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입원 환자의 섬망 치료에서 멜라토닌의 효과에 관한 후향적 연구
양정우,김종우,강원섭,이상민,김영종,백종우 한국정신신체의학회 2018 정신신체의학 Vol.26 No.2
Objectives:Delirium is one of the most common mental illnesses that can affect cognitive function. Melatonin has been shown to be effective in the treatment of insomnia, and recent studies have shown a protective effect to prevent delirium. This study was conducted to investigate the efficacy of melatonin in delirium patients. Methods:All patients were referred to psychiatric department for insomnia and symptoms of delirium, and were diagnosed delirium by the DSM-5 diagnostic criteria. We compared base line severity of delirium with KDRS- R-98-R (Korean version of Delirium Rating Scale revised 98) and after taking 2mg of melatonin, retrospectively. The side effects were also identified by referring to the medical records. Results:A total 21 patients had taken melatonin for insomnia and delirious symptoms. The K-DRS-R-98 scores were decreased from 15.24±2.64 before treatment to 6.57±5.42 after treatment. And CGI-S scores were also decreased from 4.14±0.48 before treatment to 2.81±0.93 after treatment (p<0.05). Conclusions:This study illustrates the possibility of melatonin as an effective treatment option for delirious symptoms such as disorientation, motor agitation, lability of affect and hallucinations as well as insomnia, with less concerns of drug side effect. Further study with a larger sample and prospective design will be required to confirm these results. 연구목적: 섬망은 신체 질환과 같은 기저 의학적 상태의 변화에 의해 나타나는 뇌의 기능장애로 환자의 사망률을 높이고 치매의 위험도를 높이는 등 불량한 예후와 연관되어 있다. 기존 섬망의 치료에 주로 사용된 항정신병약제는치료 효과에 대한 논란이 있으며 추체외로 부작용 등에 대한 우려가 있다. 따라서 수면 주기 조절 및 섬망 예방효과가 있는 것으로 알려진 멜라토닌 투여를 통해 섬망 호전 정도와 안전성을 조사하고자 하였다. 방 법: 불면을 동반한 섬망 증상으로 정신건강의학과에 진료 의뢰되어 멜라토닌 2mg을 투여 받은 환자를 대상으로 의무기록을 통해 섬망 증상의 초기 중증도 및 멜라토닌 투여 후의 섬망 증상 변화 여부를 한국판 섬망 평가척도-98 개정판(K-DRS-R-98)과 CGI-S를 통해 확인하였으며 부작용을 검토하였다. 결 과: 총 21명의 환자가 불면을 동반한 섬망 증상으로 멜라토닌을 투여받았다. K-DRS-R-98 심각도 점수는 투약전 15.24±2.64에서 투약 후 6.57±5.42로 감소하였으며 CGI-S 점수는 4.14±0.48에서 2.81±0.93로 감소하였다(p<0.05). 의무기록 상 부작용은 관찰되지 않았다. 결 론: 약물의 기전 상 추체외로 증상과 QTc연장 등의 문제를 유발하지 않는 멜라토닌의 사용은 보다 안정성을
오승영,김종우,강원섭,백종우,반건호,송지영 대한우울조울병학회 2014 우울조울병 Vol.12 No.3
Objectives : Several studies suggested that major depressive disorder (MDD) with psychotic features might be a distinct disease in several clinical features. Therefore, we investigated the clinical features of the inpatients with MDD with psychotic features at a university hospital in Korea. Method : We performed a retrospective analysis of 79 patients who had ever been hospitalized as DSM-IV-TR MDD with psychotic features in a University Hospital from 2002 to 2012. We investigated and analyzed several clinical aspects, such as diagnostic changes, concomitant psychotic symptoms, family histories, and suicidal attempts from the medical records of the patients. Results : Among 79 patients whose initial diagnoses were MDD, 70 (88.6%) were not changed, 6 (7.6%) shifted to Bipolar disorder and 3 (3.8%) shifted to Schizophrenia. In the two groups, persisting MDD and shifting to other diagnoses, significant differences were found in the follow-up duration and the number of hospitalization. In the whole patients, 35 patients (44.3%) had hallucinations, 70 patients (88.6%) had delusions, 25 patients (31.6%) had family histories and 38 patients (48.1%) had suicidal ideations. Conclusion : The diagnostic stability of MDD with psychotic features was slightly higher than previous researches. The follow-up duration and the number of hospitalization were significant predictors associated with diagnostic shift.
일대학 대학생 및 교직원의 정신건강의학과 개명에 대한 웹기반 조사
심재현,박재옥,백종우,김종우,송지영 대한신경정신의학회 2012 신경정신의학 Vol.51 No.3
Objectives: Psychiatric patients had less access to psychiatric care due to a stigma associated with psychiatric care. However there have been numerous efforts to break down the stigma. One of them was to change the name of the discipline to Mental Health Medicine, which was established nationwide in August, 2011. Authors try to understand the change of concepts by according to the change of the name of psychiatry. Subjects consisted of undergraduate and graduate students, and university faculty members. Methods: The survey was conducted by the Kyung Hee University mass e-mail system. Mails were delivered to the undergraduate and graduate students, and university faculty members. The contents of the survey consisted of questions regarding awareness of the name change (psychiatry->mental health medicine), positive or negative impressions of the name change, psychiatric history, and eligibility of access to the psychiatric clinic. Results: Most respondents were not aware of the name change (90.8%), however they generally responded to the changed name positively (92.7%). Also they responded that by changing the name, the possibility of the easy access to psychiatric treatment would be expected. The undergraduate students group, the graduate students group, and the below 22 year old group responded more favorably to the name change compared to the faculty group and the above 22-year-old group. They also responded positively to the improvement of easy access to psychiatric treatment. However, regarding the effects of the name change on deciding to receive the psychiatric treatment, only small numbers were agreed to accept treatment. Conclusion: This survey showed that the less-than-22-year-old group, undergraduate students group, and graduate students group thought more positively to the name change (psychiatry->mental health medicine) compared to the group of more than the 22 years old and the faculty group. However, only small numbers of those groups answered that they can visit and receive psychiatric treatment when they are needed. One of the reasons they are reluctant to receive psychiatric care is due to the concern of the discrimination in employment and insurance coverage. Campaigns against stigmas for the psychiatric care via the proper method and time are needed nationwide, and should be enhanced. Practical policy should be re-established. 이 연구는 정신건강의학과로의 개명에 대한 인식도를 대량 이메일 설문 조사를 통해 조사하였다. 그 결과 일반대학생들은 여전히 정신질환에 대한 편견이 존재한다라고 생각하고 있었다. 설문 응답자 대부분(90.8%)은 정신건강의학과로의 개명 사실에 대해 인식하지 못하고 있었다. 그리고 정신건강의학과로의 개명에 대해 호의적(92.7%)이었으며, 정신질환의 치료의 문턱을 낮추는데 도움을 줄 것이라고 생각하였다. 그렇지만 보다 젊은 층에서는 실제로 치료를 받을것이라는 비율이 나이 많은 군보다 낮게 측정이 되었다. 이는 정신질환자는 취업에서 불이익이 있을 수 있다는 생각과,보험 가입 등에서 실제적인 차별이 있을 것이라는 인식에기인할 수 있다. 이를 개선하기 위하여 향후 정부나 학회 차원에서의 적극적인 편견 퇴치 운동 및 보험 정관에서 정신질환자에 대한 불합리란 제한이 해소될 수 있는 등의 실질적인 보완책이 필요할 것으로 생각한다.
박찬민,강원섭,김종우,백종우,김영종,전준희,이미애,김재광,송지영 대한신경정신의학회 2017 PSYCHIATRY INVESTIGATION Vol.14 No.2
Objective: We assessed the cumulative conversion rates (CCR) from minor cognitive impairment (MCI) to dementia among individuals who failed to participate in annual screening for dementia. Additionally, we analyzed the reasons for failing to receive follow-up screening in order to develop better strategies for improving follow-up screening rates. Methods: We contacted MCI patients who had not visited the Dongdaemun-gu Center for Dementia for annual screening during the year following their registration. We compared the CCR from MCI to dementia in the following two groups: subjects registered as having MCI in the Dongdaemun-gu Center for Dementia database and subjects who failed to revisit the center, but who participated in a screening test for dementia after being contacted. The latter participants completed a questionnaire asking reasons for not previously visiting for follow-up screening. Results: The final diagnoses of the 188 subjects who revisited the center only after contact were 19.1% normal, 64.9% MCI and 16.0% dementia. The final diagnoses of the 449 subjects in the Dongdaemun-gu Center for Dementia database were 25.6% normal, 46.1% MCI and 28.3% dementia. The CCR of the revisit-after-contact group was much lower than anticipated. The leading cause for noncompliance was “no need for tests” at 28.2%, followed by “other reasons” at 23.9%, and “I forgot the appointment date” at 19.7%. Conclusion: Considering the low dementia detection rate of the group who revisited only after contact and the reasons they gave for noncompliance, there appears to be a need for ongoing outreach and education regarding the course and prognosis of MCI.
우울증으로 오진되었던 이차성 부신기능저하 : 증례 보고
문덕수,강원섭,백종우,송지영,김종우,Moon, Duk-Soo,Kang, Won-Sub,Paik, Jong-Woo,Song, Ji-Young,Kim, Jong-Woo 한국정신신체의학회 2011 정신신체의학 Vol.19 No.2
연구목적: 시상하부-뇌하수체-부신 축의 이상은 다양한 정신과적 증상과 연관이 있으며, 우울 증상도 나타날 수 있다. 저자들은 뇌하수체 기능저하 및 이차성 부신기능저하와 연관된 두통, 무의욕, 무기력, 정신운동 저하, 식욕 저하, 불면 및 걱정 등의 우울 증상을 주소로 정신과에 입원한 71세 남자 환자에 대해 증례 보고하고자 한다. 환자는 정신과 입원 후 두통, 불면, 불안 및 소화기 증상은 호전되었으나, 무기력감은 지속되었다. 퇴원 후 고열 및 의식 혼탁으로 감염내과에 재입원을 하였으며, 부신기능 저하소견을 동반한 범뇌하수체기능저하증이 진단되었고, 코티졸 투여로 전반적인 증상이 호전되었다. 뇌하수체 기능저하에 따른 갑상선 기능저하, 부신기능저하, 성장호르몬 저하 등은 무기력, 피곤, 불면, 체중 감소, 식욕 저하 등의 여러 가지 비특이적 증상들을 나타내고, 임상에서 이러한 비특이적 우울 증상을 가진 환자의 경우, 내분비 질환에 대한 감별이 필요하다. The abnormalities in Hypothalamic-pituitary-adrenal(HPA) axis are associated with many psychiatric symptoms including depression. We present a report of a 71 year old man who was admitted to the psychiatric department presenting symptoms of headache, avolition, loss of energy, psychomotor retardation, poor appetite, insomnia, anxiety resulting from adrenal insufficiency and hypopituitarism. Hypothyroidism and electrolyte disturbance were managed and headache, insomnia, anxiety, GI symptoms were improved. But he remained in anergic state. After discharge, he was readmitted to infection department with high fever and drowsy mentality. Adrenal insufficiency was recognized and he was treated with corticosteroid replacement therapy. Finally his diagnosis was made as panhypopituitarism and overall symptoms were resolved. In this case, we showed how the atypical symptoms resulting from hypopituitarism develop and progress. Hypothyroidism, adrenal insufficiency, and growth hormone deficiency resulting secondarily from panhypopituitarism were associated with various nonspecific symptoms such as loss of energy, fatigue, insomnia, weight loss, decreased appetite etc. In clinical situation, differential diagnosis with depression is needed when clinicians were met a patient with these nonspecific symptoms. It is important that laboratory tests and differential diagnosis with endocrine diseases should be conducted, especially in geriatric patients with nonspecific symptoms like anergia, fatigue, poor appetite and so on.
일 대학병원에서 5개년간 섬망의 발생 및 치료 경향의 변화
배재호,강원섭,백종우,김종우,Bae, Jae Ho,Kang, Won Sub,Paik, Jong Woo,Kim, Jong Woo 한국정신신체의학회 2012 정신신체의학 Vol.20 No.2
연구목적 : 섬망은 의식 수준과 인지기능 변화로 인해 사고, 언어, 행동, 수면 양상 등에 갑작스러운 지장을 초래하는 장애로 정의된다. 본 연구의 목적은 최근 5개년간 일 대학병원의 정신과로 자문 의뢰된 섬망 환자들의 특성과 치료 방법을 분석하여 향후 섬망 연구에 있어 기초 자료를 제공하고 섬망의 발생과 치료에 변화가 있었는지 알아보고자 하는 것이다. 방 법 : 2007년 1월부터 2011년 12월까지 서울 회기동 소재의 경희대학교 병원에서 정신과로 자문 의뢰된 환자를 대상으로 섬망으로 진단된 475명의 환자의 의무기록을 후향적으로 검토하여 환자의 성별, 연령, 의뢰과, 의뢰 이유, 섬망의 원인, 섬망의 분류, 의뢰의의 오진율, 치료 방법, 처방 약물 종류 등을 조사 및 분석하였다. 결 과 : 5년간 섬망으로 진단된 475명의 환자 중 남성이 61.7%로 여성보다 더 많았다. 섬망 환자를 정신과로 의뢰하게 된 이유는 수면 장애가 80.8%로 가장 많았고 섬망이 발생한 원인으로는 수술 후 섬망이 30.9%로 가장 많았다. 전체 치료 건수 중 약물 처방이 76.6%이었으며 연도에 따라 유의하게 증가하는 양상을 보였다. 약물 처방 건수 중 항정신병 약물의 사용 빈도는 76.4%였으며 항정신병 약물중 Quetiapine의 사용 비율이 46.8%으로 가장 높았다. 그리고 타과 의뢰의가 섬망의 진단을 놓치게 된 이유는 환자가 이전에 치매를 진단받았을 경우가 6.8%로 가장 많았다. 결 론 : 근 5개년간 일 종합병원에서 정신과로 의뢰되는 섬망은 수술 후 발생하는 경우가 가장 많았고 약물 처방율이 높아지는 추세였다. 환자에게 이전 치매 병력이 있을 경우 섬망이 아닌 다른 질환으로 오진되기 쉬웠다. 본 연구를 통해 섬망의 임상 증상 및 원인, 의뢰 이유, 치료 경향에 대해 평가하고, 수면 주기의 변화에 대한 주의를 기울이며, 수술 후 섬망에 대한 예방전략 수립 및 약물 치료에 따른 치료 근거를 확립하는데 의의를 둘 수 있을 것이다. Objectives : Delirium is a disorder defined as a sudden disturbance in thinking, speaking, acting and sleep pattern due to altered level of consciousness and cognitive function. The objective of this study is to analyze characteristics and therapeutic methods of the delirious patients during the recent 5 years, and provide basic data for further studies and investigation regarding delirium in the occurrence and treatment. Methods : We retrospectively reviewed medical records of 475 patients who were consulted for delirium in Kyunghee University Medical Center from January 2007 to December 2011. Results : During the 5 years, among the 475 patients who were diagnosed as delirium, men were more common(61.7%). The most commonly consulted reason and cause were sleep disturbance(80.8%) and post-operational delirium(30.9%), respectively. The medication prescription percentage was 76.6% and was significantly increased year after year. Ratio of using antipsychotics were 76.4% among prescribed medication and the most frequently prescribed antipsychotic drug was quetiapine(46.8%). Other specialists commonly misdiagnosed delirium when the patient was previously diagnosed as dementia(6.8%). Conclusions : In our study, post-operational delirium was the most commonly referred reason and the percentage of medication prescription tended to increase. Patients with history of dementia were more easily misdiagnosed as diseases other than delirium. Our study suggests that we should evaluate symptoms, causes, reasons of consultation, management tendency of delirium. We should also closely observe changes in sleep patterns and establish the prevention strategies for post-operational delirium and therapeutic bases for pharmacotherapy.
정신분열병 환자에서의 병식과 사회적 단서 인식능력간의 관계 연구
문수진 ( Su Jin Moon ),박정수 ( Jeong Soo Park ),이원혜 ( Won Hye Lee ),김종우 ( Jong Woo Kim ),백종우 ( Jong Woo Paik ),송지영 ( Ji Young Song ) 한국정신병리진단분류학회 2010 精神病理學 Vol.19 No.1
Objective: In the patients with schizophrenic disorder, lack of insight might have a direct effect on the prognosis and which lead to an overall decline in his social cue perception. And, the social cognition abilities in the schizophrenic patient, especially the perception of emotions, are proposed as important variant factors in his/her handicap in social function. However, there is currently a lack of studies that directly explore the relationship between insight and social cue perception, and no relationships between the two have been established. This study seeks to focus on the relationship between the schizophrenic patient`s abilities in the perception of emotion and his/her insight. Methods: In this study, a total of 29 subjects, all of whom were patients that had been diagnosed with schizophrenia, were evaluated with the Korean version of the SUMD-K(The Scale to Assessment Unawareness of Mental Disorder: Korean Version), a method recognized in its validity and reliability to measure the subjects` insight. To measure the social cue perception of the subjects, the study utilized an evaluation method called the Korean-Social Cue Recognition Test-Revised(K-SCRT-R), which uses 8 stages: positive-middle arousal, positive-high arousal, negative-middle arousal, and negative-high arousal to assess the subjects. Results: There seemed to be no correlation between the SUMD-K score and age, years of education, IQ, and the negative symptom score in PANSS. However, the SUMD-K score had a moderate positive correlation with the positive symptom score in PANSS(r=.419, p<.05), and a significant negative correlation with the GAF score(r=-.568, p<.01). The score in negative-high arousal, a part of K-SCRT-R, had a significant negative correlation with the negative symptom score of PANSS(r=-.518, p<.01). Particularly, the SUMD-K score showed a significant negative correlation with the negative-high arousal stage(r=-.501, p<.01). Conclusion: Although for schizophrenic patients, the more severe the positive symptoms are, the more they suffer from lack of insight, there was no direct correlation between the positive symptom and the social cue perception ability. However, out of the social cue perception abilities, the decrease in perception ability in the negative high-arousal stage had a high correlation to the lack of insight, and the negative symptoms also had a high correlation with the perception ability in the negative-high arousal stage. Therefore, even though the severity of positive symptoms is related directly to the lack of insight, it did not show a direct relation to the decline in social cue perception ability. Rather, considering that the severity of the negative symptom, which has no direct relation to the lack of insight, has a strong relation to the decline in social cue perception abilities in the negative-high arousal stage, the schizophrenic patient`s social cue perception ability, especially his ability in the negative-high arousal stage, is likely to be due to the structural changes in the brain that result in negative symptoms and decline of insight.