정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

정신과 입원환자의 서비스 만족척도의 개발

김철권,이지연,송영선,김규호,김경률,김제원,이동기,최병무 大韓神經精神醫學會 2006 신경정신의학 Vol.45 No.3

목적 본 연구의 목적은 국내 정신의료기관(정신병원, 종합병원 정신과)에서 간편하게 사용할 수 있는 신뢰도와 타당도가 검증된 입원환자의 서비스 만족척도를 개발하기 위한 것이다. 방법 여러 단계를 거쳐 국내 실정에 맞는 문항을 개발하였고,정신병원, 종합병원, 대학병원 정신과 병동에서 퇴원하는 348명의 환자들을 대상으로 신뢰도와 타당도를 조사하였다. 요인분석 결과 5개의 요인이 추출되었으며 전체 변량의 63.04%를 설명하였다. 내적 일관성에 대한 신뢰도 계수 (Crohnbach's α)는 0.95로 상당히 높은 수준이었고, 수정된 개별문항-총점 상관계수는 0.50부터 0.72까지의 범위에 속하였다. 요인분석을 통해 추출된 서비스 만족척도의 각 하위척도 점수와 서비스 만족척도에 첨부된 각 영역에 대해 전반적인 만족도를 묻는 세 개의 문항 점수 간의 상관성 역시 유의하게 높았다. 결과 진단명에 따른 서비스 만족척도의 전체 점수에서는 불안/신체형/강박장애 환자군과 기분장애 환자군이 각각 정신분열병 및 기타 정신병 환자군과 알코올중독 장애 환자군에 비하여 유의하게 높은 점수를 보였으며, 입원형태에 있어서는 자발적 입원군이 강제 입원군에 비하여 전체 만족점수가 유의하게 높았다. 그러나 성별, 월수입, 학력, 직업, 종교, 결혼상태 등의 변수에서는 서비스 만족척도의 전체 점수에서 유의한 차이가 발견되지 않았으며, 마찬가지로 연령, 입원일수, 입원횟수, 첫 발병나이, 유병기간 등의 임상적 변수에서도 서비스 만족척도의 전체 점수와 유의한 관계를 보이지 않았다. 서비스 만족척도의 전체점수에서 대학병원 환자군이 정신병원 환자군과 종합병원 환자군에 비하여 각각 유의하게 높았다. 결론 결론적으로 국내 정신의료기관에 입원한 환자들의 서비스 만족을 평가하기 위한 목적으로 개발된 본 척도는 높은 수준의 신뢰도와 타당도를 보였으며, 또 국내 정신의료 환경에 맞는 요인구조를 보였다. 따라서 정신의료 서비스에 대한 정신과 환자의 만족도에 대한 연구가 거의 없는 실정에서 본 척도의 개발은 향후 국내 정신의료의 질과 치료결과를 높이는 도구로 활용될 수 있을 것으로 기대된다. Objectives : To develop and test the validity and reliability of a brief self-completed questionnaire (Service Satisfaction Scale : SSS) for routinely assessing the quality of service in psychiatric ward inpatients. Methods : A 30-item multidimensional questionnaire was developed by several steps of face validity and content validity. The questionnaire was administered to inpatients (n=348) discharged from psychiatric hospitals, general hospitals, and University hospitals. Construct validity was supported by performing principal component analysis. Reliability was estimated by calculating internal consistency of Cronbach's alpha. Results : Factor analysis yielded five factors comprising staff attitude, treatment quality, ward environment, access/cost, and ward rule, which account for 63.04% of the common variance. The internal consistency of the scale was high (Cronbach's alpha=0.95). The concurrent validity was supported by the significant correlation of each of five factors with item that measured overall satisfaction of SSS. Patients with neurosis (anxiety disorder, somatoform disorder, obsessive compulsive disorder) and mood disorders were significantly satisfied than those with psychosis and alcoholic disorders. Patients who admitted voluntarily were more significantly satisfied than those who admitted involuntarily. Sociodemographic variables such as age, gender, marital status, monthly income, education level, employment status and religion were not significantly different at the total scores of SSS. Similarly, clinical characteristics such as age of onset, duration of illness, lengths of hospital stay and number of previous hospitalization did not associate significantly with the total scores of SSS. Patients discharged from university hospitals were significantly more satisfied than those of the general and psychiatric hospitals. Conclusion : SSS performed well in the validity and reliability, indicating that it can be a useful tool for measuring Satisfaction of psychiatric inpatients in Korea.

한국인 알코올 의존 환자에서 알코올 대사 효소 유전자형 빈도의 남녀 차이

김성곤,김철민,이덕기,황인복,이현숙,김성연,전은숙,송영상,박제민,최병무,김명정 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.2

Objectives : There are a number of preceding epidemiological studies reporting gender differences in the genetic etiology of alcohol dependence. The author investigated gender difference in the frequencies of ADH2 and ALDH2 genoypes between the patients with alcohol dependence and normal control. Methods : The subjects were 141 alcohol dependent patients (104 males, 37 females) and 138 normal control (79 males, 59 females). The frequencies of 1/1 and 1/2+2/2 (2+ afterward) genotypes for ADH2 and ALDH2 were investigated in male and female between alcohol dependence and normal control group. DNA was extracted from WBC in peripheral venous blood and PCR-RFLP method was used out for genotyping. Results : First, the frequency of ADH2 1/1 genotype was significantly higher in alcohol dependent patients than normal control in both genders. Second, while there was no gender difference in the frequency of ADH2 1/1 genotype in normal controls, in the patient group however, the frequency was significantly higher in females than males. Third, in male subjects with alcohol dependence, the frequency of ALDH2 1/1 genotype was significantly higher than in male normal control subjects. On the other hand, in female subjects with alcohol dependence, the frequency of ALDH2 2+ genotype was significantly higher than in female normal control subjects. Conclusion : These results suggest that while the risk of alcohol dependence is predominantly affected by ALDH2 1/1 geno-type in male, the female ADH2 1/1 genotype is mainly associated with the risk of alcohol dependence. This means that there are gender differences in the genetic etiology of alcohol dependence.

파킨슨씨병에서 Selegiline HCI (MAO-B^(�))의 효과 및 안전성

조기현,김명규,김태선,김병채,이승한,황인용,김준태,김종기 全南大醫大 2000 전남의대학술지 Vol.36 No.2

여자중학생들의 주관적운동강도 (RPE)활용에 관한 연구

金昞完,白明基 忠南大學校體育科學硏究所 1993 體育科學硏究誌 Vol.11 No.1

The purpose of this study was to determine the ability of 20 middle school girls, ages 12 to 14 years, to regulate the intensity of their exertion using perceived exertion ratings during cycling. The Borg Rating of Perceived Exertion 6 to 20 Scale was used as a perceptual frame of reference. Maximal oxygen uptake and power output were predicted from telemetered heart rate data collected during a submaximal graded exercise test. Subjects were fully familiarized with the RPE scale and attended three consecutive sessions of cycling. They adjusted the workloads themselves so as to produce effort intensities for scale ratings of 9 (very light), 13 (somewhat hard) and 17 (very hard). Heart rates were sampled during the final half minute of each session and the data were examined with using a mixed factorial analysis of variance. This showed highly significant differences (p〈.001) between the three RPE levels but no significant effects for age, or trials. It was concluded that the RPE is readily learned by older children and adolescents and is a potentially useful reference when self-regulating effort intensity during high-intensity exercise.

급성 및 만성 간질환에서 C형 간염바이러스 항체(anti-HCV)양성률

김삼용,성자원,김병호,이기천,허승식,길준영,정현용,이헌영,김영건 충남대학교 의과대학 지역사회의학연구소 1992 충남의대잡지 Vol.19 No.2

The prevalence of antibody against hepatitis C virus (anti-HCV) was investigated in 331 patients with various liver diseases from April 1992 to September 1992. The presence of anti-HCV was detected by Lucky HCD EIA test in 331 cases and by (Ortho HCV Antibody ELISA test 148 patients) The results are summarized as follows: 1. Overall, antibody to HCV(anti-HCV) was positive in 37(11%) of 331 patients with various liver diseases. 2. 16(11%) of 144 patients with chronic hepatitis, 2(5%) of 37 patients with alcoholic liver disease, 17(22%) of 76 patients with liver cirrhosis and 2(5%) of 38 HBsAg carriers were positive for anti-HCV.None of 12 patients with acute hepatitis, 11 patients with drug induced hepatitis and 13 patients with hepatocellular carcinoma was anti-HCV positive. 3. HBsAg positivity in patients who had anti-HCV was 24%(9/37). 4. A positive correlation was found between Lucky HCD and Ortho HCV test. Of 128 Lucky HCD negative cases, 124 cases were negative for Ortho HCV ELISA and 4 cases were positive for Ortho HCV ELISA Of 20 Lucky HCD positive cases, 11 cases were positive for Ortho HCV ELISA and 9 cases were negative for Ortho HCV ELISA. These results suggest that hepatitis C virus has an important etiologic role in HBsAg negative chronic hepatitis and liver cirrhosis in Korea. The diagnostic value of Lucky HCD EIA test may be slightly better or equivalent to Ortho HCV ELISA test in the diagnosis of Hepatitis C virus infection.

3차 의료기관 응급실로 내원한 안면부 열상 환자에 대한 임상적 고찰

김양원,안성훈,류석용,김홍용,전병민,김기태 대한응급의학회 2001 대한응급의학회지 Vol.12 No.2

Background: Facial laceration is a common clinical problem in the emergency room that is frequently associated with other craniofacial injuries. It elicits an emotional response from the patient because of the underlying concern of permanent scar and secondary facial disfigurement, so they demand prompt and adequate treatment. The aim of this study is to analyze the incidence, etiology, depth, and site of facial lacerations to provide basic data for further understanding. Method: This study reviewed 1,043 facial-laceration patients treated in the emergency room at Pusan Paik Hospital between March 1999 and February 2000. This retrospective study was done by reviewing and analyzing the sex and age distributions, the monthly and daily distributions, the causes of injury, the types of injury, the sites of injury, the lengths of the lacerations, and associated injuries. Results: The sex ratio of men to wemen was 2.4:1, and the 0~10 age group was at the top of the age distribution. The number of patients was the highest on sundays and during March. About 9.2% of the patients visited the emergency room between 10:00 P.M. and 11:00 P.M. Falls(38.1%) were the most common cause of facial laceration, and deep laceration(51.8%) was the most common type of facial laceration. The most common laceration site was the forehead, followed by the chin and the nose. The most common associated craniofacial injury was facial bone fracture(39%), Facial-lacerations were sutured by plastic surgeons(80%), emergency physicians(10%), and oromaxillofacial surgeons(10%). We found statistical significance in the types and lengths of lacerations between men and women, among age groups(p<0.05). Conclusion: Facial laceration is one of the most common craniofacial injuries in the emergency room. By now, most lacerations have been repaired by plastic surgeons, But, the causes of lacerations are diverse and many patients are admitted due to the associated injuries. Therefore, emergency physicians should participate more aggressively in the care of facial-laceration patients to improve the outcome of the patients.

내시경으로 확인된 상부소화관 용종의 임상적 고찰

김영건,김병호,성자원,이기천,허승식,이종선,정현용,이헌영 충남대학교 의과대학 지역사회의학연구소 1991 충남의대잡지 Vol.18 No.2

From January 1987 to October 1991, we performed 14,333 cases of upper gastrointestinal endoscopy and diagnosed 527 cases with U.G.I polyp. We assesed these 527 cases and obtained following results: 1) The overall incidence of U.G.I. polyps was 3.6%, and there was no sexual difference. The peak incidence was in 6th decades(32.4%). 2) The U.G.I. polyps were located chiefly at stomach(415 cases, 78.7%), among which antrum occupied antrum 43.5%, body 24.0% and funds 5.1%. And the others were esophagus(6.5%) and duodenum(12.3%). 3) The size of U.G.I. polyp was below 1cm in 72.3%, from 1cm to 1.9cm in 20.7% and above 2cm in 7.0%. According to Yamada' classification, type Ⅰ, Ⅱ, Ⅲ and Ⅳ was 31.9%, 51.3%, 13.7% and 3.0%. 4) Histological nature of U.I.G. polyp were hyperplastic polyp(85.8%), adenomatous polyps(9.3%), carcinomatous polyps(3.3%) and etc. The size of neoplastic polyp such as adenomatous polyps(mean 1.0±0.7cm) and carcinomatous polyps(niean 2.0±1.8) were larger man hyperplastic polyp(mean 0.6±0.4) (p<0.05) 5) The gastric polyps were associated with peptic ulcer(7.5%), gastric cancer(3.2%), other malignancy(3.5%), hepatobiliary disease(5.5%), post subtotal gastrectomy(5.5%). And others(75%) werenot associated with specific disease.

월슨씨병에서 나타난 안검개방실행증 1예

박기종,권오영,최낙천,김남곤,김태유,임병훈 대한신경과학회 1997 대한신경과학회지 Vol.15 No.5

휠체어 검도 경기를 위한 경기규정에 관한 연구

김영학,공병덕,이병기 龍仁大學校 武道硏究所 2002 武道硏究所誌 Vol.13 No.1

The purpose of this study was to build revised game rules for wheelchair Kumdo for the physically challenged confined to wheelchair, after teaching 10 people how to play Wheelchair Kumdo. It's ultimately intended to determine whether or not the revised game regulations were appropriate and workable and ultimately to promote Wheelchair Kumdo. There Kumdo trainees of the 4th, 5th and 6th grades respectively and three physically different people were coached to draft game rules in three phases, and they were finalized through an advice of a specialist. And then five disabled Kumdo trainees, who included three of the 3rd grade and two of the 2nd grade, learned the regulations for a month to find out their adequacy. As a result of interviewing them and analysing the collected data, the following findings were given: First, the stadium should have a flat floor, by using proper materials such as wood or concrete, to guarantee the smooth operation of wheelchair. It should be in a square form and 11 meter or higher in length. The starting lines should bo marked 'T' on both sides from the central line, and the upper parts of the marks should face each other. There should be 1.7m distance between the central and starting lines and 2 meter or higher extra spaces in the external sides. Second, the bamboo sword should be redesigned to be 114cm in length and 370g in weight to fit in wheelchair Kumdo. Third, among Kumdo equipment, Homyun(護面, Headgear), part of HoKu(Protection-equipment, 護具), should be made of lighter materials, thicker in the head part, and easy to wear. Gab(甲, Chest-guard) should have a sort of shock absorber in it, and a remodeled Hoku that has no wings on both sides should be used. To prevent wheelchair from shock and ensure its safety, a Quickie All Court model should be selected, and each contestant should wear a suit of different color that has his or her name on the shoulder portion. Fourth, each game should run four minutes, constituted by two periods, and a break time should be given. The judgment should be made without no extra time, and a contestant who hits one of the due points ahead of the other should be a winner. Fifth, as for Yuhyo-Geokja(有效擊刺, Point), action against the head, wrist or waist should be considered Geokja(擊刺, Strike), and one against the chest part should be regarded as Jabu(刺部, Stab). Based on the above-mentioned findings, there are some suggestions about wheelchair Kumdo games: First, as games could be held out in the field, outdoor programs should be attempted. Second, every game is divided into the first and second periods, and coaches need to develop programs suitable for the two-part competition to give better guidance. Third, general Kumdo equipment isn't suitable for wheelchair Kumdo, and a lot of research efforts should urgently be dedicated to developing separate equipment for that.