2016국민환경의식조사 연구

곽소윤 ( So-yoon Kwak ),이창훈 ( Chang-hoon Lee ),임용빈 ( Yong-bin Im ) 한국환경정책평가연구원 2016 한국환경정책평가연구원 기초연구보고서 Vol.2016 No.-

본 연구는 정기적으로 환경 전반에 대한 국민의 의식과 태도를 파악하기 위하여 기획되었으며, 매해 반복되는 기본부문과 당해 연도 정책이슈를 다루는 특별부문으로 구성된 2016년 국민 환경의식조사를 수행하고 환경에 대한 국민들의 인식을 살펴보았다. 2012년부터 시작된 국민환경의식조사의 기본 부문은 환경인식, 환경의식 및 태도, 환경 실천, 환경정책 수요, 삶의 질·지속가능성 부문으로 구성된다. 2016년 조사에서는 기후변화와 미세먼지가 특별 부문의 주제로 선정되었다. 본 설문조사는 전국의 만 19세 이상 69세 이하 성인 남녀 1,000명을 대상으로 조사전문기관의 방문면접조사를 통해 수행되었다. 환경 하면 떠오르는 이미지로 ‘기후 변화’라는 응답이 가장 높게 나왔고, 환경에 대한 만족도는 ‘자연 경관’에 대해 높게 나타났다. 국민의 과반수가 평소 환경문제에 대해 관심을 가지고 있는 것으로 나타났고, 환경보전이 개인에게 중요한 정도는 2015년에 비해 약간 감소하였으나 여전히 높은 수준을 보이며 국민의 대다수가 환경을 중요하게 생각하는 것으로 파악되었다. 생태주의적 세계관을 나타내는 점수는 2012년 조사 시작 이래 2015년까지 증가해오다 올해 조사 결과에서는 다소 감소하였다. 가장 우려하는 환경문제로는 ‘쓰레기 증가’를 꼽았고, 정보가 부족하다고 생각되는 환경문제로는 ‘자연자원의 고갈’을 응답하였다. 한편 환경오염 및 훼손에 대한 책임은 일반국민에게 있다고 생각하지만, 환경보전에 대한 책임은 주로 중앙정부에 있다고 생각하는 것으로 나타났다. 특별부문인 기후변화에서는 대부분의 응답자가 기후변화에 대해 인지하고 있는 것으로 나타났으며, 기후변화 하면 가장 먼저 떠오르는 이미지로 ‘평균 기온 상승’을 응답하였다. 대다수의 국민이 미세먼지에 관심을 가지고 있으나 우리나라의 미세먼지 수준에 대해서는 불만족스러워하는 것으로 나타났다. 또한 정부의 미세먼지 감축 노력에 대해서는 과반수의 국민이 부족하다고 느끼고 있는 것으로 파악되었다. 이와 같은 연속적인 국민환경의식조사 결과에 대한 정보를 통해 국민들의 인식 및 태도를 파악하고, 나아가 조사결과가 다양한 분석의 기초자료로 활용되어 정책의 활용도를 높이는 데에 일조하기를 기대한다. This study was planned to identify public awareness of and attitudes towards the environment on a regular basis. It conducted the 2016 survey of public attitudes towards the environment, which is consisting of the yearly repetitive basic parts and the special parts discussing issues of the year, and reviewed public awareness of the environment. The basic parts of the survey of public attitudes towards the environment that started from 2012 are composed of environmental perception, awareness of and attitudes towards the environment, environmental practice, demands for the environmental policies, and quality of life and sustainability. In the survey in 2016, climate change and particulate matter were selected as the subjects of the special parts. The survey was carried out on 1,000 men and women aged 19-69 years across the country through a face-to-face interview by a specialized survey agency. The image most associated with the environment was ‘climate change’, and the satisfaction for the environment was high with ‘natural landscape.’ It was identified that the majority of people were interested into the environmental issues in their everyday life. While the importance of environmental conservation to individuals slightly dropped from 2015, it was still high and most people was considering that the environment matters. The score of ecological world view had increased to 2015 from 2012 but slightly decreased this year. People chose ‘a rise in garbage’ as their most concerned environmental issue and ‘lacking natural resources’ as an environmental issue that they did not have enough information. On the other hand, people thought that the public was responsible for environmental pollution and damages but the central government should be held accountable for environmental conservation. In the special parts about climate change, most of the respondents were aware of climate change and answered that the image most associated with climate change was ‘average temperature rise’ It was figured out that most of the people were interested in particulate matter but dissatisfied with the level of particulate matter in South Korea. In addition, the majority of people thought that the government’s efforts to reducing particulate matter were not enough. It is expected to identify public awareness of and attitudes towards the environment based on the results of the annual survey of public attitudes towards the environment, and that the results can contribute to making policies as a fundamental data for various analyses.

공동주택 발코니 확장에 따른 결로 방지를 위한 창호 디자인의 실험적 연구

윤대원(Yoon Dae-Won),정창헌(Cheong Chang-Heon),김지영(Kim Ji-Yoeng),유선용(Yoo Seon-Yong),김태연(Kim Tae-Yeon),이승복(Leigh Seung-Bok) 대한건축학회 2008 대한건축학회논문집 Vol.24 No.10

According to the legalization of balcony expansions in apartment houses since January 2006, most of the apartment houses now are built with expanded balcony space. The existing balcony space was physically a buffer between the outside environment and the inside environment. In addition, it was a space that functioned to minimize the indoor environmental changes in relation to external weather changes. However, as apartment houses with extended balconies have become more common recently, the possibility of dew condensation increased due to the weakening of the insulation capacity as the space that can carry out these environmental buffer roles have disappeared. Also, the indoor thermal environment has been weakened. Thus, this paper seeks to resolve problems related to the expansion of balconies by presenting a new method that improves the insulation performance and prevents condensation in the window design that an apartment house with an extended balcony should have. also performance evaluation is executed on new window design to prevent condensation.

항정신병약물 사용 중인 정신분열병 환자에서 올란자판으로의 교체 방법에 관한 연구(II) : Comparison of Safety 안전성 비교

안용민,권용실,권준수,민성호,박두병,양문정,소형석,송종호,신윤식,우행원,유범희,이홍석,정한용,한창환,김용식 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.5

연구목적: 이 다기관 공동임상연구는 사용 중인 항정신병약물을 ’직접 교체 방법’또는 ’시작-감량 교체 방법’중 한 가지 방법으로 올란자핀으로 교체한 후, 안정성 측면에서 두 교체 방법 간의 비교와 교체후의 변화를 관찰하기 위한 것이다. 방법: 국내 13개 병원의 입원 및 외래에 내원한 환자들 중 ICD-10 지단기준으로 정신분열병에 해당되며, 임상적으로 항정신병약물 교체가 필요한 환자를 대상으로 하였다. 두 가지 교체 방법 중 한 가지를 무작위로 피험자에 적용하였으며, ’직접 교체 방법’에 배정된 경우에는 사용중인 항정신병약물을 일시에 중단하고 10㎎의 올란자핀을 바로 투여하였고, ’시작-감량 교체 방법’에 배정된 경우는 10㎎의 올란자핀 투여하고 2주에 걸쳐서 기존 약물을 감량하여 중단하였다. 올란자핀 사용기간은 총 6주이며, 용량은 5∼20㎎ 범위로 제한하였다. 한정성 평가를 위해서 체중, 생명징후, 자발적인 이상반응 복, 실험실 검사 그리고 Simpson-Angus Scale(SAS), Barnes akathisia rating scale(BARS), Abnormal involuntary movement scale(AIMS). Liverpool University neuroleptic side effect rating scale(LUNSERS)등을 이용하였다. 결과: 총 103명의 정신분열병 환자를 대상으로 하였다. 사용한 올란자핀의 용량, 벤조디아제핀의 병용률, 탈락률과 탈락 사유, 자발적인 이상반응 보고, 생명징후, 실험실 검사 그리고 대부분의 부작용 척도 상에서 임상적으로 의미 있는 차이를 두 교체 방법간에 발견하지 못하였다. 다만 AIMS의 감소는 ’직접 교체 방법’군에서 보다 적었고, 항콜린제의 병용률은 ’시작-감량 교체 방법’군에서 보다 많았다. 기저 상태에서 전체 피험자의 SAS와 BARS 점수는 각각 3.5점과 1.8점이었으며 70% 이상의 피험자가 고프로락틴 혈증을 보였다. 올란자핀으로 교체한 후, SAS, BARS, AIMS 점수의 유의한 감소가 있었으며 고프로락틴 혈증을 보인 피험자 분율도 약 30%이하로 감소하였다. 그러나 교체 방법과 상관없이 올란자핀 교체 후 유의한 체중 증가가 있었다. 결론: 이 연구를 통해 교체 방법에 관계없이 비교적 안전하고 용이하게 올란자핀으로 교체 할 수 있음을 알 수 있었다. 그리고 기존 항정신병약물을 올란자핀으로 교체함으로써 일부 부작용들을 줄일 수 있음을 간접적으로 관찰할 수 있었다. 하지만 이 연구는 여러 제한점과 문제점을 지니고 있기 때문에 보다 체계적인 연구를 통해 검정이 필요하리라 생각된다. Objectives: This multicenter clinical trial involving 13 hospital sites compared the safely of switching to olanzapine between ’direct switching method’ and ’start-tapering switching method’. Method: This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For ’direct switching method’group, previous antipsychotics were abruptly discontinued and 10㎎ of olanzapine was administered, and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20㎎. The safety of switching to olanzapine was measured with vital sings including body weight, adverse events reported spontaneously, laboratory tests, and various scales such as Simpson-Angus Scale(SAS), Barnes Akathisia Rating Scale(BARS). Abnormal Involuntary Movement Scale(AIMS), and Liverpool University Neuroleptic Side Effect Rating Scale(LUNSERS). Results: 103 patients were switched to olanzapine in this study. The comparison between two switching methods did not show any significant difference in the dosage of olanzapine used, the concomitant use of benzodiazepine, the rate and reasons of drop-out, the adverse events, vital signs, laboratory tests, and most scales for measuring side-effects. However, the decrease in AIMS scores was significantly lower in ’direct switching method’ group, and the concomitant use of anticholinergics was comparatively greater in ’start-tapering switching method’ group. At baseline, SAS and BARS scores were 3.5 and 1.8 points respectively, and more than 70% of the subjects showed hyperprolactinemia. After switching to olanzapine, SAS, BARS, and AIMS scores were significantly decreased and the proportion of the patients with hyperprolactinemia was also decreased to less than 30%. However significant weight gain after the treatment of olanzapine was observed regardless of switching method. Conclusion: This study may suggest that switching to olanzapine can be done with relatively high safety regardless of switching methods and olanzapine can significantly decrease some side-effects induced by other antipsychotics.

환경농업조성지구내 용수원 및 채수시기별 수질비교

김찬용,김창배,김종수,서영진,윤재탁 한국환경농학회 2002 한국환경농학회지 Vol.21 No.3

A study was conducted to investigate the seasonal changes in water quality of watershed in the Agricultural Environment Promotion Zone. samples collected were 12 GW (ground water), 2 IW (irrigation water), 2 SW (stream water) in An-Doug City, 4 GW, 6 IW, 11 SW in Young-Yang Gun, and sampling was conducted separately during dry and rainy season. In the ground water, EC and ionic species, except pH, were higher than those in stream water, and especially NO_3-N concentration exceeded the limitation of drinking water. Concentration of ions decreased as the sampling depth was far from the soil surface. During a rainy season, the concentrations of NO_3-N and K In the stream water were slightly higher than those during season. COD was lower during dry season in Yong-Yang, while the trend was contrasted to An-Doug. These results suggest that ground water was polluted by fertilization and compost while streamwater was polluted by loss of soil and organic during the rainy season. Principal chemical components related with changing water quality were EC, NO_3^-, Ca, Mg, Na, CI^-, SO_4^- in ground water, whereas NH_4-N, K, Mg, CI^-, SO_4^- in stream water.

精神科 敎育이 精神障碍에 對한 態度에 미치는 影響

金昌潤,金容植,李符永 大韓神經精神醫學會 1988 신경정신의학 Vol.27 No.1

The attitudes toward mental disorder were investigated as a function of psychiatric education in order to determine which of them and in which direction they were changed by the increase of information and exposure to mental patients. The subjects were lst year and 3rd year nursing students as experimental groups and nonnursing students of the same grade as control groups. None of the subjects except the 3rd year nursing students had psychiatric formal lecture and mental hospital experience. The attitudes toward mental disorder were measured by self-reporting questionnaire which contained eight case descriptions (mental retardation, epilepsy, acute psychosis, mania, depressive psychosis, process schizophrenia, depressive neurosis, alcoholism). The results are summarized as follows : Authoritative and restrictive attitudes in the management of psychotics were changed in the favorable direction by psychiatric education and experiences. Emotional fear toward psychotics as well as misconceptions about their violonce and excitement decreased as the students educated and exposed to psychiatry. However, the opinions about the psychotics' social judgement and their ability to live independent were not influenced by psychiatric education. Most of the impressions about mental disorder were not influenced by psychiatric education except changes in two adjective pairs (strong-weak, unpleasant-familiar) which showed changes in the weaker and less unpleasant direction. The ability to recognize mental disorder increased by psychiatric education in most of the mental cases presented, especially in the cases of mania, depressive psychosis and precess schizophrenia. However the opinions about the patients' marriage prospect, living at home and the ability to work became more pessimistic by psychiatric education.

정신분열병 및 정신분열형 장애에 대한 올란자핀의 효과와 안전성

안용민,강대엽,권준수,김창윤,김철응,반건호,신영민,이기철,이동우,이중서,조현상,채정호,김용식 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.4

연구목적 : 본 다기관 공동임상연구는 국내 환자를 대상으로 새로운 항정신병약물인 올라자핀의 치료 효과와 안전성을 확인하고자 시행되었다. 방 법 : 1999년 7월부터 2000년 3월까지 국내 10개 병원에 방문한 정신분열병 및 정신분열형 장애 105명을 대상으로 비대조 개방 임상연구를 시행하였다. 중등도 이상의 정신병 증상을 지니거나, 부작용으로 약물교체가 필요한 경우 또는 기분장애 증상의 치료가 필요한 환자를 대상으로 하였다. 2∼7일간의 약물 배설기간 후에 1일 10mg의 올란자핀을 투여하였고, 이후로 3∼7일 간격으로 용량을 조절하여 총 8주간 투여하였다. 치료 효과는 PANSS(Positive and Negative Syndrome Scale), BPRS(Brief Psychiatric Rating Scale), CGI(Clinical Global Impression-Severity), MADRS(Montgomery-Asberg Depression Rating Scale), HAM-A(Hamilton Rating Scale for Anxiety)로 판정하였다. 안전성 평가는 자발적인 이상반응 보고, 활력징후와 혈액 검사 및 SAS(Simpson-Angus Scale), BARS(Barnes Akathisia Rating Scale), AIMS(Abnormal Involuntary Movement Scale)척도를 이용하였다. 결 과 : 105명중에서 85.7%인 90명이 8주간의 치료를 완료하였다. 평균 최빈 용량은 일일 16.1(±4.7)mg이었고, 종료시점에서의 BPRS전체 점수가 기저 상태에 비해 40%이상 감소된 반응군은 69.5%이었다. PANSS의 양성 증후군과 일반정신병리 뿐만 아니라 음성 증후군 소척도에서도 유의한 감소를 보였으며, 이 감소들은 치료 초기부터 나타나서 8주간 지속되었다. 43.8%의 피험자가 중등도 이상의 우울증상을 같이 지니고 있었으며, 올란자핀에 의해 MADRS와 HAM-A가 유의하게 감소하였다. 치료 기간 동안에 활력징후에는 뚜렷한 변화가 없었으나 체중은 8주간 지속적으로 증가하였다. SAS와 AIMS는 감소하였으며, 정좌불능증을 제외한 나머지 추체외로 증상의 발생비율도 낮았다. 임상적인 증상이나 징후를 동반하지 않는 ALT/SGPT의 상승을 보였지만 프로락틴을 포함하는 대부분의 혈액 검사상 뚜렷한 이상 변화는 없었다. 결 론 ; 비록 본 임상연구가 비대조 개방 임상연구로서 많은 제한점을 가지고 있지만, 올란자핀이 기존 약물에 내약성을 보이거나 기분증상을 동반하는 정신병에 치료 효과가 있었다. 그리고 기존 항정신병약물 치료시에 문제가 되었던 추체외로 증상과 고프르로락틴 혈증을 포함하는 대부분의 부작용면에서 안전성을 보여 주었다. Objective : This multicenter clinical trial was carried out to investigate the efficacy and the safety of olanzpine for the treatment of Korean patients. Mothod : 105 patients with schizophrenia and schizophreniform disorder, visited at 10 mental or university hospitals, had received an open and non-comparative treatment with olanzapine for 8 weeks. Patients had psychotic or depressive symptoms with the severity above moderate degree or intolerable side effects to previous antipsychotics. After a wash-out period of 2-7 days, 10mg olanzapine was prescribed initially to all the patients, and then the dosage could be adjusted within the range of 5-20mg/day of olanzapine by 3-7 days. Results : 90(85.7%) of 105 patients completed the 8-weeks trial and the mean modal dose of olanzapine was 16.1(±4.7%)mg/day. At the end of the trial, 73 patients(69.5%) were classified as responder, which was defined as 40% or more improvement in BPRS(Brief Psychiatric Rating Scale) score comparing to baseline. There was a significant reduction in the scores of PANSS(Positive and Negative Syndrome Scale)and subscales including negative symptom scores and CGI. Also weekly analysis showed that the reductions in scores were kept on for the whole period of the trial. 43.8% of all the patients had depressive symptoms at the baseline and total scores of MADRS(Montgomery-Asberg Depression Rating Scale) and HAM-A(Hamilton Rating Scale for Anxiety) were also reduced after the trials. Vital signs revealed no clinically significant changes but continuous weight gain was observed during the treatment with olanzapine. The scores of SAS(Simpson-Angus Scale) and AIMS(Abnormal Involuntary Movement Scale) for assessing the EPS(extrapyramidal symptoms)and tardive dyskinesia respectively were significantly decreased and only a few patients reported EPS as adverse events. Although mild and clinically non-significant of ALT/SGPT was observed, most laboratory parameters including plasma prolactin level showed to significant changes during the trial. Conclusions : Although this trial had many limitations because it was a non-comparative and open study, olanzapine showed high efficacy on the positive, negative and depressive symptoms in schizophrenia and schizophreniform disorder.In addition to that, olanzapine showed a substantially favorable safety profile, such as low incidence of EPS and hyperprolactinemia.

정신분열병 환자에서 가족력, 산과적 합병증 및 신체미세기형의 관련성에 관한 연구

안용민,김용식,정희연,신지용,윤세창,배안,이중서,주은정,이창인 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.2

연구목적 : 저자들은 태생기 동안에 받는 유전외적 요인, 즉 환경적 요인이 산발성 정신분열병 환자들의 발병에 크게 관여할 것이라고 가정하였다. 이를 검증하기 위하여 형제 중 1인 이상이 발병하여 가족력을 분명히 알 수 있는 정신분열병 환자군(이하 형제 환자군)과 가족력이 없는 산발성 정신분열병 환자군(이하 산발성 환자군) 및 정상대조군을 대상으로 산과적 합병증, 신체미세기형 및 정신분열병의 임상 양상을 비교하였다. 방 법 : 연구 대상은 형제 환자군 43명(남 22명, 여 21명), 산발성 환자군 43명(남 23명, 여 20명), 정상대조군 43명(남 20명, 여 23명)이었다. 산과적 합병증은 Lewis 척도를 이용하여 평가하였고 신체미세기형은 Waldrop 척도를 이용하여 측정하였다. 임상 양상으로서 발병 연령, 병전 기능 수준, 정신병리, 약물에 대한 반응, 회복시의 전반적 기능 수준, 지연성 운동장애의 유무를 평가하였다. 결 과 : 정상대조군과 정신분열병 환자군 전체를 비교하였을 때 산과적 합병증과 신체미세기형의 총점과 각 소항목의 점수에 차이가 없었다. 산발성 환자군과 형제 환자군을 비교하였을 때 산과적 합병증의 전체 점수에서는 유의한 차이가 없었으나, 출생 당시에 태아가 받은 스트레스 항목의 점수가 산발성 환자군에서 유의하게 높았다. 신체미세기형에서는 전체 점수 및 입의 미세기형 점수가 산발성 환자군에서 유의하게 높았다. 신체미세기형의 전체 점수가 4점 이상인 환자수도 산발성 환자군에서 높은 경향성을 보였다. 산과적 합병증과 신체미세기형 사이의 상호 연관성은 찾을 수 없었다. 정신분열병의 임상 양상 중에서는 Krawiecka 척도의 총점 및 양성 증상 점수와 회복시의 전반적 기능 수준만이 형제 환자군에 비해 산발성 환자군에서 유의하게 높았다. 성별에 따라서는 형제 환자군에서 남자 환자의 산과적 합병증이 유의하게 높았다. 결 론 : 본 연구를 통해 산과적 합병증 및 신체미세기형 연구가 정신분열병의 원인을 규명하기 위한 유용한 방법임이 시사되었지만, 가족력, 산과적 합병증 및 신체미세기형의 관련성에 대해서는 분명한 결론을 내리지 못하였다. The authors hypothesized that sporadic schizophrenic patients had more chances of receiving environmental insults during the fetal neural development compared with familial schizophrenics. We tested our hypothesis by comparing obstetric complications(OCs), minor physical anomalies(MPAs) and other clinical features, and examining the correlation between OCs and MPAs in schizophrenic patients who had one or more sibling with schizophrenia(sibling group) and sporadic schizophrenics(sporadic group) and normal controls. OCs were evaluated by the scale of Lewis, and MPAs were measured by the Waldrop scale. There were no significant difference in OCs and MPAs between schizophrenic and control groups. Sporadic group had significantly higher fetal distress, total Waldrop score and Waldrop score for mouth than sibling group. And there was a tendency that the number of subjects having the Waldrop score over 4 points was greater in the sporadic group. No significant correlation was observed between CCs and MPAs. The scores of initial psychopathology and post-treatment functioning were much higher in the sporadic group, but the other clinical feature showed no difference. Although male patients had more OCs than female patients in sibling group, no sex difference were observed as a whole. Our results suggest that, if the methodological weakness were complemented, OCs and MPAs would be useful tools in the search for the cause of schizophrenia.

중량물 들고 보행시 잡기유형의 차이에 대한 운동학적 분석

서국웅,윤양진,김용재,이훈식,정미라,이창민,이중숙 한국운동역학회 2000 한국운동역학회지 Vol.9 No.2

The purpose of this study was to examine the kinematic changes of the body according to various weight loads and the holding during carrying object. The experiments were conducted with utilizing image, analyses for five male and five female adults as subjects. The results were as followed. 1. Meaningful differences were shown partially in the angle changes of the subject's wrist joints, elbow joints and coxal articulations, but not in the angle changes of the subject's knee joints, according to the types of holding the objects while subjects carrying 5kg objects. So, carrying a light object of 5kg in workplaces or gyms doesn't have much influence on human joints and muscles. 2. Meaningful differences of angle changes were shown between right holding and vertical holding while subjects carrying 10kg objects. Female subjects had difficulties to hold the angles of their wrist joints and elbow joints, carrying 10kg objects, because the first loads were imposed on their wrists and female has weaker muscles than male. In right holding of 10kg objects, female subjects had backward body centers from their bodies, the angle of their coxal articulation became bigger and they had unstable behaviors. 3. Female subjects had wider angle of their wrist joints and elbow joints while carrying 15kg objects than male subjects. But male subjects had bigger angle of coxal articulation than female subjects. Because female has weaker muscles, female subjects couldn't maintain the angles of their wrist joints and elbow joints. 4. The 20kg objects influenced the angles of the wrist joints, the elbow joints and the coaxal articulations of both sex subjects in any type of holding during their carrying 20 kg objects, but didn't influence their knee joints. 5. in carrying 25kg objects, female subjects had wider angles of their wrist joints, elbow joints and knee joints in each holding type than male subjects and the significant difference were shown according to the holding type. But in the case of coxal articulation, male subjects had the bigger angles and meaningful differences. This comes from the weakness of female's muscle. N\Male subject's upper bodies were drawn back and the objects influenced their wrists more than their arms.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

A Multicenter Analysis of Clinical Features and Long-Term Outcomes of POEMS Syndrome in Korea

Kook Hye Won,Jang Ji Eun,Min Chang-Ki,Yoon Dok Hyun,Kim Kihyun,Bang Soo-Mee,Park Yong,Lee Jae Hoon,Yoon Sung-Soo,Kim Jin Seok 대한의학회 2024 Journal of Korean medical science Vol.39 No.2

Background: POEMS syndrome is a rare form of plasma cell dyscrasia characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal proteins, and skin changes. Owing to its low incidence, there are few reports regarding this syndrome. This multicenter study included 84 patients diagnosed with POEMS syndrome in South Korea. Methods: We retrospectively evaluated 84 patients diagnosed with POEMS syndrome at 8 hospitals in South Korea between January 2000 and October 2022. The clinical characteristics and treatment outcomes were analyzed. Results: The median patient age was 53 years (range, 26–77 years), and 63.1% of the patients were male. All patients had peripheral neuropathy, and 81 (96.4%) had monoclonal plasma cell proliferation. Plasma vascular endothelial growth factor levels were available for 32 patients with a median of 821 pg/mL (range, 26–12,900 pg/mL). Other common features included skin changes (54.2%), volume overload (71.4%), and organomegaly (72.6%). Of the 84 patients, 75 received initial treatment (local radiotherapy, 6 [8.0%]; chemotherapy, 17 [22.7%]; both chemotherapy and local radiotherapy, 9 [12.0%]), upfront autologous stem cell transplantation (ASCT), 43 (57.3%; with induction chemotherapy, n = 12, 16.0%; without induction chemotherapy, n = 31, 41.3%). The median follow-up duration was 40.7 months. The 5-year overall survival (OS) was 78%, and the 5-year progression-free survival (PFS) was 55%. Patients who underwent upfront ASCT and were diagnosed after 2014 had a longer OS and PFS. Conclusion: The demographics of Korean patients with POEMS syndrome were similar to those reported previously. Because of the introduction of new treatment agents and the reduced rate of transplant-related mortality related to ASCT, the treatment outcomes of Korean patients with POEMS syndrome have improved in recent years.