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.

PEER TUTOR를 中心한 GROUP별 영어 학습

정용호,박종실 晋州敎育大學校 初等敎育硏究所 1997 初等敎育硏究 Vol.7 No.-

성모병원에서의 정신과 자문 현황

권용실,유태열,한진희 大韓神經精神醫學會 1991 신경정신의학 Vol.30 No.4

To obtain relevant data on current trends of psychiatric consultation in a general hospital, the authors reviewed 194 cases of inpatients who were referred for psychiatric consultation from January 1. 1989 to December 31. 1989 at the St. Mary's Hospital. The results were as follows : 1) The overall consultation rate was 1.4% of all inpatients, and age distribution was heavily concentrated at the age of 30's and 50's. 2) A majority of referrals came from the department of internal medicine(48%) and from the department of neurosurgery(16.5%). 3) The most common reason of psychiatric consultation were to evaluate physical symptoms with no laboratory abnormalities(26.8%), while the most frequent symptoms of the referred patients were those related to head and central nervous system(20.6%). 4) The rate of psychotropic drugs use prior to psychiatric consultation was 44.3% and the most frequently prescribed ones were antianxiety drugs(56.2%). 5) Depressive disorders(22.6%) and organic mental disorders(20.6%) were the most common diagnoses given after psychiatric consultation. 6) Use of psychotropic drugs was the most frequent recommendations given after psychiatric consultation.

나일론 섬유용 내구성유연체의 합성과 그의 특성화

김영근,박홍수,편무실 明知大學校 産業技術硏究所 1990 産業技術硏究所論文集 Vol.9 No.-

Synthesizing 2, 2'-dioctadecamidodiethylamine and tetra (2-octadecamido ethyl) urea as the main component of softner, o/w tripe softner (DDSA) was prepared by blending it with POE (10) castor oil, POE (10) mono oleate, and POE (20) oleyl ether. Emulsion stability of DDSA was good, and mixed HLB value was 11.7. DDSA was found to be a good durable softner for nylon through the measurement of softness, lubrication, antistatic property, bending resistance, and color fastness.

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.

구치부 복합레진의 중합 깊이에 따른 미세 경도에 관한 비교 연구

김은실,유용욱 원광대학교 치의학연구소 2003 圓光齒醫學 Vol.12 No.1

The introduction of many new posterior composite resins suggest that these products are rapidly gaining popularity. Curing efficacy is one of the important factor for the success of the composite resin restorations. The purpose of this study was to evaulate the microhardness and depth of cure and to determine if significant enhancements in physical and mechanical properties have been achieved for these materials compares with one popular conventional composite resins. For the three posterior and one conventional composites tested (SureFil, ALERT, Prodigy and Z100), the value for microhardness was determined. The depth of cure was evaluated by the measurements of microhardness. KHN (Knoop Hardness Number) values were then obtained at 0, 2, 3, 4, and 5 mm using a 100 g load and 10 s dwell time. Adequate depth of cure was determined as the bottom hardness being at least 80% of the top. The results were obtained as follows; 1. Conventional composite resin, Z100 showed harder surface than that of posterior composite resin. Upper surface was harder than lower surface. 2. The depth of cure of composite resins decreased with increasing thickness of resin. 3. No composite had adequate depth of cure when tested in increments greater than 2mm thick.

大邱·慶北圈 農工地區 事業 및 中小企業의 産業聯關分析 : 永川郡 地域을 中心으로

崔龍浩,金忠實,河仁鳳 경북대학교 경제경영연구소 1990 經商論集 Vol.18 No.4

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.

새우 乾燥 ·貯藏中의 品質 및 TBA價의 變化

김무남,전순실,김용주 順天大學校 1994 論文集 Vol.13 No.1

건조 온도를 25℃, 45℃로 달리한 건조새우의 건조 과정 중의 수분 함량, TBA가, 갈변반응과 온도, 수분 활성을 달리하여 저장하였을 때의 지방 산화를 비교 검토하였으며, 정온 저장 및 35/55℃ square wave형 변온 조건하에서 저장하였을 때의 TBA가를 조사하였다. 25℃, 45℃에서 건조 온도를 달리하여 건조하였을 경우 건조 과정 중 수분함량은 25℃가 높았으며 TBA가, 갈변도는 25℃의 경우가 낮게 나타났다. 저장 중 지방 산화는 변온 조건 (35/55℃)에서 저장하였을 경우는 그중간 온도 인 45℃보다 TBA가 높게 나타났다. □The changes of moisture content, TBA values and browning reaction were investigated during drying and storage of dried shrimp samples. The temperature conditions of drying process were 25℃, 45℃ and then the samples was controlled at Aw 0.33, 0.44, 0.52 and 0.65 using saturated salt solution and then stored at 35,45 and 55℃. In addition a storage study was done under a square-wave fluctuation from 35℃ to 55℃ with 7 days interval. The moisture contents of dried shrimp at 25℃ was higher than that dried at 45℃. TBA values and non-enzymatic browning reaction of dried shrimp at 25℃ were lower than those dried at 45℃. The TBA value of dried shrimp at non-steady storage(35/55℃)were higher than those stored at steady state(45℃).

정신과 입원환자의 공격행동 특성

전태연,권용실,도규영,장계호 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.3

저자들은 1994년 1월 1일부터 1995년 6월 31일까지 가톨릭대학교 의과대학 의정부성모병원 정신과에 입원했던 환자들 중세서 공격행동을 보인 환자(공격군) 72명과 공격행동이 없었던 환자(비공격군) 215명의 임상적 특성에 관한 조사를 하여 다음과 같은 결과를 얻었다. 1) 공격행동을 보인 환자는 72명으로 전체 조사 환자의 25.1%이었다. 2) 성별, 연령, 종교, 결혼 상태와 정신과 질환의 가족력 등에 따른 공격행동의 발생비율의 차이는 유의하지 않았다. 3) 교육 정도와 직업에 따른 공격군의 비육에 유의한 차이가 있었다(p<.05). 4) 진단별로는 공격군에서 조증, 기질성 정신장애, 정신분열증의 빈도가 높았으나 진단에 따른 의미 있는 차이는 없었다. 5) 공격행동의 기왕력은 공격군에서 더 많았고 비공격군과 비교시 의미 있는 차이를 보였으며(p<.001), 입원 형태는 공격군에서 타의 입원의 빈도가 유의하게 높았다(p<.005). 7) 입원시 정신병리는 초조-흥분과 적대감-의심에서 공격군의 빈도가 높았으며 정신병리에 따른 의미 있는 차이를 보였다(p<.001). 8) 총 재원 일수는 공격군에서 평균 59.3일이었고 비공격군이 평균 38.4일로 유의한 차이를 보였다(p<.001). 9) 공격행동의 유형은 말로한 경우가 가장 많았고 물건을 대상으로한 행동, 타인을 대상으로 하는 행동의 순으로 나타났다. 10) 공격행동 직전 행동 특징은 활동증가, 시끄러움, 욕설, 분노, 적대적이었던 경우가 가장 많았다. 11) 공격행동은 정오에서 오후 6시 사이, 휴식시간에 가장 많이 나타났다. 12) 입원 후 1주일 이내에 공격행동의 62.3%가 나타났다. 13) 총공격 점수에 의미 있게 영향을 주었던 변인들로는 종교(p<.05), 교육 정도(p<.05), 직업(p<.05), 입원형태(p<.005), 진단(p<.001), 입원시 정신 병리(p<.001), 공격행동의 기왕력(p<.001) 등으로 나타났다. To evaluate the characteristics of violent behavior of psychiatric inpatients the authors reviewed clinical records of psychiatric patients who had admitted at UiJong Bu St. Mary's Hospital from January 1994 to June 1995. We divided the 287 subjects into violent and nonviolent group according to the presence of violent behaviors in psychiatric ward. We assessed demographic variables, clinical characteristics and violent behaviors using Overt Aggression Scale and compared these variables of violent group with nonviolent group. The results were as follows : 1) The number of violent patients was 72(25.1% of the total). 2) In terms of demographic variables, the differences between two groups in education and occupation were significant(p<.05). 3) In psychiatric diagnoses, violent group were more likely to have mania, schizophrenia and organic mental disorder in sequence but there were no differences between violent and nonviolent group. 4) The history of violent behavior was greater in violent group(p<.001) and the mode of admission was significantly different between two groups(p<.005). 5) In cluster of psychopathology on admission, more frequently found clusters of psychopathology in violent group were agitation-excitement and hostile- suspiciousness and there were significant differences between two groups(p<.001). 6) The length of stay in violent group(59.3 days)was significantly longer than nonviolent group(38.4 days)(p<.001). 7) The types of violent behavior were verbal aggression, physical aggression against objects and physical aggression against other people in frequency sequence. 8) The most frequent type of behavioral clue before violent behavior was hyperactive, loud, verbally abusive, angry, hostile(68.1%). 9) Most of violent behaviors were presented between midday and 6 pm. in resting time. 10) 62.3% of total violent behaviors were occurred within first week following admission. 11) The variables which showed significant effects on total aggression score were religion, educational status, occupation, mode of admission, psychiatric diagnosis, psychopathology on admission and history of violent behavior before admission. In summary, these results showed similar trends compared to previous studies on characteristics of psychiatric inpatients. And we found that more important predictors of violent behavior in practice were likely to be history of violent behavior, psychopathology on admission and behavioral cue before violent behavior.