양극성장애 I형의 장기적인 경과 및 순환 형태

이황빈,임선진,유남희 대한우울조울병학회 2014 우울조울병 Vol.12 No.3

Objectives: We evaluated the clinical characteristics, longitudinal courses and the cycle-length patterns of patients with bipolar I disorder. Methods: We assessed one hundred twenty patients (n=120) with bipolar I disorder by retrospective medical records review. Single manic, continuous and rapid cycling courses were excluded. Results: There were some differences in longitudinal course of patients with bipolar I disorder according to gender and the index episode. Manic onsets were more frequent in men (53.4%), whereas depressive onsets were more frequent in women (51.6%). The age of onset in mixed or hypomanic onset group (16.0±0 yrs, 20.0±2.4 yrs) were younger than in manic (24.6±7.3 yrs) or depressive (25.7±7.5 yrs) onset group. Initial manic episode was more related to later mania, whereas initial depressive episode was more related to later depression. Consistent findings of progressive shortening of cycle were not observed. Conclusion: The type of the index episode appears to have gender-related clinical differences. Age of onset is different according to the index episode. The index episode seems to influence the predominant polarity of the bipolar I disorder in each individual patient. The cycle-length patterns were not progressive cycling over time, nor gradual lengthening in later episodes in this study.

한국형 우울장애 약물치료 알고리듬 2012(II) : 정신병적 양상을 동반한 우울장애

이황빈,정종현,송후림,서정석,박영민,홍정완,김원,왕희령,임은성,민경준,박원명,홍진표,전덕인 대한우울조울병학회 2013 우울조울병 Vol.11 No.1

OBJECTIVE: To update treatment strategies for psychotic depression, we revised Korean medication algorithm for depressive disorder based on the expert clinical consensus. METHODS: We developed the 44-item questionnaire consisted of six parts, including treatment strategies for psychotic depression. The questionnaire was sent to the review committee consisting of 123 experienced korean psychiatrists. They were asked to rate their preference for various treatment options and treatment medications on a 1-9 point scale. We classified expert opinions to 3 categories (the first, the second, or the third choice). RESULTS: The combination of antidepressant and atypical antipsychotic medication is preferred for the initial treatment strategy for psychotic depression. For patients who fail to respond fully to the initial treatment strategy, switching or adding an antidepressant or atypical antipsychotic medication is the most likely chosen for the subsequent treatment strategy. To allow sufficient time for treatment effects to take place, it is recommended to wait 2-5 weeks before changing the treatment regimen when the initial treatment strategy is not responsive, whereas 3-7 weeks is recommended when the initial treatment strategy is partially responsive. Mirtazapine, SSRIs, and SNRIs are the most preferred antidepressants. Quetiapine, aripiprazole, olanzapine, and risperidone are preferred antipsychotics. CONCLUSIONS: For psychotic depression, the combination of antidepressant and atypical antipsychotic medication is the treatment-of-choice. Mirtazapine, SSRIs, SNRIs, quetiapine, aripiprazole, olanzapine, and risperidone are preferred drugs.

양극성장애 환자의 아침형-저녁형에 따른 임상특성 연구

이황빈,강시현,유남희,이준우 대한우울조울병학회 2017 우울조울병 Vol.15 No.2

characteristics in remitted patients with bipolar disorder. Methods : Using the self-reporting scale, the 13 items of a Korean version of morningness eveningness composite scale, we assessed the morningness-eveningness in the remitted patients with bipolar disorder. We analyzed the correlation between the morningness-eveningness and the clinical characteristics of bipolar disorder. Results : A total of 77 patients (53.2% of women) were enrolled. 18 patients (23.4%) were the eveningness-type, 27 patients (35.1%) were the morningness-type, and 32 patients (41.6%) were the intermediateness-type. The morningness-eveningness was correlated with the index episode (χ2=13.078, df=2, p=0.001). Among patients with eveningness-type, manic onsets were more frequent (B=2.438, p=0.002, Exp(B)= 11.445), while depressive onsets were less frequent compares to patients with morningness-type. Conclusion : Index episode appears to be associated with the morningness-eveningness in patients with bipolar disorder

초경 연령과 우울증 발병 연령의 상관관계

이황빈,유남희,김정원 대한우울조울병학회 2016 우울조울병 Vol.14 No.1

Objectives : We evaluated the relationship between the age at menarche and the age at onset of depression in Korean women. Method : We analyzed data obtained from the Korean national health and nutrition examination study (from 2007 to 2013). Among 31,852 women, a total of 22,273 female participants were included in the final analysis. Results : A total of 5.4% (1,212/22,273) women were diagnosed with depression. In an instance, the earlier ages of menarche appeared to be associated with the earlier age at onset of depression, but it was because of the downward trend in the average age at menarche. After adjustment for birth year, the earlier age at menarche was not correlated with the earlier age at onset of depression. The means of age at menarche were decreased from 16.68 to 12.68 years among female born between 1920s and 1990s. In addition, the age at onset of depression is decreasing with each generation. Conclusion : The earlier ages of menarche appeared to be unrelated with the earlier age at onset of depression. The age at onset of depression is decreasing with each generation.

알코올 의존 환자의 혈장 5-hydroxyindoleacetic Acid 농도와 음주 행태와의 상관 관계

이황빈(Hwang-Bin Lee):정혜경(Hae-Gyung Chung):최진희(Jin-Hee Choi):김규현(Kyu-Hyun Kim):장동원(Dong-Won Chang) 한국중독정신의학회 2001 중독정신의학 Vol.5 No.1

Objectives:The purpose of this study was to investigate the difference between alcoholics and normal controls on plasma 5-hydroxyindoleacetic acid (5-HIAA) concentration, alcohol consummatory behavior and aggression and to examine their interrelationship in alcoholics. Methods:We studied 70 recently abstinent, treatment-seeking alcoholics and compared with 40 normal controls. All subjects were assessed by plasma 5-HIAA concentration and State-Trait Anger Expression Inventory. Severity and age at onset of alcohol consumption were documented with selected alcoholism screening questionnaires (National Mental Hospital Alcoholism Screening Test). Results:1) Plasma 5-HIAA concentrations were more lower in alcoholics than in controls. 2) Alcoholic group had drunken more amount of alcohol and more frequently than control group. 3) Scores of anger in alcoholic group were significantly higher than in control group. 4) Reduced plasma 5-HIAA concentrations were correlated with amount and frequency of alcohol intake and early onset alcoholism. 5) There was no statistically significant correlation between reduced plasma 5-HIAA concentrations and scores of aggression in alcoholics. Conclusion:It is tempting to conclude that alcoholics may have lowered plasma 5-HIAA concentration. Reduced plasma 5-HIAA concentration is associated with more severe alcohol consumption and early onset alcoholism in alcoholics.

Association between Polymorphisms of Leptin Receptor and Hypercholesterolemia, Hypertension, and Obesity in Korean Population

김재영,이황빈,임성훈,이병욱,백형환,김영옥,박헌국,정주호 대한스트레스학회 2011 스트레스硏究 Vol.19 No.2

Leptin is an adipocyte-specific hormone that regulates body weight. Leptin receptor (LEPR) is a receptor for leptin and plays a crucial role in the regulation of fat metabolism. To test the relationship between LEPR polymorphisms and dyslipidemia, hypertension, and obesity in Korean population, we analyzed 263 subjects. Three missense single nucleotide polymorphisms (SNPs) (rs1137100, Lys109Arg, K109R; rs1137101, Gln223Arg, Q223R; rs8179183, Lys656Asn, K656N) in the coding region of the LEPR gene were selected and genotyped by direct sequencing. SNPStats, SNPAnalyzer Pro, and HelixTree programs were performed to obtain odds ratio (OR), 95% confidence interval (CI), and p value. Haploview version 4.2 was used to determine the linkage disequilibrium (LD) block and haplotypes among three SNPs. Multiple logistic regression models were conducted to analyze of genetic data. Two missense SNPs were associated with the HDL-cholesterol levels (rs1137101, p=0.024 in codominant1 model, p=0.039 in dominant model, p=0.011 in overdominant model; rs8179183, p=0.028 in dominant model, p=0.035 in overdominant model, p=0.026 in log-additive model, p=0.042 in allele frequencies). Two missense SNPs were also associated with hypertension (rs1137100, p=0.044 in allele frequencies; rs1137101, p=0.010 in codominant1 model, p=0.012 in dominant model, p=0.013 in overdominant model, p=0.019 in log-additive model, p=0.014 in allele frequencies). One missense SNP was related to the development of overweight/obese (rs1137101, p=0.027 in codominant1 model, p=0.015 in dominant model, p=0.029 in overdominant model, p=0.013 in log-additive model, p=0.014 in allele frequencies). These results suggest that LEPR polymorphisms may be associated with hypercholesterolemia, hypertension, and obesity in Korean population. 비만은 여러 질환의 위험요소로 알려져 있으며, 최근 비만에 대한 후보 유전자의 단일염기다형성(single nucleotide polymorphism, SNP)에 관한 연구가 급격히 증가하고 있다. 렙틴 수용체(leptin receptor, LEPR)는 체중 조절에 중요한역할을 하는 렙틴의 수용체이며 또한 지방 대사의 조절에도 관여한다. 본 연구의 목적은 이러한 LEPR 유전자의 다형성이 고지혈증, 고혈압 및 비만에 미치는 영향을 알아보고자, 263명의 실험 참여자를 분석하였다. LEPR 유전자의액손(exon) 영역에서 3개(rs1137100, Lys109Arg, K109R; rs1137101, Gln223Arg, Q223R; rs8179183, Lys656Asn, K656N)의missense SNP을 선정하고 염기서열 분석기를 이용하여 유전자형(genotype)을 분석하였다. SNPStats, HelixTree,SNPAnalyzer Pro 및 Haploview version 4.2 소프트웨어를 이용하여 데이터 분석을 하였다. 실험결과, rs1137101 (Q223R)의 유전자형과 rs8179183 (K656N)의 유전자형과 대립형질(allele)이 HDL-cholesterol의 혈중 농도와 관계가 있었다(rs1137101, p=0.024 in codominant1 model, p=0.039 in dominant model, p=0.011 in overdominant model; rs8179183,p=0.028 in dominant model, p=0.035 in overdominant model, p=0.026 in log-additive model, p=0.042 in allele frequencies). 또한, rs1137100 (K109R)의 대립형질과 rs1137101 (Q223R)의 유전자형과 대립형질은 고혈압에서 유의성을 보였다(rs1137100, p=0.044 in allele frequencies; rs1137101, p=0.010 in codominant1 model, p=0.012 in dominant model, p=0.013in overdominant model, p=0.019 in log-additive model, p=0.014 in allele frequencies). 과체중/비만에서는 rs1137101 (Q223R)의 유전자형과 대립형질이 유의성을 나타냈다(rs1137101, p=0.027 in codominant1 model, p=0.015 in dominant model,p=0.029 in overdominant model, p=0.013 in log-additive model, p=0.014 in allele frequencies). 이러한 결과는 LEPR 유전자의 다형성이 고콜레스테롤혈증, 고혈압 및 비만 발생과 관련이 있음을 시사한다.

한국형 우울장애 약물치료 알고리듬 2012(I) : 정신병적 양상이 없는 주요우울장애

송후림,서정석,이황빈,박영민,홍정완,김원,왕희령,임은성,정종현,전덕인,홍진표,민경준,박원명 대한우울조울병학회 2013 우울조울병 Vol.11 No.1

Objectives : Nowadays, the pharmacological method is widely used as the standard treatment for depression. However, as a result of newer agents being introduced, pharmacological treatment strategy continues to develop. To overcome problematic nature in this trend, Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD)had been developed in 2002 and revised in 2006. And we propose the third revision of KMAP-DD reflecting the new research results and the latest trends in the areas of pharmacological treatment. Methods : 123 psychiatrists who had rich clinical experiences in depression were primary selected then surveyed via mail ;67 surveys were retrieved. This survey was constructed with 44 questions which contained overall treatment strategies to specific treatment strategies. Each treatment strategy or treatment option was evaluated with the overall score of nine and the following 95% confidence interval. Results were divided into three phases of recommendation; primary, secondary, tertiary. Results : The initial strategy for pharmacological treatment in major depression disorder without psychotic features is a single treatment of antidepressant which does not take into consideration of the severity of depressive episode. Also, primary recommendations for the mild to moderate episodes are SSRIs except fluvoxamine, SNRIs and mirtazapine. As for the severe episodes, SSRIs except fluvoxamine and flouxetine, SNRIs except milnacipran, and mirtazapine are recommended. In case of no response to the initial treatment, switching to another antidepres-sants or adding another antidepressants are the preferred methods. In case of partial responses to initial treatment, adding another antidepressants or combination of atypical antipsychotics are preferred. As for atypical antipsychot-ics, aripiprazole and quetiapine are selected primarily in the combined pharmacological therapy. Conclusion : If psychotic features are not apparent in major depression disorder, SSRIs, SNRIs and mirtazapine are initially consid-ered for single treatments. There are trends in which if enough response is not obtained in the initial treatment, stra-tegically adding another antidepressants are still preferred as well as combination of atypical antipsychotics. (J of Kor Soc for Dep and Bip Disorders 2013;11:5-11)

한국형 우울장애 약물치료 알고리듬 2012(VI) : 비약물학적 생물치료

정종현,왕희령,이황빈,박영민,홍정완,김원,서정석,임은성,송후림,전덕인,홍진표,박원명,민경준 대한우울조울병학회 2013 우울조울병 Vol.11 No.1

Objectives: Pharmacological treatment of depression is widely used. As new medication for depression has been introduced continuously, pharmacological treatment strategy is also changing. To overcome problematic nature this trend, Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) was developed in 2002 and revised in 2006. Since the last revision six years ago, this revision reflected the new research result and the latest trends in the areas of pharmacological treatment. Methods: 123 psychiatrists who have vast clinical experiences in depressive disorder are primary selected then survey was sent to them via mail, 67 surveys were retried. This survey is constructed with 44 questionnaires in which contained from overall treatment strategies to treatment strategies under the specific circumstances. Each treatment strategy or treatment option is evaluated with the overall score of nine and the following 95% confidence interval result treatment option were divided into three phases of recommendation; primary, secondary, tertiary. Results: Electroconvulsive therapy(ECT) was recommended as an initial strategy for major depressive disorder, severe without psychotic features with urgent suicidal risk, and as a second strategy for non-responders on antidepressant combination therapy and combined with physical illness. In the patient of major depressive disorder, severe with psychotic features, ECT was preferred as an initial strategy for urgent suicidal risk patients, but as a second strategy for non-responders on antipsychotics and antidepressants combination therapy and combid with physical illness. Many experts have considered ECT (84.4%) as a good treatment strategy, and 53% of experts have execute ECT. TMS was not recommended as a initial treatment strategy for major depressive disorder, but could be a second strategy for non-responder on antidepressants combination therapy in severe episodes without psychotic features and non-responders on pharmacotherapy in moderate episodes. Light therapy, omega-3 and megavitamine combination therapy could be a second strategies for treatment refractory patients. Conclusions: ECT was an initial strategy in severe episode with/without psychotic features who has an urgent suicidal risks, and secondarily preferred in case of non-responders, comorbid with physical illness and pregnants. Combination with complementary therapy was a second strategy for treatment refractory patients.

한국형 우울장애 약물치료 알고리듬 2012(V) : 안정성, 부작용, 동반 신체질환을 고려한 항우울제 선택

임은성,송후림,정종현,이황빈,박영민,홍정완,서정석,김원,왕희령,민경준,박원명,홍진표,전덕인 대한우울조울병학회 2013 우울조울병 Vol.11 No.1

Objectives: Since there were the development of new antidepressant and considerable advances in clinical trials and psychopharmacology, the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) need to be revised again in 2012. Methods: To compare the results between KMAP-DD 2006 and KAMP-DD 2012, the executive committee decided to maintain the same way used in first revision in 2006. The review committee consisted of 123 experienced psychiatrists. From the total of 22 questions in the questionnaire, 2 questions were used for the antidepressant choice according safety and side effect and comorbid 4 physical illnesses. Response rate was 54.5%. Preferred antidepressant was chosen by the review committee's opinion. Results: 1) According to the side effect, bupropion is preferred for sexual dysfunction, sedation, and weight gain, and mirtazapine for insomnia and GI trouble, and (es)citalopram for anticholinergic side effect. 2) According to safety, (es)citalopram was preferred for cardiovascular disease and seizure, bupropion for serotonin syndrome, and mirtazapine for suicidality. 3) (Es)citalopram and sertraline were preferred for diabetes mellitus, thyroid, liver and renal disease. Conclusion: These results suggest that clinicians would pay proper attention to choose antidepressant considering the side effect, safety and comorbid physical conditions.

한국형 우울장애 약물 치료 알고리듬 2012(IV): 소아 청소년/노인/여성

왕희령,박원명,박영민,이황빈,송후림,정종현,서정석,임은성,홍정완,김원,전덕인,홍진표,민경준 대한정신약물학회 2013 대한정신약물학회지 Vol.24 No.1

새로운 항우울제의 도입 이후 다양한 임상상황에서 우울장애의 치료에 많은 변화가 있어왔다. 이에 국내에서는 이미 2002년과 2006년에 한국형 우울장애 약물 치료 알고리듬이 개발된 바 있다. 본 연구자들은 2006년 알고리듬 개발 이후 6년이 지난 현 시점에서 우울장애의 약물 치료에 대한 새로운 연구 결과와 최근의 임상 경향을 반영하여 한국형 우울장애 약물 치료 알고리듬을 개정하게 되었다. 우울장애에 대한 임상 경험이 풍부한 정신과 전문의 123명을 선정하여 설문지를 발송하였고, 이 중 67명이 설문지를 보내왔다. 설문지는 총 44문항으로 구성되었으며, 전반적인 치료전략으로부터 시작하여 구체적인 상황에서의 치료전략에 이르는 세부항목들로 이루어졌다. 각 치료 전략이나 치료적 선택은 9점 척도로 평가되었고, 각각의 95% 신뢰구간에 따라 1차, 2차, 3차 선택으로 구분하였다. 소아 청소년 주요우울장애에 있어서, 경도 및 중등도 삽화, 정신병적 양상이 없는 중증 삽화의 초기 약물 치료 전략으로 항우울제 단독치료가 1차 치료로 권장되었다. 정신병적 양상이 동반된 중증 삽화에서는 항우울제와 비정형 항정신병약물의 병합치료가 1차 치료로 권장되었다. 노인 주요우울장애에서 경도 및 중등도 삽화에서의 초기 약물 치료 전략으로는 항우울제 단독치료가 최우선 치료로 권장되었으며, 정신병적 양상이 없는 중증 삽화에서도 항우울제 단독치료가 1차 치료로 선택되었다. 정신병적 양상이 동반된 중증 삽화에서는 항우울제와 비정형 항정신병약물의 병합치료가 최우선 치료로 선택되었다. 노인 주요우울장애의 임상유형별 항우울제 선택에 있어서는, 경도 및 중등도, 정신병적 양상이 없는 중증 삽화에서 fluoxetine과 fluvoxamine을 제외한 SSRI, SNRI, mirtazapine이 1차 약물로 선택되었으며, 정신병적 양상이 동반된 중증 삽화에서는 fluvoxamine을 제외한 SSRI, SNRI, mirtazpine이 1차 약물로 권장되었다. 여성 우울장애의 약물치료에서, 월경전 불쾌기분장애의 치료에서는 항우울제 단독치료가 1차 치료로 권장되었으며, (es)citalopram, fluoxetine, paroxetine, sertraline, duloxetine, venlafaxine이 1차 약물로 선택되었다. 산후 우울증의 약물 치료 전략에 있어서, 경도 및 중등도 삽화에서는 항우울제 단독치료가 1차 치료로 선택되었다. 정신병적 양상이 없는 중증 삽화에서는 항우울제 단독치료, 항우울제와 비정형 항정신병약물의 병합치료가 1차 치료로 권장되었으며, 정신병적 양상이 있는 중증 삽화에서는 항우울제와 비정형 항정신병약물의 병합치료, 기분조절제와 비정형 항정신병약물의 병합치료가 1차 치료로 선호되었다. Korean Medication Algorithm for Depressive Disorder 2012에서는, KMAP-DD 2006에서는 다루지 않았던 소아 청소년 우울장애와 노인 주요우울장애의 약물 치료가 추가되어 현재 임상 상황에서의 치료 전략이 소개되었다. 여성 우울장애의 치료 전략에 있어서는 KMAP-DD 2006과 비교하여 초기 전략에 있어 큰 차이는 없었으나, 산후 우울증 치료에서 정신병적 양상이 없는 중증 삽화에서 항우울제 단독치료뿐만 아니라 항우울제와 비정형 항정신병약물의 병합치료가 1차 치료로 선택되었고, 정신병적 양상이 있는 중증삽화에서는 항우울제와 비정형 항정신병약물의 병합치료뿐만 아니라 기분조절제와 비정형 항정신병약물의 병합치료도 1차 치료로 추가로 선택되었다. Objective Since the introduction of selective serotonin reuptake inhibitor in 1980s, there have been many changes in the treatment strategies for depressive disorders. To be of help for clinicians to select appropriate treatment strategies, Korean Medication Algorithm Project for Major Depressive Disorder was developed in 2002 and revised in 2006. To reflect changes in treatment pattern for depressive disorders since 2006, we revised the previous algorithm and developed Korean Medication Algorithm Project for Depressive Disorder 2012 (KMAP-DD 2012). Methods 123 psychiatrists who have vast clinical experiences in treating depressive disorders are primarily selected, and the survey was sent to them via mails. Among them, 67 psychiatrists answered the survey. This survey was composed of 44 questionnaires of which the contents covered from overall treatment strategies to treatment strategies under the specific circumstances. Based on 95% confidence interval and overall scores, each treatment of option was classified into three categories of recommendation; first-line, second-line, and third-line treatment option. Results In child and adolescent, antidepressant monotherapy was selected as first-line treatment option for mild, moderate, and severe episode without psychotic features. The combination of antidepressant and atypical antipsychotics was advocated as first-line treatment option for severe episode with psychotic features. In geriatric depression, antidepressant monotherapy was advocated as treatment of choice for mild to moderate episode. For severe episode without psychotic features, antidepressant monotherapy was selected as first-line treatment option. For severe episode with psychotic features, combination of antidepressant and atypical antipsychotics was selected as treatment of choice. In premenstrual dysphoric disorder, antidepressant monotherapy was advocated as first-line treatment option. In postpartum depression, antidepressant monotherapy was selected as first-line treatment option for mild to moderate episode. For severe episode without psychotic features, both antidepressant monotherapy and combination of antidepressant and atypical antipsychotics were selected as first-line treatment option. For severe episode with psychotic features, both combination of antidepressant and atypical antipsychotics and combination of mood stabilizer and atypical antipsychotics were advocated as first-line treatment option. Conclusion In KMAP-DD 2012, the recommendations for treatment options in Child and Adolescent Depressive Disorder and Geriatric Depression were newly introduced. In aspects of treatment options for Female Depression, KMAP-DD 2006 and KMAP-DD 2012 had some similarities. But there were some changes of the treatment strategies in KMAP-DD 2012 which seemed to reflect recent study results.