정신자극제의 올바른 사용

남범우 대한의사협회 2018 대한의사협회지 Vol.61 No.8

Psychostimulants are a broad class of sympathomimetic drugs that include drugs of abuse, such as illegal substances, as well as therapeutic drugs, such as methylphenidate and modafinil. The common effect of psychostimulants is to improve motivation, mood, movement, energy, wakefulness, arousal, anorexia and attention. Methylphenidate and modafinil are psychostimulants used in the treatment of attention deficit hyperactivity disorder and narcolepsy. They have also been found to be effective for treating certain cognitive disorders that result in secondary depression or profound apathy, obesity, cancer-related fatigue as well as in specific treatment-resistant depressions as an augmentation therapy with antidepressants. Psychostimulants are also used in an non-medical manner, such as cognitive and/or performance enhancers in healthy population. However, the most limiting adverse effect of psychostimulants is their vulnerability to psychological and physical dependence. Therefore, the abuse and misuse of stimulants, including methylphenidate and modafinil, for the purpose of neuroenhancement is an issue of concern throughout the world including Korea. Although several recent studies have reported on the cognitive and performance enhancement effects of methylphenidate and modafinil in healthy population, psychostimulants should be administered with discretion in the light of their potential adverse effects and the lacks of long-standing efficacy.

Comparing the Effects of Bupropion and Escitalopram on Excessive Internet Game Play in Patients with Major Depressive Disorder

남범우,Sujin Bae,Sun Mi Kim,Ji Seon Hong,Doug Hyun Han 대한정신약물학회 2017 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.15 No.4

Objective: Several studies have suggested the efficacy of bupropion and escitalopram on reducing the excessive internet game play. We hypothesized that both bupropion and escitalopram would be effective on reducing the severity of depressive symptoms and internet gaming disorder (IGD) symptoms in patients with both major depressive disorder and IGD. However, the changes in brain connectivity between the default mode network (DMN) and the salience network were different between bupropion and escitalopram due to their different pharmacodynamics. Methods: This study was designed as a 12-week double blind prospective trial. Thirty patients were recruited for this research (15 bupropion group+15 escitalopram group). To assess the differential functional connectivity (FC) between the hubs of the DMN and the salience network, we selected 12 regions from the automated anatomical labeling in PickAtals software. Results: After drug treatment, the depressive symptoms and IGD symptoms in both groups were improved. Impulsivity and attentional symptoms in the bupropion group were significantly decreased, compared to the escitalopram group. After treatment, FC within only the DMN in escitalopram decreased while FC between DMN and salience network in bupropion group decreased. Bupropion was associated with significantly decreased FC within the salience network and between the salience network and the DMN, compared to escitalopram. Conclusion: Bupropion showed greater effects than escitalopram on reducing impulsivity and attentional symptoms. Decreased brain connectivity between the salience network and the DMN appears to be associated with improved excessive IGD symptoms and impulsivity in MDD patients with IGD.

호흡기 질환의 신경정신과적 측면

남범우,Nam, Beom-Woo 한국정신신체의학회 2009 정신신체의학 Vol.17 No.2

호흡기 질환은 전 세계에 걸쳐 수백만 명의 사람에게 영향을 준다. 많은 연구에서 호흡기 질환과 정신 질환의 관련성을 보고하고 있음에도 불구하고 호흡기 질환을 가진 환자의 정신과적 질환과 증상의 치료에 대한 자료 및 호흡기약물과 정신약물간의 상호작용에 대한 지식은 매우 부족하다. 이 논문에서는 1) 의사들이 임상에서 흔히 볼 수 있는 천식, 만성폐쇄성폐질환, 과호흡, 결핵, 폐암과 같은 주요 호흡기 질환의 신경정신과적 측면 2) 폐 질환 환자에서의 불안, 우울, 정신병적 증상과 같은 정신과적 증상의 치료 3) 정신약물이 호흡기에 미치는 영향과 호흡기 약물과의 상호 작용을 고찰하였다. Pulmonary diseases distress millions of people worldwide. Numerous studies have shown an association between pulmonary disease and psychiatric disorders. Despite this, little is known about the treatment of psychiatric disorder in patients with pulmonary disease. The three main goals of this article are 1) to discuss the major disorders such as asthma, chronic obstructive pulmonary disease, hyperventilation, tuberculosis, lung cancer that most clinicians see in practice, 2) to provide an information about psychiatric treatment such as anxiety, depression, psychosis in pulmonary disease, and 3) to provide some clinically relevant suggestions about pharmacologic interactions between pulmonary and psychotropic drugs.

양극성장애와 새로운 항경련제의 효과

남범우,서정석,정헌종,최진영 건국대학교 의과학연구소 2004 건국의과학학술지 Vol.13 No.-

Bipolar disorder, like epilepsy and migraine, is episodic in nature and psychiatric illness requiring lifelong treatment. So, it should not be surprising that anticonvulsants such as carbamazepine and valproate have proven efficacy as mood stabilizers. The newer anticonvulsants such as lamotrigine, gabapentin, topiramate, oxcarbazepine, tiagabine, and zonisamide may also be effective treatments for bipolar disorder. Identifying an anticonvulsant for use in bipolar disorder should take into account not only the pathophysiology of bipolar disorder but also the mechanism of action of the anticonvulsant. Evidence for effectiveness of these novel antiepileptic drugs in treating acute mania and depression as well as in preventing the recurrence of mania and depression is reviewed. In conclusion, although the novel anticonvulsants appear to be clinically useful, more controlled trials are needed to assess the effectiveness in bipolar disorder.

가족력 유무에 따른 여성 알코올 중독자의 임상적 차이 연구

남범우,박두병,신광철,나철 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.6

저자는 1990년 7월 1일부터 1995년 6월 30일까지 정신과에 입원한 여성 알코올중독환자 38 명을 대상으로 여성 알코올 중독자의 임상적 특성을 가족력 유무에 따라 비교 분석하여 타 연구 결과와 비교하고 여성 알콜중독의 특징과 관련하여 고찰하였다. 연구결과를 요약하면 다음과 같다. 1) 연구 대상 38명의 환자중 가족력이 있는 군은 11명(28.9%)이었으며 가족력이 없는 군은 27명(71.1%)이었다. 2) 가족력이 있는군이 가족력이 없는 군에 비해 낮은 평균 연령, 높은 기혼 비율, 높은 알코올 의존의 비율, 높은 응급입원 비율, 조기 음주 시작, 장기간의 음주기간, 빈번한 입원, 높은 진전 섬망의 비율, 높은 우울장애의 비율을 보였으나 결혼 상태를 제외하고는 모두 통계적인 유의성은 없었다. 3) 양군 모두 교육수준 및 사회경제력 수준이 비교적 낮은 것으로 나타났다. 4) 양군 모두 병발 질환으로 우울 장애와 간 질환이 가장 많았다. Sex is major risk factor for alcoholism in every culture. In virtually all societies, there is more male than female drinking. It has been suggested that the group of familial alcoholis had more severe clinical pictures of alcoholism, more frequently diagnosed as personality disorders, worse academic and social functioning, more severe physical complication and lower socioeconomic status. Thus the authors intended to compare 38 women alcoholis who had been admitted to department of psychiatry from July 1st 1990 to June 30th 1995 according to their family history of alcoholism. The results were follows: 1) The group with family history were 11(28.9%) and the group without family history were 27(71.1%). 2) The group with family history showed to have lower mean age, higher married state, more diagnosis of alcohol dependence, more emergent admission, younger onset age of drinking, longer duration of drinking, more frequent hospitalization, and higher rates of delirium tremens and depressive disorder, compared to the group without family history. But there was no statistically significant difference except marital status. 3) The level of education and socioeconomic state were relatively low in both groups. 4) Depressive disorder and liver disease were associated most frequently in both groups.

비흡연 의과대학 남학생의 시험 스트레스로 인한 순환 자연살세포 백분율의 변화와 성격 특성

남범우,기백석,나철 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.5

비흡연 의과대학생 32명을 대상으로 시험 20일 전과 시험시작 첫날 순환 자연살 세포의 백분율을 측정하고 다면적 인성검사 및 이화방어기제검사로 성격특성을 측정하여 다음과 같은 결과를 얻었다. 1) 시험시작 첫날에 측정한 순환 자연살 세포의 백분율은 시험전 20일에 측정한 순환 자연살 세포의 백분율에비해 유의하게 감소하였다. 2) 순환 자연살 세포의 백분율의 변화와 성격특성간의 비교에서 이화방어기제검사의 허세 및 유머 척도 사이에서만 의미 있는 부적 상관관계를 보였다. 결론적으로 본 논문은 스트레스와 면역기능간의 관계성에 대한 증거를 지지하는 결과를 보여주었으나 성격적 특성과의 상관관계에 대한 의미 있는 결과를 보이지는 못했다. The present report investigated whether percentages of circulation natural killer cells are changed under examination stress and whether percentages of circulating natural killer cells are associated with personality characteristics. Subjects(n=32) for this study were selected from non-smoking medical male students. For measuring percentages of circulating natural killer cells, blood was drawn twice, with a baselinesample taken 20 days before the final examination and a stress sample drawn on the first day of final examination. Both samples were analyzed using a flow cytometer(FACScan : Becton-Dickinson). Minnesota Multiphasic Personality Inventory(MMPI) and Ewha Defense Mechanism Test(EDMT) were examined for personality characteristics. Percentages of circulating natural killer cells significantly decreased in stress sample as compared with baseline sample. But there is no association between the subscale scores of the two psychological questionnaires and percentages of circulating natural killer cells except show off and humor subscales in EDMT. It is concluded that, in the current setting, there is association between percentages of circulating natural killer cells and examination stress, but no definite evidence for involvement of psychological variables.

병적 웃음과 울음 : 병태 생리와 치료

김지현,남범우,최진영,Kim, Ji Hyun,Nam, Beom Woo,Choi, Jin-Yong 한국정신신체의학회 2013 정신신체의학 Vol.21 No.2

병적 웃음과 울음(Pathological laughing and crying, PLC)은 감정과 관계없이 갑작스럽게 표출되는 웃음이나 울음이 특징이며 신경계 질환과 관련 있다. 이는 환자의 대인관계 및 일상생활에 상당한 곤란을 가져오지만 약물치료에 비교적 반응이 좋으므로 적절한 진단이 중요하다. PLC는 전전두엽과 변연주변 네트워크(paralimbic network), 소뇌 및 교뇌 기저의 조절이상으로 발생한다. 이들의 조절에는 여러 신경전달물질이 관여하며 특히 세로토닌성 기능의 이상이 관련있다. 주된 치료는 약물치료이며 선택적 세로토닌 재흡수 억제제를 비롯한 항우울제에 좋은 효과를 보인다. 그 외 도파민계 약물, 비경쟁적 NMDA 수용체 길항제도 일부 효과가 있다. PLC의 진단과 평가에는 몇 가지 척도들이 사용되고 있으나 그 특징적 임상양상을 파악하는 것이 가장 중요하다. 따라서 이러한 PLC의 임상양상과 병태생리를 이해하고 적절한 치료법을 살펴봄으로써 임상에서의 관심을 높이고자 한다. Pathological laughing and crying(PLC) is a condition that is characterized by episodic, brief, contextually inappropriate, uncontrollable outbursts of laughing and/or crying. It can be observed in patients with various neurological disorders. PLC often causes distress in interpersonal functioning and activities for patients and their families. PLC can be recognized easily with proper understanding of the condition and its nature. Also it generally shows good response to various pharmacological treatments. This review aims to encourage the diagnosis and treatment of PLC by providing definition and clinical presentation of PLC, analysis of its pathophysiology and various current treatment options.

한국 성인의 혈중 알코올 제거율 및 관련 인자에 대한 Spaghetti Plot을 이용한 재분석 및 예측 모델

이중석,남범우,서정석,서정철,방한준,안민철,홍봉식,이승환 한국중독정신의학회 2019 중독정신의학 Vol.23 No.2

Objectives : Alcohol-related pharmacokinetic (PK) parameters and related factors in Korean male and female were reported respectively in our previous works, but they lacked methodological validity. We recalculated more reliable parameters including the volume of distribution (Vd) and blood alcohol elimination rate (β-value) and examined the potential of predictive models using new analytic techniques. Methods : Out of 101 men and 91 women, 66 men and 65 women were selected for the final data analysis. New PK parameters were obtained from redrawn blood alcohol concentration (BAC)-time spaghetti plots for every subject. Regression analyses were used to determine β-values and predictive models for Vd and β-value. Results : For men, β-value was 0.147±0.045 g/L/hr and ranged between 0.050-0.240 g/L/hr, for women it was 0.155±0.047 g/L/hr and ranged between 0.060-0.270 g/L/hr, demonstrating a significant difference after adjustment for age, past drinking behavior, and smoking. Influence of alcohol dose on β-value was not significant. Vd was significantly predicted by height, weight and sex multifactorially (R2=0.562, p<0.001), and body fat ratio monofactorially (R2=0.812, p<0.001). β-value was significantly predicted by sex, weight, total body water, and past drinking behavior (R2=0.706, p<0.001). Conclusion : Using new analytic methods, we updated alcohol related PK parameters and investigated the influence of related factors on Vd and β-value with predictive models. It is expected that the outcomes of this study could be a contribution to a more precise BAC estimation in forensic psychiatry fields.

불안-우울 환자에서 역기능 호흡

손인기,남범우,홍정완,이재창 한국정신신체의학회 2021 정신신체의학 Vol.29 No.2

Objectives:Although dysfunctional breathing is a common symptom in general population and affects qualities of life, it is still underdiagnosed. There are some studies of prevalence of it in astma, but few studies in anxiety and depressive disorders. The purposes of this study were to explore the prevalence of it in anxiety and depressive disorders, and to investigate whether anxiety and depressed mood influence it. Methods:135 patients diagnosed with anxiety or depressive disorders, and 124 controls were recruited. Nijmegen questionnaire was used to assess dysfunctional breathing, and Hospital anxiety depression scale was used. Results:The prevalence of dysfunctional breathing in anxiety or depressive disorders was higher than that in control. In the linear regression model, anxiety accounted for 59.6% of dysfunctional breathing, but depressed mood did not. With covariate adjusted for anxiety, scores of dysfunctional breathing in anxiety or depressive disorders were higher than in controls. Conclusions:Dysfunctional breathing in anxiety or depressive disorders is higher than that in control. Adjusting anxiety, its difference is still. Anxiety affects dysfunctional breathing, but depressed mood does not. 연구목적: 역기능호흡은 일반 외래 진료에서 흔히 마주치는 증상이며, 삶의 질에 영향을 주지만, 간과되는 경우가 흔하다. 천식과 같은 호흡기 장애에서 유병률은 조사가 되었지만, 불안-우울장애에서는 연구가 적다. 본 연구는 정신과 외래에 방문한 불안-우울장애에서 역기능호흡의 유병률을 조사하고, 불안과 우울의 영향을 평가하고자 한다. 방 법: 본 연구는 135명의 불안-우울장애 환자(불안장애 54명, 우울장애 81명)와 124명의 대조군을 대상으로 하였다. 역기능호흡 평가는 Nijmegen 척도를 사용하였고, 불안-우울의 정도는 병원 우울불안 척도를 사용하였다. 결 과: 환자군에서 불안, 우울과 역기능호흡의 점수가 대조군에 비하여 높았다. 환자군과 대조군에서 역기능호흡의점수에 대하여 불안은 유의한 설명력을 보였지만, 우울은 그렇지 않았다. 불안을 공변량으로 하여 비교하였을때에도, 환자군의 역기능호흡의 점수가 대조군보다 높았다. 결 론: 불안-우울장애환자들은 정상대조군보다 역기능호흡의 정도가 높다. 역기능호흡에 불안은 영향을 주지만, 우울은 영향을 주지 않는다. 또한 불안을 조정하였을 때도 역기능호흡의 정도는 불안-우울장애에서 정상대조군 보다 높다.

선택적 함구증을 보이는 15세 남아의 Fluoxetine 치료 경험 1례

이영식,남범우,김종범 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.2

4세 이후 11년간 어머니를 제외하고는 아무와도 말을 하지 않았던, 선택적 함구증으로 진단된, 15세 남환 일례를 체험하였기에 문헌 고찰과 함께 보고하였다. 입원 14주 째 Fluoxetine을 투약하였고 투여 후 6주가 되면서부터 함구증의 현저한 호전을 보이기 시작하였고, 불안감의 감소 및 대인관계의 호전이 동반되었다. 본 증례는 치료방법 및 경과 면에서 사회공포증과 관련된 선택적 함구증으로 판단되며, 향후 더 많은 임상예를 통해 선택적 함구증에 대한 질병분류 및 치료방법의 고찰이 필요할 것으로 보인다. Elective mutism is a rare disease, and still its nosologic disease nature has not been clearly clarified. The authors experienced dramatic improvement in a 15-year-old boy with elective mutism by 6 weeks of fluoxetine treatment. His symtoms started 4 years ago and vivid social phobic symptoms were accompanied in adolescence. From these findings, we noticed the possibility of using fluoxetine generally in elective mutism patient and reviewed the nosologic concept of elective mutism in social phobic aspect.