전기경련요법후 뇌하수체 호르몬의 순차적인 분비 반응

김도관,김수정,최도선,복혜숙,김승태,Kim, Doh Kwan,Kim, Soo Jeong,Choi, Do Sun,Bok, Hae-Sook,Kim, Seungtai Peter 대한생물정신의학회 1996 생물정신의학 Vol.3 No.2

전기경련요법을 시행받은 9명의 정동자애 환자들과 2명의 정신분분열형장애 환자들에서 각각 3분 간격으로 혈액을 채취하여 각 채취하여 AVF, ACTH, PRL, cortisol 등의 호르몬에 대해 기저농도 및 전기경련요법 후의 농도 변화를 측정함으로써 각 호르몬 분비 반응 사이의 시간적인, 그리고 양적인 관계를 비교분석하였다. 또한 경련 지속 시간과 각 호르몬 분비반응들 사이의 상관관계도 검토하였다. 상기 호르몬 모두에서 전기경련요법 대한 의미있는 분비반응이 관찰되었다. 즉, AVP는 1.2pg/ml에서 33.3pg/ml(P<0.001). PRL은 21.8ng/ml에서 102.2ng/ml(P<0.005)로 cortsol은 20.1ug/dl에서 31.1ug/dl(P<0.001)로 각각 중가 되었다. 뇌하수체에서 분비되는 AVP, ACTH, PRL 세가지 호르몬 모두는 전기경련 요법 후 3분내에 분비 반용이 시작되었지만, 최고 농도에 도달하는 시간은 각각 3분, 6분, 12~15분대로 분명히 구별되는 소견을 보였다. cortisol은 6분후부터 증가하기 시작하여 20~30분 사이에 최고 농도를 보였다. 경련 지속 시간과 분비 반응과는 의미있는 상관관계를 보이지 않았다. 이상의 연구결과를 토대로 저자들은 다음과 같은 결론에 도달하였다. 1) 전기경련 요법에 대한 뇌하수체 호르몬의 반응은 동시적이라기 보다는 순차식으로 일어나는 것이다. 2) AVP는 다른 어떤 호르몬 보다도 아주 빠르고 양적으로 많은 반응을 보였다. 3) AVP 반응 후에 뒤따르는 ACTH 반응은 대부분의 과거 연구들에서 보고된 것보다 빠르고 강력했다. 4) 이러한 결과들은 뇌하수체 호르몬이 전기 자극보다는 경련의 결과로 분비된다는 가설을 지지해 주는 소견이다. 5) 시상하부-뇌하수체-부신피질 축 호르몬들의 순차적 반웅 양상은 각 호르몬의 분비 반응에 되먹임 조절 기전이 관여할 수 있음을 추정케 한다. Background : Most studies of the pituitary hormonal responses to electroconvulsive therapy(ECT) have used limited blood sampling schedules. Little is known about the precise sequence of neuroendocrine events immediately following en ECT application. or about the regulation of the hormonal responses. Methods : Blood was sampled at three minute intervals from eleven patients(two schizophrenics and nine affective disorder patients) undergoing ECT. Each sample was immunologically assayed for arginine vasopressin(AVP), adrenocorticotropic hormone(ACTH), prolactin(PRL), and cortisol. Baseline hormone concentrations and several measures of response were determined for each hormone. The temporal and quantitative relationships among the hormonal responses were determined. Correlations were calculated between seizure duration and secretory responses. Results : All four hormones demonstrated significant secretory responses to ECT, with AVP increasing from 1.2 to 33.3pg/ml(P<0.001), ACTH from 5.4 to 32.3fmol/ml(P<0001). PRL from 21.8 to 102.2ng/ml(P<0.005) and cortisol from 20.1 to 31.1ug/dl(P<0.001). The three pituitary hormones showed consistent time courses of secretion with onset of responses by three minutes but clearly differing peak times of 3, 6, and 12-15 minutes for AVP, ACTH, and PRL, respectively. Cortisol began to rise after 6minutes and pecked between 20-30minutes. There ware no significant correlations between seizure duration and any of the secretory response measures. Conclusions : 1) The pituitary hormone response to ECT is sequential rather than synchronous 2) The AVP response was extremely rapid and more massive than those of any other hormones. 3) The ACTH response of this study was more rapid and mare robust than thai revealed by the mast of past studies. 4) The results strongly suggest that the pituitary hormones are released as a result of the seizure rather tho, the electrical stimulus. 5) The sequential pattern of responses suggests that neuroendocine feedback-regulatory mechanisms determine the response profile.

치매환자의 평가

金度寬(Doh Kwan Kim) 대한노인정신의학회 1997 노인정신의학 Vol.1 No.1

Dementia is the clinical syndrome characterized by acquired losses of cognitive and emotional abilities severe enough to interfere with daily functioning and the quality of life. In Korea, the majority of patients with symptoms of dementia are initially evaluated by a general practitioner, and many do not receive a follow-up assessment by a specialist. Accordingly, general practitioners play a vital role in identifying patients with possible dementia and undertaking additional diagnostic procedures. It is important that tests to confirm the presence of dementia be performed uniformly, irrespective of the specialty of the examining physician. This article will discuss the several issues in the evaluation of dementia which may be raised frequently by general practitioners. The infrastructure for dementia assessment team, the evaluation of patients with mild memory complaints, the assessment of cognitive and functional disability, and screening examination to detect the reversibility of dementic symptoms will be reviewed.

BPSD의 정신증적 증상

金度寬(Doh Kwan Kim) 대한노인정신의학회 2000 노인정신의학 Vol.4 No.1

치매 환자들은 인지기능의 장애와 더불어 행동 심리적증상(behavioral and psychological symptoms of de-mentia, BPSD)들을 경험한다. 치매의 임상경과 중에 발생하는 BPSD는 질병의 경과에 따라 진행되는 신경 세포군의 손상 정도를 반영하기도 하지만, 인지기능의 장애와 서로 영향을 미치게 된다. 치매 환자가 경험하는 인지기능 장애는 그 병의 진행 정도를 반영하는 문제이지만 이로 말미암아 환자와 그 가족들이 고통을 당하지는 않는다. 하지만 BPSD는 치매 환자와 가족을 고통스럽게 하고, 환자의 삶의 질을 현격히 저하시키며, 그들 관계를 소원하게 만들어 치매 환자를 가족에게서 내치는 단초를 제공하기도 한다. 그러므로 치매 환자에서 발생하는 BPSD를 이해하고 적절하게 치료함은 임상의사들에게 대단히 중요한 과제이다. BPSD 중 정신증적 증상의 유병률은 망상(delusion)의 경우 전체 치매 환자들 중 20∼73%, 오식별(misidentification)의 경우 23∼50%, 그리고 환각(hallucination)의 경우 15∼49% 정도에서 관찰된다고 한다. 이 글에서는 치매환자의 임상경과 중 나타나는 BPSD 중 이러한 정신증적 증상의 평가와 원인 그리고 약물학적 치료 및 비 약물학적 치료에 대하여 살펴보았다. Dementia is a multi-dimensional disorder associated with cognitive symptoms, functional impairment, and behavioral and psychological symptoms such as agitation, depression and psychosis. Behavioral and psychological symptoms of dementia (BPSD) are an integral part of the disease process and present severe problems to patients, their families and caregivers, and society at large. BPSD are treatable and are more amenable to therapy than other symptoms or syndromes of dementia. Thus, the recognition and appropriate management of BPSD are important factors in improving our care of dementia patients and their caregivers. Psychotic symptoms presented as delusions, misidentifications, and hallucinations are most prevalent BPSD in Alzheimer’s disease and related dementia. The author has reviewed the clinical feature, etiology, and pharmacological and non-phrmacological management of psychotic symptoms of BPSD.

한국 노인정신의학 교육의 발전

김도관(Doh Kwan Kim) 대한노인정신의학회 2004 노인정신의학 Vol.8 No.1

The requirements for fellowship program in geriatric psychiatry in Korea has been proposed. Geriatric psychiatry is that area of psychiatry which focuses on prevention, diagnosis, evaluation and treatment of mental disorders and disturbances seen in old adult patients. An educational program in geriatric psychiatry must be organized to provide professional knowledge and well-supervised clinical experience. Educational goals, institutional organization, faculty and staff, facilities and clinical setting, and educational programs were covered in this article. The program requirements in Korea should be modified based on the environment and readiness with respect to the facilities and human resources. The fellowship period may be for one or two years, depending on the needs of the trainee. The one year program emphasizes clinical training while the two year option combines clinical and research training. The program has both didactic and experimental components. The didactic curriculum addresses normal and pathological aspects of aging, as well as current concepts for the assessment and treatment of elderly patients using the biopsychosocial model. The experimental component provides clinical and research experience in geriatric psychiatry.

치매의 원인질환

김도관(Doh Kwan Kim),김재경(Jaegyeong Kim) 대한노인정신의학회 1999 노인정신의학 Vol.3 No.1

Dementia is the clinical syndrome characterized by acquired losses of cognitive abilities severe enough to interfere with daily functioning and the quality of life. More than 50 illnesses, some nonprogressive, can cause dementia. The etiologies of dementia may be grouped as follows : neurodegenerative illnesses, vascular causes, space occupying lesions, traumatic causes, toxic causes, infectious diseases, and metabolic imbalances. Because all types of dementia are treatable, at least with psychosocial interventions, accurate diagnosis is essential to determine the appropriate treatment and to provide information about prognosis, possible genetic risks, and health care planning to the patient and family. This article will review several etiological illnesses of dementia which may be faced frequently by general psychiatrists.

알코올 섭취가 경도인지장애의 치매 진행에 미치는 영향

김진영(Jinyoung Kim),김상하(Sangha Kim),명우재(Woojae Myung),강효신(Hyo Shin Kang),나덕렬(Duk L. Na),김성윤(Seong Yoon Kim),이재홍(Jae-Hong Lee),한설희(Seol-Heui Han),최성혜(Seong Hye Choi),김상윤(Sang Yun Kim),김도관(Doh Kwan Kim) 대한노인정신의학회 2014 노인정신의학 Vol.18 No.2

Objective:Patients with mild cognitive impairment (MCI) are at high risk for dementia. Excessive alcohol consumption is known to adversely affect cognitive function. This study aimed to investigate the relationship between alcohol consumption and the risk for dementia in a cohort of MCI patients. Methods:Participants (n=416) with (MCI) who met Petersen’s criteria were recruited from a nationwide, prospective cohort study of dementia and were followed for a median of 17.52 months (range 5.4-63.48). Alcohol consumption was evaluated at baseline. Results:One hundred twenty seven individuals (30.5%) developed incident dementia (115 Alzheimer disease) during follow-up. Patients with current alcohol consumption at baseline had a higher rate of progression to Alzheimer’s dementia than those without current alcohol consumption (hazard ratio 1.61 ; 95% confidence interval 1.03 to 2.53). Conclusion:Alcohol consumption may increase the risk of progression to Alzheimer’s dementia in patients with MCI.

알쯔하이머병에서 양전자방출단층촬영을 이용한 국소뇌포도당대사의 변화에 관한 연구

김병태(Byung Tae Kim),김상은(Sang Eun Kim),최용(Yong Choi),이경한(Kyung Han Lee),최연성(Yearn Seong Choe),나덕렬(Duk Lyul Na),이정림(Jeong Rim Lee),김도관(Doh Kwan Kim),이광호(Kwang Ho Lee),김승태(Seung Tai Kim) 대한핵의학회 1996 핵의학 분자영상 Vol.30 No.3

N/A The purpose of the present study was to validate the use of tissue radioactivity ratios instead of regional metabolic rates for the assessment of regional metabolic changes in Alzheimer's disease(AD) with [18F]FDG PET and to examine the correlation of ratio indices with the severity of cognitive impairment in AD. Thirty-seven AD patients(age 68±9 yrs, mean±s.d.; 36 probable and 1 definite AD), 28 patients with dementia of non-Alzheimer type(age 66±7 yrs), and 17 healthy controls(age 66±4 yrs) underwent [18F]FDG PET imaging. Two simplified radioactivity ratio indices were calculated from 37-66 min image: region-to-cerebellar radioactivity-ratio(RCR) and a composite radioactivity ratio(a ratio of radioactivity in the most typically affected regions over the least typically affected regions: CRR). Local cerebral metabolic rate for glucose(LCMRglu) was also measured using a three-compartment, five-parameter tracer kinetic model. The ratio indices were significantly lower in AD patients than in controls(RCR in temporoparietal cortex, 0.949±8.136 vs. 1.238±0.129, p=0.0004; PCR in frontal cortex, 1.027±0.128 vs. 1.361±0.151, p〈0.0001; CRR, 0.886±0.096 vs. 1.032±0.042: p=0.0024). On the RCR analysis, 86% of AD patients showed a pattern of bilateral temporoparietal hypometabolism with or without frontal involvement; hypometabolism was unilateral in 11% of the patients. When bilateral temporoparietal hypometabolism was considered to be suggestive of AD, the sensitivity and specificity of the RCR was analysis for the differential diagnosis of AD were 86% and 73%, respectively. The RCR was correlated significantly with the macroparameter K [K1k3/(k2+k3)] (r=0.775, p〈0.0001) and LCMRglu(r=0.633, p=0.0002) measured using the kinetic model. In patients with AD, both average RCR of cortical association areas and CRR were correlated with Mini-Mental Status Examination(r=0.565, p=0.0145; r=0.642, p=0.0031, respectively), Clinical Dementia Rating(r=-0.576, p=0.0124; r=-0.591, p=0.0077), and total score of Mattis Dementia Rating Scale (r=0.574, p=0.0648; r=0.737, p=0.0096). There were also significant correlations between memory and language impairments and corresponding regionl RCRs. The results suggest that the [18F]FDG PET ratio indices, RCR and CRR, reflect global and regional metabolic rates and correlate with the severity of cognitive impairment in AD. The simplified ratio analysis may be clinically useful for the differential diagnosis and seral monitoring of the disease.

Clozapine 투여 후 경련성 발작을 보인 환자 1례

서만길,김도관,김이영,Seo, Man Kil,Kim, Doh Kwan,Kim, Eyong 대한생물정신의학회 1999 생물정신의학 Vol.6 No.1

The authors described a case of male schizophrenia who developed myoclonic jerk repeatedly and one episode of convulsive seizure during the treatment of clozapine. According to literatures and reported cases, myoclonic jerks induced in a small amount of clozapine may precede and predict the development of a convulsive seizure. Therefore clinicians have to pay attention to the development of a myoclonic jerk during the administration of clozapine. They may decrease the dosage of clozapine step by step at first in the convulsive state, and observe EEG changes of patients frequently.

주요우울증에서 아드레날린 알파 2 수용체 유전자 다형성과 Mirtazapine 치료반응의 연관성에 대한 연관연구

김진우(Jin Woo Kim),임신원(Shinn Won Lim),최홍(Hong Choi),김수연(Su Yeon Kim),명우재(Woo Jae Myung),이유진(Yu Jin Lee),송지혜(Ji Hye Song),정재원(Jae Won Chung),김도관(Doh Kwan Kim) 대한노인정신의학회 2010 노인정신의학 Vol.14 No.1

Objectives : Genetic differences may contribute to the inter-individual differences in treatment response to antidepressants among patients suffering from major depression. This study investigated a possible association of treatment response to mirtazapine with various adrenergic alpha 2 receptor polymorphisms in major depressive patients. Methods : A 6-week naturalistic treatment study with a blinded outcome examined 84 Korean patients with major depression. Treatment response to mirtazapine was defined as ≥50% decrease in HAM-D scores at six weeks. In this study, four genetic polymorphisms were selected ; ADRA2A MspI, ADRA2A DraI, α2BDel301-303, andα2CDel322-325. Results : The Del/Del genotype of α2CDel322-325 exhibited a significant association with response to mirtazapine through multiple logistic regression. ADRA2A DraI, α2BDel301-303, and α2CDel322-325 did not showed a significant association with response to mirtazapine. Conclusion : Based on the finding that α2CDel322-325 polymorphism had an association with the mirtazapine response, we postulate that the polymorphism related to the mechanism of the antidepressant effect is important in predicting the response to antidepressants.

불안신경증과 알코올남용·의존 환자에서 Tofisopam의 항불안 및 항우울 효과 검증

김승태(Seungtai. Peter Kim),홍경수(Kyung-Sue Hong),김도관(Doh Kwan Kim),홍성도(Sungdo David. Hong),유범희(Bum-Hee Yu) 한국중독정신의학회 1997 중독정신의학 Vol.1 No.1

The study aims at evaluating antianxiety and antidepressant effects of tofisopam, a benzodiazepine-related chemical substance with some variations in its nitrogen number and positions. The study subjects were 27 adult outpatients, namely, 11 anxiety neurosis patients(M 6, F 5) and 16 alcohol abuse or alcohol dependence patients(M 13, F 3), diagnosed according to DSM-IV. Tofisopam, doses ranging 100-150mg per day, was administered to each patient in an open clinical trial, over a period of 6-8 week. Each patient was administered with Hamilton Anxiety Scale(HAS) and Hamilton Depression Scale(HDS) twice, before the initiation of tofisopam admininistration and at the completion of 6-8 weeks of the medication administration, to assess the degree and extent of improvements of anxiety and depression symptoms. The following results were obtained from the study: (1) Tofisopam showed noticeably significant antianxiety effects and less significant antidepressant effects. (2) There were no clinically observable or reported untoward CNS effects(e.g. drowsiness, impaired memory, disturbance in attention, etc.) by tofisopam. (3) The more significant improvements among the anxiety symptom clusters were physical(musculomotor and sensory) and autonomic nervous system symptoms. (4) During and immediately after the completion of 6-8 weeks of tofisopam adminstration, alcoholic patients reported of significantly reduced or extinct alcohol cravings. However, it remains to be carefully evaluated whether anticraving effects of tofisopam is transient, long lasting, or psychogenic, etc. The study results warrants further careful revalidations by use of a longitudinal double-blind crossover design and on a large number of patients.