알코올 의존 환자에서의 Aldehyde Dehydrogenase II와 CYP2E1 유전자 다형성과 임상적 특성간의 연관성

정인원,김영랑,지경환,김헌,Chung, In-Won,Kim, Yeoung-Rang,Chi, Kyung-Hwan,Kim, Heon 대한생물정신의학회 2002 생물정신의학 Vol.9 No.1

Objective:This study was to explore the relation of genetic polymorphisms of ALDH2 and CYP2E1 to clinical characteristics of alcoholic patients and alcohol induced liver damage. Methods:The genotype and allele frequencies of 128 male hospitalized patients who met DSM-IV criteria for alcohol dependence were compared with 128 healthy male control subjects. The genetic informations of ALDH2 and CYP2E1 were identified with the technique of polymerase chain reaction and restriction fragment length polymorphism. The clinical characteristics of the alcoholic patients were assessed and analyzed in relation to the family history of alcoholism. For the relation of CYP2E1 genetic polymorphism to the liver damage, the blood levels of various liver function indicators such as ALT, AST, and protein were checked out. Results:1) The alcoholic patients with the family history of alcoholism had the earlier onset of age (p=0.001), the longer duration of illness(p=0.045), and higher NCA scores(p=0.018) than those without the family history of alcoholism. 2) Most alcoholic patients were homozygous for $ALDH2^*1$, compared to control subjects.(p=0.000) 3) There was no difference of CYP2E1 distribution between alcoholic patients and control subjects. However, alcoholic patients having mutant c2 allele showed higher alcoholism severity scores(p=0.004) and more hospitalizations(p=0.014) than those having c1 allele. 4) There was no relationship between CYP2E1 genotype and the functional abnormalities of the liver. Conclusion:This study suggests that $ALDH2^*1$ is highly related with alcohol dependence. Also mutant c2 allele of CYP2E1 is correlated with the severity of alcoholism and the number of hospitalization. But genetic polymorphim of CYP2E1 seems to have no relation to liver damages.

폭력과 자살의 병리와 치료에서 세로토닌의 역할

정인원,Chung, In-Won 대한생물정신의학회 1997 생물정신의학 Vol.4 No.2

Along with psychosocial factors of suicide, biological backgrounds of suicide are explored by extensive works mostly on biological markers, neurobiological models, genetic bases, and relationships with aggression and violence. The biology of suicide confers on neurotransmitters in central nervous system exploring metabolites, receptor binding affinities, neuroendocrine challenge tests in brain, cerebrospinal fluid, blood and etc. The major concerns with suicide are focused mainly on serotonin system : low CSF 5-HIAA concentration, higher $5-HT_2$ receptor binding, and blunt prolactin response to fenfluramine. Postmortem study, in vivo study, genetic contributions, and some other issues such as suicidal methods, serum cholesterol, alcohol, and selective serotonin reuptake inhibitors are reviewed and discussed.

입원한 알코올 의존 환자의 임상적 특성 및 Aldehyde Dehydrogenase II와 Arylsulfatase A 유전자 다형성

정인원(In-Won Chung),홍주봉(Joo-Bong Hong),이상익(Sang-Ick Lee),김 헌(Heon Kim),손정우(Jung-Woo Son) 한국중독정신의학회 2000 중독정신의학 Vol.4 No.2

Aldehyde dehydrogenase II (ALDH2) and arylsulfatase A (ASA) gene polymorphisms were explored for the association of alcohol dependence and/or its clinical characteristics. Polymerase chain reaction and restriction fragment length polymorphism were used to determine the genotypic and allelic frequencies of 128 male hospitalized alcoholic patients who met DSM-IV criteria for alcohol dependence and 128 agematched healthy male control subjects. The ALDH2 genotypic frequencies in alcoholic patients were 0.992 (NN), 0.008 (ND), and 0.000 (DD), which were significantly different from those of control subjects (0.484, 0.430, and 0.086, respectively). The ASA genotypic frequencies at the pseudodeficient Nglycosylation and polyadenylation sites showed grossly no differences between alcoholic patients and control subjects. There was no association between genotypic distributions of ALDH2 and ASA and clinical characteristics of alcohol dependence. These results suggested that the D allele of ALDH2 gene has a protective role against alcohol dependence. The further extensive researches for the relationship between alcohol dependence and the pseudodeficient ASA gene polymorphisms are required.

정신장애인 가족의 동거의향에 영향을 미치는 요인

정인원(In-Won Chung),지경환(Kyung-Whan Chi),손정우(Jung-Woo Son),신철진(Chul-Jin Shin) 대한사회정신의학회 2002 사회정신의학 Vol.7 No.1

연구목적: 지역사회에서 정신장애인을 직접 부양하고 있는 가족들이 느끼고 있는 부담이 향후에도 지속적으로 정신장애인과 동거하면서 부양할 의향에 미치는 영향을 알아보고, 이들의 동거 및 부양을 유지시킬 수 있는 사회적 지지 요인을 추적하고자 하였다. 방 법: 충북 청원군정신보건센터에 등록되어 있는 192명의 정신장애인 중 조사 당시 정신장애인과 동거하고 있었던 111명의 가족을 대상으로, 각 가정을 방문하여 개별면담 방식으로 구조화된 설문지를 통해 가족이 느끼고 있는 부담감과 정신장애인과의 향후 동거의향 및 가족들에게 필요한 사회적 지지를 조사하였다. 결 과: 가족들이 정신장애인을 부양하면서 느끼는 부담은 경제적 어려움, 일상생활의 침해 등으로 나타났다. 대상 가족 대부분은 향후에도 지속적으로 동거하면서 부양하겠다고 응답하였으나 상당수(34.7%)는 정신장애인을 평생 혹은 일시적으로 입원이나, 입소시키기를 원하고 있었으며, 이런 의향은 가족들이 느끼고 있는 부담의 정도와 연관이 있었다(p<0.01). 가족들이 필요하다고 생각하는 사회적 지지는 경제적 지원, 정신과적 응급조치 순 이었다. 또 정신장애인과 동거할 의향이 없다고 응답한 가족 중 일부(24.2%)는 사회적 지지가 제공되더라도 동거할 의향이 없다고 응답하였으며, 이런 생각은 자신들의 정신건강이 나빠지는 것에 대한 부담을 크게 느끼는 가족일수록 심했다(p<0.05). 동거의향이 없던 가족들의 생각을 변화시키는데 유의하게 영향을 줄 수 있는 사회적 지지요인은 주간 보호 서비스였다(p<0.05). 결 론: 가족들에 대한 정신건강의 개입과 정신장애인에 대한 주간보호 서비스는 정신장애인과 동거하면서 부양하고 있는 가족들이 느끼고 있는 부담을 줄여줄 수 있다. 이는 지역사회 정신보건 서비스의 필요성을 시사하며, 그 결과 정신장애인의 장기 입원 등을 감소시키는데 도움을 줄 것이다. Objectives:The purpose of this study is to show whether the burden of family members living with mentally ill patients affects on the intention of living with mentally-ill patients continuously and seek factors of social support keeping a family to live with the patients. Methods:Subjects consisted of 111 families living with mentally-ill patients among 192 mentally ill patients who were registered in Cheongwongun Mental Health Center at the time of the study. The survey was administered through face-to-face interview and structured questionnaires for the purpose of finding family burden, the intention of living with mentally-ill patients and necessary social support for the family. Results:Burdens likely to happen due to living with mentally-ill patients were ‘financial difficulties’ and ‘infringement on the privacy of the family’. Most families answered they would take care of the patients, living with them. However, 34.7% of the total respondents wanted the patients to accommodate at a hospital or sanatorium temporarily or permanently. This kind of tendency was correlated with the level of the burden of family living with the patients (p<0.01). The needs of family for social support were ‘financial assistance’, ‘psychiatric emergency care’ in that order. The 24% of families who answered they would not live with the patients responded that they would not live with the patients in the future even if the social supports were provided. This tendency was associated with the burden of family about worsening their mental health(p<0.05). The social support which can positively affect on the mind of the family who did not have any intention to live with the patients was day care service(p<0.05). Conclusion:Social support to those family’s mental health and day care service to the mentally-ill patients can lessen the burden of family living with the patients. This finding implicates the needs of mental health service. And as s result, it will help to minimize the chances of long term accommodation of mentally ill patients.

충북대학교 의과대학에서의 문제중심학습의 실행 및 평가

정인원(In-Won Chung),신철진(Chul-Jin Shin),한헌석(Hun-Seok Hahn),송영진(Young-Jin Song) 한국의학교육학회 1999 Korean journal of medical education Vol.11 No.2

충북대학교 의과대학에서는 1996년부터 문제중심학습을 시범적으로 시행하여 오다가 1998년 처음으로 0.5학점을 부과하며 정규과목으로 편성하여 시행하였다. 문제중심학습의 대상자는 충북대학교 의과대학 의학과 3학년 학생 51명을 대상으로 하였으며, 기간은 1998년 8월 17일부터 2주간의 기간동안 진행되었다. 학생들에 관한 평가는 두 사람의 지도교수가 동시에 매 증례토의 시간마다 평가하여 이를 합산토록 하였다. 문제중심학습이나 증례에 대한 평가는 학생들과 지도교수에 대하여 설문조사를 함으로써 평가되었다. 문제중심학습 증례토의에 관한 설문 조사 결과, 대체적으로 긍정적인 평가를 한 것으로 나타났으며, 문제중심학습의 결과로서 구체적 학습 기술의 향상보다는 학습태도나 자율성 등의 측면에서 더욱 좋은 반응을 나타내었다 (Fisher s Exact test, p<0.01). 또한 지도교수의 역할에 관해서는 과반수이상이 지시작인 역할 보다는 보완적, 지지적인 역할만을 담당해주길 원하였다. 문제중심학습 성적에 따라 설문조사를 비교하여 본바, 문제중심학습 성적상위집단에서 반응이 좋았으나 (Fisher s Exact test, p<0.01), 그러나 내과학 성적에 따른 상하위 그룹의 만족도는 유의한 차이가 없었다. 문제중심학습 성적과 기존의 학습방법에 의한 내과학 성적과 상관성을 살펴보았으나 유의한 상관관계는 나타나지 않았다. 이는 문제중심학습에 대한 학생들의 반응이 거부적이지 않으며 또한 적어도 일부의 학생들에게는 기존의 강의식 학습방법보다 더 효과적임을 시사하는 결과라고 할 수 있다. 따라서 기존 학습방법에 대한 보완, 자율학습 태도 고취, 정보검색 및 활용능력의 강화 등의 측면에서 문제중심학습의 도입은 필수불가결한 것으로 생각되며, 그러나 이러한 잇점을 살리기엔 2주간은 불충분한 것으로 여겨진다. 문제중심학습의 도입이 부분적일 수 밖에 없는 현실이라면 문제중심학습의 효과를 짧은 시간내에 극대화시키기 위하여서는 학습기간을 8~10주이상으로 늘리거나 문제중심학습 전후의 PBL 준비단계와 PBL완결단계의 도입이 그 해결책이 아닌가 생각된다. Problem-based learning(PBL), introduced to medical education committee of Chungbuk National University in 1996, was firstly implemented as a regular course of medical education only with 0.5 credit in 1998. Tutorials of the PBL course were assigned to seven discussion groups consisted of seven or eight junior students during first two weeks of third quarter. Every groups were supervised by two tutors, who evaluated students performances in terms of problem-solving, stating problems, and presenting referred sources. The aptitude for PBL course was asked to students and tutors after two weeks course by means of questionnaires. Most students showed positive responses about PBL course, and preferred the tutors in a supportive or facilitative attitude. However, two weeks of PBL course seemed not enough for maximal educational benefits. Pre- and post-PBL blocks may be one of the useful methods that ensure successful results of short-term PBL course.

약물유전체학과 정신분열병

이규영,정인원,Lee, Kyu Young,Chung, In Won 대한생물정신의학회 2001 생물정신의학 Vol.8 No.2

The pharmacotherapy of schizophrenia exhibits wide inter-individual variabilities in clinical efficacy and adverse effects. Recently, human genetic diversity has been known as one of the essential factors to the variation in human drug response. This suggests that drug therapy should be tailored to the genetic characteristics of the individual. Pharmacogenetics is the field of investigation that attempts to elucidate genetic basis of an individual's responses to pharmacotherapy, considering drug effects divided into two categories as pharmacokinetics and pharmacodynamics. The emerging field of pharmacogenomics, which focuses on genetic determinants of drug response at the level of the entire human genome, is important for development and prescription of safer and more effective individually tailored drugs and will aid in understanding how genetics influence drug response. In schizophrenia, pharmacogenetic studies have shown the role of genetic variants of the cytochrome P450 enzymes such as CYP2D6, CYP2C19, and CYP2A1 in the metabolism of antipsychotic drugs. At the level of drug targets, variants of the dopamine $D_2$, $D_3$ and $D_4$, and 5-$HT_{2A}$ and 5-$HT_{2C}$ receptors have been examined. The pharmacogenetic studies in schizophrenia presently shows controversial findings which may be related to the multiple involvement of genes with relatively small effects and to the lack of standardized phenotypes. For further development in the pharmacogenomics of schizophrenia, there would be required the extensive outcome measures and definitions, and the powerful new tools of genomics, proteomics and so on.

뇌자기공명영상의 노화에 따른 변화

지은경,정인원,윤탁,Ji, Eun-Kyung,Chung, In-Won,Youn, Tak 대한생물정신의학회 2014 생물정신의학 Vol.21 No.1

Normal aging causes changes in the brain volume, connection, function and cognition. The brain changes with increases in age and difference of gender varies at all levels. Studies about normal brain aging using various brain magnetic resonance imaging (MRI) variables such as gray and white matter structural imaging, proton spectroscopy, apparent diffusion coefficient, diffusion tensor imaging and functional MRI are reviewed. Total volume of brain increases after birth but decreases after 9 years old. During adulthood, total volume of brain is relatively stable. After 35 years old, brain shrinks gradually. The changes of gray and white matters by aging show different features. N-acetylaspartate decreases or remains unchanged but choline, creatine and myo-inositol increase with aging. Apparent diffusion coefficient decreases till 20 years old and then becomes stable during adulthood and increase after 60 years old. Diffusion tensor properties in white matter tissue are variable during aging. Resting-state functional connectivity decreases after middle age. Structural and functional brain changes with normal aging are important for studying various psychiatric diseases such as dementia, schizophrenia and bipolar disorder. Our review may be helpful for studying longitudinal changes of these diseases and successful aging.

학령기 아동에서의 ADHD와 게임중독 및기타 정신병리와의 연관성 조사

박상원(Sang-Won Park),윤탁(Tak Yoon),정인원(In-Won Chung),김성찬(Sung-chan Kim) 대한사회정신의학회 2012 사회정신의학 Vol.17 No.2

연구목적 : 한국 학령기 아동의 게임중독현황 및 ADHD 현황에 대한 조사와 더불어, 게임중독 및 ADHD와 연관된 정신병리에 대하여 알아보고자 하였다. 방 법 : 본 연구는 2010년도에 경기도 파주시 초등학교 학생 중 6~8세 아동 2481명을 모집단으로 하여 실시되었다. 선별검사로서 KARS(Korea ADHD Rating Scale)를 아동의 보호자를 통해 시행하였다. 이후 19점 이상인 아동의 보호자를 대상으로 CBCL 6-18(Child Behavior Checklist for Ages 6-18)을 시행하였다. CBCL 6-18을 통해 선별된 아동 36명을 대상으로 정신과 전문의의 면담과 함께 K-SADS-PL-K(Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime VersionKorean Version)를 시행하였다. 동일 아동을 대상으로 K-CDI(Kovacs’ Children’s Depression Inventory)와 GAS(Game addiction scale), STAI(Spielberger Stait-Trait Anxiety Inventory) 그리고 PCCI(Parents-Children Communication Inventory)를 시행하 였다. 게임중독 및 ADHD와 연관된 정신병리에 대하여 파악하기 위하여 상관분석, 평균비교, 교차분석을 시행하였다. 결 과 : 게임중독과 K-CBCL의 ADHD 항목 및 기타문제 항목 사이에서 유의한 양의 상관관계가 입증되었다. ADHD로 진단된 그룹에 서의 게임중독척도 점수 평균은 ADHD로 진단되지 않은 그룹에서의 게임중독척도 점수 평균에 비하여 유의하게 높았다. 또한 연구 대상을 게임중독척도에 따라 문제행동군과 문제행동이 없는 군으로 분류하였을 때, ADHD로 진단된 그룹에서 문제행동군의 비율이 유의하게 높았다. 결 론 : 연구결과는 ADHD가 게임중독의 행동과 깊은 관련이 있다는 기존의 가설을 뒷받침한다. Objectives : The purpose of this study was to survey the present condition of school-aged children‘s game addiction and ADHD, and to investigate the associated psychopathology of game addiction and ADHD. Methods : The study included 2481 boys and girls, with an age between 6 to 8, collected from elementary schools in Paju city, South Korea, in 2010. Primary caregivers were required to complete Korean ADHD Rating Scale(K-ARS) as screening tool. Primary caregivers whose their children’s K-ARS score exceeded 19 point were required to perform Child Behavior Checklist for ages 6-18 (CBCL 6-18). Psychiatric interview and ADHD section of Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version (K-SADS-PL) was performed by psychiatrist to the 36 children who were screened by CBCL 6-18. Kovacs’ Children’s Depression Inventory (K-CDI) and Korean form of the Spielberger Stait-Trait Anxiety Inventory for Children (STAI) were completed by above 36 children and Internet Game Addiction Scale for Children (GAS) and Parent-Child Communication Inventory (PCCI) were completed by their primary caregivers. Correlation, student’s t-test and chi-square test were conducted to investigate the associated psychopathology of game addiction and ADHD. Results : Game addiction score demonstrated positive correlations with CBCL 6-18’s ‘ADHD factor’ and ‘other problem factor’. Average score of game addiction scale was significanlty higher in ADHD group than non ADHD group. And ADHD group also showed higher proportion of ‘problematic game use’ compared to non ADHD group. Conclusion : This study supports hypothesis of previous studies which insist that ADHD is highly related with game addiction.

정신분열병 환자의 임상적 증세 호전에 따른 99m Tc - HMPAO 뇌 SPECT 소견의 변화

신철진,궁성수,정인원 ( Chul Jin Shin,Sung Soo Koong,In Won Chung ) 대한핵의학회 1997 핵의학 분자영상 Vol.31 No.3

자살기도자의 절망감과 자살치명도간의 관계

박정래,이상익,김재진,김석중,정인원,Park, Jeong-Rae,Lee, Sang-Ick,Kim, Jae-Jin,Kim, Seok-Jung,Chung, In-Won 한국정신신체의학회 1996 정신신체의학 Vol.4 No.1

The objective of this study is to evaluate the relationship of hopelessness and suicidal lethality of suicide attempters. The subjects were 72 persons who attempted suicide and came to the emergency room of Chungbuk National University Hospital from April 1st, 1995 to March 31st, 1996. The hopelessness of suicide attempter was assessed by Beck Hopelessness Scale(BHS), and the suicidal lethality was assessed by Risk-Rescue score. The Risk-Rescue Scores exhibited no significant differences in demographic characteristics (sex, age, education, religion, marital status, socioeconomic class, occupation) and psychiatric diagnoses. But the Risk-Rescue scores were significantly higher in high BHS group(BHS score ${\geq}$ 9) than in low BHS group(BHS score <9) and positive correlation was observed between the BHS and the Risk-Rescue score(Rs=0.77 : p<0.05). These results suggest that level of hopelessness be a major risk factor for suicidal lethality.