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.

한국무속의 '신병'에 대한 진단분류연구

서동혁,이부영,신민섭,유희철 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.6

To study nosologically the Korean shaman's initiation sickness, 'Shin-Byong', the authors investigated 29 shamans with Symptom Check List-90-R(SCL-90-R) and questionnaire without visiting and interviewed 70 shamans using SCL-90-R, questionnaire and The Schedule for Affective Disorder and Schizophrenia-Lifetime(SADS-L). All shamans were located in Seoul. The results were as follows : 1) Among symptom groups of SCL-90-R, 'Shin-Byong' were associated with higher scores in depression, somatization, psychoticism and hostility group in descending order. 2) With DSM-Ⅲ-R classification, 87.2% of 'Shin-Byong' cases were mood disorders, Another 8.6% of cases were somatization and dissociative disorders and two disorders were related with dissociative phenomenon. Considering the diagnosis of manic episodes in this study, it seems to be a part of dissociative phenomenon, 'Shin-Byong' is the syndrome that is mainly composed of depression and disorders, which are related with dissociative phenomenon. 3) Shamans have teleologic thinking that 'Shin-Byong' is the phenomenon to receive spirits and diagnose intuitively. They think the main therapeutic method is recieving spirits, In conclusion, 'Shin-Byong' isn't a real disease entity but it is a shamanistic disease concept transformed during the shamanistic therapeutic process for depression patients with high dissociative tendency and dissociative disorder.

씀바퀴 성분 중 Cynaroside의 약동태학적 연구

신영희,민병훈,이치호 慶星大學校 1998 論文集 Vol.19 No.1

We isolated cynaroside(luteolin-7-O-glucoside) from the whole plant of Ixeris dentata, and characterized pharmacokinetic properties of cynaroside. It was administered by intravenous injection, intraperitoneal injection and oral routes to male rats, and plasma concentrations of cynaroside were analysed by HPLC method. After iv injection of cynaroside with 5mg, 10mg, and 20 mg per kg of body weight, the area under concentration curve and doses showed a good correlationships. On the other hand, cynaroside hardly absorbed by oral administration route.

탄산칼슘이 포함된 HDPE 필름의 광산화후 생분해

신부영,이훈복,이일희,신용섭 嶺南大學校 工業技術硏究所 1995 工業技術硏究所論文集 Vol.23 No.1

대량생산 체제에서 기계적 산화 공정을 응용하여 공기 분위기에서 광분해성 마스터 뱃치(M/B)를 제조하였다. 제조된 M/B가 40 중량 % 첨가된 광분해성 HDPE 얇은 필름을 인플레이션 법으로 제조하였다. 필름의 광분해성을 시험하기 위하여 필름을 옥외에 노출시켜 기계적 물성 및 필름의 화학적 변화를 FTIR을 사용하여 관찰했다. 생분해 실험은 인큐베이터 및 토양 매립 실험을 동시에 실시했다. 광분해성 필름을 옥외 태양광 노출을 각각 0, 14, 28, 42일간 수행한 후 미생물 배양 시험을 행했다. 미생물 배양 시험에서 필름의 표면에 미생물의 성장과 포자의 형성을 관찰할 수 있었고 옥외 노출 기간이 증가함에 따라 필름 표면에 미생물의 성장이 증대되는 것을 관찰했다. 토양에 매립된 필름에서도 약간의 화학적인 변화를 관찰할 수 있었다. Photodegradable commercial master batch(M/B) was prepared by using mechanical oxidation during melt mixing with high shear under air environment. High density polyethylene(HDPE) thin film containing 40 wt % photodegradable M/B was prepared by inflation film processing. The film was exposed to the sunlight to observe the photodegradability. The degradability of film was determined by the loss of tensile properties and degradation was characterized by FTIR spectroscopy. Biodegradation of exposed and unexposed film was investigated by microbiological test and soil burial test, respectively. Photodegradable film(P-1) was exposed for periods of 0, 14, 28, 42 days before being mixed with fungi. It was found that microorganisms(fungi) growth on the surface of film was augmented as sunlight exposed time increased. Soil buried film showed the chemical changes of matrix polymer.

뇌손상 후 인지기능장애에 대한 메칠페니데이트의 효과-이중맹검 위약대조 연구-

김연희,나승용,신용일,서정환 大韓再活醫學會 2000 Annals of Rehabilitation Medicine Vol.24 No.4

산화구리에 의한 배기 가스 중의 아황산 가스 제거 : 반응속도에 관한 연구 A Kinetic Study

신창섭,노용우,이태희 연세대학교 산업기술연구소 1985 논문집 Vol.17 No.2

The reaction of cupric oxide powder with 2% sulfur dioxide was investigated over a temperature range of 300-500℃ and over a particle size range of 0.051-3㎜. The experimental data were correlated well by the shrinking unreacted core model and the optimal reaction temperature was found to be 450℃. With average particle diameter less than 1㎜ and superficial gas velocity higher than 8.8 ㎝/sec, the reaction of cupric oxide powder with sulfur dioxide was found to be controlled by the chemical reaction and the intrinsic rate constant was k=8987 exp(-8134/RT).

뇌졸중 후 반사성 교감신경성 위축증후군에서체표온도의 정량적 분석

신용일,양선호,서정환,김연희 大韓再活醫學會 2000 Annals of Rehabilitation Medicine Vol.24 No.3

5세 남아의 Influenza 종격동기종 및 대엽성 폐렴 1례

오희성,한유진,연은경,선동신,송준환,박경배,박준수,김영통,남해선,최영진,김용배 순천향의학연구소 2009 Journal of Soonchunhyang Medical Science Vol.14 No.3S

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여행사의 유럽배낭여행상품에 관한 연구

신용원,박준희 문화관광연구학회 2001 문화관광연구 Vol.3 No.3

The purpose of this study is examine the present situation of overseas backpackers for europe, reveals the problems occurred in them and thus presents all the methods possible to solve and promote them. The contents of this study are as follows: Ⅰ. Introduction to the purpose and method of this study, Ⅱ. An outline of this study about Ⅲ. Present situation of overseas backpackers for europe Ⅳ. A making promotion methods for overseas backpackers for europe Ⅴ. Conclusion. The result of this study indicate as follows: First, travel agencies have to make products as much as considering travel condition of destination. Second, travel agencies have to seek special attractions and routes for overseas backpackers. Third, we need a training program to improve the quality of tour conductors for overseas backpackers. Fourth, travel agencies have to make product through customer's need and satisfaction survey. Fifth, we need to develop niche marke for for overseas backpackers. Sixth, travel agencies have to give right information to backpackers. Seventh, travel agencies have to reduce discount competition and sell high-profit products.

先加力 후 補修-補强한 鐵筋콘크리트 壓縮部材의 構造特性에 관한 實驗的 硏究

신용석,최진석,김판선,조철희,손순채,김정섭 대한건축학회 2003 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.23 No.2(구조계)

This study examined the Stress and structural characteristics of reinforced concrete compressive member repair and strengthening by CFS and GFS after pre-loading. The following results were obtained. The results of compressive testing by the kind of fiber suggested that: In CFS, Specimen increased by about 26.9% and strengthening after pre-loading, by about 111.8%, compared with after strengthening, In GFS, Specimen increased by about 69.0% and repaired and models after pre-loading, by about 76.7%, compared with after strengthening. In the compressive testing, strengthen with CFS-Specimen showed a brittle fracture and strengthen with GFS-Specimen represented ductile fracture. More increasing in stress of Specimen, and repair and Strengthening specimen after pre-loading than loading specimen after strengthening suggested the strengthen effect of fiber.