Comparison of Effectiveness between Aripiprazole and Risperidone for Treating Delirium in Hospitalized Patients

Jeong-Kyu Sakong(사공정규),Young-Hoon Han(한영훈),Sung-Won Jung(정성원) 대한생물치료정신의학회 2011 생물치료정신의학 Vol.17 No.1

목적:비전형 항정신병 약물인 리스페리돈이 섬망 치료에서 부작용이 적고 효과적이라고 알려져 있다. 아리피프라졸도 항콜린성 및 추체외로계 부작용이 적은 비전형적 항정신병 약물 중 하나이지만 섬망 치료에 대해 입증된 연구는 적다. 본 연구는 아리피프라졸이 섬망 치료에 대해 효과적인지 조사해 보고자 하였다. 방법:43명의 섬망 환자를 무작위로 2군으로 나누었으며 투약 첫날에는 리스페리돈 1㎎, 아리피프라졸 5㎎을 투여하였으나 둘째 날부터는 임상상태에 따라 자유롭게 용량을 조절하였다. 리스페리돈 환자 27명과 아리피프라졸 환자 16명이 연구에 포함되었으며 이중맹검법을 사용하여 비교하였다. 비교는 치료전과 치료 일주일 Clinical Global Impression-Severity(CGI-S), 한국판 섬망평가척도(Korean version of Delirium Rating Scale ; K-DRS), 간이정신상태검사(Korean Mini Mental Status Examination; K-MMSE), 한국판 섬망평가척도(Korean version of Delirium Rating Scale-Revised-98 ; K-DRS-R-98), 추체외로계증상 평가척도(Extrapyramidal Symptom Rating Scale ; ESRS)의 점수를 사용하였다. 결과:리스페리돈과 아리피프라졸 두군 모두에서 치료 전후의 CGI-S, K-DRS, K-DRS-98의 점수가 통계적으로 의미 있는 차이를 보였다(p<0.05). 하지만 아리피프라졸 치료군의 경우 리스페리돈 치료군에 비해 차이를 보이지는 않았다. 결론:아리피프라졸이 섬망 치료에 있어 리스페리돈과 유사한 효과가 있을 것으로 기대된다.

우울증 환자 가족들의 심리적 스트레스에 관한 연구 : 정신분열병 환자 가족과 비교

김진희,이은정,정성원,성형모,사공정규,김정범,Kim, Jin-Hee,Lee, Eun-Jeong,Jung, Sung-Won,Sung, Hyung-Mo,SaKong, Jeong-Kyu,Kim, Jung-Bum 대한불안의학회 2010 대한불안의학회지 Vol.6 No.1

Objective : This study compared the psychological stresses of depressed patients' families with those of schizophrenic patients' families. We investigated the influence of depressive patients' clinical features and their families' demographic characteristics on the families' depressive symptoms and stresses. Methods : Participants were 23 family members of depressed patients and 20 family members of schizophrenic patients. We measured the patients' clinical features (duration of illness, number of previous hospitalizations, and satisfaction with medication), and each family member's socioeconomic status and psychological characteristics (depressive mood, anxiety, family stress, and stress response), analyzing the data via independent t-test, chi-square test, and correlation and hierarchical multiple regression analyses. Results : The depressed patients' average clinical global impression (CGI) was significantly higher than that of the schizophrenic patients. The depressed patients' family members showed stress responses significantly higher than those of schizophrenic patients' family members. Furthermore, in depressed patients, frequency of hospitalization was positively correlated with family members' stat anxiety. For both patient types, family stress was positively correlated with the patient's severity of illness and the family's state anxiety, trait anxiety, and stress response ; socioeconomic status was positively correlated with the family's depressive symptoms ; the family's state anxiety positively correlated with the family's trait anxiety and stress response ; and the family's trait anxiety positively correlated with the family's stress response. Socioeconomic status predicted the family's depressive symptoms, and socioeconomic, illness severity and stress response predicted family stress. Conclusion : These findings suggest that both depressed patients' families and schizophrenic patients' families suffer from psychological stress. The study data also have important clinical implications, in that families of depressed patients need psychiatric intervention, as well as the patients themselves. In particular, family intervention should focus on psycho-education and stress coping strategies.

일 대학 대학생의 문제 음주 실태 조사와 문제 음주 군의 정서 및 성격 특성 연구

손용표(Yong-Pyo Son),사공정규(Jung-Kyu Sakong),박창중(Chang-Jeung Park),장우영(Woo-Young Jang),곽경필(Kyung-Phil Kwak),이광헌(Kwang-Hun Lee) 대한생물치료정신의학회 2012 생물치료정신의학 Vol.18 No.2

Objectives:Based on the degree of problematic drinking on the early twenties in college students, the study emphasizes the emotional and characteristic traits in anxiety, depression, self-esteem, impulsiveness and stress coping. Methods:The survey has been conducted on 361 college students. It includes “The Korean version of Alcohol Use Disorders Identification Test(AUDIT-K)”, “Beck Depression Inventory(BDI)”, “Beck Anxiety Inventory(BAI)”, “Barratt Impulsiveness Scale(BIS)”, “Self-Esteem Scale(SES)”, “Ways of Coping Checklist(WCCL)”, and “Checklist for Alcohol-induced Problems”. The sample has been classified into two, problematic drinking(AUDIT≥8) and non-problematic drinking (AUDIT<8) groups. The characteristic difference has been analyzed through Chi-square test and t-test. Results:The 60.4 percent of participants have problematic drinking. Male gender and extra-curriculum activities have been related to problematic drinking. Most of alcohol induced problems occur in the group of problematic drinking. The scores of BDI, BAI and BIS are high, and the SES score is low in problematic drinking group. Emotion-focused coping is mostly used for stress coping. Conclusions:Emotional and mental problems caused by problematic drinking in the college students are issued from our study, and therefore, the education for the prevention of alcoholic abuse has come first.

한국판 정신과적 진단 선별 질문지(Psychiatric Diagnostic Screening Questionnaire; PDSQ)의 진단적 타당도

최정식 ( Jeong Shik Choi ),김희철 ( Hee Cheol Kim ),정성원 ( Sung Won Jung ),이은정 ( Eun Jung Lee ),성형모 ( Hyung Mo Sung ),사공정규 ( Jung Kyu Sakong ),신임희 ( Im Hee Shin ),김정범 ( Jung Bum Kim ) 한국정신병리진단분류학회 2009 精神病理學 Vol.18 No.1

Objectives: Although many tools have been developed to diagnose mental disorders so far, it has not been easy to administer because it is necessary to undergo training for the professionals as well as time required to administer those tools. The Psychiatric Diagnostic Screening Questionnaire; PDSQ, developed by Zimmerman et al, 2001, is self-reporting test for screening DSM-IV axis I disorders in clinical settings, and it is well known for its simplicity and availability. This study compared Korean PDSQ with Mini-International Neuropsychiatric Interview(M.I.N.I.-Plus) for their diagnostic availability, as a part of standardization of Korean version. Methods: The samples were 320 patients, who were selected from 3 university hospitals in Daegu and Kyoungbook for K-PDSQ and Mini-International Neuropsychiatric Interview(M.I.N.I.-Plus). The diagnostic correspondence, sensitivity, specificity and administering time were evaluated for PDSQ as well. Results: For the diagnostic correspondence of PDSQ, Cohen`s kappa coefficient was .69 between PDSQ and MINI-Plus. The administering time was 19.3±12.9min, which was similar to the M.I.N.I.-Plus` minutes. The sensitivity was higher than 90% in most of the 13 PDSQ subscales(MDD; 100%, PTSD; 75%, Bulimia Nervosa; 100%, OCD; 68%, Panic Disorder; 93%, Psychosis; 59%, Social Phobia; 98%, Alcohol Dependence/Abuse; 94%, Drug Dependence/Abuse; 100%, Agoraphobia; 83%, GAD; 88%, Somatoform Disorder; 100%, Hypochondriasis; 96%), and the AUC(area under the curve) values of them were above 0.79(MDD; 0.91, PTSD; 0.82, Bulimia Nervosa; 1.00, OCD; 0.80, Panic Disorder; 0.94, Psychosis; 0.79, Social Phobia; 0.87, Alcohol Dependence/Abuse; 0.96, Drug Dependence/Abuse; 1.00, Agoraphobia; 0.92, GAD; 0.81, Somatoform Disorder; 0.99, Hypochondriasis; 0.97). Conclusion: PDSQ showed significant diagnostic correspondence. time-efficiency and high level of sensitivity and specificity. PDSQ is considered to be useful diagnostic tool before the first interview of the patients for the screening of DSM-IV Axis I diagnosis because it is simplicity and reliability.

반복적 스트레스가 흰쥐의 Opioid성 신경전달에 미치는 영향

사공정규,이광헌,김진성,구본훈,이종범,하정희 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.3

연구목적: 반복적인 스트레스에 노출된 실험동물에서 opioid성 신경전달의 변화양상을 검색하고 내인성 opioid peptide의 변화양상을 알아보기 위하여 본 연구를 시행하였다. 방 법: 본 연구에서는 웅성 흰쥐에게 하루 2시간, 2주간의 반복적인 부동화 스트레스를 가한 후 뇌의 각 부위에서 opioid 수용체의 mu-, delta- 및 kappa- 아형의 최대결합력 및 친화력의 변화 양상을 관찰하였다. 결 과: 반복적 부동화 스트레스 노출군에서는 대조군에 비하여 delta-아형 수용체의 수가 시상하부(hypo-thalamus) 및 선조체(striatum)에서 증가하였다. 본 연구결과 관찰된 선조체에서의 delta-아형 수용체의 상향조절과 관련지어 delta-아형 수용체의 내인성 효현제인 enkephalin의 뇌조직 내에서의 활성도를 검색하였을 때, 반복적 스트레스 노출군에서는 대조군에 비하여 그 함량이 감소하였다. 이러한 뇌조직내 enkephalin 활성도 감소 현상은 수용체 변화와 상응하게 시상하부 및 선조체에서 관찰되었으며, 이러한 수용체의 조절 현상은 내인성 수용체 효현제인 enkephalin의 활성도의 감소에 따른 생체의 적응 현상으로 해석되었다. 결 론: 이상의 결과로부터 반복적인 스트레스는 opioid 수용체 delta-아형을 상향조절하였으며, opioid 수용체 delta-아형의 내인성 효현제의 활성도를 감소시킴을 관찰하였다. Objectives : Research into emotional or behavioral stress typically focuses upon the hypothalamic-pituitary-adrenal axis. It is well established that the hypothalamic-pituitary-adrenocortical axis is subject to inhibitory control by opioids in a variety of animal species including pigs. Exposure to acute stress induces the upregulation of opioid receptors and the release of endogenous peptides which mediate the stress-induced analgesia. There is some literature substantiating that repeated stress can lead to changes in opioidergic neurotransmission. However, the changes are highly variable. This study was designed to observe the modulatory effect of repeated immobilization stress on opioidergic neurotransmission. Methods : Male Sprague-Dawley rats weighing 150-200g were forced to suffer immobilization stress for 2 hours on each of 14 successive days. Then we examined the maximum binding capacity and affinity of each opioid subtypes(mu, delta, kappa). Results : Repeated immobilization stress increased the binding of [³H]DPDPE on the delta-subtype opioid receptor in the striatum and hypothalamus. Saturation experiments followed by scatchard analyses of the results showed an increase in the density of delta-subtype opioid receptors, but the affinity of the delta-subtype opioid receptor remained unchanged. Repeated immobilization stress reduced enkephalin activity of striatum and hypothalamus. Conclusions : From these results, it could be concluded that repeated immobilization stress up-regulated the delta-subtype opioid receptors and reduced the activity of enkephalin, an endogenous ligand for the delta-subtype opioid receptor.

섬망 치료에 있어서 Quetiapine과 Risperidone의 효과 비교

사공정규,정성원 대한생물치료정신의학회 2011 생물치료정신의학 Vol.17 No.2

본 연구에서는 최근에 개발된 비전형 항정신병 약물인 quetiapine이 섬망의 치료에 효과가 있는지와 비전형 항정신병 약물인 risperidone과 효과의 차이가 있는지 평가하고자 하였다. 총 71명의 환자가 본 연구 대상에 포함되었고 CGI, K-DRS, K-DRS-R-98, K-MMSE를 평가 도구로 하여 치료 전과 치료 일 주일 후 측정한 전체 점수를 비교하였다. 부작용에 대한 평가도구로는 ESRS 점수를 치료 전후에 비교하였다. 연구 결과 두 군 모두에서 일주일 후 측정한 CGI-S, K-DRS, K-DRS-R-98, K-MMSE에서 통계학적으로 유의한 차이를 보였다. 두 군 간 치료전후의 통계학적인 차이는 보이지 않았다. 부작용은 두군 모두에서 나타나지 않았다. 이번 연구에서 quetiapine은 섬망 환자의 치료에 있어 risperidone과 동등한 효과를 보이고 부작용이 적어 섬망 환자의 치료에 안전하게 사용할 수 있을 것으로 기대된다. Objectives:It has been shown that risperidone, an atypical antipsychotics, has effectiveness for treatment of delirium as good as haloperidol and has less side effects than haloperidol. Quetiapine also has less extrapyramidal side effects and has effectiveness for treatment of delirium. The aim of this study was to investigate whether quetiapine is effective for the treatment of delirium compared with risperidone. Methods:All subjects(71 patients) were randomized to receive either risperidone(35 patients) or quetiapine(36 patients) with fixed dose at the first day of treatment. Then, all subjects received either medications with flexible doses according to judgement on clinical status of patients. The effectiveness was evaluated using Clinical Global Impression-Severity(CGI-S), Korean version of Delirium Rating Scale(K-DRS), Korean Mini Mental Status Examination(K-MMSE), and Korean version of Delirium Rating Scale-Revised-98. Results:There was no significant difference between both groups in the baseline K-DRS, K-DRS-R-98, K-MMSE and CGI scores. At the seventh day of the treatment, K-DRS, K-DRS-R-98 and CGI scores were significantly improved from the baseline both in the quetiapine and risperidone treatment group. Conclusion:Quetiapine is effective for treatment of delirium.

포항시 지역주민의 정신질환자에 대한 요구도 연구

정철,사공정규 東國大學校醫學硏究所 2004 東國醫學 Vol.11 No.1

연구목적: 포항시 지역사회 정신보건사업을 수행함에 있어, 포항시 지역주민의 정신질환자에 대한 태도를 평가하고 이를 결정하는 요인과의 상관관계를 밝혀서 향후 포항시에 적합한 지역사회 정신보건사업의 기초 자료로 활용하고자 한다. 연구대상 및 방법: 2003년 4월 1일부터 동년 5월 3일까지 포항시에 거주하는 포항시민 693명을 대상으로 설문조사를 시행하였다. 설문의 내용은 성별, 연령, 결혼상태, 학력, 종교, 경제상태, 주거형태, 정신질환자 접촉 경험, 가족 및 본인의 정신과 치료경험, 지역주거기간, 지역에 대한 안전도, 지역에 대한 만족도 등 14문항과, 정신보건시설에 대한 태도를 질문하는 내용 5문항을 포함하였다. 연구결과: 본 조사대상 중 여성이 전체의 59.5%(412명)를 차지하였고 연령별로는 20세에서 49세에 해당하는 수가 611명(88.2%)으로 조사되었다. 포항시 거주기간은 6년 이상이라고 응답한 수가 548명(79.1%)이었다. 주거지역 내에 정신보건시설(정신병원 제외)이 설치와 관련하여 일반시민은 133명(54.7%)이 찬성하였으며 정신보건관련요원은 242(53.8'/,)가 찬성한다고 응답하였다. 지역 내 정신보건센터에 대해 일반시민 중 들어본 적이 있거나 잘 알고 있는 수는 108명(44.4%)이었으며, 정신보건관련요원 중 한번도 들어본 적이 없는 수가 132명(29.3%)으로 나타나 홍보의 필요성을 시사하였다. 정신보건센터에서 일반인을 위한 정신건강 프로그램을 운영할 경우 그 필요성에 대한 설문에서 필요하다는 응답이 일반시민은 202명(83.1%)이었던 반면 정신보건관련요원은 346명(76.9%)으로 나타났다. 앞으로 정신질환자를 위한 자원봉사활동을 할 의향이 있는지에 대해서는 일반시민 중 158명(65.0%), 정신보건관련요원 중 253명(56.2%)이 있다고 응답하였다. 결론: 정신질환자에 대해 부정적인 태도를 가지고 있는 대상에게 정신보건문제에 대한 합리적이고 적절한 정보를 제공하고 정신질환자에 대한 홍보와 계몽이 필요하리라 생각되며, 긍정적인 태도를 가지고 있는 대상들을 자원으로 활용하여 효율적인 정신보건사업이 될 수 있도록 사업계획을 수립하는 것이 필요할 것으로 생각된다. Purpose: To execute the mental health project in Pohang city, we would assess the attitude of citizen to mentally ill person and establish the correlation between factors. With these data, we could make an appropriate local community mental health project. Methods: We executed questionnaire survey to 693 citizens from April 1 to May 3, 2003. The questionnaire contain 14 questions (sex, age, marriage status, educational level, religion, economic status, housing tenure, experience for contacting mentally ill persons and their family, resident duration, security of residency, satisfaction of residency) and 5 additional questions on attitudes of the mental health facility. Results: Among the subjects, female were 412 (59.5%) and 611 (88.2%) persons were at the age of 20-49. The number of residents in Pohang City over 6 years were 548 (79.l%). Total of 133(54.7%) citizens and 242 (53.8%) mental health-related persons agreed to establish mental health facility in their village. Recognition status about Mental Health Center were 44.4% (108 persons) in citizens and 29.3% (132 persons) in mental health related-related persons. These data strongly suggest the need of public information for both citizens and mental health-related persons. In addition, both 202 (83.l%) citizens and 346 (76.9%) mental health-related persons required mental health programs. The intention of volunteering service for Mental Health Center were 158 (65.0%) in citizen, 253 (56.2%) in mental health related person. Conclusion: It should serve the appropriate information of mental health and be necessary to educate the negative attitude persons. We should establish the plan for the effective mental health project by making the best use of positive attitude person.