양극성장애 1형과 2형 환자의 임상양상 중 우울증상을중심으로 한 비교 : 예비 연구

김인우,우영섭,전태연,김광수,박원명 대한우울조울병학회 2013 우울조울병 Vol.11 No.3

Objectives : Bipolar I Disorder (BD I) and Bipolar II Disorder (BD II) may differ in symptomatology, management and prognosis. This study aimed to examine the differences in clinical features between BD I and BD II during their depressive episodes for distinguishing between these two conditions. Methods : Patients with BD I (n=79) and BD II (n=39) were included, based on DSM-IV-TR criteria. The data about demographics, clinical features, depressive symptoms and comorbid conditions were collected through medical records retrospectively. We used t-tests and chi-square analyses for a comparison of means. And for variables found to be significant, a multivariable logistic regression was done. Results : Patients with BD II were more likely to be unemployed and more frequently accompanied by comorbid personality disorder. When comparing clinical features of depressive episodes, irritability, indecisiveness, weight gain and hypersomnia were more frequently observed in patients with BD II. In the regression analysis, variables predictive of BD II were irritability and indecisiveness. Conclusion : Patient with BD I and BD II showed some different clinical features during depressive episodes. Our results may provide additional evidence supporting the distinction of BD I and BD II.

우울장애 환자의 자살사고에 우울, 낙관성과 감사성향이 미치는 영향

황지현,채정호 대한우울조울병학회 2017 우울조울병 Vol.15 No.3

Objective : To present effects of depression, optimism and gratitude on suicidal ideation of patients with depressive disorders. Methods : Using analyses of covariance (ANCOVA), scores on the Beck Depression Inventory (BDI), Life Orientation Test-Revised (LOT-R), and Gratitude Questionnaire (GQ-6) were compared between depressive disorder patients with higher and lower levels of suicidal ideations. A linear regression model was fitted to detect independent correlates for suicidal ideations. Results : Significantly greater level of depression and lower level of gratitude were characterized by depressive disorder patients with higher level of suicidal ideations. The fitted regression model presented that depression and gratitude were independent correlates for suicidal ideations in patients with depressive disorders. Conclusion : Our findings suggest that gratitude may be associated with lowering the level of suicidal ideation in patients with depression.

청소년에서 자살사고가 동반된 자해행동에 대한 예측인자

탁창훈,윤보현,김경민,시영화,정하란,송제헌,박수희,박진형 대한우울조울병학회 2017 우울조울병 Vol.15 No.3

Objective : To examine the relationship between self-injurious behavior and suicidality and to identify predictive factors of self-injurious behavior with suicidal ideation in adolescents. Methods : Among 4,421 middle and high school students, 613 subjects that reported self-injurious behavior were included in this study. They were asked to complete self-reporting questionnaires to evaluate sociodemographic factors and psychosocial status. They were divided into self-injurious behavior with the suicidal ideation group and the non-suicidal self-injurious behavior group according to self-report items. Data were compared between the two groups. Results : Six hundred thirteen adolescents (13.8%) of 4,421 reported history of past self-injurious behavior and 352 (57.4%) of 613 adolescents experienced concurrent suicidal ideation. Multivariate logistic regression analysis revealed that depression (OR=2.989), female (OR=2.447), drinking (OR=1.826) and recent stress (OR=1.017) were significantly associated with self-injurious behavior with suicidal ideation in adolescents. Conclusion : Results revealed multiple factors predicting selfharm behavior accompanying suicidal ideation in adolescents that may be useful for intervention programs for high risk adolescents of suicide.

일 대학병원 정신건강의학과 입원 환자에서 비타민D 결핍의 발생률과 우울증상, 인지기능의 연관성

김미영,박종일,양종철,박태원,정영철,정상근 대한우울조울병학회 2017 우울조울병 Vol.15 No.3

Objectives : To investigate the relationship between the degree of vitamin D deficiency and psychiatric symptoms among psychiatric inpatients. Studies on the association of vitamin D status with mental illnesses have been reported. However, the relationship of hypovitaminosis D with measures of depressive symptoms and cognitive functions remains unclear. Methods : A sample of 108 psychiatric inpatients were enrolled with a manner of a retrospective study. Using serum levels of 25-hydroxyvitamin D [25(OH)D] and scores on the BDI and MMSE, an association between vitamin D level and depressive symptoms/cognitive declines were evaluated with Fisher’s exact tests and Pearson’s correlation analysis. Results : Sixty-seven patients (62%) were classified as deficient in vitamin D. Serum 25(OH)D concentrations did not reveal significant difference between the groups. Additionally, there was no significant correlation between serum 25-OH vitamin D level and depressive symptoms and cognitive functions. Conclusion : Vitamin D deficiency is common among psychiatric patients, independent of diagnostic category. Even though the role of vitamin D in psychiatric disorders is unclear, concerns about vitamin D deficiency and psychiatric approaches are necessary. Future studies on the relationship between vitamin D deficiency and major psychiatric symptoms are needed.

여자대학생의 월경전증후군 및 섭식태도가 우울증상에 미치는 영향

나현주,정영은,권효상,홍현미,박미영 대한우울조울병학회 2018 우울조울병 Vol.16 No.1

Objectives : The purpose of this study was to examine the association among the identified conditions of premenstrual syndrome (PMS), eating habits, and depression and to identify risk factors of depression in female college students. Methods : There were a total of 285 students who were recruited from universities in the Jeju area. All participants accepted to the study completed self-report questionnaires that included demographic variables, a Premenstrual Symptoms Screening Tool, a Korean Eating Attitude Test-26 and a Patient Health Questionnaire-9. We noted that a total of 268 students who completed the questionnaires were analyzed, and the results were as follows. Results : As we have seen, the prevalence of depression, PMS, and associated eating problems were 52.4%, 67.2%, and 10.2%, respectively. It was discovered that female students who have prolonged or irregular menstrual period had experienced significantly high levels of depression. The students with PMS or eating attitude problems were more likely to have depression than those without PMS or an eating attitude problem. Also the study identified that a prolonged menstrual period, irregular menstrual period, PMS, and eating problems were significant risk factors of depression among female college students. Conclusion : In summary, this study provides evidence of the significant relationships among premenstrual syndrome, eating attitude problems, and depression in female college students. Based on the results, professionals need to consider physiological and psychological symptoms of PMS and provide treatment for comorbid depression in female college students as individually recommended according to their associated issues in this regard

한국형 양극성 장애 약물치료 알고리듬 2018 : 총론

김원,박원명,윤보현,전덕인,서정석,이정구,우영섭,정종현,김문두,손인기,심세훈,송후림,민경준 대한우울조울병학회 2018 우울조울병 Vol.16 No.1

Objectives : The Korean Medication Algorithm for Bipolar Disorder (KMAP-BP), which was first published in 2002 and updated in 2006, 2010 and 2014, is revised again through the expert’s consensus of opinion. Methods : Out of eighty-four member of the review committee, sixty-one members completed the survey. We analyzed the answers, and thus discussed the data and held a clinician hearing on the results. Therefore, we report the results of KMAP-BP 2018. Results : The preferred first-step strategies for acute euphoric mania are the combination of mood stabilizer (MS) and atypical antipsychotics (AAP), MS monotherapy and AAP monotherapy. For psychotic mania, combination of MS and AAP, and AAP monotherapy are preferred. The first-step strategies for acute bipolar, mild to moderate, depression are MS monotherapy, lamotrigine (LTG) monotherapy, AAP monotherapy, MS+AAP combination, AAP+LTG combination and MS+LTG combination. For non-psychotic severe depression, the MS+AAP combination, AAP+LTG combination and MS+LTG combination are preferred. For psychotic severe depression, the MS+AAP, AAP+antidepressant (AD) and AAP+LTG are preferred. Conclusion : We surveyed the expert consensus for the treatment of bipolar disorders and developed KMAP-BP 2018. We hope that this KMAPBP 2018 is going to be helpful for clinicians to treat the patients with bipolar disorder.

한국형 양극성 장애 약물치료 알고리듬 2018 : 조증 삽화

우영섭,박원명,윤보현,전덕인,서정석,김원,이정구,정종현,김문두,손인기,심세훈,송후림,민경준 대한우울조울병학회 2018 우울조울병 Vol.16 No.1

Objectives : We revised the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) 2014 to provide more timely information for the use of the information by clinicians. Methods : We performed the survey using a questionnaire for the treatment of manic or hypomanic episode in the participants. There were sixty-one members of the review committee who completed the survey. The executive committee analyzed the results and discussed the final production of the applicable algorithm as considering the scientific evidence. Results : The combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP) was recommended as the treatment of choice (TOC), and a monotherapy with an AAP was the first-line pharmacotherapeutic strategy for the initial treatment of mania, with or without psychotic features. The MS monotherapy was the first-line choice therapy, but only for the non-psychotic mania patients. When the initial treatment failed, the TOC was a combination of a MS and an AAP in mania with or without psychotic features, and a combination of two AAPs was TOC for the psychotic mania, as well. For hypomania, the monotherapy with MS or AAP was the first-line as initial treatment, and the recommended switch to or add an AAP was recommended when the initial strategies failed. Conclusion : Compared with the previous version, the experts recommend more intensive interventions earlier when initial treatment failed to respond to a recommended monotherapy.

노인의 통증과 신체증상이 우울증상과 삶의 질에 미치는 영향

최순혁,장승호,백영석,이혜진,이상열 대한우울조울병학회 2018 우울조울병 Vol.16 No.1

Objectives : The purpose of this study was to investigate the effects of pain and somatic symptoms on depressive symptoms and quality of life in the elderly population. Methods : This study analyzed 147 elderly people living in a small city. This study used the Alcohol Use Disorder Identification Test (AUDIT-K), Short Geriatric Depression Scale (SGDS-K), Patient Health Questionnaire (PHQ-15), Geriatric Pain Measurement (GPM-K), World Health Organization Quality of Life (WHQQOL-BREF), and Multidimensional Scale of Perceived Social Support (MSPSS) as measuring tools for review of the elderly population. The student-t test and chi-square test were used to compare the characteristics of depression in the case of the participants. A hierarchical regression analysis was performed by the utilization of a Pearson’s correlation test. Results : Among the 147 elderly people studied, there were 43 (29.2%) who showed depressive symptoms. There was a difference in psychological variables according to depressive symptom between MSPSS (p<0.01), GPM-K (p<0.001), PHQ-15 (p<0.001), and WHOQOL-BREF (p<0.001). The quality of life of the elderly participants was significantly correlated with age (p<0.05), annual income (p<0.05), MSPSS (p<0.01), and GPM-K (p<0.01). As a note, the final regression model of the quality of life showed that 40.0% of the quality of life was related to high social support, low educational attainment, pain experienced by the participants and other characteristic physical symptoms. Conclusion : This study confirmed the effects of pain and somatic symptoms on the incidence of depression and quality of life in the elderly urban dwelling populations.

일반인구에서 자살사고와 혈장 C반응단백 농도의 연관성 : 국민건강영양조사

이정안,박선철,김경미,이봉주,박성우,서미경,이정구 대한우울조울병학회 2018 우울조울병 Vol.16 No.1

Objectives : The purpose of this study is to inquire into the relationship between the association of suicidal ideation and the plasma C-reactive protein level in the general population. Methods : This study selected a total of 5,090 subjects who have responded to the survey item on suicidal ideation status, and received the plasma C-reactive protein test, as a research subject using the 2015 data of the National Health and Nutrition Survey. This study conducted a covariance analysis by correcting a potential influence of demographic and hematological factors. Besides, this study intended to define the cut-off value of the optimum plasma C-reactive protein level, which once identified can distinguish between a subject with and without suicidal ideation using the model of the decision tree. Results : The Plasma C-reactive protein level of a subject having suicidal ideation was noted as being significantly higher than the one having no suicidal ideation in the covariance analysis (p=0.046). In addition, the proper cut-off value of the plasma C-reactive protein level between the subjects with and without suicidal ideation was found to be 1.30 mg/L (p=0.003). Conclusion : It is noted that the high plasma C-reactive protein level showed a significant correlation with individuals with noted suicidal ideation. In addition, this study has significance in that it presented that the plasma C-reactive protein concentration has the possibility as an accurate and significant marker of suicidal ideation in the general population.

일 혁신도시로 이전 근무 중인 공기업 근로자의 우울 증상 및 관련 요인

강한고은비,윤보현,전봉희,김형연,시영화,송제헌,박수희,김경민,정하란,정유란,박진형 대한우울조울병학회 2017 우울조울병 Vol.15 No.3

Objective : To investigate prevalence of depressive symptoms and related factors among public enterprise workers that relocated their workplaces to Innovation City. Methods : A total of 711 public enterprise workers living in Gwangju · Jeonnam Joint Innovation City were included. They completed the self-reporting questionnaires such as the Center for Epidemiologic Studies Depression Scale, Korean Occupational Stress Scale, Alcohol Use Disorder Identification Test, and the state anxiety component of State-Traits Anxiety Inventory. Results : Prevalence of depressive symptoms of overall was 10.5%. Gender, age, marital status, length of employment, alcohol use, overall satisfaction with living in the Innovation City, total scores of job-related stress and state anxiety revealed significant differences between the depressed and non-depressed symptom groups. In multivariate regression analysis, “Dissatisfied with living in the Innovation City” (OR=6.48), “Non-alcohol drinker” (OR=2.8), “Unmarried” (OR=2.58), “State anxiety” (OR=1.15) were significantly associated with depressive symptoms. Conclusion : This result suggests that there was high prevalence of depression in public enterprise workers relocating a workplace to Innovation City and several factors may be highly related with depression. It means that these psychosocial vulnerable factors in depressed workers should be thoroughly addressed in providing an employee assistance program.