지연성 운동장애 환자에서 뇌 척수액 丫-Aminobutyric Acid 농도에 관한 연구

권준수,김재진,우종인 대한신경정신의학회 1990 신경정신의학 Vol.29 No.6

The present study was undertaken to clarify the role of 丫-aminobutyric acid(GABA) in the pathophysiology of tardive dyskinesia. GABA concentrations in CSF were m easured in 14 schizophrenic patients without tardive dyskinesia, 15 schizophrenic patients with tardive dyskinesia and 18 neurologic patients without psychotic symptoms. In addition, GABA concentrations in CSF and clinical improvement of tardive dyskinesia w ere checked for dyskinetic schizophrenics after 8 weeks of treatm ent with sodium valproate, the GABAergic drug. Results were as follows: 1 ) A significant reduction in CSF GABA levels was observed in dyskinetic schizophrenics compared with the neurologic patients. 2) CSF GABA levels in schizophrenic patients without tardive dyskinesia were not significantly differnet from those in neurologic patients, although the data suggested a decrease in CSF GABA levels in schizophrenic patients. 3) A significant decrease in dyskinetic symptoms occurred with the administration of sodium valproate, associated with increase in CSF levels of GABA. The results of this study can be taken as a strong suggestion that GABA system is involved in the pathophysiology of tardive dyskinesia.

대한신경정신의학회 '장기발전계획 테스크 포스팀' 활동 보고

권준수 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.4

Ganser 증후군 1례의 임상적 고찰

박원명,권준수 대한신경정신의학회 1990 신경정신의학 Vol.29 No.2

We have experienced a 22year-old soldier with Ganser syndrome. He showed appropriate but incorrect answer, clouded consciousness, somatic symptoms and hallucinations. Also, differential diagnosis and psychodynamics were discussed with review of literature. There have heen a controversy in nosological status of this syndrome. Further stundy is required to understand the nature of this syndrome.

慢性精神分裂病 患者에서 電氣衝擊療法이 腦脊髓液 5-HT와 5-HIAA 濃度에 미치는 影響에 관한 研究

권준수,김기웅,우종인 대한신경정신의학회 1992 신경정신의학 Vol.31 No.5

The effect of a series of ECT treatments on the C SF 5-HT and 5-HIAA concentrations was studied in the 10 patients suffering from chronic treatment-resistant schizophrenia. The clinical improvement of the patients was assessed with BPRS weekly. Total BPRS scores signiflcantiy decreased after a series of ECT treatments. A nd positive, negative, thinking disturbance, withdrawal/retardation and hostility/suspiciousness symptom subscale scores were also decreased significantly after ECT treatments. But anxiety/depression symptom subscale score did not show statistically significant change. The CSF 5-HT concentrations significantly decreased after a series of ECTs. But the CSF 5-HIAA concentrations showed a trend to decrease which was not statistically significant. Percentile improvement on total BPRS score was positively correlated with pre-ECT concentration of CSF 5-HT showed the better clinical improvement. And percentile improvement on total BPRS scores showed significant negative correlation with change in the concentration of 5-HT after ECT treatments. These results suggest that ECT may be effective in the treatm ent of treatment-resistant chomic schizophrenia and, although it’s mechanism is still unknown, may affect the central serotonergic system in schizophrenics, which may be related to the clinical improvement after a series of ECTs.

치료저항성 강박장애의 약물학적 치료 및 통합적 치료 모형의 제안

권준수,하태현 대한신경정신의학회 2003 신경정신의학 Vol.42 No.3

There have been considerable advances in our understanding of the neurobiology and the treatment of obsessive-compulsive disorder (OCD). However, it seems that many patients with OCD are not met with proper treatment, and even the patients who receive sufficient therapy the response rate is not high. This paper reviews the pharmacological treatments of OCD with special focus on therapeutic options for treatment resistance cases. In treating a resistant case, the clinical characteristics including comorbid conditions of the patient should be reevaluated. Through until recently, there has been no standarized guideline to treat resistance cases and much is up to clinician’s preference, but thoughtful selection and combination of drugs with optimized psychosocial approach may improve the response rate. We propose an integrative therapy model for treatment resistant OCD to emphasize the need for the expansion of treatment resources. Treatment resistant OCD deserves more clinical and socioeconomic attentions and needs further research for management.

치료 저항성 환청을 호소하는 정신분열병 환자에 대한 반복 경두개 자기자극(rTMS)과 전기충격요법(Modified ECT)의 연속적인 치료 경험 1례

권준수,전홍진,윤탁 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.4

정신분열병에서 치료에 반응하지 않으며 지속되는 환청은 환자에게 매우 불쾌한 감정을 유발할 수 있으며 환청의 내용에 따라 위험한 경우도 있다. 환청에 대한 기능적 뇌영상 연구 결과로 환청이 정상 청각경로의 비정상적인 활성으로 발생하며, 환청이 들리는 동안에 좌측 상부 측두엽 등이 활성화 된다는 사실을 알게 되었다. 본 증례에서는 항정신병 약물에 대한 치료 저항성 환청을 가진 35세 기혼 여자 환자에 대해서, 좌측 상부 측두엽을 국재화한 후 뇌의 국소적 자극이 가능한 Magstim 200장비와 Double cone shaped coil을 이용하여 1HZ slow wave 반복 경두개 자기자극(rTMS)을 가하였다. 항정신병 약물을 유지한 상태에서 최고 100pulse의 총 14회의 자극을 통해 환청의 주관적인 크기의 30% 감소와 정동의 호전을 관찰할 수 있었다. 반복 경두개 자기자극(rTMS)종료 2주 뒤에 추가적으로 시행된 9회의 전기충격요법(ECT)결과 환청이 빠른 속도로 완전히 소실되었다. 치료저항성 환자의 환청에 대한 치료효과는 rTMS보다 ECT가 효과적임을 알 수 있었다. The Persistent auditory hallucinations may provoke the uncomfortable feeling and be dangerous according to its contents in treatment-resistant schizophrenic patients. Previous functional brain imaging studies on suditory hallucinations reported that the abnormal activations of the normal auditory pathway and the activations of the left upper temporal lobe were found while patients were hallucinationg voices. Base on the these findings, we treated a female schizophrenic patient with persistent auditory hallucinations that were treatment-refractory with rTMS and the ECT continuously while she was on the drug treatment. The total amount of pulses applied in each trial ranged from 240 to 1000pulses. Fourteen trials were done and resulted in decrease by 30% in the subject severity of auditory hallucinations and the improvement of the affect. Two weeks after the completion of rTMS trials, nine trials of ECT were administered which leaded to complete disappearance of auditory hallucinations. This result suggest that ECT is more effective than rTMS in treating persistent auditory hallucinations in treatment-resistant schizophrenic patients.

Harvard 醫科大學 精神科 專攻醫 敎育 參觀記

權俊壽 서울大學校 醫科大學 精神科學敎室 1996 精神 醫學 Vol.21 No.1

硏修記 : 하바드 의대 정신과 Dr. McCarley's Lab.

權俊壽 서울醫大 1997 精神醫學 Vol.22 No.2

손을 자주 씻는다'는 것을 주소로 내원한 25세 여자환자

權俊壽 대한의사협회 1999 대한의사협회지 Vol.42 No.1

한국 성인을 대상으로 한 전산화 Standard Progressive Matrices의 표준화 예비연구

홍경수,이민수,오병훈,하규섭,유한익,이창욱,연병길,김성윤,신민섭,김재진,권준수 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.5

연구목적 : 전산화 Standard Progressive Matrices(SPM) 검사의 한국인 성인 표준자료를 확립함으로써, 간이로 지능을 평가하는 경우에도 보다 정확하게 지능지수를 추정하기 위해서 본 연구를 수행하였다. 방 법 : 18세 이상의 남녀 정상인 자원자 353명을 대상으로 전산화 SPM 검사를 시행하고, 백분율 및 표준점수(T-점수)를 기준으로 하여 표준화 자료를 작성하였다. 전체 대상군을 성별, 연령별로 구분한 후 평균과·분포가 유사한 집단은 군을 합치는 방법을 사용하였다. 한국인 표준자료에 근거하여 추정한 SPM 지능지수와 외국인 표준자료에 근거하여 추정한 SPM 지능지수를 각각 KWAIS 지능지수와 비교함으로써 타당도를 검증하였다. 결 과 : 18∼30세, 31∼40세, 41∼50세, 51세 이상의 연령군으로 구분된 한국 정상 성인의 SPM 표준화 자료를 산출하였다. 본 연구 결과에 의한 표준화 자료를 적용하여 지능지수를 추정하는 것이 현재 사용하고 있는 외국인의 표준화 자료를 이용하는 것보다 KWAIS 지능지수에 더욱 근접한 결과를 보였다. 결 론 : 18세에서 50세까지의 한국인 남녀에게는 간이지능평가도구로서 전산화 SPM 검사의 한국인 표준화 자료를 유용하고 타당하게 적용할 수 있음을 확인하였다. Objectives : We conducted this study to provide standardized data of the computerized Standard Progressive Matrices(SPM) test in Korean adults. Methods : The computerized SPM test was administered to 353 healthy volunteers aged 18 years over. We provided the standardized data(percentile and standardized T-scores) for the groups with similar mean and distribution of SPM scores, which was originally divided by age and sex. The validity of the new standardized data was tested by comparing IQs estimated by SPM and K-WAIS. Results : The standardized SPM data were provided for four age groups : 18 to 30 years, 31 to 40 years, 41 to 50 years, 51 years and over. IQ estimated by this standardized data tends to be closer to IQ by K-WAIS than the IQ estimated by foreign normative data. Conclusion : The standardized data of the computerized SPM were proven to be a useful and valid tool for measuring IQ briefly, compared with the conventional way of measuring IQ.