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.

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.

일 도시지역 고등학생의 흡연현황과 니코틴 의존도에 관한 연구

정현강(Hyun-Gang Jung),이문수(Moon-Soo Lee),고영훈(Young-Hoon Ko),김승현(Seung-Hyun Kim),조숙행(Sook-Haeng Joe),정인과(In-Kwa Jung),박정란(Jung-Ran Park),박성근(Seong-Guen Park) 한국중독정신의학회 2006 중독정신의학 Vol.10 No.1

Background:The purpose of this study was to investigate the prevalence of smoking, the level of nicotine dependence and smoking-depression relationship among high school students. Methods:Subjects were 839 high school students in Siheung city. The main assessment measures were the Fagerstrom Test for Nicotine dependence and the Zung Self-rating Depression Scale. We also used structured self-report questionnaires which included socio-demographic data, cigarette habit and alcohol consumption. Results:Our study found that the prevalence of smoking in high school students was 20.7%. Among students who had experience of smoking, 7.5% were substantially dependent on nicotine, 46.9% had mild dependence and 45.6% had no dependence. Nicotine dependence was correlated with duration and amount of cigarette smoking. Smokers tend to drink alcohol more frequently than non-smokers (smokers vs non-smokers:3.19±2.57/month vs 2.29±3.35/month). There was significant positive correlation between amounts of smoking and scores of the Zung Self-rating Depression Scale in students who had experience of smoking. Conclusion:More than 10% of high school students initiate cigarette smoking at their early teenage. Cigarette smoking is probably associated with various psychosocial factors such as depression, mental stress and poor primary support group. The-refore, multidisciplinary strategies are required to reduce the prevalence of adolescent cigarette smoking.

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.

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.

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.

우울 장애의 치료에 있어서 dothiepin-sertraline 병합과 dothiepin 단독 요법의 비교

차지현,정인과,이민수,Cha, Ji Hyun,Jung, In-Kwa,Lee, Min Soo 대한생물정신의학회 1997 생물정신의학 Vol.4 No.2

The dysfunction of either or both noradrenaline and serotonin system are important in the pathophysiology of depression. Previous reports have suggested that there may be an important interaction between these two systems. Recently, some investigators have suggested that the combination of tricyclic antidepressants(TCAs) and selective serotonin reuptake inhibitors(SSRIs) would produce a rapid synergistic effect on down-regulation of either or both of these two systems and that this combination may produce a more rapid and absolute antidepressant effect. We compared the treatment efficacy, treatment associated side effects, treatment satisfaction, and the quality of life between the combination therapy of dothiepin-sertraline as well as the therapy of dothiepin alone in the treatment of major depressive disorder and dysthymic disorder. In our study, the combination therapy of dothiepin and sertraline produced a more rapid and absolute antidepressant effect than dothiepin alone. And the patients with combination therapy experienced relatively high treatment satisfaction than the patients with dothiepin therapy. The patients' quality of life improved more rapidly in the combination therapy, especially, in the health perception, social behavior, and life satisfaction, than dothiepin alone. These results support the hypothesis that the combination of TCA and SSRI may produce a rapid synergistic effect on either or both norepinephrine and serotonin system, and more rapid antidepressant effect and high treatment satisfaction.

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.

3년간 치료를 지속한 정신과 외래 노인 환자에서의 다제요법에 대한 연구

유해선(Hae-Sun Yoo),정인과(In-Kwa Jung) 대한노인정신의학회 2010 노인정신의학 Vol.14 No.1

Objectives : The objective of this study was to investigate the prescription trends for the elderly psychiatric outpatients at a university hospital. Methods : We performed a retrospective study based on medical records. Data on 146 elderly patients (65 years and older) diagnosed with psychiatric disorders according to ICD-10 from January 2005 to March 2008 were collected. Analyses were performed regarding demographic characteristics, prevalence of polypharmacy, and the doses and types of drugs prescribed. Results : In 146 subjects, the mean age was 76.14±5.21. More than five types of drugs were prescribed to 49.5% of the patients in 2008. The percentage of stable users (those without changes in the category of polypharmacy for 3 years) was 69.8%. Each patient received an average of 4.20±1.50 kinds of drugs in 2005 and 4.02±1.77 in 2008. The average dose of drugs was 6.1±3.50 in 2005 and 6.49±4.09 in 2008, and the difference was not statistically significant. The average number of types of psychiatric drugs prescribed to the patients decreased from 2.37±0.86 in 2005 to 2.17±0.87 in 2008 (p<0.05). Conclusion : Although practice of polypharmacy showed a slow increase over the 3 years from 2005 to 2008, almost half of the elderly patients we studied received multiple drugs. Since polypharmacy can increase drug-drug interactions and adverse effects in the elderly, appropriate drug monitoring and careful prescription are necessary.

지역사회 노인에서의 인지기능 추적 연구

양재원(Jae Won Yang),정인과(In Kwa Jung),서용진(Yong Jin Seo),이헌정(Heon Jeong Lee),권호인(Ho In Kwon) 대한노인정신의학회 2003 노인정신의학 Vol.7 No.2

Object : The purpose of this study was to measure the natural changes of cognitive function over 6 month and to determine which cognitive tests were valuable for early detection of dementia in community dwelling elderly. Method : Cognitive function were measured in 94 elderly registered at the Public Welfare Center in Gwacheon, the urban community of Kyunggido. After 6 months, same cognitive functions were re-measured in 54 elderly. The measures were Korean version of Mini-Mental State Examination (MMSE-K), Subtests of Korea Version of Memory Assessment Scales (K-MAS), Verbal Fluency Test, Clock Drawing Task, Wechsler Digit Substitution Test and Wechsler Similarity Test. Results : The mean age was 73.61±5.97 year. Most part of the tests were influenced by education, but not by age and sex. Of the MMSE-K subtests, the score of memory registration and memory recall declined after 6 months. The score of delayed recall of K-MAS declined, too. Decreased score was also observed in 'country' of the category verbal fluency test and 'n' of phonemic verbal fluency test, Wechsler digit substitution test and Wechsler similarity test. But, score decline was not statistically significant. Three persons were diagnosed as dementia after 6 months. And, they acquired low scores in above cognitive function tests in first cognitive function tests. Conclusion : Memory registration and memory recall of MMSE-K, delayed recall of K-MAS, verbal fluency test, Wechsler digit substitution test and Wechsler similarity test were sensitive to cognitive decline. The results suggest that cognitive function tests could be applied to detect minimal changes of cognitive function in community dwelling elderly.