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.

돌와(Gynostemma pentaphyllum)엑기스가 白鼠의 肝臟障碍에 미치는 影響

丁明鉉,文永熙,姜壽鐵,李炳柱 조선대학교 약학연구소 1989 藥學硏究誌 Vol.11 No.1

This study was attempted to invesigate the effects of extract and crude saponins of Gynostemma pentaphyllum Makino on the activities of S-GPT, S-GOT, Al.P, LDH and the levels of total-bilirubin, total-cholesterol in the serum of nomal rats and experimentally CCl_4-intoxicated rats, and on the effect of body, liver and spleen weight in CCl_4-intoxicated rats. The results were shown as follows; The extract (GE.) and crude saponins were showed a significantly decrease in the activities of S-GPT, S-GOT, Al.P and the level of total bilirubin in the serum elevated by CCl_4, but crude saponins was more decreased than GE. The activities of LDH were significantly decreased of the 4th and the 6th days after administration of GE., and crude saponins was decreased in proportion to the number of days. The level of total cholesterol were significantly decreased in all sample groups. when compared with control group, but remarkably decreased in GE. 500㎎/㎏ and crude saponins 100㎎/㎏. The liver and spleen weight were decreased on the administration of GE. and crude saponins. According to the above results, it is thought that GE. and crude saponins exhibited significant antihepatotoxic activity in the CCl_4-intoxicated rats.

Enterococcus faecium 19-46-4에 의한 Cholic Acid의 생산

정은영,김명수,이철훈,김병홍 한국산업미생물학회 1996 한국미생물·생명공학회지 Vol.24 No.5

항균활성을 갖는 혐기성 미생물에 대한 탐색연구에서 항균활성이 강한 Enterococcus faecium 19-46-4를 선발하여 혐기적 배양으로 이 균주가 생산하는 항생물질의 분리, 정제 및 이화학적 특성 및 구조분석을 행하였다. 40ℓ 균배양액으로부터 iso-butanol extraction, C-18 liguid column chromatography, HPLC등을 통해 약 100mg의 항균물질을 분리정제하여 KIST 194로 명명하였고, KIST 194를 UV, IR, ^1H-NMR, ^13C-NMR, EI-MS와 LC-MS 등의 기기분석을 한 결과 cholic acid (3α, 7α, 12α-trihydroxy-5β-cholan 24-oic acid)로 동정하였다. A facultative anaerobe Enterococcus faecium 19-46-4 was used to study the production of an antimicrobial substance in anaerobic conditions. Major part of the antibiotic activity was found in the culture filtrate of the bacterium. The active compound was extracted by an equal volume of iso-butanol and concentrated in vacuo (at 50℃) before purification by C-18 liguid column chromatography and HPLC. A chromatographically pure compound was obtained by two passages of HPLC columns, The compound appeared as a pale-yellow powder. The yield was about 2.5 mg l^-1 culture filtrate. The compound was named as KIST 194. KIST 194 were identified as cholic acid (3α, 7α, 12α-trihydroxy-5β-cholan 24-oic acid) based on its physico-chemical properties determined by UV, IR, ^1H-NMR, ^13C-NMR, EI-MS and LC-MS.

열형광선량계에 의한 선량평가 알고리즘 개발

송명재,김희근,하정우,이태영,윤석철 대한방사선 방어학회 1992 방사선방어학회지 Vol.17 No.2

본 연구의 목적은 ANSI N13. 11-1983의 시험기준에서 제시한 개인선량계의 선량평가 시험범주를 모두 만족시킬 수 있는 선량평가 알고리즘을 개발하는데 있다. 알고리즘 개발 대상 개인선량계로는 Teledyne Isotopes사의 PB-3 열형광선량계로 하였다. 개발된 알고리즘에 대한 미국 Atlan-Tech사와의 2차례의 검증결과, 본 알고리즘은 ANSI N-13. 11-1983의 선량평가 범주를 모두 만족시키는 것으로 나타났다. The purpose of this study is to develop an algorithm of TLD dose evaluation to meet all requirements stated in ANSI N13. 11-1983. It made the PB-3 TLD of Teledyne Isotopes an object of the development. Personal dosimetry performance testings of the development algorithm have been performed twice through the Atlan-Tech, INC. in accordance with the criteria of testing described in ANSI N13. 11-1983. As a result, it is assured that the developed algorithm has complied with all requirements stated in ANSI N13-1983.

입원한 기분장애 소아청소년의 임상특성 : 주요 우울증과 양극성장애의 우울삽화 비교를 중심으로

임명호,조수철,백기청,이경규,김현우,홍강의 대한소아청소년정신의학회 2000 소아청소년정신의학 Vol.11 No.2

본 연구는 소아청소년에서의 우울증 및 조울증의 우울삽화에 대한 임상특성을 알아보고자 하였다. 1993년 3월 1일부터 1999년 10월 31일까지 ○○대학교 어린이 병원 소아청소년 정신과에 입원하였던 34명의 우울증 환아와 17명의 조울증 우울삽화 환아를 대상으로 병록지 기록을 통해서 이들의 사회인구학적 특성, 진단적 분류, 입원시 주 증상 및 문제점, 증상의 빈도, 주산기 모 병력과 아동기 발달력, 공존정신 질환 및 신경 심리학적 검사 가족의 임상적 특성, 가족 정신병리 및 가족 병력, 치료반응등에 대하여 조사하였다. 1) 우울증에서 남자의 비율이 여성의 경우보다 높았으며, 조울증 우울삽화에서는 남녀의 비율이 비슷하였다. 2) 평균 발병 연령은 조울증 우울삽화에서 14.1세, 우울중에서 12.8세로 우울증에서 일찍 발병하는 양상을 나타냈으며, 입원 횟수에 있어서는 조울증 우울삽화에서 우울증에 비해서 많았다. 3) 조울증 우울삽화와 우울증 모두에서 식물증상의 호소가 신체증상보다 많았으며, 자살사고 증상은 우울증에서, 공격적인 증상은 조울증 우울삽화에서 많았고, 정신병적 증상에서는 망상은 우울증에서 환각은 조울증 우울삽화에서 많이 나타났다. 4) 두 집단 모두에서 불안장애가 가장 많이 동반되었으며, 신체형 장애, 정신지체, 인격장애 등이 동반되었다. 5) 조울증 우울삽화와 우울증 모두 높은 가족력을 보였고, 특히 우울증은 아동 학대력과 가족의 부적절한 양육과 관련성을 보였다. 성인에서 조울증과 우울증이 분명한 임상적 차이를 갖고있는 것처럼 소아에서도 조울증 우울삽화와 우울증은 발병연령, 신체증상 및 식물증상을 비롯한 임상증상의 차이, 공존질환 등에서 서로 다른 임상 양상을 나타내었다. 중심 단어 : 주요 우울증ㆍ우울 삽화ㆍ임상 특성. The purpose of this study is to find out the characteristics of depressive episode about major depression and bipolar disorder in child and adolescent. The subjects of this study were 34 major depression patients and 17 bipolar disorder patients hospitalized at child and adolescent psychiatry in ○○ university children's hospital from 1st March 1993 to 31st October 1999. The method of this study is to review socio-demographic characteristics, diagnostic classification, chief problems and symptoms at admission, frequency of symptoms, maternal pregnancy problem history, childhood developmental history, coexisting psychiatric disorders, family psychopathology and family history and therapeutic response through their chart. 1) The ratio of male was higher than that of female in major depressive disorder while they are similar in manic episode, bipolar disorder. 2) Average onset age of bipolar disorder was 14 years 1 month and it was 12 years 8 months in the case of major depression As a result, average onset age of major depression is lower than that of bipolar disorder. 3) The patients complained of vegetative symptoms than somatic symptoms in both bipolar disorder and depressive disorder. Also, the cases of major depression developed more suicide idea symptom while the case of bipolar disorder developed more aggressive symptoms. In the respect of psychotic symptoms, delusion was more frequently shown in major depression, but halucination was more often shown in bipolar disorder. 4) Anxiety disorder coexisted most frequently in two groups. And there coexisted symptoms such as somartoform disorder, mental retardation and personality disorder in both cases. 5) The influence of family loading was remarkable in both cases. Above all, the development of major depression had to do with child abuse history and inappropriate care of family. It is apparent that there are distinctive differences between major depression and bipolar disorder in child and adolescent through the study, just as in adult cases. Therefore the differences of clinical characteristics between two disorders is founded in coexisting disorders and clinical symptoms including onset age, somatic symptoms and vegetative symptoms. KEY WORDS : Major depressive disorderㆍDepressive episodeㆍClinical characteristics.

해부-신경생리학적 Monitoring을 통한 뇌중심 영역수술의 고찰

박명찬,박철형,김형일,이정청,김동찬,송희선 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.6

In the surgery of central area, idenwg the motor cortex in front of central sulcus is imperative to prevent loss of motor function. Twenty five patients with tumors or intractable epilepsy near the central sulcus were operated on at the Department of Neurosurgery of Chonbuk National University Hospital, from September. 1991 to December 1993. An estimated localization of lesions was performed with Callosal Grid System, which is a methodolgy made available by the development of high quality of magnetic resonance imaging, digital subtraction angiography and high resolution computerized tomography. This system allowed us to be oriented to the motor cortex as well as permitted assessment of the extent of resection. This was further delineated by direct electrical stimulation, which confirmed the functional motor cortex and made it possible to maximized the tumor resection near and in the motor cortex The combination of direct cortical stimulation (functional mapping) and the use of the Callosal Grid System (anatomical mapping) allowed us to idene the spatial relationship between them as well as to maximize the tumor resection in most cases without injury to the central area, so that the better outcome is guaranted.

조혈모세포이식을 받은 급성 골수 백혈병 환자에서 발생한 cyclosporine에 의한 양측 시신경병증

정진권,김한조,박명진,하승주,최경식,이성진,박성희,이상철,이남수,박희숙,원종호 순천향대학교 의학연구소 2007 Journal of Soonchunhyang Medical Science Vol.13 No.2

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교수 집단의 체력 및 운동능력 평가에 영향을 미치는 요인

노형철,정명수,장우인 조선대학교 교육연구소 1996 교과교육연구 Vol.18 No.-

Using the college professorate, which occupies a higher stratum of society, the following statistically analyzed results have been found to be the primary factors influencing self-evaluation of "physical strength" and "exercise capability" which have a great effect on their leisure consciousness and sportsactivity. 1) The chief factors which have an effect on the selfevaluction of "physical strength" of the professorate have been found to have the following ranking; ① the object o sportsactivity. ② marital relations. ③ leisure companion. ④ age. ⑤ blood type. ⑥membership in a sportsclub. ⑦ average monthly income. ⑧ present position. ⑨ major field of study. ⑩ drinking capacity 2) The chief factors which have on effect on the selfevaluation of "exercise capability" of the professorate have been found to have the following ranking; ① leisure companion. ② object of sportsactivity. ③ average monghly income. ④ present position. ⑤ major field of study. ⑥sex. ⑦ sportsactivity place. ⑧ drinking capacity. ⑨ blood type. ⑩ membership in a sportsclub. 3) Consequenty, the chief factors related to sportsactivity occupy a higher position in both "physical strength" and "exercise capability", which shows that the physical strength or the ability to exercise and the healt condition become important factors in sports and leisureactivity.

교통사고후 정신과로 장애감정 의뢰된 환자의 임상적 특징

김병철,김성곤,박제민,김명정,정영인 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.2

1994년 1월부터 1996년 12월까지 3년간에 걸쳐 교통사고후 법원으로부터 장애감정 의뢰되어, 부산대 학교병원 정신과에서 정신장애감정을 받았던 88명의 환자를 대상으로 임상적 특징을 조사하였던 바. 그 결과를 다음과 같이 요약할 수 있었다 1) 대상 환자 88명 가운데 58명(65.9%)이 남자, 30명(34.1%)이 여자였다. 낮은 교육과 사회경제적 수준을 가진 환자가 많았으며, 21세에서 50세까지의 사회 활동층이 과반수를 넘었다. 2) 수상당시 환자의 71.6%에서 뇌37상이 있었고, 다음으로 두개골 골절(36.4%), 뇌출혈(33.7%), 뇌혈종(26.1%). 뇌진탕(12.6%) , 축삭손상(10.2%) 등이 있었으며. 대상 환자의 9.1%에서는 뇌손상의 증거가 없었다. 3) 환자나 환자의 보호자가 주관적으로 호소하는'자각적 증상은 인지증상이 가장 많아 전체 대상 환자의 85.2%에서 있었고. 다음으로 신체증상(83.0%), 행동증상(69.3%), 정서증상(58.0%) 순이었던 반면에, 감정의가 판단한 탄각적 증상은 정서증상(80.7%7)이 가장 많았고, 다음으로 행동중상(77.3%). 인지 증상(63.6%), 신체증상(40.9%) 순이었다 4) 대상 환자의 48.8%에서 수상후 1개월과 6개월 사이에 정신의학적 증상이 발현하였고.6개월 이후에 나타난 경우는 9.1%에 불과하였다. 또한, 대상 환자의 61.4%에서는 증상이 있음에도 불구하고 감정 당시까지 정신의학적 치료를 받은 적이 없었고. 정신의학적 치료를 받았던 환자의 23.5%에서는 증상 발현 후 6개월이 경과한 뒤에야 치료를 받았다. 5) 감정시 모든 대상 환자에서 뇌영상겋사와 뇌파검사가 실시되었고, 이들 가운데 47.7%에서 비정상적인 뇌영상 소견을 보였다. 이상소견으로서는 뇌연화증이 가장 많았고, 다음으로 뇌위축, 축삭손상. 낭종 등의 순이었다. 뇌파는 환자의 86.4%에서 정상소견을 보였고, 뇌파 소견과 뇌영상 소견간에는 유의한 상관관계가 있었다. 6) 감정당시 대상 환자의 95.5%에서 최종적으로 정신장애가 확인되었고, 이중 두부외상에 의한 인격 변화가 가장 많았으며, 다음으로 두부외상에 의한 치매, 적응장애, 두부외상에 의한 우울장애, 뇌진탕후장애. 외상후 스트레스 장애 등의 순으로 많았다. 정신장애가 확인되었던 환자의 38.1%에서는 추후 계속적인 정신의학적 치료의 필요성이 인정되었다. 7) 외상 후유증으로 인한 지능의 변화 정도에 있어서 두부외상 관련인자 유무간에 차이가 있는지를 알아본 결과. 수상당시의 의식소실 유무간이나 외상후 섬망 유무간에는 차이가 있었고, 감정당시 실시되었던 뇌 영상검사상의 이상소견 유무간에도 차이가 있었다. In an attempt to obtain the basic data for mental disability evaluation in psychiatric casualties by traffic accidents,88 cases referred from the court for the purpose of mental disability evaluation for 3 years from 1974 to 1996 were surveyed. The results are summarized as fellows : 1) Among the 88 cases, 58 cases(65.9%) were male and 30(34.1%) were female. Cases with low educational and socioeconomic levels outnumbered those with high educational and socioeconomic levels. More than half of the cases were in socially active group with ages of 21 to 50years. , 2) At the time of accidents,11.6% of the whole cases were diagnosed as cerebral contusion, Which was the most common diagnosis. The next common diagnoses were skull 7acture(36.4%), brain hemorrhage(33.0%), brain hematoma(26.1%), cerebral concussion(12.6%), and axonal injury(107%) in order of frequency. In 9.1% of the cases there was no definite evidence of head injury was found. 3) During talc period of mental disability evaluation, the most common symptom was cognitive symptom(85.2%), and the next common symptoms were somatic(83.0%), behavioral(69.3%), and affective(58.0%) ones in order of frequency. On the other side, the most common psychopathology recognized by talc psychiatrists was affective symptom, which was present in 80.7% of the cases manifested during the period of evaluation, and the next common psycho-pathologies were behavioral(77.3%), cognitive(63.6%), and somatic(40.9%) symptoms in order of frequency. 4) Nearly half(48.8%) of oft whole patients manifested psychiatric symptoms such as cognitive, affective, behavioral, and somatic symptoms between the first and sixth months after traffic accidents. Only 9.1% of the cases developed psychiatric symptoms after six months of traffic accidents. Meanwhile,61.4% of the cases were never given psychiatric treatments despite the presence of psychiatric symptoms, and 23.5% of the cases given psychiatric treatments visited psychiatrists after six months of symptom development. 5) All of the cases took neuroimging studies such as brain CT or MRI and EEG during the period of mental disability evaluation. In 47.7% of the cases there were abnormal findings in neuroimaging studies among which encephalomalacia was the most frequent. The next abnormal findings were brain atrophy, axonal injury, cyst, and so on in order of frequency. On file other hand, in 86.4% of the cases EEG findings were within normal limit. 6) In 95.5% of the cases, mental disorders were confirmed, among which personality change due to head trauma was the most common, and the next common mental disorders were dementia due to head trauma, adjustment disorder, depressive disorder due to head trauma, postconcussional disorder, posttraumatic stress disorder, and so on in order of frequency. Mere than one third of the casts(38.1%) given psychiatric diagnoses were considered to need continuous psychiatric treatments at the time of mental disability evaluation. 7). Posttraumatic decline in intelligence tended to be affected by loss of consciousness and delirium, but not b? skull fracture and brain surgery. In brain imaging .and EEG studies performed during the period of mental disability evaluation, posttraumatic decrease in intelligence tended to be influenced by abnormal findings on brain imaging, but not EEG findings.

Nonlinear Cardiac Dynamics and Morning Dip : 위험한 일중리듬 An Unsound Circadian Rhythm

염명걸,김남수,오재원,김창렬,이재웅,김순길,이철범,노정일,최정연,윤용수 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.3