정신병적 우울증의 치료 전략

이소영,정한용,Lee, Soyoung Irene,Jung, Han-Yong 대한생물정신의학회 2006 생물정신의학 Vol.13 No.4

정신병적 우울증의 심한 정도와 나쁜 예후, 그리고 현재까지의 연구 실적을 고려했을 때, 임상의사들은 정신병적 증상을 동반한 우울증과 정신병적 증상을 동반하지 않는 우울증을 구분하여 치료계획을 수립하는 것이 바람직하다. 저자들은 체계적인 검색을 통해 광범위하게 조사를 하였으나, 정신병적 우울증 환자의 약물치료에 대한 근거는 아직 부족한 것으로 생각한다. 소수의 연구 결과들이지만 현재까지 발표된 근거에 의하면, 항우울제와 항정신병약물의 병합치료와 전기충격요법이 그 효과에 대한 근거 수준이 가장 높아서 정신병적 우울증 환자를 위한 일차적 치료법으로 생각된다. 그러나 최근에 항우울제 단독치료가 항우울제와 항정신병약물의 병합치료에 비해 효과 면에서 떨어지지 않는다는 분석 결과가 발표되면서 항우울제-항정신병약물 병합치료법과 항우울제를 사용하다가 필요시에 항정신병약물을 추가하는 방법 둘 다 권고된 바 있다. 이는 기존 치료 권고 사항과 대조가 되기 때문에, 향후 이러한 관점에서 기존의 치료 전략들이 어떻게 영향을 받을지 주목된다. 그러나 적어도 정신병적 우울증 환자에게 항정신병약물을 단독으로 사용하는 것은 항우울제와 병합하였을 때 보다 덜 효과적이므로 항정신병약물 단독으로 시작하는 것은 바람직하지 않다는 데에는 연구자들 간에 의견이 일치하고 있다. 항우울제 중에서는 삼환계 항우울제에 대한 근거 수준이 가장 높고 선택적 세로토닌 재흡수 차단제의 경우 현재는 근거가 부족하나 앞으로 유망할 것으로 보인다. 항우울제와 항정신병약물 병합 치료에 반응이 없거나 부작용으로 인해 투여할 수가 없을 경우에는 항우울제의 종류를 바꾸거나 lithium을 강화하는 방법을 고려할 수 있다. 실제 임상에서는 환자 개개인의 위험과 이득을 고려하여 약물을 선택하는 것이 중요하다. 또한 선택된 약물을 충분한 양, 그리고 충분한 기간 동안 시도했는지도 중요하다. 이와 함께 부작용의 출현에 대해 잘 모니터링을 해야 하고, 특히 우울증 자체가 악화되는 것과 구분해야 한다. 결론적으로, 임상의사들은 정신병적 증상을 동반하는 우울증 환자의 치료 전략을 현재까지 수행된 연구 근거의 양과 수준을 감안하여 받아들여야 하고, 아직까지 명백한 결론을 이끌어내기에는 부족하기 때문에 향후 이에 대한 많은 체계적 연구들이 필요할 것이다. Objectives : Several factors, such as biological markers, clinical correlates, and course of the depressive disorders with psychotic symptoms differ from those without psychotic symptoms. Therefore, specification of a treatment algorithm for depressive disorder with psychotic symptoms is legitimated. This article provides a systematic review of somatic treatments for depressive disorder with psychotic symptoms. Methods : According to the search strategy of the Clinical Research Center for Depression of Korean Health 21 R & D Project, first, PubMed and EMBASE were searched using terms with regard to the treatment of depressive disorders with psychotic symptoms(until July 2006). Reference lists of related reviews and studies were searched. In addition, relevant practice guidelines were searched using PubMed. All identified clinical literatures were reviewed and summarized in a narrative manner. Results : Treatment options, such as a combination of an antidepressant and an antipsychotic versus an antidepressant or an antipsychotic alone are summarized. In addition, issues regarding the electroconvulsive therapy( ECT), combination therapy, and maintenance treatment are discussed. Conclusion : In former times, the combination of an antidepressant and an antipsychotic or ECT were recommended as the first line treatment for depressive disorder with psychotic symptoms. Recently, however, there was a suggestion that there was no conclusive evidence that the combination of an antidepressant and an antipsychotic drug is more effective than an antidepressant alone. More evidence regarding the pharmacological treatment for depressive disorder with psychotic symptoms is needed.

임신과 수유기 우울증의 치료 전략

이소영,정한용,Lee, Soyoung Irene,Jung, Han-Yong 대한생물정신의학회 2007 생물정신의학 Vol.14 No.2

임신 및 수유기 동안의 우울증의 치료에 관한 연구 실적을 고려했을 때 일반적인 우울증과는 구분하여 치료계획을 수립하는 것이 필요하다. 이에 저자들은 체계적인 검색을 통해 광범위하게 조사를 하였으나, 임신과 수유기 우울증 환자의 약물치료에 대한 근거는 아직까지 전체적으로 부족한 것으로 생각된다. 임신과 수유기 우울증의 치료는 그 시점과 개개인의 상황에 따라 최선의 의사결정을 해야 한다. 의사 결정은 위험과 이득에 관한 평가에 기초해서 이루어져야 하는데, 여기에는 약물치료의 위험과 우울증의 위험, 약물의 위험과 대체 치료의 위험, 그리고 정신치료의 효과가 지연되었을 때의 위험과 산모의 안전에 대한 위험 등을 모두 저울질 해보는 것이 포함된다. 또한 임신과 우울증 그리고 치료의 이득과 위험에 대해 산모와 보호자에게 충분히 상담을 해주고 동의를 구한 후에 치료가 이루어져야 한다. 증상을 조기에 발견하여 치료하는 것이 중요하고, 일단 치료가 시작되면 출산 후까지 지속적으로 재발 예방을 해야 한다. 각 치료법은 우울증의 정도에 따라 선택하는 것이 바람직한데, 경도에서 중등도 우울증의 경우 정신사회적 치료법과 더불어 광선치료와 같은 비약물학적 치료를 먼저 제공하고, 중등도에서 심한 정도의 우울증이나 재발 위험이 높은 우울증의 경우 정신사회적 치료와 약물치료를 함께 실시하도록 한다. 또한 자살의 위험성이 있는 우울증이거나 약물을 잘 견딜 수 없는 경우라면 전기충격요법을 활용할 수 있다. 약물을 선택할 때에는 정보에 기초하여 약을 선택하는 것이 바람직하고 용량도 치료 반응을 얻을 수 있는 가능한 최소한의 용량을 선택하도록 하며, 시기에 따라 약물의 용량을 조절해야 한다. 지난 10여 년간 선택적 세로토닌 재흡수 차단제의 임신과 수유기 동안의 안전성에 관한 연구 결과들이 발표되고 있고, 일차 치료제로써 선택되어지고 있다. 하지만 일반적으로 비교적 최근에 출시된 항우울제들은 임신이나 주산기 동안에 산모나 태아에게 미치는 영향에 대해 연구가 상대적으로 덜 이루어졌기 때문에 아직까지는 덜 권장되고 있다. 결론적으로, 임상의들은 임신과 수유기 동안의 우울증 치료 전략을 현재까지 수행된 연구 근거의 양과 수준을 감안하여 받아들여야 하고, 아직까지 명백한 결론을 이끌어 내기에는 부족하기 때문에 향후 관련 분야의 연구 결과들에 대해 예의 주시하여야 한다. Objectives : Considering the impact of depressive illness on physical and mental health of both mother and fetus, specification of a treatment algorithm for depressive disorder during pregnancy is legitimated. This article provides a systemic review of treatments for depressive disorder during pregnancy and lactation. Methods : According to the search strategy of the Clinical Research Center for Depression of Korean Health 21 R & D Project, PubMed and EMBASE were searched using terms with regard to the treatment of depressive disorders during pregnancy and lactation. Reference lists of related reviews and studies were searched. In addition, relevant practice guidelines were searched using the PubMed. All identified clinical literatures were reviewed and summarized in a narrative manner. Results : Pharmacotherapy during pregnancy and lactation requires a comprehensive assessment of the risks and benefits of treatment for both mother and fetus or neonate. Recently, there is growing evidence that the use of tricyclic and selective serotonin reuptake inhibitors during pregnancy and lactation does not result in increased risks of teratogenicity. Treatment strategies are described according to the point of time of pregnancy or lactation. FDA categories for antidepressants during pregnancy and lactation are described. In addition, issues regarding to the electroconvulsive therapy and psychosocial treatment are discussed. Conclusion : The treatment option for depressive disorders during pregnancy and lactation depends on the severity of depressive illnesses of the individual patient. For mild to moderate depression, the non-pharmacological treatment should be considered first. For moderate to severe depression, pharmacotherapy should be administered in addition to the psychosocial treatment. ECT is recommended for depressive disorder of severe intensity. As the research knowledge is limited, the recommendations should based on the best judgement of psychiatrists.

틱장애와 도파민 D2 수용체 유전자와의 연합 연구

이소영,조인희,김선미,이민수,정한용,Lee, Soyoung Irene,Cho, In Hee,Kim, Seon Mee,Lee, Min-Soo,Jung, Han-Yong 대한생물정신의학회 2006 생물정신의학 Vol.13 No.4

Objectives : The purpose of the present study was to investigate whether the TaqI A polymorphism of dopamine receptor D2 gene(DRD2) is associated with Tourette syndrome(TS) and chronic motor tic disorder(CMT) in Korean population. Methods : DRD2 TaqI A RFLP genotyping was carried out with DNA extracted from blood samples of 75 patients with tic disorders(47 with TS and 28 with CMT) and 90 healthy subjects. Genotype and allelic frequencies for the DRD2 gene polymorphisms of the tic disorder group as a whole were compared to those of the control group. Separating the TS group, thereafter, the frequency of genotypes and alleles were compared to those of the controls. Results : The results demonstrated that genotype and allele distributions for the DRD2 gene polymorphism in the tic disorder as a whole, TS, and control groups were not significantly different. Conclusion : No association was found for DRD2 gene, TS and CMT. The data suggest that DRD2 gene may not be a useful marker for the prediction of the susceptibility of tic disorder.

아동.청소년주의력결핍/과잉행동장애 하위유형에 따른 작업기억의 비교

이소영,임은지,박준호,정한용,Lee, Soyoung Irene,Lim, Eun-Ji,Park, Joon-Ho,Jung, Han-Yong 대한생물정신의학회 2010 생물정신의학 Vol.17 No.2

Objectives : This study investigated the differences of working memory among the subtypes of ADHD. Methods : Eighty-one children and adolescents with ADHD and thirty normal controls were recruited. Children with any cognitive disorders and low intelligence were excluded. In order to evaluate the verbal and visuospatial working memory, Digit span and Finger windows tasks were measured, respectively. Performances on these measures between children with ADHD and controls were compared. Further, performances among the groups of ADHD predominantly inattentive(ADHD-IA)(n=40), predominantly hyperactive-impulsive(ADHD-HI)(n= 10), and combined type(ADHD-C)(n=31), were compared. Results : Scores of Finger windows forward task were lower in the ADHD group as compared to the control group, whereas, the Digit span forward showed no difference. Both scores of Digit span backward and Finger windows backward task were lower in the ADHD group than the controls. Children with ADHD-IA performed poorer than children with ADHD-C on the Finger windows backward task. Conclusion : The results of this study showed that children with ADHD have deficits in spatial short-term memory and verbal and visuospatial working memory when compared to normal children. The deficits were evident in children with ADHD-IA subtype and in particular, performance on the visuospatial working memory task in this group was poorer than the ADHD-C group.

비만 : 유전이냐 환경이냐

이소영,정한용,Lee, Soyoung Irene,Jung, Han-Yong 대한생물정신의학회 2003 생물정신의학 Vol.10 No.1

Debates relevant to the etiology of weight gain or obesity, i.e., the dichotomous understandings about whether obesity arises from the genetic predisposition or from the environmental influences, has long existed. This is an important issue because it is related to the therapists's prejudice when treating patients with obesity. In this review, the authors first discuss the environmental and the genetic factors that cause the obesity, and in the latter part, the interactions between genetic and environmental factors will be discussed. This issue is considered and described especially in a conceptual aspect for the therapists ultimately to understand how the genetic and the environmental factors interact to arise obesity. Conclusively, obesity is best understood as a complex, multifactorial, and chronic disabled state, which cause an individual with genetic predispostion to obesity under the environmental influences. In future, in favor of the accumulated knowledge about the genetic and environmental impacts and their interactions in detail, we will be able to provide a client-specific management or prevention of obesity.

가족 환경이 아동의 자기 개념에 미치는 영향

이소영(Soyoung Irene Lee),정한용(Han-Yong Jung),백종우(Jong-Woo Paik),강이헌(Rhee-Hun Kang),이민수(Min-Soo Lee) 대한사회정신의학회 2006 사회정신의학 Vol.11 No.1

목 적: 본 연구에서는 초등학생들을 대상으로 자기 개념과 가족 환경을 평가하여 가족이 아동의 자기 개념 형성에 영향을 미치는지 알아보고자 하였다. 방 법: 과천시에 거주하는 초등학교 1학년부터 6학년 학생 1,500명에게 한국판 소아자기개념척도와 한국판 가정환경척도를 평가하도록 한 후, 자기 개념과 가족 환경 간의 상관관계를 알아보았고 가족 환경이 자기 개념에 미치는 영향을 알아보기 위해 회귀 분석을 실시하였다. 결 과: 총 1,338명(남=666명;여=672명)의 결과를 분석한 결과, 가족 환경의 결합력, 지적 및 학업상태 그리고 조직화 영역이 아동의 자기 개념과 정적 상관관계를, 그리고 가족의 갈등은 부적 상관관계를 나타내었다. 특히 가족의 결합력은 아동의 자기 개념 변이의 18.2%를 설명하였다. 결 론: 초등학생들의 자기 개념은 가족 구성원들과의 관계 속에서 다양하게 표현되고 있다. 따라서 아동의 자기 개념을 평가할 때에는 아동의 가족 체계에 대한 이해가 함께 이루어져야 한다. 가족의 결합력과 지적이고 문화적인 활동을 추구하는 경향은 자녀의 자기 개념에 긍정적인 영향을 미치고, 가족의 갈등은 부정적인 영향을 미친다. Purpose:The purpose of this study was to evaluate the influence of family on the self concept of elementary school children by assessing the family environment and children’s self concept. Methods:1,500 elementary school children from grade one to six living in Gwacheon city were instructed to complete the Korean Form of Piers-Harris Children’s Self Concept Scale(K-PHCSCS) and Family Environment Scale(K-FES). Correlational and regression analyses were used to evaluate the relationship between family environment and self concept. Results:Cross-sectional analyses of 1,338 children(666 male, 672 females) indicated that among the K-FES subscales, cohesion, intellectual-cultural orientation, and organization were positively correlated to the self concepts of the children, and the conflict subscale was negatively correlated. Particularly, the family cohesion accounted for 18.2% of the variance in the child’s self concept rating. Conclusion:The self concept of the elementary school children are variably expressed within the context of the relatedness between the family members. Therefore, appreciation of the family system should be included when assessing the self concept of the children. The cohesion and the intellectual and cultural orientation of the family impact positively on the self concept of the offsprings, while the family conflict has an negative impact.

소아청소년정신과에서의 허가 초과 및 비승인 약물 처방

이소영(Soyoung Irene Lee) 대한소아청소년정신의학회 2011 소아청소년정신의학 Vol.22 No.2

The purpose of licensing system is to ensure that the medicines are examined for safety, efficacy and quality. Nevertheless, offlabel or unlicensed drug usages in pediatric practice is widespread in Korea and worldwide. Psychotropics are one of the most commonly used off-label or unlicensed drugs. The most valid approach to face this dilemma will be to have more evidences from pediatric pharmacological studies. Clinicians, in addition, need to monitor closely their off-label or unlicensed drug prescriptions to minimize the trial and error in practice. Researchers should publish their experiences and provide guidelines. Pharmaceutical companies, regulatory authorities, and consumer organizations should endeavor altogether for the children’s right to get safe and efficacious drugs as adults do. Here, the definition as well as the current status of off-label and unlicensed drug prescriptions will be introduced. Critical issues regarding the off label drugs are discussed. In addition, I will describe the present condition as to the off-label and unlicensed drugs in child and adolescent psychiatry and the authorization process of off-label drug prescription in Korea. Lastly, direction we should like to take in this field will be mentioned.

아동·청소년 문제행동평가척도를 이용한 반항성 도전장애의 선별

이소영(Soyoung Irene Lee),박준호(Joon-Ho Park),임은지(Eun-Ji Lim),정한용(Han-Yong Jung) 대한소아청소년정신의학회 2011 소아청소년정신의학 Vol.22 No.2

Objectives:This present study examined the power of the Korean Child Behavior Checklist (K-CBCL) subscales to predict a DSM-IV diagnosis of oppositional defiant disorder (ODD). Methods:The sample included 37 children and adolescents with ODD and 46 normal controls. The participants and their parents were interviewed for clinical diagnosis using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) and the parents completed the K-CBCL. Logistic regression analysis was used to predict the diagnosis of ODD. Results:Among the CBCL subscales, Delinquent and Aggressive Behavior scales significantly predicted ODD diagnosis. The means of these CBCL subscales were significantly higher in the ODD group when compared to the controls. Conclusion:Two CBCL subscales (Deliquent and Aggressive Behavior) displayed good diagnostic efficiency for assessing ODD in children and adolescents. Through combining information from the CBCL, an empirical-quantitative approach to psychopathology in children and the DSM-IV diagnostic criteria, the results demonstrated that a clinical diagnostic approach is an effective diagnostic paradigm for children with ODD.

한국판 소아신체화척도 개발을 위한 예비연구

이소영(Soyoung Irene Lee),박준호(Joon-Ho Park),정한용(Han-Yong Jung) 대한소아청소년정신의학회 2008 소아청소년정신의학 Vol.19 No.3

Objectives: The purpose of this study was to develop the Korean Somatization Scale for Children (KSS-C) and to evaluate the reliability and validity of this scale. Methods: Sixty-five children and adolescents with somatic symptoms were evaluated the KSS-C, Child Version, the Childrens Depression Inventory (CDI), and the State-Trait Anxiety Inventory for Children (STAIC). 65 parents of the subjects evaluated the KSS-C, Parent Version and Korean version of the Child Behavior Checklist (K-CBCL). Psychometric properties and associations with the internalizing symptoms were. Results: Three factors were extracted by factor analysis. KSS-C was significantly correlated with the CDI, the STAIC, and the internalization, externalization and somatization scale of the K-CBCL. The KSS-C, Parent Version was significantly correlated with the KSS-C, Child Version. Frequently reported somatic symptoms in children were fatigue, headache, low energy, stomachache, and nausea. Conclusion: Both KSS-C, Child Version and KSS-P, Parent Version were valid and reliable instrument assess somatic symptoms in Korean children and adolescents.

소아·청소년의 재해정신의학

이소영(SoYoung Irene Lee) 대한소아청소년정신의학회 2002 소아청소년정신의학 Vol.13 No.1