불면증과 성격유형

함병주,김린,Ham, Byung-Joo,Kim, Leen 대한수면의학회 2002 수면·정신생리 Vol.9 No.2

Personality traits in insomniac patients have been a subject of many studies. A number of these studies have used the MMPI and have demonstrated elevated scores on several clinical scales reflecting somatic concerns, somatization, depression, anxiety, worry and social alienation. And it was suggested that insomnia was due to a process of internalization of psychological distress. Another hypothesis about psychological mechanisms has focused upon worry. Excessive and uncontrollable cognitive activity seem to be a characteristic feature of many insomniacs. One author emphasized the role of the dependency need and found a characteristic pattern among insomniacs. The central feature of this pattern is frustration of dependency need. The purpose of this paper was to review possible personality variable that may be predisposing causal factors of insomnia. Several factors are suggested by many studies, but in order to explore their causal importance other experimental and longitudinal studies are needed.

우울증의 약물유전체학

함병주,이민수,Ham, Byung-Joo,Lee, Min-Soo 대한생물정신의학회 2001 생물정신의학 Vol.8 No.2

The pharmacotherapy of depression has reduced morbidity and improved outcome for many depressive patients. A wide range of classical and new antidepressants are available for their treatment. However, 30-40% of all patients do not respond sufficiently to the initial treatment and present adverse effects. Pharmacogenetics studies the genetic basis of an individual's ability to respond to pharmacotherapy. Recently, some reports on serotonin transporter gene polymorphisms and their influence on the response to antidepressive therapy provide an interesting diagnostic tool in assessing the chances of response to antidepressants. We also investigated the relationship between serotonin transprter polymorphisms(5-HTTLPR) and the long-term effect of the antidepressant treatment. 128 depressive patients were enrolled into 2nd year study. The therapeutic response of each subset was not different at 8th, 16th week, but the subset with homozygote(l/l) of long variant showed a better therapeutic response to antidepressant than the heterozygote(l/s) of long and short variant, which showed a better therapeutic response than the subset with homozygote (s/s) of short variant at 1st year and 2nd year after the antidepressant treatment. This result shows that the serotonin transporter polymorphisms may be related to the long-term effect of antidepressant treatment. The potential for pharmacogenomics, the use of genetic information to guide pharmacotherapy and improve outcome by providing individualized treatment decisions, has gained increasing attention. pharmacogenomics will contribute to individualize drug choice by using genotype to predict positive clinical outcomes, adverse reactions, and levels of drug metabolism. Personalized medicine, the use of marker-assisted diagnosis and targeted therapies derived from an individual molecular profile, will impact the antidepressant therapy and this approach will replace the traditional trial-and-error practice of medicine.

감정표현불능증 : 그 개념과 치료적 함의

함병주,김린,Ham, Byung-Joo,Kim, Leen 대한수면의학회 2002 수면·정신생리 Vol.9 No.1

Alexithymia represents deficits in the cognitive processing and regulation of emotions. It is observed in many cases of psychosomatic disease, anorexia nervosa, panic disorder, depression etc. Many studies have shown that alexithymia is associated with maladaptive styles of emotion regulation, low emotional intelligence, interhemispheric transfer deficit, and reduced rapid eye movement density. Psychotherapies that enhance emotional awareness may be effective in alleviating the difficulties of alexithymic individuals. Aexithymia is useful for constructing the role of personality and emotions in the pathogenesis of psychiatric disorders. It may serve as a bridge between neurobiology and psychology. We review recent alexithymia theory and research and their implications for treatment of psychosomatic disorders.

항우울제와 우울증 환자의 삶의 질 - 삼환계 항우울제와 Sertraline을 중심으로 -

함병주,이민수,Ham, Byung-Joo,Lee, Min-Soo 대한생물정신의학회 1997 생물정신의학 Vol.4 No.1

This study investigated the antidepressant efficacy and it's impact on the quality of life of depressed patients. We performed Hamilton Depression Rating Scale(HDRS), and Montgomery-Asberg Depression Rating Scale(MADRS), and Health-related Quality of Life Questionnaire(HQLQ) to both tricyclic antidepressant(TCA) and sertraline groups. There were 16 subjects in this study. The tricyclic group had 9 subjects and the sertraline group had 7. The TCA and sertraline produced a similar degree of response. Both groups experienced a reduction of 70% or more in mean HDRS and MADRS total score after 6wks. In HQLQ, the TCAs group also showed improved bed disability days, alertness behavior, and social interaction, the sertraline group showed improved health perception, alertness behavior, home management, and social interaction. We suggested that the improvement of "Quality of life" were not in proportion to the clinical symptom's improvement. Therefore, clinicians should consider the benefit of antidepressant treatment in terms of quality of life.

우울장애의 신경생물학적 최신 지견 : 세로토닌 전달체에 대한 영상 유전학적 연구를 중심으로

함병주,Ham, Byung-Joo 대한생물정신의학회 2011 생물정신의학 Vol.18 No.4

Depressive disorders have strong genetic components. However, conventional linkage and association studies have not yielded definitive results. These might be due to the absence of objective diagnostic tests, the complex nature of human behavior or the incomplete penetrance of psychiatric traits. Imaging genetics explores the influences of genetic variation on the brain function or structure. This technique could provide a more sensitive assessment than traditional behavioral measures in psychiatric studies. Imaging genetics is a relatively new field of psychiatric researches, and may improve our understanding on neurobiology of psychiatric disorders. In this review, current understanding in neurobiology of depressive disorders, especially imaging genetic studies on serotonin transporter will be discussed.

수면 무호흡증이 있는 양극성 장애 환자에서 급속 정온요법으로 인해 발생한 급성 호흡 장애

함병주,서용진,김린,Ham, Byung-Joo,Seo, Yong-Jin,Kim, Leen 대한수면의학회 2001 수면·정신생리 Vol.8 No.2

Chemical restraint or "rapid tranquilization" is another option in treating patients who are a danger to themselves or others and struggle violently once physically restrained. The most commonly used drugs are benzodiazepines and antipsychotics. The use of benzodiazepines, either alone or in combination with high potency neuroleptics, has increased in recent years. Benzodiazepines are extremely safe but may cause respiratory depression and hypotension. Respiratory depression is more likely with intravenous administration, therefore these medications should be given slowly and titrated to the desired effect. Special care should be taken when sedating patients who are under the influence of alcohol or narcotics and are sleep apneic patients. This report deals with a case of respiratory distress in a patient with sleep apnea syndrome after the rapid tranqulization. All patients receiving chemical restraint must be carefully monitored. For critically ill patients who require sedation or chemical restraint, the constant attendance of a physician may be warranted.

Brain-Derived Neurotrophic Factor(BNDF) Val66Met 유전자 다형성과 성격 특성에 대한 연합연구

함병주,안희범,조수민,류성곤,최명진,이민수,최인근,Ham, Byung-Joo,An, Hwei-Beom,Cho, Su-Min,Ryu, Sung-Gon,Choi, Myoung-Jin,Lee, Min-Soo,Choi, Ihn-Geun 대한생물정신의학회 2005 생물정신의학 Vol.12 No.2

Background:Brain-derived neurotrophic factor(BDNF) genes are thought to be important factors in some personality traits. The goal of this study was to determine the role of these genes in personality traits. Method:The participants included 170 healthy adults with no history of psychiatric disorders and other physical illnesses for the last 6 months. All participants were tested by the Temperament and Character Inventory (TCI). BDNF Val64Met gene polymorphisms were analyzed with PCR(Polymerase Chain Reaction). Differences on TCI dimensions and sub-scales among groups were examined with ANOVA. Result:There was a significant correlation between BDNF Val64Met and Persistence(PS)(p=0.036) in female subjects, but none with the other TCI dimensions. A post-hoc comparison revealed significant a difference between Val/Val and Met/Met (p=0.031). Conclusion:Our study suggests that the BDNF Val64Met gene polymorphism is associated with persistence in Korean female subjects, but the small number of subjects limits generalization of our results. Further studies with a larger number of homogenous subjects are needed to confirm whether the BDNF gene is related to personality traits.

한국의 노인우울증 환자에서 조발성 우울증과 만발성 우울증의 임상증상의 비교

박기홍,이화영,함병주,이민수,Park, Ki-Hong,Lee, Hwa-Young,Ham, Byung-Joo,Lee, Min-Soo 대한생물정신의학회 2010 생물정신의학 Vol.17 No.3

Objectives : Clinical differences between elderly patients with early and late onset depression have been described although these have been inconsistent. We aimed to compare differences of clinical symptoms using the 17 items Hamilton Rating Scale for Depression(HAM-D-17) between two groups. Methods : Data of 175 elderly patients with a diagnosis of major depressive disorder according to DSM-IV from January 2005 to November 2009 were collected. Seventy five patients were early onset depression and one hundred patients were late onset depression. Depressive symptoms were assessed by the 17-item Hamilton Rating Scale for depression. Results : There were some differences in HAM-D-17 scores between early and late onset depression. Early onset depression patients scored significantly higher in retardation(t = 2.41, p = 0.017) and somatic symptoms( general)(t = 2.37, p = 0.019) than late onset depression patients. Conclusion : We concluded that early onset depression patients have more severe psychomotor retardation and general somatic symptoms than late onset depression patients in Korea. Because of some limitations of this study, further investigations will be needed to validate this study results.

한국인 우울 장애 환자에서 5-HTTLPR과 항우울제의 장기 치료 반응

이화영,함병주,이민수,Lee, Hwa Young,Ham, Byung-Joo,Lee, Min Soo 대한생물정신의학회 2002 생물정신의학 Vol.9 No.1

Background:Since serotonin neurotrasnmission plays an important role in the pathophysiology of depression, the drug that acts on serotonin transporter can be an effective antidepressant. The aim of this study was to investigate the relationship between serotonin transporter polymorphisms(5-HTTLPR) and the long-term effect of the antidepressant treatment. Method:The 175 depressive patients, who met DSM-IV criteria for major depressive disorder or dysthymic disorder were enrolled into three year study. The genotypes of the patients were investigated by polymerase chain reaction of genomic DNA with promoter regions of the serotonin transporter gene. The patients were assessed by the Clinical Global Impression Scale, at the 1st visit, 8th week, 16th week, 1st year, 2nd and 3rd year after the antidepressant treatment. Result:The genotypes of 138 patients were investigated and 128 of them finished this 1st year study and 107 remained in the study after 2-year treatment, and, 97 completed this 3-year study. The therapeutic response of each subset was not different at 8th, 16th week, but the subset with homozygote(l/l) of long variant showed a better antidepressant therapeutic response than heterozygote(l/s). The heterozygote(l/s) showed a better response than the subset with homozygote(s/s) of short variant at 1st, 2nd and 3rd year after the antidepressant treatment in CGI-global improvement score. Conclusion:This result shows that the serotonin transporter polymorphism may be related to the long-term effect of antidepressant treatment and there may be also ethnic difference.

알코올 의존 환자의 혈중 탄수화물결핍 트랜스페린 변화에 대한 4주간 추적 연구

박병양(Byung-Yang Park),이상걸(Sang-Keol Lee),이병철(Boung-Chul Lee),함병주(Byung-Joo Ham),최인근(Ihn-Geun Choi) 한국중독정신의학회 2008 중독정신의학 Vol.12 No.1

This purpose of this study is to explore the factors influencing the change of plasma CDT after a 4-week abstinence in patients with alcohol dependence. The subjects were 79 alcohol-dependent inpatients whose % CDT was greater than 2.6% at the baseline. In the monitoring of % CDT at the 4-week follow-up, 35 patients (32 male and 3 female) showed lower than the cutoff value of 2.6%, and 44 patients (37 male and 7 female) showed still less than that. The change of %CDT was associated with the age that the patients started drinking, certain he-patic indexes such as AST, ALT, and GGT in the baseline, and alcoholic cirrhosis. Otherwise, baseline %CDT, mean amounts and duration of drinking, BMI, amount of daily smoking, alcoholic hepatitis, and fatty liver were not associated with the change of %CDT. Further extensive studies are needed.