치료저항성 우울증 환자의 양극성 경향

우영섭,채정호,서호준,송후림,전태연,김광수,박원명 대한정신약물학회 2006 대한정신약물학회지 Vol.17 No.5

Objective: In this study, we determined the prevalence of bipolarity in patients with treatment resistant depression (TRD) by investigating demographic and clinical characteristics, diagnostic subtypes, and illness outcome. Method: A medical record review of patients admitted to a university hospital with the diagnosis of major depressive disorder (MDD) was conducted. DSM-IV diagnoses at index hospitalization and six months after discharge and detailed clinical information were obtained. We categorized subjects into a TRD group or a non-TRD group and re-evaluated the patients using the recently proposed criteria for bipolar spectrum disorder(BSD). Patients in the TRD group were compared with patients in the non-TRD group with regard to the prevalence rate of BSD at the index hospitalization and at the end of the follow up period. Results: There were 281 patients diagnosed as MDD. At discharge, the number of patients who fulfilled the criteria for BSD was higher (p<.001) in the TRD group (32/68, 47.1%) than in the non-TRD group (8/213, 3.8%). At the end of six-month follow-up period, the diagnoses of 38 patients changed; 18 (26.5%) in the TRD group were subsequently classified as having bipolar disorder, and seven (3.3%) in the non-TRD group (p<0.001). There was no difference between these two groups in other clinical and demographic variables. Conclusions: The findings suggest that a large number of patients with TRD have a bipolar diathesis.

經濟成長과 未來의 企業

우영섭 경기대학교연구교류처 1971 論文集 Vol.1 No.-

한국형 양극성 장애 약물치료 알고리듬 2014: 조증 삽화

우영섭,박원명,전덕인,서정석,이정구,정종현,김문두,손인기,심세훈,민경준,윤보현,신영철 대한정신약물학회 2014 대한정신약물학회지 Vol.25 No.2

Objective The pharmacotherapy of bipolar disorder has many difficulties such as various clinical feature according to eachepisode, recurrence, breakthroughs, treatment resistance, switching and worsening of its course. Recent rapid developmentand research of bipolar disorder and psychopharmacology, including atypical antipsychotics and new anticonvulsants, makeit more difficult to choose the appropriate pharmacological options. Therefore, we decided to revise the Korean MedicationAlgorithm Project for Bipolar Disorder (KMAP-BP) 2010 in order to provide more proper guideline for clinicians. Methods Like the previous version, KMAP-BP 2010, we performed the survey using questionnaire comprising 55 mainquestions in which 8 main questions and 478 sub-items for treatment of manic or hypomanic episode were included. Sixtyfourmembers of the review committee completed the survey. The executive committee analyzed the results and discussedthe final production of algorithm considering scientific evidence. Results The first-line pharmacotherapeutic strategy for acute manic episode is combination of mood stabilizer and anatypical antipsychotic, and it is the treatment of choice for euphoric, psychotic and dysphoric/mixed mania. The preferencefor monotherapy with atypical antipsychotic (for all three types of mania) or mood stabilizer (for euphoric mania) was increasedin KMAP-BP 2014. Valproic acid and lithium are chosen as the preferred mood stabilizer of the first-line treatment ofacute manic episode and valproic acid was the treatment of choice for all types of mania. Atypical antipsychotics is morewidely accepted than before in manic and hypomanic episode. Moreover, the preference for combination treatment in manicpatients who failed to respond in early stage treatment was increased. Conclusion Compared with the previous version, we found that ‘no-consensus’ decreases in this revision. These suggestthat the many clinicians agree with others in the treatment of acute manic/hypomanic episode, and the pharmacotherapy ofmanic/hypomanic episode become more obvious than before. Atypical antipsychotics such as aripiprazole, olanzapine andquetiapine gain more awareness in the treatment of bipolar mania and hypomania. We expect this algorithm may provide cliniciansgood information and help about the treatment of bipolar disorder, manic/hypomanic episode. 정신과적 질환의 약물치료의 발전에 따라, 이를 실제 임상상황에 맞도록 정리하여 제시하는 지침서 또는 알고리듬의역할은 점점 확대되고 있다. 이에 2002년 발간되었던 KMAPBP2002와 2006년 개정판(KMAP-BP 2006), 2010년 개정판(KMAP-BP 2010)에 이어 2014년판 한국형 양극성 장애 약물치료 알고리듬을 발간하였다. 본 개정판에서는 양극성 장애에 대한 근거자료의 축적과 치료 전략과 진단적 접근의 변화를 반영한 전문가들의 의견을 취합하였다. 모든 조증 유형에서 기분조절제(valproic acid 또는 lithium)와 비정형 항정신병약물의 병합 치료가 최우선 치료였으며, 경조증의 경우에는 기분조절제 혹은 비정형 항정신병약물 단독 치료가 1차 선택이었다. 급성기 조증의 치료에 사용하는 기분조절제로서는 valproic acid가 모든 형태의 조증에서 최우선 치료로 선택되었고, lithium은 모든 형태의 조증에서 1차 약물로 평가되었다. 기분조절제 단독 치료에 반응이없는 경우에는 비정형 항정신병약물을 추가하는 것이 최우선치료였으며, 단독 치료에 반응이 전혀 없다면 비정형 항정신병약물로 교체하는 것 또한 1차 치료로 평가되었다. 또한 비정형 항정신병약물 단독 치료에 반응이 불충분하다면 기분조절제를 추가하는 것이 1차 치료 전략이었다. 급성기 조증 삽화에 대하여 선호되는 비정형 항정신병약물은 aripiprazole,olanzapine, quetiapine, risperidone이었으며, 특히 혼재성 조증 및 정신병적 조증에서는 olanzapine이 최우선 치료로 선택되었다. 조증 삽화 부분에서 KMAP-BP 2014의 특징은 이전 판에비하여 유쾌성 조증에 대해서는 기분조절제 단독 치료의 선호도가 증가하고, 혼재성 조증에서는 기분조절제와 비정형항정신병약물 병합 치료의 선호도가 증가하였고, 비정형 항정신병약물 단독 치료에 대한 선호도는 개정을 거듭할수록증가하고 있다는 점이다. 이는 조증의 각 아형과 비정형 항정신병약물의 다양한 치료 효과에 대한 연구결과가 축적되고이해가 증가하면서, 증상의 특성에 따른 좀 더 특화된 치료가선호되고 있음을 의미한다고 할 수 있다. 또한 전문가들 사이에 컨센서스를 이루지 못한 항목이 이전에 비하여 줄어들어,조증 삽화의 치료에 대하여 많은 전문가들의 의견이 일치되고 있음을 알 수 있었다. 양극성 조증의 치료에 대해서는 지속적으로 새로운 약물이도입되고, 기존의 약물들의 치료적 적용에 대한 새로운 접근도 계속되고 있다. 향후 이러한 변화를 반영한 알고리듬의 제작과 실제 임상에서의 적용 효과에 대한 관심은 지속적으로필요할 것이다.

신경내분비계 조절 기전의 새로운 항우울제들: 시상하부-뇌하수체-부신 축을 중심으로

우영섭,박원명 대한우울조울병학회 2010 우울조울병 Vol.8 No.1

Despite the availability of numerous options for the treatment of depression, most depressed patients fail to achieve remission and a substantial minority show minimal improvement. Although the monoaminergic neurotransmitters are undoubtedly involved, it is now recognized that changes in the levels of monoamines produced are not sufficient on their own to explain the mechanism of action of antidepressants. Many studies have gathered substantial evidence that hypothalamic-pituitary-adrenal (HPA) system dysregulation plays an important role in the pathophysiology of depressive disorder. According to the corticoid receptor hypothesis of depression, hyperactivity of the HPA is one of the major pathophysiological factors. CRH1 Receptor antagonist has a huge amount of preclinical data suggesting antidepressant effect, but failed to show significant differences between this drug and placebo in the only controlled trial. There is some evidence from animal studies that vasopressin V1b receptor antagonist may have anxiolytic and antidepressant properties. Cortisol synthesis inhibitor (metyrapone) has significant AD effect as augmentation. Glucocorticoid receptor antagonist (mifepristone) significantly reduce psychotic symptom in psychotic major depression but showed no significant effect in depressive core symptoms. DHEA has antiglucocorticoid properties and significant antidepressant efficacy.

양극성 장애 외래 환자에 대한 약물 처방 경향:비정형 항정신병약물을 중심으로

우영섭,박원명,민경준,하규섭,전덕인,조현상,윤보현 대한정신약물학회 2006 대한정신약물학회지 Vol.17 No.6

우울증의 치료

우영섭 대한내과학회 2006 대한내과학회지 Vol.70 No.2

Metformin을 투여하여 항정신병약물 유발 무월경이호전된 여성 조현병 환자 2예

우영섭,박원명 대한정신약물학회 2013 대한정신약물학회지 Vol.24 No.4

본 증례들은 항정신병약물의 투여 이후 발생한 무월경에 대하여 metformin을 500~1,000 mg/day 투여한 후 월경이 회복된 증례이다. 두 증례 모두에서 metformin을 투여한 이후 4~10주 이내에 월경이 회복되었으며, metformin 투여와 관련하여 신체적, 정신과적 부작용은 발견되지 않았다. 본 논문에서 보고된 2예만을 근거로 metformin의 무월경에 대한 효과를 입증하기는 어려우나, 많은 여성 조현병 환자에서 항정신병약물 치료에 문제를 유발하는 무월경 증상에 대한 치료적 대안으로 metformin을 고려할 수 있을 것으로 생각한다. 향후 잘 계획된 연구를 통하여 metformin의 무월경에 대한 효과와 그 기전의 규명이 필요할 것으로 생각한다. Amenorrhea is a common adverse event in female patients treated with antipsychotics. Because amenorrhea can produce difficulties for women suffering from schizophrenia, attempts should be made to alleviate antipsychotic-induced amenorrhea. We report two cases of female schizophrenic patients whose antipsychotic-induced amenorrhea were treated with metformin. Two patients who treated with metformin resumed their menstruation within three months. There was no adverse event reported during metformin treatment. This paper presents the rationale for the use of metformin for female patients who suffered from antipsychotic-induced amenorrhea through a literature review

經濟發展과 人口成長의 相互關聯性에 대한 硏究

우영섭 경기대학교연구교류처 1976 論文集 Vol.4 No.-

조기 발병 양극성 장애 환자의 임상적 특징 : 후향적 의무기록 조사 연구

우영섭,박민현,서호준,채정호,전태연,박원명 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.5

Objective : Bipolar disorder is a disease with diverse clinical profiles and outcomes. In recent years, it is suggested that if bipolar disorder occurs early in one's life, functional and symptomatic prognoses are poor. The prognoses include severe Symp-toms, frequent psychotic symptoms, comorbidity ofmental illnesses, slow improvement of the symptoms, and high suicide rate. We investigated the clinical characteristics of early onset bipolar inpatients. Method : The subjects of this study were selected from the patients who were discharged after hospitalization between January 1, 2001 and May 31, 2005 and diagnosed with bipolar disorder according to DSM-IV criteria. These patients were examined for the following data ; the type of bipolar disorder, comorbid psychiatric disorders, the age at onset of the illness, the acuteness of the disorder, and the duration of the disorder. The presence of four major clinical psychopathology, rapid cycling, Psychotic symptoms, comorbid psychiatric disorders, and suicide attempt, was also examined. The patients whose onset of the illness was before the age of 19 were classified as the early onset group and after the age of 19 were classified as the late onset group. Data on demographics, family histories, four major clinical psychopathologies and other clinical variables were compared between the early onset group and the late onset group. Results : Of the 53 patients, 19 patients belonged to the early onset group. There was higher incidence ofpsychotic Symp-toms in the early onset group than in the late onset group, and the difference was statistically significant according to the χ² - test (84.2% vs 44.1%, P=0.005). The incidence of comorbid psychiatric disorders was higher in the early onset group than in the late onset group, and the difference was also statistically significant according to the χ²-test (52.6% vs 23.5%, P=0.032).However, there was no statistically significant difFerence between the groups regarding the incidence of rapid cycling and suicide attempt. The result of logistics regression showed correlation of psychotic symptoms (0R=6.756 ; 1.655≤95% CI≤27.580) and comorbid psychiatric disorders (0R=3.611 ; 1.088≤95% CI≤11.984) with the early onset group. Conclusion : Early onset of bipolar disorder is related to the manifestation of psychotic symptoms and frequently accom-panies comorbid psychiatric disorders. The results of this study will help understand the mechanism of the onset of complexbipolar disorder and estimate the prognosis.

스트레스, 우울증과 HPA 축의 관련성

우영섭,박원명 대한우울조울병학회 2014 우울조울병 Vol.12 No.1

Major depression is highly prevalent mental illness and one of the leading causes of premature death and disability. Despite the high prevalence and disabilities, knowledge about pathophysiology of depression is still rudimentary. In this review, we summarize the current state of knowledge of the mechanism of depression, especially concentrate on the recent advances in the role of stress system. Considering its role at the interface between stress and brain functioning, it is perhaps not surprising that the Hypothalamic-Pituitary-Adrenal axis (HPA axis) has been found abnormal in depression. HPA axis activity is governed by the secretion of corticotropin-Releasing Hormone (CRH) and vasopressin (AVP) from the hypothalamus, which activate the secretion of adrenocorticotrophic hormone (ACTH) from the pituitary, which subsequently stimulates the secretion of the glucocorticoids from the adrenal cortex. Glucocorticoids then interact with their receptors in multiple target tissues including the HPA axis. We will present data supporting the hypothesis that HPA axis hyperactivity and abnormality in its components is not a simple consequence or an epiphenomenon of depression, but on the contrary that it is a risk factor predisposing to the development of depression.