Mianserin에 의한 불안정 하지 증후군 4례

박원명,김용찬,백인호 大韓神經精神醫學會 1986 신경정신의학 Vol.25 No.2

This is a clinical report of 4 cases of restless legs syndrome developed in patients diagnosed as major depressive disorder by DSM-III criteria, who were treated with "Mianserin" which is known as one of the new generation tetracyclic antidepressants. With the duration of the average of 1 or 2 weeks following the administration of mianserin, all of these patients showed characteristic symptoms of restless legs syndrome which included unpleasant creeping sensation and vague discomfort on the both legs at rest typically in the evening and during the night. For the prevention of exacerbation of these symptoms, hotbag, diazepam, lowering or discontinuation of mianserin, and shifting to another antidepressants including tricyclic antidepressants had concurrently been tried and proved effective.

정신분열증 환자의 Haloperidol 투여에 따른 혈청 Neopterin 농도의 변화

이충기,이 철,박태영,김정진,이창욱,이수정,백인호 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.5

본 연구는 정신분열증과 세포매개성 면역반응의 관계를 간접적으로 규명하고자 가톨릭대학교 강남성모병원 정신과에 입원한 환자 17명과 정상대조군 17명을 대상으로 neopterin 농도를 측정하였으며 환자군내에서 항정신병약물 투여에 따른 neopterin 농도 변화를 관찰하고 동시에 neopterin 농도변화와 BPRS 점수에 의한 임상증상과의 관성을 알아보아 다음과 같은 결과를 얻었다. 1) haloperidol 투여전 환자군 neopterin 농도(11.93±5.72nmol/1)는 정상대조군 neopterin 농도(6.65±1.97nmol/1)에 비해 유의하게 높았다.(p<0.05). 2) 정신분열증 환자에서 haloperidol(평균용량 20.47±5.42mg) 투여후 neopterin 농도(10.05±4.32nmol/1)는 투여전 neopterin 농도(11.93±5.72nmol/1)에 비해 유의하게 감소하였다(p<0.05). 3) 정신분열증 환자군에서 haloperidol 투여전과 투여후 4주째 측정한 neopterin 농도변화와 임상증상 변화사이에는 유의한 상관관계를 보이지 않았다. 약물 투여 전후에 따른 호전군과 비호전군 두 집단에서 neopterin 농도 변화와 임상증상 변화사이에는 유의한 상관관계를 보이지 않았다. 이상의 결과에서 정신분열증 환자의 세포매개성 면역반응과 관련된 cytokine의 활성도를 간접적으로 반영하는 neopterin 농도가 정상대조군에 비해 높았고, haloperidol 투여후의 neopterin 농도는 투여전에 비해 낮았으나 임상증상과 상관관계는 없었다. Objects : This study was designed to investigate the relationship of cellular immune function to schizophrenia by quantitative analysis of neopterin. Also, it examined the change of serum neopterins following the administration of haloperidol, and correlation between reponse of improvement and change of neopterin concentrations in schizophrenis. Methods : The subjects consisted of 17 schizophrenics who had been admitted to the Department of Psychiatry, Catholic University Kangnam St. Mary's Hospital from Dec. 1, 1994 to June 31, 1995, and 17 normal controls. We measured serum neopterin levels by radioimmunoassay. Also, we observed the correlation between the changes of serum neopterin concentrations and clinical improvement measured by BPRS before and 4 weeks after haloperidol administration. Results : The results were as follows : 1) The serum neopterin concentrations in unmedicated schizophrenics were significantly higher than those of normal controls(p<0.05). 2) The serum neopterin concentrations measured after haloperidol administration were significantly lower than those before haloperidol administration in schizophrenics(p<0.05). 3) The correlations between changes in serum neopterin and clinical improvement were not significant. Conclusions : These results suggested that altered cellular immunity might in part play a role in the pathophysiology of schizophrenia. However, it did not seem that serum neopterin would be associated with clinical response in schizophrenics.

Clozapine 투여후 설사와 혈소판 감소증이 나타난 환자 1례

김진희,이창욱,김정진,김우선,백인호 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.3

The clozapine has been used to the treatment of schizophrenic patients unresponsive to conventional antipsychotics, but to administration of clozapine has been restricted because of its propensity to cause agranuloytosis. So side effects associated with the administration of clozapine have probably not been fully elucidated. The authors describe a case of a male schizophrenic who developed prefuse diarrhea, spiking fever and thrombocytopenia associated with the administration of clozapine. Discontinuance of clozapine therapy resulted in improvement of diarrhea and fever followed by normalization of the platelet count. Previous reports of adverse hematologic side effects and gastroenteric reaction induced by clozapine administration are also discussed. We suggest that the physician must keep in mind these side effects and administer clozapine cautiously.

Lorazepam과 Diphenhydramine 의 추제외로증후군에 대한 효과비교

서미라,최보문,백인호 大韓神經精神醫學會 1986 신경정신의학 Vol.25 No.1

In this study, a comparative evaluation on clinical efficacy between intravenous lorazepam and diphenhydramine for extrapyramidal symptoms occurring on neuroleptic therapy was made. Subjects were consisted of 42 cases including 8 males and 34 females. They were under double-blind procedure, given single injections of 4 miligrams of lorazepam(21 cases) and 50 miligrams of diphenhydramine(21 cases) seperately. The effects were evaluated by Extrapyramidal Symptoms(EPS) Rating Scale for extrapyramidal Symptoms as well as by the Brief Psychiatric Rating Scale(BPRS) for psychotic symptoms and signs. The results were as follows: 1)Most of extrapyramidal symptoms including parkinsonian symptoms, akathisia and dystonia were noted to be significantly improved 60 minutes after injection on EPS Rating Scale scores. 2)BPRS evaluation 60 minutes after injection resulted in significant reduction of the total mean scores in both groups, although no significant difference can be made in terms of efficacy between the group when the two groups were compared. 3)Clinically it can be suggested that the sedative effect of diphenhydramine was less than that of lorazepam. The above mentioned results suggest that lorazepam and diphenhydramine may well be the drugs of choice for the treatment of extrapyramidal symptoms occurring on the neuroleptic therapy.

만성정신분열장애 환자의 시각유발전위: 대뇌기능의 비대칭성에 대한 예비적 연구

박원명,김용찬,백인호 大韓神經精神醫學會 1986 신경정신의학 Vol.25 No.3

The etiology and pathophysiology of schizophrenics has not been precisely described until now. There has been many studies which have elucidated the neuroanatomical and neurophysiological abnormalities of schizophrenics using the up to date bilolgical measurement methods like brain CT, positron emission tomography, cerebral evoked potentials, and measuring regional cerebral blood flows. The authors have chosen the visual evoked potential which have recently turned out ot be one of important neurophysiological diagnostic tools, and tried to confirm the asymmetry of cerebral function & local dysfunction in schizophrenics. We have performed visual evoked potential to 20 patients admitted to Kangnam St. Mary's Hospital of Catholic Medical College from Oct. 1985 till March 1986, and to 20 normal controls, and the results were as follows; 1) Amplitude at stimulus intensity of 0.6 Joule (Median, Range); Patient group showed 5.6㎶, 9.9㎶ at O₁site, 5.9㎶, 10.3㎶ at O₁site, 6.3㎶, 10.6㎶ at O₂site. 2) Amplitude at stimulus intensity of 1.2 Joule (Median, Range); Patient group showed 5.2㎶, 18.4㎶ at O₁site, 7.0㎶ 17.2㎶ at O₂site and control group showed 7.7㎶, 18.2㎶ at O₁site, 5.8㎶, 16.5㎶ at O₂site. 3) Latency at stimulus intensity of 0.6 Joule (Mean ±SD); Patient group showed 108.0 ±13.7 msec at O₁site, 108.0 ±13.6 msec at O₂site and control group showed 107.2 ±11.1 msec at O₁site, 109.3 ±10.6 msec at O₂site. 4) Latency at stimulus intensity of 1.2 Joule (Mean ±SD); Patient group showed 111.6 ±4.6 msec at O₁site, 109.8 ±17.2 msec at O₂site and control group showed 103.7 ±11.0 msec at O₁site, 103.5 ±11.8 msec at O₂site. 5) There was no asymmetry of visual evoked potential obtained from right & left hemisphere of both patients & controls. 6) We have also compaired the amplitude & latency and found no significant difference statistically between the two groups.

만성정신분열증 환자에서 Cholecystokinin의 치료효과

이창욱,김보연,최중철,백인호 大韓神經精神醫學會 1994 신경정신의학 Vol.33 No.2

This study was designed to investigate antipsychotic properties of cholecystokinin-octapeptide(CCK-8) in schizophrenic patients. Subjects were 30 chronic schizophrenics with residual symptoms following stablization with antipsychotic drugs. CCK-8(0.2㎍/㎏) or placebo was administered intravenously single injection with double-blind method while patients received constant dose of antipsychotic drugs. The clinical effect of CCK-8 was evaluated with BPRS which was applied to patients 2 hours before and 3 and 7 days after drug administration. Results showed no significant differences between CCK-8 group and placebo group.

단기순환형 정동장애 3례

김은혜,최보문,유태열,백인호 大韓神經精神醫學會 1988 신경정신의학 Vol.27 No.4

Three cases of rapid cycling affective disorders were examined from a clinical perspective. We presented several different etiologies to the rapid cycling pattern in these patients. It was revealed that the rapid mood swings were due to natural expression of the affective disorder, tricyclic induced, lithium induced, and a combination of the aforementioned etiologies. Brief reviews on factors considered to induce rapid cycling, its etiopathogensis, clinical features and treatment strategies were also presented.

PC12 세포에서 Sertraline을 위시한 항우울제에 의한 칼슘길항 유사효과

박기창,공인덕,정해숙,한준규,박규상,이중우,백인호 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.3

본 실험에서는 PC12 세포를 신경세포 모델로 형광물질인 fura-2 및 bisoxonol을 이용하여 세포내 유리 칼슘이온 농도 및 막전압을 각각 측정하여 화학구조가 서로 다른 몇몇 항우울제가 막전압 의존성 칼슘통로의 활성화 및 ATP를 통한 수용체 의존성 칼슘통로의 활성화에 미치는 영향을 관찰하여 아래와 같은 결과를 얻었다. 1) 선택적 serotonin 재흡수 억제제의 하나인 sertraline은 60mM KCI 자극 및 100μM ATP 자극에 의한 [Ca²+]i의 증가를 억제하였으며 이때 IC50 값은 각각 2.5μM과 5.3μM이었다. 2) 막전압 의존성 칼슘통로 및 ATP에 의한 수용체 의존성 칼슘통로의 억제효과는 sertraline을 비롯한 선택적 serotonin 재흡수 억제제나 삼환계 항우울제인 경우 크나, 비전형 항우울제인 trazodone 이나 MAO 억제제인 moclobemide의 경우에는 효과가 미미했다. 3) Sertraline 자체는 농도 의존적으로 지속적인 막전압의 탈분극을 유발하였으며 이에 따라 안정시의 세포내 유리 칼슘이온 농도를 일부 증가시켰다. 4) Sertraline에 의한 칼슘이온 농도 증가효과는 일부 세포내 Ca²+ 저장소로부터 동원이 관여하나 주로 세포막을 통한 칼슘유입에 의해 일어난다. 5) 여러 항우울제 중 sertraline에 의한 탈분극 효과가 가장 컸으며 그 외의 선택적 serotonin 재섭취 억제제, 삼환계 항우울제들은 탈분극 효과가 있었으나 비전형 항우울제인 trazodone은 일부의 효과를 그리로 MAO 억제제인 moclobemide는 막전압에 전혀 영향을 주지 않았다. 6) ATP는 일시적인 탈분극을 유발하였는데 sertraline 전처지로 탈분극 효과가 억제되었으며 이때 IC50는 30μM이었다. 7) ATP에 의한 세포내 칼슘이온 농도의 증가는 nimodipine에 의해 일부만 억제되었으나 sertraline을 함께 투여한 경우에는 그 억제 효과가 훨씬 더 증가하였다. 이상의 실험결과로 미루어 보아 항우울제 중에서 sertraline을 비롯한 선택적 serotonin 재흡수 억제제나 삼환계 항우울제들은 신경세포를 지속적으로 탈분극 시키고 세포내 유리 칼슘농도를 증가시키는 한편 막전압 의존성 칼슘통로와 수용체 의존성 칼슘통로를 차단하여 그 효과가 나타나는 것으로 사료된다. It has been known that antidepressants have calcium antagonist-like action in neuronal tissues. However, their mechanisms are still obscure. For the study of neurochemical mechanism of antidepressants, the authors examined the effects of antidepressants(1-100μM) on the intracellular Ca²+ concentration ([Ca²+]i) and the membrane potential in PC12 cells using fluorescent dyes, fura-2/AM and bisoxonol, respectively. The results were as follows : 1) Sertraline, a selective serotonin reuptake inhibitor(SSRI), inhibited the increment of [Ca²+]i induced by high 60 mM KCl and 100μM ATP with an IC50 value of 2.5μM and 5.4μM, respectively. 2) SSRIs(sertraline, paroxetine and fluoxetine) and tricyclic antidepressants(imipramine and amitriptyline) had strong effects on the inhibition of both voltage-dependent Ca²+ channel and receptor-dependent Ca²+channel, whereas atypical antidepressant(trazodone) and MAO inhibitor(moclobemide) had little effects. 3) Sertraline itself depolarized the membrane potential in a sustained manner depending on its own concentration and it also increased the basal level of [Ca²+]i. 4) The increment of [Ca²+]i might be induced partly by the release from the intracellular calcium store, but mostly induced by the calcium transport through membrane. 5) Among those antidepressants tested, sertraline was the most potent one, Other SSRIs(paroxetine and fluoxetine) and tricyclic antidepressants(imipramine and amitriptyline) were moderately potent. Atypical antidepressant(trazodone) had little effects, and MAO inhibitor(moclobemide) had no effect on the depolarization. 6) External application of ATP induced temporary depolarization. This effect was blocked by prior treatment with sertraline with an IC50 value of 30μM. 7) The increment of [Ca²+]i through voltage-dependent Ca²+ channel was almost inhibited by a selective calcium channel blocker(nimodipine). However, the ATP-induced increment of [Ca²+]i was partially inhibited by nimodipine. These inhibitor effects were potentiated by the addition of sertraline. In the light of these results, it is likely that SSRIs and tricyclic antidepressants could show the blocking effects on both voltage-dependent and receptor-dependent calcium channel by depolarizing neuronal cell membrane potential in a sustained manner and by increasing intracellular free calcium level.

음성 정신분열증 환자의 이중 맹검법을 이용한 Methylphenidate와 Haloeridol 병합투여 효과 및 1년 후 추적비교

김보연,김진희,김정진,한양순,이창욱,이수정,이철,백인호 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.2

목 적: 본 연구는 음성증상이 두드러진 정신분열증 환자를 대상으로 중추신경자극제인 MP를 HPD과 병합투여하여 MP의 음성증상에 대한 효과를 알아보고 약물투여에 반응이 있는 환자들을 중심으로 임상변인과의 관계를 평가해 보고자 하였다. 방 법: HPD를 복용중인 22명의 음성 증상이 두드러진 만성 정신분열증 환자를 대상으로 이중맹검법을 이용하여 6주간 MP를 병합투여하였다. MP투여군은 10mg으로 시작하여 2주마다 10mg씩 증량하여 30mg까지 복용하도록 하였다. MP투여군과 대조군에게 MP 병합투여 전, 병합투여 후 2.4, 6주에 각각 PANSS, AIM또 약물의 부작용 등을 평가하였고, 각 임상변인과의 연관성을 알아보았다. 1년 후에 환자들의 증상변화를 추적조사하였다. . 결과: 1) MP투여군과 대조군은 투여시점에 따라 음성증상과 일반 정신병리에서 유의한 감소가 있었으나 두 군 사이에는 통계적으로 유의한 차이가 없었다. 2) AIMS로 특정한 이상운동의 변화, 약물에 의한 기타 부작용 등은 연구기간 중에 악화되거나 관찰 되지 않았다. 3) 정신병리에 대한 1년 후의 추적검사에서 두 군 사이에 유의한 차이가 없었다. 결 론: MP는 정신분열증의 음성증상에 대해 뚜렷한 효과를 가지지 못하는 것으로 보여진다. Objective : This study was designed to examine, whether methylphenidate(MPD) might have an effect on the negative symptoms in schizop Method : We administered MPD to 22 schizophrenic patients who had been taking haloperidol(HPD) by double-blind trial for 6 weeks. The scores of PANSS(Positive and Negative symptom Scale) and AIMS(Abnormal Involuntary Movement Scale) and other side effects were compared between the group of MP and HPD coadmistration and that of HPD at baseline and 2,4 and 6 weeks after. All patients were fo11owed up for the clinical changes 1 year after the study. Result : There were not significant differences between the group of MP and HPD coad-ministration and that of HPD in PANSS, AIMS and other side effects. The clinical scores were not changed in the group of MP and HPD coadministration as well as in that of HPD. Conclusion : These results suggest that MP would not have an effect on the negative symptoms in schizophrenic patients.

청소년의 부모에 대한 기대와 만족도 : Normal Population 정상집단

백인호 大韓神經精神醫學會 1976 신경정신의학 Vol.15 No.1

Psychiatric theories suggest that child rearing practice and parent-child relationship are main clue to the development of personality. Having this kind of view in mind, this study aimed to evaluate perceived parental attitude and children's expectancy toward parents and to identify what kind of parental attitudes are more influencing on the locus of control such as internal control or external control. Perceived parental attitudes was estimated by MacDonald's Perceived Parental Attitude Scale which is revised in Korean. And in order to evaluate the expectancy toward parents the auther make up another rating scale according to the MacDonald's perceived parental Attitude Scale. Subjects are consited of 200 adolescent, 15-16 years old boys and girls. The results were as follow; 1. Eventhough there are some differences between child's perception and expectancy to parents, it seems grossly to be satisfactory. But compared with the result of MacDonald's research, principal discipline and instrumental companionship are more less than its expectancy, both sexes, in this sample. 2. Fater, compared with Mother, seems to be significantly less nurturance than expectation in male. 3. Low Locus of Control seems to be more influenced by mother's attitudes such as instrumental companionship, principal discipline, and emotional punishment. This kind of results suggest that instrumental companionship and principal discipline in concordance with achievement pressure must be considered for the desirable parent-child relationship as well as healthy personal adjustment.