2015 and 2017. All participants were assessed using structured questionnaires to elucidate psychopathology, social function, quality of life, and hyperprolactinemia-related side effects. The standard levels for hyperprolactinemia were 24ng/mL for women and 20ng/mL for men. Results:The average prolactin levels were 73.45±49.37ng/mL in patients with hyperprolactinemia and 9.16±6.42ng/mL in those without hyperprolactinemia. The average prolactin level in women was significantly higher than that in men(p=0.04). Risperidone was most commonly administered in patients with hyperprolactinemia(58.1%, p<0.01), while aripiprazole was most commonly administered in those without hyperprolactinemia(44.7%, p<0.01). Patients with hyperprolactinemia had significantly higher Positive and Negative Syndrome Scale(p=0.03) and Patient Health Questionnaire-9(p=0.05) scores and had significantly lower Social and Occupational Functioning Assessment Scale(p=0.04) and Strauss–Carpenter Levels of Functioning Scale(p=0.03) scores than patients without hyperprolactinemia. There were no significant differences in side effects or quality of life between the two groups. Conclusion:These findings demonstrate that hyperprolactinemia confers negative effects on depression and social function, but does not directly affect the quality of life. These results suggest that patients with schizophrenia who take antipsychotics that increase prolactin or cause side effects of hyperprolactinemia need to be assessed and receive interventions for depression.

양극성 I형 장애 환자와 발병하지 않은 일차 친족에서 인지조절의 비교

윤혜림,우선진,이상원,진보현,우정민,원승희,Yun, Hyerim,Woo, Seonjin,Lee, Sang-Won,Jin, Bo-Hyun,Woo, Jungmin,Won, Seunghee 대한생물정신의학회 2018 생물정신의학 Vol.25 No.1

Objectives This study intended to identify the deficits of cognitive control among patients with bipolar I disorder and their first-degree relatives, and identify the possibility of cognitive control as an endophenotype of bipolar disorder. Methods The study included three groups: euthymic states patients with bipolar I disorder (n = 55), unaffected first-degree relatives of probands with bipolar I disorder (n = 30), and a healthy control group (n = 51), that was matched on age, sex, and years of education. The AX version of the continuous performance test (CPT) was used to examine cognitive control. Error rate, correct response times of each subsets (AX, BX, AY, BY), and d' as an indication of accuracy sensitivity index were calculated. Psychopathology, intelligence, and psychomotor speed were also assessed. Results Patients with bipolar I disorder showed significantly worse error rates in the AX (p = 0.01) and BX (p = 0.02) subsets and d' (p = 0.05) than the others. They also showed more delayed correct response times than the healthy control group and first-degree relatives in all subsets (p < 0.01). But first-degree relatives showed neither high error rates nor delayed correct response times than healthy control group. Conclusions These findings suggest that cognitive control is impaired in bipolar I disorder but less likely to be an endophynotype of bipolar I disorder.