일 종합병원에서 정신분열병과 분열정동장애를 진단받은 환자에서 항정신병약물의 1차 선택약물의 비율 및 1년 유지율에 관한 연구

왕관수(Kuan-Shu Wang),김정기(Jeong-Gee Kim),조동환(Dong-Hwan Cho),제호준(Ho-Jun Je),서영익(Young-Ik Seo),장옥진(Og-Jin Jang),최성진(Seong-Jin Choi) 대한생물치료정신의학회 2008 생물치료정신의학 Vol.14 No.1

Objectives: This study was designed to evaluate prescription rate and indirectly the tolerability of antiosychotics using the maintenance rate for 1 year. The study was done in a situation where the patients who were diagnosed with either schizophrenia or schizoaffective disorder were given the antipsychotics and were looked into the prescription rate and the state of use of drugs at first regardless of kind of drugs. Methods: This was a retrospective, naturalistic study using the data from medical record conducted in both inpatients and outpatients from January 1st in 2002 and June 30th in 2004 with a diagnosis of schizophrenia and schizoaffective disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Patients were evaluated at 3, 6, 9, and 12th months after the onset of medication for the first-drug prescription rate and maintenance rate. Results: In total, 105 patients were recruited, and 40 out of 105 were male and 65 out of 105 were female. The mean age was 34.71 years old. The number of patients with schizophrenia was 94 and that of schizoaffective disorder was 11. For the prescription rate of first drugs, of total risperidone was 56.2% ; likely, 25.7% for olanzapine ; 10.5% for haloperidol ; 4.8% for quetiapine ; and 2.9% for chlorpromazine. For 1-year maintenance rate, of total, haloperidol was 45.5% ; 33.3% for chlorpromazine ; 22.0% for risperidone ; 14.8% for olanzapine ; and 20.0% for quetiapine. Conclusion: Overall, atypical antipsychotics were far more prescribed than typical ones(86.7% and 13.3% for atypical and typical anti psychotics respectively). Although atypical antipsychotics were more prescribed than typical ones, the one-year maintenance rate was not higher than typical anti psychotics unlike our expectation that atypical antipsychotics would have better compliance and higher maintenance rate for 1 year under the circumstances with uncontrolled naturalistic conditions. There should be more statistical data available with larger sample size in the future.

심한 정신지체 환자에서 발견된 Tuberous Sclerosis 1례

이중권(Joong-Kwon Lee),김정기(Jeong-Gee Kim),조동환(Dong-Hwan Cho),왕관수(Kuan-Shu Wang) 대한생물치료정신의학회 2007 생물치료정신의학 Vol.13 No.1

본 증례의 환자는 임상증상, 방사선학적 소견, 조직학적 검사를 토대로 하여 결절성 경화증으로 진단을 내렸다. 전형적인 결절성 경화증과는 달리 드물게 나타나는 심장과 소화기의 종양을 가지고 있었으며 영아연축 및 경련의 시작, 피부병변의 발생시점이 늦게 시작되었다. 경련의 발생시점이 늦은 것으로 보아 정신지체는 경련과의 연관성보다는 현재 관찰되는 전두엽, 측두엽, 후두엽 내의 병변의 위치와 다수의 결절성 병변으로 인한 것으로 생각된다. 이로 인해 언어표현, 이해, 주의집중, 계산, 이해, 판단 등 제반 정신기능의 발달이 매우 지체되어 있을 것으로 판단되며 환자의 예후는 좋지 않을 것으로 생각된다. The authors have diagnosed with tuberous sclerosis complex for a patient who was mentally retarded and has been showing impairment in intelligence and social functioning, and seizure. Usually patients with tuberous sclerosis complex have a high rate of mental retardation associated with cortical tubers, seizure and genetic factors. In this case, the patient has developed seizure attacks since he was 4 years old. He had no specific abnormality found in earlier medical examination. He fled and returned home after he was found 7 years later. Unlike his previous condition, he had developed generalized tonic-clonic seizure along with severe stuttering, tremor, drooling and sleep disturbance. He visited the hospital for further evaluation and management. The psychiatric problems included, severe mental retardation, sleep disturbance, impulsive behavior, difficulty in attention and other problems. Multiple adenoma sebaceums found in his face and fibromas in his ungal areas(nail & toe) have been observed. We have also found a mass suspected as rhabdomyoma in the heart and multiple harmatoma in brain, kidney, and colon through radiological and endoscopic examination. We concluded the patient could be diagnosed with tuberous sclerosis complex since he showed the typical clinical manifestations of seizures, mental retardation and dermatological symptoms and ventricular rhabdomyoma, multiple angiomyolipoma in kidneys, multiple cortical tubers in radiological findings and ganglioneuroma in a colonoscopic biopsy, and adenoma sebaceum in a skin biopsy.

만성 정신질환자들의 체중 조절에 대한 행동 치료적 접근

이중권(Joong-Kwon Lee),김정기(Jeong-Gee Kim),조동환(Dong-Hwan Cho),이수진(Soo-Jin Lee),왕관수(Kuan-Shu Wang),서영익(Young-Ik Seo),최성진(Seong-Jin Choi),이다교(Da-Gyo Lee) 대한사회정신의학회 2007 사회정신의학 Vol.12 No.1

목 적: 항정신병 약물 사용 전에도 체중증가와 관련된 대사 장애는 정신질환을 지닌 개인에게 문제를 일으켜왔다. 최근에는 비정형 항정신병 약물의 사용으로 증상의 치료나 부작용 면에서는 우수한 결과를 나타내었으나, 환자들은 점차 약물 관련성 체중 증가와 대사증후군 등의 위험에 노출되게 되었다. 이번 연구의 목적은 낮 병원 환자들을 대상으로 행동수정을 통한 치료적 접근이 체중과 같은 위험요소들에 어떠한 효과를 나타내는가를 평가하기 위한 것이다. 방 법: 본원 낮 병원에 재원 중인 16명의 환자들 중 참여의사를 표시한 12명을 대상으로 하여 2006년 4월 21일부터 2006년 9월 4 일까지 17주간의 교육과 행동수정 프로그램을 실시하였다. 결과에 대한 평가는 개인 체중과 허리둘레, 체질량지수(BMI) 및 시행 전후 지질 검사 상에서 나타나는 저밀도지단백 콜레스테롤, 고밀도지단백 콜레스테롤, 중성 지방의 혈중 농도 변화를 비교하였다. 또한 사전과 사후의 삶의 질에 대한 만족도를 한국판 스미스클라인 비챰‘삶의 질’척도를 사용하여 측정하였다. 결 과: 과정을 완료한 환자들은 총 11명이었으나 2명은 혈청 검사를 거부하였다. 시행 전 평균체중은 71.81±9.51kg, 평균허리둘레는 91.32±5.71cm로 측정되었다. 시행 후 평균체중은 70.04±8.89kg, 허리둘레의 평균은 89.68±5.09cm로 측정되었다. 혈중 지질 농도는 시행 전후 비교에서 통계적으로 유의한 수준을 보이지 않았다. 사후 평가에서‘삶의 질’에 대한 척도는 연구시작 시점 보다 상승된 점수를 보였고, 참가자들은 변화된 생활습관에 대한 만족감을 보고하였다. 결 론: 이번 연구는 체계화된 교육과 운동처방을 사용하여 만성 정신질환을 가진 환자들에게 동기부여를 통한 생활습관의 변화를 일으켰고, 그 결과 일부 참가자들의 체중과 허리둘레가 감소되는 결과를 보였다. 앞으로 더 많은 숫자의 환자를 대상으로 하는 대규모 연구가 필요할 것으로 생각되며, 장기적으로 약물 복용을 해야 하는 환자들에게 체중 증가를 예방하기 위한 행동수정 프로 그램이 긍정적인 영향을 줄 수 있을 것이라 생각된다. Objectives:Even before using the antipsychotics, the metabolic disturbances associated with weight gain have been troublesome in subject with psychiatric disease. Although the atypical antipsychotics show excellent results in management and side effects, patients become more and more to expose to the risks such as drug related weight gain and metabolic disturbances. The objective of this study is to evaluate how the therapeutic approaches through life style modification to the patients in day hospital work and improve the risk factors such as weight gain. Methods:This study was a 17-weeks open-label trial of 12 out of 16 patients who attended in day hospital and study performed between april 21st and september 4th in 2006. The primary outcome measure was the comparison of personal weight, waist circumference, BMI, LDL cholesterol, HDL cholesterol and TG before and after the trial. The secondary outcome measure was to evaluate the QOL using korean version of the Smithkline Beecham quality of life’ scale. Results:The number of patient who completed the trial was 11, but 2 out of 11 patients turned down the withdrawal of blood. Before the trial, the mean weight was 71.81±9.51kg, mean waist circumference was 91.32±5.71cm. After the trial, the mean weight was 70.04±8.89kg, the mean waist circumference was 89.68±5.09cm. There was no statistically significant difference in lipid profile before and after the trial. In the post-trial evaluation, the measurement of QOL has improved in score and this represent the satisfaction for the eating habit and exercise program. Conclusion:This study gave the patients with chronic psychiatric illness the motivation to modify their life style using the organized education and exercise. As a result, some of the participants showed reductions in weight and waist circumference. There may require a large scale study. Life style modification program to prevent weight gain could affect in positive way to the patient who need oral medication in the long run.