자살의 생물학적 기전

천은진(Eun-Jin Cheon) 대한생물치료정신의학회 2018 생물치료정신의학 Vol.24 No.3

Suicide is a behavior that is intended to cause death by itself and requires medical treatment, resulting in suicidal attempt or completion. Suicide causes loss of life, damages the body, costs a lot of medical expenses, and causes families to fall into sorrow and suffering therefore this suicide is a huge loss to family and society. There have been attempts to reduce and prevent suicide by understanding the mechanism of suicide. The mechanism of suicide can be thought of as psychological mechanism and biological mechanism. In the past, if we considered the psychological and biological mechanisms separately, the development of neuroscience now connects and integrates these two. Psychological factors affect biological factors and biological temperaments also affect perception or thinking about the situation and increase psychological vulnerability. Distant factors in suicidal behavior-such as childhood adversity and family and genetic predisposition-increase the lifetime risk of suicide. They alter the response to stress and other processes through changes in gene expression and regulation of emotional and behavioral characteristics. Distant factors affect the biological system and consequently changes in these systems can increase the risk of suicide. In other words, the distal factor does not directly induce suicidal behavior but rather acts indirectly through developmental or mediating factors. These mediating factors are impulsive aggressive and anxious trait, and chronic use of substances. The mechanism of this disorder is the abnormality of the serotonin system and the abnormality of the lipid level. Proximal factors are associated with the onset of suicide events and include changes in the major neurotransmitter systems, inflammatory changes, and dysfunction of glial cells in the brain. A series of studies, including a variety of research methods and postmortem and in-vivo imaging studies, show the impairment of the serotonergic neurotransmitter system and hypothalamic-pituitary-adrenal axis stress response system for suicidal behavior. These disorders lead to suicidal behavior due to difficulty in cognitive control of mood, pessimism, reactive aggression, abnormality in problem solving abilities, excessive response to negative social signals, severe emotional distress, and cognitive dysregulation of suicidal ideation.

우울증의 뇌파변화

천은진(Eun-Jin Cheon) 대한생물치료정신의학회 2013 생물치료정신의학 Vol.19 No.2

Electroencephalography is the most practical and accessible neuroimaging technique. An abnormal pattern of asymmetric activity in the frontal regions due to relative hyperactivity over the right and/or relative hypoactivity over the left frontal regions has been demonstrated in the electroencephalographic studies of depression. Alterations in brain functional cortical connectivity in resting-state networks and a loss of selectivity in resting functional connectivity were detected in an electroencephalographic study of major depressive disorder. Researchers suggested that several electroencephalography-based methods may be useful biological marker for predicting antidepressant response. Alpha- and theta-band EEG abnormalities, the combined Antidepressant Response Index(ATR), cordance, EEG source localization have the potential to offer predictors of treatment response. Future studies will be needed to validate their usefulness for clinical practice.

소아청소년 신경증 환자에서 뉴로피드백 효과에 대한 예비연구

채진혁(Jin-Hyuk Chae),김혜금(Hye-Geum Kim),정진영(Jin-Young Jung),최중현(Joong-Hyun Choi),천은진(Eun-Jin Cheon),서완석(Wan-Seok Seo),구본훈(Bon-Hoon Koo) 대한생물치료정신의학회 2014 생물치료정신의학 Vol.20 No.2

Objectives:The purpose of this study was to evaluate the characteristics and the effects of neurofeedback from child and adolescent patients with neurosis. Methods:Thirty-two patients who received neurofeecback from hospital in Korea from July, 2005 to July, 2010 participated in this study. The demographic data, characteristics of psychiatric disorders, and states of neurofeecback were analyzed. CGI(Clinical Global Impression) score and The Hill-Castro Checklist was evaluated before and after neurofeedback training. Results:Depression was the most common psychiatric disorder(16 patients, 50%), followed by anxiety disorder(10 patients, 31.3%). The remainder of the study group included patient suffering from adjustment disorder, somatoform disorder. Thirty patients(93.8%) has been taking medicine, and fifteen patients(46.9%) of those patients has been taking medicine for less than a year. The average frequency of neurofeecback was 33.84, and neurofeedback protocol was individualized according to patient’s symptom. In this study, neurosis patients preferred α/θ(53.1%) training. Significant change of CGI after training was noticed using covariance with frequency(<.001), and self rating scale also showed significant changes in inattention, hyperactivity, impulsivity, immaturity, depression, self esteem and hostility(<.001). Conclusion:This is the retrospective study in clinical setting, so there are several limitations. But this study demonstrates the significant positive effects of neurofeecback in objective and subjective rating scales for child and adolescent patients with psychiatric disorders. Prospective controlled studies are needed in the future.

정신분열병 환자의 우울증상에 미치는 요인

김진성(Jin Sung Kim),구본훈(Bon Hoon Koo),서완석(Wan Seok Seo),천은진(Eun Jin Cheon),박상준(Sang Jun Park) 대한생물치료정신의학회 2008 생물치료정신의학 Vol.14 No.1

정신분열병의 우울증상에 영향을 미치는 요인들을 알아보고 입원과 외래환자에서 우울증상의 빈도, 우울증상에 관련된 요인들의 차이를 알아보기 위해 2005년 9월 1일에서 2007년 3월 30일까지 DSM-Ⅳ 진단 기준에 의해 정신분열병으로 진단된 총 177명, 외래환자 87명, 입원환자 90명을 대상으로 BDI, HRSD를 시행하였다. 정신분열병 환자의 우울증상에 관련된 요인은 교육정도와 직업, 이환 기간, 정신분열증의 진단 아형, GAF 점수 등이 있었다. 교육정도가 낮고, 직업이 없으며 정신분열병의 이환기간이 짧은 환자, 잔류형과 편집형, GAF 점수 50~59점 사이인 군에서 우울증상이 높게 나타났다. 입원 및 외래환자 사이에 성별, 연령, 종교, 이환기간, 자살경험에 따른 우울점수의 차이를 보였다. 외래 환자의 경우 나이가 많은 여자환자에서, 입원환자는 젊은 남자환자에서 우울증상이 많았다. Objectives : The primary aim of this study was to investigate severity and factors of depressive symptoms in schizophrenics, and compare the score between inpatient and outpatient of schizophrenia. Methods : The score of BDI(Beck depression inventory), HRSD(Hamilton rating scale for depression) were compared between two groups. Results : Lower level of education, being unemployed, shorter duration of illness, residual and paranoid type, GAF score 50-59 group were more depressed significantly. Depression scores by gender, age, religion, duration of illness and suicidal history were different significantly between two groups. Conclusion : Lower level of education, being unemployed, shorter duration of illness, residual and paranoid type of schizophrenia should be given special attention for depressive symptoms. Old female outpatients and young male inpatients should be evaluated and monitored for depression.

우울증의 생체 지표

김혜금(Hye-Guem Kim),천은진(Eun-Jin Cheon) 대한생물치료정신의학회 2015 생물치료정신의학 Vol.21 No.2

Depression is one of the most common psychiatric disorders that is associated with high level of disability, morbidity and mortality. Depression is a heterogeneous disorder, and it seems to be the result of complex interaction of several factors including genetic and environmental factors. Numerous studies have reported available biomarkers in depression, which is detectable biological character reflecting pathogenic process or treatment response. They include neuroendocrine system such as hypothalamic-pituitary-adrenal axis, inflammatory markers, neurotrophic factors, fatty acid markers, sleep factors, structural brain images and functional brain images. Understanding biomarkers is essential for classifying the clinical features of depression and subsequently help determine individualized treatment for each subgroup. This article reviewed literatures about biomarkers in depression, in order to reconsider potential clinical use of it.

노인성 우울증과 알츠하이머병의 관계

김혜금(Hye-Guem Kim),천은진(Eun-Jin Cheon),구본훈(Bon-Hoon Koo) 대한생물치료정신의학회 2016 생물치료정신의학 Vol.22 No.1

There are many overlapping symptoms between geriatric depression and dementia, particularly Alzheimer type. Patients with geriatric depression have cognitive impairment resulting from attention deficit, rigidity of thinking, processing speed, and so on. The cognitive impairment caused by depression does not completely disappear even after cured depression. Also, patients with Alzheimer’s disease(AD) often have comorbid depressive symptoms including apathy. And of patients with minor cognitive impairment(MCI), patients with neuropsychiatric symptoms including depression, anxiety, converted to AD more often. Numerous studies have indicated that lifetime depression is associated with developing AD. Recently, amyloid PET is a available measure that demonstrate the relation between depression and AD. In conclusion, when the patient with geriatric depression also have cognitive impairment, we should carefully follow up the patients whether develop AD or not, and we can check the amyloid PET to make further clinical decision and plan.

세로토닌 재흡수 억제제에 대한 아리피프라졸 및 부프로피온 부가요법의 우울증 세부증상에 대한 효과 비교 : 다기관, 개방표지, 무작위 연구

이가원,이광헌,박영우,이종훈,구본훈,이승재,성형모,천은진,Lee, Ga-Won,Lee, Kwang-Hun,Park, Young-Woo,Lee, Jong-hun,Koo, Bon-Hoon,Lee, Seung-Jae,Sung, Hyung-Mo,Cheon, Eun-Jin 대한불안의학회 2017 대한불안의학회지 Vol.13 No.2

우울증은 높은 유병률을 가지며 심각하고 만성화 될 수 있는 질병이다. 환자가 증상 없이 기능적 회복이 되어 일상을 영위하기 위해 임상가는 단독요법 이상의 치료 전략이 필요하다. 본 연구에서 SSRI와 aripiprazole 또는 bupropion 부가 요법은 우울증의 증상 호전을 보였다. SSRI와 aripiprazole 부가 요법은 우울증의 전반적 점수의 호전뿐 아니라 세부척도의 핵심 증상에서 bupropion 병합 요법에 비해 더 의미 있는 변화를 보였다. 또한 두 약제 모두 핵심 우울증상이라 할 수 있는 개별증상(우울한 기분, 일과 활동, 정신적 불안)에서 가장 큰 변화를 보였다 Objective : The purpose of this study was to examine the effects of adjunctive aripiprazole versus bupropion on specific symptoms of depression. Methods : Data were from 6-week, randomized, prospective, open-label multi-center study in 103 patients with major depressive disorders. Participants were randomized to receive aripiprazole (2.5-10 mg/day) or bupropion (150-300 mg/day) for 6 weeks. Change in four subscales of the 17-item Hamilton Depression Rating Scale (HAM-D17) that capture core depression symptoms was determined, and change in individual HAM-D17 items was also assessed. Changes in three composite subscales-anxiety, insomnia, and drive were also examined. Results : Within-group change in the four core subscales was large [effect size (ES)=1.30-1.47] and it was similar to that in the HAM-D17 total score. Differences between aripiprazole and bupropion were significant for each of the four core subscales and the HAM-D17 total score favored aripiprazole (p<0.001). On three composite scales, both treatments caused substantial changes in anxiety (within-group ES=1.10 (aripiprazole) vs. 1.00 (bupropion)], insomnia (ES=0.75 vs 0.50), and drive (ES=1.17 vs 1.15). Conclusion : This results suggested that both aripiprazole and bupropion adjunctive therapies with selective serotonin reuptake inhibitors resulted in significant and clinically meaningful changes in core symptom subscales for depression.

정신과 질환에서의 임상 병기 및 조기 개입

김혜금(Hye-Guem Kim),강석헌(Suk-Hun Kang),천은진(Eun-Jin Cheon) 대한생물치료정신의학회 2016 생물치료정신의학 Vol.22 No.2

There is increasing awareness of the limitations of the current diagnostic system in psychiatry. Clinical staging is another complementary method that make possible to rate the severity of the disease, and to use of appropriate stage-specific evidence-based interventions including early non-invasive intervention. This paper summaried previous studies about the development of clinical staging and the early intervention or prevention by using this staging method in psychiatry. Clinical staging in psychiatry can clarify which people are at risk of psychiatric disease and what novel therapeutic strategies are most likely to successfully achieve remission and reduce the risk of persistence and recurrence for patients in each stage.

소아청소년 주의력결핍 과잉행동장애에서 뉴로피드백의 효과

이영지(Young Ji Lee),김혜금(Hye Geum Kim),하수홍(Su Hong Ha),천은진(Eun Jin Cheon),서완석(Wan Seok Seo),이종범(Jong Bum Lee),구본훈(Bon Hoon Koo) 대한생물치료정신의학회 2014 생물치료정신의학 Vol.20 No.3

Objectives:The purpose of this study was to evaluate the characteristics and the effects of neurofeedback from child and adolescent patients with ADHD in retrospective setting. Methods:Forty-eight patients who received neurofeedback from a university hospital in Korea from July, 2005 to July, 2010 participated in this study. Twenty-nine patients were placed in medication group, the other 19 patients were placed in no-medication group. Two groups are not statistically different in intelligence, ADHD severity and baseline CGI. The demographic data, characteristics of psychiatric disorders, and states of neurofeedback were analyzed. The effects of neurofeedback were evaluated before and after training using CGI and subjective self-rating scale(The Hill-Castro Checklist). Results:Twenty-nine patients had been taking medicine, and 13 patients(44.8%) of those patients have been taking medication for less than a year. The average frequency of neurofeedback was 36.1, and neurofeedback protocol was preferred β/SMR(58.3%) for both groups. Significant changes in CGI before and after training were noticed in both groups(<.001). And self- rating scale also showed significant changes in attention, hyperactivity, impulsivity, immaturity, self- esteem and hostility(<.001) in medication group and attention, hyperactivity, impulsivity, hostility and aggressive/sadistic behavior in no-medication group. Both medication groups and no-medication group showed significant improvement. Conclusion:This is a retrospective study in clinical setting, so there are several limitations. But this study demonstrates the significant positive effects of neurofeedback in objective and subjective rating scales for young patients with ADHD. Prospective controlled studies are needed in the future.

초등학교 고학년 정상 남아에서 정서 인식능력과 신경인지기능과의 관계

최정민(Jeung Min Choi),서완석(Wan Seok Seo),천은진(Eun Jin Cheon),배대석(Dai Seg Bai),최호동(Ho Dong Choi) 대한생물치료정신의학회 2013 생물치료정신의학 Vol.19 No.1

Objectives:This study had explored the relationships between emotional recognition ability and neurocognitive functions, and the indirect relationships between emotional recognition test and neurobiological indexes in elderly childhood normal boys. Methods:59 elderly childhood normal boys were selected under a guideline of IRB for a study. All of participants were examined developmental and psychiatric histories, intelligence, behavioral symptoms, neurocognitive functions, and web based emotional recognition test-revised(ERT-R). Neurocognitive function test was composed of 3 area(attention, memory and higher neurocognitive function), 12 subtests. Web based ERT-R was developed for examine the emotional recognition ability as emotional recognition, emotional discrimination and contextual understanding. Results:All of neurocognitive function was related to emotional recognition abilities, but domains of attention and memory functions had a limited relationship with emotional recognition abilities and suggested that those domains had affects to a preprocessing stage in sensation and perception of emotional stimuli or events. Higher neurocognitive functions as executive functions assessed by WCST and Stroop color word intereference test had a gross affect to emotional recognition abilities, and those were composed of the ability to inhibit prepotent responses, attribute identification, hypothesis formation, problem solving or reasoning, and sustained attention to related stimuli or events. Conclusions:These results had proved that emotional recognition abilities and higher cognitive functions as executive functions were closely related, and would be interpretive guidelines in a emotional recognition defect of ADHD or other childhood psychiatric disorders.