정신과 외래 환자에서 우울증상과 무감동의 관계

박정원 ( Jung Won Park ),이문수 ( Moon Soo Lee ),양재원 ( Jae Won Yang ),김승현 ( Seung Hyun Kim ),조숙행 ( Sook Haeng Joe ),정인과 ( In Kwa Jung ) 한국정신병리진단분류학회 2009 精神病理學 Vol.18 No.1

Introduction: Apathy was found in patients with disorders seemingly unrelated with depression such as dementias, stroke, Parkinson`s disease, Alzheimer`s disease, and schizophrenia. As apathy is common in depressive patients and depressive patients with apathy have poorer prognosis than depressive patients without apathy, it might be important that we evaluate the relationship between apathy and depressive symptoms in clinical practice. Therefore, we evaluated the relationship between apathy and depressive symptoms in patients using Hamilton Rating Scale for depression(HRSD), Beck depression inventory(BDI), and apathy evaluation scale-clinician version(AES). Method: This study was performed in Korea university medical center, Guro hospital. Outpatients diagnosed as currently having depressive disorders or have achieved state of remission were enrolled (n=70). We translated AES into Korean and performed a cross-sectional assessment using HRSD, BDI and AES. Results: There was a positive correlation between total score of HRSD and the total score of AES (R=0.757, p<0.001). The AES score was higher correlated with subtotal scores of the four apathyrelated items from HRSD; loss of interest, psychomotor retardation, loss of energy, and loss of insight (R=0.827, p<0.001). Moreover, there was a positive correlation between total score of BDI and the total score of AES(R=0.552, p<0.001). In high BDI score group(n=33), 32 patients showed apathy syndrome. However, there was not a positive correlation between total score of BDI and the total score of AES. In low BDI group(n=37), 21 patients showed apathy syndrome. There was not a positive correlation between total score of BDI and the total score of AES. In high HRSD group(n=21), all patients had clinically meaningful apathy syndrome. There was not a positive correlation between total score of HRSD and the total score of AES. On the other hand, in low HRSD group(n=49), 32 patients had apathy syndrome. There was a statistically significant positive correlation between total score of HRSD and the total score of AES(R=0.720, p<0.001). Moreover, there was also a significant correlation between subtotal scores of the four apathy-related items from HRSD and the total score of AES(R=0.793, p<0.001). Conclusion: This cross-sectional study shows that apathy symptoms are different from the depression. However, apathy symptoms frequently coexist with depression. Even if the depressive patients scored below cut-off value in HRSD or BDI as they are in clinically remission state, we should consider the possibility of apathy syndrome.

한국 노인의 우울요인

박인옥(In Ok Park),김진세(Jin Se Kim),이강준(Kang Joon Lee),정인과(In Kwa Jung) 대한노인정신의학회 1998 노인정신의학 Vol.2 No.1

Depression is one of most frequent psychiatric disorders in the elderly. Major depression has higher prevalence in the elderly compared with younger subjects. Depression in the elderly is a major health concern that can be life threatening, if not recognized and not treated. An untreated depression may result in needless suffering, institutionalization, and suicide. Inadequated treatment may occur because the signs and symptoms of depression in the elderly are different from those in the young, and because the depressive symptoms may be viewed by the physician as a normal part of aging. The purpose of this study is to evaluate depressive factors in the Korean elderly. Four hundred and sixty eight Koreans were evaluated for depressive factors in 60 years old or more. The author performed a clinical evaluation guide, an intensive questionnaire, and Mini-Mental Status Examination-Korean version (MMSE-K). Stastically ANOVA, Scheffe, Duncan and Chi-square methods were used to find out depressive factors in the Korean elderly. Depression, dissatisfaction, suicidal idea and distress factors were evaluated in the Korean elderly depressed persons. Depressive factors were associated with physical health problems, family problems, psychiatric health problems, loneliness, economic problems, interpersonal conflicts, and occupational problems. Among these depressive factors, physical health problems were most frequently dominant in the elderly. Physical health problems are closely related to depression in the elderly. Depressive syndromes in the elderly are frequently combined with somatic complaints. And depression may be masked by multiple somatic complaints or by pain, for which no organic cause can be found. However, the etiology and mechanism of the association between physical illness and depression are unkown. Such factors as described above may be important in reducing the high prevalence of depression in elderly people. 한국노인의 우울요인을 조사하기 위하여 정신과에 내원한 주요우울증 환자노인군과 무료복지병원, 복지회관, 파고다 공원 및 경로당의 일반노인군 등 468명을 대상으로 훈련받은 면접원이 1:1 면접 방식으로 인구통계학적 자료와 순위별 요인 분석을 하여 다음과 같은 결론을 얻었다. 첫째, 일반노인군보다 환자노인군에서 여자, 동거자녀가 없는 경우, 건강상태가 좋지 않다고 생각하는 경우, 용돈이 없는 경우, 용돈을 약값 및 병원비로 주로 사용하는 경우가 많았다. 그러나 학력, 결혼상태, 경제상태, 용돈액수에는 두 군간의 차이가 없었다. 둘째, 일반노인군과 환자노인군 모두에서 신체적 건 강 문제, 특히 주관적으로 느끼는 건강문제가 있을 때 가장 우울한 것으로 나타났다. 세째, 일반노인군과 환자노인군 모두에서 신체적 건강문제, 특히 현재 앓고 있는 질병이나 사고에 대한 걱정이 있을 때 가장 불만인 것으로 조사되었다. 다음으로 일반노인군에서는 경제적 어려움이 있을 때, 환자노인군에서는 정신적 건강 문제가 있을 때 불만이 있었다고 하였다. 네째, 전체적으로 39.3%의 노인들이 자살사고가 있었으며, 환자노인군은 56.1%로 32.2%인 일반노인군 보다 높은 자살사고를 보였다. 또한 환자노인군과 일반노인군 모두에서 신체적 건강 문제, 특히 현재 앓고 있는 질병이나 사고에 대한 걱정으로 죽고 싶다고 하였으며, 환자노인군에서는 불안, 초조 등의 정신적 건강문제로 죽고 싶다는 경우도 15.6%에서 나타났다. 다섯째, 살아오면서 가장 괴로웠던 사건이나 일은 일반노인군에서는 자녀 걱정이었으나, 환자노인군에서는 배우자와의 갈등이었다. 한국 노인의 우울 요인으로 신체적 건강 문제, 자녀와의 문제, 경제적 어려움이 가장 중요한 것으로 조사되었고, 영속적 상황에서는 배우자와의 갈등이 가장 중요한 우울요인인 것으로 조사되었다. 향후 노인 우울증 환자의 진단 및 평가에 있어서는 이러한 우울요인들이 비중있게 반영되어야 할 것이다. 그리고 본 연구의 제한점이라고 할 수 있는 연령 및 남녀비율의 편중을 고려하여, 더 광범위하게 지역 및 경제적 분포가 고른 대상을 표집하여 연구가 진행되어야 할 것이다.

SPAQ에 의한 계절성과 TCI에 의해 평가된 기질과 성격과의 관련성 - 한국 고등학생을 대상으로 -

홍준근,이문수,김승현,조숙행,정인과,Hong, Jun-Keun,Lee, Moon-Soo,Kim, Seung-Hyun,Joe, Sook-Haeng,Jung, In-Kwa 한국정신신체의학회 2007 정신신체의학 Vol.15 No.1

연구목적: 고등학생을 대상으로 계절성 평가 도구인 계절성 양상 평가 설문지(Seasonal Pattern Assessment Questionnaire, SPAQ)와 인격 성향을 평가하는 기질과 성격 검사(Temperament and Character Inventory, TCI)와의 상관관계에 대해 조사하여 계절성과 인격 구조와의 유전적 요인과의 관계에 대해 알아보고자 하였다. 방법: 서울에 거주하는 600명의 고등학생을 대상으로 Rosenthal의 SPAQ와 Cloninger의 TCI 한국어판을 사용하였다. 결과 : 여학생은 harm avoidance, reward dependence, cooperativeness에서 높은 점수가 나온 반면 남학생에서는 persistence, self-transcendence에서 높은 점수가 나왔다. 총계절성 점수(Global seasonality score)와 TCI의 하부척도를 비교한 결과 harm avoidance, self-transcendence와는 정적 상관관계가 나타났으며, self-directedness, cooperativeness와는 부적 상관관계가 나타났다. 로지스틱 회귀분석 결과, SAD의 경우 회귀계수는 self-directedness와 유의한 부적 상관관계가 나타났으며 self-transcendence와는 정적 상관관계가 나타났다. S-SAD의 경우에는 cooperativeness와 부적 상관관계를 보였으며 self-transcendence와는 정적 상관관계를 보였다. GSS가 11점 이상일 경우에는 그렇지 않은 경우에 비해 self-transcendence 점수가 높게 나타났으며, 겨울에 가장 기분이 저하되는 경우에는 그렇지 않은 경우에 비해 더 낮은 cooperativeness 점수를 보였다. 계절성 변동이 중등도 이상의 문제를 일으키는 경우에는 높은 harm avoidance, self-transcendence 점수를 보였다. 결론: 계절성과 성격 및 기질적인 부분이 서로 연관성을 보였다. 이 연구가 우리나라에서 고등학생을 대상으로 한 최초의 연구로서 여기에서 보인 결과들은 임상적 적용에 도움을 줄 수 있을 것으로 보인다. Objectives : Recently, many authors investigated the relation of temperament and character to seasonality and the genetic factors in seasonality and personality. In this study, we investigated the relation between personality structure obtained from the psychobiological Temperament and Character Inventory (TCI) and self-reported seasonal variations in mood and behavior measured by the Seasonal Pattern Assessment Questionnaire (SPAQ). Methods : 600 high-school students who live in Seoul of Korea, were participated in this study. Subjects were surveyed with the Korean translation of the SPAQ of Rosenthal, an instrument for investigating mood and behavioral changes with respect to the seasons of the you. Korean version of the TCI of Cloninger was also used for assessment of personality. Results : Female students were significantly higher scores on harm avoidance, reward dependence, and cooperativeness than male students who had significant higher scores on persistence and self·transcendence than the formers. GSS were showed positive correlation with harm avoidance and self-transcendence, and negative correlation with cooperativeness and self-directedness. By employing logistic regressions, the regression coefficients of SAD were significantly negative in SD, and positive in ST. Also, the regression coefficients of S-SAD were significantly negative in CO, and positive in ST. Those with GSS at least 11 were significantly higher mean ST values compared to the remaining individuals, and those with worst in winter were significantly lower mean CO values compared to the remaining individuals. Those who considered the seasonality as a problem at least to a moderate degree were associated with high HA and ST. Conclusion : We add the evidence that the seasonality is related to the temperament and character. Although there have been many reports about the seasonality in relation to the temperament and character in foreign countries, there has been very limited report from Korea before. We hope that this result would be a helpful in the clinical field in Korea.

배우자와 사별(死別)한 노인의 우울증상

김진세(Jin Se Kim),이현수(Hyun Soo Lee),정인과(In Kwa Jung),곽동일(Dong Il Kwak) 대한노인정신의학회 1998 노인정신의학 Vol.2 No.1

사별은 노인에 있어 우울증 발현의 중요한 요소로 연구되고 있다. 그러나 우리나라의 경우는 서구와 다르게 사별로 인한 배우자의 상실이 보다 지속적으로 유지되는 실정이고 우리나라 노인의 우울증상은 사회문화적 차이로 인해 서구의 노인과는 다르므로, 우리나라 노인을 대상으로 표준화된 노인 우울 척도인 KGDS를 이용하여 사별이 노인 우울증상에 미치는 영향을 조사하였다. 60세 이상의 노인 175명을 대상으로 KGDS를 시행하여, 사별군과 비사별군을 비교하고, 사별군의 성별, 연령, 동거자녀 유우에 따른 비교 및 사별시의 나이, 사별기간과 KGDS와의 상관관계를 분석하였다. 연구 결과, 사별군이 비사별군 보다 KGDS 점수가 유의하게 높았으며, 특히'요소 1','요소 2','요소 4'는 통계적으로 유의하였다. 사별군에서 여성의 KGDS 점수가 유의하게 높았으며, 특히'요소 2','요소 3','요소 5'는 통계적으로 유의하였다. 사별군에서 통계적 유의성은 없었으나, 동거자녀가 있는 군의 KGDS 점수가 동거자녀가 없는 군보다 높았다. 사별시 대상의 연령.사별기간과 KGDS와의 상관관계에서, 젊은 나이에 사별을 하고 사별기간이 길수록 KGDS 점수가 높았으며,'요소3'은 통계적으로 유의하였다. 본 연구에서 배우자와 사별한 노인은 배우자가 있는 노인보다 우울증상이 많았으며, 주된 우울증상은 감정적 불편감, 부정적 사고 및 불행감, 그리고 인지기능이상이었다. 저자들은 우리나라의 노인에서도 서구와 마찬가지로 사별은 우울증의 중요한 유발인자이고, 사별군에서는 여성, 사별한 나이가 젊고 사별기간이 길수록 우울증의 고위험이 있으며, 우리나라의 경우 사별 기간이 긺으로서 사별이 지속적인 우울요인으로 작용할 수 있다는 것을 제시하였다. There are many studies of the spousal bereavement as an important etiologic factor of depression in elders. But there are some differernt natures of spousal bereavement between the Korean and the western elderly. The problems of spousal bereavement in Korean would be more persistent than that in western. And the depressive symptoms of Korean elders are different with that of western elders due to the differences of sociocultural background. The authors studied the effect of the spousal bereavement to the depressive symptoms of elders by using KGDS (Korean Form of Geriatric Depression Scale), which already has been standardized in Korea. The subjects were consist of one hundred seventy-five, 60 years and older. The authors compared KGDS and its 5 factors in the spousal bereaved subjects group (SBG) with those in the spousal non-bereaved subjects group (SNG), and also investigated the differences according to sex and children living with the subject in the SBG. And the authors analysed the correlations between ages at spousal death, durations after spousal death and KGDS in the SBG. The mean KGDS scores in the SBG were significantly higher than that of the SNG, and especially Factor 1, Factor 2 and Factor 4 were significant. In the SBG, the mean KGDS scores of the female were significantly higher than that of the male, and especially Factor 2, Factor 3, and Factor 5 were significant. And in the SBG, the mean KGDS scores of the subjects living with children were slightly higher than those of the subjects living without children. And also in the SBG, there were negative correlations between KGDS scores and ages at spousal death, and positive correlations between KGDS scores and durations after spousal death. The authors found that the spousal bearevement could be an important etiologic factor of geriatric depression, and the risk factors of depression were female, younger at spousal death and longer duration after spousal death in bereaved elders, as the earlier studies in the western. However, the authors found that, in Korea, there were some different results from the western, such as the longer duration after spousal death and higher ratio of the widower to the widow than that in the western, the spousal bereaved elders living with children were rather depressive than who living without children.

한국형 노인우울검사(Korean Form of Geriatric Depression Scale;KGDS) 표준화 연구

정인과(In-Kwa Jung),곽동일(Dong-Il Kwak),조숙행(Sook-Haeng Joe),이현수(Hyeon-Soo Lee) 대한노인정신의학회 1997 노인정신의학 Vol.1 No.1

본 연구는 한국형 노인우울검사(KGDS)에 대한 표준화 연구로, 예비 연구에서 제기되었던 문항 내용 및 길이, 표집의 문제를 개선하여 최종적으로 30문항을 확정한 후 신뢰도와 타당도를 검증하였다. 연구대상은 60세 이상의 노인 450명으로, 우울환자 군은 129명(남자 28명, 여자 119명)이었고 대조군은 321명(남자 276명, 여자 194)이었다. KGDS의 신뢰도를 검증한 결과, Cronbach의 계수는 .88, 반분신뢰도는 .79, GDS와의 상관은 .87로서 만족스러운 수준이었고 두 집단의 평균의 차이를 검증해본 결과 α=.001 수준에서 유의하였다(환자군 평균 17.82(10.52), 대조군 평균 10.52(5.12), t=12.07). KGDS의 구성타당도와 내적 구조를 파악하기 위해 실시한 요인분석에서는 정서적 불편감(Emotional discomfort), 비관적 사고 및 불행감(Negative thinking and Unhappiness feeling), 신체적 약화 및 기력쇠퇴(Physical weakening and decreased vitality), 인지기능 저하(Cognitive dysfunction), 사회적 관심과 활동저하(Decreased social interest and activity) 등 총 5개의 구성요인이 밝혀졌고 총 설명변량은 53.72%였다. 마지막으로 KGDS의 판별력과 최적 절단점수를 확인하기 위해 판별분석 및 민감도, 특이도의 지표를 구하여 본 결과 전체판별률은 75%이었고 최적 절단점수는 14점이 제안되었으며 고전적인 백분위점수분포를 추가적으로 고려하여 14∼18점 사이는 경계선수준 및 경도의 우울증, 19∼21점 사이는 중등도의 우울증, 22점 이상은 심도의 우울증으로 분류할수 있을 것으로 기대되었다. 결론적으로, 기존의 노인 우울검사(GDS)의 낮은 진단 변별력을 개선시키고자 새로이 만든 한국형 노인우울검사(KGDS)는 기존 검사에 비해 진단변별력이 10% 가량 향상되었을 뿐 아니라 신뢰도, 타당도도 만족스러운 수준을 보여 노인우울 진단용 검사로 유용하게 쓰일 수 있을 것으로 여겨진다. This study was aimed to standardize the Korean Geriatric Depression Scale (KGDS). In order to slove the unsatisfied discriminating power of Geriatric Depression Scale (GDS:Yesavage et al. 1983) presented in Korean studies, the authors made KGDs. The preliminary KGDS was costructed of 40 items selected from GDS, BDI, SDS, MMPI-D, CES-S and had satisfied reliability and validity, but had some problems in item contents, number of times, and sampling. Thus by correcting these problems, the authors made new KGDS of 30 item, and tested the reliability and validity of the final version of KGDS. The values of Cronbach's α and Split-half reliability were .88 and .79 respectively, and correlational coefficent with GDS was .87. The differences of means was signified at α=.001 level (patients group mean=17.82 (10.52), control group mean=10.52 (5.12), t=12.07). On factor anlaysis, 5 factors in KGDS were extracted. They were labeled Emotional discomfort (factor 1), Negative thinking and Unhappinesss feeling (factor 2), Physical weakening and decreased vitality (factor 3), Cognitive dysfunction (factor 4), Decreased social interest and activity (factor 5), which represent depressive features of the elderly in thought, emotional, cognitive, physical, social aspects. The total percentage of variance of 5 factors was 53.72%. The result of discriminatin anlaysis showed that hit ratio of KGDS was 75%, and the score of 14 was suggested as the optimal cutoff score. Additionally, by use percentile score distribution of control group (normal) subjects, each of the score of 14-18, 19-21, over 22 suggested borderline or mild depression, moderate depression, severe depression, respectively. Conclusively, the final version of KGDS not only improved diagnostic discriminatory power approxtimately 10% than GDS, but also showed satisfiable reliability and validity. So the KGDS could be a useful tool for evaluaion of elderly depression.

기분장애의 병리와 치료에 있어 세로토닌의 역할

정인과,김진세,Jung, In Kwa,Kim, Jin Se 대한생물정신의학회 1997 생물정신의학 Vol.4 No.2

The serotonin has been known to play important roles in pathology of the mood disorders. We summerize the evidences of serotonin in pathology of the mood disroders in a view of neuroanatomical and neurochemical aspects. Nowaday, the selective serotonin reuptake inhibitors(SSRIs) may be practically the first line of antidepressants with traditional tricyclic antidepressants(TCAs). Authors review the role of serotonin in the treatment of the mood disorders, in a view of the general considerations in selecting antidepressants, pharmacology, therapeutic indications, side effects, doses of medication, drug-discontinuation syndrome, drug-to-drug interactions, and special therapeutic situations.

한국형 노인우울검사 보호자용(Collateral Source Version of the Korean Form of Geriatric Depression Scale:CS-KGDS)의 타당도 연구

이현수(Hyeon-Soo Lee),유영수(Young-Soo You),한준수(Jun-Soo Han),곽동일(Dong-Il Kwak),정인과(In-Kwa Jung) 대한노인정신의학회 1998 노인정신의학 Vol.2 No.2

In order to examine elderly depression in the elderly that too weakened cognitively, and physically to check depressive symptoms reliably, the authors deviced collateral source version of elderly depression scale and tested it's validity. Sixty elderly depression patients and forty-eight old person in normal group completed the KGDS (Korean Form of Geriatric Depression Scale), and their collateral source (CS) completed a CS version of the KGDS (CS-KGDS). The differences of CS-KGDS means was signified at α =.001 level (patients group mean=18.33 (4.71), control group mean=7.60 (5.25), t=11.18). The values of Cronbach's α and Split-half reliability were .88 and .81 respectively, and correlational coefficent with KGDS was .68. On factor analysis, 5 factors were extracted. They were labeled ‘Physical weakening and decreased vitality’(factor 1), ‘Emotional discomfort’(factor 2), ‘Negative thinking and Unhappiness feeling’(factor 3), ‘Cognitive dysfunction’(factor 4), ‘Decreased social interest and activity’(factor 5), which congruous with internal structure of KGDS. The result of discrimination analysis showed 87.09% of hit ratio, and suggested the score of 13 as optimal cut-off score. This cut-off score was identical to that of KGDS. Conclusively, CS-KGDS could be a useful tool for evaluaion of elderly depression instead of KGDS in such case that KGDS can not be administered reliably. 치매가 의심될 정도로 인지적, 신체적으로 약화된 노인들에서 우울증을 효율적으로 검사하고자 보호자용을 만들어 신뢰도와 타당도를 검증하고자 하였다. 연구대상은 노인우울증 환자 60명, 신체적으로 건강하고 정신과적 질환이 없는 정상노인 48명과 그 보호자들이었다. 노인들에게는 KGDS(Korean form of Geriatric Depression Scale)을 실시하였고 보호자들에게는 KG DS의 보호자용(CS-KGDS;Collateral Source Version of KGDS)을 실시하였다. 연구 결과, CS-KG DS는 KGDS와 마찬가지로 우울증 환자집단[Mean(SD)=18.33(4.71)]과 정상집단[Mean(SD)=7.60(5.25)]에서 유의하게 점수의 차이를 보였다(t=11.18, p<.001). KGDS와 높은 상관을 보였고(r=.68, p<.001) 내적일치도(α=.88), 반분신뢰도(.81) 모두 만족스러운 수준이었다. 요인분석결과'신체적 약화와 활력감소','정서적 불편감','부정적 사고 및 불행감','인지적 기능저하','사회적 관심과 활동저하'의 5개 요인이 밝혀져 KGDS의 5개 요인과 동일한 내적 구조를 보였다. 판별분석결과 KGDS와 전체 판별률은 87.09%였고 최적절단점수는 KGDS와 같은 13점으로 밝혀졌다. 이상에서 볼 때, CS-KGDS는 기능이 좋지않아 검사를 실시하기 어려운 노인들의 우울증을 평가할 때 대체용 검사로 신뢰롭게 쓰일 수 있을 것으로 생각된다.

Clozapine과 Risperidone에서 Olanzapine으로 교체 연구 : 12개월 추적연구

조방현,정인과,백종우,Cho, Bang Hyun,Jung, In Kwa,Paik, Jong Woo 대한생물정신의학회 2001 생물정신의학 Vol.8 No.1

In clinical setting, treatment-refractoriness, medication induced tardive dyskinesia and amenorrhea in chronic schizophrenia are frequently problematic. However, there are few guideline solving these problem available to clinicians. The goal of this study was collecting clinical data on clinical effectiveness and predictors of response of switching to olanzapine. We attempted to switch to olanzapine from risperidone and clozapine in chronic 31(risperidone 17, clozapine 14) schizophrenia and schizoaffective disorder patients suffering from sustained symptoms, weekly blood monitoring, medication induced tardive dyskinesia and amenorrhea. Previous antipsychotics dosage was gradually decreased for 2 or 3weeks, at the same time olanzapine dosage was gradually increased. At baseline, after 1 week, after 2 weeks and after 4 weeks we checked Brief Psychiatric Rating Scale, Clinical Global Impression Scale, Sympson-Angus Rating Scale, Barnes Akathisia Rating Scale and followed up after 12 months. Successful switch after 4 weeks was achieved in 25 patients(clozapine 9(64.2%), risperidone 16(94.1%)). Overall, mean BPRS and CGI scores increased significantly. Successful maintenance after 12 months was achieved in 17 patients(clozapine 5(35.7%), risperidone 12(70.5%)). Overall, mean BPRS and CGI scores increased significantly too. Switching to olanzapine from other atypical antipsychotics is recommendable in chronic schizophrenia with treatment refractoriness and drug induced side effect.

노년기 기분장애의 생물학적 치료

정인과(In Kwa Jung) 대한노인정신의학회 1998 노인정신의학 Vol.2 No.1

The aging process makes the changes of pharmacokinetics and pharmacodynamics of psychotropic drugs. The author discussed the biological treatment of geriatric mood disorders in this review. In the acute treatment of geriatric mood disorder, there are some different considerations about the biological treatment, such as the poor physical health, the high suicidal risk, the impaired judgment and reality testing, the likelihood of poor compliance, the impaired cognitive functioning, and the lack of social supports. Psychiatrists who prescribe for the mood disorder of the elderly must bear in mind the risks and benifits of pharmacotherpy in a view of pharmacokinetic and pharmacodynamics. The author reviewed the properties and cautions of the classical antidepressant TCAs and newer atypical antidepressants, such as trazodone and venlafaxine. And also the author reviewed the special situations in geriatric mood disorders, which are the delusional depression, the treatment-resistent depression, and the neuropsychiatric disorder.

불응성 정신분열증환자의 Clozapine 치료효과

이민수,정인과,곽동일,Lee, Min-Soo,Jung, In-Kwa,Kwak, Dong-Il 대한생물정신의학회 1995 생물정신의학 Vol.2 No.1

Clozapine은 정형적 항정신병약물에 반응하지 않는 불응성 정신분열증 환자에게 효과적이며, 추체외로부작용이 적은 비정형적 향정신병약물로 보고되고있다. 따라서 저자들은 불응성 정신분열증환자를 대상으로 clozapine의 항정신병효과 및 부좌용에 대해 대표적 전형적 항정신병약물인 haloperidol과 비교연구하였다. 대상환자를 clozapine투여군(17명) 과 haloperidol 투여군 (16명)으로 나누어 12주 동안 각각의 약물을 투여하는 전향적 개방대조연구를 하였다. 두가지 약물의 치료효과와 부작용은 BPRS, PANSS, Simpson-Angus Rating Scale 및 Adverse Events-Somatic Symptoms를 사용하여 평가하였다. 약물투여 12주후 clozapine투여군이 76.5% 에서 치료반응을 보인데 비해 haloperidol투여군은 31.2%의 치료반응을 보임으로써 두약물 투여군간에 유의한 차이가 있었다. BPRS와 PANSS 척도상 clozapine투여군이 haloperidol투여군에 비하여 BPRS, PANSS 양성증상 및 일반증상 척도는 약물투여 8주후부터, PANSS 음성척도는 약물투여 4주후부터 12주까지 일관성있게 지속적으로 의미있는 호전을 보였다. Clozapine투여군에서는 타액분비(70.6%), 졸리움(52.9%), 변비(29.4%) 및 저혈압(23.4%)이, haloperidol투여군은 진전(37.5%), 정좌불능(25.0%), 강직(18.8%) 및 무운동(18.8%)이 흔히 보고되었다. 하지만 두약물 투여군 모두에서 대부분 경미하고 환자가 견딜 정도였다. Clozapine투여군에서 약물투여 전에 비해서 약물투여 12주후 백혈구와 호중구의 유의한 변화는 없었다. 이상의 결과를 종합해볼 때, clozapine은 정형적 항정신병약물에 치료효과가 없거나 추체외로부작용 때문에 약물투여가 어려운 경우의 한국인 불응성 정신분열증환자에게 효과적인 비정형적 항정신병약물이다. Clozapine, on atypical antipsychotic drug, has been estimated to be a major improvement in the treatment-refractory schizophrenic patients. We evaluated the clozapine efficacy in the treatment of schizophrenic patients who are refractory to classic neuroleptics. The patients were assigned in a prospective, open, comparative trial for 12 weeks. Following an dose titration, 33 inpatients with treatment-refractory schizophrenia diagnosed according to DSM-III-R were given a clozapine(N=17, approximate 300-600mg/day) or haloperidol(N=16, approximate 20-30 mg/day) for 12 weeks. The clinical state was assessed before treatment, and 1st, 4th, 8th and 12th week during treatment using Brief Psychiatric Rating Scale(BPRS) and Positive and Negative Syndrome Scale(PANSS). Assessment of side effects were mode weekly using Simpson-Angus Scale for Extrapyramidal Side Effects and Adverse Events-Somatic Symptoms. Clozapine produces significant improvement than haloperidol on the BPRS and PANSS scores. 77% (13/17) of the clozapine-treated patients were categorized as responders, who showed at least 20% decrease in total BPRS scores, compared with 31% (5/16) of haloperidol-treated patients. Extrapyramidal side effects occurred in only one patient in clozapine group, but nine patients in haloperidol group. Salivation, sleepiness, constipation and hypotension were most frequent adverse effects observed in clozapine group. There was no significant changes in total WBC and neutrophil during clozapine treatment. These findings suggest that clozapine is on effective antipsychotic drug for the Korean treatment-refractory schizophrenic patients, who are nonresponsive to or unable to tolerate classcal antipsychotic drugs due to extrapyramidal side effects.