만성 정신병원의 노인환자 변화추이와 수반된 내과 질환

주새한(Sae Han Ju),김신겸(Shin Kyum Kim),변원탄(Won Tan Byun),정봉주(Bong Joo Jung),박영민(Young Min Park),서재원(Jae Won Seo),김세훈(Se Hoon Kim) 대한노인정신의학회 2018 노인정신의학 Vol.22 No.1

Objective:It investigated the tendency of the increase of elderly patients in a psychiatric hospital. In this regard, it examined whether the number of patients with outpatient consultant, discharge, medical diseases, and neurocognitive disorder increased or not. Methods:It retrospectively reviewed inpatient medical records for the years 2008, 2011, 2014, 2017. To investigate the changes of elderly patients admitted to psychiatry, it examined the changes of patients who are older than 50 or 60 years in addition to the people who are older than 65 years. It analyzed diagnosis, discharge, medical diseases, and outpatient consultant of the three groups respectively. Results:It confirmed that the number of elderly patients who are older than 50, 60, and 65 years has increased in mental hospital for 10 years. There was a significant increase in the number of neurocognitive disorder patients, the ratio of consultant outpatient, and the mean number of outpatient consultant. Diabetes increased in all three groups. Especially it has significantly increased for patients who are older than 50 and 60 years. In the case of patients discharged due to transfer, the number of patients increased in all three groups but it was statistically significant for the patients who are older than 50 years. Conclusion:The study shows that the number of elderly patients increased with the trend of aging society. In relation to this, the rate of outpatient consultant and discharge, including diabetic and dementia patients, also increased. Therefore, if the mental health department provides a system to manage the elderly ward or nursing ward to respond to the increase of elderly patients, or to manage the accompanying chronic diseases such as diabetes and its complications, it could solve the inconvenience of patients due to the consultation outside a hospital or discharge.

공급 사슬 관리에서 안전 재고 수준을 이용한 효율적인 납기회신 시스템의 개발

한주윤(Joo Yun Han),정호상(Ho Sang Jung),전종태(Jong Tae Jeon),정봉주(Bong Ju Jeong) 한국SCM학회 2002 한국SCM학회지 Vol.2 No.1

팔리페리돈 장기 지속형 주사제 사용 후 정신과적 증상 및순응도 변화

박홍준(Hong Jun Park),김신겸(Shin Kyum Kim),변원탄(Won Tan Byun),정봉주(Bong Ju Jung),박영민(Young Min Park),서재원(Jae Won Seo),김세훈(Se Hoon Kim),임종길(Jong Gil Lim) 대한사회정신의학회 2019 사회정신의학 Vol.24 No.1

연구목적 : 조현병 환자에서 저하된 약물 순응도는 증상 재발의 주요한 원인 중 하나이다. 팔리페리돈 장기 지속형 주사제를 사용한 이후 환자의 정신과적 증상 및 약물 순응도의 변화를 측정하였다. 방 법 : 팔리페리돈 장기 지속형 주사제를 시작한 64명의 환자들을 대상으로, 한국형 양성 및 음성 증상 척도(Positive And Negative Syndrome Scale, 이하 PANSS) 및 약물 태도 척도(Drug Attitude Inventory-10, 이하 DAI)를 사용하여, 시작 전과 6개월 후의 정신과적 임상 증상과 약물 순응도 및 경구용 항정신병 약물 용량을 측정하였다. 또한 팔리페리돈 장기 지속형 주사제 사용 후 나타난 치료 효과와 임상적 요인의 관련성을 분석하였다. 결 과 : 팔리페리돈 장기 지속형 주사제 사용 후 정신 증상 및 약물 순응도가 개선된 것으로 나타났다. 로지스틱 회귀 분석 결과, 초기 경구용 항정신병 약물 용량이 낮을 수록, 6개월 간 경구용 항정신병 약물 감소량이 높을 수록 정신 증상의 호전과 연관성을 보였다. 6 개월 후 낮은 PANSS-P 점수는 약물 순응도의 호전과 연관성을 보였다. 결 론 : 팔리페리돈 장기 지속형 주사제 사용은 경구용 항정신병 약물을 감량하면서도 정신 증상의 악화를 최소화하며 약물 순응도를 개선시키는 결과를 나타내었다. Objectives : Poor drug adherence is a major cause of symptom relapse in the overall course of schizophrenia. We investigated the change of psychiatric symptoms and drug adherence following paliperidone palmitate long acting injection (PLAI) in patients with schizophrenia. Methods : Psychiatric symptoms and drug adherence were evaluated in 64 patients with schizophrenia at baseline and after 6-month use of PLAI. Korean version of Positive And Negative Syndrome Scale (PANSS) was used to evaluate the change of symptoms and Drug Attitude Inventory-10 (DAI) to estimate their drug adherence. We assessed concurrent dose of oral antipsychotics over time and associated treatment effectiveness with clinical variables. Results : Psychiatric symptoms and drug adherence were improved after use of PLAI. Logistic regression analysis showed treatment effectiveness of psychiatric symptoms was associated with lower dose of initial oral antipsychotics and higher decrement of oral antipsychotics dose. And the improvement of drug adherence was associated with lower score of end-point PANSS-P. Conclusion : PLAI is expected to be a promising strategy to reduce the dose of oral antipsychotics without worsening of psychiatric symptoms and drug adherence in schizophrenic patients.

연구논문 : 의사결정능력 도구인 University of California, SanDiego Brief Assessment of Capacity to Consent (UBACC)의 타당도와 신뢰도 평가

정인숙 ( Ihn Sook Jeong ),김성곤 ( Sung Gon Kim ),이진성 ( Jin Seong Lee ),정봉주 ( Bong Ju Jung ) 한국의료윤리학회 2011 한국의료윤리학회지 Vol.14 No.3

This study aimed to validate one of the tools for assessing decision-making capacity: the University of California at San Diego`s Brief Assessment of Capacity to Consent (UBACC), which is composed of a 10-item scale that includes questions focusing on the understanding and appreciation of information concerning research protocol. The subjects in the study were 30 inpatients and 30 outpatients with schizophrenia or schizoaffective disorder and, for comparison, 30 healthy subjects, all of whom received information about a simulated clinical drug trial. Using the MacArthur Competency Assessment Tool for Clinical Research (MacCAT-CR) as a gold standard, inter-rater reliability with intra-class correlation coefficient (ICC) was measured. The ICC for inter-rater reliability ranged from 0.987 to 0.994. The UBACC was found to be a useful and valid instrument for the screening of decision-making capacity before obtaining informed consent. We recommend that it be used not only for schizophrenia patients but also for various vulnerable groups including the elderly or cognitively impaired subjects.

밀리온 임상 다축 검사(MCMI)를 이용한 알코올의존 입원 환자의 아형 분류 연구

이덕기(Duk-Gi Lee),최진환(Jin-Hwan Choi),정봉주(Bong-Ju Jung),정순민(Sun-Min Jung) 한국중독정신의학회 2004 중독정신의학 Vol.8 No.2

Objectives:The purpose of this study is to classify the personality characteristics of individuals with alcohol dependence through cluster analysis, and to examine clinical characteristics of each subtype. Methods:402 Inpatients with alcohol dependence were received MCMI, AUI, MAST, and ADS. The classification of personality subtypes of alcohol dependence was done through the cluster analysis. Results:1) Personality characteristics of patients with alcohol dependence could be classified into three subtypes. Subtype 1 showed the most severe personality pathology. Subtype 2 showed the relatively milder personality pathology. Subtype 3 showed the intermediate level of personality pathology. 2) There is no difference in age, educational level, marital status, and the onset age of alcohol problem, and the existence or nonexistence of job, family history of alcoholism, medical disease, and smoking among three subtypes. 3) As a result of comparative analysis of alcohol-related variables, mental functioning, compulsive drinking, drinking problem, insight of problem, anxiety, and physical, psychological dependence showed statistically significant difference between subtype 1 and subtype 2 or 3. 4) There was a significant difference in anxiety, somatization, mania, alcohol dependence, posttraumatic stress symptom, thought disorder, major depression, and delusional disorder among three subtypes. There was a significant difference in the degree of drug abuse between subtype 1 and subtype 2 or 3. Conclusion:It is possible to classify personality characteristics of patients with alcohol dependence into three subtypes by means of MCMI in Korea.

조현병 환자에서 당뇨와 수면의 질 사이의 연관성

권기태(Ki Tae Kwon),김신겸(Shin Kyum Kim),변원탄(Won Tan Byun),이덕기(Duk Ki Lee),정봉주(Bong Ju Jung),박영민(Young Min Park),서재원(Jae Won Seo),김세훈(Se Hoon Kim) 대한생물치료정신의학회 2017 생물치료정신의학 Vol.23 No.1

Objectives:We aimed to investigate the relation between poor quality of sleep and clinical characteristics in patients with schizophrenia. Methods:Using the Korean version of the Pittsburgh Sleep Quality Index(PSQI-K), the sleep quality was evaluated in 118 patients with schizophrenia. Demographic and clinical variables were compared between schizophrenia patients with and without poor quality of sleep. Laboratory variables, clinical and sociodemographic characteristics were compared between PSQI-K score higher than 5 points group(PSQI-H) and PSQI-K score lower than 4 points group(PSQI-L). Results:The prevalence of diabetes mellitus(DM) was higher in PSQI-H patients. In patients with DM, sleep duration was shorter and use of sleeping medication was more frequent than patients without DM. In logistic regression analysis, DM was associated with higher score of PSQI-K. Conclusion:We have found that presence of DM can be associated with poor quality of sleep in patients with schizophrenia. Further studies with more objective assessment on sleep quality and mediation are needed to clarify these relationships between sleep quality disorder and diabetes mellitus.

항정신병약물을 복용 중인 환자의 공복혈당장애 : 이환율과 공복혈당의 내당능장애에 대한 선별 검사로서의 유용성

최진환(Jin-Hwan Choi),박영민(Young-Min Park),조진석(Jin-Seok Cho),정순민(Sun-Min Jung),정봉주(Bong-Ju Jung),변원탄(Won-Tan Byun) 대한생물치료정신의학회 2007 생물치료정신의학 Vol.13 No.1

목적 : 항정신병약물을 투여 받는 환자에서 당뇨병과 고혈당의 이환율이 높음을 시사하는 연구들이 많이 있어 왔다. 본 연구에서는 비정형 항정신병약물을 포함한 다양한 항정신병약물을 투여 받고 있는 환자들을 대상으로 공복혈당장애의 이환율을 알아보고, 심혈관 질환의 위험도를 잘 반영한다고 알려져 있는 당부하 검사를 함께 시행하여, 공복혈당과 당부하 후 혈당 간의 상관관계를 분석함으로써 항정신병약물을 투여 받고 있는 환자들에서의 공복혈당 선별 검사의 유용성을 밝히고자 하였다. 방법 : 최소 2개월 이상 같은 종류의 항정신병약물을 복용한 환자 96명을 대상으로 8시간 이상의 공복 상태를 유지하게 한 후 공복혈당 검사를 하였고, 바로 경구 포도당 75g을 복용하게 한 후 2시간 후에 다시 혈당 검사를 하였다. 환자를 미국 당뇨협회에서 제시한 공복혈당(fasting blood glucose, 이하 FBG)을 기준으로 하여 정상 공복혈당군(FBS <100㎎/dl)과 공복혈당장애군(FBS ≥100㎎/dl)의 두 군으로 나누어 당부하 후 혈당을 비롯한 인구학적인 특성과 임상적인 특성들을 비교 분석하였다. 환자에 대한 기본 정보는 환자와의 직접 면담과 의무 기록을 통해 얻었으며, 기존의 당뇨병 환자는 제외되었다. 결과 : 총 96명의 대상 환자 중 공복혈당장애는 22명(22.9%)였으며 이 중 10명(45.5%)에서 당부하 검사 상 내당능장애가 있었고 나머지 12(54.5%)명은 정상 소견이었다. 정상공복혈당 군 74명 중 52명(70.3%)은 당부하 검사상 정상이었고, 22명(29.7%)에서는 공복혈당장애가 없으면서 내당능장애가 있는 것으로 나타났다. 공복혈당장애군과 정상 공복혈당군 간의 당부하 후 혈당에는 유의한 차이가 있었지만 공복혈당과 당부하 후 혈당의 상관관계는 높지 않았으며(Spearman’s R=0.265, p<0.01). 항정신병약물 중 정형 약물과 비정형 약물 간의 공복혈당 및 당부하 후 혈당의 유의한 차이는 없었다. 결론 : 항정신병약물을 복용 중인 환자에서 공복혈당은 환자의 당부하 혈당과 상관 관계가 낮아 환자의 심혈관 질환의 위험도를 제대로 반영하지 못할 수 있으며 따라서 선별 검사로서 적합하지 않을 수 있다. Objectives : The aims of this study were to examine the prevalence of impaired fasting glucose, to analyze the correlation of fasting glucose level with 2-hour glucose level after oral glucose loading, and to clarify the usefulness of the fasting glucose test as screening in the patients who are taking antipsychiotic medications. Methods : We examined the fasting glucose level and 2 hour glucose level after loading 75g of glucose in 96 hospitalized psychiatric patients who had been taking the same medications for at least 2 months. We divided the subjects into 2 groups, impaired fasting glucose and normal fasting glucose group, based on American Diabetes Association criteria proposed in 2004, and compared the demographical and clinical characteristics between the two groups. The subjects with preexisting diabetes mellitus were excluded. Results : Among 96 subjects, impaired fasting glucose group were 22(22.9%), 10 of them(45.5%) had impaired glucose tolerance, and the rest 12(54.5%) were normal in oral glucose t lerance test. In the normal fasting glucose group of 74 subjects, 52(70.3%) were normal, and 22(29.7%) had impaired glucose tolerance but normal fasting glucose. There was a positive correlation between fasting glucose levels and 2-hour glucose levels after oral glucose loading but the correlation was not strong(Spearman’s R=0.265, p<0.01). There were no significant differences in fasting and 2-hour glucose levels between typical and atypical antipsychotics groups. Conclusion : Fasting glucose test could not reflect the cardiovascular risk well in patients who are taking antipsychotics, thus it would not be appropriate to use this as screening test.

주정중독 환자에서 Fluoxetine이 혈중 알콜 농도와 음주효과에 미치는 영향

김명정,박제민,정봉주 大韓神經精神醫學會 1994 신경정신의학 Vol.33 No.1

The effect of chronic administration of fluoxetine on blood alcohol concentration and on a number of alcohol induced physical and psychological effects was studied. The subjects were 14 hospitalized alcoholics without significant depression. After 21 days of 60mg daily fluoxetine and placebo administration. 2.5ml/kg body weight of 40% alcohol was administrated in a single dose and blood alcohol concentrations were measured 10, 20, 40, 60, 120, and 240min, after the alcohol intake. Mania Rating Scale score(MRS), pulse rate, respiratory rate and subjective physical condition were measured before and 30min, after alcohol intake. The results were as follows: 1) Blood alcohol concentrations were significantly higher after fluoxetine administration than placebo administration at 40min, and 60min, after alcohol intake. 2) Fluoxetine suppressed the increase of pluse rate induced by alcohol intake. However, no significant difference was noted in the alcohol induced changes in the scores of MRS, respiratory rate, and subjective physical condition between the drug and placebo administrations. 3) After fluoxetine administration, a significant negative correlation was shown between blood alcohol concentration, 10min after alcohol intake and MRS. In contrast, however, a significant positive correlation was seen between the two variable after placebo administration. From these results, it is suggested that fluoxetine increases blood alcohol concentration only during higher alcohol concentration and that the reduction of alcohol intake after chronic administration of fluoxetine may be due, at least in part, to an attenuation of positie reinforcement of alcohol effect, rather than to an enhancement of the aversion reaction to alcohol.

글로벌 SCM 환경에서의 통합 생산계획 모델에 관한 연구

정호상,송익수,정봉주 한국로지스틱스학회 2002 로지스틱스연구 Vol.10 No.1

본 논문은 글로벌 SCM(Supply Chain Management) 환경에서 생산 연계 비용의 최소화를 목적으로 하는 생산 계획 수립 알고리즘을 제안한다. 글로벌 SCM환경은 지역적으로 분리된 여러 개의 공장에서 각각 부분품 및 완제품의 생산이 이루어지는 환경이다. 이러한 환경에서 완제품의 주문량 또는 수요 예측량을 만족하지 위해 제품의 BOM(Bill-Of-Material) 구조를 고려하여 각 부분품의 생산계획량을 결정해야 한다. 각 공장에서는 제한된 생산 능력을 가지면, 특정 부분품 또는 완제품을 생산한다. 부분품의 생산은 특정 공정 시간을 가지며 완성된 부분품은 이후 공정을 위해 다른 공장으로의 이동시간을 갖는다. 본 논문의 목적은 공장의 생산능력을 만족시키면서 제품의 공장별 생산 비용, 재고 비용, 공장 간 물류 비용을 최소화 시키는 생산 계획을 수립하는 문제의 해를 구하는 것이다. 본 논문에서는 글로벌 SCM 네트워크를 정의하고, 주어진 네트워크의 생산 계획문제를 혼합 정수 계획법을 이용하여 모델링한다. 효과적으로 문제를 해결하기 위해 계산 시간면에서 효율적인 발견적 기법을 제안하고 실험을 통해 해법의 성능을 검증한다. This paper presents a production planning algorithm for minimizing the costs of production and distribution in Global SCM(Supply Chain Management) environments. In the Global SCM environment, the several local plants produce parts and products. In this environment, we have to decide the production volumes of both parts and products considering the BOM(Bill-Of-Material) structure to meet the fixed order quantity or forecasted demand quantity. Each plant produces the specified parts of product and has a certain production capacity. There exist a fixed production lead time to make products and transportation lead time to move parts to different plants for subsequent processes. The objective of this study is to solve the production planning problem, which minimizes the total costs of production, inventory, and transportation under constraints of production capacity. For this problem, the integrated production planning model was formulated as a mixed integer programming, and an efficient heuristic algorithms was proposed. The experimental investigation shows that the proposed heuristic generates quite good solutions at very low computation costs.

공급 사슬 환경에서의 고객주문만족 시스템

장지홍,정호상,정봉주 연세대학교 산업기술연구소 2000 논문집 Vol.32 No.2

기업의 틀을 뛰어넘어 고객과 공급자까지 자사를 중심으로 통합하는 공급 사슬 환경에 있어서 고객 만족 수준을 향상시키는 것은 매우 중요하다. 고객 만족 수준을 높이기 위해서는 우선 정확한 수요예측을 통하여 주문에 대비해야 하며, 주문이 들어올 경우 고객에게 정확한 납기회신을 제공해야 한다. 물류, 정보, 자금 등의 흐름을 총괄하는 공급 사슬 환경의 특성상, 정확한 수요예측과 납기회신을 제공하기 위해서는 제품의 공급자, 고객을 포함한 공급 사슬내의 여러 파트너 들에 대한 종합적인 고려가 이루어져야 한다. 본 연구에서는 일반적인 공급 사슬 환경에서 사용 가능한 수요계획 시스템을 구축하는데 필요한 모델과, 고객의 주문에 대한 납기 제시를 위한 납기회신 알고리듬을 제시하고자 한다. : 공급사슬관리, 수요계획, 납기회신