항우울제의 부작용과 대처 방안(1) - 성기능 장애를 중심으로 -

김정기,이수진,Kim, Jeong-Gee,Lee, Soo Jin 대한생물정신의학회 2006 생물정신의학 Vol.13 No.4

Sexual dysfunction is a relatively common adverse effect in the use of antidepressants. The sexual side effects may result in a lack of compliance with the prescribed antidepressants. The author reviewed the prevalence and updated treatment for the antidepressant-induced adverse effects focusing on sexual dysfunction. The incidence of sexual dysfunction is reported to exceed more than 50% especially with SSRIs. In order to obtain a quantified baseline and as an ongoing evaluation tool, clinicians may use some of the established questionnaires and validated instruments such as the Arizona Sexual Experience scale and Changes in Sexual Functioning Questionnaire. Clinicians should be aware that delayed ejaculation and orgasm, symptoms most frequently associated with antidepressants, are not usually associated with depression itself. Although many antidotes have been proposed, few have been subjected to double-blind trials. Some evidences have suggested that bupropion and buspiron may be the effective antidotes for SSRI induced sexual dysfunction. Additional trials will be requied to define what role, if any, bupropion and buspiron might have in the treatment of SSRI-induced sexual side effects. The available evidence is rather limited, with only small number of trials assessing each strategy. While further randomized data is awaited, for men with antidepressant induced erectile dysfunction, the addition of sidenafil or tadalafil may appear to be an effective strategy.

만곡된 치근을 가지며 매복된 하악 제 1대구치의 교정적 치험례

김정기(Jeong-Gee Kim) 대한치과의사협회 1993 대한치과의사협회지 Vol.31 No.4

한국인 여성 알코올 의존 환자의 단축효과에 관한 연구

김효정(Hyo-Jeong Kim),김성곤(Sung-Gon Kim),이덕기(Duk-Ki Lee),황인복(In-Bok Hwang),최용성(Young-Sung Choi),김정기(Jeong-Gee Kim),이해국(Hae-Gook Lee),제영묘(Young-Myo Jae) 대한생물치료정신의학회 2007 생물치료정신의학 Vol.13 No.1

목적 : 여성 알코올 의존 환자는 남성 알코올 의존 환자에 비하여 음주를 늦은 나이에 시작하더라도 알코올 의존으로는 더 빠르게 진행되었다는 단축효과의 선행 연구 결과들이 있다. 본 연구에서는 한국인 남녀 알코올 의존 환자를 대상으로 음주 시작시기와 알코올 관련 문제 발생 시기 등을 조사하여, 한국인 여성 알코올 의존 환자에서도 단축효과가 있는 지를 조사하였다. 방법 : 알코올 의존 환자 229명(남자 167명, 여자 62명)을 대상으로 병력지와 담당의사와의 면담을 통하여 대상자의 인구학적 특성 및 음주력에 대하여 조사하였다. 결과 : 1) 여성 알코올 의존 환자(이하 여성군)는 남성 알코올 의존 환자(이하 남성군)에 비하여 늦은 나이에 음주를 시작하였으나, 알코올 관련 문제가 처음 발생된 나이와 음주로 인해 처음 정신과 병원에 입원한 나이는 두 군간 차이가 없었다. 2) 최초로 음주를 시작한 후 알코올 관련 문제가 처음으로 발생될 때까지 걸리는 시간은 여성군에서 남성군에 비해 유의하게 짧았으며, 최초로 음주를 시작한 후 음주로 정신과에 처음 입원할 때까지 걸리는 시간도 남성군에 비해 여성군에서 유의하게 짧았다. 또 알코올 관련 문제가 처음 발생된 후부터 음주로 처음 정신과에 입원할 때까지 걸리는 시간도 여성군에서 유의하게 짧았다. 3) 여성군은 남성군에 비하여 평균 나이가 적었고, 음주 일일 평균 음주량이 적었다. 심각한 알코올 금단 병력이 있었던 경우 및 일차 친족에 알코올 의존의 가족력이 있었던 경우도 여성군에서 더 많았다. 결론 :이러한 결과는 한국인 여성 알코올 의존환자에서도 단축효과가 나타나는 것을 말한다. 따라서 남성에 비하여 여성 알코올 음주에 대한 치료자, 가족 및 사회의 관심이 더 필요할 것으로 생각된다. Objective : Previous studies have shown that in women, alcohol dependence develops faster than in men, even though women often start drinking at a later age than men. This is often referred to as the telescoping effect. The present study is based on data concerning the age of at which drinking began and the development of alcoholrelated problems in both male and female Korean alcohol-dependent patients. This study investigates whether the telescoping effect is present in female Korean alcohol-dependent patients. Methods : Through patients' histories and interviews with psychiatrists, information on dermographic characteristics and history of drinking were gathered in 299 alcoholic dependent patients(167males, 62females). Results : 1) Although the female alcohol-dependent patients(hereafter referred to as the female group) started drinking at later age than male patients(hereafter referred to as the male group), no difference was found regarding the time of the onset of alcoholic problems in both groups. 2) The t me at which the development of alcoholic problems occurred and the time at which patients were first admitted to a psychiatric hospital due to development of alcoholic problems was shorter in the female group than the male group. 3) The average age of th female group is younger than that of th male group. In addition, even though daily alcohol consumption per drinking day in the female group was smaller in terms of amount than in the male group, the female group had significantly more subjects having severe alcohol withdrawal syndrome. Also, there were more subjects who had first-degree relatives who have alcohol-related problems in the female group than in the male group. Conclusion : It has bean shown that the telescoping effect is also present in female Korean alcohol-dependent patients. Therefore, it is thought that more attention from physicians and family and more social interest should be given to female drinkers than to male drinkers.

만성 정신질환자들의 체중 조절에 대한 행동 치료적 접근

이중권(Joong-Kwon Lee),김정기(Jeong-Gee Kim),조동환(Dong-Hwan Cho),이수진(Soo-Jin Lee),왕관수(Kuan-Shu Wang),서영익(Young-Ik Seo),최성진(Seong-Jin Choi),이다교(Da-Gyo Lee) 대한사회정신의학회 2007 사회정신의학 Vol.12 No.1

목 적: 항정신병 약물 사용 전에도 체중증가와 관련된 대사 장애는 정신질환을 지닌 개인에게 문제를 일으켜왔다. 최근에는 비정형 항정신병 약물의 사용으로 증상의 치료나 부작용 면에서는 우수한 결과를 나타내었으나, 환자들은 점차 약물 관련성 체중 증가와 대사증후군 등의 위험에 노출되게 되었다. 이번 연구의 목적은 낮 병원 환자들을 대상으로 행동수정을 통한 치료적 접근이 체중과 같은 위험요소들에 어떠한 효과를 나타내는가를 평가하기 위한 것이다. 방 법: 본원 낮 병원에 재원 중인 16명의 환자들 중 참여의사를 표시한 12명을 대상으로 하여 2006년 4월 21일부터 2006년 9월 4 일까지 17주간의 교육과 행동수정 프로그램을 실시하였다. 결과에 대한 평가는 개인 체중과 허리둘레, 체질량지수(BMI) 및 시행 전후 지질 검사 상에서 나타나는 저밀도지단백 콜레스테롤, 고밀도지단백 콜레스테롤, 중성 지방의 혈중 농도 변화를 비교하였다. 또한 사전과 사후의 삶의 질에 대한 만족도를 한국판 스미스클라인 비챰‘삶의 질’척도를 사용하여 측정하였다. 결 과: 과정을 완료한 환자들은 총 11명이었으나 2명은 혈청 검사를 거부하였다. 시행 전 평균체중은 71.81±9.51kg, 평균허리둘레는 91.32±5.71cm로 측정되었다. 시행 후 평균체중은 70.04±8.89kg, 허리둘레의 평균은 89.68±5.09cm로 측정되었다. 혈중 지질 농도는 시행 전후 비교에서 통계적으로 유의한 수준을 보이지 않았다. 사후 평가에서‘삶의 질’에 대한 척도는 연구시작 시점 보다 상승된 점수를 보였고, 참가자들은 변화된 생활습관에 대한 만족감을 보고하였다. 결 론: 이번 연구는 체계화된 교육과 운동처방을 사용하여 만성 정신질환을 가진 환자들에게 동기부여를 통한 생활습관의 변화를 일으켰고, 그 결과 일부 참가자들의 체중과 허리둘레가 감소되는 결과를 보였다. 앞으로 더 많은 숫자의 환자를 대상으로 하는 대규모 연구가 필요할 것으로 생각되며, 장기적으로 약물 복용을 해야 하는 환자들에게 체중 증가를 예방하기 위한 행동수정 프로 그램이 긍정적인 영향을 줄 수 있을 것이라 생각된다. Objectives:Even before using the antipsychotics, the metabolic disturbances associated with weight gain have been troublesome in subject with psychiatric disease. Although the atypical antipsychotics show excellent results in management and side effects, patients become more and more to expose to the risks such as drug related weight gain and metabolic disturbances. The objective of this study is to evaluate how the therapeutic approaches through life style modification to the patients in day hospital work and improve the risk factors such as weight gain. Methods:This study was a 17-weeks open-label trial of 12 out of 16 patients who attended in day hospital and study performed between april 21st and september 4th in 2006. The primary outcome measure was the comparison of personal weight, waist circumference, BMI, LDL cholesterol, HDL cholesterol and TG before and after the trial. The secondary outcome measure was to evaluate the QOL using korean version of the Smithkline Beecham quality of life’ scale. Results:The number of patient who completed the trial was 11, but 2 out of 11 patients turned down the withdrawal of blood. Before the trial, the mean weight was 71.81±9.51kg, mean waist circumference was 91.32±5.71cm. After the trial, the mean weight was 70.04±8.89kg, the mean waist circumference was 89.68±5.09cm. There was no statistically significant difference in lipid profile before and after the trial. In the post-trial evaluation, the measurement of QOL has improved in score and this represent the satisfaction for the eating habit and exercise program. Conclusion:This study gave the patients with chronic psychiatric illness the motivation to modify their life style using the organized education and exercise. As a result, some of the participants showed reductions in weight and waist circumference. There may require a large scale study. Life style modification program to prevent weight gain could affect in positive way to the patient who need oral medication in the long run.

경도 인지 장애와 알츠하이머 병 환자의 혈액 검사 지표 비교

이동기(Dong-Ki Lee),김정기(Jeong-Gee Kim),김양태(Yang-Tae Kim) 대한생물치료정신의학회 2011 생물치료정신의학 Vol.17 No.1

Objectives : The purpose of this study is to compare laboratory blood test markers in patients with mild cognitive impairment(MCI) and Alzheimer’s disease(AD) among elderly over the age of 65. Methods : 176 subjects who scored lower 1.5SD of the Korean version of Mini-Mental State Examination(MMSEKC) were evaluated using the Korean version of the Consortium to Establish a Registry for AD(CERAD-KC) and Clnical dementia Rating(CDR) and Global Deterioration Scale(GDS). 70 subjects scored over 0.5 in CDR and they were divided into two subgroups. 24 subjects was diagnosed with AD. And 40 subjects was diagnosed with MCI. We evaluated them with laboratory test and demographic factors. Results : According to the demographic data, there was a correlation between old age/low level of education and AD. Regarding the laboratory findings of total cholesterol level and total bilirubin level. There were significant differences between Alzheimer’s disease and mild cognitive impairment(p<0.05). Conclusion : There were correlations between Alzheimer’s disease(AD) and high serum total cholesterol level/low serum total bilirubin level.

일 종합병원에서 정신분열병과 분열정동장애를 진단받은 환자에서 항정신병약물의 1차 선택약물의 비율 및 1년 유지율에 관한 연구

왕관수(Kuan-Shu Wang),김정기(Jeong-Gee Kim),조동환(Dong-Hwan Cho),제호준(Ho-Jun Je),서영익(Young-Ik Seo),장옥진(Og-Jin Jang),최성진(Seong-Jin Choi) 대한생물치료정신의학회 2008 생물치료정신의학 Vol.14 No.1

Objectives: This study was designed to evaluate prescription rate and indirectly the tolerability of antiosychotics using the maintenance rate for 1 year. The study was done in a situation where the patients who were diagnosed with either schizophrenia or schizoaffective disorder were given the antipsychotics and were looked into the prescription rate and the state of use of drugs at first regardless of kind of drugs. Methods: This was a retrospective, naturalistic study using the data from medical record conducted in both inpatients and outpatients from January 1st in 2002 and June 30th in 2004 with a diagnosis of schizophrenia and schizoaffective disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Patients were evaluated at 3, 6, 9, and 12th months after the onset of medication for the first-drug prescription rate and maintenance rate. Results: In total, 105 patients were recruited, and 40 out of 105 were male and 65 out of 105 were female. The mean age was 34.71 years old. The number of patients with schizophrenia was 94 and that of schizoaffective disorder was 11. For the prescription rate of first drugs, of total risperidone was 56.2% ; likely, 25.7% for olanzapine ; 10.5% for haloperidol ; 4.8% for quetiapine ; and 2.9% for chlorpromazine. For 1-year maintenance rate, of total, haloperidol was 45.5% ; 33.3% for chlorpromazine ; 22.0% for risperidone ; 14.8% for olanzapine ; and 20.0% for quetiapine. Conclusion: Overall, atypical antipsychotics were far more prescribed than typical ones(86.7% and 13.3% for atypical and typical anti psychotics respectively). Although atypical antipsychotics were more prescribed than typical ones, the one-year maintenance rate was not higher than typical anti psychotics unlike our expectation that atypical antipsychotics would have better compliance and higher maintenance rate for 1 year under the circumstances with uncontrolled naturalistic conditions. There should be more statistical data available with larger sample size in the future.

만성적 정신분열병 또는 분열정동장애를 가진 입원환자에서 Aripiprazole와 Haloperidol의 치료효과 및 안정성 비교 : 16주간의 임상적 연구의 결과

서영익(Young-Ik Seo),김정기(Jeong-Gee Kim),장옥진(Ok-Jin Jang) 대한생물치료정신의학회 2009 생물치료정신의학 Vol.15 No.2

1) 16주간 elozarpipira과 direpolah이을 사용한 군에서 나온 PANSS 점수를 보면 두 약물군 모두에서 효과를 보였다. 양성 증상에서는 두 군에서 차이를 보이지 않았으나 음성 증상, 일반 증상 그리고 총점에서는 모두 aripiprazole 군에서 더 나은 치료효과를 보였는데 이 중 음성 증상만이 통계적으로 의미있는 차이가 있었다. 2) 대사 증후군과 관련된 수치들을 살펴보면 체중, 허리둘레, 혈압에서는 두 군 사이에 차이가 없었으나 총 콜레스테롤에서는 aripiprazole 군이 haloperidol군에 비해 의미있는 감소를 보였으나 고밀도 콜레스테롤은 두 군 모두 감소하였다. 앞으로 만성 정신분열병 환자에서 대사증후군 발생에 대한 일관된 결과를 얻기 위해서는 좀 더 장기적인 연구와 관찰이 필요할 것으로 보인다. 3) 혈중 프로락틴의 경우 aripiprazole이 haloperidol에 비해 통계학적으로도 의미있는 감소를 보였다. Objectives: The authors compared the efficacy and safety between aripiprazole and haloperidol in the treatment of patients with chronic schizophrenia and schizoaffective disorder. Methods: This study was conducted in December, 2004 through April, 2007. We selected the subjects who were admitted to psychiatric clinic due to chronic schizophrenia or schizoaffective disorder as defined by DSM-Ⅳ criteria. The assessment of clinical symptoms was evaluated with PANSS before taking the drugs and every two weeks afterwards. The standard laboratory tests were also performed. The prolactin level was evaluated in every 4 weeks Results: Total of 72 subjects were assigned either aripiprazole(N=33) or haloperidol(N=39) according to the admission order. There were no statistically significant differences on demographic variables. After 16-week study was completed, there were no statistically significant differences in positive, general and total score in PANSS except negative symptom. There were no significant differences among the variables related to metabolic syn?drome except serum glucose and HDL cholesterol level between two groups. However, there was a significant difference in serum prolactin level. Conclusion: In the end, aripiprazole was generally good choice of treatment with less side effects, better tolerability than haloperidol. One, aripiprazole showed more improvements in negative, general and total PANSS subscales with no statistical significances except negative PANSS score. The other, the variables related to the metabolic syndrome need a further evaluation. And the last, aripiprazole yields more favorable serum prolactin level than haloperidol.

심한 정신지체 환자에서 발견된 Tuberous Sclerosis 1례

이중권(Joong-Kwon Lee),김정기(Jeong-Gee Kim),조동환(Dong-Hwan Cho),왕관수(Kuan-Shu Wang) 대한생물치료정신의학회 2007 생물치료정신의학 Vol.13 No.1

본 증례의 환자는 임상증상, 방사선학적 소견, 조직학적 검사를 토대로 하여 결절성 경화증으로 진단을 내렸다. 전형적인 결절성 경화증과는 달리 드물게 나타나는 심장과 소화기의 종양을 가지고 있었으며 영아연축 및 경련의 시작, 피부병변의 발생시점이 늦게 시작되었다. 경련의 발생시점이 늦은 것으로 보아 정신지체는 경련과의 연관성보다는 현재 관찰되는 전두엽, 측두엽, 후두엽 내의 병변의 위치와 다수의 결절성 병변으로 인한 것으로 생각된다. 이로 인해 언어표현, 이해, 주의집중, 계산, 이해, 판단 등 제반 정신기능의 발달이 매우 지체되어 있을 것으로 판단되며 환자의 예후는 좋지 않을 것으로 생각된다. The authors have diagnosed with tuberous sclerosis complex for a patient who was mentally retarded and has been showing impairment in intelligence and social functioning, and seizure. Usually patients with tuberous sclerosis complex have a high rate of mental retardation associated with cortical tubers, seizure and genetic factors. In this case, the patient has developed seizure attacks since he was 4 years old. He had no specific abnormality found in earlier medical examination. He fled and returned home after he was found 7 years later. Unlike his previous condition, he had developed generalized tonic-clonic seizure along with severe stuttering, tremor, drooling and sleep disturbance. He visited the hospital for further evaluation and management. The psychiatric problems included, severe mental retardation, sleep disturbance, impulsive behavior, difficulty in attention and other problems. Multiple adenoma sebaceums found in his face and fibromas in his ungal areas(nail & toe) have been observed. We have also found a mass suspected as rhabdomyoma in the heart and multiple harmatoma in brain, kidney, and colon through radiological and endoscopic examination. We concluded the patient could be diagnosed with tuberous sclerosis complex since he showed the typical clinical manifestations of seizures, mental retardation and dermatological symptoms and ventricular rhabdomyoma, multiple angiomyolipoma in kidneys, multiple cortical tubers in radiological findings and ganglioneuroma in a colonoscopic biopsy, and adenoma sebaceum in a skin biopsy.

Multiloop Edgewise Arch Wire의 응력분포에 대한 광탄성학적 연구

이승호(Sheung-Ho Lee),김정기(Jeong-Gee Kim) 대한치과교정학회 1994 대한치과교정학회지 Vol.24 No.4

This study was designed to investigate the stress distribution, intensity and force mechanism derived from the MEAW by photoelastic stress analysis of the artificial teeth and surrounding bone composed of photoelastic(material/ PL-3 ). The findings of this study were as follows. 1. In case of no elastic on the MEAW with tip back, the moderate stress was observed on the molar and canine area, and the light stress was observed on the other area. 2. In case of the vertical elastic on the plain A.W. and the MEAW without tip back, the great stress was observed on the lateral incisor area, but on the MEAW with tip back, the moderate stress was observed on the anterior area and molar area. 3. In case of the C II elastic on plain A.W., the stress was concentrated on the anterior area hanged by elastic but on the MEAW without tip back, the stress was transmitted equally from the anterior area to the posterior teeth area, On the MEAW with tip back, the great stress was observed on the anterior and molar area. 4. In case of the C III elastic on the plain A.W., the stress was concentrated on the posterior area hanged by elastic but on the MEAW without tip back, the stress was transmitted equally from the posterior area to the anterior area. On the MEAW with tip back, the great stress was observed on the posterior area and the moderate stress was observed on the anterior area.

신투석 환자와 신장 이식 환자의 정신의학적 비교 연구

조동환,박범용,공진민,김정기,Cho, Dong-Hwan,Park, Bum-Yong,Kong, Jin-Min,Kim, Jeong-Gee 한국정신신체의학회 1998 정신신체의학 Vol.6 No.1

Objectives: This research was performed to know severity of depression and anxiety, the psychopathology of hemodialysis patients and kidney transplantation patients using Minneesota Multiphasic Personality Inventory(MMPI) and Zung's Self-rating Depression Scale (SDS), Zung's Self-rating Anxiety Scale(SAS), MMPI Subscales. Methods: We surveyed 31 hemodialysis patients and 119 kidney transplantation patients. 119 kidney transplantation group(KT) was investigated at ; 1) Before kidney transplantation (KT-1), 2) Three days after kidney transplantation(KT-2), 3) Three weeks after kidney transplantation(KT-3),4) Follow up at OPD(F/U). Results: 1) According to dermographic data, mean age was KT 33.1, HD 42.2, Control 33.1 years old and KT, HD were belonged to lower economic states and lower educational level than Control. 2) In the depression scale for SDS, KT-1 was more depressed than F/U and Control but depression scale was significantly decreased at KT-2 in comparison with HD. In the anxiety scale for SAS, KT-1 was more anxious than Control but anxiety scale was not different within IT subgroups and in comparison with HD. 3) In comparison of MMPI scales, Hs, D, Pt, Ma at KT-1, Pd, Pa, Pt, Ma at KT-2, F, D, Pd, Pt, Pa, Sc, Ma at KT-3, Pt at F/U were more high scores than Control.