정신과 영역에서 벤조다이아제핀계 약물의 사용과 문제점

오강섭,Oh Kang-Seob 대한불안의학회 2005 대한불안의학회지 Vol.1 No.1

Benzodiazepines are widely used for a variety of conditions in psychiatric field. In this article, the author reviewed the indications, the effects on anxiety and sleep disorders, the side effects, the drug-drug interactions, and the tapering strategies. Benzodiazepines were relatively safe and useful for the treatment of anxiety and sleep disorders. However, used clinically, benzodiazepines can induce many adverse effects (e. g. over-sedation, cognitive impairments, paradoxical effects, dependence and withdrawal symptoms, and so on). Currently available informations about their effects on the developing fetus is controversial. For this reason, pregnant women and nursing mother should be cautioned against the use of benzodiazepines. Drug-drug interactions have to be considered in combination treatments. For the tapering issues, gradual tapering was important to prevent the withdrawal symptoms. Especially, the tapering schedules have to be individualized for the each long-term benzodiapzepine users.

한국인에서의 도파민 수송체 유전자 다형성(Dopamine Transporter Gene(DAT1) Polymorphism)과 사회공포증과의 연관성에 관한 예비 연구

오강섭,윤형근,이민수,Oh, Kang Seob,Yoon, Hyung Kun,Lee, Min Soo 대한생물정신의학회 2004 생물정신의학 Vol.11 No.2

Objective:Although polymorphism of dopamine transporter gene(DAT1) has been considered to be implicated in the pathogenesis of social phobia, previous investigations have been inconsistent and controversial. The authors investigated the relationship between DAT1 polymorphism and social phobia in Koreans. Methods:DAT1 and alleles of fifty subjects who met DSM-IV criterion of social phobia, and those of age- & sex- matched fifty normal controls in Korea were compared. Additionally, patients were grouped into generalized(33) and nongeneralized(17) types and DAT1 polymorphism was compared with that of age- & sex- matched controls. DAT1 with variable number of tandem repeats(VNTR) were determined by using polymerase chain reaction. To compare the distribution of the DAT1 polymorphism between different groups, Fisher's exact test was used. Results:There were no significant differences in either genotypic(p=0.451) or allelic(p=0.452) distributions between the social phobia patients and the controls. There also were no differences in genotypic distribution between subtypes of social phobia patients and the controls. Conclusion:We couldn't find any association between DAT1 polymorphism and social phobia. Further studies including larger number of samples and diverse clinical variables should be conducted to elucidate the present findings.

불면증 환자의 정신생리 상태 -수면 직전 각성 정도, 자기 효율 정도, 수면 위생, 불안과 우울 정도-

오강섭,이소희,이시형,Oh, Kang-Seob,Lee, So-Hee,Lee, Si-Hyung 대한수면의학회 1995 수면·정신생리 Vol.2 No.1

Objectives : Insomnia is significantly influenced by the pre-sleep arousal, self efficacy, sleep hygiene, depression and anxiety. The authors tried to explore how these factors are related with the clinical features of sleep. Methods : Fifty three patients diagnosed as insomnia by DSM-IV criteria were studied. They filled up the pre-sleep arousal scale(PSAS), sleep efficacy scale(SES), sleep hygiene awareness and practice scale, BDI, and state and trait anxiety scales. Results: 1) The mean values of sleep-related variables were as follows : Sleep latency,136.89 minutes ; frequences of awakening during a night, 2.28 ; minutes to get back to sleep, 42.70 ; total sleep time, 180.19 minutes ; duration of illness, 72.00 months. 2) The mean scores of scales were as follows : PSAS(cognitive), 22.40 ; PSAS(somatic), 17.32 ; SES, 20.16 ; sleep hygiene knowledge, 25.96 ; caffein knowledge, 59.78 ; sleep hygiene practice, 42.12 ; BDI. 18.2 ; state anxiety, 41.24 ; trait anxiety ; 44.50. 3) In the subjects with superimposed depression, the mean frequency of awakening during a night and the mean pre-sleep arousal scale score were higher than in those without depression. 4) Frequency of awakening were correlated positively with a PSAS(a tight tense feeling in your muscle) and sleep hygiene awareness. PSAS(cognitive) were correlated positively with a PSAS(somatic). BDI correlated positively with a PSAS item(a jittery, nervous feeling in your body)and a SES item (not allow a poor night's sleep to interfere with daily activities). Anxiety scales were correlated positively with sleep hygiene practice scale sleep, and PSAS were correlated negatively with SES. Conclusions : The mean scores of PSAS, SES, sleep hygiene awareness and practice scale, BDI, state and trait anxiety scales of insomniacs were correlated either positively or negatively in insomnia patients. These factors seem to contribute to the development and maintainence of insomnia.

한국인 정신분열병 가계의 염색체 5번 D5S39(p105-153Ra), D5S76(p105-599Ha) 및 도파민 $D_2$, $D_3$ 수용체 유전자좌간의 연관관계 연구

오강섭,김영태,이민수,Oh, Kang-Seob,Kim, Young-Tae,Lee, Min-Soo 대한생물정신의학회 1994 생물정신의학 Vol.1 No.1

The author examined the relationship of two markers, D5S39(p105-153Ra), D5S76(p105-599Ha) of chromosome 5 and $D_2$, $D_3$ receptor genes in a Korean schizophrenic pedigree using polymerase chain reaction(PCR). The results were as follows : 1) On D5S39 locus, 5 different alleles(224/226 bp : 4 cases, 218/226 bp : 3 cases, 222/226 bp : 3 cases, 218/230 bp : 1 case, 222/224 bp : 1 case) were produced. 2) On D5S76 locus, 5 different alleles(102/112 bp : 4 cases, 94/112 bp : 3 cases, 108/112 bp 3 cases, 94/94 bp : 1 case, 102/108 bp 1 case) were produced. 3) On $D_2$ receptor gene, 3 different alleles($A_1A_2$ : 8 cases, $A_1A_1$ : 2 cases, $A_2A_2$ : cases) were produced. 4) On $D_3$ receptor gene, 2 different alleles(1/2 : 7 cases, 1/1 : 5 cases) were produced. The author had not find any specific alleles on all four loci in all pedigree nor any specific alleles in the schizophrenic patients. Though the author has not found absolute relationship between the four loci and the onset of schizophrenia, there still remains the possibilities if the more detailed and elaborated pedigree studies are done.

진화심리학적 관점에서의 불안 및 불안장애

오강섭,Oh, Kang Seob 대한생물정신의학회 2017 생물정신의학 Vol.24 No.2

Anxiety is one of the basic human emotions. From the evolutionary psychology point of view, it is a necessary factor for survival and prosperity of human beings that had been developed throughout time with the history of human survival and development. Anxiety plays the role of protecting one from social or physical threats. In reality, lacking of anxiety showed lots of examples of maladjustments. But the result of over-adjustment, which is overanxious disorder, is definitely disturbing one's survival and growth, and it can lead to anxiety disorder that needs to be treated. Anxiety from the evolutionary psychology point of view, started as a primary adjustment form and it evolves into various types of anxiety disorders that relates to the modern society's characters. Therefore, having the grasp of evolutionary psychology, which can be the base of treating anxiety and anxiety disorders, is very important. So from now on, studies for this aspect would need to be done as integrated and multidisciplinary studies not only by psychiatrists, but by including epidemiologists, psychologists, ecologists, biologists, and neuropsychologists. In this article, the author tried to review and explore the idea of anxiety and anxiety disorders from the evolutionary psychology point of view.

사회공포증 환자의 기능장애에 관한 연구

오강섭,오명신,이시형,Oh, Kang-Seob,Oh, Myung-Shin,Lee, Si-Hyung 한국정신신체의학회 1999 정신신체의학 Vol.7 No.1

본 연구는 1996년 10월에서 1997년 7월까지 강북 삼성병원 신경정신과를 처음 방문하여 사회공포증으로 진단 받은 66명의 환자들을 대상으로 사회공포증의 증상정도, 기능장애의 정도, 이환 기간, 아형간의 연관성을 살펴보았다. 대상환자들에게 SPS(Social phobia scale), SDS(Social disability scale), LSRDS(Liebowitz self-rated disability scale)을 시행하여 다음과 같은 결과들을 얻었다. 1) 상당수의 사회공포증 환자들은 일, 여가, 가정, 사회생활 등 여러 영역에서의 중등도 이상의 기능장애를 보이고 있다. 2) 사회공포증 환자들의 기능장애는 여가, 일, 가정 순으로 높게 나타났다. 3) 사회공포증 환자들의 기능장애의 정도는 이환 기간보다는 현재의 증상 정도와 관련성이 높았다. 4) 비가해형 보다는 가해형 사회공포증 환자에서 타인에 의해 주시될 상황에 대한 주관적 두려움의 정도가 의미 있게 높았다. 5) 비가해형 보다는 가해형 사회공포증 환자에서 전반적인 기능장애의 정도가 심각하였으며 현재의 증상이 심할수록 기능장애의 정도가 심해지는 양상이다. 결론적으로 사회공포증 환자들은 교육, 직업, 가족관계, 애정관계, 사회적 관계 등 전반적 생활영역에서의 기능장애가 있음을 확인할 수 있었으며 특히 가해형 사회공포증 환자에서 그 정도가 심각하였다. This study was aimed to investigate the nature of functional impairment in social phobia and the correlation between the functional impairment and the duration of the disease, and the severity of the symptoms. In 66 patients with social phobia, the functional impairments were assessed with the SDS(Sheehan's disability scale) and the LSRDS(Liebowitz self-rated disability scale), and the severity of the symptoms was assessed with the SPS(social phobia scale). The results were summarized as follow : 1) Most of the social phobic patients reported moderate to severe impairment in their lives in areas of education, employment, family relationships, romantic relationships, social networks, and other interests, etc. 2) There was a significant correlation between the severity of the symptoms and the disability in their lives. 3) The offensive social phobic patients reported that they had more disability in their lives and more severe symptoms than non-offensive patients did. 4) There was no significant correlation between the duration of disease and the disability in their lives. Conclusively, we confirmed that social phobia was associated with the functional impairment in most areas of their lives.

노년기 불안장애

오강섭(Kang Seob Oh) 대한노인정신의학회 2006 노인정신의학 Vol.10 No.2

Anxiety disorder is the one of the most prevalent psychiatric disorders in the elderly. However, there were no sufficient studies on the anxiety disorder in late life. Geriatric anxiety disorders are under-diagnosed and under-treated. For the proper evaluation and diagnosis of anxiety disorder in the elderly, comprehensive approaches considering medical, psycho-social aspects are needed. Various treatment modalities including pharmacotherapy and psycho-social treatments were reported. In this article, the author reviewed the general features of geriatric anxiety disorders, epidemiological characteristics, clinical features of each anxiety disorders, and treatment issues. We need more systematized studies for the advances on the diagnosis and treatment of geriatric anxiety disorders.

불안증상을 보이는 노인환자들에 대한 약물치료지침

오강섭(Kang Seob Oh) 대한노인정신의학회 2003 노인정신의학 Vol.7 No.1

To provide a recent knowledge about pharmacological treatment of anxiety disorders in elderly, the author reviewed the articles and books for the treatment of elderly anxiety patients. Anxiety is the one of the most prevalent psychiatric symptoms in the elderly. Many psychological and physical causes including used drugs can induce the anxiety symptoms in elderly. However, it is often unrecognized and inadequately treated. The pharcokinetics and pharmacodynamic changes, con-comittent illnesses, compliance problems, and increased sensitivity to drugs in elderly have to be considered. Various pharmacological treatments (e.g benzodiazepines, buspirone, antidepressnats, beta-blockers, antihistamines, neuroleptics)were reported as having therapeutic effects for the treatment of geriatric anxiety disorders patients. They have their own advantages and disadvantages. However, anxiety in elderly have received little focus to date. The study results often depend on the studies from adult samples. A comprehensive, flexible, integrated, and specific treatment approaches should be applied to elderly anxious patients. The more systematized studies are needed to broaden the knowledge of the pharmacological treatment of anxiety disorders in the elderly.

기분부전장애와 비전형우울증의 약물치료

임세원,오강섭,Lim, Se-Won,Oh, Kang-Seob 대한생물정신의학회 2007 생물정신의학 Vol.14 No.1

Objectives : The diagnosis of depression is based on a highly variable set of symptoms. Therefore, depression should not be viewed as a single disease, but a heterogenous syndrome comprised of different pathophysiologies. There are several subtypes of depression which were already incorporated in DSM-IV. This article provides a systematic review of pharmacological treatments of two recognized subtypes of depression-dysthymic disorder and atypical depression. Methods : Systematic search of relevant literatures on dysthymic disorder and atypical depression was performed by proposed search strategy of the Clinical Research Center for Depression of Korean Health 21 R&D Project. All identified literatures were carefully reviewed and classified according to SIGN grading system and summarized in a narrative manner. Results : For the treatment of dysthymic disorder and atypical depression, selective serotonin reuptake inhibitors( SSRIs) and moclobemide have more evidence than the other antidepressants. SSRIs and moclobemide showed superior tolerability than tricyclic antidepressants. Conclusions : The authors proposed treatment recommendations for dysthymic disorder and atypical depression by the methods of evidence-based medicine(EBM). However, guideline developing methods of EBM also have several inevitable limitations. Therefore, in the absence of clear and significant differences in efficacy, the choice of medication must be individualized for a particular patient based on psychiatrist's own clinical decision.

구강내 장치를 이용한 수면 무호흡 환자의 치료 증례

강국진,오강섭,이시형,Kang, Kook-Jin,Oh, Kang-Seob,Lee, Si-Hyung 대한수면의학회 1998 수면·정신생리 Vol.5 No.2

OSA(Obstructive Sleep Apnea) is a condition with repeated obstruction of the upper airway while sleeping. This obstruction of the upper airway may result if sleep-induced physiologic change in muscle activity is superimposed on various structural defects of the upper airway. Macroglossia, micrognathia, retrognathia, and decreased airway lumen have all been implicated in OSA. There are a variety of surgical and nonsurgical treatment modalities currently available for OSA. Recently the uvulopalatopharyngoplasty has achieved widespread use, but success rates vary and long-term effects are still unknown. Current nonsurgical treatment methods can be cumbersome and uncomfortable with variable responses. For this case. we diagnosed as OSA by using polysomnographic analysis and cephalometric analysis, and delivered intraoral removable appliance which is more conservative, reversible and easy to use for patient. And we got results that Apnea Index(AI) decreased from 14.4 to 3.1, Total Respiratory Disturbance Index(Total RDI) decreased from 18.1 to 7.0 and removal of chronic headache in daytime.