정신분열병, 정신증 임상적 고위험군 및 대조군에서의 시상 용적에 관한 연구

전명욱,정위훈,최정석,정명훈,김지원,최치훈,권준수 대한신경정신의학회 2009 신경정신의학 Vol.48 No.5

Objectives: To investigate the changes in thalamic volumes in subjects at ultra-high risk (UHR) for psychosis. Subjects manifest changes which are similar to but different from those found in subjects with schizophrenia, and thalamic structural changes were often reported in schizophrenic subjects. MethodsZZThalamic volumes of 29 UHR subjects, 31 subjects with schizophrenia and 29 healthy controls, were measured from their T1-weighted coronal magnetic resonance (MR) images using manual tracing. Results: UHR subjects showed greater right (6.243±0.848 cm3) and total (12.254±1.532 cm3) thalamic volumes compared to healthy control subjects (right thalamic volume=5.527±0.715 cm3, total thalamic volume=11.058±1.490 cm3) or patients with schizophrenia (right thalamic volume=5.855±0.938 cm3, total thalamic volume=11.513±1.784 cm3). The difference was significant for right (F=5.837, p=0.004) and total (F=4.217, p=0.018) thalamic volumes after intracranial volume had been accounted for as a covariate in ANCOVA. However, thalamic volume of subjects with schizophrenia showed no significant difference from controls. This difference was not affected by the presence of major depressive disorder or the magnitude of psychotic symptoms. Those among the UHR subjects taking antipsychotic agents did not show enlarged thalamic volume compared to controls. Conclusion: Our findings suggest that the possibility of a volumetric alteration of the thalamus characteristic of the UHR state. 결론적으로, 본 연구에서는 정신증 고위험군에서의 우측 시상 용적 증가가 관찰되었다. 이는 고위험군 시기에 특징적으로 나타날 수 있는 뇌의 용적 변화의 가능성을 제시하며, 또한 정신증의 경과 중 동적인 용적 변화가 병태생리와 연관되 어 있을 가능성도 있음을 시사한다.

정신분열병, 정신증 임상적 고위험군 및 대조군에서의 시상 용적에 관한 연구

전명욱,정위훈,최정석,정명훈,김지원,최치훈,권준수 대한신경정신의학회 2009 신경정신의학 Vol.48 No.4

Objectives To investigate the changes in thalamic volumes in subjects at ultra-high risk (UHR) for psychosis. Subjects manifest changes which are similar to but different from those found in subjects with schizophrenia, and thalamic structural changes were often reported in schizophrenic subjects. Methods Thalamic volumes of 29 UHR subjects, 31 subjects with schizophrenia and 29 healthy controls, were measured from their T1-weighted coronal magnetic resonance (MR) images using manual tracing. Results UHR subjects showed greater right (6.243±0.848 cm3) and total (12.254±1.532 cm3) thalamic volumes compared to healthy control subjects (right thalamic volume=5.527±0.715 cm3, total thalamic volume=11.058±1.490 cm3) or patients with schizophrenia (right thalamic volume=5.855± 0.938 cm3, total thalamic volume=11.513±1.784 cm3). The difference was significant for right (F= 5.837, p=0.004) and total (F=4.217, p=0.018) thalamic volumes after intracranial volume had been accounted for as a covariate in ANCOVA. However, thalamic volume of subjects with schizophrenia showed no significant difference from controls. This difference was not affected by the presence of major depressive disorder or the magnitude of psychotic symptoms. Those among the UHR subjects taking antipsychotic agents did not show enlarged thalamic volume compared to controls. Conclusion Our findings suggest that the possibility of a volumetric alteration of the thalamus characteristic of the UHR state.

Prescription Pattern of Antidepressants for Children and Adolescents in Korea Based on Nationwide Data

전명욱,이중선,정석훈,김양식,김효원 대한의학회 2017 Journal of Korean medical science Vol.32 No.10

Antidepressant prescription for youths has recently been on the increase. There is a growing concern over the increasing off-label usage of antidepressants. Current data on off-label antidepressant usage vary across countries and healthcare systems. Therefore, we examined the extent and pattern of antidepressant prescription for Korean children and adolescents using population-based data. Our data was retrieved from the Korean National Health Insurance Service National Sample Cohort of the year 2013. Among 0.2 million children and adolescents aged 6–18 years from the cohort, subjects who had received any antidepressant medication in the year 2013 were investigated for the prescribed medication, concomitant psychotropic medication, and the associated diagnosis. A total of 2,190 children and adolescents (boys, 55.4%) received antidepressant medication. The most common diagnosis was depressive disorders (n = 469, 21.4%), followed by attention-deficit/hyperactivity disorder (n = 442, 20.2%). Among the prescriptions (n = 3,370), escitalopram (n = 650, 24.1%) and fluoxetine (n = 553, 20.5%) were the two most frequently prescribed drugs. A majority of prescriptions (n = 2,039, 60.5%) included concomitant psychotropic agents, consisting of antipsychotics (n = 901, 26.7%), sedatives (n = 263, 26.3%), medication for attention-deficit/hyperactivity disorder (n = 822, 24.4%), and some others. Our study shows the prescription pattern of antidepressants for children and adolescents in Korea, of which a large proportion is off-label. The results call for close monitoring by clinicians treating this population.

Gender Difference in the Prodromal Symptoms of First-episode Schizophrenia

최정석,전명욱,강도형,권준수,정명훈 대한의학회 2009 Journal of Korean medical science Vol.24 No.6

To investigate the gender difference of early symptoms appearing before the onset of the psychotic symptoms in patients with first-episode schizophrenia, we reviewed the medical records of 63 patients (38 males, 25 females), who were hospitalized for first-episode schizophrenia. The frequency and duration of prodromal and psychotic symptoms, Clinical Global Impression scale scores, Global Assessment of Functioning (GAF) scale scores at admission, and other clinical characteristics were recorded for all patients. Overall, the most common prodromal symptoms were attenuated positive symptoms (89%), followed by mood symptoms (86%). Negative symptoms were the most common in male patients (97.4%), whereas attenuated positive symptoms were the most common in female patients (84%). Male patients demonstrated more frequent negative, cognitive, and obsessive-compulsive symptoms than female patients did and also showed a tendency of having negative symptoms for the longer period. Correlational analysis showed a significant negative correlation between the duration of negative symptoms and GAF scores at admission in male patients. Our findings suggest that different patterns of prodromal symptoms between male and female begin before the onset of the psychosis. Further prospective studies should be needed.

항-NMDA-수용체 뇌염으로 진단된 긴장증 사례

이세정,전명욱,이중선,김창윤 대한조현병학회 2017 대한조현병학회지 Vol.20 No.1

We report a case of a young female patient with catatonic features who later turned out to be suffering from an anti-NMDA (N-methyl- D-aspartate)-receptor-antibody encephalitis. A previously healthy 21-year-old woman was admitted to psychiatric inpatient care presenting with acute psychotic behavior with catatonic features. Laboratory tests of serum and CSF (Cerebrospinal fluid), EEG (Electroencephalogram), brain MRI (Magnetic Resonance Imaging) were unremarkable except vague slow wave on EEG. However, subtle cognitive impairment at the bedside examination suggested further imaging studies to rule out possible organic etiology like autoimmune encephalitis. Brain PET (Positron Emission Tomography) and SPECT (Single Photon Emission Computed Tomography) suggested probable inflammation in the brain. In case of autoimmune encephalitis, given the severity of symptoms and worsening course, steroid pulse therapy was initiated promptly even though the diagnosis was not confirmed but presumed at that time. She recovered completely with steroid therapy. Later her disease turned out to be anti-NMDA-receptor-antibody encephalitis by the antibody test which was not available at the time of admission. Psychiatrists need to be aware of autoimmune encephalitis like anti-NMDA-receptor-antibody encephalitis in the differential diagnosis of acute psychosis with catatonic features. Subtle cognitive impairment which tends to be overlooked due to catatonic features might be a clue to suspect the organic etiology.

양극성 장애 환자에서 불안이 질병 경과에 미치는 영향 : 전향적 추적관찰에 대한 중간분석

김수정,김소정,송혜현,이원혜,전명욱,남윤영,박동연,Kim, Soojeong,Kim, So Jeong,Song, Hye Hyun,Lee, Wonhye,Chon, Myong-Wuk,Nam, Yoon Young,Park, Dong Yeon 대한생물정신의학회 2021 생물정신의학 Vol.28 No.1

Objectives Despite growing attention to anxiety in bipolar disorder (BD), little research has assessed anxiety symptoms in the course of BD. The current prospective follow-up study examines the influence of subjectively and objectively measured anxiety symptoms on the course of BD. Methods A total of 49 patients with BD were followed-up prospectively for average of one year at an average of four months interval. The Korean version of the Beck Anxiety Inventory (K-BAI), the Hamilton Anxiety Rating Scale, heart rate variability (HRV) were used to measure anxiety subjectively, objectively and physiologically. Participants were divided into high and low anxiety groups based on their K-BAI scores. Kaplan-Meier survival analysis was performed to compare the recurrence of mood episode, suicide attempt, emergency room visit, and psychiatric hospitalization between two groups. Mediators were investigated with Cox proportional hazards models. Results Compared to the low anxiety group, the high anxiety group reported significantly higher impulsiveness (p = 0.016) and lower high frequency component on HRV (p = 0.007) after controlling for severity of BD. Regarding survival analysis, the high anxiety group showed hastened depressive episode recurrence (p = 0.048) and suicidal ideation was the mediator of the hazard ratio (HR) 1.089 (p = 0.029) in the Cox model. Moreover, the high anxiety group showed a tendency of accelerated suicide attempt (p = 0.12) and impulsivity was the risk factor of suicide attempt (HR = 1.089, p = 0.036). Conclusions This interim analysis of prospective study suggests that high anxiety level in BD may anticipate unfavorable course. Further studies are needed to understand the multifactorial mechanism of anxious bipolar patients.

학교 밖 청소년의 자살위험에 영향을 미치는 요인

조지현,김장래,배활립,전명욱,이경신,이소희 대한신경정신의학회 2023 신경정신의학 Vol.62 No.4

Objectives This study examined the factors associated with suicide risk among out-of-school youths (OSY) by analyzing their medical records retrospectively. Methods The medical records of 280 OSYs who were admitted to the National Medical Center from January 2015 to December 2018 were examined. The demographic and clinical records, including behavioral problems, post-traumatic symptoms, harmful alcohol consumption, family functioning, and quality of life, were analyzed. Results Among the 280 subjects, 80 (28.6%) were considered a high-risk suicidal group. The number of post-traumatic symptoms was found to be positively correlated, and the family functioning scores were negatively correlated with the increasing risk of suicide in the OSY based on the multiple regression analysis of the medical records. Conclusion The result of this study provides inputs for suicide prevention programs targeted at OSYs by identifying the risk and protective factors associated with suicide among the group.

정신치료 수련의 질과 역량에 관한 정신건강의학과 전공의 인식도 조사

김예지(Ye Ji Kim),견영기(Yeong Gi Kyeon),이승재(Seung Jae Lee),전명욱(Myong-Wuk Chon),이상원(Sang Won Lee),정성원(Sung Won Jung),이강욱(Kang Uk Lee),대한신경정신의학회 수련위원회(The Committee of Residency Training of the Korean Neurop 대한신경정신의학회 2021 신경정신의학 Vol.60 No.3

Objectives This study surveyed the quality of psychotherapy training and psychotherapy competencies during residency in Korea. Methods A questionnaire developed by The Committee of Residency Training of the Korean Neuropsychiatric Association was completed by fourth-year residents of Korean psychiatry (n=120). The questionnaire examined their demographic characteristics, their experience of clinical psychotherapy training, their degree of satisfaction in the quality of psychotherapy training, and self-rated competence regarding the six types of psychotherapies, including supportive psychotherapy, cognitive behavioral therapy, interpersonal psychotherapy, psychoanalytic psychotherapy, group psychotherapy, and family psychotherapy. Results The degree of satisfaction of the residents with the psychotherapy training was diverse among the types of psychotherapy and contents of training. Across all types of psychotherapies, the satisfaction levels of the quantity and quality of supervision education were low, except for psychoanalytic psychotherapy. Overall, more than 70% of residents were not satisfied with the theoretical education, clinical practice, and supervision education in three types of psychotherapies, including interpersonal psychotherapy, group psychotherapy, and family psychotherapy. A positive correlation was found between the degree of satisfaction with the quality of training experience and self-rated competence of psychotherapy. Specifically, the self-rated competence of psychotherapy was more highly correlated with the experience of clinical cases and supervision than theoretical education Conclusion This study showed the quantitative and qualitative status of psychotherapy training in Korean psychiatry residency programs, and the satisfaction level of psychotherapy education was low except for psychoanalytic psychotherapy. There is a strong need for the improvement of psychotherapy training programs in Korea.

정신건강의학과 외래에서의 벤조디아제핀계 향정신성의약품 처방간격 관련요인 분석

심재환(Jae-hwan Sim),한지연(Ji Yeon Han),전진용(Jin-yong Jun),전명욱(Myong-Wuk Chon) 한국중독정신의학회 2021 중독정신의학 Vol.25 No.1

Objective : This study investigated the factors affecting the prescription interval of benzodiazepines and related psychotropics. Methods : The prescription intervals were extracted from all patients (n=1873) who visited the outpatient department of a single psychiatric hospital for one month in June 2019, and the potential factors related to longer psychotropic prescription were explored. Logistic regression analysis was performed to assess the relationship between the potential risk factors and the length of psychotropic medication prescription in days. Results : Two cutoff values (30 days and 35 days) were used for the appropriate prescription interval. Older age [cutoff 30 days, Exp(B)= 1.014, p=0.001 ; cutoff 35 days, Exp(B)=1.014, p=0.001], fewer number of admissions [30 days, Exp(B)=0.459, p<0.001; 35 days, Exp(B)=0.438, p<0.001], fewer number of treatment sessions [30 days, Exp(B)=0.894, p<0.001; 35 days, Exp(B)=0.899, p<0.001], and longer duration of treatment [30 days, Exp(B)=1.022, p= 0.004 ; 35 days, Exp(B)=1.024, p=0.001] were related to a longer prescription interval of psychotropics. Longer duration of illness [30 days, Exp(B)=1.017, p=0.017] was related to a longer prescription term and on-site reception compared to reservation [35 days, Exp(B)=0.585, p=0.022] with a shorter prescription term. Conclusion : Our results suggest that the elderly and patients with a longer duration of illness need closer monitoring for long-interval prescription of benzodiazepines and related psychotropics.

양극성장애 환자용 한국어판 기분 기록 스마트폰 어플리케이션의 개발 및 임상적 적용

송가영(Kayoung Song),이세정(Saejeong Lee),윤 운(Woon Yoon),김창윤(Changyoon Kim),주연호(Yeonho Joo),이중선(Jungsun Lee),전명욱(Myong-Wuk Chon) 대한신경정신의학회 2018 신경정신의학 Vol.57 No.3

Objectives The aim of this study was to develop a Korean version of a mood chart application on an Android platform. Methods This application is based on the traditional mood chart. Eighteen adults with DSM-5 bipolar disorder were enrolled from November 2016 to March 2017. They were asked to rate their daily mood scores and severity of irritability and impulsivity for six months. Their clinicians rated their symptom severity monthly using the Clinical Global Impression-7 (CGI-7) scale. After six months, the participants completed an anonymous questionnaire regarding their satisfaction with the application. Results Of the 18 patients, one withdrew their consent from this study and six were males (35.3%) ; their mean age was 31.71±8.56 years. The mean follow-up duration was 159.12±49.45 days and the period of application use was 143.65±52.11 days. The mean total response rate was 59.45% and the mean response rate on the same day was 43.06%. The adherence to using the application decreased significantly declined over the duration since enrollment [odds ratio (OR)=1.008, p=0.008] but tended to increase according to age (OR=0.958, p=0.002). The application mood scores were correlated significantly with the manic (β=0.307, p=0.004) and depressive (β=-0.701, p<0.001) subscale, and the total (β=1.026, p=0.002) of the CGI-7 (linear mixed models). The majority of subjects agreed that the application helped them manage their symptoms (92.86%), stating that the application was easy to use (78.57%). Conclusion This application could be a valid and useful tool to monitor the mood symptoms of patients with bipolar disorder in Korea.