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.

외상 후 스트레스 장애 환자에서 성별에 따른 증상 차이

김유라,우영섭,고효진,정영은,서호준,채정호,Kim, Yoo-Ra,Woo, Young-Sup,Ko, Hyo-Jin,Jung, Young-Eun,Seo, Ho-Jun,Chae, Jeong-Ho 대한불안의학회 2008 대한불안의학회지 Vol.4 No.2

PTSD 환자들에서 성별에 따른 증상의 차이를 보기 위한 본 다기관 연구에서, 여성은 남성에 비해 재경험, 회피 항목에서 높은 빈도와 심각도를 보였다. 즉 과도한 기억과 각성, 만성적인 회피로 이어지는 PTSD 발생 과정에서 남, 녀간 차이가 있을 수 있다는 것을 시사하며, 앞으로 이를 확인하기 위한 연구가 더욱 필요할 것이다. Objective : The present study investigated gender differences in the symptoms of posttraumatic stress disorder (PTSD) among Korean PTSD patients from a multicenter sample. Methods : Data were collected from 18 psychiatric units of training hospitals nationwide. All the patients were interviewed by attending psychiatrists using a structured format for PTSD by DSM-IV diagnoses. Additionally the Davidson Trauma Scale was used to evaluate all self-reported symptomatology. Results : Forty-three patients with PTSD, 23 female and 20 male patients, were enrolled in this study. There were significant differences in the frequency and severity of avoidance symptoms, and severity of re-experience symptoms. The female patients reported a higher level of re-experience and avoidance symptoms than the male patients. Conclusion : The results of the present study were found to be consistent with previous studies on gender differences. Women were more susceptible to PTSD symptoms than men, especially exaggerated re-experience and chronic avoidance. Since all patients groups were enrolled from the hospital, this findings needs to be reexamined using community samples.

한국형 우울장애 약물치료 알고리듬 2021 (II) : 임상 아형

박영민(Young-Min Park),서정석(Jeong Seok Seo),우영섭(Young Sup Woo),박원명(Won-Myong Bahk),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) was developed in 2002 and revised in 2006, 2012, 2017. In 2021, the fifth edition was published. This edition reflected new findings and the latest trends in the areas of pharmacological treatment. The aim of this study is to present strategies and treatment options according to the subtype of depression using data from the KMAP-DD-2021. Methods Ninety-seven psychiatrists with clinical experience in depressive disorder were selected. The questionnaires for KMAP-DD 2021 were sent to participants via mail. KMAP-DD 2021 consists of overall treatment strategies and treatment options under specific circumstances. Each treatment strategy or treatment option was evaluated with an overall score of nine and was divided into the three phases of recommendation that include primary, secondary, and tertiary. Results For persisting depressive disorder, antidepressant monotherapy including selectiveserotonin reuptake inhibitor (SSRI) (escitalopram, fluoxetine, sertraline, paroxetine), serotoninnorepinephrine reuptake inhibitor (SNRI) (desvenlafaxine, venlafaxine, duloxetine, milnacipran), vortioxetine, and mirtazapine, was recommended as first-line medications. For melancholia of major depressive disorder, SSRI, SNRI, vortioxetine, and mirtazapine also were recommended as first-line medications. For mixed features, SSRI, bupropion, mirtazapine, SNRI, except for duloxetine, and milnacipran were recommended as first-line medications. For anxious distress, SSRI, mirtazapine, and SNRI, except milnacipran, were recommended as first-line medications. Conclusion The preferences of antidepressants by experts differed according to the subtype of depression. These findings suggest that experts treat patients with a major depressive disorder after considering the subtype of depression involved.

한국형 우울장애 약물치료 알고리듬 2021 (VI) : 비약물학적 생물치료

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

Objectives The Korean Medication Algorithm Project for Depressive Disorder 2021 (KMAP-DD 2021) was made to update new researches and data. This study focused on non-pharmacological biological treatments. Methods Ninety-seven psychiatrists with extensive clinical experience in the non-pharmacological biological treatment of depressive disorder were primary selected and a questionnaire was sent to each of them by mail, 65 of the 97 replied. Results Electroconvulsive therapy (ECT) was recommended as an initial strategy for major depressive disorder, severe depressive disorder with/without psychotic features with urgent suicidal risk, or a severe depressive episode with psychotic features in pregnant patients, for non-responders on pharmacotherapy for a moderate depressive episode, and as a second strategy for non-responders on antidepressant monotherapy or combination therapy combined with physical illness. For pregnant women with a severe episode of major depressive disorder, repetitive transcranial magnetic stimulation (rTMS) was preferred as a first-line strategy, and as a second strategy for non-responders on combined antipsychotic and antidepressant therapy and non-responders with comorbidity and physical illness. Complementary or novel treatment was not recommended as the first-line treatment strategy for depressive disorder, but transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), deep brain stimulation (DBS), light therapy, and omega-3 fatty acid nutritional therapy were second-line treatment strategies. Conclusion ECT and rTMS are initial strategies in specific clinical situations. Preferences for complementary or novel treatments such as tDCS, light therapy, and omega-3 fatty acid nutritional therapy have increased gradually, but in practice, their usages are still limited.

알코올에 의한 숙취 상태에서 혈중 Methanol 농도의 변화

윤수정(Su-Jung Yoon),우영섭(Young-Sup Woo),이해국(Hae-Kook Lee),김태훈(Tae-Hoon Kim),최보문(Bo-Moon Choi),이정태(Chung- Tai Lee),김대진(Dai-Jin Kim) 한국중독정신의학회 2004 중독정신의학 Vol.8 No.2

A hangover is characterized by the constellation of unpleasant physical and mental symptoms that occur between 8 and 16 hours after drinking alcohol. We induced experimental hangover in normal individuals, measured the blood methanol concent-ration prior to and after alcohol consumption, and assessed the association of the hangover condition and blood methanol concentration. A total of 13 normal adult males participated in this study. They did not have any previous histories of psychiatric or medical disorders. The blood ethanol concentration prior to the alcohol uptake (3.73±3.95 mg/dL) was not significantly different from that of 13 hours after the alcohol consumption (6.80±8.62 mg/dL). However, the difference of methanol concentration between the day of experiment (prior to the alcohol uptake) and the next day (13 hours after the alcohol uptake) was significant. (2.80±1.72 mg/L Vs 4.82±2.64 mg/L) This result suggest the possible correlation of methanol as well as its toxic metabolite to hangover.

약물 복용력이 없는 주의력결핍 과잉행동장애 아동에서의 뒤쪽 내정상태회로 이상

최지욱(Jeewook Choi),고효진(Hyo Jin Go),우영섭(Young Sup Woo),송승훈(Seung Hoon Song),양보성(Po Song Yang),정범석(Bumseok Jeong) 대한소아청소년정신의학회 2012 소아청소년정신의학 Vol.23 No.2

Objectives:Characteristic symptoms, including hyperactivity and easy distractibility, in children with attention-deficit hyperactivity disorder (ADHD) suggest that their brain status, even at rest, might differ from that of healthy children. This study was conducted in order to determine whether resting state brain activity is compromised in medication-naive children with ADHD. Methods:Twenty medication-naive children with ADHD (mean age 10.3±2.5) and 28 age- and gender-matched healthy volunteers (mean age 10.3±2.0) underwent measurements for resting state brain activity using functional magnetic resonance imaging (fMRI). Among resting state related-independent components (RSICs) extracted from fMRI data using independent component analysis, a significant difference in RSICs was observed between groups, using a mixed Gaussian/gamma model. Results:Except for IQ, which was higher in the healthy control group, no demographic difference was observed between the two groups (p<.001). Significantly less activation of one RSIC, which includes the bilateral precuneus/posterior cingulate cortex, occipito-temporal junction, and anterior cingulate cortex, was observed in the ADHD group, compared with the control group (p<.05). Conclusion:An abnormal RSIC, posterior default mode network (DMN), was observed in the medication-naive ADHD group. Results of our study suggest that abnormality of posterior DMN is one of the main pathophysiologies of ADHD.

한국형 우울장애 약물치료 알고리듬 2021 (V) : 안전성, 부작용, 동반 신체질환을 고려한 항우울제 선택 및 치료저항성 우울증의 임상적 정의

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

Objectives To revise Korean Medication Algorithm Project for Depressive Disorder 2017 (KMAPDD 2017) guidelines by revising antidepressant choices based on their safety, adverse effects, comorbid physical illnesses, and the clinical definition of treatment-resistant depression (TRD). Methods A 33-item questionnaire comprised of six parts was developed. A 65-expert consensus (65/97, 67.0%) was obtained on pharmacological treatment strategies regarding antidepressant choice with respect to safety, adverse effects, and comorbid physical illnesses. Multiple response sets were subjected to statistical analysis. Results The results obtained showed that first-line pharmacotherapeutic strategies based on various clinical considerations were as follows: mirtazapine (for patients with increased suicidality, Gastrointestinal discomfort, and insomnia), bupropion (for patients with orthostatic hypotension, history of a safety accident, serotonin syndrome, sedation, sexual dysfunction, and weight gain), and escitalopram (for patients with anticholinergic side effects). For patients exhibiting comorbid conditions, duloxetine was the first line pharmacotherapeutic strategy for chronic pain, escitalopram was the first-line pharmacotherapeutic strategy for diabetes, hypertension, liver disease, Parkinson’s disease, renal disease, epilepsy, and thyroid disease, and sertraline was a first-line pharmacotherapeutic strategy for arrhythmia and cardiovascular disease. Conclusion Pharmacological treatment strategy of KMAP-DD 2021 is similar to that of KMAPDD 2017. Additional study is required to determine antidepressant choices for TRD and cancer patients with depression.

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.

한국형 우울장애 약물치료 알고리듬 2021 (III) : 소아·청소년

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

Objectives The Korean Medication Algorithm Project for Depressive Disorder 2021 (KMAP-DD 2021) was a revision of previous works. The main purpose of the current study was to amend guidelines for the treatment of a major depressive disorder (MDD) for children and adolescents. Methods The survey consisted of 21 questionnaires for children and adolescents. A total of 33 of the 46 experts in child and adolescent psychiatry answered the survey. Results Antidepressant (AD) monotherapy was selected as the 1st line option for MDD with mild to moderate severity. As the 1st line of treatment for MDD severe without psychotic features in children and adolescents, AD monotherapy and AD augmented with atypical antipsychotics (AAP) were recommended. For MDD with psychotic features, AD augmented with AAP was preferred as the 1st line of treatment. Conclusion We developed an algorithm for child and adolescent populations with depressive disorders, more specifically than the KMAP-DD 2017. We expect this algorithm will provide clinicians useful information and help in the treatment of children and adolescents with depressive disorders.

조기 발병 양극성 장애 환자의 임상적 특징 : 후향적 의무기록 조사 연구

우영섭,박민현,서호준,채정호,전태연,박원명 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.5

Objective : Bipolar disorder is a disease with diverse clinical profiles and outcomes. In recent years, it is suggested that if bipolar disorder occurs early in one's life, functional and symptomatic prognoses are poor. The prognoses include severe Symp-toms, frequent psychotic symptoms, comorbidity ofmental illnesses, slow improvement of the symptoms, and high suicide rate. We investigated the clinical characteristics of early onset bipolar inpatients. Method : The subjects of this study were selected from the patients who were discharged after hospitalization between January 1, 2001 and May 31, 2005 and diagnosed with bipolar disorder according to DSM-IV criteria. These patients were examined for the following data ; the type of bipolar disorder, comorbid psychiatric disorders, the age at onset of the illness, the acuteness of the disorder, and the duration of the disorder. The presence of four major clinical psychopathology, rapid cycling, Psychotic symptoms, comorbid psychiatric disorders, and suicide attempt, was also examined. The patients whose onset of the illness was before the age of 19 were classified as the early onset group and after the age of 19 were classified as the late onset group. Data on demographics, family histories, four major clinical psychopathologies and other clinical variables were compared between the early onset group and the late onset group. Results : Of the 53 patients, 19 patients belonged to the early onset group. There was higher incidence ofpsychotic Symp-toms in the early onset group than in the late onset group, and the difference was statistically significant according to the χ² - test (84.2% vs 44.1%, P=0.005). The incidence of comorbid psychiatric disorders was higher in the early onset group than in the late onset group, and the difference was also statistically significant according to the χ²-test (52.6% vs 23.5%, P=0.032).However, there was no statistically significant difFerence between the groups regarding the incidence of rapid cycling and suicide attempt. The result of logistics regression showed correlation of psychotic symptoms (0R=6.756 ; 1.655≤95% CI≤27.580) and comorbid psychiatric disorders (0R=3.611 ; 1.088≤95% CI≤11.984) with the early onset group. Conclusion : Early onset of bipolar disorder is related to the manifestation of psychotic symptoms and frequently accom-panies comorbid psychiatric disorders. The results of this study will help understand the mechanism of the onset of complexbipolar disorder and estimate the prognosis.