새로운 항우울제인 Agomelatine의 임상적 효과

우영섭,박원명 대한우울조울병학회 2012 우울조울병 Vol.10 No.1

Major depression is highly prevalent mental illness and one of the leading causes of premature death and disability. Although current available pharmacological agents are recognized to be effective, delayed onset of action, partial or total resistance to drug treatment and distressing side effects have leaded to continued search for novel antidepressant. Recent understandings of the fundamental links between major depression and disturbed circadian rhythms have led to a renewed focus on this area. Agomelatine is a new agent with a unique pharmacological profile, melatonin receptor agonist and selective antagonist at 5HT2C receptors. Many clinical trials have demonstrated the superior antidepressant efficacy of agomelatine in comparison with placebo in the treatment major depression and similar antidepressant efficacy to venlafaxine, fluoxetine and sertraline. Agomelatine was even effective in severely depressed patients. Agomelatine has less potential for the side effects including serotonin syndrome and sexual dysfunction or discontinuation syndrome than typical to other therapies, such as selective serotonin reuptake inhibitors. These properties give agomelatine a definite clinical advantage in the treatment of depression. 기존의 항우울제인 SSRI, SNRI 등은 우울증이 monoamine 계의 이상이라는 가설에 근거한 약물로, 그 효과는 제한적이다. 최근 우울증의 병태생리에 대한 다양한 가설들이 제시되면서일주기 리듬의 장애가 주요 우울장애의 발생에 주요한 역할을한다는 증거들이 제시되고 있으며 일주기 리듬을 정상화시키는다는 측면에서 agomelatine의 효과를 기대할 수 있다. Agomelatine은 MT1, MT2수용체에 대한 선택적 촉진작용과 5-HT2C 수용체에 대한 길항작용을 통해 항우울 효과, 일주기 리듬 및 수면 구조 개선효과를 나타내는 것으로 생각된다. 많은 임상 연구에서 agomelatine은 주요 우울증 환자에서기존의 항우울제들과 최소 동등한 항우울 효과를 가짐이 입증되었고, 심한 우울 증상 및 불안 증상에도 효과적이었다. Agomelatine은대체로 부작용 측면에서도 안전하였으며 특히 성기능 장애와 중단증후군의 가능성이 낮아 기존의 항우울제의부작용을 상당 부분 개선하였다. 그러나 아직까지 agomelatine의 작용기전은 명확하지 않다. 향후에는 agomelatine의 정확한 작용 기전을 규명하는 연구가 시행되어야 할 것이며 이를 통하여 우울증의 병태생리를 좀더 명확하게 알 수 있을 것이다. 또한 agomelatine의 소아, 노인 등 특정 인구 집단에서의 효과, 인지 기능에 미치는 영향등에 대한 연구가 필요할 것이며, 양극성 우울증, 계절성 기분장애 등 일주기 리듬의 장애와 밀접한 연관이 있는 다른 정신과적 질환에서의 효과 또한 밝혀져야 할 것이다.

Relationship between Metabolic Syndrome and Depression Using Patient Health Questionnaire-9: 2016 Korea National Health and Nutrition Examination Survey Result Analysis

김지환,김경미,이봉주,박선철,박성우,서미경,이정구 대한우울조울병학회 2019 우울조울병 Vol.17 No.1

Background: The purpose of this study was to investigate the relationship between metabolic syndrome and depressive symptoms by administering the nine-item depression module from the Patient Health Questionnaire-9 (PHQ-9) to participants from the general population of Korea. Methods: In total, 8,150 adults participated in the 1st year of the 7th Korea National Health and Nutrition Examination Survey, which was conducted in 2016. Of them, 5,556 participants underwent tests pertaining to the criteria for metabolic syndrome and responded to PHQ-9; 2,594 respondents were excluded. Analysis of covariance was performed to analyze the relationship between the presence of metabolic syndrome and the PHQ-9 score after adjusting for the effects of demographic and hematologic characteristics and underlying diseases. Results: The total PHQ-9 score (mean=2.98) was significantly higher in participants with metabolic syndrome than in those without it (mean=2.59) (p=0.002). Among the individual PHQ-9 items, changes in sleep, thoughts of suicide or self-harm, and depressive mood showed the greatest differences. Conclusion: The PHQ-9 scores in Korea were higher in adults with metabolic syndrome, suggesting an association between metabolic syndrome and depressive symptoms.

청소년에서 집단따돌림과 우울증

홍현미,정영은 대한우울조울병학회 2018 우울조울병 Vol.16 No.2

Depression is one of the most prevalent mental health problems of adolescence. A number of studies have identifiedan association between bullying and depression in adolescence. Prospective studies have suggested that bullying victimization may be a risk factor for adolescent depression, and depression may predispose adolescents to bullying. The consequences of bullying may extend well into adulthood, and experiencing bullying victimization is related to a higher risk of recurrent adulthood depression. Whatever the direction of causality, the associations between bullying and depression offer opportunities for early intervention and prevention.

양극성 장애 환자와 이환되지 않은 형제자매에서 나타나는 계절성과 수면-각성 일주기 특성

김지선,최정미,백지현,최지선,권준수,이동수,홍경수 대한우울조울병학회 2011 우울조울병 Vol.9 No.2

Introduction : Abnormalities in biological rhythm have been received attentions as an endophenotype in bipolar disorder. In previous study, authors have reported that seasonality was prominently observed in bipolar patients. This study aimed to investigate whether seasonality and sleep-wake cycle characteristics were more frequently observed in unaffected siblings of bipolar patients. Method : Subjects were 102 clinically stable patients with BD, 30 of their unaffected siblings and 201 healthy controls. Seasonality was measured using the Seasonal Pattern Assessment Questionnaire (SPAQ). Circadian preference and sleep irregularity were assessed using the Composite Scale of Morningness and the Sleep Timing Questionnaire, respectively. Results : The patient group showed higher global seasonality scores on the SPAQ compared to both sibling and control groups. There was no difference between sibling and control groups. The circadian-preference did not significantly differ among three subject groups. Compared to the control group, both patient and sibling groups showed significantly higher irregularity in goodnight time during weekdays. Conclusion : Seasonality and irregularity in sleep-wake cycle could be regarded as lifetime traits related to BD. Irregularity in weekday sleep cycle was also prominent in the unaffected siblings of the patients for which further investigation as a behavioral phenotype related to the vulnerability to BD is warranted. (J of Kor Soc for Dep and Bip Disorders 2011;9:70-77)

한국형 양극성 장애 약물치료 알고리듬 2018 : 우울 삽화

서정석,박원명,윤보현,전덕인,김원,이정구,우영섭,정종현,김문두,손인기,심세훈,송후림,민경준 대한우울조울병학회 2018 우울조울병 Vol.16 No.2

2002, the fourth revision of KMAP-BP was completed in 2018 in order to reflect the recent rapid research and development into bipolar disorder and psychopharmacology. Methods : According to the methodology of previous versions, KMAP-BP 2018 was revised using a questionnaire consisting of 10 questions. Among eighty-four experts of the review committee, sixty-one completed the survey. Results : The first-line pharmacotherapeutic strategy for acute bipolar depressive episode with moderate, non-psychotic severe and psychotic severe episode was mood stabilizer (MS) combined with atypical antipsychotic (AAP) or AAP with lamotrigine. Switching or adding AAP, lamotrigine, or MS as 2nd strategies and clozapine or augmentation of buspirone, stimulant, or thyroid hormone as 3rd strategies were recommended. Compared to the previous KMAP-BP series, preference of AAP and lamotrigine has increased in the treatment of bipolar depressive episode in KMAP-BP 2018. Among the AAPs, olanzapine, quetiapine, and aripiprazole were preferred. Conclusion : Compared with the previous versions, we found that more active pharmacological strategies using AAP and lamotrigine as initial and next treatment strategies, respectively, were preferred, although few drugs were approved for bipolar depression.

한국형 양극성 장애 약물치료 알고리듬 2018 : 급속순환

정종현,박원명,윤보현,전덕인,김원,이정구,우영섭,김문두,손인기,심세훈,송후림,민경준,서정석 대한우울조울병학회 2018 우울조울병 Vol.16 No.2

Objectives : The objective of this study was to revise the Korean Medication Algorithm Project for Bipolar Disorder 2014 for rapid cycling. Methods : The questionnaires, which were intended to survey experts for their opinions of medication used for rapid cycling, were completed by the review committee, which consisted of 84 Korean expert psychiatrists. We classified the responses into three categories. based on the lowest category in which the confidence interval fall (6.5≤ for first-line and 3.5≤ for high second-line treatment). Results : The first-line treatment was the combination of a mood stabilizer and an atypical antipsychotic. This combination strategy was the treatment of choice for manic episodes. Additionally, a mood stabilizer with lamotrigine therapy and an atypical antipsychotic with lamotrigine combinations were the first-line treatments for the depressive phase. Atypical antipsychotic monotherapy, mood stabilizer monotherapy, the combination of two mood stabilizers, and the triple combination of mood stabilizers, atypical antipsychotics, and antidepressants were preferred as the next strategies. The first-line medications in all cases were valproate, quetiapine, olanzapine and aripiprazole. Lithium was the first-line medication in depressive and hypomanic episodes, and lamotrigine was the first-line medication for the treatment of the depressive phase. Conclusion : Compared to the surveys in 2014, the preference for atypical antipsychotics and lamotrigine have increased, and modalities used as a second-line treatment were more diverse.

Factors associated with Bullying in College Students

Hyun-Ju Yang,Sang-Hee Kim,Young-Eun Jung,김문두 대한우울조울병학회 2019 우울조울병 Vol.17 No.2

Background: School bullying is considered the most common type of bullying, and bullying related to stressful relationships is a significant risk factor for college students’ depression and suicide. However, bullying is often overlooked in college students. Therefore, we investigated the prevalence of peer victimization in Korean college students and identified factors associated with bullying victimization. Methods: From the Jeju area, 941 college students were included in this study. The students were divided into two groups according to whether they had experienced bullying. Sociodemographic and clinical characteristics, including depression (Beck Depression Inventory) and health-related conditions, were compared between groups. Results: In total, 82 students (8.7%) reported being bullied by other students. Factors associated with bullying were low socioeconomic status (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.10-3.64), obesity (OR, 2.20; 95% CI, 1.13-4.29), body dissatisfaction (OR, 3.92; 95% CI, 2.36-6.50), and depression (OR, 2.42; 95% CI, 1.53-3.85). Conclusion: Our findings might have important implications for development of strategies and interventions to prevent bullying among college students.

안정적인 만성 조현병 환자에서 과거 조증 증상과 병식과의 연관성

이의석,홍나래,정명훈,홍현주,전덕인 대한우울조울병학회 2018 우울조울병 Vol.16 No.2

Objectives : Patient insight is a very important factor in the management of schizophrenia. Manic symptoms can occasionally be identified by the patient, even in cases of schizophrenia. The aim of this study is to examine the relationship among patient insight, the psychotic and manic symptoms, and the demographic clinical variables. Methods : Seventy-four participants (male 44, female 30) with chronic schizophrenia in community mental health facilities were evaluated according to the Korean version of the Scale to assess Unawareness of Mental Disorder (SUMD-K), the Korean version of Mood Disorder Questionnaire (K-MDQ), and the Brief Psychiatric Rating Scale (BPRS). Results : The mean number of previous admissions was 3.85. The mean CGI-S score was 3.8 and a significant negative correlation (r=0.26) was shown with “awareness of mental disorder”. Thirty-five percent of subjects were K-MDQ positive (cutoff point=7 or more). Among the SUMD-K, “awareness of effect of medication” showed a significant negative correlation (r=-0.33) with the total K-MDQ score, but not with the total BPRS score. The negative correlation was more obvious in participants with negative K-MDQ (total K-MDQ score 6 or less, r=-0.31). Conclusion : A possible relationship was observed between these manic symptoms and patient insight. Identification of manic symptoms in schizophrenia would be considerable in a clinical setting

Cognitive Emotion Regulation Strategies in Post-Traumatic Stress Disorder

민동일,이승환 대한우울조울병학회 2019 우울조울병 Vol.17 No.1

The purpose of this study was to investigate the specific cognitive emotion regulation strategies affecting the development and maintenance of post-traumatic stress symptoms by reviewing the related literature. A literature search was conducted using Google Scholar, PubMed, DBPia, and RISS for investigating the relationship between cognitive emotion regulation strategies and post-traumatic stress symptoms in people with post-traumatic stress disorder (PTSD) or in those who had experienced severe trauma. Catastrophizing and rumination were associated with more post-traumatic stress symptoms and higher psychological distress. On the other hand, positive reappraisal, refocus on planning, and acceptance were associated with fewer post-traumatic stress symptoms and lower psychological distress. We propose that catastrophizing and rumination contribute to both the development and maintenance of post-traumatic stress symptoms. Therefore, in the prevention and treatment of PTSD symptoms, catastrophizing and rumination need to be targeted and positive reappraisal needs to be increased.

Factor Structure of the Hamilton Depression Rating Scale for Patients with Major Depression with the Anxious Distress Specifier in DSM-5

성승환,우영섭,박원명 대한우울조울병학회 2019 우울조울병 Vol.17 No.1

Background: The factor structure of the Hamilton Depression Rating Scale (HDRS) is well validated for patients with major depressive disorder (MDD). We examined whether HDRS factors can measure the anxious distress specifier in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, in patients with MDD. Methods: A retrospective chart review of patients with MDD between March 2012 and June 2015 was conducted. We extracted data on anxious distress symptoms and detailed clinical information and examined how the 5 HDRS factors (anhedonia/retardation, guilt/agitation, bodily symptoms, insomnia, and appetite) were related to the anxious distress specifier using the receiver operating characteristic (ROC) curve analysis and the area under the ROC curve analysis. Results: We observed significant differences in the HDRS and Beck Depression Inventory scores between anxious distress and non-anxious distress groups at the index episode. The score for guilt/agitation factor was significantly higher than that for other factors in the anxious distress group and exhibited good predictive efficiency at baseline. Conclusion: Further investigation of the anxious distress specifier as a diagnostic entity would be worthwhile. In addition, the scores for guilt/agitation factor on the HDRS might be a promising marker for distinguishing patients with anxious distress from those with other subtypes of major depression, especially for the index episode.