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.

노인에서 정서 인식의 저하

이경욱,채정호,최인철,이해국,권용실,이정태 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.2

Objectives : The purpose of this study was to investigate whether elderly and young adults differ in their recognition of facial expressions of emotion. Methods : A total of 120 (elderly group 53, young group 67) subjects participated in this study. Korean facial expressions of emotion including happiness, sadness, fear, anger, disgust, surprise and neutral were used as stimuli for facial affect recognition test. Computerized facial affect recognition test that consists of facial affect discrimination test and facial affect intensity test was performed. Results : For facial affect discrimination test, there was a significant difference between two groups (F==3.986, P<.01) after controlling the effect of education. Elderly participants showed significantly less correct recognition rate with sadness, anger and disgust (p<.05). For facial affect intensity test, there was no significant difference between the groups in recognition of emotional intensity. Chi-square test or t-test was done according to the clinical variables. Multivariate analysis of covahance was done to test group differences of correct recognition rate and emotional intensity. Conclusion : This is the first report of differential decrease of facial affect recognition in elderly using Korean facial expressions. This study suggests that the decrement of facial affect recognition maye be a part of normal aging process.

In vivo에서 수종이장재의 산도변화에 관한 연구

이미정,안연실,이용우,손호현,이광원 大韓齒科保存學會 1998 Restorative Dentistry & Endodontics Vol.23 No.1

The purpose of this study was to observe the changes of acidity of resin cement(Time Line), glass ionomer cement(GC Fugi Lining LC), zinc phosphate cement(Fleck's zinc cement), zinc oxide eugenol cement(Sultan, Chemists.) in vivo and in vitro. Class I cavities with 3mm depth were prepared on the occlusal surfaces of 20 recently extracted human Mn. molar teeth and 20 human Mn. 3rd molar teeth in oral cavity. The prepared cavities were divided into 4 groups of each 5 teeth using the above 4 cavity liners. Each cement was mixed in accordance with manufacturer's direction at the room temperature of 23˚± 5℃ and filled into the cavity in a width of 1mm. The microelectrode of pH meter was inserted into the prepared cavity in a width was filled with mixed cement, and the acidity of cement was measured for 3 days from the beginning of cement mix in vitro and in vivo. The measured acidity was then statistically analyzed by ANOVA. The results were as follows. 1. In vitro, the pH of zinc oxide eugenol cement was statistically lower than that of the three other groups at 2min, 4min, 6min, 8min, 10min, 12min, 18min, 20min. (p<0.05). 2. The pH of zinc oxide eutenol cement in vivo was statistically higher than that in vitro at 16min, 16min, 20min(p<0.05). 3. The pH of zinc phosphate cement in vivo was statistically higher than that in vitro at 4min, 20min(p<0.05). 4. In vitro and in vivo, there was no significant difference in the pH between the resin cement and the glass ionomer cement(p>0.05). 5. The initial acidity was not high, but almost neutral in all kinds of the cements.

人蔘 Saponin成分이 흰쥐 膽膵液 分泌에 미치는 效果에 관한 硏究

愼鏞會,李炫實,朴鍾大,趙台淳 成均館大學校 科學技術硏究所 1990 論文集 Vol.41 No.2

The effect of saponins including water extract of Panax Ginseng was studied on the pancreaticobiliary secretion and cholate output and amylase activity in rats. The saponins tested were crude saponin, panaxadiol (PDS), panaxatriol (PTS). After single or two weeks administration of the samples, pancreaticobiliary juice of rats were collected for 8 hrs and the results obtained were summarized as follows. (1) In animals with single administration, pancreaticobiliary juice volume(PJV) was not significanty increased as compared to the control group. However, there was a significant increase in PJV of animals from 4 to 6 hrs after two weeks administration of water extract (500mg / kg / day) or crude saponin(50mg / kg / day). (2) Cholate output was increased dose-dependently from 1 to 5 hrs after the single administration of PDS, PTS. On the other hand, after two weeks administration of crude saponin (50mg/kg/day), the cholate output of the animals was increased significantly. (3) amylase activity in the juice were intermittently increased in single administration of water extract, crude saponin and PTS(100mg / kg). After two weeks administration, there was a significant increase in amylase activity of animals treated with PTS as compared to the control group.

주요 우울증을 동반한 신경성 식욕과항진증 1례

신석호,권용실,김보연,이정태,이성필 한국의학사 1992 診斷과治療 Vol.12 No.7

의료보험 고액진료비 환자의 특성연구

문옥륜,강선희,이은표,좌용권,이현실 韓國保健行政學會 1993 보건행정학회지 Vol.3 No.1

A small number of high cost patients usually spend a larger proportion of scarce health resources. Korea is no exception. Under the national health insurance, 12% of the insured persons have consumed approximately half of the national health insurance expenditures. Therefore, it is necessary to identify the characteristics of the high cost patient group, if we would like to reduce them. This study has defined high cost patients as those who have spent one and half million won and over Per 6 months. The study reveals that high cost users are those who have a longer length of stays(LOS), 40 days of LOS in the 6 months, have multiple admissions, 2 to 3 admissions per 6 months and are the eiderly patients. They have Spent 814, 126won per day on the average, and commonly suffered from malignant neoplasms, circulatory diseases, fracture, diabetes mellitus, etc. Unlike the case of western developed countries, early readmissions are not the major causes of high cost spending in Korea. Undoubtedly, a lengthy admission is the main cause of large spending. Health policies should vigorously be explored to respond appropriately. There are evidences that hospital beds are often misused. As the Korean health care system is lacking in a mechanism of patient evaluation under the fee-for-service remuneration system, an idea of progressive patient care needs to be tested. The Government should set up health policy to diversify the role of long-term care facilities and encourage people to establish them. Further studies are needed to identify factors influencing large medical bills necessary for formulating the health policy on cost containment.

정신병적 증상이 동반된 기면병 1예

홍승철,송정민,정종현,권용실,한진희,이성필 大韓神經精神醫學會 2003 신경정신의학 Vol.42 No.5

Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations and disrupted nocturnal sleep. We report a patient with a diagnosis of schizophrenia who was subsequently diagnosed as narcolepsy. A case of a 22-year-old woman with concomitant narcolepsy and psychotic symptoms was discussed from a perspective of the diagnosis and therapeutic challenges, particularly on pharmcological treatment dealing with issues raised by their coexistence.

Which Environmental Factors Caused Lammas Shoot Growth of Korean Red Pine?

Lee, Chang-Seok,Song, Hye-Gyung,Kim, Hye-Soo,Lee, Bit-Na-Ra,Pi, Jeong-Hoon,Cho, Yong-Chan,Seol, Eun-Sil,Oh, Woo-Seok,Park, Sung-Ae,Lee, Seon-Mi The Ecological Society of Korea 2007 Journal of Ecology and Environment Vol.30 No.1

Lammas growth, a rare phenomenon for Korean red pine (Pinus densiflora), occurred in 2006. Lammas shoots showed higher frequency and longer length in Seoul's hotter urban center than in urban boundary or suburban forest sites. Frequency and length showed a close correlation with urbanization density and vegetation cover expressed in NDVI. Air temperature in the late summer of 2006 was more than $1^{\circ}C$ higher than an average year. Of the predominant environmental signals that modulate bud flush, only temperature changed significantly during the year. Differences in temperature between the urban centers, urban boundaries and suburban forests correlated with varying land-use density. The rise in temperature likely spurred lammas growth of the Korean red pine. Symptoms of climate change are being detected throughout the world, and its consequences will be clearer in the future. Considerate interest in the responses of ecological systems to the variable changes is required to prepare for unforeseeable crises. Monitoring of diverse ecological phenomena at Long Term Ecological Research sites could offer harbingers of change.

Transforming Growth Factor-α Increases the Yield of Functional Dopaminergic Neurons from in vitro Differentiated Human Embryonic Stem Cells Induced by Basic Fibroblast Growth Factor

Lee, Keum Sil,Shin, Hyun Ah,Cho, Hwang Yoon,Kim, Eun Young,Lee, Young Jae,Wang, Kyu Chang,Kim, Yong Sik,Lee, Hoon Taek,Chung, Kil Saeng,Park, SePill,Lim, Jin Ho 충남대학교 형질전환복제돼지연구센터 2004 논문집 Vol. No.8

An Evaluation of the Effects of Rehabilitation Practiced in Coal Mining Spoils in Korea: 2. An Evaluation Based on the Physicochemical Properties of Soil

Lee, Chang-Seok*,Yong-Chan Cho,Hyun-Chul Shin,Seon-Mi Lee,Woo-Seok Oh,Sung-Ae Park,Eun Sil Seol,Choong-Hwa Lee,Ahn-Heum Eom,조현제 한국생태학회 2008 Journal of Ecology and Environment Vol.31 No.1

The effectiveness of rehabilitation programs for coal mining spoils in Samcheok, Jeongsun, and Mungyung were evaluated based on the physicochemical properties of soil in the rehabilitated areas. These spoils were reclaimed by introducing plants such as black locust (Robinia pseudoacacia), pitch pine (Pinus rigida), birch (Betula platyphylla var. japonica), alder (Alnus hirsuta), bush clover (Lespedeza cyrtobotrya), and grass (Lolium perenne) in planting beds covered with forest soil. In the surface soil, the pH, organic matter, total N, available P, and exchangeable Ca showed significant changes over the years after reclamation. The pH and exchangeable Ca content decreased exponentially over time, whereas organic matter increased linearly and total N and available P increased exponentially. Changes in the physicochemical properties of subsurface soils displayed a different pattern. There were significant changes over time in the organic matter, available P, and exchangeable Ca and Mg contents of the soil. Organic matter increased logarithmically with years since rehabilitation and available P increased exponentially. Meanwhile, exchangeable Ca decreased exponentially, and Mg decreased logarithmically. The changes in the subsurface soil were not as dramatic as those in the surface soil. This result suggests that the ameliorating effects of the establishment and growth of plants more pronounced on the surface soil layer. Stand ordination data showed different relationships with time since rehabilitation in the early and later stages of the rehabilitation process. In the early stages of rehabilitation, stands tended to be arranged in the order of reclamation age. However, in the later stages, there was not a clear relationship between reclamation age and vegetation characteristics. This result suggests that soil amelioration is required for the early stages, after which an autogenic effect becomes more prominent as the vegetation becomes better established.