강박장애의 임상적 특징과 충동성의 관련성

노대영,김세주,김찬형 대한신경정신의학회 2009 신경정신의학 Vol.48 No.5

강박장애 환자의 충동성에 대한 기왕의 연구들이 있었으나 결과는 일관되지 않았다. 본 연구 결과 강박장애 환자의 충동성은 정상인보다 전반적으로 높은 편이나, 무계획 충동성에 있어서는 정상인과 차이가 없는 특성을 지닌다. 발달적 접근과 증상차원적 접근을 통해 강박장애를 체계적으로 이해하려는 노력은 비교적 최근에 이루어지기 시작한 편이다. 그 중에 조기발병 강박증과‘저장’ 유형은 그 중에서도 병태생리 및 치료반응의 측면에서 뚜렷이 구별되는 유력한 아형들 중 하나이다. 본 연구에서 충동성이 강박장애 환자의 빠른 발병 연령과‘저장’ 증상차원의 공통적인 특성으로 확인된 바, 강박장애의 아형 분류에 중요한 근거로 이용될 수 있을 것이다. 추후 보다 많은 환자군들을 대상으로 한 전향적 연구와 더불어 신경심리학적 실험 연구와 공존질환에 따른 비교 연구 등 충동성에 대한 다양한 접근이 필요하겠다. Objectives: Previous studies have indicated that obsessive-compulsive disorder (OCD) is associated with high levels of impulsiveness. The aim of this study was to assess whether there are differences in clinical correlates with impulsiveness between OCD patients and healthy controls, and whether there is a significant relation between certain obsessive-compulsive symptomatic dimensions and impulsiveness. Methods: A group of 45 OCD outpatients and 45 matched healthy controls were interviewed and diagnosed according to DSM-IV criteria. All subjects were assessed by means of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Barratt Impulsiveness Scale (BIS-11), the Hamilton Anxiety Scale (HAM-A), and the Montgomery-Asberg Depression Rating Scale (MADRS). Results: Compared with healthy controls, OCD patients exhibited significantly higher BIS-11 scores except for with respect to non-planning impulsiveness. The MADRS scores and age at onset in patients with OCD were significantly correlated with BIS-11 total scores. Multiple regression analyses revealed that only age at onset showed an independent positive correlation with impulsiveness. Hoarding was the only dimension significantly associated with impulsiveness. Conclusion: These findings suggest that groups of patients with early onset OCD may show some association with impulsiveness, and that impulsiveness may be another distinct clinical feature of hoarding in OCD.

스페셜 이슈 : 사회적 기업 육성체계와 개선방안

노대영 대한지방행정공제회 2012 地方行政 Vol.61 No.708

중증 정신 질환 환자에서의 약물 순응도 향상

노대영,장진구,김찬형 대한정신약물학회 2012 대한정신약물학회지 Vol.23 No.4

Adherence to treatment in mental health is generally regarded as central for optimizing recovery. However, poor adherence of patients with psychiatric disorders can have devastating consequences such as relapse, rehospitalization and poor quality of life. Adherence problems are likely to be multi-determined and related to different factors in different individuals. Combining subjective and objective quantitative assessment with a more qualitative interview might help assess adherence better in patients with mental illness to determine the presence of adherence problems and investigate their cause. The therapeutic relationship between patient and clinician has been found to be important for treatment adherence. Adherence problems should be regarded not as the result but as the process of the treatments to facilitate the therapeutic alliance. Clinicians and patients need to cooperate with each other in a model of shared decision-making to choose the best treatment option for the specific individual. Psychoeducation might provide information about the risk and benefit of the medication to patients and their family. The collaborative approach is helpful for the clinicians to have an open dialogue about what patients think and perceive about the treatment. 정신과 환자의 치료 순응도 문제는 질환의 경과와 예후 및 삶의 질에 결정적인 영향을 미칠 수 있다. 비순응 및 순응도 저하는 중증 정신 질환의 재발과 환자의 재입원의 가장 흔한 원인 중 하나이다. 순응도는 약물뿐 아니라 환자 개인과 환자를 둘러싼 가족 및 사회 환경의 여러 요인들이 복합적으로 관련되어 있다. 치료자 입장에서 환자의 순응도 파악이 어렵기 때문에 다양한 방법을 활용하여 환자의 치료 순응도를 정확하게 평가하는 것이 우선이다. 순응도 개선을 위해서는 환자 치료자 간의 치료 관계를 긍정적으로 유지하는 것이 중요하며, 순응도 문제를 치료의 결과로 생각하기 보다는 과정으로 받아들이는 태도가 도움이 된다. 또한 공통의 의사결정 과정을 통해 환자 중심의 치료가 이루어져야 한다. 환자 및 환자 가족들을 대상으로 치료 효과 및 부작용에 대한 충분히 교육할 필요가 있다. 또한 치료자는 약물 처방에 관한 환자의 느낌과 태도를 꾸준히 살펴보고, 개방적인 자세로 환자와 소통하려는 노력이 요구 된다.

강박장애의 개념과 진단기준의 변천과 향후 방향

노대영,김지민,김찬형,Roh, Dae-Young,Kim, Ji-Min,Kim, Chan-Hyung 대한불안의학회 2010 대한불안의학회지 Vol.6 No.2

Research on obsessive-compulsive disorder (OCD) has advanced substantially since the DSM-IV was published in 1994. It is time to reexamine the nosology of this disorder, reviewing conflicting views regarding the classification as well as subtypes and specifiers of OCD. Although there is ongoing debate, OCD experts have suggested that OCD be retained in the section related to anxiety disorders and also that along with OCD, this section include obsessive-compulsive spectrum disorders (OCSD), a group of disorders closely related to OCD. A combined 'anxiety and obsessive-compulsive spectrum chapter' has also been proposed to include OCSDs. A growing body of scientific data has provided empirical support for the inclusion of a 'tic-related' subtype of OCD in the DSM-V. However, it remains controversial as to whether to introduce OCD symptom dimensions as specifiers as well as items in the diagnostic criteria. With regard to compulsive hoarding, there has been sufficient evidence to recommend that it be classified in the DSM-V as a separate disorder. Much work remains in order to ensure that the DSM-V is as evidence based as possible. It is necessary to strive toward integrating the biological and psychological data related to OCD and OCSD based on their endophenotypic features.

시공간 특성을 이용한 고속 움직임 백터 예측 방법

노대영,장호연,오승준,석민수 대한전자공학회 2003 電子工學會論文誌-SP (Signal processing) Vol.38 No.2

움직임 예측은 화질을 유지하면서 영상을 낮은 비트율로 부호화하는 중요한 기술이다. 일반적인 전역 탐색 방법을 사용하면 많은 계산량이 요구된다. 이전의 많은 고속 움직임 예측 방법들은 탐색점의 수를 줄이는데 초점을 두고 있기 때문에 움직임 백터 예측의 정확도가 낮다. 그러므로 본 논문에서는 주위 볼록간의 시공간적 상관관계를 이용하는 새로운 움직임 예측 방법을 제안한다. 신뢰할 수 있는 예측 움직임 벡터(Reliable Predicted Motion Vector : RPMV)를 정의한 후 전역 탐색 방법과 결과를 비교하여 RPMV의 성능을 검증한다. 검증된 RPMV 의 크기와 방향을 이용하는 새로운 움직임 백터 예측 방법을 제안한다. 실험을 통해 제안된 방법을 현재까지 제안된 방법 중 효율적인 것으로 알려진 Nearest Neighbor 방법과 비교하였을 때 약 l1∼14% 정도 속도 향상이 있었다. The Motion Estimation (ME) process is an important part of a video encoding systems since they can significantly reduce bitrate with keeping the output quality of an encoded sequence. Unfortunately this process may dominate the encoding time using straightforward full search algorithm (FS). Up to now, many fast algorithms can reduce the computation complexity by limiting the number of searching locations. This is accomplished at the expense of less accuracy of motion estimation. In this paper, we introduce a new fast motion estimation method based on the spatio-temporal correlation of adjacent blocks. A reliable predicted motion vector (RPMV) is defined. The reliability of RPMV is shown on the basis of motion vectors achieved by FS. The scalar and the direction of RPMV are used in our proposed scheme. The experimental results show that the proposed method Is about l1~14% faster than the nearest neighbor method which is a wellknown conventional fast scheme.

[123I]-Iomazenil SPECT를 이용한 공황장애 환자에서 대뇌 벤조다이아제핀 수용체 결합 이상

노대영,박경민,김영기,이상민,류영훈,김찬형 대한신경정신의학회 2010 신경정신의학 Vol.49 No.2

Objectives: Researchers have long hypothesized that the benzodiazepine-GABA system plays a role in the pathophysiology of panic disorder (PD). However, previous neuroimaging studies have been inconclusive, possibly due to matching discrepancies between patients and controls,confounding medication factors, and/or image analyzing methods. This study aimed to compare benzodiazepine receptor binding between PD patients and healthy controls. Methods: Via 123I-iomazenil single-photon emission computed tomography (IMZ-SPECT), we obtained regional brain patterns of benzodiazepine receptor binding for 12 unmedicated PD patients and 8 healthy age-and sex-matched volunteer controls. To analyze the image data, we used statistical parametric mapping (SPM). Results: Benzodiazepine receptor binding showed a decrease in both the parietal and occipital lobes in PD patients as compared to controls. The anterior cingulate cortex, left parahippocampal gyrus, and both temporal lobes showed increased binding in PD patients. Conclusion: Our findings provide evidence of an abnormal BZD-GABA system in PD patients,suggesting that basal and/or compensatory changes in inhibitory neurotransmissions contribute to the pathogenesis of human PD. 이번 연구는 국내에서 공황장애 환자를 대상으로 BZDGABA계의이상을 처음으로 직접 확인하였다는 데에 큰 의의가 있을 것으로 생각된다. 정상인과 비교했을 때, 공황장애환자에서 벤조다이아제핀 수용체 결합이 뇌의 영역에 따라차이(증가 혹은 감소)가 나타난 것은 BZD-GABA계 이상이공황장애의 병태생리와 연관될 가능성을 시사한다. 공황장애의 병태생리를 이해하기 위해서는 향후 좀 더 많은 환자군을 대상으로 치료적 개입 및 임상 증상의 변화에 따른 추적연구가 도움이 될 것이다. 또한 PET와 같이 보다 높은 해상도의 다른 영상학적 연구 방법을 이용하여 병태생리에 관여하는 신경해부학적 영역을 확인할 필요가 있겠다.

Antipsychotic Prescribing Patterns in First-episode Schizophrenia: A Five-year Comparison

노대영,장진구,Sol Yoon,김찬형 대한정신약물학회 2015 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.13 No.3

Objective: Early treatment choice is critical in first-episode schizophrenia-spectrum disorders. The purpose of this study was to describe prescribing trends of antipsychotics use in patients with first-episode schizophrenia in 2005 and 2010, respectively. Methods: We reviewed the medical records of newly treated patients with schizophrenia from a university psychiatric hospital in 2005 (n=47) and 2010 (n=52). We defined patients as receiving a high antipsychotic dose if their ratio of prescribed daily dose (PDD) to defined daily dose (DDD) was greater than 1.5. Results: The rates of high-dose antipsychotic prescription were 61.7% and 53.8% in 2005 and 2010, respectively. The rates of antipsychotic polypharmacy were 34.6% in 2005 and 34.0% in 2010. The most common first-prescribed antipsychotics were (in descending order of prescription frequency) olanzapine, risperidone, aripiprazole, and haloperidol in 2005 and risperidone, quetiapine, paliperidone, and olanzapine in 2010. High-dose antipsychotics were significantly associated with antipsychotic polypharmacy (odds ratio=23.97; p<0.01). More individuals were treated with mood stabilizers in 2010 than in 2005 (p=0.003). Conclusion: The practice of prescribing high-dose antipsychotics and associated antipsychotic polypharmacy were common even for initial treatment of first-episode schizophrenia in 2005 and 2010. In 2010, the list of the most common first-prescribed antipsychotics changed, and the use of mood stabilizers increased in non-affective schizophrenia.

정신병 위험상태 : 관련된 문제와 향후 전망

노대영,김찬형,Roh, Dae-Young,Kim, Chan-Hyung 대한생물정신의학회 2011 생물정신의학 Vol.18 No.4

In medicine, general clinical practice moves in the direction of early detection and intervention for the prevention of progressive disease. In psychiatry, research in subjects with the risk syndrome for psychosis, has been conducted for the prevention of schizophrenia, known as a devastating chronic disease. The inclusion of 'attenuated psychosis syndrome', based on the results of early intervention studies, is one of the major issues in the upcoming DSM-V. Further investigations are needed to find biological markers and endophenotypes to supplement the diagnostic criteria. In the future, adoption of clinical staging is promising to overcome the shortcoming of current diagnosis of schizophrenia. In clinical practice, more concerns are needed about attenuated psychotic symptoms which might be risk signals for the transition to psychosis.

정신질환에서 뇌자극술의 적용

노대영,강리영,김도훈,Roh, Daeyoung,Kang, Lee Young,Kim, Do Hoon 대한생물정신의학회 2017 생물정신의학 Vol.24 No.4

Based on advances in biotechnology and neuroscience, neuromodulation is poised to gain clinical importance as a treatment modality for psychiatric disorders. In addition to old-established electroconvulsive therapy (ECT), clinicians are expected to understand newer forms of neurostimulation, such as deep brain stimulation (DBS), vagus nerve stimulation (VNS), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS). Given the growing interest in non-invasive neuromodulation technologies, clinicians may seek sufficient information about neuromodulation to inform their clinical practice. A growing literature suggests that applications of non-invasive neuromodulation have evidence particularly for indications where treatments are currently insufficient, such as drug-resistant depression. However, positive neuromodulation studies require replication, and the precise interactions among stimulation, antidepressant medication, and psychotherapy are unknown. Further studies of long-term safety and the impact on the developing brain are needed. Non-invasive neuromodulatory devices could enable more individualized treatment. However, do-it-yourself (DIY) stimulation kits require a better understanding of the effects of more frequent patterns of stimulation and raise concerns about clinical supervision, regulation, and reimbursement. Wide spread enthusiasm for therapeutic potential of neuromodulation in clinical practice settings should be mitigated by the fact that there are still research gaps and challenges associated with non-invasive neuromodulatory devices.

정신의학에서 대마 관련 약물의 전망

노대영,김찬형,장기원 대한생물정신의학회 2023 생물정신의학 Vol.30 No.2

Cannabis, presently being one of the most commonly employed psychoactive agents globally, ranks after alcohol and nicotine. Despite the permissibility of employing cannabis for medicinal objectives in Korea, the discussion regarding the authorization and control of cannabis for both recreational and medicinal intentions persists, giving rise to apprehensions about the plausible hazards and repercussions of cannabis on public well-being and health. Cannabis has the potential to induce positive experiences that mitigate certain psychiatric symptoms depending on the individual. However, a multitude of studies have demonstrated a close association between cannabis usage and detrimental effects on the brain, including the onset of schizophrenia and the deterioration of cognitive function. The endocannabinoid (eCB) system, which serves as the primary target for the active components of cannabis, was only recently discovered, and the precise mechanisms through which the intricate substances within cannabis interact with the body remain inadequately comprehended. The use of medical cannabis for mental illness has shown promise in treating anxiety, post-traumatic stress disorder, sleep disorders, and substance use disorders. Recent research has focused on the discovery of the eCB system, which plays a role in the therapeutic effects of cannabinoids. These studies are advancing the development of new treatments for mental disorders through research and clinical trials. In conclusion, while cannabis-related substances carry a risk for mental health, the eCB system also holds potential as a new therapeutic mechanism. Further research is needed to better understand the mechanisms of cannabinoids and determine appropriate medical uses.