The Genetic Basis of Panic Disorder

나해란,강은호,이재헌,유범희 대한의학회 2011 Journal of Korean medical science Vol.26 No.6

Panic disorder is one of the chronic and disabling anxiety disorders. There has been evidence for either genetic heterogeneity or complex inheritance, with environmental factor interactions and multiple single genes, in panic disorder’s etiology. Linkage studies have implicated several chromosomal regions, but no research has replicated evidence for major genes involved in panic disorder. Researchers have suggested several neurotransmitter systems are related to panic disorder. However, to date no candidate gene association studies have established specific loci. Recently, researchers have emphasized genome-wide association studies. Results of two genome-wide association studies on panic disorder failed to show significant associations. Evidence exists for differences regarding gender and ethnicity in panic disorder. Increasing evidence suggests genes underlying panic disorder overlap, transcending current diagnostic boundaries. In addition, an anxious temperament and anxiety-related personality traits may represent intermediate phenotypes that predispose to panic disorder. Future research should focus on broad phenotypes, defined by comorbidity or intermediate phenotypes. Genome-wide association studies in large samples, studies of gene-gene and gene-environment interactions, and pharmacogenetic studies are needed.

CPAP 사용으로 유발된 조증 삽화 1예

나해란,강은호,유범희,Na, Hae-Ran,Kang, Eun-Ho,Yu, Bum-Hee 대한불안의학회 2008 대한불안의학회지 Vol.4 No.2

저자들은 심한 수면 무호흡증을 가진 성인 남자에서,CPAP 치료 후 조증 및 경조증 삽화가 유발된 증례를 보고하였다. 본 증례는 정신과적 병력 및 가족력이 없던 환자에게서 CPAP 치료 후 조증 삽화와 경조증 삽화가 연속해서 유발된 첫 번째 보고이다. 환자는 CPAP 치료 시작 직후부터 약 한달 동안 기분 고양감과 목적지향 활동의 증가를 보이다가 2~3일만에 정신병적 증상이 동반된 조증 삽화를 보였다. 또한 퇴원 후 투약을 지속하면서 다시 CPAP치료를 한 직후 경조증 삽화로 추정되는 일련의 기분 및행동 변화가 나타났다. 따라서 이 환자의 조증 삽화와 경조증 삽화로 추정되는 기분 변화는 CPAP 치료로 유발되었을 가능성이 있다고 판단되었다. 폐쇄성 무호흡증이 심하여 CPAP 치료가 처방되는 경우에 임상의들은 정신과적 질환의 기왕력이나 위험 인자가 없는 환자에서도 조증상태가 발생할 수 있는 가능성에 대해 유의하여야 하고, 주기적으로 객관적인 척도를 사용하여 기분 변화 정도를 점검할 필요가 있다. 특히 CPAP 사용 후 특별한 이유 없이 행동 변화나 기분 고양의 정도가 심해질 때는 조증 가능성을 의심해 보아야 할 것으로 사료된다. Continuous positive airway pressure (CPAP) has been known as a safe and effective therapy for the patients with obstructive sleep apnea (OSA). Previous studies on CPAP treatment have often reported significant improvement in mood state in those patients. However, there are very few reports on its potential to induce manic or hypomanic episode in the patients with OSA. We report a case of 34-year-old patient with OSA who developed manic and hypomanic episodes consecutively after CPAP treatment with facial mask. We suggest that CPAP treatment could induce a manic or hypomanic episode in patients with obstructive sleep apnea.

Factors Influencing Skin Tolerability to the Rivastigmine Patch in Patients with Alzheimer’s Disease

나해리,박문호,김상윤,양동원,최성혜,양현덕,양영순,한현정,이정석,윤영철,고성호,김정은,구본대,김희진,박경원,김은주,윤보라,박기정 대한치매학회 2015 Dementia and Neurocognitive Disorders Vol.14 No.1

Background and Purpose The one-day rivastigmine patch is reportedly well tolerated and has minimal side effects. However, Asian patientsshow more side effects than those in Western countries. We evaluated tolerability of the rivastigmine patch in South Korean patientswith Alzheimer’s disease (AD) and the specific factors affecting adverse events of the skin. Methods A 6-month, open labeled, multi-centered, observational study was carried out in 440 patients with probable AD from July 2009to September 2010 (NCT01312363). Results A total of 25.9% of the patients experienced adverse skin events at the rivastigmine patch application site and 17.0% discontinuedtreatment due to adverse events at the skin application site. The most common adverse events were itching and erythema. Patients with an allergichistory and users of electric heating appliances reported skin discomfort. Older age was associated with discontinuing treatment. Conclusions These results suggest that the rivastigmine patch induced some adverse skin events and may contribute to understanding andimproving skin tolerability to the rivastigmine patch.

중증 대뇌반구경색 환자의 사망률과 초기 예후인자

나해리,강우열,정승철,유경호,마효일,이병철 대한노인병학회 2001 대한노인병학회지 Vol.5 No.2

연탄재를 활용한 도자기 소지 개발

나해리,이현수,이지연 한국폐기물자원순환학회 2017 한국폐기물자원순환학회지 Vol.34 No.5

Coal briquette ash is an inorganic and non-combustible material. Although coal briquette ash is mainly composed of SiO2, Al2O3, and is an acceptable raw industrial material (containing Fe2O3, K2O, MgO, CaO, TiO2, and Na2O), it is merely considered waste and is exploited as a building material for concrete admixtures and bricks. Because mullite (3Al2O3 2SiO2), which coal briquette ash contains, is a stable compound with a crystalline structure, it plays essential roles in its fracture strength and bending strength. This study serves the purpose of developing environmentally friendly, economical clay bodies through the use of coal briquette ash as a substitute for kaolin to provide Al2O3 and SiO2. We also investigated the seed effects during sintering process by feeding mullite directly into clay bodies. The results show that in 1,300°C heat, a mixture of 40% coal briquette ash, 40% feldspar/limestone (8 : 2), and 20% clay indicates a fracture strength value of 525 kgf/cm2, an absorption rate of 0.72%, burning shrinkage of 11.5%, and an average bending strength of 0.6 cm, which is superior to other clay bodies. The addition of coral briquette ash in clay bodies promoted mullite formation and grew as mullite acted as a seed. In addition to the developing clay bodies, it can also make an oatmeal-colored glaze to widen the spectrum of its usability. This study will help resolve waste problems, reduce environmental pollution, and raise economic value by using coal briquette ash as a raw material for ceramics. Clay bodies made with coal briquette ash are expected to continuously contribute to the development of the ceramics industry with upcycling effects.

주택화재보험 활성화 방안

나해인,Na, Hae-In 한국화재보험협회 1999 防災와 保險 Vol.80 No.-

이중언어자에서 보인 두 형태의 실어증 : 증례보고 A Case Report

나해리,이정욱,박성민,박수열,권순용,이현정 대한치매학회 2004 Dementia and Neurocognitive Disorders Vol.3 No.2

Since many people in Korea know more than one language, bilingual aphasia is an important line of research in clinical and theoretical neurolinguistics. Nowadays we meet many people who speak other languages along with Korean, who are immigrants from foreign countries, especially from China. Differential recovery of language affected by an aphasic deficit is documented. In the present work, we introduced a patient with bilingual aphasia who showed different recovery patterns in Korean and Chinese. A 66-year-old man was presented with language disturbance and right hemiplegia. On past medical history, he had received a hematoma evacuation through burr-hole due to left basal ganglia hemorrhage. After the event, he showed nearly global aphasia in Korean, but he showed minimally preserved language function on comprehension and fluency in Chinese. This result suggests that aphasia in bilingual subject may show different pat-terns of recovery between two languages.

사설

나해리 신학지남사 1920 신학지남 Vol.3 No.3

Multimodal Assessment of Neural Substrates in Computerized Cognitive Training: A Preliminary Study

나해리,임재성,김우정,장재원,백민정,김정은,박영호,박소영,김상윤 대한신경과학회 2018 Journal of Clinical Neurology Vol.14 No.4

Background and Purpose Several studies have validated the clinical efficacy of computerized cognitive training applications. However, few studies have investigated the neural substrates of these training applications using simultaneous multimodal neuroimaging modalities. We aimed to determine the effectiveness of computerized cognitive training and corresponding neural substrates through a multimodal approach. Methods Ten patients with mild cognitive impairment (MCI), six patients with subjective memory impairment (SMI), and 10 normal controls received custom-developed computerized cognitive training in the memory clinic of a university hospital. All of the participants completed 24 sessions of computerized cognitive training, each lasting 40 minutes and performed twice weekly. They were assessed using neuropsychological tests (both computerized and conventional), electroencephalography, fluorodeoxyglucose positron-emission tomography (FDGPET), volumetric magnetic resonance imaging (MRI), and diffusion-tensor imaging (DTI) at pre- and posttraining. Results The patients with MCI exhibited significant improvements in the trail-making test– black & white-B, and memory domain of the computerized cognitive assessment. Subjects with normal cognition exhibited significant improvements in scores in the language and attention-/ psychomotor-speed domains. There were no significant changes in subjects with SMI. In the pre- and posttraining evaluations of the MCI group, FDG-PET showed focal activation in the left anterior insula and anterior cingulate after training. Volumetric MRI showed a focal increase in the cortical thickness in the rostral anterior cingulate. DTI revealed increased fractional anisotropy in several regions, including the anterior cingulate. Conclusions The anterior cingulate and anterior insula, which are parts of the salience network, may be substrates for the improvements in cognitive function induced by computerized cognitive training.

건강한 독거노인에게서 회복탄력성의 외로움에 대한 사회적 지지의 매개 효과

나해인,최소연,엄태림,김태희 대한노인정신의학회 2019 노인정신의학 Vol.23 No.2

Objective:This study aims to identify the impact of social support on the relationship between loneliness and resilience for the elderly who are mentally sound, financially stable and living in a single household setting. Methods:A sample of 197 mentally healthy (Mini-Mental State Examination for Dementia Screening ≥-1.5 standard deviation and Geriatric Depression Scale <10) community-dwelling elderly 65 years of age or older was recruited. Multidimensional individual and interpersonal resilience measure, Medical Outcomes Study Social Support Survey, and University of California, Los Angeles Loneliness Scale were used followed by structured face to face interviews. Descriptive statistics, t-test, analysis of variance, Pearson correlation, and stepwise regression analysis were used for data analysis. Results:The mean score of Resilience was 70.7 (±11.7)/111, social support was 60.2 (±21.4)/95, and Loneliness was 38.5(±11.9)/80. For the Resilience, there was a statistically significant correlation between loneliness (r=0.56, p<0.01) and social support (r=0.72, p<0.01). Hierarchical analysis shows that social support completely mediates the effect of resilience on loneliness. Stepwise regression analysis represents affection emotional support and positive social interaction have the highest descriptive power. Conclusion:In conclusion, social support fully mediates the impact of resilience on loneliness. The findings suggest developing social support intervention programs, especially which can give emotional support and positive social interaction, is effective and crucial to decrease loneliness for elderly who are living alone.