인터넷 시대와 정신과

박원명(Won-Myong Bahk),배치운(Chi-Un Pae) 대한사회정신의학회 2001 사회정신의학 Vol.6 No.1

1999년도의 인터넷 사용자는 1억 6천만 명, 연간 e-mail 사용 회선은 2조 7천만번, 건강 관련 websites는 10만개에 달하였으며, 2002년에는 인터넷 사용자가 전세계적으로 3억 명에 달할 것으로 추산될 정도로 computer를 이용한 정보의 공급과 소비는 더욱 늘어날 전망이다. 정신과 영역에서도 인터넷의 보급은 확산 일로에 있지만 정신과 영역에서 장점과 위험성 등 그 잠재성은 정확하게 알려져 있지 않다. 또한, 인터넷은 수많은 환자와 정신과 의사가 무한의 정보를 교류할 수 있는 영역이며 동시에 비밀 유지(confidentiality), 환자와의 소통방법 변화, 임상적 적용과 관련된 적절한 software의 개발 필요성 등 변화에 적절히 대응해야할 요소가 많으므로 본고에서는 Internet communication의 model, 정신과 영역에서 최근 대두되고 있는 인터넷으로 인한 부정적인 영향, 정신과적 적용과 한계, 그리고 미래 등을 문헌과 online 검색을 통하여 소개하려고 한다. In 1999, the internet had 160 million users world wide, the number of websites related to health is 100000, and with 2.7 trillion e-mail messages sent annually. By the year 2002 it is anticipated that there will be 300 million internet users. At present, with increasing the internet services, but there is no accurate information and knowledge of internet application in psychiatry. Additionally, internet is the communicative field of many psychiatrists and patients, and has some problems including confidentiality, change of communication with patients, need of software related to clinical practice, and so on. According to recent trends, in this article authors want to introduce potential risks and adverse events, model of internet communication, the drawbacks and application to psychiatric area, and the future by journal review and online search.

거미낭으로 일과성 정신병 유발이 의심되고 리스페리돈 치료에 효과적이었던 증례

박원명,배치운,전태연,김광수,유태열,Bahk, Won-Myong,Pae, Chi-Un,Jun, Taeyoun,Kim, Kwang-Soo,Lew, Tae-Yul 대한생물정신의학회 2001 생물정신의학 Vol.8 No.1

There had been few reports of arachnoid cyst accompanying psychiatric disturbance and no report treated with low-dose risperidone administration. We report a patient, developed first-transient psychotic episode considered to be provoked by an arachnoid cyst, responsive to risperidone, which was found in the middle cranial fossa as follows. A 57-year-old man was admitted by suddenly developed headache, auditory hallucination, delusion of persecution and, an arachnoid cyst in the anteromedial aspect of middle cranial fossa was found on MRI after admission. The psychotic episode was first to him and he was also negative to other clinical evaluation including endocrine abnormality, his psychotic symtom was suspected to be induced by arachnoid cyst and was well controlled to low-dose risperidone administration. He left hospital free from psychotic symptoms on 14 hospital days.

우울장애 아형간에 Isoproterenol 자극후 임파구 Cyclic AMP Levels의 차이

박원명,전양환,김광수,성양숙,Bahk, Won-Myong,Jeon, Yang-Whan,Kim, Kwang-Soo,Sung, Yang-Sook 대한생물정신의학회 1996 생물정신의학 Vol.3 No.1

주요 우울장애 환자와 기분부전장애 환자에서 정상대조군과 비교하여 임파구에 isoproterenol 자극 후 cyclic AMP 생성반응에 차이가 있는지를 알아보고, 이 두 질환군에서 net cyclic AMP levels와 우울정도간의 상관성을 알아보고자 주요 우울장애군 8명, 기분부전장애군 9명, 정상대조군 10명을 대상으로 본 연구를 시행하였다. Cyclic AMP 농도는 방사면역 측정법 (radioimmunoassay)으로 측정하였다. 결과를 요약하연 다음과 같다. 1) HDRS 정수상 주요 우울장애군이 기분부전장애군보다 유의하게 우울정도가 높았다. 2) Isoproterenol 자극전 basal cyclic AMP levels는 정상대조군, 주요 우울장애군, 기분부전장애군간에 차이가 없었다. 3) Isoproterenol $10^{-5}mol/L$ 자극후 net cyclic AMP levels는 정상대조군 주요 우울장애군, 기분부전장애군간에 유의한 차이를 보였다. 4) 주요 우울장애군에서 isoproterenol $10^{-5}mol/L$ 자극후 net cyclic AMP levels와 HDRS 점수간에 유의한 역상관관계를 보였으나, 기분부전장애군에서는 상관관계를 보이지 않았다. 이상의 결과로 저자들은 기분부전장애가 임상적으로는 주요 우울장애의 우울정도가 경미한 한 형태로 보이지만 생물학적으로는 이들 두 질환이 다른 질환일 수 있다고 생각하였다. This study was designed to examine the basal cyclic AMP levels and the $10^{-5}mol/L$ isoproterenol-stimulated cyclic AMP levels of lymphocytes, by which ${\beta}$-adrenoceptor function was shown, between to normal controls and 17 drug free patients(8 major depresive patients and 9 dysthymic patients), who were diagnosed by DSM-III-R. The severity of depression was assessed by Hamilton Rating Scale for Depression (HDRS). Cyclic AMP levels were measured by radioimmunoassay(double antibody). The results were as follows ; 1) HDRS score was significantly higher in major depressive patients($41.8{\pm}4.6$) than in dysthymic patients($24.0{\pm}4.2$)(p<005). 2) There was no Significant difference in basal cyclic AMP levels among normal controls($3.9{\pm}1.7pmol/10^6cells/10min$), major depressive patients($2.1{\pm}0.5pmol/10^6cells/10min$), and dysthymic patients($3.9{\pm}1.8pmol/10^6cells/10min$). 3) There was significant difference in net cyclic AMP levels($10^{-5}mol/L$ isoproterenol-stimulated cyclic AMP levels minus basal cyclic AMP levels) among normal controls($16.5{\pm}6.0pmol/10^6cells/10min$), major depressive patients($3.0{\pm}1.4pmol/10^6cells/10min$), dysthymic patients($10.9{\pm}4.4pmol/10^6cells/10min$)(p <005). 4) The net cyclic AMP levels were significantly correlated with HDRS scores in major depressive patients(${\gamma}=-0.8^6$, p<0.05), but not in dysthymic patients(${\gamma}=0.43$, p=0.25). In conclusion, we suggested that the dysthymic disorder might differ from the molar depressive disorder not only in the severity of depressive symptoms but also in ${\beta}$-adrenergic responsiveness of lymphocytes, which was regarded as a biological marker of depressive disorder.

한국형 우울장애 약물치료 알고리듬 2021 (IV) : 여성 및 노인

왕성민(Sheng-Min Wang),박원명(Won-Myong Bahk),우영섭(Young Sup Woo),서정석(Jeong Seok Seo),박영민(Young-Min Park),김원(Won Kim),정종현(Jong-Hyun Jeong),심세훈(Se-Hoon Shim),이정구(Jung Goo Lee),장승호(Seung-Ho Jang),양찬모(Chan-Mo Y 대한신경정신의학회 2021 신경정신의학 Vol.60 No.4

Objectives An expert consensus guideline for the treatment of depressive disorder, the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD), was first established in 2002 and updated in 2017. To provide an up-to-date treatment guideline, KMAP-DD 2021 was recently completed. This study was undertaken to provide a guideline for the treatment of depressive disorder in a selected population that included females and elderly. Methods The survey conducted consisted of 7 questionnaires for each population, females and elderly, with depressive disorder. A total of 65 of 97 experienced psychiatrists answered the survey. Results For the treatment of premenstrual dysphoric disorder, the selective serotonin reuptake inhibitors, venlafaxine, and desvenlafaxine were recommended as first-line therapies. For major depressive disorder (MDD) during pregnancy, antidepressant (AD) monotherapy was recommended as a first-line therapy for mild to moderate and severe depression, and combined electroconvulsive therapy and AD with atypical antipsychotics (AAP) were recommended as a first-line therapy for severe depression with psychotic features. AD plus AAP was generally recommended for post-partum depression. In elderly with depression, AD monotherapy was recommended as the treatment of choice for mild to moderate episodes, and AD monotherapy and AD plus AAP were recommended as a first-line therapy for severe depression without psychotic features. Lastly, AD plus AAP was chosen as the treatment of choice for psychotic depression. Conclusion Present study provides an updated algorithm for the treatment of females and elderly with depressive disorders. This algorithm provides a practical aid to clinicians for the treatment of females and elderly with MDD.

일 대학병원에서 외상 후 스트레스장애 입원환자의 약물 치료 경향

민정아,정영은,서호준,박원명,전태연,채정호,Min, Jung-Ah,Jung, Young-Eun,Seo, Ho-Jun,Bahk, Won-Myong,Jun, Tae-Youn,Chae, Jeong-Ho 대한불안의학회 2008 대한불안의학회지 Vol.4 No.1

현재 PTSD와 관련한 여러 병태생리 기전들이 밝혀지고 있으며 이에 초점을 둔 다양한 약물치료가 행해지고 있다. 본 연구에서는 일 대학병원에서 PTSD로 진단된 환자들의 의무기록을 검토하여 약물치료의 경향에 대해 알아보았다.1998년 1월부터 2007년 12월까지 DSM-IV에 의해 PTSD로 진단된 입원 환자 75명이 대상군이 되었으며, 이들의 인구학적 요인들, 입원기간, 외상의 종류, 외상 후 경과시간 및 정신과적 공존병리 및 처방 받은 약물을 조사하였다. 조사 결과, 75명 중 남자는 33명, 여자는 42명이었다. 정신과적 공존병리는 총 50명(66.7%)에서 존재하였으며, 우울장애, 인지장애, 정신장애 및 불안장애 순이었다.73명(97%)의 대상군은 항우울제를 처방 받았으며, 그 중 paroxetine이 54.7%로 가장 많았고 두 가지 이상의 항우울제를 처방 받은 경우도 24%였다. 또 거의 대부분의 환자에서 비정형 항정신병약물(33.3%), 기분안정제(17.3%),항불안제(94.7%)가 항우울제와 병용 처방된 것으로 조사되었다. 여러 제한점에도 불구하고 본 연구에서 얻어진 약물 처방 경향은 향후 국내 실정에 맞는 치료 지침을 수립하는 데에 하나의 근거 자료가 될 수 있을 것이다. Objective : Due to a better understanding of the pathophysiology of posttraumatic stress disorder (PTSD) and the relative limitations in the treatment of patients with PTSD, a variety of medications and treatment algorithms for PTSD have been investigated. This study was conducted to investigate the trends in the pharmacotherapy used in the treatment of inpatients with PTSD at a single university hospital in Korea. Methods : Data from 75 patients diagnosed with PTSD according to the DSM-IV criteria from January 1998 to December 2007 were collected. Demographic data and clinical data, including medications prescribed, were investigated. Results : Thirty-three of the 75 subjects included in this study were male, and 42 were female. Considering psychiatric comorbidity, depressive disorder, cognitive disorder, psychotic disorder and anxiety disorder were reported in order. Approximately 97% of the subjects were treated with antidepressants, including paroxetine in 54.7%, and 24% of the subjects were treated with two different kinds of antidepressants. In addition, atypical antipsychotics were prescribed in 33.3% of patients, mood stabilizers in 17.3%, and anxiolytics in 94.7% of the subjects. Conclusion : In our study, various kinds of antidepressants were prescribed for most patients with PTSD. Antipsychotics and mood stabilizers were added to the treatment regimens of some subjects, and anxiolytics were added to the treatment regimens of most subjects. Despite its many limitations, this study shows the prescription pattern and trends in PTSD treatment in Korea. We hope that these preliminary data would be helpful for the development and integration of a practical guideline for the treatment of PTSD in Korea.

리아프노프 지수를 이용한 알쯔하이머형 치매 환자 뇌파의 비선형 역동 분석을 위한 예비연구

채정호,김대진,최성빈,박원명,이정태,김광수,정재승,김수용,Chae, Jeong-Ho,Kim, Dai-Jin,Choi, Sung-Bin,Bahk, Won-Myong,Lee, Chung Tai,Kim, Kwang-Soo,Jeong, Jaeseung,Kim, Soo-Yong 대한생물정신의학회 1998 생물정신의학 Vol.5 No.1

치매에서의 뇌파 연구는 주로 주파수 분석과 지형화 분석을 이용하여 정량화하는 것을 위주로 진행되어 왔으나, 이러한 선형적 분석은 뇌파와 같이 복잡한 신호를 분석하는 것에는 한계가 있었다. 최근 새로운 패러다임인 카오스 이론에 근거를 두고 뇌파를 비선형적으로 측정하는 방법이 소개되고 있다. 본 연구는 알쯔하이머형 치매 환자의 뇌파 신호를 최대 양수 리아프노프 지수를 이용하여 비선형적으로 분석하는 것이 가능한 가를 알아보고 그 결과를 대조군과 비교해보기 위하여 시도되었다. 3명의 알쯔하이머형 치매 환자와 3명의 대조군에서 뇌파 신호를 받아 디지털화한 후에 비선형 분석법 중 하나인 최대 양수 리아프노프 지수를 산출하였다. 알쯔하이머형 치매군은 전체 15개의 전극 부위 중 8곳의 전극 부위에서 대조군에 비하여 유의하게 낮은 최대 양수 리아프노프 지수를 나타내었다. 각 두뇌 영역별 및 반구별 분석에서도 알쯔하이머형 치매군이 대조군에 비하여 전 두뇌 영역에서 최대 양수 리아프노프 지수가 유의하게 낮았다. 이에 따라 알쯔하이머형 치매 환자의 뇌파를 비선형적 분석하여 조사한 이들 두뇌의 카오스적 성상이 감소되어 있다는 것을 확인할 수 있었다. 이 결과는 향후 뇌파의 비선형적 분석인 리아프노프 지수 산출이 두뇌 기능을 조사하는 데에 유용한 새로운 방법이 될 가능성이 있다는 것을 시사한다. The changes of electroencephalogram(EEG) in patients with dementia of Alzheimer's type are most commonly studied by analyzing power or magnitude in traditionally defined frequency bands. However because of the absence of an identified metric which quantifies the complex amount of information, there are many limitations in using such a linear method. According to the chaos theory, irregular signals of EEG can be also resulted from low dimensional deterministic chaos. Chaotic nonlinear dynamics in the EEG can be studied by calculating the largest Lyapunov exponent($L_1$). The authors have analyzed EEG epochs from three patients with dementia of Alzheimer's type and three matched control subjects. The largest $L_1$ is calculated from EEG epochs consisting of 16,384 data points per channel in 15 channels. The results showed that patients with dementia of Alzheimer's type had significantly lower $L_1$ than non-demented controls on 8 channels. Topographic analysis showed that the $L_1$ were significantly lower in patients with Alzheimer's disease on all the frontal, temporal, central, and occipital head regions. These results show that brains of patients with dementia of Alzheimer's type have a decreased chaotic quality of electrophysiological behavior. We conclude that the nonlinear analysis such as calculating the $L_1$ can be a promising tool for detecting relative changes in the complexity of brain dynamics.

주요 우울증에서 Interleukin-10 유전자의 제한효소 절편길이 다형성

전태연,배치운,이정태,박원명,김광수,Jun, Taeyoun,Pae, Chi-Un,Lee, Chung Tai,Bahk, Won-Myong,Kim, Kwang-Soo 대한생물정신의학회 2000 생물정신의학 Vol.7 No.2

Objective : Major depression is known to have immunologic dysfunctions, the recent studies revealed that cytokines including IL-6 and IL-$1{\beta}$ were increased in patients with major depression. Since molecular genetic methods have been progressed, this study was to investigate the relationship between major depression and immunologic aspects by analyzing polymorphism of IL-10 gene. Method : 92 patients with major depression were included and data of 146 normal controls obtained from the Catholic Hemopoietic Stem Cell Information Bank of Korea were used in this study. DNA was extracted from whole blood, thereafter amplified by polymerase chain reaction, and digested by Mae III After that procedure, we obtained and assessed RFLP of two alleles, IL-10T and IL-10C. All data were analyzed by ${\chi}^2$ test. Results : 1) There were no significant difference in genotype frequencies of $IL-10^*T/T$, $IL-10^*T/C$, and $IL-10^*C/C$ between major depression patients group and control group. 2) There were no significant difference in allelic frequencies of $IL-10^*T$ and $IL-10^*C$ between major depression patients group and control group. Conclusion : We did not verified the differences in frequencies of $IL-10^*T/^*IL-10^*C$ gene between the major depression patients group and control group, respectively. But the results of this study do not declare that the IL-10 gene has no association with major depression. We do suggest that further systematic studies including various clinical variables should be conducted.

우울증과 전두엽

채정호,이경욱,양완석,박원명,전태연,김광수,Chae, Jeong-Ho,Lee, Kyung-Uk,Yang, Wan-Seok,Bahk, Won-Myong,Jun, Tae-Youn,Kim, Kwang-Soo 대한생물정신의학회 2002 생물정신의학 Vol.9 No.2

Objectives:Abnormalities in the frontal lobe have been consistently suggested in the pathophysiology of depression. The purpose of this review is to discuss the relationship between the frontal lobe and depression. Methods:Recent researches on the frontal lobe in depression were reviewed and abnormalities in this region were considered within the context of modern functional neuroanatomy. Results:This paper reviewed evidence strongly implicating the frontal lobe as a key brain structure in depression. Conclusion:Taken together, these abnormalities in the function of the frontal lobe implicate interconnected neural circuits in depression and offer suggestions for the themes of future research and treatment. Further research is needed to investigate the association between emotion and the brain in the paradigm of "affective neuroscience".

한국형 우울장애 약물치료 알고리듬 2021 (I) : 주요우울삽화의 치료 전략

우영섭(Young Sup Woo),박원명(Won-Myong Bahk),서정석(Jeong Seok Seo),박영민(Young-Min Park),김원(Won Kim),정종현(Jong-Hyun Jeong),심세훈(Se-Hoon Shim),이정구(Jung Goo Lee),장승호(Seung-Ho Jang),왕성민(Sheng-Min Wang),정명훈(Myung Hun 대한신경정신의학회 2021 신경정신의학 Vol.60 No.3

Objectives The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) is a consensus-based medication guideline. To reflect advances in pharmacotherapy for depressive disorders, we have undertaken a fourth revision of the KMAP-DD. Methods The review committee for the new version of the KMAP-DD (KMAP-DD 2021) included 143 Korean psychiatrists with clinical experience in the field of depressive disorders. Each treatment strategy or treatment option was evaluated with an overall score of nine, and the treatment option was categorized into the three levels of recommendation of primary, secondary, and tertiary. Results The first-line pharmacotherapeutic strategy for mild to moderate major depressive episodes (MDE) was antidepressant (AD) monotherapy. For severe MDE without psychotic features, AD monotherapy or the combination of AD and atypical antipsychotics (AAP) was the first-line strategy. The combination of AD and AAP was recommended as the first-line for the MDE with psychotic features as well. When treatment response to initial AD monotherapy was insufficient, a combination of AAP or another AD was recommended. In the case of unsatisfactory response to initial treatment with an AD and AAP combination, switching to another AAP or adding another AD was recommended. Conclusion Generally, there were no significant changes in the recommendations for MDE management in the KMAP-DD 2021 compared to previous versions. However, it was notable that the preference for the use of AAP and AD with the novel mechanism of action including vortioxetine and agomelatine increased.

공황장애에서 인지행동치료와 약물치료 병합요법의 단기 효과

채정호(Jeong Ho Chae),안희원(Hee Won Ahn),이정준(Jeong Jun Lee),박원명(Won Myong Bahk),전태연(Tae Youn Jun),김광수(Kwang Soo Kim) 한국정신병리진단분류학회 1999 精神病理學 Vol.8 No.2

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