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.

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

주요 정신 질환 약물치료의 한국형 알고리듬 개발

권준수,박원명 대한의사협회 2004 대한의사협회지 Vol.47 No.2

대한신경정신의학회 '장기발전계획 테스크 포스팀' 활동 보고

권준수 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.4

[18F]FDG PET을 이용한 강박증 환자에서 뇌 포도당 대사의 이상에 관한 연구

권준수,이동우,이재성,최정임,이동수,정준기,조맹제,이명철,류인균 대한신경정신의학회 2000 신경정신의학 Vol.39 No.2

연구목적: 강박증에 대한 기능적 뇌영상 연구들에서 강박증 환자들의 안와전두엽과 미상핵의 대사율 증가 소견이 비교적 일과되게 발표되어 왔으며, 전두-피질하 회로의 이상이라는 이론이 수립되기도 하였다. 그러나 기존의 연구들은 강박증의 유병기간에 따른 구분없이 시행된 연구였고, 영상분석 방법에 있어서도 관심영역 방법을 이용했다는 한계를 지니고 있다. 본 연구의 목적은 첫째, 강박증의 유병기간에 따라 환자군을 구분하여 PET 영상소견을 분석함으로써 유병 기간에 따른 차이가 있는지를 조사하였으며, 둘째, 강바증 환자의 포도당 양전자방출 단층촬영(18-Fluor-deoxyglucose Positron Emission Tomography : FDG-PET) 영상분석에 통계적 매개변수 지도법(Statistical Parametric Mapping : SPM)을 이용함으로써 강박증의 병인기전 및 강박증상과 뇌기능 간의 관계를 명확히 규명하고자 하였다. 방법: 구조적 면담도구(Structured clinical interview for DSM-IV : SCID-IV)를 적용하여 진단된 12명의 강박증 환자들과 10명의 정상 대조군에 대해 FDG-PET을 촬영하여 SPM으로 분석하였다. PET 촬영 전 적어도 4주 동안에는 약물복용을 하지 않은 상태였다. 결과: 1) 환자군과 대조군의 비교 : 강박증 환자군은 대조군에 비해 양측 두정 영역의 대사율이 유의하게 감소되어 있었으며(P<0.01). 대사증가를 보인 영역은 없었다. 강박증의 유병기간이 10년 이상인 만성강박증 환자 4명은 양측 안와전두엽에서 유의한 대사증가 소견을 보였으며(P<0.01), 양측 두정영역에서 유의한 대사감소 소견을 보였다 (P<0.01), 유병기간이 10년 이하인 환자에서는 전체 환자군의 분석에서와 마찬가지로 대조군에 비해 유의한 대사증가 소견을 보인 영역은 없었으며, 양측 두정엽 부위에서 유 의한 대사 감소 소견을 보였다.(P<0.01). 2) 강박증상의 심각도와의 상관관계 분석 : 우측 두정엽의 대사율은 강박장애 척도 점수와 유의한 음의 상관관계를 보였으며(p<0.01), 양측 시상 영역의 대사율은 예일-브라운 강박장애 척도의 강박장애척도 점수와 유의한 양의 상관관계(p<0.01)를 보였다. 결론: 본 연구는 결과는 기존의 연구들에서 보고된 안와전두엽의 대사 증가 소견이 강박증의 만성화로 인해 나타나는 2차적 장애이며, 두정엽의 대사 저하가 보다 1차적인 장애일 가능성을 시사한다. Baxter가 수립한 전두-피질하 회로 이론은 두정엽의 이상을 포함하는 전두-두정엽 복합체 이론으로 확장되어야 할 것이다. Objectives: Functional imaging studies on obsessive-compulsive disorder(OCD) subjects have repeatedly reported increased metabolism in orbitofrontal lobes and caudate nucleus, resulting in the "frontal-subcortical" circuit abnormality theory. Limitations of the previous studies to date include little consideration for the duration of illness, and the use of regions of interest methods, as an image analysis method. Our study objectives are 1) to include the duration of illness as an important study variable, and 2) to use Statistical Parametric Mapping(SPM) method in order to tap relations between the brain function and the psychopathology and symptoms of OCD. Methods: The [18] fluorodeoxyglucose positron emission tomography(FDG-PET) scans of OCD subjects and normal comparison subjects, as diagnosed by the Structured Clinical Interview for DSM-IV(SCID-IV), were analyzed using SPM. Results: 1) Comparison of OCD and control groups : OCD subjects had significantly decreased metabolism in both parietal lobes and didn't have any areas of increased metabolism in comparison to comparison subjects(p.<0.01). four OCD subjects with the illness duration of 10 years or longer, had significantly increased metabolism in both orbitofrontal lobes<p<0.01). OCD subjects whose illness duration is shorter than 10 years didn't have any areas of increased metabolism and had significantly decreased parietal lobe metabolism, as in the analyses of all subjects(p<0.01). 2) Correlation analysis between areas and symptom severity : Metabolism of both thalamic sreas showed significant positive correlation with Yale-Brown Obsessive-Compulsive Scale(Y-BOCS) scores(p<0.01). Metabolism of right parietal area showed significant negative corre lation with Y-BOCS scores(p<0.01). Conclusions: The current findings suggest that the increased metabolism in orbitofrontal lobe, previously rported, may be a secondary phenomenon due to the extended illness dur- ation and that decreased metabolism in the parietal lobes are primary abnormality in OCD subjects. Thus Baxter's fronto-subcortical circuit theory should be extended into "fronto-pari-etal" complex theory, which includes the parietal lobes.