약물 의존에서 Cannabinoid 1 수용체 길항 약물

조근호(Keun-Ho Joe),김대진(Dai-Jin Kim),이영식(Young-Sik Lee) 한국중독정신의학회 2006 중독정신의학 Vol.10 No.1

It is now being elucidated that the endocannabinoid system is one of the neurotransmitter system normally existed in our brain. Anandamide, one of the main endocannabinoids, act as a retrograde messenger in the synapse through cannabinoid 1 receptor, and it modulates the activities of synaptic transmission by decreasing the function s of presynaptic neuron. The process is so-called long-term depolarization. Therefore the endocannabinoid system is believed to do a pivotal role in the formations of memory process and habit formation. Furthermore, the endocannabinoid system is thought to be involved into the development, maintenance and relapse of the syndromes in substance dependence, by the endocannabinoid system itself or by the interaction with other neurotransmitter system. By the selective cannabinoid 1 receptor antagonists, the repetitive behaviors of animals or humans toward addictive substance like nicotine, alcohol, opioids, and cocaine were changed. It could mean that not only the brain reward circuit through mesolimbic dopaminergic pathway but also the alternations of neurons by endocannabinoid system will be on the important position in the neurobiologic backgrounds of addiction. Several CB1 receptor antagonists were in developing (e.g., Rimonabant) to treat the substance dependence. According to the outcomes of clinical trials, some of the pharmacological agents will be applied to our patients. Until now, clinically approved medications in addiction fields were just an aversive agent (e.g., disulfiram) and anticraving agents (e.g., naltrexone and acamprosate). It will be meaningful for us to have another therapeutic tools with novel mechanism.

위험 음주자의 선별을 위한 한국어판 Alcohol Use Disorders Identification Test(AUDIT-K)의 최적 절단값

조근호(Keun-Ho Joe),채숙희(Suk-Hi Chai),박애란(Aeran Park),이해국(Hae-Kook Lee),신임희(Im-Hee Shin),민성호(Seong-Ho Min) 한국중독정신의학회 2009 중독정신의학 Vol.13 No.1

Objects:Through this study, we intended to set up new cut-off score for the screening of hazardous drinking using the Korean version of alcohol use disorders identification test (AU-DIT-K). Methods:A total of 1,100 subjects were enrolled in this study. Questionnaires about drinking patterns, AUDIT-K, CAGE and NAST (National Alcohol Screening test) were col-lected. The cut-off scores of AUDIT-K for hazardous drinking were calculated and determined by area under the Receiver Operating Characteristic (ROC) curve. Pearson’s correlation test was applied to validate the test and re-test data. Results:Suggestible cut-off scores based on drinking frequency and amount, the AUDIT-K for screening the hazardous drinking would be 11 for men and 8 for women. However, we further proposed the CAGE 1 point as a reference value and concluded that cut-off scores of 10 for men and 6 for women were more appropriate in screening of hazardous drinking in Korean subjects. According to these scores recommended limits for normal drink-ing behavior among Koreans would 13 standard drinks per week for men and 6 standard drinks per week for women. Conclusion:The lower cut-offs of 10 for men and 6 for women suggest that nationwide a more vigorous effort in screening for hazardous drinking is needed in order to prevent alcohol abuse and hazardous consequences.

전자의무기록 보급 및 활용에 대한 정신건강의학과 전문의의 인식

조근호(Keun-Ho Joe),윤해주(Haijoo Yoon),이수정(Soojung Lee),박종익(Jong-Ik Park) 대한사회정신의학회 2019 사회정신의학 Vol.24 No.1

목 적 : 전자의무기록의 보급이 확대되고 있으나, 정신건강의학과는 다른 전문과목과 활용도에 차이가 있을 것으로 추정된다. 이에 정신 건강의학과 전문의들을 대상으로 전자의무기록의 경험 정도를 확인해보고자 하였으며, 현행 전자의무기록의 의미 및 향후 확대 보급하기 위한 조건에 대한 의견을 조사해 보고자 하였다. 방 법 : 수련병원, 정신병원 및 정신건강의학과 의원 등으로 의료기관의 유형을 분류한 후, 유형별로 각각 150기관을 무작위로 선별하였다. 이후 각 기관 마다 1명씩의 정신건강의학과 전문의를 무작위로 추출하여 총 450명에게 이메일 설문을 배포하였다. 설문 수거 또한 온라인으로 진행하였다. 전자의무기록의 사용 경험에 대해서 교차분석을 시행하였으며, 사용경험 여부 및 소속 의료기관에 따라 전자의무기록의 의미 및 향후 확대 조건에 대한 의견에 차이가 있는 지 여부를 분석하였다. 결 과 : 설문에 응답한 112명의 정신건강의학과 전문의 중 87.5%에서 처방전달시스템을 사용한 경험이 있다고 하였으며, 84.8%에서 전산 화된 경과기록을 사용한 경험이 있다고 하였다. 전자의무기록의 도입은 병원의 경영효율화 및 의료진간의 의사소통에 도움이 되는 측면이 있다는 응답에 동의한 전문의들이 많았으며, 상대적으로 의료질 향상이나 의사결정에 도움이 된다는 응답은 적었다. 전자의 무기록의 확대를 위해서는 수가를 통한 보상이 필요하다는 응답이 많았으며, 상담 내용의 비밀 보장을 위한 별도의 메뉴가 필요하 다는 응답이 많았다. 그에 비해 표준화된 전자의무기록의 보급이나 지역사회와의 정보교류 네트워크 확보 등에 동의한 비율은 상대 적으로 낮았다. 결 론 : 우리나라에서도 전자의무기록의 도입은 급속히 이루어지고 있지만, 병원의 경영 효율성 증대 및 병원 내 직원 들 간의 의사소통 수준에 머물러 있으며, 의료질 향상이나 업무 표준화 및 지역사회 기관들과의 연계체계, 진료 시 의사결정지원 등의 차원까지 발전 되지는 못하였다. 향후 전자의무기록의 변화에 대해 정신건강의학과 전문의들의 관심이 더 필요한 시점이다. Objectives : Even though the adoption of electronic medical record in hospital increases nowadays but certain hurdles might exist in the department of psychiatry. Therefore, we performed this study to evaluate the experiences of electronic medical record in psychiatrists and invested that the opinions of psychiatrists on the current applying electronic medical record and the necessary conditions to disseminate it more in the future. Methods : Hospitals were divided into three groups as training hospital, mental hospital, and private clinics and randomly selected 150 hospitals/clinics of each group. Request for participation on this survey was sent via e-mail to the 1 psychiatrist of each hospital/clinics who extracted randomly also. The answers were collected by on-line. The cross analysis or nonparametric comparison were done to identify the statistical significances of the responses by the experiences of elec-tronic medical record or by the affiliated hospitals types of the subjects. Results : 87.5% of 112 responded psychiatrists reported their experiences on the order communication system and 84.8% reported their experiences on the electronic progress note. The responded psychiatrists strongly agreed that the adoption of electronic medical record will be helpful for hospital management but weakly agreed that the positive effects on the clinical quality improvement and decision making. They said that the additional reimbursement should be provided to disseminate more in clinical situation and building up special menu to ensure the patients’ privacy. However, the psychiatrists showed slight agreement on the necessary of standard electronic medical record and organizing systemic network between community and hospital through electronic medical record. Conclusion : Despite the rapid spread of electronic medical record in Korea, the psychiatrists' recognition on electronic medical record remains within the boundary of individual hospital. They regarded that the electronic medical record has benefits on hospital management rather than on the communication between the all involved facilities, clinical performance indicator, or assistant for clinical decision. More attentions of psychiatrists should be needed on the evolution of electronic medical record.

니코틴의존의 약물치료

조근호(Keun-Ho Joe) 한국중독정신의학회 2008 중독정신의학 Vol.12 No.1

Despite the short history of pharmacotherapeutic approaches in nicotine dependence, numerous medications were developed and stand as significant clinical advances. In this review, the biological mechanisms, therapeutic usages, and results of meta-analyses in nicotine dependence will be discussed for medications such as nicotine replacement therapy agents, bupropion SR, varenicline, etc. First of all, the diverse formulations of nicotine replacement therapy agents and their properties are summarized. Clinical ap-plication methods of nicotine gum, patch, and lozenge will be explained. Specific features and cautions of bupropion SR and newly-developed varenicline will also be dealt with. Novel candidate agents for nicotine dependence under clinical trials will be mentioned with brief descriptions about the pharmacological mechanisms involved.

니코틴 의존의 정신사회적 치료

조근호(Keun Ho Joe) 한국중독정신의학회 2015 중독정신의학 Vol.19 No.1

There are still debates that the needs of medical advice for smoking cessation. On the contrary, some physicians look down on the addictive characters of nicotine and act as if they can handle it only with some medications easily. However, similar to another addiction problem, the medications for smoking cessation are not the perfect remedy yet. Even though it is possible to reduce the withdrawal and craving some extent through the medication, the risk of recurrence is still present. The psychosocial intervention itself can increase the success rate of for smoking cessation, and when combined with some medications it can improve the cessation rate and reduce the relapse rate. The psychosocial advices for smoking cessation are diverse, for example, from simple way like brief medical advice of the doctors, up to the more complex and systematized program on the basis of the motivation enhancement therapeutic and cognitive behavioral therapeutic approach. The smoking rate is much higher in mentally ill patients compared to the general population, and heavier smoking also leads to more physical problems. Accordingly, psychiatrists in Korea who could effectively apply both psychosocial intervention and pharmacological treatment could practice better smoking cessation programs.

니코틴 의존자에서 인지행동 단독치료와 Naltrexone 추가치료 간의 흡연행동 비교

성종호(Jong-Ho Sung),이영식(Young-Sik Lee),조근호(Keun-Ho Joe),나 철(Chul Na) 한국중독정신의학회 2003 중독정신의학 Vol.7 No.1

Objectives:The present study was performed to evaluate the effectiveness of naltrexone combined CBT(cognitive behavior therapy). Method:This study design was double blind placebo controlled method. Naltrexone(n=13) and placebo(n=12) were added to CBT for 2 weeks in 25 subjects. Administered Naltrexone dosage was 23.4 mg/day in 1st week and 37.1 mg/day in 2nd week. Multimodal CBT technique was conducted for three times once every week. Total cigarette consumption amounts per a week, Brief Questionnaire for Smoking Urge (B-QSU), and expiratory CO levels, Fagerstrom Tolerance Questionnaire (FTQ) were checked at baseline and 4 weeks later. Results: 1) There were no differences between naltrexone add-on CBT group and CBT alone group in nicotine withdrawal symptoms and drug side effects containing GOT/GPT levels. 2) In Naltrexone add-on CBT group, total cigarette consumptions (p=0.021), the expiratory CO levels (p=0.039), B-QSU score (p=0.036), and FIQ scores (p=0.028) were significantly lower than CBT alone group. 3) Subjective reports about the smoking reduction are greater in naltrexone add-on CBT group than CBT alone (53.0% vs. 16.7%). Conclusions: Naltrexone and CBT combined therapy could be a effective and safe treatment in nicotine dependence.

비정신과 의사의 벤조디아제핀 사용에 관한 예비 조사

송진옥(Jin-Ohk Song),조근호(Keun-Ho Joe),원승희(Seung-Hee Won),서정석(Jeong-Seok Seo),문석우(Seok-Woo Moon),김소연(So-Youn Kim) 대한생물치료정신의학회 2006 생물치료정신의학 Vol.12 No.1

저자들은 본 연구를 통해 비정신과 의사들에서 벤조디아제핀의 처방 경향과 벤조디아제핀이라는 약물에 대한 인식 정도를 파악하고자 하였다. 이에 대구, 서울, 충주 소재 3개 대학병원에 근무하는 74명의 비정신과의사를 대상으로 설문조사를 시행하였고, 성별, 연령 혹은 계열(내과계, 외과계 및 기타 계열)에 따른 처방 현황 및 인식 정도를 비교 분석하였다. 연구 결과 비정신과의사들에게 벤조디아제핀이 광범위하게 처방되고 있으며, 각 과별로 다양한 질환에서 환자의 증상에 따라 정신과 약물이라는 특별한 장벽 없이 사용하고 있음을 확인하였다. 또한 현실적인 처방에 있어서는 적정 용량 이내에서 가능한 한 단기간 사용하고자 노력하고 있음도 확인하였다. 벤조디아제핀 장기 처방 영역에 있어서, 계열 별로 어느 정도 차이를 보이는데, 벤조디아제핀의 감량이나 중단을 위한 의사의 시도에 저항하는 환자의 비율에 대한 질문에 있어 내과계 의사는 환자의 36.6%에서, 외과계 의사는 환자의 40.3%에서 그러한 경향이 있다고 응답한 반면, 기타 과목 의사는 12.1%의 환자에서만 그러한 경향이 있다고 응답하였다(χ²=9.79, p=0.007). 또한, 외래 진료 중 벤조디아제핀을 장기 처방 받고 있는 환자를 우연히 발견하는 비율은, 내과계 의사는 진료 중 “벤조디아제핀 장기 복용 중인 사실을 알게 되는 환자의 비율이 내원 환자의 10% 이상에 달한다.”라고 응답한 의사가 8명에나 이른 반면, 외과계 의사나 기타 과목 의사는 각각 1명씩 밖에 없었다. 또한 기타 과목 의사는 “벤조디아제핀 장기 복용 중인 사실을 알게 되는 환자의 비율이 내원 환자의 0.1% 미만이다.” 혹은 “그런 환자가 전혀 없다”라고 응답한 사람이 전체의 63.6%인 7명에 해당하여 약 22%가 그렇게 대답한 내과 의사와는 의미 있는 차이를 보였다. 본 연구 결과, 벤조디아제핀의 처방 및 인식에 있어 연령 혹은 성별에 따른 차이는 없었으나, 약물 선호 경향 및 장기 처방에 관한 인식에 있어 계열 별로 몇몇 문항에서 차이를 보였다. 이는 벤조디아제핀을 장기간 처방함에 있어 의사의 인식 혹은 진료 중 벤조디아제핀의 복용력에 대한 의사의 보다 높은 수준의 주의가 필요하다는 의미일 수 있겠다. Objectives : Nowadays benzodiazepines were expended their usages into diverse area not only by the psychiatrists but also the non-psychiatric doctors. This study was performed to investigate the non-psychiatric doctors' attitude toward benzodiazepines when they prescribe. Methods : 74 doctors with various medical specialties except psychiatry working at one of the following general hospitals were recruited, Daegu catholic university medical center, Kunkuk university Cheung-ju hospital, and Chung-Ang university medical center. 11-item questionnaires were distributed and requested to fill-up, which were about benzodiazepine prescription. The answers were interpreted with χ² analysis. Results : Benzodiazepines were prescribed to manage diverse diseases by non-psychiatric doctors. Alprazolam is the most popular to physician, but diazepam to other doctors including surgeons and others. Symptoms for which benzodiazepines were prescribed showed no differences depending on their specialties. Most of the doctors intended to avoid the administration of benzodiazepine with higher dosages. 36.5% of non-psychiatrists maintained benzodiazepines until the symptoms disappear without considerations about the total administered durations of benzodiazepine. 17.6% of non-psychiatrists discontinue benzodiazepine within 3 months and only 13.5% of them discontinue benzodiazepine with 1 month. Non-psychiatrists reported approximately 33.4% of patients resisted when doctors intend to decrease the benzodiazepine dosage but 62.2% of doctors reported less than 10% of all patients demanded re-escalation of benzodiazepine dosage. Conclusion : Depending on the specialties, the detection rates of benzodiazepine long-term users are varied. It means more surveillance needed to prevent long-term benzodiazepine use.

중증 정신질환자에 대한 집중사례관리의 효과성

장미(Mi Jang),조근호(Keun Ho Joe),황태연(Tae-Yeon Hwang) 대한사회정신의학회 2020 사회정신의학 Vol.25 No.2

연구목적 : 지역사회 정신건강 서비스의 중요성이 강조되면서 집중사례관리에 대한 관심이 높아지고 있으나 국내의 관련 최신 연구가 많지 않다. 본 연구에서는 지역 사회에 거주하는 중증 정신질환을 가진 성인들을 대상으로 집중사례관리와 기존 지역사회 치료(표준적 지역사회 치료, 일반적인 사례관리 포함)의 치료 효과에 대해 비교하고 집중사례관리의 발전방향에 대해 논의하고자 하였다. 방 법 : Embase, Pubmed, Cochrane database of systematic reviews(마지막 검색 2019년 11월 8일)에서 문헌검색을 시행하였다. 중증 정신질환을 가진 성인을 대상으로 지역사회에서 시행한 집중사례관리의 치료효과에 대한 체계적 문헌고찰과 최신 무작위배정 비교 임상시험을 선정하였다. 결 과 : 표준적 지역사회 치료와 비교했을 때, 집중사례관리는 전체 입원기간을 줄이고, 독립적 생활 기능과 만족도를 높이는데 효과적이 었다. 중증 정신질환을 가진 성인 노숙인에게 집중사례관리와 주거지원을 함께 제공했을 때 기존 지역사회 정신건강서비스에 비해 연령, 인종, 기간에 관계없이 주거안정성을 향상시켰다. 결 론 : 중증 정신질환을 가진 성인, 특히 장기입원 치료의 필요성이 높은 환자에게 집중사례관리가 독립적 생활 기능, 주거안정성, 만족 도를 향상시키는데 효과적이며, 나아가 다른 지역사회 정신건강 서비스와 신체건강에 대한 의료서비스의 통합적인 접근에 대한 고려도 필요하다. Objectives : The aim of this study was to investigate the effectiveness and future directions of intensive case management (ICM) for adults with severe mental illness in the community. Methods : A literature search was conducted in the following database: Embase, Pubmed, Cochrane database of systematic reviews (last update search November 8, 2019). All relevant systematic reviews about ICM compared with treatment as usual(standard care or non-ICM) and current randomized controlled trials (April 10, 2014~) about effectiveness of ICM focusing on adults with severe mental illness treated in the community setting was included. Results : Compared to standard care, ICM was effective in reducing total number of days spent in hospital, improving independent living function, and satisfaction. ICM with rent supplements had a positive effect on housing stability for homeless adults with mental illness regardless of age, race or duration. Conclusion : ICM was more effective for adults with severe mental illness, especially with high risk of long-term admission than standard community care in the domains of independent living function, housing stability and satisfaction. Considerations about integrative approach of ICM with other community mental health services and medical services for physical health are needed.

약물 중독 환자에서 약물 사용 시작 나이에 따른 우울, 불안 및 사용 특성과의 연관성

곽여인(Yeo-In Kwak),조근호(Keun-Ho Joe),김양태(Yang-Tae Kim),권도훈(Do-Hoon Kwon),김대진(Dai-Jin Kim),조성남(Sung-Nam Cho) 한국중독정신의학회 2011 중독정신의학 Vol.15 No.1

Objectives : The purpose of this study was to investigate as how the age at the first use of substance influences the psychiatric symptoms such as, depression, anxiety and the characteristics of substance use in the patients with substance abuse or dependence. Methods : Self-administered questionnaire were applied to a total of 447 drug addicts (including those admitted at medical institutions or confinement installations, and those under probation) and ex-addicts, who had been through recovery from addiction at medical/rehabilitation centers. Participants were classified into 4 groups, 0-19 years, 20-29 years, 30-39 years, and older than 40 years, according to the age at which the substance was first used. Psychiatric assessments were based on BDI, BAI, SCL-90-R. The data were statistical-ly analyzed by SPSS 15.0. Result : The average age of participants was 44 years. The number of patients, who used the sub-stance for the first time during 0-19 years of age were 102, in their 20-29 years of age were 146, in their 30-39 years of age were 126, and when they were 40 years and older were 63. Use of substance at an early age was correlated with more frequent use of other illegal substances, high er rate of dependence on the substance, higher frequency of liver diseases and legal problems. Amongst the 4 groups, there were significant differences in Beck Depression Inventory and Beck Anxiety Inventory. Conclusion : The earlier use of substance may lead to more serious problems of drug abuse and correlated with higher risk of development of psychiatric symptoms including, anxiety and depression. Such a condition can lead to degradation of patient’s quality of life and would complicate the treatment procedure. An earlier education to the adolescents about harmful effects of drug use and addiction in conjunction with earlier relevant psychiatric evaluations of substance abusers should also be provided.

알코올성 치매

천영훈(Young-Hoon Cheon),조근호(Keun-Ho Joe),김대진(Dai-Jin Kim) 대한노인정신의학회 2012 노인정신의학 Vol.16 No.2

Chronic alcohol use may have direct or indirect neurotoxic effects on the brain that can lead to cognitive impairment. However, the precise relationship between alcohol and dementia remains unclear. There are several epidemiological studies suggest that the protective effect of light-moderate alcohol drinking in dementia. But obviously the heavy alcohol drinking can lead to brain dam-age and increase the risk of various types of dementia. The clinicopathological issues and criteria regarding so-called ‘alcoholic de-mentia’ remain under debate. Alcohol-induced persisting amnestic disorder, alcohol-induced persisting dementia, and Wernicke-Korsakoff syndrome (thiamine deficiency) may constitute distinct disease entities, but they may also share some common features. Based on this theory, Oslin and colleagues proposed the broader diagnostic scheme and criteria for Alcohol Related Dementia (ARD), which may include cases of Wernicke-Korsakoff syndrome and also other cases of dementia that appear to be alcohol-re-lated. In pathogenesis of the alcoholic dementia, the chronic exposure to ethanol results in the adaptive up-regulation of NMDA re-ceptor sensitivity, which can result in an increased vulnerability to glutamate induced excitotoxicity. Despite the clinical importance of ARD, few medical treatments for ARD have been proposed and studied. Most of all, the gold standard of the treatment in alco-holic dementia is the maintaining abstinence. Some therapeutic trials with cholinesterase inhibitors (donepezil and rivastigmine) and memantine (NMDA receptor antagonist) have been conducted for the patients with Wernicke-Korsakoff syndrome and alco-hol-related dementia, and these studies reported favorable outcomes. Especially memantine can be a more effective agent in the treatment of alcoholic dementia because of anti-craving effect reported in several studies.