정신분열증 환자에서 Cimetidine에 의한 Prolactin 분비 반응 - 양성 및 음성 아형 남자 환자에서 -

진혁희,권영준,정희연,한선호,Jin, Hyuk Hee,Kwon, Young Joon,Jeong, Hee Yeon,Han, Sun Ho 대한생물정신의학회 1996 생물정신의학 Vol.3 No.1

Objects : There is considerable interest in the role of serotonin(5-HT) in the pathophysiology of schizophrenia. Cimetidine, $H_2$ antagonist, produces transient increase in serum prolactin(PRL) levels by indirect serotonergic mechanism in man following intravenous administration. Therefore the authors investigated the effects of cimetidine on serum PRL levels of male unmedicated schizophrenics. Method : Baseline serum prolactin level and psychopathology were measured at 9:00 AM. in the two groups(12 positive schizophrenics, 7 negative schizophrenics) and $T_{30}$ levels were measured 30 minutes after intravenous injection of cimetidine (ie, 9:30 AM) Results: 1) Baseline prolactin levels were not different in the three groups. 2) Prolactin levels of 30 minutes after intravenous injection of cimetidine($T_{30}$) compared with baseline prolactin levels were increased all in the three groups. 3) Degrees of interval change from baseline to $T_{30}$ were significantly different between normal control and negative schizophrenics(p<0.05). Conclusion : The prolactin response to cimetidine was significantly blunted in negative male schizophrenics than normal control. These data are consistent with the hypothesis of an abnormality of serotonergic activity, including down-regulation $5-HT_2$ receptors, in male negative schizophrenics. 최근에 정신분열증의 병태생리에 세로토닌계에 대한 관심이 고조되고 있고 cimetidine이 간접적인 세로토닌계 자극으로 PRL 분비 반응을 유발한다 하여 본 연구에서는 양성 및 음성 증상 척도 (PANSS)에 의하여 양성 및 음성 아형으로 정신분열증 환자군을 구분, 정상대조군과 두 아형들간의 PRL 기저지와 cimetidine 유발성 PRL $T_{30}$치를 측정하여 정신분열증의 아형에 따른 seretonin과의 상관 관계를 규명하고자 연구가 시도되었다. 대상은 DSM-N(APA 1994)의 진단 기준을 만족시키는 입원 당시 7일 이상 항정신병약물을 복용하지 않은 남자 정신분열증 환자 19명으로 하였고, PANSS에 의해 양성 아형 (12명) 및 음성 아형 (7명) 환자군으로 나누어 오전 9시에 PRL 기저치 측정과 함께 cimetidine(5mg/kg) 정액 점주 30분 후인 9시 30분에 cimetidine에 의한 PRL $T_{30}$치를 측정하여 다음과 같은 결과를 얻었다. 1) PRL 기저치는 세 군에서 차이가 없었다. 2) 기저와 $T_{30}$간에 PRL치의 변화는 세 군에서 증가했음을 보여주었다. 3) 기저와 $T_{30}$간에 PRL치 증가량에 대한 상대적인 비교에서 정상대조군과 양성 아형 환자군 간, 양성 아형 환자군과 음성 아형 환자군 간에는 차이가 없었으나 정상대조군과 음성 아형 환자군 간에서 상호 유의한 차이가 있었다(p<0.05). 상기 연구 결과들은 정상대조군에서 보다 음성 아형 환자군에서 cimetidine에 의한 PRL반응이 둔감하게 나타난 것을 보여준다 하겠다. 이러한 결과들은 정상대조군에서는 나타나지 않지만 남자 음성 아형 정신분열증 환자군에서 $5-HT_2$ 수용체 하향 조절을 포함하는 세로토닌계 활성 이상 소견이 나타날 수 있다는 가설(Meltzer등 1993) 들과 일치한다 하겠다.

교대근무자에서 사회정신의학적 특성, 수면양상 및 신체증상에 관한 연구

진혁희 순천향의학연구소 2000 Journal of Soonchunhyang Medical Science Vol.6 No.2

To investigate the sociopsychiatric characteristics, nocturnal sleep parrerns and somatic symptoms in shift workers, the author compared 105 shift workers and 105 non-shift workers. The results are as follows; 1. Sociopsychiatric Characteristics. 1) Smoking above 1 pack/day was significantly more frequent in shift workers. 2) Shift workers were more frequently used to alcohol but statistically not significant. 3) Use of sleeping pill or tranquilizer were significantly more frequent in shift workers 4) Exercise above 3 times/week was more frequent in non-shift workers but statistically not significant. 5) Daytime sleepiness and decreased concentrations were more frequent in shift workers but statistically not significant. 6) Complaints of depressed mood were significantly more frequent in shift workers. 7) Complaints of anxious mood and experienced stress were more frequent in shift workers but statistically not significant. 2.Nocturnal Sleep Patterns 1) Total sleep time during the night was significantly longer in shift workers. 2) Sleep inducing time and time of falling back to sleep were significantly longer in shift workers. 3) The number of awakening and recall dreams were significantly more frequent in shift workers. 4) In comparison with the non-shift workers, shift workers were awakened more frequently during the second part of the typical night but statistically not significant. 3. Somatic Symptoms 1) The symptoms of GI disturbance such as hunger soreness, postprandial epigastric pain, epigastric fullness, weight change, constipation and anorexia were significantly more frequent in shift workers. 2) Somatic symptoms such as fatigability, chest tightness, chest palpitation, headache, dizziness, tingling sensations of the shoulder and extremities were significantly more frequent in shift workers.

좋은 예후를 보인 품행장애 환자에 대한 정신의학적 고찰

진혁희,한선호,한상우 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.2

The following results were gathered from the extensive research done on the conduct disorder of patients improving and relative conditions. 1. All were good students in elementary school and showed no disobedience. 2. The majority of them had many strong relationships and were very outgoing. 3. Their parents showed much affection toward them in their childhood. Also, they were either the youngest or the oldest in their families consisting of 2 or more. 4. Five out of the 6 patients belonged to upper-middle or just upper class parts of society. 5. Fathers occupied professional occupations and the mothers occupations were domestic housekeeping. 6. They all had parents who were both well educated. 7. The patients attitude toward their parents changed from assertiveness ot obedience and respectfullness. 8. The degree of educational interest by their parents was very high ; 4 out of 6 9. Parents attitudes toward their children changed from traditional to democracy. The family relationship situation was deterioration. Then overtime, the situation inproved dramatically. 10. Parents method of punishing children seems to have changed from the tendency of tough punishment and patients respectful attitude toward their parents has changed from assertive to obedient. 11. There was no history of mental disorders in the family. 12. Most patients had jobs or continued their studies. 13. Conduct disorders occurred in these patients in their late teens. 14. They have never been imprisoned or placed in a mental hospital before.

Haloperidol로 치료한 Tourette 장애에서 발생한 항정신병약물-퇴행 증후군 1례

정희연,조현주,권영준,박인준,진혁희,Jeong, Hee-Yeon,Cho, Hyun-Ju,Kwon, Young-Joon,Park, In-Joon,Jin, Hyuk-Hee 대한생물정신의학회 1998 생물정신의학 Vol.5 No.1

Authors report a case of separation anxiety disorder, which developed as a side effect during haloperidol treatment of Tourette syndrome(TS). In this case, 14 years old boy developed attention deficit symptoms during his infancy. At 4th grade of primary school, he developed vocal tic, motor tic, and coprolalia. With 5mg/day of haloperidol treatment his symptoms of TS were subsided. During the treatment, he developed features of separation anxiety disorder, including dependence, pleading, clinging, and sadness. Symptoms of attention deficit and separation anxiety disorder were improved by 25mg/day of imipramine treatment. During haloperidol treatment of TS, careful observation may be needed whether separation anxiety disorder-like symptom develops.

주정의존 환자에서 초발연령에 따른 ${\beta}$-Endorphin의 반응

정희연,박인준,김진만,진혁희,Jeong, Hee-Yeon,Park, In-Joon,Kim, In-Man,Jin, Hyuk-Hee 대한생물정신의학회 1998 생물정신의학 Vol.5 No.1

정상대조군 29명 및 남자 주정의존 환자 48명을 발병연령에 따라 분류하여 입원 7일 후 오전 9시에 알코올 0.75gm/kg을 투여하기 전후의 혈중 ${\beta}$-endorphin농도, alcohol농도, cortisol농도, 그리고 혈당을 측정하여 비교한 결과는 다음과 같다. 1) 25세 이전과 25세 이후에 발병한 환자군의 비율은 약 2 : 3이었다. 2) 25세 이전과 25세 이후에 발병한 두 환자군간에 입원 당시의 연령은 차이가 없었다. 3) 25세 이전과 25세 이후에 발병한 두 환자군과 정상대조군에서 알코올 투여 후 혈중 알코올의 농도변화는 세 군간에 차이가 없었다. 4) 25세 이전과 25세 이후에 발병한 두 환자군과 정상대조군에서 알코올 투여 후 혈중 ${\beta}$-endorphin의 농도변화는 세 군간에 차이가 없었다. 5) 25세 이전과 25세 이후에 발병한 두 환자군과 정상대조군에서 알코올 투여 후 혈중 cortisol의 농도변화는 세 군간에 차이가 없었다. 6) 25세 이전과 25세 이후에 발병한 두 환자군에서 알코올 투여 후 혈당변화는 양군간에 차이가 없었다. Objectives : To evaluate the relation of onset-age and plasma level of ${\beta}$-endorphin, Ethanol, ${\beta}$-endorphin, cortisol and blood glucose were compared in 48 male alcoholics and 29 normal controls Methods : Alcoholics are divided into two groups by onset-age of alcoholism. Blood samples were obtained before and after 0.75gm/kg of ethanol consumption at the 7th admission day. Results : 1) The ratio of onset-age before 25 years to after 25 years of the patient group was 2 to 3. 2) There was no significant difference in age at admission between two patient groups. 3) There was no significant difference in change of plasma ethanol levels among three groups. 4) There was no significant difference in change of plasma ${\beta}$-endorphin levels among three groups. 5) There was no significant difference in change of plasma cortisol level among three groups. 6) There was no significant difference in change of fasting blood sugar level among two patient groups.

자살시도 환자의 혈소판내 세로토닌 농도와 심리학적 특성에 관한 연구

정희연,권영준,박인준,홍세용,최의정,진혁희,Jeong, Hee Yeon,Kwon, Young Joon,Park, In Joon,Hong, Se Yong,Choi, Eui Jung,Jin, Hyuk-Hee 대한생물정신의학회 1999 생물정신의학 Vol.6 No.1

자살 시도군 21명, 우울증 환자군 14명, 그리고 정상 대조군 10명을 대상으로 혈소판내 세로토닌의 농도, 반 구조화된 설문조사, 다면적 인성검사, HAM-D, 충동성 검사를 시행하여 비교한 결과는 다음과 같았으며, 자살 시도군의 자살방법은 대부분 농약 중독이었다. 1) 자살 시도자의 남녀 비는 차이가 없었다. 2) 혈소판내의 세로토닌의 농도는 자살 시도군, 우울증 환자군 및 정상 대조군간에 차이가 없었다. 3) 다면적 인성검사 결과는 자살 시도군의 경우 D, Hs, Pt 척도가 높았으며, 우울증 환자군의 경우 D, Pa, Si 척도가 높았다. 4) HAM-D 점수는 우울증 환자군과 자살 시도군 모두에서 높았으며, 특히 우울증 환자군의 경우 더 의미 있게 높았다. 5) 충동성 검사 결과는 자살 시도군이 우울증 환자군에 비하여 무계획 충동성, 운동 충동성이 의미 있게 높았다. Objectives : Significant progress has been made in understanding psychosocial, psychological, and environmental factors associated with suicide. However it is only recently that attention has been paid to the understanding of the neurobiology of suicide. The aim of this study was to examine the relationship between platelet serotonin level and suicidal behavior and psychological features of the suicidal attempters. Methods : After a suicidal attempt platelet serotonin level was measured from 21 patients and compared it with those from depression patients and normal controls. Also MMPI, HAM-D, Barratt impulsiveness scale(BIS) were done to evaluate their psychological features. Results : 1) There was no significant difference in sex ratio of the suicidal attempters. 2) There was no significant difference in platelet serotonin levels among three groups. 3) The analysis of MMPI revealed that the scores of D, Hs, Pt in clinical scales were significantly higher in suicide patients and scores of D, Pa, Si were in depression patients. 4) The HAM-D score was significantly higher in depression and suicide patients, especially in depression patients. 5) The analysis of Barratt impulsiveness scale revealed that the scores of nonplanning, motor and cognitive impulsiveness scale were significantly higher in suicide patients. Conclusions : There was no significant difference in platelet serotonin levels among three groups. However the analysis of psychological features revealed significant differences. Therefore we concluded that psychological examinations are benefit to evaluate the suicidal tendency.