한국어판 알코올 사용장애 진단 검사(AUDIT:Alcohol Use Disorders Identification Test)의 개발:신뢰도 및 타당도 검사

이병욱(Byung Ook Lee),이충헌(Choong Heon Lee),이필구(Pil Goo Lee),최문종(Moon Jong Choi),남궁기(Kee Namkoong) 한국중독정신의학회 2000 중독정신의학 Vol.4 No.2

Objectives:This study was designed to develop the Korean version of Alcohol Use Disorders Identification Test (AUDITK) and AUDIT Alcohol Consumption Questions (AUDIT-CK) which is composed of the first 3 questions of AUDIT, a screening tool for the alcohol use disorder. Methods:The translation, including back translation procedure, was carried out, keeping the basic structure of AUDIT. AUDIT-K, AUDITC-K, Korean version of Michigan Alcoholism Screening Test (MAST-K), Korean version of CAGE (CAGE-K) and clinical diagnosis were administered to 43 alcohol use disorder patients and 43 non-alcohol use disorder control subjects. The reliability and validity of AUDIT-K and AUDIT-C-K were evaluated. The sensitivity and specificity for each cut-off point of AUDITK and AUDIT-C-K were calculated and the Receiver Operating Characteristic (ROC) curve analysis was done to get their optimal cut-off points. Diagnostic efficiency of AUDITK and AUDIT-C-K was evaluated by ROC curve analysis. Results:AUDIT-K was found to have significantly high internal consistency, and test-retest reliability. The correlation coefficients of AUDIT-K with MAST-K and CAGE-K were 0.86 and 0.80, respectively, and significant correlation was shown. Its optimal cut-off point was estimated as 12, and the sensitivity and specificity were 0.84 and 0.86, respectively. The correlation coefficients of AUDIT-C-K with MAST-K and CAGE-K were 0.60 and 0.56, respectively. Its optimal cut-off point was estimated as 8, and the sensitivity and specificity were 0.95 and 0.77, respectively. The ROC curve analysis indicated that the diagnostic efficiency of AUDIT-K and AUDIT-C-K was comparable with that of MAST-K and superior to that of CAGE-K. Conclusion:AUDIT-K and AUDIT-C-K have not only high reliability and validity, but also usefulness as a screening instrument for alcohol use disorder.

알코올 관련 기억 장애

이병욱(Byung-Ook Lee) 한국중독정신의학회 2006 중독정신의학 Vol.10 No.1

Heavy alcohol consumption can impacts cognitive function including memory. Alcohol-related memory impairments are relatively common conditions and have various mechanisms. This article reviews two alcohol related memory impairments. One is alcohol related blackout and the other is WernickeKorsakoff syndrome. Rapid ingestion of large amount of alcohol produces memory impairments, which are periods of memory loss for the events that occurred during drinking. The mechanisms of blackouts are reviewed. Wernicke-Korsakoff syndrome is severe form of alcohol-related memory disorder. Thiamine deficiency due to heavy alcohol consumption and poor nutrition is a main cause of this condition. This article reviews the pathogenesis and clinical manifestation of WKS and address the importance of early treatment and prevention.

인터넷상 동의보감 방제의 약물구성 계보 표현 방법에 관한 연구

이병욱(Lee Byung Ook),정훈(Jung Hoon),권영규(Kwon Yung Kyu) 한국의사학회 2008 한국의사학회지 Vol.21 No.2

As the IT technology develops there is a service on internet in which the herbal treatments from medicinal classics can be found in a form of a database. If an assay, and a verification on individual informations on materia medica and the herbal treatments from medicinal classics is established, it would be an enormously efficient asset for the formation of new treatment as well as interpreting the basic information on the efficacy of a treatment. If asp.net is used to make such a system, the user can have access to the informations on materia medica and its treatment without having to setting up a separate system, and especially the user can attain visual information on the genealogy of the herbal treatments in its formation. However, there is a need to develop a more efficient program in terms of organizing the informations on herbs and herbal treatments.

알코올 의존 환자 제독치료에서 벤조다이아제핀의 Fixed-Schedule doses Therapy와 Symptom-Triggered doses Therapy

이병욱(Byung-Ook Lee),김정훈(Jung-Hoon Kim) 한국중독정신의학회 2005 중독정신의학 Vol.9 No.1

Objectives:The aim of this study is to investigate the effect and safety of a fixed-schedule therapy and a symptom-triggered therapy of benzodoazepine for alcohol withdrawal. Methods: Subjectives were 31 alcohol dependence patients and randomized to either the fixed-schedule therapy group or the symptomtriggered therapy group using by URN randomization program. URN randomization’s variables were a history of delirium tremens, CIWA-Ar score and a history of excessive alcohol drinking. Total amount of lorazepam administered and duration of medication treatment were measured. Results:The mean lorazepam dose administered in the symptom-triggered therapy group was 8.47 mg compared with 12.3 mg in the fixed-schedule therapy group (p<.05). The mean duration of lorazepam treatment was 69.3 hours in the symptom-triggered therapy group compared with 95.2 hours in the fixed-schedule therapy group (p<.05). Conclusion:Symptom-triggered therapy decreased both the amount of benzodiazepine used and treatment duration, and was as efficacious as fixed-schedule therapy for alcohol withdrawal.

폐외 결핵에서 전혈 인터페론 감마 측정법의 진단적 유용성

이혜민 ( Hye Min Lee ),조성근 ( Sung Gun Cho ),강형구 ( Hyung Koo Kang ),박성운 ( Sung Woon Park ),이병욱 ( Byung Ook Lee ),이재희 ( Jae Hee Lee ),전은주 ( Eun Ju Jeon ),최재철 ( Jae Chol Choi ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.4

Background: The whole-blood interferon-gamma release assay (QuantiFERON-TB Gold [QFT-G]: Cellestis, Carnegie, Victoria, Australia) has been studied primarily for the use of diagnosing active pulmonary tuberculosis (TB) or latent TB. In the present study, the usefulness of QFT-G was evaluated for the diagnosis of extra-pulmonary tuberculosis (EP-TB). Methods: From June 2006 to February 2009, we evaluated the usefulness of QFT-G in patients (n=65) suspected with EP-TB, retrospectively. The diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the QFT-G assay were analyzed. Results: EP-TB was diagnosed in 33 (51%) participants. The overall sensitivity, specificity, PPV, and NPV of the QFT-G assay for EP-TB were 78%, 79%, 81%, and 77%, respectively. Of the 33 with EP-TB, 14 (42%) were diagnosed with TB pleurisy, 7 (21%) with TB lymphadenitis, 7 (21%) with intestinal TB, and 5 (15%) with EP-TB in other sites. In subgroup analyses according by site of infection, the QFT-G showed 86% sensitivity, 64% specificity, and 78% NPV in TB pleurisy. On the other hand, the sensitivity, specificity, and NPV of the assay were 71%, 83% and 71%, respectively in TB lymphadenitis, and 86%, 100% and 88%, respectively in intestinal TB. Among the patients with suspected alternative site EP-TB, the sensitivity, specificity, and NPV of the assay were 50%, 80% and 67%, respectively. Conclusion: The QFT-G assay showed moderate diagnostic accuracy in EP-TB. However, negative QFT-G assay does not exclude EP-TB because of the low NPV of this assay.

24주 추적 조사를 통한 한국인 알코올 의존 환자의 재발 예측 인자 규명 연구

김철민,김성곤,남궁기,조동환,이병욱,최인근,김민정,Kim, Cheol Min,Kim, Sung Gon,NamKoong, Kee,Cho, Dong Hwan,Lee, Byung Ook,Choi, Ihn Geun,Kim, Min Jeong 대한생물정신의학회 2007 생물정신의학 Vol.14 No.4

목 적: 본 연구에서는 알코올 의존의 재발 예측 인자로 중요하다고 알려진 사회 인구학적 변인, 음주력, 음주갈망, 치료 동기, 병식과 같은 요인들 중에 어떤 요인들이 한국인 알코올 의존의 재발을 예측하는지를 전향적으로 조사하였다. 방 법: 알코올 의존 환자 48명을 대상으로 사회 인구학적 특성, 음주력, Timeline Follow-Back(TLFB), Obsessive-Compulsive Drinking Scale(OCDS), Alcohol Urge Questionnaire(AUQ), Pennsylvania Alcohol Craving Scale(PACS), University of Rhode Island Change Assessment(URICA), Hanil Alcohol Insight Scale(HAIS)등을 조사한 후, 24주간 총 11회에 걸쳐 외래를 방문하도록 하였다. 24주 동안 조사한 TLFB자료에 근거하여 대상자 중에서 과음(일일 5standard drinking 이상)일이 나타난 경우 혹은 더 이상 추적 방문이 되지 않은 경우 모두 재발한 것으로 하여 재발군으로 분류하였으며, 그렇지 않은 경우를 비재발군으로 분류하였다. 알코올 의존의 재발을 예측할 수 있는 요인을 찾는 방법으로 SPSS PC+11.5 프로그램의 로지스틱 회귀분석을 이용하였다. 결 과: 음주를 시작한 연령, 음주로 인한 문제가 발생된 연령, 최근 1년간 1일 음주량, 최근 1년간 월 음주일수, PACS, AUQ, OCDS, URICA, HAIS와 같은 요인들 중 최근 1년간 1일 음주량과 HAIS 점수가 알코올 의존의 재발에 영향을 주는 것으로 나타났다(p<.05). 결 론: 알코올 의존 환자의 치료에서 1일 음주량이 많은 경우와 병식이 낮은 경우가 재발 가능성이 높으므로 앞으로의 치료에서 이러한 요인을 고려해야 할 것이다. Objectives : The aim of this prospective study is to investigate predictors estimating relapse in Korean alcohol-dependent patients using variables like alcohol history, drinking craving, treatment motivation and insight. Methods : Alcohol dependent patients(N=48) who completed questionnaires about sociodemographic variables and drinking history, Timeline Follow-Back(TLFB), Obsessive-Compulsive Drinking Scale(OCSD), Alcohol Urge Questionnaire(AUQ), Pennsylvania Alcohol Craving Scale(PACS), University of Rhode Island Change Assessment(URICA), Hanil Alcohol Insight Scale(HAIS) were followed-up for 24weeks. Subjects who drank heavily(5 standard drinking or more/day) or were not followed up anymore were classified as the relapse group. We used logistic regression analysis with backward elimination of SPSS PC+11.5 to investigate relapse estimate predictors. Results : Average drinking amount per drinking day for last 1 year and HAIS score were predictors of relapse in alcohol-dependent patients. Conclusions : Our findings suggest that therapist should give more attention to alcohol-dependent patients who had more drinks per drinking day for last 1 year and had lower insight level.

알코올 의존 치료를 위한 아캄프로세이트의 임상적 사용

이필구(Pil-Goo Lee),이병욱(Byung-Ook Lee),최문종(Moon-Jong Choi),이충헌(Choong-Heon Lee),남궁기(Kee Namkoong) 한국중독정신의학회 2000 중독정신의학 Vol.4 No.1

Acamprosate (calcium bis acetylhomotaurinate) is a new medication that appears to be clinically useful in the treatment of alcohol dependence. Although it has proved effective in reducing relapse into drinking in clinical trials its exact neurochemical mechanism of action is not clear yet. Evidence is presented that the drug does not act in any of the conventional ways to reduce alcohol intake or psychotropical medication and it is proposed that it may be a novel kind of agent that suppresses craving. On the basis of its known pharmacological effects in pre-clinical studies it is suggested that acamprosate may reduce craving that is associated with conditioned negative withdrawal. Current trends of the prescriptions through European countries show its therapeutic effectiveness and availability. In addition to the potential therapeutic value of acamprosate, the drug may be useful because work directed toward understanding its mechanism of action may shed light on some of the fundamental processes that constitute alcohol abuse and relapse in weaned alcohol dependent patients.

알코올 의존 환자에서 단주 프로그램 수행과 재입원

배성범(Seongbeom Bae),이병욱(Byung-Ook Lee),김영기(Youngki Kim),박상진(Sangjin Park) 한국중독정신의학회 2008 중독정신의학 Vol.12 No.2

알코올 의존 환자에 대한 기존의 국내 연구에서 사회인구 학적 변인이 치료 경과에 미치는 영향에 대한 보고가 거의 없었으나 본 연구에서는 결혼 상태가 재입원 즉 재발에 상당 한 영향을 주고 있어 단주 및 지속적인 외래 치료를 유지하는데 배우자의 역할이 중요함을 생각해 볼 수 있었다. 가장 주목할 만한 본 연구의 결과로는 입원 기간 중 절대적인 단주 프로그램의 수행 횟수 및 입원 기간에 비해 단주 프로그램에 얼마나 열심히 참여했는지가 향후 치료 경과에 중요함을 알 수 있었고 이는 제독 치료만을 마치고 퇴원을 원하는 환자들에게 단주 프로그램 참여를 권하는 데 있어 객관적인 근거로 사용될 수 있을 것으로 기대된다. 또한 동반된 신체 질환이 많을수록 재입원을 많이 하는 것으로 나타난 결과를 통해 임상 각 과와의 긴밀한 치료 협력 체계 구축을 통해 타 과적 처치가 끝난 후 단주 치료로 연계함으로써 단주 치료의 기회를 더욱 늘릴 수 있을 것으로 생각되었다. Objectives:The purpose of this study was to evaluate the effect of abstinence programs on the prognosis of alcoholic patients. Other factors that might also influence the prognosis of alcohol dependence were identified. Methods:A retrospective study was done by reviewing medical records of patients diagnosed as alcohol dependent between January 1, 2001 and December 31, 2005 at the National Health Insurance Medical Center, Ilsan Hospital, and data from the records of 207 patients who have been followed up on for more than 1 year were analyzed. The data included sociodemographic information. Results:Married patients were found to have a lower readmission rate com-pared to those who were single, divorced, bereaved, and separated, and those with alcoholic liver disease were more likely to relapse. Patients who had been re-admitted had statistically lower abstinence program participation numbers and participations (rates=participation number divided by admission day). Even in the re-admission group, the abstinence period was found to be longer in patients who had participated in more abstinence pro-grams during admission. Conclusion:Participation in inpatient abstinence programs was found to be a major factor of the patients’ prognosis. The role of spouses of alcoholic patients was also found to be important in preventing their re-admission.

자살시도자의 정신건강의학과 치료 연계 형태에 따른 동반질병 심각도의 차이

이혁,오승택,김민경,이선구,석정호,최원정,이병욱,Lee, Hyeok,Oh, Seung-Taek,Kim, Min-Kyeong,Lee, Seon-Koo,Seok, Jeong-Ho,Choi, Won-Jung,Lee, Byung Ook 한국정신신체의학회 2016 정신신체의학 Vol.24 No.1

연구목적 자살시도자는 일반적인 경우에 비해 의사결정 능력이 떨어지며, 다시 자살을 시도할 위험성이 높기 때문에 재시도 전에 정신건강의학과 치료로 연계하는 것이 중요하다. 특히 신체적 질병이 있는 사람은 자살시도를 할 확률이 높고, 사망률 역시 높아진다. 이 연구는 자살시도자의 특성을 조사하고, 자살시도 후 응급실에 방문하여 정신건강의학과 치료를 받기로 결정하는 데 신체적 질병이 어떤 영향을 주는지 분석하였다. 방 법 2012년 1월부터 12월까지 경기도의 일 종합병원 응급실에 내원한 132명의 자살시도자를 대상으로 하였다. 환자의 의무 기록을 후향적으로 검토해 인구통계학적, 임상적 요인을 조사하였고 정신건강의학과 치료 연계여부에 따라 분석하였다. 결 과 입원과 외래 상관 없이 정신건강의학과 치료를 받는 것에 영향을 주는 요인은 정신건강의학과 진단 유무, 직업 유무, 정신건강의학과 치료 과거력, 자살시도 과거력이었다. 정신건강의학과 치료 형태를 입원과 외래로 나누어 동반된 의학적 질병의 심각도(Charlson comorbidity index)를 비교했을 때, 입원을 통해 정신건강의학과 치료를 받은 자살시도자와 치료 자체를 거부한 자살시도자는 외래에서 치료를 받은 자살시도자보다 동반된 의학적 질병의 심각도가 높게 나타났다. 결 론 이 연구 결과 응급실에 내원한 자살시도자에게 동반된 의학적 질병의 심각도(Charlson comorbidity index)가 정신건강의학과 치료 형태에 영향을 미친다는 점을 알 수 있었다. 따라서 정신건강의학과 의사는 응급실에 내원한 자살시도자에 대해 의학적 동반질병의 여부 및 심각도를 평가하여 동반된 의학적 질병이 상대적으로 심각함에도 불구하고 자의퇴원을 진행하려고 하는 자살시도자에게 좀 더 합리적인 의사결정을 할 수 있도록 도움을 줄 수 있어야 한다. Objectives : Suicide attempters have impaired decision making and are at high risk of reattempt. Therefore it is important to refer them to psychiatric treatment. Especially, People with medical comorbidity are at higher risk of suicidal attempt and mortality. The aim of this study was to investigate the characteristics of suicidal attempters and to analyze the influence of the medical comorbidity on decision to receive psychiatric treatment after visit to an emergency department. Methods : One hundred and thirty two patients, who visited the emergency room of a general hospital in Gyeonggi-do between January, 2012 and December, 2012 were enrolled as the subjects of this study. After reviewing each subject's medical records retrospectively, demographic and clinical factors were analyzed. Results : Regardless of the engagement type, either via admission or outpatient clinic, the determinant factors of psychiatric treatment engagement were psychiatric diagnosis, employment status, previous psychiatric treatment history, and previous attempt history. Comparison of severity of medical comorbidity(Charlson Comorbidity Index) showed that suicide attempters who received psychiatric treatment via admission or refused the treatment tended to have higher level of medical comorbidity than who received psychiatric treatment via outpatient department. Conclusions : Our findings showed that medical comorbidity of suicide attempters affected the decision to accept psychiatric treatment. All psychiatrists should evaluate the presence and the severity of medical comorbidity of the suicide attempters and consider implementing more intervention for the medically ill attempters who are willing to discharge against advice.

주의력결핍 과잉행동장애에서 노르에피네프린 수송체 유전자와 오로스 메칠페니데이트 부작용의 연관성

송정은(Jungeun Song),홍현주(Hyun Ju Hong),이병욱(Byung Ook Lee),육기환(Ki-Hwan Yook) 대한소아청소년정신의학회 2014 소아청소년정신의학 Vol.25 No.2

Objectives:The aim of our study was to investigate association of norepinephrine transporter gene (SLC6A2) polymorphism and side effects of osmotic-release oral system methylphenidate (OROS MPH) in children with attention-deficit hyperactivity disorder (ADHD). Methods:We recruited drug naive children with ADHD (N=97). We administered OROS MPH by tolerable dosage. At week 8 of treatment, parents completed the Barkley’s side effect rating scale. We analyzed two SLC6A2 single nucleotide polymorphisms (SNPs), rs192303 and rs3785143, with blood of subjects. We compared the frequency and severity of each side effect among SLC6A2 genotypes of 2 SNPs. Results:In the analysis of frequency of each side effect, irritability differed according to rs192303 and rs3785143 genotype. In comparisons of severity, talking less and disinterest differed according to rs192303 genotype. In the case of rs3785143, severities of disinterest and irritability were involved with genotype. Conclusion:Side effects of OROS MPH showed an association with SLC6A2 genotype.