노인 환자에서 나타나는 섬망의 임상적 접근

한명일(Myeong Il Han) 대한노인정신의학회 2004 노인정신의학 Vol.8 No.2

Delirium is not uncommon and is a devastating clinical syndrome. Elderly patients are vulnerable to delirium, especially demented or/and medically-surgically ill patients. Old age, comorbid psychiatric, medical and/or neurological diseases, medications, changed pharmacodynamics, sensory impairment and psychosocial stresses contribute to the development of delirium. Delirium in elderly patients is somewhat different from delirium in younger patients, sometimes under detected and/or poorly managed. This review discusses the diagnosis, classification, etiology and treatment, and presents 3 clinical cases of delirium in elderly patients. This review also focuses on a practical approach in assessing and managing delirium in elderly patients. The management of delirium consists of identifying and correcting the underlying problems, including prescribing suitable medication.

알츠하이머 치매의 행동심리증상에서 비정형 항정신병약물

한명일(Myeong-Il Han),황태영(Tae-Young Hwang),이지은(Jieun Lee) 대한노인정신의학회 2015 노인정신의학 Vol.19 No.2

AD 환자의 치료에서 BPSD를 조절하는 것은 매우 중요하다. 이를 통하여 환자의 삶의 질을 향상시키고 가족과 수발자 의 부담을 경감시키며 요양시설 등에의 입소를 지연시켜 의료비의 감소를 유도할 수 있다. AD 환자에서 빈발하는 정신증, 초조증상, 그리고 공격성 등의 BPSD 치료에 공인된 약물은 아직 없다. 다만 임상 지침서와 전문가의 의견을 토대로 AAP 가 일차적 선택 약물로 추천된다. AD 환자에서 정신증을 비롯한 BPSD의 치료에 사용되는 risperidone과 aripiprazole의 치료적 효과는 분명하지만 효 과의 정도는 크지 않다. Olanzapine의 치료 효과는 앞의 두 가지 약물에 비해 다소 부족하고, quetiapine은 고용량에서 어느 정도 효과가 있을 것이라고 기대된다. AAP의 사용과 관련하여 흔히 발현되는 부작용으로는 졸림, EPS, 말초 부종 등이 있다. AAP는 인지기능 저하, CVAEs 증가, 그리고 사망률 증가 등의 심각한 부작용을 발생시킨다. 치료 효과는 크 지 않고 부작용은 심각하기 때문에 AD 환자의 BPSD를 치료하기 위해 AAP를 사용하는 경우에는 약물 사용에 따른 편익(benefits)과 위험(harms)을 충분히 비교하면서 접근하 는 것이 중요하다. In addition to cognitive and functional decline, various behavioral and psychological symptoms in dementia (BPSD) are mani-fested in the patients with Alzheimer’s dementia (AD). Some of BPSD, especially psychosis, agitation, and aggression could be challenges to caregivers and clinicians. Atypical antipsychotic drugs (risperidone, olanzapine, quetiapine, and aripiprazole) are widely prescribed to manage complicated neuropsychiatric symptoms associated with AD. It is known that atypical antipsychotics (AAP) have modest and significant beneficial effects in the short term treatment of BPSD. However their safety of AAP has been concerned with potentially increased adverse events. This article reviewed the treatment outcomes and adverse effects of AAP when managing BPSD in the patients with AD. The effects of risperidone and aripiprazole are obvious on psychosis and aggres-sion, but with small effect size. AAP could exacerbate cognitive decline, and it could increase the rate of cerebrovascular accidents and mortality rate in the patients with AD.

농촌형 치매 안심마을 사업이 지역주민의 치매 인식도, 인지기능, 우울감에 미치는 영향 :

한명일(Myeong-Il Han),김경민(Gyung-Min Kim),오지영(Ji-Young Oh),박미경(Mi-kyeong Park),강남인(Nam-In Kang),김재원(Jae-Won Kim) 대한노인정신의학회 2018 노인정신의학 Vol.22 No.1

Objective:According to the 3rd Korean National Dementia Plan, the dementia-friendly community initiative was launched. The aim of this study was to evaluate the effects of a rural dementia-friendly village project on the participants. Methods:Jeollabukdo Provincial Dementia Center designated Sosu-maeul, located in Buan-gun Jeollabuk-do, as a rural dementia-friendly village. We conducted dementia partnership education, youth-elder matching activity, and cognitive enhancing program. The efficacy of this project was evaluated by the changes in dementia awareness, cognitive function, and depressive symptoms. We used dementia awareness questionnaire, Mini-Mental Status Examination for Dementia Screening (MMSE-DS), and Korean version of Short form of Geriatric Depression Scale (SGDS-K). Results:This study was carried out with 24 residents in this community. There was no significant change in dementia awareness score between pre- and post-intervention (p=0.25). MMSE-DS score was significantly increased from 24.5 to 25.5 (p<0.001) and SGDS-K score was statistically improved from 3.5 to 2.5 (p=0.04) after interventions. Conclusion:We Jeollabukdo Provincial Dementia Center carried out a pilot study of a rural dementia-friendly village project. This project led to improvements on cognitive functions and depressive symptoms in the participants. But the improvement of dementia awareness was not achieved. More direct and experiencing interventions for people with dementia are necessary to improve dementia awareness.

노인환자에서 대뇌질환에 의해 나타나는 섬망

한명일(Myeong Il Han) 대한노인정신의학회 2008 노인정신의학 Vol.12 No.2

There are well known predisposing and precipitating factors for delirium in elderly patients. Although cerebral disease is a major precipitating factor for delirium, the concept of cerebral disease is not clear. Stroke is a typical condition reflecting intracranial change. There are not many studies about delirium post stroke. This paper reviewed delirium post stroke, instead of cerebral disease induced delirium as a whole. The etiology of delirium post stroke is not well established. The neuroanatomical site and the extent of stroke are important risk factors for the development of delirium. In spite of many limitations CAM, DRS, and MMSE are useful evaluating tools for delirium. In some cases of post stroke delirium, it was developed directly by stroke without any additional cause. In other cases there were also medical complications. And in the rest of the cases, there were multiple potential causes for delirium. Although there are not specific preventive interventions for delirium post-stroke, identifying and correcting the underlying stroke, as well as preventing secondary medical complications are important. Multicomponent non-pharmacological interventions are helpful to prevent delirium, and pharmacological methods for treating behavioral symptoms are sometimes necessary. There should be more studies about cerebral disease induced delirium.

Glutamate가 일측 흑질체 파괴 백서의 회전운동에 미치는 영향

한명일,정영철,은홍배,황익근,정상근 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.5

본 연구는 glutamate( , 과 M)가 일측 흑질체를 파괴한 백서에서 apomorphine으로 유도되는 회전운동에 미치는 영향을 알아보고자 하였다. 6-OHDA으로 우측 흑질체를 파괴한후 apomcrphine(0.1mg/kg)을 피하로 주사하면 병소반 대측으로 회전운동이 유발된다(641.7±163.9/hr). Glutamate는 apomorphine으로 유도되는 회전운동을 유의하게 감소시켰다. 그러나 이 glutamate의 감소효과는 GABA 길항제인 bicuculine에 의해 길항 그리고/ 또는 역전되었다. 이상의 실험결과에서 glutamate는 apomorphine으로 유도되는 회전운동을 감소시키고, 그 작용은 glutamate( ∼ M)가 선조체와 흑질체의 GABA 농도를 증가시킴으로써 나타났을 가능성을 시사한다. The aim of this study was to examine the effects of various concentrations of glutamate( , and M) on the circling movement induced by apomorphine in the unilateral substantia nigra-lesioned rats. Subcutaneous apomorphine(0.1mg/kg) elicited contralateral circling movement(641.7±163.9/hr). Glutamate( - M) significantly reduced the numbers of apomorphine-induced circling movement. This reducing effect of glutamate was antagonized and/or reversed by M GABA antagonist bicuculine. These results suggest that glutamate reduces circling movement induced by apomorphine and this reducing effect of glutamate may be mediated by increased GABA concentration in striatum and substantia nigra.

COVID-19 환자에서 나타나는 섬망에 대한 고찰

한명일(Myeong-Il Han),김용(Yong Kim),김철응(Choel Eung Kim),최말례(Mal-Rye Choi) 대한노인정신의학회 2021 노인정신의학 Vol.25 No.2

We reviewed the clinical features, prevalence, pathophysiology, and prevention and treatment of delirium in patients with coronavirus disease of 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, has neurotropic properties, and can penetrate the central nervous system and affect brain neurons. These characteristics may explain the fact that COVID-19 patients may be particularly susceptible to delirium. COVID-19 delirium occurred more frequently in intensive care unit and emergency room settings. Patients with neurologic disorders and the elderly were more vulnerable to delirium. Clinical symptoms of COVID-19 delirium may manifest as a hyper/hypoactive type. Prevention and treatment appear to be similar to conventional treatment strategies. And the patient’s feeling of isolation due to social distancing and a highly intensive labor force of medical personnel must be overcome. Melatonin, alpha-2 agonist, antipsychotics, and valproic acid have been recommended for the treatment of delirium symptoms. However, this article did not go through a systematic literature review.

학술발표 : 해양 , 환경분야 / 포스터발표 ; 하계 진도 마로해의 해양환경과 엽록소 α 량의 공간적 분포 특성

윤양호,한명일,서호영,박종식,김병섭 한국국제경제학회 2001 한국국제경제학회 학술대회발표 논문집 Vol.2011 No.3

감정표현불능증 특성을 보이는 건강한 여성의 화소 기반 형태분석 방법을 통한 회백질 용적 감소의 정량적 분석

한규만,최인광,한명일,이민수,함병주 대한우울조울병학회 2012 우울조울병 Vol.10 No.3

Objectives : Alexithymia is a condition characterized by impaired ability to identify and describe subjective feelings. In this study, we aimed to investigate whether an alexithymic trait is associated with structural abnormalities in cerebral cortex in healthy adults with voxel-based morphometry (VBM). Method : 71 healthy women were enrolled in this study and the Korean version of 20-item Toronto Alexithymia Scale (TAS-20) was carried out to determine their alexithymic traits. Gray matter (GM) volume was assessed with a VBM protocol from magnetic resonance images acquired on a 1.5 T scanner. We compared GM volumes between subjects with alexithymic traits and non-alexithymic subjects. Results : In the reigion-of-interest (ROI) analysis of both frontal lobes and hippocampal regions, the subjects with alexithymic traits showed a trend of smaller GM volume in the superior frontal gyrus (Talairach coordinate=-12, 23, 53 ; cluster size=47 ; Z-score=3.26), parahippocampalgyrus (24, -34, -9 ; 38 ; 2.95) and middle frontal gyrus (42, 50, 17 ; 22 ; 2.87). Conclusion : Our results suggest that the subjects with alexithymic traits would have a trend of smaller GM volumes in the superior frontal gyrus, parahippocampalgyrus and middle frontal gyrus.

노인 우울증에 영향을 미치는 요인들에 대한 연구

김용(Yong Kim),한명일(Myeong Il Han),박종일(Jong-Il Park),정상근(SangKeun Chung) 대한노인정신의학회 2021 노인정신의학 Vol.25 No.2

Objective: The purpose of this study was to investigate the related factors of elderly depression among Korean adults aged 60 years and above. Methods: From the database of Korea National Health and Nutrition Examination Survey conducted in 2018, data of 2,288 adults over age 60 who responded to the questionnaires of health interview were included in this study. We analyzed the data using logistic regression analysis. Results: According to our results, the number of chronic diseases seemed to be associated with depression in elderly people, especially when they have more than 4 chronic diseases. Poorer self-rated health was identified as a significant factor and the odd ratio was the highest among all independent variables in our study. Walking over 10 minutes more than 4 times a week was considered as a protective factor for elderly depression. The association between education level and depression was inconsistent. Variables such as female gender, single status, smoking showed statistically insignificant results. Older age itself was not identified as a risk factor as odd ratios of all groups (over age 65) compared to reference group (age 60-64) were below 1. Conclusion: This study confirms several related factors for elderly depression. Having more than 4 chronic diseases, poorer self-rated health were identified as a significant risk factor for depression. Regular walking was considered as a protective factor for elderly depression. The knowledge of these factors might help to manage risks of elderly depression and devise early intervention approaches.

지역사회에 거주하는 노인에게 집단 인지훈련이 인지기능, 우울감, 삶의 질에 끼치는 효과

고요한(Eyohan Ko),한명일(Myeong-Il Han),이건학(Keon-Hak Lee),홍수정(Su-Jeong Hong) 대한노인정신의학회 2021 노인정신의학 Vol.25 No.1

Objective: There are reports that cognitive training improves cognitive performance in patients with mild cognitive impairment and dementia. However, the research on the effects of cognitive training in the community-dwelling elderly is insufficient. This study aimed to verify the effectiveness of cognitive training in the community-dwelling elderly. Methods: The participants were community-dwelling elderly aged 60 years or over. We collected demographic data and assessed Korean Version of Montreal Cognitive Assessment (MoCA-K), The Short form of the Geriatric Depression Scale-Korean (SGDS-K), and Geriatric Quality of Life-Dementia (GQOL-D). Cognitive training consisted of performing tasks for multi-cognitive domains. It was a paper- and group-based program, conducted 15 sessions each 60 minute. After the intervention, clinical characteristics were reassessed. Paired t-test, pearson correlation, analysis of covariance (ANCOVA) were performed using R version 3.6.1. Results: There were 206 participants. 162 participants completed the intervention, and were eligible for analyses. After the cognitive intervention, MoCA-K was improved 2.10±0.61 which was statistically significant (p<0.001). SGDS-K was decreased 0.57± 0.46 (p=0.003). GQOL-D was increased 1.65±1.64 (p=0.048). ANCOVA showed that the score change in MoCA-K was not influenced by baseline SGDS-K or baseline GQOL-D score. Conclusion: Group-and paper-based cognitive training could improve MoCA-K, SGDS-K, and GQOL-D for the communitydwelling elderly. Baseline SGDS-K and GQOL-D scores were not associated with cognitive training effects in the community-dwelling elderly.