급성 조증환자에서 Risperidone의 치료효과: 임상 개방 연구

백인호,이창욱,이철,이수정,김재현,Paik, In Ho,Lee, Chang Uk,Lee, Chul,Lee, Soo Jung,Kim, Jae Hyun 대한생물정신의학회 1995 생물정신의학 Vol.2 No.2

Objects : Manic phase of bipolar disorder is treated with a combination of mood stabilizer and antipsychotic drug, especially in the acute phase. Such combined treatment is often required for the clinical management of manic symptoms until therapeutic effects of mood stabilizer become evident. The present study was the first open trial to evaluate the efficacy of risperidone, and safety of the combination of mood stabilizer and risperidone in the treatment of acute manic patients. Method : This study was performed as an open clinical study. The subjects of this study were 42 patients who had been admitted with first manifestations or acute exacerbations of illness were selected, using DSM-III-R criteria for bipolar disorder, manic episode. Patients were rated using the the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI), Extrapyramidal Symptom Rating Scale(ESRS). Other adverse events were assessed by a symptom checklist and by observation by medical personnel. Vital signs were monitored in a standard way and electrocardiography, routine laboratory analysis were performed. Results : Thirty patients(67%) completed the 12-week trial period. The CGI showed a good therapeutic effect with a minimal incidence or severity of side effects. The majority of patients showed a continuos reduction in their BPRS scores. The extrapyramidal symptoms assessed on ESRS generally showed mild to moderate degree. laboratory porameters showed no significant changes during the course of treatment. Conclusion : The results of the study showed a good efficacy of the risperidone in manic patients and further controlled studies are warranted.

정신분열병 환자의 Tyrosine Hydroxylase 유전자 Intron 1의 VNTR 다형성

백인호,도규영,이창욱,김정진,이수정,이철,Paik, In-Ho,Toh, Kyu-Young,Lee, Chang-Uk,Kim, Jung-Jin,Lee, Soo-Jung,Lee, Chul 대한생물정신의학회 1999 생물정신의학 Vol.6 No.2

가족연구, 쌍생아연구, 양자연구 등은 정신분열병의 발생에 유전적 원인이 작용하고 있음을 보여주고 있으며, 생화학적 연구들은 도파민이 중요한 역할을 하는 것으로 보고하고 있다. 한편, tyrosine hydroxylase(TH)는 도파민의 생성에 속도제한효소로 중요한 작용한다. 따라서 본 연구에서는 TH의 유전적 다형성과 정신분열병의 발생, 임상아형 등과의 관련연구를 시행하였다. 환자군은 가톨릭대학교 강남성모병원에 입원하였던 환자중 정신장애 진단 및 통계를 위한 편람 III-R의 진단기준에 의하여 정신분열병으로 진단된 환자로 신경과 질환이나 다른 정신과적 질환이 없는 374명을 대상으로 하였으며, 대조군은 강남성모병원에서 근무하는 직원, 가톨릭대학교 의과대학생, 그리고 강남성모병원 건강진단센터를 방문한 사람중 지원자를 대상으로 하여 393명을 포함하였다. TH 대립유전자의 분포는 환자군과 대조군 사이에 유의한 차이를 보이지 않았으나, 환자군에서는 양성군인 경우 대립유전자 A형의 빈도가 음성군에 비해 높은 것으로 나타났다. 또한 대립유전자 A형을 가지고 있는 환자군은 A형을 가지고 있지 않은 환자군 보다 유의하게 양성증상점수가 높은 것으로 나타났다. 이상의 결과들은 정신분열병의 양성증상과 TH 대립유전자 A형이 관련되어 있음을 시사해 준다고 하겠다. Until recently, the etiology of schizophrenia was generally attributed to abnormalities in dopaminergic neurotransmission. Specifically, an excess of dopaminergic activity in the mesolimbic system has been postulated to produce the positive symptoms, while decreased dopaminergic activity in the mesocortical system has been suggested to cause negative symptoms. Accordingly, we performed an association study of schizophrenia with TH gene. Three hundred and seventy four biologically unrelated schizophrenic patients meeting DSM-III-R criteria from Kangnam St. Mary's Hospital affiliated with Catholic university of Korea were recruited for our study. The 393 healthy controls were volunteers for DNA library of Kangnam St. Mary's Hospital without personal or family history of psychiatric and neurologic illness. DNA was extracted from peripheral mononuclear cells and polymorphic region was amplified by polymerase chain reaction. TH intron 1 VNTR polymorphism was typed by silver staining. The allele distributions of TH gene were not different between schizophrenics and controls. However, the frequency of allele A was significantly higher in positive group than that of negative group of schizophrenics. These findings suggest that poitive schizophrenia may be associated with allele A of TH gene.

알코올 의존증과 세로토닌

백인호,Paik, In-Ho 대한생물정신의학회 1995 생물정신의학 Vol.2 No.1

알츠하이머병 환자의 전반적 피질 위축, 내측두엽 위축, 백질 고강도 신호와 인지기능의 연관성

최린,주수현,이창욱,백인호,Choi, Leen,Joo, Soo-Hyun,Lee, Chang-Uk,Paik, In-Ho 대한생물정신의학회 2015 생물정신의학 Vol.22 No.3

Objectives The aim of this study is to investigate the correlation between degenerative changes in brain [i.e., global cortical atrophy (GCA), medial temporal atrophy (MTA), white matter hyperintensities (WMH)] and neurocognitive dysfunction in Korean patients with Alzheimer's disease. Methods A total of 62 elderly subjects diagnosed with Alzheimer's disease were included in this study. The degenerative changes in brain MRI were rated with standardized visual rating scales (GCA or global cortical atrophy, MTA or medial temporal atrophy, and Fazekas scales) and the subjects were divided into two groups according to the degree of degeneration for each scale. Cognitive function was evaluated with Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) and several clinical features, including apolipoprotein E ${\varepsilon}4$ status, lipid profile and thyroid hormones, were also examined. Chi-square test and Fisher's exact test were performed to analyze the relationship between the degree of cerebral degeneration and neurocognitive functions. Results Demographic and clinical features, except for the age, did not show any significant difference between the two groups divided according to the degree of cerebral degenerative changes. However, higher degree of GCA was shown to be associated with poorer performance in verbal fluency test, word list recall test, and word list recognition test. Higher degree of MTA was shown to be associated with poorer performance in Mini-Mental State Examination in the Korean Version of CERAD Assessment Packet (MMSE-KC), word list recognition test and construction praxis recall test. Higher degree of white matter hyperintensities was shown to be associated with poorer performance in MMSE-KC. Conclusions Our results suggest that severe brain degeneration shown in MRI is associated with significantly poorer performance in neurocognitive tests in patients with Alzheimer's disease. Moreover, the degree of GCA, MTA and white matter hyperintensities, represented by scores from different visual rating scales, seems to affect certain neurocognitive domains each, which would provide useful information in clinical settings.

정신분열병 환자의 작동기억 이상에 대한 기능적 자기공명영상 연구

박여진,김태석,노사봉,배치운,김정진,이수정,이철,백인호,이창욱,Park, Yuh-Jin,Kim, Tae-Suk,Roh, Sa-Bong,Pae, Chi-Un,Kim, Jung-Jin,Lee, Soo-Jung,Lee, Chul,Paik, In-Ho,Lee, Chang-Uk 대한생물정신의학회 2005 생물정신의학 Vol.12 No.1

Objective:Impaired processing of working memory is one of the cognitive deficits seen in patients with schizophrenia. This aimed at corroborating the differences in the brain activities involved in the process of working memory between patients with schizophrenia and the control subjects. Method:Fourteen patients with schizophrenia and 12 healthy volunteers were recruited in this study. Functional magnetic resonance imaging(fMRI) was used to assess cortical activities during the performance of a 2-back visual working memory paradigm using the Korean alphabet as mnemonic content. Results:Group analysis revealed that left lateral prefrontal cortex and right parietal lobule showed decreased cortical activities in the patient group. On the other hand, an increased activation in left superior and middle frontal gyrus, left middle temporal gyrus, right cuneus, both occipital lobes, right fusiform gyrus and right cingulate gyrus. The activation in left anterior lobe and both declive of cerebellum was also increased. Conclusions:This study showed a decreased activation in left lateral prefrontal and right parietal neural networks from the patient group and confirmed the earlier findings on the impaired working memory of patients with schizophrenia using fMRI investigation. The regions implicated in our study suggest an abnormal functioning of the fronto-parietal cortical areas that are critical to the information processing stream, which might be correspondent to common pathophysiology rather than a common etiology in schizophrenia.

알츠하이머형 치매 환자 뇌파의 비선형 역동 분석 - 상관차원을 이용한 예비적 연구 -

채정호,김대진,정재승,김수용,고효진,백인호,Chae, Jeong-Ho,Kim, Dai-Jin,Jeong, Jaeseung,Kim, Soo Yong,Go, Hyo Jin,Paik, In-Ho 대한생물정신의학회 1997 생물정신의학 Vol.4 No.1

치매에서의 뇌파 연구는 주로 주파수 분석과 지형화 분석을 이용하여 정량화하는 것을 위주로 진행되어 왔으나 이러한 선형적 분석은 뇌파와 같이 복잡한 신호를 분석하는 것에는 한계가 있었다. 최근 새로운 패러다임인 카오스이론에 근거를 두고 뇌파를 비선형적으로 측정하는 방법이 소개되고 있다. 본 연구는 알츠하이머형 치매환자의 뇌파 신호를 상관차원을 이용하여 비선형적으로 분석하는 것이 가능한가를 알아보고 그 결과를 대조군과 비교해보기 위하여 시도되었다. 3명의 알츠하이머형 치매 환자와 3명의 대조군에서 뇌파 신호를 받아 디지털 화한 후에 비선형분석법 중 하나인 상관차원 값을 계산하였다. 전체 15개의 전극부위 중 3곳을 제외하고는 모든 전극과 두뇌 영역별, 반구별 분석 모두에서 알츠하이머형 치매군의 상관차원값이 유의하게 낮았다. 본 연구 결과는 알츠하이머형 치매 환자에서 카오스 이론을 이용한 비선형적 전기신경생리학적 분석으로 알아낼 수 있는 두뇌의 복합성, 즉 두뇌의 카오스적 성상이 감소되어 있다는 것을 의미하며 향후 뇌파의 비선형적 분석이 두뇌 기능을 조사하는 데에 유용한 새로운 방법이 될 가능성이 있다는 것을 시사한다. The changes of electroencephalogram(EEG) in patients with dementia are most commonly studied by analyzing power or magnitude in certain traditionally defined frequency bands. However because of the absence of an identified metric which quantifies the complex amount of information, there are many limitations in using such a linear method. According to chaos theory, irregular signals of EEG can also result from low dimensional deterministic chaos. Chaotic nonlinear dynamics in the EEG can be studied by calculating the correlation dimension. The authors have analyzed EEG epochs from three patients with dementia of Alzheimer type and three matched control subjects. The multichannel correlation dimension is calculated from EEG epochs consisting of 15 channels with 16,384 data points per channel. The results showed that patients with dementia of Alzheimer type had significantly lower correlation dimension than non-demented controls on 12 channels. Topographic analysis showed that the correlation dimensions were significantly lower in patients with Alzheimer's disease on frontal, temporal, central, and occipital head regions. These results show that brains of patients with dementia of Alzheimer type have a decreased complexity of electrophysiological behavior. We conclude that the nonlinear analysis such as calculating correlation dimension can be a promising tool for detecting relative changes in the complexity of brain dynamics.

정신분열병 환자에서 올란자핀과 연관된 체중 증가에 대한 니자티딘의 효과 : 예비 연구

배치운(Chi-Un Pae),정유경(Yoo-Kyung Jung),이창욱(Chang-Uk Lee),이수정(Soo-Jung Lee),이철(Chul Lee),백인호(In-Ho Paik) 대한생물치료정신의학회 2003 생물치료정신의학 Vol.9 No.1

본 연구는 올란자핀을 투여 후 체중 증가가 관찰된 정신분열병 환자들을 대상으로 nizatidine의 효과를 조사하고자 시도되었다. 올란자핀을 처음 투여 받은 환자들 중 체중 증가가 발생된 10명을 대상으로 하였다. 모든 환자에게 nizatidine을 300㎎/day로 투여하였으며 임상 증상에 미치는 영향을 배제하기 위하여 PANSS와 BPRS를 기저 시점과 nizatidine 투여 후 4주 및 8주 시점에 측정하여 임상 증상의 변화를 평가하였다. 연구 시작 후 4주 및 8주 시점에서 체중 변화는 각각 1.1㎏(1.5%)와 2.5㎏(3.5%)이었으며 BMI의 경우 4주와 8주 시점에서 각각 0.4(1.6%)와 0.9(3.7%)로 연구 기간동안 모두 유의한 감소를 보였다. 올란자핀을 복용하여 체중 증가가 관찰되었던 10명의 정신분열병 환자를 대상으로 하여 8주간 nizatidine을 투여한 결과, 연구 방법상의 제한점이 있으나 nizatidine은 올란자핀 관련체중 증가의 치료에 효과적인 약물로 생각된다. Objectives : This pilot study was conducted to evaluate the effect of nizatidine on olanzapine-associated weight gain(OAWG) in schizophrenic patients in Korea. Methods : Ten subjects with OAWG from outpatients clinic who were diagnosed with schizophrenia and schizophreniform disorder in accordance with DSM-Ⅳ criteria. Positive and Negative Syndrome Scale(PANSS) and Brief Psychiatric Rating Scale(BPRS) were measured at baseline, week 4 and week 8 as were weight and Body Mass index(BMI). A flexible dose of olanzapine plus fixed 150㎎(b.i.d) dose of nizatidine was administered to all patients. Weight and BMI(㎏/m²) were recorded at each visit. Results : A combination of nizatidine resulted in significant reversal of OAWG without worsening the psychopathology. In line with studies of Western populations, an add-on therapy of nizatidine could be an effective option for the control of weight gain in olanzapine-treated patients in Korea. Conclusion : Our findings call for further evaluation of the effect of this drug on schizophrenics, with randomized placebo-controlled studies, in Asian populations.

노인 입원 환자에 대한 일 대학 병원의 리스페리돈과 올란자핀의 처방 경향 : 자연적 연구

임현국(Hyun Kook Lim),최은형(Eun Hyung Choi),이영란(Young Ran Lee),오근(Keun Oh),배치운(Chi Un Pae),이철(Chul Lee),백인호(In Ho Paik),이창욱(Chang Uk Lee) 대한노인정신의학회 2007 노인정신의학 Vol.11 No.1

Several studies have reported that either risperidone or olanzapine is effective and tolerable in the elderly patients with psychotic symptoms. However, there is a lack of clinical data of risperidone and olanzapine prescription for elderly patients in the Aisan population. We reviewed retrospectively the medical records of risperidone (n=112) and olanzapine (n=96) treated patients older than age 60 who were admitted to a university-affiliated hospital between October 2005 and August 2006. The mean daily dose of risperidone was 3.4±1.5 mg and olanzapine, 8.8±5.6 mg, respectively. The response rate on the CGI (much and very much improved) appeared to be 67.4% in the risperidone group and 70.8% in the olanzapine group, respectively. Adverse events were reported in 48.2% in the risperidone group and 46.9% in the olanzapine group, without serious adverse events, respectively. This study showed that either risperidone or olanzapine would be effective and tolerable in elderly patients with psychotic symptoms and that provides similar results to those reported from western countries.

조현병 환자의 유병기간에 따른 강박증상

서주현,백인호,김임렬,김수룡,조정민,Seo, Ju-Hyun,Paik, In-Ho,Kim, Im-Yel,Kim, Su-Ryong,Jo, Jung-Min 대한생물정신의학회 2018 생물정신의학 Vol.25 No.2

Objectives The aim of this study was to evaluate the psychopathological features such as depression and anxiety in schizophrenics with obsessive-compulsive symptoms (OCS) as well as the severity of OCS according to duration of schizophrenia. Methods We randomly selected sixty four inpatients with schizophrenia. We classified the patients into two groups (OCS group, non-OCS group) according to the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Clinical and demographic features were evaluated. To assess OCS, Y-BOCS were performed. The Korean version of the Positive and Negative Syndrome Scale(K-PANSS), the Brief Psychiatric Rating Scale (BPRS), the Korean version of the Calgary Depression Scale for Schizophrenia (K-CDSS), the Beck Anxiety Inventory (BAI) and the Satisfaction With Life Scale (SWLS) were conducted. Independent t-test and chi-square test were conducted to compare the two groups. Pearson correlation analysis was performed to examine the relationship between the duration of schizophrenia and the Y-BOCS score. Results The Y-BOCS, K-CDSS, and BAI scores were higher in the OCS group. There was a significant correlation between the duration of schizophrenia and the Y-BOCS score. Conclusions Anxiety and depression symptoms were severe in the OCS group. In addition, the results of this study indicate that the longer duration of schizophrenia, the more severe the OCS. Therefore, the evaluation of OCS in schizophrenics should be accompanied by treatment intervention.

경증 전신성 홍반성 루프스 환자의 인지기능장애

김진희,이철,이창욱,백인호,Kim, Jin-Hee,Lee, Chul,Lee, Chang-Uk,Paik, In-Ho 한국정신신체의학회 1997 정신신체의학 Vol.5 No.1

SLE 환자들에서 인지기능의 장애가 있는지를 알아보기 위해서 신경정신과적 병력이 없는 내과 외래 SLE 환자 20명과 정상 대조군 20명을 대상으로 전산화 신경인지기능 검사인 Vienna test system을 시행하고 이를 인지기능에 영향을 미칠 수 있는 임상 변인들과의 연관성을 분석하여 다음과 같은 결과를 얻었다. 1) SLE 환자군과 정상 대조군의 신경인지기능 검사의 각 항목 비교 인식력 검사항목에서 SLE 환자군은 정상 대조군에 비해 정확하게 응답한 반응수가 적었으며 '예'와 '아니오' 중 '아니오'를 정확하게 반응한 수도 적었다. 또한 '예'와 '아니오'에 대해 각각 정확한 반응을 하는 평균 반응시간이 길었으며 검사소요 시간도 길었다. 주의력 검사항목에서는 SLE 환자군이 정상 대조군에 비해 정확하게 응답한 반응수가 적었고, 평균 반응시간이 길었다. 그러나, corsi단기 기억력 검사항목에서는 시각적 단기 기억력 범위와 정확하게 맞춘 총 응답수에서 두군 간에 유의한 차이가 없었다. 표준도형 지능검사항목에서 SLE 환자군은 정상 대조군에 비해 정확하게 응답한 반응수가 적었다. 신경행동학적 인지상태 검사중 기억력 항목에서 SLE 환자군은 정상 대조군에 비해 유의하게 낮은 점수를 보였다. 2) 신경인지기능의 각 항목과 환자군의 연령, 교육연한, SLE 질환 활성도(SLE Disease Activity Index), 우울 증상의 정도, 항 ds-DNA항체. 보체 C3/C4, 스테로이드의 용량 등의 임상 변인들과의 상관관계를 비교하였을 때 통계적으로 유의하지 않았다. 이상의 결과에서 질환 활성도가 낮은 SLE환자들은 과거 신경정신과적 증상의 병력이 없고 병의 이환 기간이 비교적 짧음에도 불구하고 인지기능의 장애를 나타내었다. 그리고 이는 기타 장기의 침범으로 인한 비특이적 영향이 아닌 중추신경계의 침범에 의한 것으로 보이며 우울정도나 스테로이드 용량에 영향을 받지 않는 것으로 생각된다. This study was designed to determine whether cognitive impairment was evident in patients with SLE. Also, it aimed to examine the association of cognitive impairment with other clinical variables. The subjects consisted of 20 patients with mildly active SLE and 20 healthy controls. Methods : A total of 20 SLE patients and 20 normal controls completed a computerized neuropsychological test battery using Vienna Test System. These included Cognitrone test, Continuous attention test, Corsi block tapping test, Standard progressive matrices. Also, neuro-behavioral cognitive status examination was done. The symptom severity of depression was measured with Beck Depression Inventory, Hamilton Depression Rating Scale, and current medications were documented. Disease activity was rated using the SLE diasease activity index (SLEDAI). Results : SLE patients had poorer performance than normal controls on the tests of Cognitrone, attention, nonverbal IQ and memory, independent of age, education, disease activity, steroid use and depression status. Conclusion : Cognitive dysfunction was not uncommon in ambulatory SLE patients as measured by standardized neuropsychological tests. It seemed to occur independently of various clinical variables. These findings would suggest that cognitive dysfunction in SLE may be explained by reflecting subclinical central nervous system(CNS) involvement, rather than coexisting psychological distress due to chronic illness or side effect of medication.