우리나라 치매관리 현황과 치매국가책임제

곽경필(Kyung Phil Kwak) 한국보건의료연구원 2018 근거와 가치 Vol.4 No.1

우울증에서 Brain - Derived Neurotrophic Factor의 역할

곽경필(Kyung-Phil Kwak),이상희(Sang Hee Lee) 대한생물치료정신의학회 2005 생물치료정신의학 Vol.11 No.2

Brain-derived neurotrophic factor(BDNF) is involved in the development, survival, maintenance and plasticity of neurons in the nervous systems. Recent pre-clinical studies suggest that the expression of BDNF is up-regulated by antidepressant treatments and the expression of BDNF might be a downstream target of antidepressant treatments. In addition, BDNF exerts antidepressant activity in animal models of depression. BDNF protects against stress-induced neuronal damage, and it might affect neurogenesis in the hippocampus, which is thought to be involved In the pathogenesis of the depression. In human studies, serum levels of BDNF in drug-naive patients with major depressive disorder are significantly decreased as compared with normal controls, and that BDNF might be a Important agent for therapeutic recovery from major depressive disorder. These findings suggest that BDNF plays a critical role in the pathophysiology of depression and in the mechanism of action of antidepressant agents.

재가치매환자를 위한 수요자 맞춤형 인지 프로그램 운영 경험에 관한 질적 연구

곽경필(Kyung-Phil Kwak),박수현(Su-Hyun Park),하아경(A-kyung Ha) 한국인지운동치료협회 2021 한국신경인지재활치료학회지 Vol.13 No.1

목적: 본 연구는 재가치매환자를 위한 맞춤형 개별 인지프로그램(customized cognitive program)의 운영 경험을 분석하여 수요자 중심(client-centered) 지역사회 치매관리사업의안착을 위해 필요한 현실적이고 구체적인 지원 방안을 모색하고자 실시되었다. 방법: 2 020년 10월, 맞춤형 개별화 인지 프로그램 운영자17명을 5~6명의 소집단으로 나누어 집단심층면담(Focus Group Interview)을 실시하였으며 전통적인 내용분석(conventional content analysis)을 이용하여 자료를 분석하였다. 결과: 분석결과, 8개의 범주(categories), 22가지 하위범주(subcategories)가 도출되었다. 연구 참여자들은 운영 경험을통해 새롭게 시도된 프로그램 운영을 통해 자기다움을 찾아가는 치매환자를 발견할 수 있었으며 운영자로써 자신의책임감과 자신감을 회복을 도출하였다. 또한 경험부족으로인한 시행착오와 운영 부담의 현실적인 어려움을 표현하였다. 마지막으로 프로그램의 활성화를 방안으로 인적지원과운영체계 개선, 환경지원이 도출하였다. 결론: 치매가 있어도 자신이 살던 곳에 지속적으로 거주하기 위해서는 치매환자에 대한 지원 뿐 아니라 서비스 지속성을 위한 전문 인력 양성과 효율적인 운영 환경 조성의 다각적노력이 필요하다. This study was conducted to analyze the experience of operators in implementing a tailored cognitive program devised for community-dwelling individuals with dementia. This study also aims to identify realistic and specific support plans necessary to establish client-centered community dementia management projects. In October 2020, 17 individualized cognitive program operators were divided into small groups of 5 to 6 members, and focus group interviews were conducted. The resulting data were analyzed using conventional content analysis. From the analysis, three areas, eight categories, and 22 subcategories of operational experience and activation plans were derived. Based on their operational experiences, the participants were able to identify patients who had recovered their self-esteem through the newly attempted program. In addition, the operators recovered their sense of responsibility and confidence. However, challenges faced by the operators were trial and error due to a lack of experience and practical difficulties in implementing the cognitive program Lastly, human support, improvement of the operating system, and environmental support were necessary to improve the program. For individuals with dementia to continue living comfortably in their residences, efforts such as professional manpower training and creating an efficient operating environment for the operators are required to ensure continuity of the operators services.

혈관성 치매

김태우,곽경필,Kim, Tae Woo,Kwak, Kyung Phil 대한생물정신의학회 2016 생물정신의학 Vol.23 No.3

Vascular dementia is a very frequent form of dementia. Debates over classification and diagnostic criteria, and controversy over identifiable treatment targets will continue until distinct pathophysiological mechanism of vascular dementia is found. Clinical diagnostic criteria are sufficiently strong to be useful for clinical trials, but need further refinement. Cognitive changes in vascular dementia are more variable than other disorders, and are dependent on the vascular pathology. Accurate diagnosis of vascular dementia is known to need the presence of reliable cerebrovascular disease on brain imaging. Although it seems obvious that cerebrovascular disease causes pathological damage and impaired cognition, it is very difficult to find the accurate contribution of cerebrovascular pathology to cognitive decline. Most studies have shown a small but significant benefit of cholinesterase inhibitors on cognition, the significance of this effect has been slight and benefits on global functioning, activities of daily living, and behaviour have not been consistently reported. Management of vascular dementia should focus on identifying and managing vascular risk factors.

지역사회 거주 노인의 우울과 자살사고에 관한 연구

박창증(Chang-Jeung Park),곽경필(Kyung-Phil Kwak),사공정규(Jeong Kyu Sakong),이광헌(Kwang-Hun Lee) 대한생물치료정신의학회 2013 생물치료정신의학 Vol.19 No.2

Objectives:This study was aimed to investigate the difference of depressive symptom and suicide ideation according to socioeconomic state in community dwelling elderly. Methods:We investigated 835 elderly subjects including 445(53.3%) of home visit health service group and 390 (46.7%) of senior center group from April 2013 to May 2013. Their demographic and socioeconomic data were investigated. Depressive symptoms were evaluated by the Korean form of the Geriatric Depression Scale(KGDS) and suicide ideation was evaluated by the Beck’s Scale for suicide ideation(SSI). Using these data, we analyzed associated factor with depressive symptom and suicide ideation. Results:The prevalence of depressive symptom was 41%. The prevalence of depressive symptom in home visit health service group(59.3%) was significantly higher than that of senior center group(22.0%)(p<0.001). The prevalence of suicide ideation in home visit health service group(15.3%) was significantly higher than that of senior center group (3.3%)(p<0.001). Depressive symptom(Odd ratio : 8.59, 95% CI : 4.49-16.40), living alone(Odd ratio : 1.72, CI : 1.01-2.94), no exercise(Odd ratio : 1.69, 1.01-2.83), no current occupation(Odd ratio : 3.41, CI : 1.16-10.07) were associated with suicide ideation independently. Conclusions:In this study, home visit health care service group in low socioeconomic elderly had higher prevalence of depressive symptom and suicide ideation than that of standard elderly. These results suggest that future mental health care policy has to consider the importance of low socioeconomic community dwelling elderly.

만성 정신분열병 여성에서 고프로락틴혈증과 골밀도 및 골대사 표지의 상관

원승희(Seung-Hee Won),곽경필(Kyung-Phil Kwak) 대한생물치료정신의학회 2006 생물치료정신의학 Vol.12 No.2

목적 : 정신분열병 환자는 질병 자체와 복용하고 있는 여러 약물들로 인하여 골다공증 및 골절의 위험성이 높다. 고프로락틴혈증은 골다공증을 유발하는 위험요인으로 알려져 있는데, 일부 항정신병약물은 혈중 프로락틴을 증가시킨다. 본 연구는 만성정신분열병 환자에서 지속적인 프로락틴 증가가 골밀도와 골대사 표지에 어떠한 영향을 주는지 그 관련성을 알아보고자 시행되었다. 방법 : DSM-IV 진단기준에 부합되는 만성 정신분열병 가임기(20~45세) 여성 환자 36명을 선별검사 하였다. 모든 대상자들은 최소 1년 이상 한 가지 항정신병약물을 복용하고, 통원치료를 받고 있으며, 최근 1년 이내 골대사에 영향을 주는 병력이 없었다. 환자의 월경력을 미리 조사하여 중기 황체기에 신체계측, 기본 검사실검사, 호르몬, 골대사 표지, 정신병리, 일일 영양소섭취량, 일일 활동량등을 측정하였다. 골밀도는 이중방사선흡수 계측기를 이용하여 원위요골, 요추, 대퇴경골의 골밀도를 측정하여 젊은 정상성인의 평균치와 비교한 T값을 이용하였다. 최종 검사결과 대상자는 프로락틴이 증가한 실험군 16명(리스페리돈 복용 15명, 올란자핀 복용1명)과 프로락틴이 증가하지 않은 대조군 12명(올란자핀 복용 12명)으로 분류되었다. 결과 : 프로락틴 수치는 실험군이 더 높고( t=5.583, p=0.000), 콜레스테롤 수치는 대조군이 더 높았으며(t=-2.107, p=0.046), 에스트라다이올 수치는 실험군 2명만 감소되었고 나머지 대상자 모두는 정상범위이었다. 골밀도 T값이 실험군은 모든 부위에서 감소되었고 대조군은 요추와 대퇴경골에서만 감소되었지만, 두군 간 유의한 차이는 없었다. 단지, 원위요골에서 실험군의 골밀도 T값(-0.16±0.73)이 대조군의 골밀도 T값(0.36±0.66)보다 낮은 경향(t=-1.968, p=0.06)을 보여주었다. 프로락틴과 골밀도 T값 또는 골대사 표지와는 유의한 상관을 나타내지 않았다. 실험군 16명만을 대상으로 시행한 상관분석(r=-0.627, p<0.01)과 전체 피험자를 대상으로 현재 항정신병약물의 복용기간, 프로락틴, 체질량지수를 통제한 부분상관분석(r=-0.418,p<0.05) 모두에서 콜레스테롤과 원위요골의 골밀도 T값 사이에 유의한 음의 상관이 나타났다. 결론 : 만성 정신분열병 여성 환자에서 항정신병약물로 유발된 고프로락틴혈증은 골소실을 증가 시키는 위험요인이었다. 또한, 프로락틴 수치와는 무관하게 콜레스테롤도 위험요인이었다. 이에 반해 에스트로겐은 골소실의 예방요인으로 작용하였다. Objectives:Osteoporosis is regularly mentioned as a possible consequence of treatment with prolactin raising antipsychotic medications. We investigated the association between schizophrenia and a decrease in bone mineral density(BMD) and to get more insight into potential underlying pathophysiological mechanisms. Methods:In a cross-sectional study, we screened 36 schizophrenic outpatient women(age 20-45 years) who were treated with same antipsychotics for at least one year. BMD measurements were performed by dual-energy X-ray absorptiometry(DEXA) in the distal forearm, lumbar spine and femoral neck. We also estimated psychopathology, menstrual regularity, body mass index(BMI), daily nutritional status, daily physical activity, hormones and bone marker (osteocalcin, deoxypyridinoline). As the results of prolactin levels, subjects were classified into two groups; prolactin raising group(PR, 16 subjects) and not raising group(No-PR, 12 subjects). Results:Mean prolactin level in PR was higher than in No-PR and mean cholesterol level in No-PR was higher than in PR significantly. Mean estradiol level was within normal ranges excluding 2 subjects in PR. The proportions of reduced bone mass(osteopenia, osteoporosis) at each sites were 12.5-31.3% in PR and 0.0-25.0% in No-PR. Mean BMD T scores at distal forearm in PR mildly lower than in No-PR( t=-1.968, p=0.06), but those of other sites were not significant differences between two groups. Correlations between prolactin levels and BMD T scores at all sites were not statistically significance. Correlations between the levels of prolactin and bone markers were not significance too. After adjusting for prolactin, BMI and medication period of current antipsychotics variables, statistically significant inverse correlation was observed for cholesterol levels - BMD T scores at the distal forearm. Conclusion:The present results suggest that hyperprolactinemia induced by long-term neuroleptics may be at high risk of reducing BMD and may be counterbalanced with estradiol incompletely in schizophrenic women. In addition, we noticed that cholesterol may be a risk factor in losing bone mass irrespective of prolactin levels.

지역사회 거주 노인의 자살경향성 유병률과 위험요인

김문범(Moon Beom Kim),이광헌(Kwang-Hun Lee),이관(Kwan Lee),곽경필(Kyung-Phil Kwak) 대한생물치료정신의학회 2018 생물치료정신의학 Vol.24 No.3

Objectives:The purpose of this study was to investigate the prevalence and risk factors of suicidality among community-dwelling elderly. Methods:The participants were 2,201 elderly people whose ages were over 65. The participants were asked to complete questionnaires, including Mini International Neuropsychiatric Interview(MINI), module C, Short Geriatric Depression Scale of Korean version(SGDS-K), Korean Geriatric Anxiety Inventory(K-GAI), The Korean Health Status Measure for Elderly V 1.0, Korean version of Mini-Mental Status Examination for Dementia Screening(MMSE-DS). Their sociodemographic factors were investigated. The data were analyzed using the chi-square test and the logistic regression test to examine the relationship between suicidality and participants’ risk factors. Results:The prevalence rate of suicidality was 23.3%. In multiple logistic regression, depressive symptoms (OR=3.301, 95% CI : 2.453-4.440), anxiety symptoms(OR=3.289, 95% CI : 2.515-4.303), low physical function (OR=1.606, 95% CI : 1.229-2.098), no spouse(OR=1.571, 95% CI : 1.037-1.690), elderly aged 80 years or older (OR=1.506, 95% CI : 1.094-1.740) were independently associated with suicidality. Conclusion:Suicidality in community-dwelling elderly was quite high, particularly related to depressive symptoms. The results of this study can be useful for development of community-based prevention and management programs for suicidality.

Brain-Derived Neurotrophic Factor와 알쯔하이머병

이상희(Sang Hee Lee),김상헌(Sang Heon Kim),곽경필(Kyung-Phil Kwak) 대한생물치료정신의학회 2005 생물치료정신의학 Vol.11 No.2

Alzheimer' s disease(AD) is associated with a decrease in brain-derived neurotrophic factor(BDNF) mRNA expression in the hippocampus, the parietal cortex, the entorhinal cortex, the hilus and temporal cortex. The expression of catalytic TrkB is found to be decreased in the basal forebrain, and the frontal and temporal cortex. A substantial body of work has shown that BDNF can prevent death of several types of injured CNS neurons, including those from the basal forebrain, hippocampus and cortex. Therefore, BDNF could help to prevent neuronal death in AD. Genetic studies have shown a polymorphism of the gene coding for BDNF that correlated with sporadic, late-onset AD, suggesting that genetic variation in the gene coding for BDNF might be associated with increased risk of AD. BDNF has been reported to modify neuronal structure and function by modifying spine turnover and dendritic arbours of cortical neurons. In the hippocampus, BDNF is an important mediator of long-term potentiation(LTP), a long-lasting increase in synaptic strength. Central local administration of exogenous BDNF might be beneficial for the treatment of AD, in order to stop or delay the progression of neuronal loss and cognitive consequences. Since decreased BDNF is related to both AD and depression, BDNF could be a bridge between AD and depression.

일 대학병원 정신과 외래를 방문한 우울증 환자에서의 하지불안증후군

이도윤(Do-Yun Lee),사공정규(Jeong-Kyu Sakong),곽경필(Kyung-Phil Kwak),한영훈(Young-Hoon Han),손용표(Yong-Pyo Son),박창증(Chang-Jeung Park),원승희(Seung-Hee Won),이광헌(Kwang-Hun Lee) 대한생물치료정신의학회 2011 생물치료정신의학 Vol.17 No.1

Objectives : This study was designed to investigate the clinical characteristics, relationship with antidepressants and incidence of restless legs syndrome(RLS) in depressed outpatients. Methods : Total 160 adult patients(male 32, female 128) of psychiatric outpatient were enrolled in this study. We use the diagnostic criteria of International RLS Study Group(IRLSSG) for RLS. Also WHO quality of life scale abbreviated version(WHOQOL-BREF), Hamilton Depression Rating Scale-17(HAM-D) and Pittsburgh Sleep Quality Index(PSQI) was used to investigate the relationship between RLS and depression severity, quality of life, sleep quality. Results : In 39(24.4%) out of the total 160 patients were diagnosed as having RLS. Among those 39 RLS patient, 19 patients(48.7%) was reported to have developed their RLS after starting depression treatment. The RLS group showed higher PSQI and HAM-D scores(p=0.02, p<0.01) and lower WHOQOL-BREF score(p=0.06) compared to those of non-RLS. Compared to those of non-RLS group, the bupropion group showed a significantly low rate of RLS group (p=0.043) and the venlafaxine group showed a significantly high rate of RLS group(p=0.018). HAM-D score 7 or more group caused RLS 4.5 times compared those of less than HAM-D score 7 group. Conclusion : In this study, depressed outpatients showed high incidence rate of RLS and RLS had influence on sleep quality, depression severity and quality of life. Moreover, certain antidepressants had potential to induce RLS. Therefore, these results suggest that appropriate treatment for depression is required to clinicians and development of RLS from depressed patients should be carefully monitored. Further research about the relationship between antidepressant and RLS is also necessary.

Clozapine이 인체내에서 인간조직적합성항원에 미치는 영향

강병조(Byung-Jo Kang),김문두(Moon-Doo Kim),곽경필(Kyung-Phil Kwak) 대한생물치료정신의학회 1997 생물치료정신의학 Vol.3 No.2

친자 감별, 개인 식별, 장기 이식 및 수혈 등에 널리 쓰이고 있는 HLA가, 난치성 정신분열증 치료에 가장 좋은 약인 clozapine에 의해서는 어떠한 변화가 생기는지를 알아보기 위하여, 3명을 대상으로 연구를 실시하였다. 이들은 적어도 2개월 이상 정신과약을 일체 투여받지 않은 성인 만성 정신분열증 환자들이었다. 이들에게 clozapine을 평균 200㎎/day씩 투여하기 전과 평균 90일 투여한 후 두번에 걸쳐서 HLA-A, B, C와 DR형을 검사하여 그 결과를 비교하였다. HLA class Ⅰ형은 Terasaki 등의 임파구세포상해시험법으로, class Ⅱ형은 PCR방법으로 결정하였다. 그 결과 class Ⅰ형에서는 3명중 2명에서 변화가 나타났고, class Ⅱ형에서는 변화가 없었다. 이와같은 결과는 clozapine이 적어도 DNA 수준까지는 영향을 미치지 않는다는 것을 말해준다. The histocompatibility antigen (human leukocyte antigen : HLA) has been used for organ transplantation, discrimination of one's real children and transfusion, etc. The objective of this study was to find out how clozapine affects HLA class Ⅰ and Ⅱ type in the humanbody when therapeutic doses are applied. The subject consists of 3 persons for class Ⅰ and class Ⅱ. They were administered for about 3 months with clozapine 150~250㎎/day (mean dally dose 200㎎). Analysis of HLA class Ⅰ type was the microcytotoxicity test of Terasaki and class Ⅱ type was PCR method of Erhlich. The results were as followings: Two of 3 were changed in HLA-A, B, C type. All three were not changed in HLA-DR type. In conclusion, the short-term application, about 3 months, of therapeutic dose of clozapine is not considered to bring about changes in DNA level.