정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

치료저항 만성 정신분열증 환자에서 Clozapine과 Haloperidol의 치료효과에 대한 비교

이홍식,김찬형,이희상,남궁기,송동호,이영문,한은선 大韓臨床藥理學會 1993 臨床藥理學會誌 Vol.1 No.2

알쯔하이머형 치매와 혈관성 치매환자에서의 ALDH2와 APOE 유전자의 다형성에 관한 연구

김동홍,김영돈,이창화,엄기춘,김은식,윤경식,김동희 대한생물치료정신의학회 2002 생물치료정신의학 Vol.8 No.2

연구목적: 본 연구는 국내 치매환자들을 대상으로 치매발병의 위험요소가 될 수있는 ALDH2와 APOE 유전자형이 어떤 양상으로 나타나는지 알아보기 위하여 시행되었다. 방 법: 충남 부여군에 위치한 부여노인병원에 입원중인 65세 이상의 알쯔하이머형 치매와 혈관성 또는 혼재성 치매환자 59명(남:19, 녀:40)을 대상으로 ALDH2와 APOE 유전자형을 제한효소법에 의하여 조사하였고 치매유형에 따른 유전자형과 대립유전자의 빈도를 비교하였다. 결 과: 1) 알쯔하이머형 치매환자군에서 혈관성 또는 혼재성 치매환자군보다 ALDH2*(-/2)유전자형의 빈도가 높았으나 통계학적으로 의미있는 차이는 없었다. 2) 알쯔하이머형 치매화자군에서 혈관성 또는 혼재성 치매환자군보다 APOE*(-/ε4) 유전자형의 빈도가 높았으나 통계학적으로 의미있는 차이는 없었다. 3) APOE*ε4와 ALDH2*2를 알쯔하이머병의 균등한 위험대립유전자로 가정하고 각 유전자형의 대립유전자의 수를 점수화하여 각 치매환자군의 위험유전자 전체점수를 비교한 결과 알쯔하이머형 치매환자군에서 점수가 더 높게 나왔으나 통계학적으로 의미있는 차이는 없었다. 결 론: 알쯔하이머형 치매환자군에서 혈관성 또는 혼재성치매치매환자군보다 ALDH2*2와 APOE*ε4 대립유전자의 빈도가 높게 나왔으나 통계학적으로 의미있는 차이는 없었다. A study on gene polymorphism of ALDH2 and APOE in patients with alzheimer's disease and vascular or mixed dementia. Objective : This study was designed to investigate gene polymorphism of ALDH2 and APOE, reported the risk factor of Alzheimer's disease, in korean dementia patients. Method : 59 Patients(male:19, female:40) with dementia, aged 65 and older in Buyeo geriatric hospital located in Buyeo-gun, chungnam, were finally included in this study. gene polymorphism of ALDH2 and APOE was typed with polymerase chain reaction in patients with Alzheimer's desease and vascular or mixed dementia. Results : 1) There was no difference in allelic frequency of ALDH2 gene polymorphism between patients with Alzheimer's disease and vascular or mixed dementia. 2) There was no difference in allelic frequency of APOE gene polymorphism between patients with Alzheimer's disease and vascular or mixed dementia. 3) Supposing APOE*ε4 and ALDH2*2 were equal risk allele of Alzheimer's disease, the sum of score by counting each risk allele was higher in patients with Alzheimer's disease than vascular mixed dementia, however there was no significant difference. Conclusion : The genotype frequency of ALDH2*(-/2) and APOE*(-/ε4) was higher in patients with Alsheimer's disease than vascular or mixed dementia, however there was no significant difference in allelic frequency of gene polymorphism of ALDH2 and APOE between patients with Alzheimer's disease and vascular or mixed dementia.

개심술후 정신의학적 합병증

임기영,조범구,민성길,이홍식,유계준 大韓神經精神醫學會 1985 신경정신의학 Vol.24 No.1

Pre-and post operative psychiatric evaluations were done using semi-structured interview with Hamilton scales for anxiety and depression in 57 open heart surgery receipients to assess post-operative psychiatric complications. Conspicuous post-operative psychiatric complications were observed in 16 (23%) of 57 patients after open heart surgery. Postcardiotomy delirium occurred in seven patients; acute psychotic reaction with paranoid ideation in one; and neurotic reaction in eight. Factors that tended to influence postoperative psychiatric complications were older age, unempolyment, previous medical/psychiatric history, and high level of preoperative anxiety. By analysis of the preoperative psychiatric evaluation, patients could be largely divided in 3 groups; anxiety group, denial group, and adjusted group. Excessive anxiety and massive denial seemed to be signficant in the postoperative psychiatric compliactions. With these findings, the author's impression was that the consultation psychiatrist should give comprehensive psychiatric evaluation and psychiatric preparation in pre-and post-open heart surgery for the possible prevention of postopertive psychiatric complications.

비혈연간 동종골수이식에 의해 치료된 중증 재생불량성빈혈 1예

김현중,이홍기,이방훈,이창근,이종태,정현식,김원석,윤성수,강원기,박근칠,김대식,고영혜,박찬형 대한조혈모세포이식학회 1997 대한조혈모세포이식학회지 Vol.2 No.1

비혈연간 동종골수이식은 혈연간 동종골수이식이 불가능한 환자에서 기존의 면역역제요법으로 효과가 없었던 경우나 재발한 경우에 적응증이 될수 있다. 이식 거부와 이식편대숙주병의 발생이 골수 이식의 성공률을 감소시키므로, 보다 강력한 conditioning regimen의 사용과 T cell이 제거된 골수를 사용하는 것이 필요하다. 기존의 high dose corticosteroid나 cyclosporine에 대하여 불응성인 이식편대숙주병의 치료를 위해서 ATG와 Mycophenolate mofetil (Cellcept®) 의 사용이나 Tacrolimus, Methotrexate와 같은 다른 면역억제제치료를 고려해 볼 수 있다. It is known that allogenic bone marrow transplantation is the most effective treatment for aplastic anemia. However, this treatment is only applicable to a minority of patients because the proportion of patients who have HLA-matched siblings about 25% to 30% of all the aplastic anemia patients. In the case of the absence of HLA-matched donor, unrelated allogenic bone marrow transplantation is considered. However, (because of severe acute and chronic GVHD and graft failure) the success rate of this approach is only 20~30%. Recently, it was reported that increased immunosuppressive condition combined with T cell depletion of the marrow graft would result in greater success. There was no case of successfully treated aplastic anemia patient by unrelated allogenic bone marrow transplantation in Korea. Here, we report a case of severe aplastic anemia successfully treated with unrelated allogenic bone marrow transplantation.

난치성 만성정신분열증 환자의 생활의 질에 미치는 정신사회치료 프로그램의 효과에 대한 예비연구

송동호,배민진,이종호,이홍식,김선경,서호석,김찬형,전지용 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.4

Objects : Recent studies of psychosocial adjustment after hospitalization have found that the combination of maintenance antipsychotic drug treatment and psychosocial treatment including psychoeducational program are highly predictive of social rehabilitation and reduction of subsequent relapse. Two groups of patients with refractory chronic schizophrenia were preliminarily compared to determine the effect of a psychosocial treatment program on the quality of life in refractory chronic schizophrenics in an open comparative trial. Methods : One group(N=11) was assigned to approximately six months of the psychosocial treatment program(including psychoeducation program and activity program such as interpersonal relationship program, social skill training, self management program, outings, etc), in a group format, twice a week and a fixed maintenance dosage of clozapine ; while scale(QLS) was used to provide an objective measure of changes in patient's psychosocial functioning and a general assessment of psychopathology was made using the Brief Psychiatric Rating Scale(BPRS). Results : Both BPRS total positive score and the QLS total score, especially in the intrapsychic foundation factor of the scale showed a statistically significant improvement in the psychosocial treatment group. But there was no significant change in both BPRS and QLS scores over a 6-month period in the non-psychosocial treatment group. A significant negative correlation was found between the negative symptom and changes of QLS total, instrumental role and common object and activities scores respectively after receiving a 6-month of the psychosocial treatment program. Conclusion : These results suggest that a psychosocial treatment program including the integration of psychoeducation and a skill training oriented activity program serve as an outpatient treatment modality to improve the quality of the life in refractory chronic schizophrenia. To further clarify the effect of psychosocial treatment in chronic schizophrenia, a randomized trial should be done.

Metabonomic Understanding of Probiotic Effects in Humans With Irritable Bowel Syndrome

Hong, Young-Shick,Hong, Kyoung Sup,Park, Min-Hwa,Ahn, Young-Tae,Lee, Jung-Hee,Huh, Chul-Sung,Lee, Jaekyung,Kim, In-Kyoung,Hwang, Geum-Sook,Kim, Joo Sung Lippincott WilliamsWilkins, Inc. 2011 JOURNAL OF CLINICAL GASTROENTEROLOGY Vol.45 No.5

GOALS: This study was undertaken to evaluate the effects of probiotics on adult patients with irritable bowel syndrome (IBS) through clinical parameters and H nuclear magnetic resonance (NMR)-based metabonomics. BACKGROUND: As systematic effect of probiotics on inflammatory bowel disease through metabonomics approach has been extensively studied to date, metabonomic characterization of the probiotics effect on IBS is also needed for better understanding the effect with respect to host metabolic mechanism. STUDY: Seventy-four IBS patients meeting Rome criteria were randomized to receive probiotics and placebo through a parallel-group, double-blind, randomized, placebo-controlled clinical study. Probiotic fermented milk and placebo were administered 3 times daily for 8 weeks. Improvements of IBS were assessed according to Rome III questionnaires and H NMR metabolic profiling of serum and fecal samples from all participants was used to characterize a significant change in serum and fecal metabolome before and after probiotics. RESULTS: Fecal counts of the Lactobacilli, but not Bifidobacteria species, which included in the probiotic milk, were increased significantly in feces of IBS patients receiving treatment (P=0.014). NMR data set coupled with multivariate statistical analysis identified intrinsically elevated serum levels of glucose (P=0.0265) and tyrosine (P=0.0016) in IBS patients. These levels normalized to those of healthy individuals in the probiotic administration group, but not the placebo group. CONCLUSIONS: This metabonomic study suggests that in a subset of IBS patients there exists a potential dysregulation in energy homeostasis (serum glucose) and liver function (serum tyrosine) that may be improved through probiotics supplementation. Moreover, global metabolic profiling highlights the potential of metabonomic approach for assessing bowel diseases or symptoms with respect to host metabolic perturbation.

Effect of Heat Treatment on Water Permeability of Yeast Cells as Measured by Pulsed Field Gradient (PFG) NMR Spectroscopy

Young-Shick Hong,Ki-Jeong Suh,Sung-Won Yoon,Vladimir Skirda,Vitaly Volkov,Cherl-Ho Lee 한국식품과학회 2004 Food Science and Biotechnology Vol.13 No.5

Metabolomics in Food Chemistry

Young-Shick HONG 한국생물공학회 2016 한국생물공학회 학술대회 Vol.2016 No.10

Cyproheptadine Augmentation of Haloperidol in Chronic Schizophrenic Patients : A Double-Blind Placebo-Controlled Study

Hong Shick Lee,Jin Hak Kim,Young Moon Lee,Eun Sun Han,Man Kwon Kim,Byung Hoon Oh,Sung Kil Min Kae Joon Yoo,Ho Young Lee 대한신경정신의학회 1994 신경정신의학 Vol.33 No.1

40명의 만성정신분열증 환자를 대상으로 Haloperdiol에 대한 Cyproheptadine 병용치료 효 과를 검중하기 위하여 6주간의 위약ᅳ대조,이중맹검 연구를 시행하였다. 6주간의 이중맹검 Cyproheptadine 병용치료는 양성 및 음성증상 모두에서 임상적인 중상의 호전을 보였으나 위약과 Haloperidol이 병용 투여된 대조군과 비교한 임상적 정신증상에서는 두군 간의 유의한 통계적 차이는 보이지 않았다. 그러나 Cyproheptadine 병용치료는 대조군에 비해 추체외로 증상의 유의한 감소를 보임으로써 항정신병 약물의 비정형적인 특성이 있음을 지지해주고 있다. 신경 내분비학적 검사에서는 Cyproheptadine 병용치료가 혈청내 prolactine치를 감소시 키지는 않았으나 혈청내 cortisol 치를 유의하게 감소시켰다. 비록 보다 장기간의 추적 연구가 필요하겠으나 본 연구의 결과는 Cyproheptadine 병용치료가 기존 전형적인 항정신병 약물로 인한 추체외로 부작용으로 지속적인 약물치료가 힘든 만성정신분열증 환자의 치료에 효과적일 수 있음을 제시한다