Clinical Outcome of Simultaneous Bilateral Pallidotomy in Advanced Parkinson's Disease

진상열,전상룡,이정교,정선주,임주혁,이명종 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.36 No.5

Objective : Pallidotomy is known to improve the symptoms of idiopathic Parkinson,s disease (PD), motor fluctuations and dyskinesia related to levodopa therapy. Previous studies reported significantly higher complication rates associated with bilateral pallidotomy than unilateral pallidotomy. The authors assess the safety and clinical outcomes of bilateral pallidotomy for advanced PD. Methods : Simultaneous bilateral pallidotomy was performed in eight patients with advanced PD between January 1, 2001 and December 31, 2001. All patients underwent lesion making in posteroventral site of internal globus pallidus. The target was localized using macroelectrode stimulation and MRI guided stereotactic technique. The lesions were made by radiofrequency currents. Results : Among eight cases, seven had severe disabling dyskinesias. Compared with baseline scores, the values of dyskinesia after surgery was significantly decreased (P<0.05) for up to 1 year. The mean score changed from 4.4± 2.1 to 0.3±0.5. According to Unified Parkinson's Disease Rating Scale (UPDRS), the mean motor score in off period, which was 38.3±13.8 was significantly decreased for 6 months (P<0.05). The ADL (on/off) scores and motor "on" scores of UPDRS were unchanged or deteriorated to 12 months after surgery. There was no apparent adverse effect after surgery in all patients. Only transient mild dysphagia happened in one patient. Conclusion : Simultaneous bilateral pallidotomy in advanced PD appears to be effective and safe, particularly in reducing the dyskinesia; in our experience, the side effects are not as high as reported by other groups.

Embolization Therapy for a Ruptured Spinal Artery Aneurysms Associated with Spinal Cord Arteriovenous Malformation and Presenting with Spontaneous Subarachnoid Hemorrhage

진상열,권양,장철훈,안재성 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.35 No.2

Spinal arteriovenous malformations(AVMs) and aneurysms should be suspected when patient present with subarachnoid hemorrhage and intracranial source has not been identified with neurologic findings attributable to the spinal cord. We report a case of subarachnoid hemorrhage(SAH) with ruptured spinal artery aneurysm associated with spinal cord AVM in 37-year old man who presented with sudden loss of consciousness with paraplegia. The result of CT-head arteriography of the brain was SAH with intraventricular hemorrhage but no intracranial aneurysm was identified. Spinal angiography revealed a cervical spinal cord AVM supplied by anterior spinal artery with an aneurysm in the feeder. The treatment of the spinal cord AVM was performed with liquid coil embolic agent, polyvinylacetylate(PVAc) and feeding artery aneurysm was treated with Guglielmi detachable coils(GDCs).

영유아 남매에서 발생한 할로페리돌 급성 중독 증례

배경열,양수진,김재민,강가은,김영옥,윤진상 대한신경정신의학회 2009 신경정신의학 Vol.48 No.6

Antipsychotic poisoning may cause significant adverse effects, su-ch as a change in consciousness and extrapyramidal symptoms (EPS), in infants and toddlers. We report the sibling cases of a 33- month-old sister and 11-month-old brother who both presented with altered states of consciousness and cervical rigidity after acute haloperidol poisoning. Initially, the pediatrician suspected a central nervous system infection, as the patients exhibited confused mental states, cervical rigidity, and ataxia in the emergency room. Various laboratory and imaging tests, including cerebrospinal fluid examinations, electroencephalograms, and brain computerized tomography did not show any particular abnormalities. After 1 day, the patients’ mother reported that she had a current haloperidol prescription, for the treatment of schizophrenia. After 3 days of symptomatic treatment, the two siblings recovered completely, without significant sequelae. Haloperidol was detected in their plasma, at concentrations of 2.1 ng/mL in the sister and 2.5 ng/mL in the brother. We emphasize that, when administering antipsychotics to patients living with young children, family education to prevent unintentional antipsychotic poisoning is essential. Clinicians must take account of the possibility of antipsychotics poisoning when a child suddenly presents an altered state of consciousness and/or suspicious EPS with no clear reason.

Valproate-induced Hyperammonemic Encephalopathy Caused by Free Carnitine Deficiency in a Patient with Bipolar Disorder: A Case Report

배경열,Ji-Eun Jang,Yong-Hwan Kim,김재민,윤진상 대한정신약물학회 2009 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.7 No.2

Valproate is commonly used in various psychiatric and neurologic settings and is usually well tolerated. We present the case of a 26-year-old man who developed encephalopathy after valproate treatment. Ten days after initiating valproate therapy, he presented with a sudden decreased level of consciousness, disorientation, seizures, and eventually coma. Notably, the serum ammonia level was elevated to 392 μmol/l with no hepatic dysfunction on laboratory tests. He did not have a urea cycle-associated enzyme deficiency on tandem mass spectrometry. However, the free carnitine level was low (5 μmol/l), and this was suspected of being caused by the valproate treatment. Due to the possibility of valproate-induced hyperammonemic encephalopathy, the valproate was discontinued, and the patient was treated with L-carnitine 50 mg/kg per day. He recovered completely within 3 days of L-carnitine treatment, and the free carnitine level was within normal limits (53.5 μmol/l) 5 months thereafter. Clinicians should consider valproate-induced hyperammonemic encephalopathy in patients who present with any mental changes or atypical psychiatric symptoms while on valproate.

Antidepressant Prescribing Patterns in Korea: Results from the Clinical Research Center for Depression Study

배경열,김성완,김재민,신일선,윤진상,정성원,이민수,임현우,전태연 대한신경정신의학회 2011 PSYCHIATRY INVESTIGATION Vol.8 No.3

Objective This study aimed to investigate antidepressant prescribing patterns, including initial choice, switching and combining, and concomitant use of non-antidepressant agents, for depressive disorders in naturalistic clinical care settings in Korea. Methods Patients with depressive disorder were recruited from both outpatient and inpatient settings in 18 hospitals from all over Korea. Treatment was performed in naturalistic patterns based on each clinician’s decision. Data were collected on the prescription of antidepressants and concomitant agents from baseline to 12-week follow-up. Results Selective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed initial antidepressant (48.9%), followed by newer dual-action antidepressants (45.8%). When an SSRI was the initial antidepressant, 46.2% of patients whose medication was changed were moved to newer dual-action antidepressants, and 67.4% of combination cases were combined with newer dual-action ones. When a newer dual-action antidepressant was the initial antidepressant, 70.6% of patients whose medication was changed were moved to SSRIs, and other antidepressants including tricyclic antidepressants were most commonly added for combination treatment (50% of combination cases). During the treatment period, 20.6% of antidepressants prescribed were augmented by non-antidepressant agents, and 75.1% were used concomitantly with anxiolytics or hypnotics. The most commonly used concomitant non-antidepressant agent was quetiapine. Conclusion The selection of antidepressants and the concomitant use of non-antidepressant agents are becoming increasingly diversified, and the results of this study reflect changes in the prescribing pattern in actual Korean practices.

노인의 인지기능에 따른 부양자의 부양부담

배경열(Kyung-Yeol Bae),신일선(Il-Seon Shin),김성완(Sung-Wan Kim),김재민(Jae-Min Kim),양수진(Su-Jin Yang),문지웅(Ji-Ung Mun),신희영(Hee-Young Shin),윤진상(Jin-Sang Yoon) 대한생물치료정신의학회 2006 생물치료정신의학 Vol.12 No.1

목적 : 본 연구의 목적은 노인의 인지기능에 따른 부양자의 부양부담 수준을 조사하고, 부양부담과 연관성이 있는 인지를 비교하는데 있다. 방법 : 2001년 7월부터 동년 12월까지 484명의 65세 이상 노인과 그들의 부양자를 대상으로 조사하였다. 부양부담은 한국판 Zarit Burden Interview로 조사하였다. 노인의 사회인구학적 특징 및 임상적 특징(인지 기능, 일상생활 수행, 우울 증상, 알코올 중독, 신체 질환), 그리고 부양자의 사회인구학적 특징 및 부양 환경(대리부양자 유무, 가족의 수, 방의 수, 월 수입, 사회적 지지)에 관한 자료를 수집하였다. 전체 대상자는 노인에 대한 인지기능평가 및 치매진단 결과에 따라 3개 군으로 분류되었다 : 정상군 319명, 인지장애는 있으나 치매는 아닌 군(Cognitive Impairment No Dementia, CIND) 104명, 치매군 61명. 결과 : 부양부담은 치매군 부양자가 정상군 및 CIND군 부양자에 비해 유의하게 높았다. 부양부담과 독립적 연관성 있는 인자는 정상군에서는 우울 증상과 알코올 중독, CIND군에서는 알코올 중독, 그리고 치매군에서는 노인의 도시거주, 인지 장애, 우울 증상, 그리고 부양자가 교육수준이 높고, 자식인 경우 및 부양자에 대한 사회적 지원이 낮은 경우였다. 결론 : 부양자의 부양부담을 줄이기 위해서는 노인의 인지 기능에 따라 다른 접근을 해야 한다 치매노인에서는 노인의 인지 기능과 우울 증상을 개선시키기 위한 치료와 함께, 부양자에 대한 사회적 지지를 제공하는 것이 필요하다. 정상 및 CIND 노인에서는 알코올 중독에 대한 관리가 필수적이며, 또한 정상노인에서 우울증을 치료하는 것도 중요하다. Objectives : This study aimed to investigate the degree of care burden of caregivers and to compare the factors associated with the care burden according to the level of cognitive function of elderly persons. Methods : The study sample consisted of 484 elderly peoples and their caregivers. Care burden was measured by the Korean version of Zarit's Burden Interview. According to the level of cognitive status and diagnosis of dementia for the elderly persons, the total participants were classified into three groups: normal group(N=319), cognitive impairment no dementia(CIND, N=104), and dementia group(N=61). Results : The degree of care burden was significantly higher in caregivers of dementia group than the others. Higher care burden was independently associated with severe depressive symptom and alcoholism in normal group, with alcoholism in CIND group, and with elderly persons' factors(urban living, cognitive impairment, and severe depressive symptom) and caregivers' factors(higher education, being a child, and lower social support) in dementia group. Conclusion : To mitigate the care burden, different approaches according to the level of cognitive function of elderly persons could be recommended.

우울증과 관상동맥 질환(I) : 병태생리적 기전

배경열,김재민,윤진상,Bae, Kyung-Yeol,Kim, Jae-Min,Yoon, Jin-Sang 대한생물정신의학회 2008 생물정신의학 Vol.15 No.4

본 논문에서는 우울증과 관상동맥 질환의 연관성에 대해 병태생리학적 기전을 중심으로 고찰하였다. 현재까지 선행 연구들을 통해 제시된 주요 병태생리학적 기전으로는 우울증에서의 증가된 혈액 응고 경향, HPA 축 기능 및 ANS 조절 이상, 상승된 염증 반응 상태 등과 더불어 관상동맥 질환과 우울증이 공통된 유전적 위험 인자를 공유하고 있을 가능성 등이 있다. 혈액 응고와 관련되어서는 혈소판의 활성 및 반응성 증가, 혈관 내피 기능 이상, 혈액 응고 인자의 증가 등이 구체적인 병리 기전으로 제시 되었으며, HPA 축 및 ANS 기능 이상과 관련되어서는 혈장내 카테콜라민의 증가와 이와 연관된 심박수 증가 및 심박 변이성의 감소, 기타 혈역학적 스트레스의 증가 등으로 인한 부정맥 및 죽상경화증의 촉진이 주요한 기전으로 제시되었다. 또한 CRP 등과 같은 염증 표지자 연구를 통해 우울증에서의 증가된 염증 반응이 죽상경화증이나 혈전 형성과 관계 되어있을 가능성 역시 제시되었다. 하지만 역으로 관상동맥 질환과 우울증의 동반 이환율이 높다는 사실은 잘 알려져 있음에도 불구하고 관상동맥 질환에서의 어떤 병태생리적 변화가 우울증의 발병 및 경과와 관련되어 있는지에 대해서는 체계적인 연구가 매우 적은 것이 사실이다. 이 이외에도 우울증과 관상동맥 질환 외의 제3의 요인 즉, 유전적 위험 인자가 두 질환에 선행함을 제시하여 우울증과 관상동맥 질환이 공통된 유전적 취약성을 공유하고 있을 가능성을 제기한 연구들도 있다. 그 밖에도 우울증과 대사 증후군과의 연관성에 기반한 연구나 ${\Omega}$-3 지방산, homocystein 수준에 주목한 일부 연구들이 존재하며, 관상동맥 질환을 가진 환자는 뇌혈관에도 죽상경화증이 있을 가능성이 높고 이로 인해 뇌의 특정 부위에 혈류장애가 있을 가능성이 높아서 이것이 혈관성 우울증을 야기할 가능성이 있다는 보고를 한 연구들도 있다. 우울증이 관상동맥 질환의 발생 및 경과에 부정적인 영향을 끼친다는 많은 연구 결과들은 우울증과 관상동맥 질환의 원인적 연관성에 대한 연구를 지속적으로 촉진시키고 있다. 하지만 우울증이라는 대상 질환 자체의 이질성과 관상동맥 질환을 가지고 있는 환자들은 대부분 항응고제 등의 약물을 투여하고 있다는 사실 등이 병태생리 규명 연구에 어려움을 주고 있는 것이 사실이다. 우울증과 관상동맥 질환의 병태생리적 연관성에 대한 지속적이고 다각적인 연구는 향후 관상동맥 질환 환자에서의 우울증의 중요성을 치료자에게 인식시키는 계기가 될 수 있으며 더 나아가 관상동맥 질환의 치료 예후의 개선으로 이어질 수 있는 통로를 제공할 것이다. Depression and coronary artery disease are both highly prevalent diseases. Many previous studies suggest that depression is a common comorbid condition in patients with coronary artery disease and has a significant negative impact on the onset, course, and prognosis of coronary artery disease. However, the exact mechanisms that underlie the association between these two diseases remain unclear. Pathophysiologic mechanisms that may explain the effect of depression on coronary artery disease include hypercoagulability, hypothalamus-pituitary-adrenal axis and autonomic nervous system dysregulation, altered inflammatory response. On the contrary, pathophysiologic mechanisms in coronary artery disease that affect depression are less well known. It is also suggested that both diseases may share a common genetic vulnerability. The authors reviewed the literature on the pathophysiologic relationships of depression and coronary heart disease.

膽道內 蛔蟲迷入症

安道烈(D.Y. Ahn),朴春鶴(C.H. Parck),朴震相(J.S. Parck),崔致敎(C.K.Choi),尹健鎬(K.H. Youn) 대한외과학회 1969 Annals of Surgical Treatment and Research Vol.11 No.1

자살시도 위험요인 및 자살에 대한 태도 연구

김성완,배경열,김재민,김선영,유준안,양수진,신일선,박지현,김세현,윤진상 대한신경정신의학회 2010 신경정신의학 Vol.49 No.4

Objectives: To examine psychosocial correlates of suicide attempts in a community population. Methods: This study investigated suicide attempt history, demographic and psychosocial characteristics including depression using the Beck Depression Inventory (BDI), and responses to a questionnaire about attitudes toward suicide in a community sample. The demographic and psychosocial correlates of suicide attempts were evaluated using univariate and multivariate analyses. Results: A total of 1,578 people completed the survey. Of these, 100 people (6.3%) had attempted suicide. In the univariate analyses, risk factors for attempted suicide were divorce, lower level of education, lack of a stable job, living in a rented house, undergoing psychiatric treatment, a family history of psychiatric illness, and being depressed (BDI ≥22). In the multivariate analysis, living in a rented house, undergoing psychiatric treatment, and being depressed were significantly associated with attempted suicide. Of the individuals who had attempted suicide, 42.0% were currently depressed, whereas the prevalence of depression in those who had not attempted suicide was 9.1%. In addition, individuals who had attempted suicide had permissive attitudes toward suicide and negative attitudes toward treatment for suicidal behavior. Conclusion: Attempted suicide was significantly associated with depression. Therefore, immediate and appropriate psychiatric treatment for depression in those attempting suicide is crucial.

뇌졸중후우울증의 유병율 및 예측인자

강희주,배경열,김성완,김재민,신일선,김준태,박만석,조기현,윤진상 대한우울조울병학회 2011 우울조울병 Vol.9 No.2

Objectives : This study aimed to investigate the prevalence and risk factors of depression within two weeks after stroke. Methods : A total of 362 stroke patients were recruited. Depression (major and minor depressive disorders) was diagnosed by applying DSM-IV criteria. Data on socio-demographic characteristics (age, gender, education, marital state, living state, religion, occupation, income, life event, and social support), stroke severity (NIHSS), disability (BI), stroke hemisphere and location, vascular risk and disease, and previous history of stroke and depression were obtained. Results : Depression was present in 90 (24.9%) patients: major depression 29 (8%) and minor depression 61 (16.9%) patients. In the univariate analyses, depression was associated with older age, higher number of stressful life event, poorer social support, severe disability, anterior stroke location, previous history of stroke and depression. In the multivariate analyses, depression was independently associated with higher number of stressful life events and poorer social support. Conclusion : Depression was common and was determined by premorbid levels of stress and social support in stroke patients at acute stage. More intensive psychiatric care and intervention is needed for the high risk group. (J of Kor Soc for Dep and Bip Disorders 2011;9:57-63)