환자용 기분기록지 개발 및 타당도 연구

차보석,최정은,장재승,김정현,하태현,유희정,최승원,하규섭 大韓神經精神醫學會 2009 신경정신의학 Vol.48 No.3

Objectives The aim of this study was to report the developmental process of the patient mood chart (named the Patient Mood Chart, PMC), and to test its validity and utility. Methods One hundred twenty nine subjects with bipolar disorder, as diagnosed using DSM-IV Criteria, completed the PMC. A trained clinician administered the Hamilton Depression Rating Scale (HDRS) the Montgomery Asberg Depression Rating Scale (MADRS), the Inventory of Depressive Symptomatology (IDS), the Young Mania Rating Scale (YMRS) and the Global Assessment of Functioning (GAF). Mood ratings on the PMC were compared with clinician-rated measures taken at initial visits and 6-month follow-ups. To examine the utility of the PMC, a patient questionnaire-type survey was done Results Depressive symptom ratings on the PMC were highly correlated with the HAMD MADRS and IDS scores. Manic symptom ratings on the PMC were correlated with the YMRS scores. Similarly a strong correlation was found between mood chart scores and the GAF scores. Most patients Considered the PMC to be useful and helpful. Conclusion These findings support the validity and utility of the PMC. The PMC can be used for Prospective assessment of symptom changes, treatment response, and long-term course for subjects with bipolar disorder.

Polarity of the First Episode and Time to Diagnosis of Bipolar I Disorder

차보석,김정현,하태현,장재승,하규섭 대한신경정신의학회 2009 PSYCHIATRY INVESTIGATION Vol.6 No.2

Objective: The current study explored the relationship between the polarity of the first episode and the timing of eventual diagnosis of bipolar I disorder, and associated clinical implications. Methods: Twelve years of clinical data from the medical records of 258 inpatients meeting DSM-III-R or DSM-IV criteria for bipolar I disorder were analyzed. Subjects were divided into two groups according to the polarity of the first episode: those with depressive polarity (FE-D), and those with manic polarity (FE-M). Comparisons were made between the two groups on variables associated with the timing of diagnosis and related outcomes. Results: In population with bipolar I disorder, a significant longer time lapse from the first major mood episode to the confirmed diagnosis was associated with the FE-D group compared to the FE-M group [5.6 (±6.1) vs. 2.5 (±5.5) years, p<0.001]. FE-D subjects tended to have prior diagnoses of schizophrenia and major depressive disorder while FE-M subjects tended to have prior diagnoses of bipolar disorder and schizophrenia. A significantly higher rate of suicide attempts was associated with the FE-D group compared to the FE-M group (12.7 vs. 1.7%, p<0.001). Conclusion: The results of this study indicate that first-episode depressive polarity is likely to be followed by a considerable delay until an eventual confirmed diagnosis of bipolar I disorder. Given that first-episode depressive patients are particularly vulnerable to unfavorable clinical outcomes such as suicide attempts, a more systematic approach is needed to differentiate bipolar disorder among depressed patients in their early stages.

The Relationship between Impulsivity and Quality of Life in Euthymic Patients with Bipolar Disorder

김윤석,차보석,이동윤,김선미,문은수,박철수,김봉조,이철순,이소진 대한신경정신의학회 2013 PSYCHIATRY INVESTIGATION Vol.10 No.3

Objective Bipolar disorder (BD) is characterized by elevated impulsivity, even during periods of remission. Many recovered BD patients have functional impairments, which can lead to poor quality of life (QoL). The aim of this study was to investigate the association between impulsivity and QoL in euthymic BD patients. Methods A total of 56 remitted or recovered patients with type I or II BD, diagnosed based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, were recruited. Psychiatrists administered the Clinical Global Impression (CGI) for BD and the Global Assessment of Functioning (GAF) scales and then interviewed the subjects to assess clinical variables. Patients completed the Barratt Impulsiveness Scale (BIS-11) and the World Health Organization Quality of Life Assessment Instrument-Brief Form (WHOQoL-BREF). Pearson correlations, univariate regression analyses, and multiple linear regression analyses were performed. Results The BIS-11 total score was significantly correlated with the WHOQoL-BREF total score (r=-0.55, p<0.01) and with the WHOQoL-BREF subscales. After controlling for GAF score and other clinical variables, the BIS-11 total score (β=-0.43, p=0.001) was independently associated with overall QoL. Additionally, the BIS-11 total score was particularly strongly associated with the physical, psychological, and social domains of the multi-dimensional QoL scale. Conclusion Our results suggest that high impulsivity is related to low QoL in euthymic BD patients. Further studies are needed to examine whether interventions for high impulsivity effectively improve QoL in patients with BD.

양극성 장애 입원환자에서 약물치료의 경향: 12년 자연적 연구

김정현,차보석,하규섭 대한정신약물학회 2002 대한정신약물학회지 Vol.13 No.1

Objective : The purpose of this study was to examine the pharmacological treatment patterns in inpatients with bipolar disorder at a university hospital, and to establish appropriate clinical practice guideline in light of recent advances of pharmacotherapy of bipolar disorder. Methods : A total of 454 first-admission cases with a diagnosis of bipolar disorder or schizoaffective disorder from 1990 to 2001 were analyzed with regard to the clinical characteristics and the use of mood stabilizers, antidepressants and antipsychotics. Results : In manic, hypomanic, and mixed episodes, there has been a substantial increase in the use of valproate while the use of lithium has decreased. Antipsychotic drugs were prescribed as combination regimen in over 80% of total cases. In 44.6% of bipolar depression cases, mood stabilizers were not prescribed. In 70.7% of bipolar depression cases not receiving mood stabilizers, antidepressant monotherapy was utilized. The use of SSRIs and RIMA has increased, while a decrease was observed for TCA. There has been a tendency of the increased use of atypical antipsychotics. In particular, clozapine monotherapy has increased in mood stabilizer resistant cases. Conclusions : The results of the present study suggest that the prescription patterns have changed in general agreement with recent advances of pharmacotherapy of bipolar disorder during the past twelve years. However, there was clear tendency to use antipsychotics rather than other mood stabilizers as the combination regimen. Moreover, accurate diagnosis and careful reconsideration for pharmacological treatment strategies are required in bipolar depression, mixed states, and rapid cycling. 목 적: 일 대학병원 양극성 장애 입원환자군의 12년간 실제 약물치료 현황과 약물사용 변화 경향을 조사하여 그간 학문적 발전 및 최근 권장되는 치료 지침과 비교하고, 임상에서 보다 바람직한 약물치료 지침을 확립하는데 기초자료로 활용하고자 본 연구를 시행하였다. 방 법: 1990년에서 2001년 사이에 첫 입원하여 양극성 장애나 분열정동장애로 진단받은 454회 입원을 대상으로 삽화 유형별로 기분조절제, 항우울제 및 항정신병약물의 사용 빈도를 연도별로 비교하였다. 결 과: 조증, 경조증, 혼재성 삽화에서 lithium의 사용은 줄고 valproate의 사용이 현저히 증가하였다. 병용요법시에는 기분조절제 병용 보다는 항정신병약물 병용을 선호하여 80% 이상에서 항정신병약물을 병용하였다. 양극성 우울증의 44.6%에서 기분조절제를 사용하지 않았고, 그 중 70.7%에서 기분조절제 없이 항우울제만을 사용하였다. 항우울제는 삼환계 항우울제에서 선택적 세로토닌 재흡수 억제제나 가역적 단가아민-A 산화효소억제제로, 항정신병약물은 전형 항정신병약물에서 비전형 항정신병약물로 변화되는 추세였다. 특히 기분조절제에 저항성인 경우 clozapine 사용이 증가하였다.

일차성 및 이차성 불면증 환자에서의 개별 인지행동치료의 임상적 효능

신윤미,차보석,임채미,신홍범,Shin, Youn-Mi,Cha, Bo-Seok,Lim, Chae-Mi,Shin, Hong-Beom 대한수면의학회 2010 수면·정신생리 Vol.17 No.1

목 적: 본 연구는 일차성 및 이차성 불면증 환자에서 인지행동치료(Cognitive Behavioral Therapy, 이하 CBT)의 임상적 효능을 평가하고자 하였다. 방 법: 2008년 1월부터 2009년 6월까지 일차의료기관 수면클리닉에 방문한 환자들을 대상으로 하였다. 전체 64명의 외래 환자가 모집되었으며, DSM-IV에 의거하여 진단 된 일차성 불면증 환자는 30명, 이차성 불면증 환자는 34명이었다. 환자들은 CBT 전후로 수면 일지, 수면에 대한 역기능적 신념 및 태도 척도(Dysfunctional Beliefs and Attitudes about Sleep Scale-16, 이하 DBAS) 및 상태-특성 불안척도(State-Trait Anxiety Inventory, 이하 STAI)를 각각 시행하였다. CBT는 1주 간격으로 7회, 1회당 40~50분 동안 개별적으로 진행하였다. 결 과: 일차성, 이차성 불면증 환자군 모두 입면 잠복기, 총 수면 시간, 수면 효율과 같은 수면 지표와 DBAS 점수의 유의한 호전을 보였다. 반복측정 분산분석에서는 두 군간에 시간에 따른 DBAS와 수면 지표의 유의한 차이는 없었다. 이차성 불면증에서의 CBT의 효과는 일차성 불면증에서의 효과와 동등하였다. 결 론: 이번 연구는 CBT가 일차의료 환경에서 일차성 및 이차성 불면증의 치료에 있어 효과적이라는 것을 시사한다. Objectives: This study aimed to evaluate the clinical efficacy of individual cognitive behavioral therapy (CBT) for Patients with Primary or Secondary Insomnia. Methods: Participants were recruited from a primary care sleep clinic from January 2008 to June 2009. The study sample included 64 outpatients with primary insomnia (n=30) and secondary insomnia (n=34) according to the criteria of DSM-IV. Participants completed sleep diaries, Dysfunctional Beliefs and Attitudes about Sleep Scale-16 (DBAS), State-Trait Anxiety Inventory (STAI) before CBT and shortly after completion of CBT. CBT was provided in 7 weekly, 40-50-minute individual therapy sessions. Results: Both groups of patients with primary and secondary insomnia showed significant improvement in the DBAS and sleep parameters including sleep onset latency, total sleep time, and sleep efficiency. Repeated-measures ANOVA of the DBAS and sleep parameters showed no significant group-by-time interactions between patients with primary and secondary insomnia, suggesting the efficacy of CBT for patients with secondary insomnia was equivalent to that of CBT for patients with primary insomnia. Conclusion: This study suggests that CBT is effective for the management of primary and secondary insomnia in a primary care setting.

비정형 항정신병약물 복용 중인 과체중 환자에서 체중 감량을 위한 행동수정요법의 개발 - 예비연구 -

신홍범,박종호,차보석,김병수,이숙경,김학령,김용식,안용민,강웅구,Shin, Hong Beom,Park, Jong Ho,Cha, Bo Seok,Kim, Byung Soo,Lee, Suk Kyung,Kim, Hak Lyung,Kim, Yong Sik,Ahn, Young Min,Kang, Ung Gu 대한생물정신의학회 2003 생물정신의학 Vol.10 No.2

Objects:The authors devebped a behavioral modification program for oveweight outpatients with schi-zophrenia and bipolar disorder will had teen treated with atypical antipsychotics, and evaluated the applicability of this program to outpatients Methods:Two men and nine women who had been treated with atypical antipsychotics and will had gained at least 5 percent of their pre-treatment body weight for 10 weeks, attended a behavioral modification program. The patients' weight, body mass index and the diet-activity scale were assessed and were compared with those of a matched comparison group will dd not attend the behavioral modification program Results:The body weight of patients who attended the behavioral modification program reduced with statistical significance, The treatment group showed significant improvement in diet-related items but not in activity-related items of the diet-activity scale Conclusions:This study suggested the applicability of a eehavioral mcdification program on weight reduction to overweight patients taking atypical antipsychotics for the frrst time in Korea Additional large scale studies are needed to validate the effectiveness of this program.

치료저항성 주요우울장애 환자의 라모트리진 강화요법: 자연관찰연구

장재승,조수현,차보석,문은수,하태현,윤인영,하규섭 대한정신약물학회 2008 대한정신약물학회지 Vol.19 No.5

Objective:Lamotrigine’s possible efficacy in the treatment of depressive disorders has been suggested. This naturalistic study investigated clinical response to lamotrigine augmentation in patients with treatment-resistant depression. Characteristics of the lamotrigine-responders were also explored. Methods:Clinical data from 40 lamotrigine- treated patients with treatment-resistant unipolar depression were analyzed. The subjects were diagnosed with DSM-IV major depressive disorder and resistant to at least 2 antidepressants. Efficacy of lamotrigine treatment was measured by the changes in mean scores of the Clinical Global Impression Severity subscale (CGI-S), which were extracted from the prospective mood chart and structured interviews. Response was defined as a decrease of at least 2 or more from baseline on the CGI-S. Untoward effects associated with lamotrigine treatment were also assessed through medical records. Results:Significant reduction in the CGI-S mean score was observed from baseline through 8 week lamotrigine augmentation in 40 patients with treatment-resistant unipolar depression (t=5.7, df=39, p<.01), and the magnitude of treatment effect was large (reffect size=0.68). Drop-outs were mainly attributable to lamotrigine-associated rash (N=5). Greater rate of improvement was associated with responder group (N=14) compared to non-responder group (N=17) from week 3 onward. Conclusion:The results of current study lend support to the potential benefit of lamotrigine augmentation in a subpopulation of patients with treatmentresistant unipolar depression. Continuation of lamotrigine add-on for more than 3 weeks may be needed to assess clinical outcome. Lamotrigine augmentation was generally well-tolerated. Large scale, double-blind studies are necessary to confirm its use as an augmentation agent. 이번 연구는 임상 실제에서 치료저항성 주요우울장애 환자를 대상으로 8주 라모트리진 강화요법의 유용성을 평가한 자연경과연구이다. 전체 대상군에서 8주간 치료 후 유의한 우울증상의 호전이 관찰되었고, 반응군과 비 반응군 간 임상증상 변화양상은 3주 이후 유의하게 구분 되었다. 라모트리진 강화요법의 안전성도 관찰되었다. 라 모트리진 강화요법의 임상효능과 반응군의 특성을 밝히 기 위하여 대규모 전향적 통제연구가 필요하다.

‘달리 분류되지 않는 양극성 장애’환자의 우울증상에 대한 Lamotrigine 병합요법의 효과:52주 전향적 자연경과연구

문은수,장재승,차보석,윤제연,하태현,하규섭 대한정신약물학회 2009 대한정신약물학회지 Vol.20 No.6

Objective:The pharmacotherapy of bipolar disorder not otherwise specified (BP-NOS) has been insufficiently studied. The aim of this prospective naturalistic study was to explore the effectiveness of lamotrigine adjunctive treatment in patients with BP-NOS. Methods:Data from 50 patients diagnosed with BP-NOS were analyzed. On the basis of the prospective mood chart methodology, the efficacy of lamotrigine adjunctive treatment was assessed by changes in the mean Clinical Global Impressions-Bipolar Version (CGI-BP) depression scores. A paired t-test was used to test the statistical significance of the changes in CGI-BP depression scores. Repeated-measures analysis of variance (RM ANOVA) with simple effect analysis was performed to explore the sequential changes during a 52-week period. Cohen’s d was calculated to measure the magnitude of the treatment effects on the changes in depression severity. Time to lamotrigine discontinuation was also calculated using the Kaplan-Meier estimates. Lamotrigine-associated adverse events were monitored every two weeks. Results:A significant decrease, with a large effect size (Cohen’s d=1.6), in the mean CGI-BP depression scores was associated with lamotrigine adjunctive treatment in intent-to-treat analysis (t=8.7, df=49, p<0.001). Twenty-four patients (48.0%) completed 52-week lamotrigine adjunctive treatment. Analysis of the data obtained from those completing the treatment revealed a large effect (Cohen’s d=4.0) on improvement in the severity of depression (t=16.8, df=32, p<0.001). Sixty percent of patients achieved remission (n=30), and 64% of patients (n=32) showed some clinical response to lamotrigine adjunctive treatment. The mean time to lamotrigine discontinuation was 31.3±3.1 weeks (CI=25.2-37.4). Lamotrigine adjunctive treatment was well tolerated, with no serious rashes reported. Conclusion: Lamotrigine seems to be effective in the management of depressive symptoms in BP-NOS. Long-term use of lamotrigine was generally safe and well tolerated. Large-scale controlled trials might be needed to confirm the findings of this naturalistic study. BP-NOS의 우울증상 치료에서 lamotrigine 병합치료의 유용성을 평가하기 위한 자연관찰연구를 시행하였다. 52주 동안 lamotrigine의 병합치료로 인해 BP-NOS환자의 우울증상이 유의하게 호전되어 유지되었다. 16주이상 lamotrigine을 지속한 환자는 대부분 1년 동안 유지치료가 가능하였다. lamotrigine의 안전성은 기존의 양극성 우울증에서 lamotrigine을 사용한 연구결과와 차이를 보이지 않았다. 향후 BP-NOS 환자의 우울증상에 대한 lamotrigine 치료의 유용성을 확증하기 위해서는 대규모 전향적 통제연구가 필요하다.

결핵전문병원에 입원한 결핵환자의 우울증위험인자

왕정현,박철수,김봉조,이철순,차보석,이소진,이동윤,서지영,안인영,백종철,강형석,문성호,Wang, Jung-Hyun,Park, Chul-Soo,Kim, Bong-Jo,Lee, Cheol-Soon,Cha, Boseok,Lee, So-Jin,Lee, Dongyun,Seo, Ji-Yeong,Ahn, InYoung,Baek, Jong Chul,Kang, Hyung 한국정신신체의학회 2015 정신신체의학 Vol.23 No.2

연구목적 결핵환자 중 우울증 고위험 환자와 저위험 환자의 비교연구를 통해 결핵환자의 우울증 위험요인을 밝히고자 했다. 방 법 57명의 결핵환자를 대상으로 벡 우울 검사 2판을 이용하여 우울증상을 평가하였다. 우울증 고위험군과 저위험군으로 나누어 이분형로지스틱회귀분석 및 계산도표를 작성하였다. 결 과 신체비만지수가 낮아질수록 우울증 고위험군에 속할 위험은 높았다. 결핵치료 임의중단력이 있을 경우 우울증 고위험군에 속할 위험은 6배 높았다. 우울증 과거병력이 있는 경우 우울증 고위험군에 속할 위험은 25배 높았다. Original C-index는 0.789였고 bias corrected C-index는 0.754로 상당한 일치를 보였다. 결 론 낮은 신체비만지수, 결핵치료 임의중단력, 우울증 과거병력은 결핵환자의 우울증 위험요인임을 밝혔다. 이는 결핵환자에 대한 정신건강의학과적 개입 및 치료를 위한 근거자료가 될 것이다. Objectives : This study aimed to investigate the risk factors of depression for patients with tuberculosis(TB). Methods : A total of 57 patients with TB were recruited. All participants completed the Becks Depression Inventory-II for evaluating depressive symptoms. The risk factor for depression was analyzed by binary logistic regression analysis. Nomogram was performed for probability of depression. Results : Low body mass index(BMI, OR 0.801, 95% CI 0.65, 0.98), interruption of treatment for TB(OR 5.908, 95% CI 1.19, 29.41), past history of depression(OR 24.653, 95% CI 1.99, 308.44) were associated with increased risk for depression. The calibration curve for predicting probability of survival showed a good agreement between the nomogram and actual observation(Original C-index=0.789, bias corrected C-index=0.754). Conclusions : The result of the present study indicate that low BMI, interruption of treatment for TB, and past history of depression were risk factors for depression in patients with TB. The psychiatric intervention may be needed to prevent depression if the patients with TB have risk factor during treatment for TB.

일 부대 현역 사병들에서 입대 전 인터넷 사용 정도와 정신건강과의 관계

김선미,박철수,손진욱,김봉조,차보석,이철순,Kim, Sun-Mi,Park, Chul-Soo,Sohn, Jin-Wook,Kim, Bong-Jo,Cha, Bo-Seok,Lee, Cheol-Soon 대한불안의학회 2010 대한불안의학회지 Vol.6 No.2

Objective : The purpose of this study was to survey the degree to which people use the Internet prior to joining the army and mental health. Methods : The author assessed Internet addiction and mental health using an Internet addiction diagnostic scale for soldiers and the Symptoms Check-list-90. A total of 508 subjects were included in the final analysis. Collected data were analyzed by independent t-test. Results : The Internet addiction risk group (n=19, 3.7%) had significantly higher mean scores for obsessive-compulsion (t=-2.43, p=0.02) and interpersonal-sensitivity subscales (t=-2.30, p=0.03) than the control group. Conclusion : Internet addiction was related to soldiers' mental health. An assessment focused on internet use would be useful in the evaluation of a person potential adaptation to the military.