남성화된 암컷 생쥐의 통각반응 양상과 에스트로겐-α 수용체의 발현 양상

제영묘(Young-Myo Jae),박제민(Je-Min Park),백선용(Sun-Yong Baek),최병무(Byung-Moo Choi),김명정(Myung-Jung Kim) 대한생물치료정신의학회 2005 생물치료정신의학 Vol.11 No.1

암컷 생쥐를 출생 직후 테스토스테론에 노출시키면 성장 후 통각반응과 중추신경계 통각조절부위의 estrogen-α 수용체(ERα)의 발현에 영향을 주는지를 조사하고자 하였다. 갓 태어난 생쥐(Institute for Cancer Research)에게 생후 24시간 이내에 testosterone propionate 100㎍(남성화군) 혹은 sesame oil 50㎕(대조군)씩 복강내 주사하였다. 13주째에 각 군을 반으로 나누고 naloxone HCI 5㎎/㎏ 혹은 동량의 생리식염수를 복강내 주사하였다. 15분 뒤에 Tail immersion test로 통각예민도(TFL, sec)를 2회 측정하였다. 이어서 모든 군에게 testosterone propionate 1㎎/㎏씩 복강내 주사하고, 15분 후에 같은 방법으로 TFL을 측정하였다. 8개월 째 식염수 전처치군의 뇌를 적출하여 일차감각대뇌겉질, 시상, 중간뇌수도관주위회색질, 큰솔기핵 및 허리와 엉치척수분절 부위를 분리하였다. 각 부위별 ERα를 Western blot 분석으로 반정량하였다. 그 결과는 다음과 같다. 생리식염수 전처치군에서 대조-암컷은 기저 TFL과 테스토스테론 투여 후 TFL이 대조-수컷 보다 유의하게 예민하였다. 테스토스테론은 모든 군에서 TFL을 유의하게 연장시켰다. 날록손 전처치-대조-암컷은 수컷이나 남성화-암컷 보다 유의하게 예민하였다. 남성화-암컷은 기저 TFL이 수컷 보다 예민한 경향이 있었고, 날록손이 테스토스테론의 진통효과를 감소시키는 경향이 있었다. 그 외는 수컷과 유사한 반응을 보였다. 남성화-암컷은 대조-암컷 보다 사상의 ERα western band의 광 밀도가 낮은 경향이 있었다. 그 외 부위는 세 군간 차이가 없었다. 대조-암컷은 수컷이나 남성화-암컷에 비하여 다른 부위 보다 시상에 밀집되어 있고, 큰솔기핵에는 적었다. 남성화-암컷은 수컷에 비해 중간뇌수도관주위회색질의 밀도가 다른 부위에 비해 낮은 경향이 있었지만, 다른 부위는 차이가 없었다. 이상의 결과로부터 출생직후 암컷 생쥐를 테스토스테론에 노출시키면 통각에 대한 반응이나 중추신경계 통각조절 부위의 ERα 발현 양상이 수컷과 비슷해진다는 결론을 얻었다. Objectives : The object of this study was to investigate the effects of neonatal exposure to testosterone in female mice on the pain responses and the expression of estrogen-α receptors(ERα) in the pain control areas of the CNS in their later life. Methods : Testosterone propionate 100㎍ or sesame oil 50㎕ was injected intraperitoneally to neonatal mice within 24 hours after birth. In the 13th week of age, animals of each group(Androgenized-Female : AF ; Control-Female : CF ; Control-Male: CM) were divided into two and pretreated with naloxone HCI 5㎎/㎏ or saline 15 minutes before tail immersion test. Tall flick latencies(TFLs) were measured before and 15 min after administration of testosterone propionate 1㎎/㎏ i p.(intra-peritoneal) In the 8th month, mice were sacrificed and brains were dissected into primary sensory cortex, thalamus, periaqueductal gray, nucleus raphe magnus and lumbosacral spinal cord. ER α protein was assayed by Western blot analysis. Results : In saline-pretreated groups, TFLs of CF measured before and after testosterone injection were significantly shorter than those of CM. Testosterone prolonged TFLs signficantly in all subgroups. Among naloxone-pretreated groups, CF was significantly more sensitive than CM and AF. TFL profiles of AF did not differ from that of CM, except that baseline TFLs were slightly shorter and naloxone seemed to decrease analgesic effect of testosterone in AF, though statistically not significant. 66kDa Western bands were detected in all 5 regions. Optic density(OD) of each area did not differ across 3 groups, except that OD of ER α In the thalamus in AF was lower than in CF. Percent OD of a region to sum of the 5 areas(OD%) showed significant difference in the thalamus and nucleus raphe magnus. CF showed higher OD% in the thalamus than in CM and AF, and lower OD% in nucleus raphe magnus than in CM and AF. Western bands profile of AF did not differ from that of CM. Conclusion : These findings suggested that the pain response patterns and the expression of ER α in the pain control areas of CNS are grossly similar between androgenized female and control male mice.

불안, 기분장애로 치료 중 보행장애 외에 서동과 강직을 동반한 정상뇌압수두증 증례

장세헌,제영묘,최진혁,배정훈,성상윤,조세훈,김영훈,Jang, Sae Heon,Jae, Young Myo,Choi, Jin Hyuk,Bae, Jung Hoon,Seong, Sang Yoon,Cho, Se Hoon,Kim, Young Hoon 한국정신신체의학회 2015 정신신체의학 Vol.23 No.1

정상뇌압수두증은 보행장애, 요실금 및 치매 등의 전형적인 세 가지 증상 외에도 추체외로 증상과 다양한 신경심리 증상이 동반될 수 있다. 이 사례는 불안과 정동증상으로 치료 중 보행장애와 요실금 증상을 보였던 46세 여자 환자에서 항파킨슨 약물의 사용과 기존 정신과 치료 약물의 중단에도 불구하고 증상의 호전이 없었으나, 뇌 컴퓨터 단층 촬영상 뇌실의 확장 소견이 보였고 시험적 뇌척수액 배액에 의해서 수일 내에 증상들이 극적으로 호전되어 정상뇌압수두증을 감별해야 했던 경우이다. 뚜렷한 대뇌 실질의 위축 소견이 없으나 뇌실이 확장되어 있을 경우 추체외로 증상과 신경심리 증상이 있을 경우 정상뇌압수두증의 전형적 세 가지 증상을 보이지 않는다 하더라도 정상뇌압수두증의 가능성을 고려해서 시험적 뇌척수액 배액 등의 시술이 진단과 치료에 도움이 될 수 있음을 보여주는 사례라고 생각된다. In addition to classical triad such as gait disturbance, urinary incontinence and dementia, parkinsonian extrapyramidal motor signs and neuropsychiatric symptoms can be observed in patients with normal pressure hydrocephalus (NPH). In our case, a 46 year old female patient showed extrapyramidal symptoms such as bradykinesia, rigidity and neuropsychiatric symptoms such as agitation, anxiety, restlessness and regressed behavior beside two(gait disturbance & urinary incontinence) symptoms of three classical triad. It was difficult to diagnose this patient as NPH from the beginning because of her relatively young age and previous psychiatric mediation history for controlling advanced anxiety and affective disorder. Antiparkinsonian agents and discontinuation of psychiatric medications did not work for this patient. Patient's brain computed tomographic finding showed enlarged ventricles. We suspected NPH and did empirical drainage of 30mL CSF. Finally, patient's pyramidal and neuropsychiatric symptoms as well as two of three classical triad of NPH were improved dramatically within several days. It is important to consider NPH as one of the differential diagnosis in patient with parkinsonian symptoms and various neuropsychiatric symptoms who did not respond to usual clinical management especially in case of ventricular enlargement in neuroimaging because of its treatable property by CSF shunt operation.

흉통 환자에서의 정서, 자존감 및 삶의 질에 대한 예비 연구

박숙현,제영묘,이대수,장세헌,최진혁,이한철,Park, Sook Hyun,Jae, Young Myo,Lee, Dae Su,Jang, Saeheon,Choi, Jin Hyuk,Lee, Han Cheol 한국정신신체의학회 2012 정신신체의학 Vol.20 No.2

연구목적 : 흉통을 호소하여 방문한 환자를 대상으로 우울, 불안, 자존감, 그리고 삶의 질 을 조사하고, 전형적 흉통과 비전형적 흉통에 따른 차이를 비교하였다. 방 법 : 39명의 흉통 환자와 40명의 대조군을 대상으로 하였으며, 순환기 내과 전문의의 문진과 심장 전산화 단층촬영, 답차운동부하검사, 관상동맥조영술 등을 시행하여 전형적 흉통과 비전형적 흉통을 감별하였다. 우울, 불안, 자존감, 그리고 삶의 질을 평가하기 위해 BDI(Beck's Depression scale), STAI(State trait anxiety inven-tory), RSES(Rosenberg Self-esteem Scale), SBQOL(SmithKlein Beecham Quality of Life Scale)를 적용하였다. 결 과 : 심질환의 위험인자는 가족력을 제외하고는 전형적 흉통군, 비전형적 흉통군, 그리고 대조군 간에 차이가 없었다. 우울은 대조군에 비해 두 가지 흉통군 모두에 더 높았으나 흉통군 간에는 차이가 없었다. 불안은 대조군에 비해 두 가지 흉통군 모두에서 더 높았고, 전형적 흉통군에 비해 비전형적 흉통군에서 더 높았다. 자존감과 삶의 질은 대조군과 전형적 흉통군에 비해 비전형적 흉통군에서 더 낮았다. 결 론 : 흉통환자에서 불안과 우울에 대한 평가와 개입이 필요하며, 특히 비전형적 흉통환자에서는 자존감과 삶의 질 저하에 대한 접근도 병행이 되어야 함을 시사한다. Objectives : The objective of this study is to measure and to compare the rate of depression, anxiety, self-es-teem and the quality of life of the patients with chest pain. Based on the result of this study, the necessity of the psychiatric assessment and treatment of the patients with chest pain is emphasized. This study is a preliminary research for a larger scale investigation to be carried out in the future. Methods : Thirty nine patients with chest pain who visited Cardiovascular Division of Dept. of Internal Medicine Pusan National University Hospital and fourty normal control group(NC) were included in this study. The patients were classified into typical chest pain group(TCP, N=19) and atypical chest pain group(ACP, N=20) based on the cause of the pain. The cause was determined by cardiac computed tomography, exercise stress test, coronary angiography, and questionaires by a cardiology specialist. The patients were assessed with Beck Depression Inventory(BDI), State-Trait Anxiety Inventory(STAI), Rosenberg Self-Esteem Scale(RSES) and Korean version of the Smith Klein Beecham 'Quality of Life' scale(KvSBQOL). Results : 1) When the risk factors of cardiac disease is compared, most of the factors(Hypertension, Diabetes, Hyperlipidemia, Cerebral infarction) did not differ significantly among the two chest pain groups, except for the family history, for which TCP group showed higher risk than ACP group did. 2) As for the self-report questionaires scores, BDI score, which indicates the rate of depression, of both ACP group and TCP group was significantly higher than that of NC group in BDI for depression. STAI score, which measures anxiety, was also significantly high in both groups. Especially, STAI score was significantly higher in ACP group than TCP group. 3) In the aspect of self-esteem and quality of life, ACP group scored significantly lower than TCP group and NC group. The scores for TCP group and NC group did not differ significantly. Conclusions : The patients with chest pain showed more depression and anxiety than normal control group, regardless of the cause of the pain. However, TCP group did not show significantly larger drop in self-esteem and quality of life than ACP group did. This result implies that early psychiatric assessment and treatment is needed for the patients with such chest pain, since it is highly likely that the pain would lead to lower quality of life of the patients.

우울증 환자에서 신체화 증상에 따른 질병행동의 차이

윤창영,장세헌,제영묘,이대수,최진혁,Yoon, Chang-Young,Jang, Se-Heon,Jae, Young-Myo,Lee, Dae-Su,Choi, Jin-Hyuk 한국정신신체의학회 2009 정신신체의학 Vol.17 No.2

연구목적 : 질병행동은 건강 상태 또는 그에 상응하는 증상을 지각, 평가, 반응하는 적응적/비적응적 방식을 의미한다. 인지치료적인 측면에서 볼 때, 신체화 증상은 신체 지각적 측면에서 증상을 지각, 평가, 반응할 때 확대나 증폭과 같은 왜곡이 일어나 생긴다고 설명된다. 즉, 신체화를 질병행동의 이상이라고 이해할 수 있다. 본 연구에서는 신체화 우울증군과 비신체화 우울증군 간의 질병행동을 비교하여 우울증 환자에서 보이는 신체화와 관련된 질병행동의 특성을 알아보고자 하였다. 방법 : 본 연구는 ICD-10의 진단 기준으로 진단된 우울증 환자 45명을 대상으로 한국형우울증척도(Korean Depression Scale)를 이용하여 신체화 우울증군과 비신체화 우울증군을 나누었으며, 두 집단에서의 질병행동의 차이점을 질병행동질문지(Illness Behavior Questionnaire)를 통해 비교하였다. 결과 : 신체화 우울증군은 비신체화 우울증군에 비해 질병확신 하위척도($6.79{\pm}2.08$ vs $4.76{\pm}2.23$, p=0.003)와 부인 하위척도($3.25{\pm}1.22$ vs $2.10{\pm}1.41$, p=0.006)에서 유의하게 높은 점수를 보였다. 건강염려 하위척도와 불안정성 하위척도에서는 유의한 차이를 보이지 않았다. 질병행동 하위척도들이 신체화에 어느 정도 영향을 미치는지에 대한 회귀분석의 결과에서도 신체화 우울증군이 질병확신 하위척도(odds ratio=1.418, p=0.089)와 부인 하위척도(odds ratio=1.880, p=0.083)에서 유의하게 높았다. 결론 : 본 연구에서 신체적으로 질병을 확신하고 심리적으로 질병을 부인하는 것이 우울증 환자에서 신체화 증상을 특징짓는 질병행동으로 나타났다. 이러한 질병행동의 하위척도들은 우울 기분과 신체화 증상을 보이는 정신질환을 감별하고 예측하는 유용한 심리적 지표로 활용될 수 있을 것이다. Objectives : Illness behavior is defined as the persistence of an adaptive/maladaptive mode of perceiving, evaluating and responding to health status and symptoms according to the status. In a cognitive aspect, somatizing symptoms are regarded as being originated from distortions, including magnification and/or amplification, of perceiving, evaluating and responding to symptoms such as bodily sensations. That is somatization may be explained by maladaptive illness behavior. In this study, we tried to investigate differences of illness behavior in depressive patient according to the presence of somatization. Methods : We divided 45 patients who were diagnosed as depression with ICD-10 diagnostic criteria into two groups(somatizing and non-somatizing group) according to the somatization subscale of Korean Depression Scale and compared two groups in the differences of illness behavior using the Illness Behavior Questionnaire. Results : Somatizing group showed significantly higher scores than non-somatizing group on the disease affirmation subscale($6.79{\pm}2.08$ vs. 4.76, p=0.003) and the denial subscale($3.25{\pm}1.22$ vs. $2.10{\pm}1.41$, p=0.006). There were no significant differences between two groups on the general hypochondriasis subscale and the affective unstability subscale. In a logistic regression analysis, somatizing group also showed higher odds ratio (OR) scores on the disease affirmation subscale(OR=1.418, p=0.089) and the denial subscale(OR=1.880, p=0.083). Conclusion : The disease affirmation and denial may be a discriminative mechanism of somatization in depressive patients. These subscales of Illness Behavior Questionnare could be useful markers, and psychiatric illnesses with somatizing and depressive symptoms may be differentially diagnosed and be predicted through these subscales.

Serotonin Reuptake Inhibitor(SRI) 유발 성기능 장애를 가진 주요우울장애 환자에서 SRI를 Bupropion Sustained Release로 교체한 후의 성기능 장애 변화에 대한 연구

최진혁(Jin-Hyuk Choi),제영묘(Young-Myo Jae),이대수(Dae-Su Lee) 대한생물치료정신의학회 2005 생물치료정신의학 Vol.11 No.1

목적: SSRI 및 venlafaxine을 포함하는 SRI는 효과적인 항우울제이나, 흔히 성기능 장애가 병발하는 것으로 알려져 왔다. 본 연구는 이들 약제를 복용한 후 성기능 장애가 발생한 주요우울장애 환자를 대상으로 bupropion SR로 항우울제를 교체한 후 성기능 장애와 우울증상의 변화를 알아보고자 하였다. 방법: DSM-IV-TR 진단 기준에 의하여 주요우울장애로 진단되었고, SRI를 복용 후 치료적 반응을 보이고 있지만(HAM-D 점수<11), 성기능 장애를 호소하는 14명의 기혼자(남성 9명, 여성 5명)를 대상으로 우울증상과 성기능 장애 정도를 각각 HAM-D 및 성기능 장애 자가 평가 설문지(PRSexDQ)를 통하여 평가한 후 복용중인 항우울제에 bupropion SR을 추가하였ㅆ고, 연구 시작 2주 후부터 2주 동안 SRI를 서서히 줄여서 끊은 다음, 이후 4주 동안 bupropion SR만 단독으로 처방하였다. 연구 시작 2주, 4주, 8주 후의 우울증상과 성기능 장애 정도를 HAM-D와 PRSexDQ를 이용하여 평가하였으며, 대응표본 T 검증을 통하여 우울증상과 성기능 장애의 변화에 대한 통계처리를 하였다. 결과: 3명이 중도 탈락하였고, 11명(78.57%)이 연구를 완결하였으며, 연구 시작 시점(0주)과 연구 시작 후 2주 사이에는 유의미한 변화가 없었으나, 2주나 4주, 4주와 8주 사이에서 성기능 장애의 유의한 감소를 보였다. 하지만, 연구 기간 중 HAM-D 점수의 의미 있는 변화는 보이지 않았다. 결론: SRI로 치료받고 있는 주요우울장애 환자에서 약물 관련 성기능 장애가 발생하였을 때 복용 중인 항우울제를 bupropion SR로 교체하는 것은 효과적인 치료 전략이 될 수 있다. Objectives : Serotonin reuptake inhibitors(SRI), including selective serotonin reuptake inhibitors(SSRI) and venlafaxine, induce both therapeutic response and sexual dysfunction. This study was conducted to examine the changes in sexual dysfunction and depressive symptoms in the patients who had major depressive disorder and SRI-induced sexual dysfunction, after substitution of SRI with bupropion sustained release(SR). Methods : This study included 14 married adults(9 men and 5 women) who had a DSM-IV-TR diagnosis of major depressive disorder in remission (Hamilton Rating Scale for Depression [HAM-D] score<11) and were receiving an SRI. Depression(using HAM-D) and sexual dysfunction(using Psychotropic-Related Sexual Dysfunction Questionaire[PRSexDQ]) were assessed at baseline, and bupropion SR was added to the current antidepressant. SRI was tapered off after 2 weeks from baseline and then bupropion SR monotherapy was tried after 4 weeks. HAM-D and PRSexDQ were assessed at 2 weeks, 4 weeks, 8 weeks from baseline. Paired sample T tests were performed to assess changes in depressive symptoms and sexual dysfunction. Results : Three patients withdrew from this study and 11 patients(78.57%) completed the study. The patients showed no significant change from baseline to week 2, but sexual dysfunction decreased significantly from week 2 to week 4 and from week 4 to week 8. All patients showed no significant change in mean HAM-D scores during study period. Conclusions : Substitution of SRI with bupropion SR is one of the effective treatment strategies for patients with major depressive disorder and SRI-induced sexual dysfunction.

지역 사회 노인의 주관적 기억 감퇴와 관련 요인에 관한 연구

이의섭(Ui Sub Lee),제영묘(Young Myo Jae),장세헌(Sae Heon Jang),최진혁(Jin Hyuk Choi),이경환(Kyoung Hwan Lee) 대한노인정신의학회 2018 노인정신의학 Vol.22 No.1

Objective:We examined the factors influencing subjective memory complaints among community dwelling elderly in urban area. Methods:The subjects of this research were 160 community-dwelling elderly people without dementia and major depressive disorder. The questionnaires regarding the socio-demographic characteristics were conducted by each person. They include Korean version of Subjective Memory Complaints Questionnaires (SMCQ), Korean version of Short Geriatric Depression Scale (SGDS-K) and Korean version of Mini-Mental State Examination (K-MMSE). Subjective memory complaints were defined as above 4 points of SMCQ. Results:39.38% of the subjects had subjective memory complaints. There were significant associations between subjective memory complaints and SGDS-K (p<0.001), physical illness (p=0.001), but there was no association with K-MMSE (p=0.383). Conclusion:There is a discrepancy between subjective memory complaints and actual cognitive impairments. This discrepancy suggests that the depressive disorders including minor depressive disorder and subsyndromal depression, might play a role in the subjective memory complaints rather than actual cognitive impairments in community-dwelling elderly people. Therefore, the treatments for the depressive disorders should be considered in dealing with the subjective memory complaints.

65세 이상 노인의 우울증에 영향을 미치는 요인-수면시간을 중심으로: 제 7기 국민건강영양조사를 중심으로

김덕형(Duck-hyoung Kim),제영묘(Young-Myo Jae),장세헌(Sae-Heon Jang),이경환(Kyoung-Hwan Lee) 대한생물치료정신의학회 2022 생물치료정신의학 Vol.28 No.2

Objectives:We investigated relationship between sleep time and depression in the aged 65 years or older. Methods:This study was based on the data from seventh Korean National Health and Nutrition Examination Survey (KNHANES). 3,285 people aged 65 years or older were selected as the subjects of this research. The demographic characteristics, sleep time and Patient Health Questinnaire-9 (PHQ-9) were administered for each subjects. Depression was defined as above 10 points of PHQ-9. Results:All the demographic variables such as age, sex, education, household income, marital status, drinking and smoking except Body Mass Index (BMI) were correlated with the depression. When we corrected the variables, inadequate sleep time groups (less than 6 hours or more than 9 hours) tended to be depressed. Conclusions:The study results showed the significant correlation between sleep time and depression in the aged 65 years or older. Adequate sleep time is important to prevent the depression of the aged.

조현병 환자에서 성기능 장애의 유병률과 양상에 관한 대조군 비교 연구

윤지환(Ji-Hwan Yoon),백대업(Dae-Up Back),제영묘(Young-Myo Jae),장세헌(Sae-Heon Jang),이경환(Kyoung-Hwan Lee),최진혁(Jin-Hyuk Choi) 대한생물치료정신의학회 2021 생물치료정신의학 Vol.27 No.2

Objectives:Sexual dysfunction is common in both untreated and treated patients with schizophrenia and known as affecting the quality of life and drug compliance. The primary objective of this study is to estimate the prevalence of sexual dysfunction in Korean patients with schizophrenia treated with antipsychotic medications compared with healthy controls. Methods:Subjects were 75 patients who were recruited from outpatients with a diagnosis of schizophrenia or schizoaffective disorder according to DSM-IV-TR criteria, who had been stabilized on antipsychotic medications for more than three consecutive months. Control group consisted of 76 volunteers without history of any psychiatric disorder were excluded. We assessed for sexual dysfunction by the ASEX. Results:The prevalence of sexual dysfunction in the patient group was 57.33%, while that of the control group was 23.37%. Female gender and the use of antidepressants were best predictors of sexual dysfunction in patient group. Sexual difference at sexual drive observed in the control group diminished in the patient group. Conclusion:The present study demonstrated a higher prevalence of sexual dysfunction in patient group than control. Clinicians should consider the differential sexual dysfunction effects of antipsychotics when prescribing medications.

6개월간의 주요우울장애 환자에서 Venlafaxine 단독요법 및 Olanzapine 병합요법의 치료 중단율

박현우(Hyun-Woo Park),장세헌(Sae-Heon Jang),제영묘(Young-Myo Jae),이대수(Dae-Su Lee),최진혁(Chin-Hyuk Choi) 대한사회정신의학회 2010 사회정신의학 Vol.15 No.1

본 연구에서 나타난 결과들은 항정신병 약물 병합군에서 더 높은 약물 순응도와 치료 효과를 나타내었다. 이는 우울증 환자들 에게서 항정신병 약물을 같이 처방함으로써 항우울제 단독으로 사용하는 것보다 환자의 약물 순응도를 높이고 치료 기간을 유지시켜 줌으로써 더 나은 치료효과를 나타낼 수 있을 것으로 보인다. Objectives:Antipsychotics augmentation is suggested as one of the strategies to improve the effectiveness of antidepressants in the treatment of major depressive disorder. This study calculated time to discontinuation of ven-lafaxine monotherapy group and olanzapine augmentation group with major depressive disorder during 6 months and discussed the effectiveness of olanzapine augmentation. Methods:We collected the data from medical records of patients who visited psychiatric outpatient clinic of Bongseng memorial hospital and were prescribed by venlafaxine XR alone, or combination of venlafaxine XR and olanzapine on first visit from Aug. 2006 to Aug. 2007. We measured time to discontinuation (no more visit), the degree of adherence by medication possession ratio (MPR) from first visit until 6 months. The degree of CGI-I, CGIS scores and dosages of each medication were also assessed by monthly for 6 months. We used chi-square test and ttest, Kaplan Meier method to analyze group differences in demographic data and clinical characteristics, treatment efficacy and survival analysis. Results:The mean survival time of augmentation group was longer than monotherapy group (129.55 days vs 99.86 days, log rank test p=0.0342). The difference of CGI-S between two groups was not different significantly (4.4 vs 4.3, p=0.743) at baseline but CGI-I of augmentation group was better than monotherapy group (1.8 vs 2.8, p<0.001) at first month. Augmentation group showed higher MPR than monotherapy group but statistically not sig-nificant (0.950 vs 0.908, p=0.351). Conclusion:Our results suggest olanzapine augmentation would be able to increase treatment adherence and effectiveness.

한국의 일 도시에서 노인과 비노인 주요 우울 장애의 증상 비교

홍성욱(Sung-Wook Hong),이대수(Dae-Su Lee),제영묘(Young-Myo Jae),장세헌(Sae-Heon Jang),최진혁(Jin-Hyuk Choi),장유경(Yu-Kyung Jang),윤창영(Chang-Young Yoon) 대한생물치료정신의학회 2008 생물치료정신의학 Vol.14 No.1

목적 우울증은 가장 흔한 정신장애 중 하나이지만, 임상 양상은 매우 다양하다. 임상적으로 우울증 환자들 중에서 우울한 기분의 호소 없이 신체 증상만을 호소하는 경우도 흔하며 이러한 양상은 구미보다는 아시아에서, 젊은 성인보다는 노인에서 더 흔한 것으로 알려져 있다. 우울증 증상의 표현은 사회문화적 요인에 의해 영향을 받는다는 전제 하에서, 17개 항목의 해밀톤 우울증상 척도[Hamilton Rating Scale for Depression-17(HAM-D-17)]를 사용해서 한국의 일 도시에서 노인 군(n=39)과 비노인군(n=54)의 우울증상 표현 양상 특징을 비교해 보았다. 연구자료 및 방법 본 연구에서는 노인군과 비노인군의 우울증상 표현 양상을 비교하기 위해서 Diagnostic and Statistical Manual of Mental Disorders 4th edition(DSM-Ⅳ)의 진단 기준에 의해 주요우울장애로 진단되어 2006년 9월부터 2007년 2월까지 부산시 소재 김원묵 기념 봉생 병원에서 치료 받았던 93명의 환자를 대상으로 17개 항목의 해밀톤 우울증상 척도를 시행하였다. 또한 두 군간 결과의 차이를 비교 분석하기 위해서 독립 표본 T-검정 (independent T-test)를 사용하였으며, 피어슨 상관계수를 적용하여 HAM-D-17과 사회인구학적 요소간의 상관관계를 확인해 보았다. 결과 HAM-D-17을 사용해 노인군과 비노인군의 우울 증상을 비교 평가해본 결과, 노인군은 7번 항목(일과 활동) (t=3.639, p=0.000), 8번 항목(지체) (t=2.063, p=0.042), 9번 항목(초조) (t=2.419, p=0.01), 11번 항목(신체적 불안) (t=2.403, p=0.018), 12번 항목(위장관계 신체 증상) (t=3.260, p=0.002)에서 비노인군보다 의미 있게 높은 점수를 보인 반면, 14번 항목(성적 증상) (t=-9.519, p=0.000)은 낮은 점수를 보였다. 결론 노인 주요 우울 장애 환자들은 비노인 주요 우울 장애 환자들보다 일과 활동 지체, 초조, 신체적 불안, 위장관계 신체 증상 등의 호소는 많았고, 성적 증상의 호소는 유의하게 적었으나, 우울한 기분의 호소는 두 군 간에 차이가 없었다. Objectives: Depressive disorders are very common diseases in the world. However, it shows various aspects in clinical manifestations. Clinically, depressive patients commonly show somatic symptoms only without any signs of depressed mood. It has been known that this kind of features occur more often in Asian societies than in Western, and moreover, in elderly than non-elderly. So far as the expression of depressive symptoms is much affected by sociocultural factors, using the 17 items Hamilton Rating Scale for Depression(HAM-D-17), this research compared the expressive characteristics of depressive symptoms between elderly(n=39) and non-elderly(n=54) in Busan city in South Korea. Material and Methods : To compare the clinical manifestation of depressive disorders between elderly and nonelderly, we evaluated 93 patients using 17 items of Hamilton Rating Scale for Depression(HAM-D-17). The differences between two groups were analyzed using independent t-test. Also, we correlated HAM-D-17 items with sociodemographic factors using Pearson's correlation coefficient. All patients were diagnosed major depressive disorder according to Diagnostic and Statistical Manual of Mental Disorders 4th edition(DSM-Ⅳ) and they had been treated at Bongseng hospital in Busan city from September 2006 to February 2007. Results: There were some differences in HAM-D-17 scores between elderly and non-elderly. Elderly patients scored significantly higher in item 7(work and activities) (t=3.639, p=0.000), item 8(retardation)(t=2.063, p=0.042), item 9(agitation) (t=2.419, p=0.01), item 11 [nxiety(somatic)]t=2.403, p=0.018), item 12[omatic symptoms(gasrointestinal)]t=3.260, p=0.002), but lower in item 14(genital symptoms)(t=-9.519, p=0.000) than non-elderly. Conclusions: We concluded that elderly patients reported significantly higher levels of work and activities, retardation, agitation, anxiety(somatic), somatic symptoms(gastrointestinal), but lower level of genital symptoms than non-elderly patients. There were no significant differences in complaining of depressed mood between two groups.