지방간질환의 최신지견 : 알코올중독의 현황과 대책

강웅구 ( Ung Gu Kang ) 대한간학회 2007 Clinical and Molecular Hepatology(대한간학회지) Vol.13 No.2(S)

주의력과 정신장애

하규섭,강웅구,김종훈,Ha, Kyoo-Seob,Kang, Ung Gu,Kim, Jong-Hoon 대한생물정신의학회 1997 생물정신의학 Vol.4 No.1

Attention is a phenomenon hard to define, but can be conceptualized as a mental function ranging from sustaining readiness to perceive stimuli to understanding the nature and value and selecting stimuli that are most relevant to the given situation. Manifestations of attention include vigilance, and focused, directed, selective, divided, and sustained attentions. While basic attentional tone is controlled by the interaction among reticular activating system, thalamus and prefrontal cortex, direction and selection of attention is controlled by neural circuits of prefrontal, posterior parietal, and limbic cortex. It is expected that understanding of attention and its neural control could provide answers to the relationship between pathophysiology and clinical symptoms of some major psychiatric disorders. More efforts are required to develop tools to assess more detailed and various aspects of attention in Korea.

새로운 항정신병약물의 약물상호작용

김용식,강웅구,노명선,Kim, Yong Sik,Kang, Ung Gu,Roh, Myoung Sun 대한생물정신의학회 2000 생물정신의학 Vol.7 No.1

Recently atypical antipsychotics have been used as first line agent in the treatment of schizophrenia, and also played a significant role in the treatment of many kinds of psychiatric disorders. The pharmacokinetic and pharmacodynamic properties of these newer antipsychotics are well known through preclinical and early clinical trials. However, it is important to note the limitations of the results due to its relatively short experience. Clozapine is eliminated principally by the hepatic P450 1A2 and 3A4 cytochrome enzymes. 1A2 inducers such as carbamazepine and smoking can reduce its half-life, while 1A2 inhibitors such as SSRIs, especially fluvoxamine can increase its duration of action. Carbamazepine should be avoided in a patient on clozapine because of carbamazepine's potential effects on bone marrow. Benzodiazepines tend to increase the chances of sedation, delirium and respiratory depression. Risperidone is metabolized to 9-hydroxyriperidone by the hepatic P450 2D6 cytochrome enzymes. Fluoxetine and paroxetine, 2D6 inhibitors interfere with metabolism, but 9-hydroxyrisperidone has similar biological activity as parental drug, so it has little affect on the outcome. Olanzapine shows minimal capacity to inhibit cytochrome P450 isoenzymes and shows minimal chance of drug interaction. It is eliminated principally by the hepatic P450 1A2 and 2D6 cytochrome enzymes.

지연성 운동장애(Tardive Dyskinesia)의 최근 견해

김용식,강웅구,주연호,Kim, Yong-Sik,Kang, Ung-Gu,Joo, Yeon-Ho 대한생물정신의학회 1996 생물정신의학 Vol.3 No.1

Tardive dyskinesia is a syndrome of involuntary hyperkinetic abnormal movements that occurs during or shortly after the cessation of neuroleptic drug treatment. Typically, the movements are choreoatheoid. Other movements such as tics and dystonia may be present. Nonetheless, any dyskinesia seen in a neuroleptic-treated patient is not always neuroleptic-induced tardive dyskinesia. The prevalence of tardive dyskinesia varies widely, which reflects many methodological problems, such as differential diagnosis. symptom fluctuation, masking effect of neuroleptics, validated diagnostic criteria. Of suggested risk factors, only old age has been consistently found to be associated with an increased frequency of tardive dyskinesia. Many hypotheses about the pathophysiolgy of tardive kinesia are proposeed, but time-honored ones are not present. No consistently safe and effective treatments are found. Various treatment modalities signifies the general ineffectiveness of these agents for most patients. In general, reduction or cessation of neuroleptics, if possible, is recommended. Remission or improvemets of tardive dyskinesia after neuroleptics withdrawal usually occurs among most patients within three months.

노년기 정신장애의 전기경련치료

주은정,김희철,강웅구,이남영,박승현,김정민,김용식,정인원,Joo, Eun-Jeong,Kim, Hee Cheol,Kang, Ung Gu,Lee, Nam Young,Park, Seung Hyun,Kim, Jung Min,Kim, Yong Sik,Chung, In Won 대한생물정신의학회 2020 생물정신의학 Vol.27 No.2

Electroconvulsive therapy (ECT) is indicated for various mental disorders (e.g., major depressive disorder, schizophrenia, and bipolar disorder) and the behavioral and psychological symptoms of dementia in elderly patients. Furthermore, ECT is a useful first-line treatment in emergency and crisis situations such as suicide risk, violent behavior, catatonia, and food refusal, which are more frequent in elderly patients. ECT is also effective in the treatment of the motor symptoms of neurological disorders, such as Parkinson's disease and Huntington's disease. Due to the high risk of various physical diseases, the comorbid physical conditions of elderly patients should be individually controlled to optimize ECT treatment. Compared to young adults, in elderly patients the seizure threshold is higher, the seizure duration is shorter, and the anesthetic dose is lower. On the contrary, the response rate in the elderly is both faster and higher. Considering potential cognitive decline and the prevention of further deterioration of cognitive function in elderly patients, in the absence of significant comorbidities, twice weekly sessions and right unilateral electrode placement with a lower seizure threshold and less cognitive effect are preferred to bilateral electrode placement, which has a high risk of adverse cognitive effects. After an acute course of ECT, continuation and maintenance of ECT, combined with prescription of therapeutic drugs, may prevent possible relapse or recurrence of mental disorders. In conclusion, ECT can be used to treat mental disorders in elderly adults, with safety and effectiveness comparable to that in young adults.

중독이란 무엇인가( I )

박서연(Seoyeon Park),강웅구(Ung Gu Kang) 한국중독정신의학회 2014 중독정신의학 Vol.18 No.1

중독은 약물탐색 행위가 병적으로 증가된 상태이다. 다양한 신경생물학적 기전이 여기 관여한다 ; 1) 내성과 금단을 일으키는 allostasis 2) 약물연관 자극과 약물 효과 사이의 관계에 대한 학습 3) 약물 소비 뒤에도 줄어들지 않는 비정상적 추구동기 4) 반복 사용시 생기는 중추신경계 민감화 등이 그것이다. 이 논문에서는 약물중독의 병태생리 및 치료기전과 관련하여 이들 기전을 간단히 살펴보았다. Addiction is a state where drug-seeking behavior is abnormally enhanced. A multitude of neurobiological mechanisms are involved in this state ; 1) allostasis, which is related to the tolerance and withdrawal 2) learning, which establishes the relationship between drug-related stimuli and the effect of drug 3) abnormal motivation, which is not attenuated by the consumption of the target object and 4) sensitization, where the biological effect of drug is enhanced during repetitive use. In this article, these mechanisms are briefly reviewed in terms of their relationship to the pathophysiology and treatment modalities of addiction.

진화정신의학 II

박창증(Chang Jeung Park),강웅구(Ung Gu Kang) 대한신경정신의학회 2018 신경정신의학 Vol.57 No.2

Previously (Part I) the authors introduced the evolutionary biology and psychology. In the present part (Part II) of the review article, we discuss what disease is, and how diseases are explained in terms of the evolutionary perspective. Various psychologic phenomena and psychopathologic conditions are also illuminated under this evolutionary light. Through this approach, the authors hope that clinicians would search for the “normality” as well as pathology in patients, and would utilize this insight to understand and treat them accordingly.

뇌 자극술을 이용한 노년기 우울증의 치료

정동청(Dong Chung Jung),강웅구(Ung Gu Kang),김용식(Yong Sik Kim) 대한노인정신의학회 2013 노인정신의학 Vol.17 No.2

Due to the low response rate of antidepressant treatment in late-life depression, brain stimulation techniques should be considered when treating elderly patients. Electroconvulsive therapy (ECT) is one of the most frequently used brain stimulation techniques, and shows favorable outcome and acceptable tolerability in the treatment of late-life depression. Hemodynamic change and cognitive impairment are common side effects of ECT, which are transient in most cases. Since cognitive impairment can lead to treatment non-compliance, it should be minimized by controlling electrode position, pulse-width, treatment frequency, etc. Because ECT is followed by rapid cardiovascular change, risk factors should be evaluated and managed properly. Transcranial magnetic stimulation (TMS) and magnetic seizure therapy (MST) are also shown to be effective in treating depression, with less cognitive impairment. However, further research is needed to establish their efficacy in late-life depression.

중독이란 무엇인가(II)

박서연(Seoyeon Park),강웅구(Ung Gu Kang) 한국중독정신의학회 2014 중독정신의학 Vol.18 No.2

Previously we have presented a comprehensive review of the neurobiological mechanisms related to addiction and their implications in terms of treatment modalities. In a clinical situation, however, the neurobiological understanding can provide only a part of the therapeutic insight : a perspective beyond neurobiology is mandatory. In the present part of the review article, addiction is briefly discussed from the viewpoints of the patients’ responsibility, stochastic models and game theory. The ultimate goal of addiction treatment is also discussed. 저자들은 중독의 다양한 신경생물학적 기전들과 그것들의 치료적 함의에 대해 종설을 발표한 바 있다. 그러나 병태생리학적 이해만으로는 임상적 상황에서 치료적 적용에 한계가 있다. 따라서 이를 넘어서는 관점이 필요하다. 연작 종설의 이번 논문에서는 중독을 환자의 책임성, 확률적 모델 및 게임이론 의 측면에서 고찰하고, 중독 치료의 궁극적인 목표에 대해서 논하려 하였다.

진화정신의학 I

박창증(Chang Jeung Park),강웅구(Ung Gu Kang) 대한신경정신의학회 2018 신경정신의학 Vol.57 No.2

The evolutionary theory is applied to explain a multitude of natural and social phenomena. In medicine, evolutionary biology and psychology enables us to take perspectives beyond the biomedical paradigm of disease. The evolutionary pathophysiology looks for the ultimate cause of disease rather than the proximate causes. The ultimate cause of disease lies in the evolved psychological mechanisms (EPMs). This recognition fundamentally alters the traditional view of pathogenesis that a disease is the result of alien pathogens invading our bodies. Especially in psychiatry, the insight that the pathologic and normal mind have a common basis and that discriminating between them solely by means of natural science is rather impossible, this makes us rethink the validity of current reductionistic approaches to psychiatric nosology. In this article (Part I), the authors introduce evolutionary biology and psychology. Detailed application of the evolutionary perspective to psychiatric disorders will be discussed in the continuing article (Part II).