입원중(入院中)인 정신분열병(精神分裂病) 환자(患者)에서 지연성(遲延性) 운동장애(運動障碍)의 유병솔(有病率)

이정구,박정환,이태환,김영훈,Rhee, Chung Goo,Park, Jeung Hwan,Lee, Tae Hwan,Kim, Young Hoon 대한생물정신의학회 2003 생물정신의학 Vol.10 No.1

Object : This cross-sectional study was performed in order to evaluate the prevalence of tardive dyskinesia among the hospitalized schizophrenic patients. Methods : Four hundred nineteen hospitalized schizophrenic patients(male=263, female=156) were recruited for this study. They were treated with antipsychotics for more than 3 months. The prevalence of tardive dyskinesia was assessed by the Abnormal Involuntary Movement Scale. Results : The prevalence of tardive dyskinesia was 35.6%(Male=36.9%, Female 33.3%). There were no significant differences in the prevalence of tardive dyskinesia among male and female schizophrenic patients. The prevalence of tardive dyskinesia among the patients over 30years old was much higher than those below 30years old. There were no significant correlations between the prevalence of tardive dyskinesia and the duration of hospitalization, the total amount of antipsychotics. The frequently involved parts of the body in the schizophrenic patients who have tardive dyskinesia were tongue, upper extremity, lips and perioral area, jaw, lower extremity, muscles of facial expression trunk, respectively. Conclusions : There was significant correlation between the age and the prevalence of tardive dyskinesia in the antipsychotic-treated schizophrenic patients. There were no correlations between the prevalence of tardive dyskinesia and gender difference, the duration of hospitalization, the total amount of antipsychotics.

항정신병약물로 인한 QTc 지연과 5-HTTLPR의 연관성

서범주,이정구,박성우,공보금,정도운,김영훈,Seo, Beom-Joo,Rhee, Jung-Goo,Park, Sung-Woo,Kong, Bo-Geum,Chung, Do-Oun,Kim, Young-Hoon 대한생물정신의학회 2004 생물정신의학 Vol.11 No.1

Objective:A Comparison of QTc prolongation for various antipsychotics and an analysis of QTc prolongation for the various types of serotonin transporter polymorphism were performed. Method:EKG was checked, followed by QTc measurement as Bazett's correction, and the serotonin transporter polymorphism was examined in 110 chronic schizophrenia patients were performed EKG before 24 weeks ago. We defiened QTc prolongation as over 450ms. The risk factor of sudden cardiac death were defiend as QTc prolongation and or 60ms in delta value. Result:The prevalence of QTc prolongation in this study was 7.3%, and the prevalence of over 60ms was 4.5%. Patients who had the risk factors were 10(9.1%). 6/52 who prescribed atypical antipsychotics and 2/58 who prescribed haloperidol showed QTc prolongation. The prevalence who had the risk factor of sudden cardiac death were 16% in atypical antipsychotics group, 3.4% in haloperidol group. QTc prolongation were observed more frequently in l/l type than s/s type. l allele frequency were 50% in QTc prolongated group, 19% in not prolongated group. l allele had an association with QTc prolongation(p<0.01). Conclusion:The prevalence of QTc prolongatin was frequent in chronic schizophrenia patients who were prescribed atypical antipsychotics. It has strong association with l allele of 5-HTTLPR.

우울증의 신경생물학

김영훈,이상경,이정구,김정익,Kim, Young-Hoon,Lee, Sang-Kyeong,Rhee, Chung-Goo,Kim, Jeong-Ik 대한생물정신의학회 1999 생물정신의학 Vol.6 No.1

At the beginning, researches on the biology of depression or affective illness have focused mainly on the receptor functions and neuroendocrine activities. And the studies of the past years did not break new theoretical background, but the recent advances in the research on the molecular mechanisms underlying neural communication and signal transduction do add some insights to many established ideas. This article will overview some of the more recent advances in the clinical researches of depression. Our major concerns to be presented here include the followings : (1) alterations in the post-synaptic neural transduction ; (2) changes in the neurons of hypothalamic neuropeptides ; (3) decreased peptidase enzyme activities ; (4) associations of hypothalamic-pituitary-adrenal axis abnormalities with serotonin neurotransmission ; (5) role of serotonin transporter ; (6) changes in the responsiveness of intracellular calcium ion levels ; (7) the inositol deficiency theory of lithium and depression ; (8) the transcription factors including immediate early genes ; (9) recent genetic studies in some families. This brief overview will suggest that changes in DNA occur during antidepressant therapy. These changes at the DNA level initiating a cascade of events underlying antidepressant modality will give us the insights on the molecular biological basis of the pathogenesis of depression and cues for a new class of antidepressants.

입원한 남자 알코올 의존 환자에서 8주 금주기간 후 음주갈망의 변화

진영호 ( Young Ho Jin ),이정구 ( Chung Goo Rhee ),윤성환 ( Sung Hwan Yoon ),정치영 ( Chi Yeong Jung ),손진욱 ( Jin Wook Son ) 한국정신병리진단분류학회 2003 精神病理學 Vol.12 No.1

알쯔하이머 질환의 분자신경생물학적 소견

김영훈(Young-Hoon Kim),이정구(Chung-Goo Rhee),김용관(Yong-Kwan Kim),김성수(Sung-Soo Kim) 대한노인정신의학회 1998 노인정신의학 Vol.2 No.1

알쯔하이머 질환은 heterogenous disorder이다. 가족성 혹은 비가족성 알쯔하이머 질환의 원인이 되거나 위험인자로 작용하는 유전인자에 대하여 정리하면 다음과 같다. 염색체 21번의 APP 유전자 돌연변이는 NP의 핵심물질인 Aβ42를 양산하고, 염색체 19번에 위치한 위험인자 Apo-E e4 allele는 Aβ를 효과적으로 제거하지 못해 Aβ40의 축적이 일어나며, 염색체 14번과 1번의 presenilin 돌연변이는 역시 섬유화 성향(fibrillogenic)이 높은 Aβ42, 43를 생산하여, 결과적으로 이들 모두 NP에 Aβ가 침착되는 것을 촉진한다(Table 4). Aβ의 침착이나, PHFtau로 형성된 NFT는 신경세포를 죽이고, 환자를 치매에 이르게 하는 최종공통경로(final common pathway)로 생각된다. 그러나 알쯔하이머 질환의 신경병리기전은 현재 그 일부만이 겨우 밝혀져 있을 뿐이다. 이 분야는 현재 뇌의 노화에 대한 과학적 접근과 중첩되는 분야로서, 기초과학적 욕구뿐만 아니라 사회의학적 관심도 고조되어 있어, 현재 어느 분야보다도 더 집중적인 연구가 이루어지고 있다. Alzheimer's disease (AD), the most common dementia in the elderly, is associated with a characteristic neuropathology:extracellular neuritic plaques (NPs) and intraneuronal neurofibrillary tangles (NFTs). AD is diagnosed clinically on the basis of progressive cognitive impairment. However, the diagnosis of AD is only reliable if a histopathological examination at autopsy shows high numbers of NPs and NFTs particularly in the hippocampus and cerebral cortex. The major component of NP is β-amyloid protein (Aβ), a fragment of the amyloid precursor protein (APP). NFTs are largely composed of paired helical filaments (PHFs) containing abnormally phospholylated form of the microtubule-associated protein (MAP), tau. A genetic etiology for AD has been established based on population survey. It is revealed that 25-40% of the AD patients are familial and the disease is inherited as an autosomal-dominant trait in most families. Age at onset patterns of AD patients in affected families had indicated that its distribution is bimodal with a cut-off age 58 years. Several mutations in the APP gene, located on chromosome 21, are linked to early-onset AD (EOAD). However, these account for only a small fraction of cases of EOAD. The remaining cases are associated with mutations in two other genes:one on chromosome 14 that encodes S182 (presenilin 1) and the other on chromosome 1 that encodes STM2 (presenilin 2). It is also known that inheritance of specific apolipoprotein E (apoE) alleles, located on chromosome 19, determines the risk and mean age of onset of late-onset AD (LOAD). In this review, we will briefly discuss the biology and hypothetical mechanisms of Aβ, presenilins, apoE and tau protein, those involved in the pathogenesis of AD.

우울증의 약물치료

이정구,공보금,김영훈 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

As The Celluar and molecular pathology of depression were revealed, the newer drugs will be adapted by the treatment of depression. For the adequate treatment of deperssion psychiatrist must know the typical symptoms of depression and the target symptoms of pharmacotherapy and the profile of adverse effects, the genetic inforamtion of individulas. The selection of antidepressant according to the indvidual variation of genetics will be very improtant.

만성 정신분열병 환자에서 지연성 운동장애와 음성증상 및 인지기능 장애와의 연관성

심주철,반철식,성기수,이정구,정도운,정청,윤진상,김영훈 대한신경정신의학회 2000 신경정신의학 Vol.39 No.4

연구목적: 정신과 전문병원에 입원해 있는 만성정신분열병 환자들을 대상으로 첫째 지연성 운동장애의 유병율과 위험인자들을 조사하고, 둘째 지연성 운동장애와 정신분열병의 음성증상 및 인지기능 장애와의 상관성을 조사하고자 한다. 방법: 연구대상자는 마산동서병원에 입원 중인 환자 중 DSM-IV의 정신분열별 진단기준에 부합하며, 최근 3개월 이상 동일 용량의 항정신병약물 복용한 271명(남자 174명, 여자 97명)의 환자들이었다. 지연성 운동장애에 대한 평가는 Abnormal Involuntary Movement Scale(AIMS)을 이용하였고, DSM-IV와 Sc-hooler와 Kane(1982)의 진단기준 양자에 부합하는 환자들만을 지연성 운동장애군으로 분류하였다, 정신 분열병 정신병리에 대한 평가는 Brief Psychiatric Rating Scale(BPRS)와 Schedule for the Deficit Syndrome(SDS)을 이용하였고, 인지기능에 대한 평가는 Mini-Mental Status Examination(MMSE)을 이용하였다. 결과: 지연성 운동장애의 유병율은 50.9%이었고, 50세 이상, 남자에서 높았다. 그러나 입원기간과 항정신병 약물의 일일 사용량에 따른 차이는 없었다. 지연성 운동장애의 호발부위는 혀, 상지, 입술과 입 주위의 순이었다. BPRS 총점 및 소항목 척도점수와 SDS 척도점수는 지연성 운동장애의 유무에 따른 차이가 없었다. MMSE 총점 및 소항목 점수도 지연성 운동장애의 유무에 따른 차이가 없었다. 결론: 평균입원기간이 9년 이상인 만성정신분열병 환자들에게서의 지연성 운동장애의 유병율은 50.5%이었고, 연령이 가장 의미있는 위험인자임을 확인했다. 만성정신분열병 환자들이 주 대상인 본 연구에서는 지연성 운동장애와 정신분열병의 음성증상 및 인지기능 장애와의 상관성은 입증하지 못했다. Objectives: The purpose of present study was to determine the prevalence rate of tardive dyskinesia and to search for its risk factors in chronically institutionalized schizophrenic subjects. We also examined the relationship between tardive dyskinesia and both negative symptoms and cognitive impairments in the same subjects. Methods: Subjects were 271 in-patients(174 males, 97 females) at Masan Dongsuh Hospital. They met DSM-IV criteria for schizophrenia and had been taking fixed doses of antipsychotics for at least 3 months. Tardive dyskinesia was assessed by Abnormal Involuntary Movement Scale(AIMS). Cases of tardive dyskinesia were ascertained by the criteria of Schooler and Kane (1982) and DSM-IV. The rating of psychopathology was acquired using Brief Psychiatric Rating Scale(BPRS) and Schedule for the Deficit Syndrome(SDS) and the assessment of cognitive function using Mini-Mental State Examination(MMSE). Results: The prevalence of tardive dyskinesia is 50.9% and the frequency of tardive dyskinesia was high est in male above the age of fifty. But there was no statistically significant relationship between the frequency of tardive dyskinesia and both the length of hospitalization and the daily dose of antipsychotics. The frequency order of abnormal movement in the patients with tardive dyskinesia was as follows : tongue, upper extremities, lips and perioral area. We couldn't find any significant difference in the total and subscale scores of BPRS between the groups with and without tardive dyskinesia. There were no differences in MMSE scores between the groups with and without tardive dyskinesia. Conclusion: This study gave us that the prevalence of tardive dyskinesia was high in chronically institutionalized schizophrenic inpatients and that age was the most significant risk factor of tardive dyskinesia. The relationship between tardive dyskinesia and both negative symptoms and cognitive impairment, however, was not revealed.

네모나프라이드의 유효성 및 추체외로 부작용 : Haloperidol 및 Risperidone과의 자연관찰적 개방형 비교연구 A Naturalistic Open Comparative Study with Haloperidol and Risperidone

서영수,김용관,신동환,공보금,이정구,박정환,윤성환,정치영,이상경,김영훈 대한생물치료정신의학회 2001 생물치료정신의학 Vol.7 No.2

Objectives : This open prospective study was performed in order to evaluate the efficacy and extrapyramidal adverse effects of nemonapride in the schizophrenic patients, and was compared wit one of typical antipshchotics. haloperidol and one of atypical antipsychotics, risperidone. Methods : Thirty male and female schizophrenic patients(DSM-Ⅳ) were treated for 12 weeks with haloperidol(n=10), risperidone(n=10) and nemonapride(n=10). The overall efficacy was assessed at baseline, 1st week, 2nd week, 4th week, 8th week, and 12th week by the Positive and Negative Syndrome Scale for Schizophrenia(PANSS). Also the overall safety was assessed in the same time period by the Extrapyramidal Symptom Rating Scale(ESRS). Results : There were no significant differences in PANSS scores(total, positive, negative, and general psycho­pathology subscale) among haloperidol, risperidone, and nemonapride groups, Treatment responders, defined as at least 20% reduction of baseline total PANSS score, were achieved by 8 patients(80%) in haloperidol group, 10 patients(100%) in risperidone group, and 8 patients(80%) in nemonapride group. And there were no significant differences in ESRS total scores among haloperidol, risperidone, and nemonapride group. Inter-group comparison among haloperidol, risperidone and nemonapride group, as assessed by the ESRS, revealed no significant differences in the shifts to the maximum score, 9.4(±9.4), 6.2(±8.4), and 11.3(±8.1) respectively, and also revealed no significant differences in the mean time reaching the maximum score, 4.5(±4.5) week, 7.8(±4.8) week, and 4.6(±4.4) week, respectivily. Conclusion : There wee no significant differences in the efficacy and extrapyramidal adverse effects among haloperidal, rispecridone and nemonapride groups. These results suggest that nemonapride was as efficacious and safe in he treatment of schizophrenia, as well known and widely used antipsychotics, haloperidol and risperidone.