조증환자의 약물 순응도에 영향을 미치는 요인

박성근,이민수,곽동일,정인과 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.4

연구목적 : 약물의 순응도는 조증환자의 장기적인 치료 결과 및 예후에 있어서 가장 중요한 사항중 하나이다. 그동안 조증환자의 약물 순응도에 관한 연구들은 많이 있어왔으나 대부분 단면적인 연구이며, 또한 첫 번째 삽화를 기준으로 조사된 연구는 없었다. 양극성 장애와 분열정동장애에서의 약물 순응도에 대한 국내 연구는 드물다. 따라서 저자들은 조증 환자에서의 약물 순응 정도를 조사하고, 약물 비순응과 연관된 여러 요인들에 대해 알아보고자 하였다. 방 법 : 환자의 순응도는 환자의 자가보고, 보호자의 보고, 치료자의 추정, 조사자와의 면담, 진료 약속의 이행, 그리고 약물의 혈중 농도등을 통하여 평가하였다. 순응도와 연관된 요인에 대한 자료들은 환자-관련 요인, 질병-관련 요인, 치료-관련 요인으로 나누어 의무기록의 검토와 환자와의 직접적인 면담을 통해 수집하였다. 결 과 : 전체 71명의 환자중 40명(56.3%)이 첫 치료기간 도중 약물치료에 비순응한 것으로 나타났다. 비순응은 아동기 외상적 사건의 경험(p=.035), 정신병적 증상의 존재(p=.020), 그리고 기분 안정제의 병합사용(p=.002) 등의 요인들과 유의한 상관관계가 있었다. 결 론 : 아동기에 심각한 스트레스성 사건을 경험한 환자, 조증삽화동안 망상이나 환각등의 증상을 보였던 환자, 그리고 두가지 이상의 기분 안정제를 병합 투여받은 환자들이 약물 치료에 순응하지 못하는 것으로 나타났다. Objectives : Drug compliance is the most important issue in long-term treatment outcome and prognosis of manic patients. Up to date, there has been no study about drug compliance at the point of the first manic episode and subsequent maintenance period. And also there are limited data regarding the rates of noncompliance in patients with biopolar disorder and schizoaffective disorder in Korea. So the author studied about the rate of noncompliance in manic patients and about the clinical predicting factors associated with their drug compliance. Methods : Compliance of a patient was assessed by patient's report, family member's report, treater's estimation, investigator-administered questionnaire, record of unkept appointment and plasma concentration of mood-stabilizer. Data about patient-related, illness-related and interview with the patient. Results : Forty patients(56.3%) were noncompliant with their pharmacologic regimen at the point of the first treatment period. Noncompliance was significantly associated with experience of childhood stressful life events(p=.035), presence of psychotic symptoms(p=.020) and treatment with combination of mood-stabilizers(p=.002). Conclusion : Patients who experienced serious life event in their childhood, had delusion or hallucination during the manic episode, or received the combination therapy of mood-stabilizer are prone to fail in treatment adherence.

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.

두부외상으로 인해 발생한 기면증 1예

박성근,김진세,김린,정인과 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.1

본 증례는 두부 외상이후 갑작스런 근긴장의 소실을 보인 51세 남자 환자의 진단과정에 대한 보고이다. 환자는 하루 수십차례씩 갑자기 온몸이 마비된다는 증상을 호소하였으나, 의식은 명료하였고, 다칠 정도로 심하게 쓰러지는 경우도 없었으며, 특히 치료진과의 면담 중에 증상이 악화되는 양상을 보였다. 통상적인 검사실 검사와 뇌영상, 뇌기능 검사상 특이한 이상소견은 없었다. 우선 저자들은 전환장애나 꾀병을 먼저 의심하게 되었다. 그러나 자세한 병력청취와 관찰상 낮동안의 수면 발작과 야간 수면에서의 어려움이 있었고, 야간수면다원검사, 수면잠복기 반복검사, 그리고 탈력발작 심화 동안의 근전도 검사등을 통해 기면증으로 진단되었다. 또한 human leukocyte antigen(HLA)-DR2 검사에서 음성결과를 보여 본 환자의 기면증이 원발성이 아님이 시사되었다. 치료약물로 imipramine을 투여하자 탈력발작의 증상은 급격히 감소하였다. 따라서 두부외상 후 졸리움과 탈력발작의 증상에 대해 드물기는 하나, 진단과 치료에 있어 기면증의 가능성을 염두해 두어야 할 것이다. The authors reported a case and its diagnostic process of post-traumatic narcolepsy which had developed after a head trauma. The 51-years-old patient showed frequent generalized paralytic attack, which was aggravated during stressful situation, diet time, and in front of hospital staffs. During the paralytic attack, consciousness was alert, and he never collapsed to hurt. All laboratory findings including serum potassium level were within normal limit, and also brain imaging studies and electroencephalography revealed no specific abnormal findings. Our clinical impression was a conversion disorder or a malingering at first, but after the detailed history taking and the careful observation, daytime sleep attack and some sleep problems were revealed. Thus nocturnal polysomnography and multiple sleep latency test(MSLT) were performed, and then the authors could diagnose as "narcolepsy". HLA-DR2 typing was negative. After imipramine trial, the frequency and the intensity of attack was dramatically reduced. The authors concluded that narcolepsy should be considered in the differential diagnosis of sleepiness or transient loss of muscle tone after traumatic brain injury.

전환장애와 감별해야할 Meige 증후군 1예

임세원,김진세,정인과,박민규,이대희 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.3

Meige 증후군은 안검경련과 구-하악부의 근긴장이상을 특징적으로 보이는 신경학적 임상증후군이다. 발병원인은 아직 불분명하나 아세틸콜린과 도파민의 신경활성과다(excess neuronal activity)가 원인으로 여겨지고 있으며, 치료로는 향도파민성약물과 항콜린성약물, 그리고 보튤리듐독소 주사가 이용되고 있다. 그러나 증상양상이 다양하며 심리적 영향을 받으므로 전환장애 혹은 불안장애 등의 정신과적 문제로 오진되는 경우가 있다. 저자들은 49세 여자로 초기에 전환장애로 진단되었으나 Meige 증후군임이 밝혀져 성공적으로 치료되었던 환자 1례를 경험하여 문헌고찰과 함께 보고한다. A Meige's syndrome is a rare neurological syndrome characterized by blepharospam and oro-mandibular dystonia. Its pathophysiology is not clearly determined yet, but the hypothesis of dopaminergic and cholinergic hyperactivity is most widely accepted. Anticholinergic drugs, antidopaminergic drugs and botulism toxin injection are currently used for the treatment of Meige's syndrome. The Meige's syndrome could be misdiagnosed as a psychiatric disorder such as conversion disorder or anxiety disorder, because clinical features of the Meige's syndrome are very variable and affected by psychological factors. The authors experienced one case of a 49-year-old female patient who was initially misdiagnosed as conversion disorder but confirmed later as Meige's syndrome, and then successfully treated.

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.

The Amplification of the Morse Codes, which Cho Ji-Hoon's Poem Silent Night 1 Leaves in the Human Body

Park, In-Kwa The International Promotion Agency of Culture Tech 2018 International Journal of Advanced Culture Technolo Vol.6 No.1

In this study, we tried to reveal the state of stillness of Cho Ji-Hoon's poem "Silent Night 1" as a healing modifier. The language of poem is synaptically linked to the calmness emotion of the human body, seeking a principle that leads to a state of healing. Therefore, this study was carried out for the purpose of applying the principle to literary therapy program. The silent signal embedded in the poem is encoded into the signals of the sound as it is synapsed to the human body. Encoding of auditory nerves by poem lines is like a Morse code that word and word leave in the human body. The action potential of the auditory nerve is further activated by the potential difference between the word and the word represented by the neural network, such as a Morse code, which is accessed to the human body by such a path. There is worked as amplified potential difference between the words perceived by a sound which is synapsed to the human body and by a silence which is synapsed to the human body. The phenomenon of the words approaching the human body and setting the absence of sound and amplifying the sound is because the words amplifies the Morse codes in the human neural network. At this time, the signals overlap each other. Thereby this poem is increasing the amplitude of the sound. This overlapping of auditory signals appears and amplifies the catharsis. If this Cho Ji-Hoon Poem's principle is applied to literary therapy program in the future, more effective treatment will be done.

Therapeutic Functor that calls semantic Argument -Focusing on the compound nouns in Sijo

Park, In-Kwa The International Promotion Agency of Culture Tech 2017 International Journal of Advanced Culture Technolo Vol.5 No.3

The human body is structured as sentence of healing. This study examines how the mechanism of healing works in the human body by the narrative relation of functor and argument. So, we predict the way of extreme healing by literary or human narrative. For this purpose, we analyze the principle that the emotional and semantic arguments are called by the functor set by the sentences containing the fingerprints of mind in Gosijo and the mechanism of healing works extensively. We analyze the process of the transition from the narrative of the literary to the narrative of the human body. Thus, the barcode of the healing, which is made up of the relationship between the functor of the literature and the argument, is transferred to the human body and it is judged that the fingerprint of the human mind is operated through the stage of encoding and re-encoding due to the action potential. In addition, it was predicted that the neurotransmitters such as dopamine and the secretion of hormones would be promoted and the healing level would be increased. In results, we conclude that the function of argument and functor which contains the fingerprint of the mind in the third sound step on the last sentence of Gosijo is transferred to the human body and is especially heavily focused and operate with healing.

A Study on Sijo Literature Therapy structuralized in the Rated Codon

Park In-Kwa 국제문화기술진흥원 2017 International Journal of Advanced Culture Technolo Vol.5 No.2

The purpose of this study is to find out how to use emotional activity rate in sentence. The aim is to estimate the Emotion-Codon status of emotion-DNA wiggling as well as the sequence of codons in which amino acids of human body are spread. It is to use as if the amino acids are translated from the DNA of the human body, and the emotions that cooperate with each other are diversified and refined. Through these attempts, we anticipate the change of emotions by literary works and present the direction of the synapse working and the direction of the encoding. Therefore, this study analyzed the emotional activity rate of Rated Emotion-Codon, which works as Rated Sijo. At this time, the emotional change in the human body, in which the sentence is more clearly pronounced, is predicted and detected. This result shows how emotions can activate the human body. This state of activation is an indicator of how much the sentence pushes the physiological action of the human body. It is judged that Codon is constructed precisely for the activation of the rated Sijo additive definition by this index. Our result is evidenced by the fact that three sentences of Rated Sijo show an array with the same rating as the Rated Codon's, The first sentence fuses with the sentiment between the second sentence and the third sentence of Rated Sijo. The emotional symbols of the first sentence’s space, which are fused with emotions flowing between the second and third sentence of Rated Sijo, are "A, U, J, L", which are rated-structured in the first base of the Codon table. The emotional symbols of the second sentence’s space, which are fused with emotions flowing between the first and third sentence of Rated Sijo, are "A, U, J, L", which are rated-structured in the second base of the Codon table. The emotional symbols of the third sentence’s space, which are fused with emotions flowing between the first and second sentence of Rated Sijo, are "A, U, J, L", which are rated-structured in the third base of the Codon table. The Rated Sijo, which is resiliently and precisely assigned to the human body's Rated Emotion-Codon, will require a rich experience in our Rated Life.

The Amplification of the Morse Codes, which Cho Ji-Hoon's Poem Silent Night 1 Leaves in the Human Body

In-Kwa Park 국제문화기술진흥원 2018 International Journal of Advanced Culture Technolo Vol.6 No.1

In this study, we tried to reveal the state of stillness of Cho Ji-Hoon's poem 「Silent Night 1」 as a healing modifier. The language of poem is synaptically linked to the calmness emotion of the human body, seeking a principle that leads to a state of healing. Therefore, this study was carried out for the purpose of applying the principle to literary therapy program. The silent signal embedded in the poem is encoded into the signals of the sound as it is synapsed to the human body. Encoding of auditory nerves by poem lines is like a Morse code that word and word leave in the human body. The action potential of the auditory nerve is further activated by the potential difference between the word and the word represented by the neural network, such as a Morse code, which is accessed to the human body by such a path. There is worked as amplified potential difference between the words perceived by a sound which is synapsed to the human body and by a silence which is synapsed to the human body. The phenomenon of the words approaching the human body and setting the absence of sound and amplifying the sound is because the words amplifies the Morse codes in the human neural network. At this time, the signals overlap each other. Thereby this poem is increasing the amplitude of the sound. This overlapping of auditory signals appears and amplifies the catharsis. If this Cho Ji-Hoon Poem's principle is applied to literary therapy program in the future, more effective treatment will be done.

A Study on Sijo Literature Therapy structuralized in the Rated Codon

Park, In-Kwa The International Promotion Agency of Culture Tech 2017 International Journal of Advanced Culture Technolo Vol.1 No.1

The purpose of this study is to find out how to use emotional activity rate in sentence. The aim is to estimate the Emotion-Codon status of emotion-DNA wiggling as well as the sequence of codons in which amino acids of human body are spread. It is as if the amino acids are translated from the DNA of the human body, and the emotions that cooperate with each other are diversified and refined. Through these attempts, we anticipate the change of emotions by literary works and present the direction of the synapse working and the direction of the encoding. Therefore, this study analyzed the emotional activity of Rated Emotion-Codon, which works as Rated Sijo. At this time, the emotional change in the human body, in which the sentence is more clearly pronounced, is predicted and detected. This result shows how emotions can activate the human body. This state of activation is an indicator of how much the sentence pushes the physiological action of the human body. It is judged that Codon is constructed precisely for the activation of the rated Sijo additive definition by this index. Our result is evidenced by the fact that three sentences of Rated Sijo show an array with the same rating as the Rated Codon's, The first sentence fuses with the sentiment between the second sentence and the third sentence of Rated Sijo. The emotional symbols between the sentence symbols "A, U, J, L" in the first base of the Codon table and the sentences fusing between the sentences of the first sentence and the third sentence are "A, U, J, L". The emotional symbols between the sentences flowing in the second base of the Codon table and between the sentences of the first sentence and the second sentence are structured in the third base of the Codon table as "A, U, J, L". The Rated Sijo, which is resiliently and precisely assigned to the human body's Rated Emotion-Codon, will require a rich experience in our Rated Life.