치료약물과 신경영상

정은기,Chung, Eun Kee 대한생물정신의학회 1995 생물정신의학 Vol.2 No.1

The application of neuroimaging techniques in psychiatry started in 1970s with the use of CT(computerized tomography). Neuroimaging methods can be categorized as anatomical and functional. Recently, attentions are focused on the functional neuroimaging methods those could give us various important informations. But results regarding to psychotropic medication effect on neuroimaging are not sufficient. Here, the study results of the medication effect with the functional imaging methods are mainly revieued.

혈관성 치매의 뇌영상

정은기(Eun Kee Chung) 대한노인정신의학회 1999 노인정신의학 Vol.3 No.2

Neuroimaging is a vascular and became an essential method to detecting and evaluating brain pathology. It is also important in evaluation of dementia, especially of vascular dementia. This article review characteristic features of methodological problems of CT and MRI, and of various dementias, especially vascular dementia.

외래치료명령제-정신질환자의 재활을 돕는 제도

홍진표(Jin-Pyo Hong),이동은(Dong-Eun Lee),김병후(Byung-Hoo Kim),최용성(Yong-Sung Choi),서동우(Tong-Woo Suh),김진학(Jin-Hak Kim),박종익(Jong-Ik Park),정은기(Eun-Kee Chung) 대한사회정신의학회 2001 사회정신의학 Vol.6 No.1

정신보건법이 제정된 후 정신질환자의 인권보호 및 삶의 질 향상을 기대했지만, 장기입원은 오히려 가속화되고 있고, 만성정신질환자의 지역사회 관리는 제대로 이루어지지 못하고 있다. 본 논문의 목적은 이런 어려움을 극복하기 위해 미국, 호주 등에서 실시되고 있는 외래치료명령제를 소개하고 국내에 도입 필요성을 강조하기 위함이다. 외래치료명령제는 정신분열병, 조울정신병같은 만성적인 정신질환을 앓고 있어서 지속적인 약물치료가 필요한 환자들이 병식이 부족하여 치료가 중단됨으로써 반복적으로 재발되는 환자들을 지역사회에서 치료받도록 법적으로 강제하는 제도이다. 외국 연구들은 외래치료명령제를 실시할 경우 재발율이 낮아지고, 입원기간이 단축되는 등 많은 효과를 보고하고 있다. 외래치료명령제가 환자의 인권을 침해하고 치료를 거부할 권리를 제한한다는 주장이 있다. 따라서 대상을 엄격히 제한하고 치료를 거부할 권리에 대한 심사를 강화하면서 외래치료명령제를 실시한다면 비의료적 이유로 장기입원된 환자들이 지역사회에서 치료를 받을 수 있는 권리를 오히려 보장하게 될 것이다. 외래치료명령제가 실시되기 위해서는 정신보건법이 개정되어야 하며 정신보건전문가의 철저한 이해와 적극적인 협조가 필요하다. After legislation of the Mental Health Law in 1995 in Korea, we have anticipated improvement of human rights and quality of life of the mentally ill. But the recent result shows contradictory to our anticipation that long-term hospitalization has been validated and community care of chronic mental patients has gone too far distant. The objective of this article is to introduce the involuntary outpatient commitment which were used as an aid for rehabilitation of the chronic mentally ill in United States and Australia and to insist on the necessity of involuntary outpatient commitment in Korea. Involuntary outpatient commitment is a form of civil commitment in which the court orders an individual who have been poorly compliant to treatment and recurrently relapsed to comply with a specific outpatient treatment program. Many studies reported that involuntary outpatient commitment appears to provide improved outcome in rates of rehospitalization and length of hospital stay. Considering some arguments that outpatient commitment entails excessive state intrusion and interferes with the right to refuse treatment, explicit criteria of outpatient commitment should be operationalized and strict review system for refusal of treatment should be applied. Outpatient commitment decreases the time individuals must spend in psychiatric hospitals and enhances the right to be treated in the least restrictive ways. Mental health law should be revised for involuntary outpatient commitment. And understanding and cooperation of mental health personnels is the essential component in implementing involuntary outpatient commitment in Korea.

정신분열병 환자에서 항정신약물 유지치료 시 재발에 대한 연구

이종일(Jong-Il Lee),한희종(Hee-Jong Han),윤해주(Hai-Joo Yoon),정은기(Eun-Kee Chung),장동원(Dong-Won Chang),김성택(Sung-Taek Kim) 대한사회정신의학회 2006 사회정신의학 Vol.11 No.1

연구목적: 재발방지는 정신분열병 유지치료에서 가장 중요한 목표이다. 이 연구는 전형적항정신약물인 haloperidol과 비전형적항정신약 물인 risperidone과 olanzapine을 사용하는 경우 3년 동안의 추적조사를 통해 재발방지를 위한 효과를 비교하고자 계획되었다. 방 법: 연구자들은 성인외래치료를 받고 있는 대상자들의 병록기록을 조사하여 haloperidol군 305명, risperidone군 179명, 그리고 olanzapine군 40명을 선정하였다. 모든 대상자들은 안정된 임상상태를 유지하고 있었다. 연구자들은 3년 동안의 재발로 인한 입원 비율과 Kaplan-Meier 생존율을 분석하였다. 결 과: 재발이외의 이유로 분석대상의 약물이 중단된 경우는 haloperidol군 43.9%, risperidone군 31.3%, 그리고 olanzapine군 37.5% 였다. 이들을 제외한 결과 재발로 인한 재발률은 각각 38.0%, 18.7%, 36.0%이었다. Risperidone군이 haloperidol군에 비해 유의하게 낮은 재발률을 보였다(χ 2 =5.419, df=1, p=0.02). Kaplan-Meier 생존분석에서 재발위험률은 haloperidol군 65.1%, risperidone군 44.1%, 그리고 olanzapine군 60.0%이었다. 생존율은 각각 34.9%, 55.9%, 40.0%이었다. Risperidone군이 hal-operidol군에 비해 높은 생존률을 보여주었다(log-rank 18.29, df=1, p=0.00). 결 론: 임상적으로 안정된 상태의 성인 정신분열병 환자 외래통원치료 시 risperidone을 사용하는 경우 haloperidol을 사용하는 경우에 비해 낮은 재발률과 높은 생존율을 보여주었다. Objective:Prevention of relapse is a major goal of maintenance treatment in patients with schizophrenia. This study examined the treatment response of haloperidol, risperidone, and olanzapine by the way of relapse rates for 3 years in schizophrenic patients Methods:Authors examined medical records of subjects who have been taken medications at adult outpatient’s clinic. Data were analyzed from three groups of haloperidol(N=305), risperidone(N=179), and olanzapine(N=40) treatment. All of subjects have been in stable condition. We analyzed data by relapse rates and Kaplan-Meier survival analysis for 3 years. Results:Of the 305 patients to haloperidol, the 179 patients to risperidone, and the 40 patients to olanzapine who remained in the analysis of relapse, 43.9%, 31.3%, and 37.5%, respectively, discontinued treatment for reasons other than relapse. The Admission rate due to relapse was showed 38.0%, 18.7%, and 36.0%, respectively. Patients in the risperidone group had a lower admission rate than the haloperidol group(χ 2 =5.419, df=1, p=0.02). In Kaplan-Meier survival analysis, the risk of relapse was showed 65.1% in haloperidol group, 44.1% in risperidone group, and 60.0% in olanzapine group. Survival rate was 34.9%, 55.9%, and 40.0%, respectively. Patients in the risperidone group had a higher survival rate than the haloperidol group(log-rank 18.29, df=1, p=0.00). Conclusion:Adult outpatients with clinically stable schizophrenia have a lower risk of relapse and a higher survival rate if they are treated with risperidone than if they are treated with haloperidol.

의약분업에 관한 정신과 환자와 가족의 견해

박정수(Jung-Soo Park),최명환(Myoung-Hwan Choi),이충경(Choong-koung Lee),정은기(Eun-Kee Chung),박용천(Yong-Chon Park),김찬형(Chan-Hyung Kim) 대한사회정신의학회 2000 사회정신의학 Vol.5 No.1

2000년 7월 1일부터 실시 예정인 의약분업은 의약품의 오·남용으로부터 국민을 보호하고 의사와 약사 두 전문 인력간의 역할구분을 명확히 하여 국민들로 하여금 정확한 의료에의 접근을 가능케 하여 궁극적으로는 국민의 건강을 보호한다는 목적을 가지고 있는데, 실제 의약분업의 목적하는 바 건강 증진의 대상인 국민조차도 의약분업에 대해서 잘 알지 못하고 있는 실정이다. 본 조사는 의약분업에 대한 정신과 환자, 보호자들의 인식과 이들이 생각하는 문제점들에 관한 것으로 각 시.도별 정신과 전문병원, 대학병원정신과, 개인 정신과 의원에 다니는 환자와 보호자를 대상으로 1999년 9월 20일부터 동년 10월30일까지 설문조사를 하였다. 설문지의 내용은 의약분업에 대한 인식도, 정신과에서의 의약분업 시 발생할 수 있는 문제점 등을 포함해서 8개 항목으로 구성되었다. 전체2,664명의 회신자료중 환자와 보호자를 구별할 수 없는 응답자 39명을 제외한 환자 응답자가 2,330명, 보호자 응답자가 295명이었다. 조사의 결과 의약분업 시행이 얼마 남지 않은 현시점에서 환자나 보호자는 의약분업이 무엇인지 정확히 알고 있는 사람이 드물었다. 또 정신과에서 의약분업 실시 때 발생할 수 있는 문제들에 대해 환자의 60.3%, 보호자의 66.4%에서 번거롭고 경제적으로 부담이 된다.고 했고, 예상 부작용에 대해서도 치료의 일관성 상실과 약물의 오·남용 심화된다.는 응답이 가장 많았다. 또 환자 보호자 대부분에서 정신과 진료에서 의약분업은 제외되어야 한다고 응답했다. 의약분업은 좋은 제도이지만 여기에는 많은 문제점이 있다. 특히 의사와 환자관계가 중요한 정신과에서는 더욱 많은 문제점들을 야기할 수 있겠다. 의약분업은 충분한 사전조사와 가능한 문제점들을 고려하여 시행되어야 할 것이다. The separation of dispensary from medical practice that is supposed be applied from July first, 2000 has two purposes. The first one is protecting people from the abuse of drugs and the second one is apparently distinguishing the roles, which are pharmacist and medical doctor, to accelerate people’s access to correct medical treatment. In this context the ultimate purpose of it could be assumed to protect people’s health. However actually people do not know much about the separation of pharmacy and clinic. This Article is about the problems that mental patients and their families could think of and the perception they might have, when the separation of pharmacy and clinic is in effect nation-wide. The mental patients and their families, who were visited from september 20th, 1999 to October 30th, 1999 in civil, national, and private hospitals, were selected for survey target. The contents of questions consist of eight items including the followings. They were the perception of mental patients and their families for the separation of dispensary from medical practice and the problems that could be expected at the time of its enforcement. The number of returned questionnaire were 2,664 and 39 of them were excluded due to the unclear distinction between patients and families. Finally the patient responders were 2,330 and the family responders were 295. As a result of survey it is very rare that patients or families know clearly what the separation of dispensary from medical practice is, the policy of the separation of pharmacy and clinic is supposed to be enforced in the near future though. For the problems that could be raised after the enforcement of it, 60.3% of patients and 66.4% of families said that they felt complicated and it would be a burden to them economically and for the expected side effect most of patients and their families answered that the loss of consistent treatment and abuse of drug would be more deepened than before. Additionally they also answered that the policy of the separation of dispensary from medical practice should be exempted in the case of psychiatric treatment. Although the separation of dispensary from medical practice is a good system, there are several problems. Actually the fact, that the doctor-patient relationship is important in the psychiatric treatment, could cause more problems. The separation of dispensary from medical practice should be enforced with the consideration of possible problems and sufficient preliminary examination.

DSM-IV 알코올 사용장애의 유병률과 관련요인들

이동우(Dong-Woo Lee),함봉진(Bong-Jin Ham),김성주(Sung-Joo Kim),성제수(Jea-Su Sung),김봉석(Bong-Seog Kim),신정호(Jong-Ho Shin),정은기(Eun-Kee Chung),홍진표(Jin-Pyo Hong),서동우(Tong-Woo Suh),조맹제(Maeng-Je Cho) 대한사회정신의학회 2004 사회정신의학 Vol.9 No.2

목 적: 본 연구는 2001년도에 전국적으로 시행된 역학조사 결과를 분석하여 한국인에서의 알코올 사용장애의 유병률과 위험요인을 알아 보고 1980년대에 시행된 전국규모 역학조사 결과와 비교하기 위한 것이다. 방 법: 전국 10개 지역에서 다단계 집락추출법을 사용하여 주민등록상에서 12,886가구를 선정하고 각 가구당 18~64세 성인 한 명을 무작위로 선정하였다. 그 중 실제 방문을 통하여 거주불명, 부재, 이사, 사망 등을 제외한 7,867명을 대상으로 조사를 실시 하였다. 5일간의 교육을 받은 조사요원이 가정방문을 하여 모든 대상자들에게 한국어판 Composite International Diagnostic Interview(K-CIDI)를 적용하였다. 면담 불능, 면담 거부 등의 경우를 제외한 6,275명이 조사를 완료하여 79.8%의 반응율을 보였다. K-CIDI 자료로부터 DSM-Ⅳ에 의한 알코올 남용, 알코올 의존의 진단을 산출하였다. 표본과 전국 인구분포의 차이를 보정 하기 위하여 연령과 성에 따른 가중치를 계산하였고 SUDAAN 통계 프로그램을 이용하여 유병율과 표본오차를 계산하였다. 결 과: 알코올 남용의 평생/일년/일개월 유병율은 7.1%/2.0%/1.2%였으며 알코올의존의 평생/일년/일개월 유병율은 10.2%/5.1%/3.5% 였다. 알코올 남용의 유병율은 남자에서 약 7배 높았으며, 알코올 의존의 유병율은 남자에서 약 3배 높았다. 관련 요인에 대한 분석 에서는 여성에서 알코올 남용의 위험도가 낮았고(OR=0.2, p=0.00), 농촌지역에서의 위험도가 높았으며(OR=2.0, p=0.03), 18~24세의 젊은 연령에 비해 25~44세(OR=0.3, p=0.03) 및 45~64세(OR=0.2, p=0.03)의 위험도가 낮았다. 알코올 의존의 위험도 또한 여성(OR=0.2, p=0.00)에서 낮게 나타났으며, 소득이 낮은 경우가 위험도가 낮았다. 이혼 또는 사별(OR=2.0, p= 0.02)한 경우는 위험도가 높게 나타났다. 결 론: 1980년대의 조사결과와 비교하여 알코올의존의 유병률은 큰 차이가 없었으나 알코올 남용의 유병률은 현저히 저하되었고 알코올 남용과 알코올 의존의 비율이 역전되었으며 남녀의 유병률 차이 또한 줄어든 양상을 보였다. 이러한 변화는 알코올 사용장애의 진단 기준의 변화, 우리 사회의 음주문화의 변화와 사회문화적 변화에 기인한 것으로 추정된다. Objectives:This study was intended to examine the prevalence and correlates of alcohol abuse and alcohol dependence by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition(DSM-IV) criteria in normal adult population using data from the Korean Epidemiologic Catchment Area(KECA) study. Methods:Data were derived from 6,275 household residents over 18 to 64 years of age who responded to KECA survey. Prevalence and correlates were assessed by World Health Organization’s(WHO) Korean Composite International Diagnostic Interview version 2.1(K-CIDI). Results:The overall weighted prevalence of alcohol abuse was 7.1%/2.0%/1.2%(lifetime/12 month/1 month). The overall weighted prevalence of alcohol dependence was 10.2%/5.1%/3.5%(lifetime/12 month/1 month). The significant correlates of alcohol abuse were male, rural haitats. Those of alcohol dependence were male, being divorced/separated/ widowed. Conclusion:The prevalence of alcohol abuse was much lower than that of the study performed by DIS in 1984. The change may be related to the sociocultural change during 15 years.

노인정신장애환자의 추적치료 실태에 대한 고찰

신명기,이충경,정은기 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.3

The authors performed this statistical study in order to get a preliminary data for further intensive study and the possible ways to improve psychiatric care for elderly patients. The authors reviewed the clinical records of 128 elderly patients who had admitted at Seoul National Mental Hospital from Jan. 1991 to Oct 1992. And the authors interviewed with telephone 74 persons who had not taken follow-up treatment. The results of the study were as follows: 1) Those who had taken follow-up treatment wer 108 patients(84.4%). 2) Those who had combined with other physical disease were 68 patients(53.1%). The Car-diovascular disease was most frequent(20.8%). 3) There were no meaningful differences between the group who had and had not taken follow-up treatment on several variables. 4) The causes of no follow-up treatment were as follows: ①Patient's death:27 cases(36.5%). ②Symptom improved:17 cases(22.9%). ③To another Hospital:16 cases(21.6%). ④Marginal adaptation:7 cases(9.5%). ⑤Others:7 cases(9.5%). readmission to Seoul National Mental Hospital:3 cases. admitted to sanitarium: 2 cases. abandoned by dependents: 1 case. discontented with Doctor: 1 case. In conclusion, there were no meaningful differences between the group that receiue cl and not receired follow-up treatment on several variables. And the most common cause of no follow-up treatment was the patients' death.

두부전산화단층촬영과 뇌파검사의 병변판별능력에 관한 비교연구

김이영,정은기 大韓神經精神醫學會 1983 신경정신의학 Vol.22 No.2

The author aimed at comparative study of pathology-detecting powers of electroencephalography (EEG) and brain scan of computed axial transverse tomography(CAT) by examining 184 patients who have undergone both of the tests simultaniously. The subjects were divided into 4 groups: Both tests positive, CT positive and EEG negative groups. Fifth seven (31%) belonged to the both tests positive group. Among them a high proportion of 74% showed the same localization of the abnormal findings. And these subjects showing abnormalities with concordant localization in both tests were found to have relatively fresh lesions. Those belonging to the second group with positive CT and 8 were considered to have brain pathologies and 6 of them were found to have old brain lesions of 6 months or longer duration. Normal EEGs in these chronic patients were considered to have resulted from functional compensation. The third group with negative CT and positive EEG findings numbered 62, about one third of total subjects. Out of the EEGs of the 62, EEGs of 45 subjects were compatible with those of convulsive disorders. The fourth group showing negative findings in both tests were 55. Among these, however, there were 20 subjects manifesting overt clinical symptoms and signs of organic character. Although not all 20 of them could be diagnosed definitely as organic mental disorders, at least several of them be given diagnoses quite convincingly. Thus, it was found that although CT has it's function of showing exact anatomical pathology, EEG also has it's capacity of revealing a functional disturbance in a wide range of patients suspected to have brain pathologies. Also localization capacity of EEG was remarkably high especially when the pathologies were recent ones of less than 6 months duration.

한국판 간이정신검사 척도를 이용한 정상청소년과 품행장애 청소년의 정신건강 비교

정은기,진혜경,장안기 국립서울정신병원 2001 臨床硏究論文集 Vol.2001 No.-

노인환자용 진단 척도에 관한 연구

정은기 국립서울정신병원 1989 臨床硏究論文集 Vol.1989 No.-