Aripirazole이 정신병적 증상을 동반한 파킨슨병 환자의 정신증상 및 운동증상에 미치는 효과

신호철(Ho Cheol Shin),한덕현(Doug Hyun Han),민경준(Kyung Joon Min),나철(Chul Na),남범우(Beom Woo Nam),이상훈(Sang Hoon Lee),정운선(Un Sun Chung) 대한생물치료정신의학회 2009 생물치료정신의학 Vol.15 No.1

Objectives:We compared the effect of aripiprazole, risperidone and quetiapine on the change of psychotic and motor symptoms during 4 weeks in Parkinson disease patients with psychotic feature after levodopa treatment. Methods:Our study included both inpatients and outpatients. Of sixty patients, nineteen patients took risperidone, 21 patients took quetiapine and 20 patients took aripiprazole. Before administration of antipsychotic medications and 4weeks later, we evaluated psychotic symptoms and motor symptoms with Scale for the Assessment of Positive Symptoms(SAPS), Scale for the Assessment of Negative Symptoms(SANS) and motor part of Unified Parkinson’s Disease Rating Scale(UPDRS). Results:After 4 weeks of antipsychotic treatments, the positive symptoms measured by SAPS showed group difference. In the post hoc test, risperidone group and aripiprazole group showed more improvement in positive symptoms scale than quetiapine. The change of motor symptoms measured by UPDRS showed group difference. In the post hoc test, the quetiapine group showed less aggravation in motor symptoms than the risperidone and the aripiprazole group. The aripiprazole group showed less aggravation in motor symptom than risperidone group, but there was no statistical significance. Conclusion:Comparing the effectiveness of three antipsychotics(risperidone, quetiapine and aripiprazole) on the motor and psychotic symptoms in Parkinsonian patients who developed psychotic symptoms after taking levodopa, aripiprazole showed greater improvement in positive symptoms than quetiapine and similar effect with risperidone.

한약투여 및 식이, 운동지도를 통한 소아성장치료의 임상적 관찰

공재철 ( Jae Cheol Kong ),이정한 ( Jeong Han Lee ),고연석 ( Youn Seok Ko ),이유진 ( Eu Gene Lee ),나철 ( Cheol Na ),박단서 ( Darn Seo Park ),송용선 ( Yung Sun Song ),신병철 ( Byung Cheul Shin ) 한방재활의학과학회 2008 한방재활의학과학회지 Vol.18 No.3

Objectives : The aim of this study was to observe and analysis the effectiveness of clinical treatments on the growth of children treated with Korean herbal medicine (KHM). Methods : Forty-two children of growth retardation were evaluated from January 2007 to May 2008. All children were administered KHM with diet and exercise guidance. Height percentile and predictive height were calculated following the General Growth Statistics Result (2007), and compared those of pre-treatment with post-treatment. Results : Thirty-one of them were improved (73.8%) and eleven were not (26.2%). The mean growth rate was 7.2cm/yr for male and 6.8cm/yr for female. The mean growth percentile of male showed 7.6% improvement (p=0.003), female 4.4% respectively (p=0.036). The mean predictive height of male showed 2.2cm improvement (p=0.005), female 1.0cm respectively (p=0.007). Change of growth percentile and predictive height were significantly higher on period of prepuberty, and in small children below 50% of height percentile. About inter-relations between growth improvement and compliance of diet, exercise or medication, meaningful statistics were shown in diet control than the others (p=0.077). Diet compliance was in close connection with exercise, but others were not shown close correlations. Conclusions : These results showed that KHM showed promising results on children growth and healthy diet would be an important factor for growth of children. And it was recommended that KHM should be applied on period of prepuberty and smaller than average height.

혈관내피세포에서 curcumin이 ICAM-1 및 VCAM-1발현에 미치는 효과

김경수 ( Kyeong Su Kim ),나철 ( Cheol Na ),신병철 ( Byung Cheul Shin ),권영달 ( Young Dal Kwon ),송용선 ( Yung Sun Song ) 한방재활의학과학회 2008 한방재활의학과학회지 Vol.18 No.1

목 적 : 동맥경화 유발에 있어서 중요한 역할을 수행하는 부착분자는 혈관내피세포가 염증성 물질에 자극 받아서 생성된다. 본 연구는 항염증성 curcumin이 혈관내피세포 부착분자 발현에 미치는 효과를 조사하였다. 방 법 : 혈관내피세포는 HUVEC을 사용하였고, 염증성 물질 TNF-α로 자극하였다. 결 과 : Curcumin은 부착분자 VCAM-1 및 ICAM-1 발현을 억제시켜, 혈관내피세포에 백혈구가 부착되는 것을 억제하였다. Curcumin은 ICAM-1 및 VCAM-1 promoter 활성을 억제하였고, 또한 억제 kB의 인산화를 차단하였다. Curcumin은 NF-kB p65의 핵내 이동을 차단하였고, 세포내 ROS 양을 감소시켰고, JNK 및 p38 인산화를 억제시켰다. 그러나 curcumin은 TNF 수용체 I 및 II에 어떠한 영향도 미치지 못했다. 결 론 : Curcumin이 NF-kB 비활성화 및 p38과 JNK의 기능저하를 매개로 VCAM-1 및 ICAM-1의 발현을 억제할 수 있음을 알 수 있었다.

흰쥐 좌골신경 압좌 손상 후 독활탕(獨活湯) 및 중성어혈약침(中性瘀血藥鍼)이 통증 억제와 신경 재생에 미치는 효과

송정섭 ( Jeong Seob Song ),나철 ( Cheol Na ),신병철 ( Byung Cheul Shin ),이수경 ( Su Kyung Lee ),권영달 ( Young Dal Kwon ),송용선 ( Yung Sun Song ) 한방재활의학과학회 2008 한방재활의학과학회지 Vol.18 No.2

Objectives : The purpose of this study was to identify the effect of Dokwal-tang(Duhuo-tang) and Jungsongouhyul Pharmacopuncture on pain control and nerve regeneration after crush injury in rat sciatic nerve. Methods : Animal model was produced through right sciatic nerve crush injury and they were randomly divided into four groups; Group I: no treatment control group; Group II: experimental group treated with Dokwal-tang(Duhuo-tang); Group III: experimental group treated with Jungsongouhyul Pharmacopuncture; Group IV: experimental group treated with Dokwal-tang(Duhuo-tang) and Jungsongouhyul Pharmacopuncture. For the pain assessment, this study was observed the paw withdrawal latency(PWL) and immunoreactivity on the substance-P. For the nerve regeneration assessment, the sciatic functional index(SFI) and immunoreactivity on the GAP-43 were measured. Results : 1. In the pain assessment, the PWL of experimental groups were significantly higher than control group and group IV was significantly higher than other groups. 2. In immunohistochemical response of substance-P, as time passes, all groups had decreased immunoreactivity gradually. Specially, group IV was observed the lowest immunoreactivity. 3. In the assessment of SFI, the SFI of experimental groups were significantly higher than control group. 4. In immunohistochemical response of GAP-43, all groups had higher GAP-43 immunoreactivity at the 14 days from post-injury and at the all days, control group was observed most lower immunoreactivity and group IV was observed most higher immunoreactivity. Conclusions : These results of this study suggest that Dokwal-tang(Duhuo-tang) and Jungsongouhyul Pharmacopuncture was related with pain inhibition and motor nerve recovery, and decreased substance-P expression and increased GAP-43 expression after sciatic nerve crush injury.

가족력 유무에 따른 여성 알코올 중독자의 임상적 차이 연구

남범우,박두병,신광철,나철 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.6

저자는 1990년 7월 1일부터 1995년 6월 30일까지 정신과에 입원한 여성 알코올중독환자 38 명을 대상으로 여성 알코올 중독자의 임상적 특성을 가족력 유무에 따라 비교 분석하여 타 연구 결과와 비교하고 여성 알콜중독의 특징과 관련하여 고찰하였다. 연구결과를 요약하면 다음과 같다. 1) 연구 대상 38명의 환자중 가족력이 있는 군은 11명(28.9%)이었으며 가족력이 없는 군은 27명(71.1%)이었다. 2) 가족력이 있는군이 가족력이 없는 군에 비해 낮은 평균 연령, 높은 기혼 비율, 높은 알코올 의존의 비율, 높은 응급입원 비율, 조기 음주 시작, 장기간의 음주기간, 빈번한 입원, 높은 진전 섬망의 비율, 높은 우울장애의 비율을 보였으나 결혼 상태를 제외하고는 모두 통계적인 유의성은 없었다. 3) 양군 모두 교육수준 및 사회경제력 수준이 비교적 낮은 것으로 나타났다. 4) 양군 모두 병발 질환으로 우울 장애와 간 질환이 가장 많았다. Sex is major risk factor for alcoholism in every culture. In virtually all societies, there is more male than female drinking. It has been suggested that the group of familial alcoholis had more severe clinical pictures of alcoholism, more frequently diagnosed as personality disorders, worse academic and social functioning, more severe physical complication and lower socioeconomic status. Thus the authors intended to compare 38 women alcoholis who had been admitted to department of psychiatry from July 1st 1990 to June 30th 1995 according to their family history of alcoholism. The results were follows: 1) The group with family history were 11(28.9%) and the group without family history were 27(71.1%). 2) The group with family history showed to have lower mean age, higher married state, more diagnosis of alcohol dependence, more emergent admission, younger onset age of drinking, longer duration of drinking, more frequent hospitalization, and higher rates of delirium tremens and depressive disorder, compared to the group without family history. But there was no statistically significant difference except marital status. 3) The level of education and socioeconomic state were relatively low in both groups. 4) Depressive disorder and liver disease were associated most frequently in both groups.

頭痛에 관한 精神醫學的 硏究

羅澈,李吉弘,李在光,奇柏錫,李在禹,兪英植,李永植 서울醫大 1990 精神醫學 Vol.15 No.3

정신분열병에 대한 리스페리돈의 효과 및 안정성(장기투여연구)

이민수,김용구,강병조,김광수,김영훈,김희철,나철,노승호,백인호,연병길,오병훈,윤도준,윤진상,이종범,이철,전태연,정인과,정인원,지익성,채정호,한상익,서광윤 대한신경정신의학회 1999 신경정신의학 Vol.38 No.1

연구목적 : 정신분열병의 환자에서 리스페리돈의 장기 치료 효과와 안전성을 조사하기 위해 다기관 개방 연구를 시행하였다. 방 법 : DSM-Ⅳ 진단기준에 의거하여 정신분열병으로 진단된 환자중 리스페리돈 장기투여에 동의한 환자 116명을 대상으로 하였다. 임상 시험전에 연구자들을 대상으로 PANSS workshop을 통해 PANSS, ESRS에 대한 표준화 작업으로 평가기간 신뢰도를 높였다. 1주일간의 약물배설기간후 리스페리돈을 56주간 투여하였으며, 기준점, 8주후, 16주후, 24주후, 32주후, 40주후, 48주후 56주후에 평가되었다. 용량은 제 1일에는 리스페리돈 1㎎씩 1일 2회, 제 2일에는 2㎎씩 2회, 제 3-7일에는 3㎎씩 1일 2회 투여하였고, 이후 환자의 임상 상태에 따라 임의로 증량하였으며, 최대 일일 16㎎을 초과하지 않도록 하였다. 임상증상과 부작용은 PANSS, ESRS, CGI로 평가되었다. 결 과 : 116명중 87명(75%)이 56주의 장기연구를 완결하였다. 치료종결시점인 56주후 PANSS 총점수가 20% 이상 호전된 환자는 87명중 80명(92.0%)이었다. PANSS 총점수는 기준점, 투여 8주후, 16주후, 24주후, 32주후, 48주후에서 각각의 시점사이에 유의한 감소를 보였다. PANSS 양성증상, 음성증상, 일반정신병리점수에서 8주후, 16주후, 24주후, 48주후 각각의 시점사이에 유의한 감소를 보였다. ESRS에서 연구기간동안 모든 항목에서 유의한 변화를 보이지 않았다. 활력징후, 일반혈액학, 생화학, 심전도검사에서 유의한 변화는 없었으나, 체중에서 유의하게 증가하였다. 결 론 : 다기관 개방연구를 통해 정신분열증 환자에 대한 리스페리돈의 장기투여는 양성증상뿐만 아니라 음성에도 효과적이며, 추세외로 부작용이 적었고, 안전하였다. Objectives : The purpose of this study was to evaluate the long-term efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Methods : This multicenter open label study included 116 schizophrenic patients drawn form 19 university hospitals. After a wash-out period of 1 week, the patients were treated with risperidone for 56 weeks and evaluated at 8 points : at baseline, and the 8th, 16th, 24th, 32th, 40th, 48th, 52th weeks of treatment. The dose was started at 2㎎ of risperidone on day 1, and increased to 4㎎ on day 2, and 6㎎ on day 3 - 7 and adjusted to a maximum of 16㎎/day according to the individual's clinical response. The psychiatric and neurological status of the patients was assessed by PANSS. CGI, and ESRS scales. Results : Eighty-seven(75%) of 116 patients completed the 56-week trial risperidone. Clinical improvement(as defined by a 20% of reduction in total PANSS score at end point) was shown by 92.0% of the patients. The mean dose of risperidone was 5.0㎎/day in the 56 week follow-up. PANSS total scores showed significantly improvements between consecutive two points at baseline, 8th, 16th, 24th, 32th, and 48th week of treatment. CGI scores showed significant reductions between consecutive two points at baseline, 8th, 16th, 24th, and 48th weeks of treatment. There PANSS factors(positive, negative, general) showed a significant improvement from the 8th week of treatment, and, after then, remained improved in the rest of the study period. ESRS showed to no significant change the 56 week trial. Laboratory parameters showed no signifiant changes during the course of treatment. Conclusion : This multicenter long-term open study suggests that risperidone is a antipsychotic drug with long term efficacy safely in the treatment of schizophrenic patients.

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.