알코올중독의 약물치료

성상경,Sung, Sang Kyung 대한생물정신의학회 1999 생물정신의학 Vol.6 No.1

This review focused on the pharmacological treatment of alcoholism, especially alcoholism-related mental disorder. The pharmacological agent for alcoholism can be divided into the following categories : anticraving agent, aversive agent, agent to treat acute alcohol withdrawal, agent to diminish drinking by treating associated psychiatric pathology, agent to induce sobriety in intoxicated individuals. Following trends are included in new trends of pharmacological treatment of alcoholism. What are precise conditions amenable to pharmacological intervention? ; How can psychosocial and behavioral intervention be integrated with pharmacotherapy to enhance treatment outcome? ; Is the concept of "matching" specific pharmacotherapy treatment to different aspect of alcoholism more efficacious than a more generalized medicational approach to treatment? One of the most important factors for alcoholics treatment is good and proper therapeutic relationship with patients and setting up individually specialized treatment program is also important.

한국인 알코올중독 환자의 예후인자에 관한 연구 : 심리적, 사회적, 생물학적 요인을 중심으로

성상경,장환일,Sung, Sang-Kyung,Chang, Hwan-Il 대한생물정신의학회 1995 생물정신의학 Vol.2 No.2

The author studied prognostic indicators of sixty Korean male alcoholics in psychological, social and biological aspects who were divided into abstinent and drinking groups. Thirty patients were assigned to each group. They were controlled in age and sex. Both groups were compared in terms of the demographic characteristics, past drinking history, treatment history, famaily history, ego strength and personality factors differences and distribution of dopamine $D_2$ receptor gene Al allele. Also the author studied relation of clinical course, alcoholic family history and dopamine $D_2$ receptor gene Al allele in both groups. The results were as follows; 1) The abstinent group had higher rate of married state, higher economic status, longer education years and maintained more stable job than the drinking group. But made no differences in occupation and religion. 2) The abstinent group showed higher rate of living with family members than the drinking group, and wives and fellows of the alcoholics anonymous were important factors for maintenance of abstinence. Family loading and parent's characters were not different. 3) The abstinent group had longer maximal length of abstinence but mean amount of alcohol consumption per day were larger than the drinking group. But there were no differences in duration of past drinking, drinking pattern, main drinking time, first drinking age and preference of the kind of alcoholic beverage in the past drinking history. 4) The abstinent group showed stronger treatment motivation, absolute abstinence in treatment goal, more voluntary adimission and maintained longer therapeutic relationship otter discharge than the drinking group. But both groups showed negative attitude toward antabuse therapy. 5) The abstinent group had higher mean score in ego strength scale than the drinking group. 6) In the personality factor questionnaire, the abstinent group showed strong laugh poise and the trait of praxernia, conservatism personality but the drinking group showed tough poise, the trait of weak ego strength(unstableness) and tough mindedness personality. 7) In comparision of dopamine $D_2$ receptor gene A1 allele, the prevalence of A1 allele was seventy percent and the frequency was 0.38 in the abstinent group. The prevalence of A1 allele was sixty percent and the frequency was 0.42 in the drinking group. Both groups were not significantly different in A1 allele prevalence and frequency. 8) In comparision of dopamine $D_2$ receptor gene A1 allele according to alcoholic family history, the prevalence of A1 allele was seventy percent and the frequency was 0.43 in the family history positive group. The prevalence of A1 allele was sixty-one percent and the frequency was 0.38 in the family history negative group. Both groups were not significantly different in A1 allele prevalence and frequency. In comparision of past drinking history according to alcoholic family history, the family history positive group showed earlier first drinking and problem drinking, but the family history negative group hod longer duration of past drinking. The mean amount of alcohol consumption per day, the longest duration of abstinence and Alcoholism Screening Test of Seoul Natoinal Mental Hospital(NAST) results were not significant. In conclusion, the results suggest that successful prognostic indicators of Korean alcoholics are married state, higher economic status, longer education years, stable job, living with family members, longer abstinence during past drinking history, strong treatment motivation, absolute abstinence in treatment goal, voluntary adimission, maintained therapeufic relationship, strong ego strength and the trait of praxernia, conservatism personality. But occupation, religion, alcoholic family history, parent's characters, duration of past drinking, drinking pattern, main drinking time, first drinking age, preference of the kind of alcoholic beverage, attitude to an

정신분열증환자에서 Nemonapride와 Haloperidol의 치료결과 및 내약성에 대한 비교분석

성상경,홍광화,Sung, Sang Kyung,Hong, Kwang Wha 대한생물정신의학회 1995 생물정신의학 Vol.2 No.1

A single-blind comparative study was performed using haloperidol as a reference drug in order to evaluate the efficacy and safety of nemonapride, a new benzamide derivative, in sixty-nine Korean schizophrenic patients. the total period of the study was 8 weeks, maximum dosage of nemonapride was 36mg and that of haloperidol was 24mg. Psychopathology and extrapyramidal symptoms were assessed every week or four weeks until the end of the 8th week using the PANSS, BPRS, and 4 point general side effect check list, The drug safety was assessed every week until the end of the 8th week using vital sign, body weight, EEG, EKG, and blood chemistry. In total. one patient discontinued nemonapride treatment and seven patients discontinued haloperidol treatment before the end of the study. Therefore sixty-one patients(88 %) completed the study. PNASS and BPRS scores of the two groups on the end study point demonstrated a significant improvement compared with baseline score. The number of patients who had a clinical improvement of at least 20% in baseline score was similiar in both treatment groups. The difference of Simpson's rating scale socres were significant in both groups, and mean scores were more high in the haloperidol group than in nemonapride group. No significant EKG, EEG changes were induced, no relevant change in body weight or clinical laboratory parameters were observed in the sixty-one patients during 8 weeks and no Significant difference in the both groups. From these results, nemonapride is considered to be a clinically useful drug having a wide range of antipsychotic effect in schzophrenic patients.

알코올중독 입원 치료프로그램의 효과성에 관한 연구(I) - 병식의 변화와 만족도를 중심으로 -

성상경(Sang-Kyung Sung),이제정(Je-Jung Lee):김한오(Hano Kim):이규항(Kyu-Hang Lee) 한국중독정신의학회 2002 중독정신의학 Vol.6 No.1

The purpose of this study is to examine the clinical effectiveness of an inpatient alcohol treatment program by researching changes in patients’ insight throughout the treatment process and patients’ level of satisfaction within the program. 89 patients (81 male and 8 female patients) were chosen for this study, all of whom were diagnosed as alcohol-dependence according to the DSM-IV diagnostic criteria and participating the inpatient alcohol treatment program at the alcohol/drug abuse treatment center in Keyo hospital. The program’s effectiveness was evaluated by:1) assessing how Hanil Alcohol Insight Scale (hereinafter HAIS), National Alcoholism Scale Test (hereinaf- ter NAST), and the level of patients’ self-recognition changed after taking the course and 2) analyzing correlations between NAST and HAIS. The result showed significant difference in the patients’ average HAIS scores before and after the program: 6.4 at the time of admission, and 9.0 after the treatment process (p<0.001). We found that the patients’ NAST and HAIS scores are positively correlated. Also, patients’ satisfactory level with the treatment program’s general circumstance was higher than that with information service about the treatment process and rule application issues, and communication service like telephone use. In conclusion, our inpatient alcohol treatment program was found to be effective in terms of improving patients’ insight, and patients’ level of overall satisfaction with the treatment program was generally high. Further studies on correlations among other variables such as the independent program’s impact on each patient, level of the patient’s insight, and follow-up treatment results may be required.

알코올리즘 입원치료프로그램 참가자들의 퇴원 후 단기경과

성상경(Sang-Kyung Sung),문황선(Whang-Sun Moon),김한오(Han-O Kim),이규항(Kyu-Hang Lee) 한국중독정신의학회 2003 중독정신의학 Vol.7 No.2

The purpose of this study is to examine the short-term course of the alcoholics who participated in an inpatient alcoholism treatment program, and the relationship between the treatment program and the short-term course of alcoholics. The 89 subjects who were diagnosed as alcohol dependence according to DSM-IV diagnostic criteria took part in the treatment program at the alcohol/drug abuse center in Keyo hospital at least for 2 weeks between January 2000 and February 2001. The mean follow-up period was 10.5 months. The subjects or their families were followed up by face-to-face or telephone interview, and medical records were reviewed to obtain the data on demographic characteristics, clinical characteristics, and past alcohol drinking history, etc. The results were as follows:1) 79 of the 89 subjects were followed up, so the follow-up rate was 88.8%. 2) Of the 79 subjects, 19 (24.0%) were classified into abstinent group, 12 (15.2%) into controlled drinking group, and 48 (60.8%) into relapse group. 3) The abstinent group had better attendance at out-patient department program and AA than the relapse group. 4) The difference of the insight assessed by Hanil Alcoholism Insight Scale (HAIS) among the three groups was not statistically significant, but the insight score of the abstinent group was higher than the other groups. 5) The family or patient response about treatment results was significantly different among groups.

이중진단을 가진 알코올 의존 환자들의 임상적 특성(II)

성상경(Sang-Kyung Sung):문석우(Seok-Woo Moon):강지언(Gi-Eun Kang),이규항(Kyu-Hang Lee) 한국중독정신의학회 2001 중독정신의학 Vol.5 No.1

Objectives:Abuse of alcohol or drugs can induce, or can result from psychiatric disorders. Any substance of habituation has psychotoxicity and can induce psychiatric symptoms. These symptoms usually disappear after the effect of the substance terminates, but the symptoms can be continued permanently. It is well known that depression, anxiety disorder, and personality disorder very often come together with the alcohol dependence. Therefore, we have selected groups having extra-psychopathology from alcohol dependence patients, and compared their clinical characteristics with patients of alcohol dependence only, to use the characteristics in the therapy. Methods:Among patients hospitalized in a mental hospital from Feb.-June of 1999 for the problem of alcohol dependence, patients diagnosed as alcohol abuse/dependence and dual diagnosis by DSM-Ⅳ were evaluated by the methods of chart review, the questionnaire of demographic characteristics, drinking history, past therapy history, family history, NAST and CAGE. Results:1)Among 179 patients diagnosed to be alcohol dependent during the period, 59 patients (33%) were dually diagnosed and their average age was 42.5±8.5, and 120 patients (67%) were diagnosed to be alcohol dependence only and their average age was 45.6±9.6. In the case of dual diagnosis, the average age diagnosed as alcohol dependence was earlier. The men/women ratio was 169 men:10 women (94.4%:5.5%). Age of first drinking was 20.3 in dually diagnosed patients and 21.2 in alcohol dependence only patients. Therefore, they started drinking in early 20s in both cases. 2) There were notable differences between them in drinking amount, self- recognition of dependence, the number of suicide attempts. 3) There were no statistical significances between them in age of first drinking, drinking period, age of withdrawal symptom experience, preference of alcohol beverage, therapy history, and demographic characteristics except age and gender Though there was no statistical significance in NAST score and the total number of questions of NAST and CAGE, the score and the total number in dual diagnosis were higher than the alcohol dependence only. This result indicates that the dually diagnosed patients recognize symptoms more seriously, and they are high risk group. Conclusions:The dually diagnosed patients among alcohol dependent patients showed higher level of self-recognition, higher score of NAST and CAGE, more number of therapy (recurrence), earlier onset age of alcohol dependence, less average drinking amount, and more suicide attempts. It is therefore believed that the dually diagnosed patients are higher risk group compared to the patients of alcohol dependence only, and it is required to do intensive evaluation and carefully designed therapy.

입원 및 외래 알코올중독 환자의 병식 차이에 대한 연구

성상경(Sang-Kyung Sung),이학구(Hak-Koo Lee),김한오(Han-O Kim),이규항(Kyu-Hang Lee) 한국중독정신의학회 2003 중독정신의학 Vol.7 No.1

Objectives:The goals of this study were to estimate level of insight in alcoholic patients and provide the fundamental data for which can be used for development of effective treatment programs. With this purpose, we compared insight status between inpatient alcoholics and outpatient alcoholics. Methods:The subjects participated in this study were 65 inpatient alcoholic patients who were admitted to alcohol/drug abuse treatment center in Kyungido between February and June, 2001 and 38 outpatient alcoholics who were undergone outpatient alcohol treatment program after discharge. We investigated demographic data, clinical characteristics, past alcoholic history by questionary survey and measured insight status by NAST (National Alcoholism Screening Test) and HAIS (Hanil Alcohol Insight Scale). Results:The outpatient alcoholic patients showed statistically significant higher NAST numbers, NAST scores and mean HAIS scores than inpatient alcoholics. In addition, outpatient alcoholics were statistically significant higher frequency of past admission, and more recognized addiction and necessary of treatment than inpatient alcoholics. Conclusion: We suggest that the necessity to adjust inpatient alcohol treatment program to insight status of individual alcoholic patient more flexibly. Further studies on correlation among other variables such as the independent program’s impact on each patient, guide goals which can increase insight status through inpatient alcohol treatment program, and development of the level of insight to abstinence may be required.

여성 알코올중독 환자의 인격 특성에 관한 연구

성상경(Sang-Kyung Sung),강지언(Ji-Eon Kang),김임렬(Im-yel Kim),함웅(Woong Hahm) 한국중독정신의학회 1998 중독정신의학 Vol.2 No.1

Objectives:This study was performed to identify the characteristics of alcoholics by comparing the characteristics of male and female alcoholics with those of a control group and to make therapeutic consideration for female alcoholics by using the identified characteristics of female alcoholics. Subjects and Methods:1) Subjects:We made two experimental groups composed of male alcoholics (N=34) and female alcoholics (N=34) who had been admitted to Keyo Hospital from January 1992 to May 1996 and one control (normal female adult) group (N=34) composed of students, the hospital personnel, and their family members. We controlled the age and the number to compare the groups. The average age of female alcoholics was 41.12±9.9, male alcoholics 41.23±10.22, and the control group 39.47±12.80. All male and female patients satisfied the DSM-Ⅲ-R criteria of alcohol dependence. 2) Method:We reviewed the patients’ charts and used a demographic statistical questionnaire and MMPI questionnaire. 3) Data analysis:Student’s t-test and chi-square test were used where appropriate. All statistical analyses were carried out with SPSSPC+Version 4.0 software. A probability of p<0.05 (two-tailed) was accepted as statistically significant. Result:1) The demographical statistics showed that the education level, economic status, and occupational status of the male and female patient groups were significantly different from those of the female control group. 2) As regards the drinking history, the reason for alcohol drinking and use of other substances, there was no difference between the male and female patient groups. But the female patient group was significantly different from the female control group. 3) When the characteristics of the male and female patient groups were compared through mean MMPI T-scores, they were not significantly different from each other. But the female patient group was significantly different from the female control group. 4) The code type comparison showed that the female and male patient groups marked higher frequency of Pd scale score on one code digit than the female control group. Also the female patient group had higher frequency of characterological profile by Lachar classification on two code digit than the female control group. Conclusion:Therefore female alcoholics are different from normal female adults. They are more impulsive and antisocial. And they have marital problem, anxiety, insomnia, and affective problem.

여성음주와 알코올중독

성상경(Sang-Kyung Sung) 한국중독정신의학회 1997 중독정신의학 Vol.1 No.1

All over the world, females have lower prevalence of alcohol dependence than males. However industrialization has made females actively participate in social activities and acquire many opportunities to drink alcohol, resulting in increasing Opsychologically and physiologically different from males, and therefore they can be thought to have different characteristics of alcohol dependence. Etiological differences of alcohol dependence between males and females have not yet be known, but both environmental and genetic factors have influenced the onset of the disorder. And due to females’ own roles in their families, female alcoholics could produce more effects on their children than male alcoholics could. The effects of alcohol on the body are different between males and females. The same amount of alcohol makes more serious effects on females than on males, and females have more accompanied psychiatric problems like suicide and depression. Especially it is reported that females who have experienced sexual abuse like sexual insult have higher incidences of alcohol dependence. Considering that female alcoholics have different clinical manifestations to male alcoholics, a therapeutic plan should be established and it is necessary to make a preventive strategy by implanting a good alcohol culture.

PTT over Cellular Standardization and Evolution Trend

Sang Kyung Sung(성상경),Hyeon Woo Lee(이현우) 한국통신학회 2005 한국통신학회 학술대회논문집 Vol.2005 No.6