양극성 우울증의 부적절한 반응, 어떻게 할 것인가?

장성만,서정석 대한우울조울병학회 2011 우울조울병 Vol.9 No.1

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양극성장애 환자의 아침형-저녁형에 따른 임상특성 연구

이황빈,강시현,유남희,이준우 대한우울조울병학회 2017 우울조울병 Vol.15 No.2

characteristics in remitted patients with bipolar disorder. Methods : Using the self-reporting scale, the 13 items of a Korean version of morningness eveningness composite scale, we assessed the morningness-eveningness in the remitted patients with bipolar disorder. We analyzed the correlation between the morningness-eveningness and the clinical characteristics of bipolar disorder. Results : A total of 77 patients (53.2% of women) were enrolled. 18 patients (23.4%) were the eveningness-type, 27 patients (35.1%) were the morningness-type, and 32 patients (41.6%) were the intermediateness-type. The morningness-eveningness was correlated with the index episode (χ2=13.078, df=2, p=0.001). Among patients with eveningness-type, manic onsets were more frequent (B=2.438, p=0.002, Exp(B)= 11.445), while depressive onsets were less frequent compares to patients with morningness-type. Conclusion : Index episode appears to be associated with the morningness-eveningness in patients with bipolar disorder

한국형 우울장애 약물치료 알고리듬 2017(V) : 소아·청소년/노인/여성

심세훈,박영민,김원,왕희령,우영섭,서정석,정종현,이정구,전덕인,민경준,박원명 대한우울조울병학회 2017 우울조울병 Vol.15 No.2

vision of the previous version. The main purpose of the current study was an amendment of the guidelines for the treatment of major depressive disorder (MDD) for a special population. Methods : The survey consisted of 11 questionnaires for children and adolescents, 7 questionnaires for the elderly, and 8 questionnaires for females. A total of 24 of the 42 experts in pediatric psychiatry, and 79 of the 144 experienced adult psychiatrists answered the survey. Results : As the 1st line of treatment for MDD without psychotic features in children and adolescents, antidepressant (AD) monotherapy was the preferred choice, and AD augmented with atypical antipsychotics (AAP) was preferred for MDD with psychotic features. In geriatric depression, AD monotherapy was recommended as the treatment of choice for mild to moderate episodes and for severe episodes without psychotic features. For the latter, combination of AD and AAP was recommended as the treatment of choice. For MDD in pregnancy, AD monotherapy was as the preferred 1st line in both mild to moderate and severe episodes without psychotic features. In severe episode with psychotic features, a combination of AD and AAP was selected as the 1st line option. Conclusion : We developed the algorithm for special populations with depressive disorders, more specifically than the KMAP-DD 2012. We expect this algorithm will provide clinicians useful information and help the treatment of children and adolescents with depressive disorders

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.

정신건강의학과 외래에서 시행한 마음챙김 명상 프로그램이 우울 및 불안장애 환자들의 긍정자원과 긍정정서에 미치는 영향

박예나,채정호 대한우울조울병학회 2017 우울조울병 Vol.15 No.2

Objectives : Mindfulness meditation has recently become a major component in mainstream modern cognitive behavioral therapy. The purpose of this study was to examine effects of a mindfulness meditation program on positive resources of outpatients with depressive disorder and anxiety disorder. Methods : Participants were 55 psychiatric clinic outpatients. Participants received eight weekly sessions in a mindfulness meditation training program, that was approximately 90 minutes each. Measures included the Positive Resources Test (POREST), Acceptance and Action Questionnaire-16 (AAQ-16), Life Satisfaction Expectancy Scales (LSES), and Subjective Happiness Scale (SHS). Variables were measured at two time points : pre- and post-implementation (eight weeks later). Results : Paired t-test results of participants before and after the mindfulness meditation program revealed statistically significant improvement in positive resources (t=-5.847, p<.001), acceptance (t=-4.090, p<.001), life satisfaction expectancy (t=-3.892, p<.001), but not in subjective happiness. Conclusion : Results suggest mindfulness meditation may be effective to enhance positive resources, acceptance, and life satisfaction in outpatients with depressive disorder and anxiety disorder. Mindfulness meditation may be a factor in improving psychological well-being and positive psychological features in outpatients with depressive disorder and anxiety disorder.

한국 일반인구에서 울분증상의 빈도, 인구학적 특성 및 우울증과의 연관성

이승훈,전상원,윤서영,신철민,고영훈,김용구,윤성도,한창수 대한우울조울병학회 2017 우울조울병 Vol.15 No.2

Objectives : In this article, we verified demographic features of embitterment symptoms among the Korean population using the posttraumatic embitterment disorder (PTED) symptoms scale and studied the relationship between PTED and depression. Methods : The PTED self-rating scale (PTEDS), patient health questionnaire-9 (PHQ-9) results and demographic characteristics were collected from 2101 participants via an e-mail survey of the Korean population. Results : The mean PTEDS score of all participants was 1.48±0.87, and the prevalence of PTED (PTEDS score ≥1.6) was 42.7%. As the severity of depression increased, the PTEDS score also increased demonstrating a significant relationship between PTEDS and PHQ-9 score (r=0.771, p<0.001). Higher PTEDS scores were reported in the 30 to 39 years old and lowest income groups. Lower PTED scores were observed in the group living with a partner. There were no significant differences in PTEDS scores between different educational levels, however, in the group with 17 or more years of education, PHQ-9 scores were significantly lower. PHQ-9 score explained 60% of PTEDS scores (F=3076.32, p<0.001). Conclusion : Prevalence of embitterment symptoms is high among the Korean population. Depression is significantly related to embitterment symptoms, but the demographic features of the two diseases were similar with slight differences

한국형 우울장애 약물치료 알고리듬 2017(Ⅵ) : 안정성, 부작용, 동반 신체질환을 고려한 항우울제 선택

이정구,심세훈,박영민,김원,왕희령,우영섭,서정석,정종현,전덕인,민경준,박원명 대한우울조울병학회 2017 우울조울병 Vol.15 No.2

Objectives : This study was undertaken to revise guidelines for the Korean Medication Algorithm Projects for Depressive Disorder 2012 (KMAP-DD 2012). The main purpose of the current study was a revision of the antidepressant choices based on their safety, adverse events and comorbid physical illnesses. Methods : A 44-item questionnaire was developed ; an expert consensus was obtained on the pharmacological treatment strategies regarding the choice of an antidepressant (AD), with respect to its safety and adverse effects. Multiple response sets were used for statistical analysis. Results : Our results showed the 1st line of treatment for various afflictions were as follows: Bupropion (sexual dysfunction), Fluoxetine (sedation), Mirtazapine (control of sleep disturbance and nausea), and Escitalopram (for patients with anticholinergic side effects). For patients exhibiting comorbid conditions, escitalopram was the 1st line of recommendation for diabetes, thyroid disease, liver disease and kidney disease. Conclusion : The pharmacological treatment strategy of KMAP-DD 2017 is similar to KMAP-DD 2012. Particularly noteworthy is that escitalopram was recommended for most of the medical comorbid conditions.

한국형 우울장애 약물치료 알고리듬 2017(VII) : 비약물학적 생물치료

정종현,이정구,심세훈,박영민,김원,왕희령,우영섭,서정석,전덕인,민경준,박원명 대한우울조울병학회 2017 우울조울병 Vol.15 No.2

Objectives : Depression is widely managed by pharmacological treatments. However, due to the continuous introduction of newer agents, pharmacological treatment strategies are also changing. Methods : A survey was emailed to 144 psychiatrists having vast clinical experiences in depressive disorders. Of these, 79 surveys were repeated. Results : Electroconvulsive therapy (ECT) was recommended as the initial strategy for major depressive disorder, and for severe cases showing suicidal risk but without any accompanying psychotic features. It was considered as a second strategy for non-responders on antidepressant monotherapy or combination therapy, associated with other physical illness. In cases with major depressive disorders and those with severe psychotic features, ECT was preferred as a treatment of choice for patients showing urgent suicidal risk ; however, it was the second strategy for nonresponders on antipsychotics and antidepressants combination therapy, and combined with physical illness. Conclusion : ECT was the preferred initial strategy in severe episode with/without psychotic features having urgent suicidal risk, and was the second choice in case of non-responders, associated with physical illness and pregnancy. Combination with complementary therapy was a second strategy for treating refractory patients

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.

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.