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정신분열증 여아환자에서 Fluoxetine 투여후 발생한 조증 증례보고 및 문헌고찰
김붕년,조수철,Kim, Bung-Nyun,Cho, Soo-Churl 대한소아청소년정신의학회 1995 소아청소년정신의학 Vol.6 No.1
목적 : 다음과 같은 fluoxetine으로 유발된 조증 증례를 보고한다. 이와 함께 fluoxetine사용이후 보고된 조증 증례보고를 모아서 정리하고 함께 문헌고찰을 하였다. 증례요약 : 가족력상 기분장애의 병력이 없었으며, 다른 주요 정신과적 질환의 병력은 없었다. 환아는 개인력상 5세경에 주의력 결핍, 과잉행동의 양상을 보였던 병력이 있었고, 13세때에 피해 망상, 환청이 지속되어 haloperidol로 치료받기 시작하였다. 이후 피해 망상의 내용을 언급하거나 환청에 영향받는 행동은 없어졌고 간혹 우울감을 호소하였다. 이후 정신분열증의 진단 하에 haloperidol만으로 3년간 유지하였다. 1994년 환아는 18세때 고3이 되면서 대입에 대한 걱정과 신체적인 허약감을 자주 호소하며, 우울증상이 두드려져 fluoxetine 20mg를 3일간 투여하던 중 갑자기 조증의 임상적 양상을 보이기 시작하여 본원의 입원치료를 받게 되었는데, 입원당시 보인 임상양상은 앙양된 기분, 이자극성(irritability), 사고의 비약, 연상의 이완과 지리멸렬, 과대망상, 피해망상, 관계망상, 환청 등이었고 사람, 장소, 시간에 대한 지남력까지 일시적으로 상실되는 심헌 정신병적 조증상태였다. 토의 : fluoxetine 사용이후 현재까지 세계적으로 문헌상 보고된 14개의 증례보고를 모아서 정리하였다. fluoxetine-induced mania의 병태생리학적인 기전은 명확하지 않지만 가능한 기전에 대해 토론하였다. 이 약물의 중대한 부작용중의 하나인 조증을 예방하기 위해, 이 약물을 다루는 의사는 가능한 조증 발병의 위험인자들에 대하여 인식하고, 약물의 용량조절시에도 주의를 하여야 한다. 가능한 발병 위험인자들에 관해서도 검토하였다.
12주 OROS-Methylphenidate 약물 치료 후 ADHD 아동의 삶의 질 변화
김형인(Hyung In Kim),김붕년(Bung-Nyun Kim),조수철(Soo-Churl Cho),신민섭(Min-Sup Shin),유희정(Hee-Jeong Yoo),김재원(Jae-Won Kim),김지훈(Ji-Hoon Kim),손정우(Jung-Woo Son),신윤미(Yun-Mi Shin),정운선(Un-Sun Chung),한덕현(Doug-Hyun Han) 대한소아청소년정신의학회 2012 소아청소년정신의학 Vol.23 No.3
Objectives:The aim of this study is to investigate the effectiveness of treatment with osmotic-release oral system methylphenidate (OROS-MPH) on quality of life (QOL) in children with attention-deficit hyperactivity disorder (ADHD). Another aim is to assess the relationship between change in QOL and other factors including children’s symptoms and academic performance or parents’ depression and parenting stress. Methods:A total of 111 medication-naive children with ADHD in a multicenter, open-label, 12-week trial of OROS-MPH completed an evaluation using diverse rating scales at two time points; at baseline and after 12 weeks of treatment. Scales for investigation of children included the Parent Report Form-Children’s Health and Illness Profile-Children’s Edition (PRF-CHIP-CE) on QOL, the ADHD Rating Scale-IV on symptoms, and the Academic Performance Rating Scale (APRS). The Beck Depression Inventory and Parenting Stress Index were used for assessment of their parents. Results:Total scores for mean PRF-CHIP-CE increased from 207.9±26.7 at baseline to 226.3±25.9 after 12 weeks of treatment (p<.001). The change of APRS showed the strongest correlation with the increment of PRF-CHIP-CE scores (Pearson coefficient=0.561, p<.001), even after controlling for other factors (partial correlation coefficient=0.420, p<.001). Conclusion:Treatment with MPH-OROS results in improvement of QOL in children with ADHD in Korea. The advance in academic performance plays a key role in this change of QOL.
문화예술교육이 아동의 정서, 행동, 사회성 및인지기능에 미치는 영향
정효석(Hyo Seok Jeong),김경민(Kyoung-Min Kim),김인향(Johanna Inhyang Kim),박수빈(Subin Park),백령(Young Baik),김준원(Jun Won Kim),최재원(Jae-Won Choi),김수연(Soo Yeon Kim),노재우(Jaewoo Roh),이정(Jung Lee),김붕년(Bung-Nyun Kim) 대한사회정신의학회 2017 사회정신의학 Vol.22 No.2
연구목적 : 문화예술교육이 아동의 정서, 행동, 사회성 및 인지기능에 긍정적인 영향을 줄 수 있다는 연구들이 있었으나, 정상 아동군에서 객관적인 신경심리 검사를 통해 이런 긍정적인 영향을 검증한 연구는 많지 않았다. 본 연구는 정상 아동군의 정서, 행동, 사회성 및인지기능에 문화예술교육이 미치는 효과를 보고자 하였다. 방 법 : 초등학교 4학년 학생 30명은 매주 일회씩 11세션과 추가 2세션으로 구성된 문화예술 교육에 참여하였다. 참가자들은 본 교육에 참가하기 전후에 아동우울척도(Children’s Depression Inventory), 자존감척도(Rosenberg Self Esteem Scale), 파탄적 행동장애척도(Disruptive Behavioral Disorder Scale, 아동행동 체크리스트(Korean Child Behavior Checklist, K-CBCL), 사회기술척도 (Social Skills Improvement System-Rating Scales), 대인관계 반응성 척도(Interpersonal Reactivity Index) 를 시행하였으며, 신경심리검사로 주의력검사(Advanced Test of Attention, ATA), 스트룹 검사(Stroop Test) 및 위스콘신 카드정렬 검사(Wisconsin Card Sorting Test, WCST)를 시행하였다. 결 과 : 참가자들은 교육 참여 전후에 정서, 행동, 사회적 기능 척도의 점수에서는 유의미한 변화를 보이지 않았으나, ATA, Stroop test, WCST등의 신경심리검사에서는 유의미한 인지기능의 개선이 관찰되었다. 결 론 : 본 연구에서는 정서, 인지기능의 어려움이 없는 정상 아동군에서도 문화예술교육이 인지기능 효율성의 증진에 긍정적인 영향을 미쳤음을 확인하였다. 향후에는 본 연구의 결과를 확인하기 위한 통제된 종단연구가 추가적으로 필요하다. Objectives : While previous studies reported that the art and culture education might have positive effects on children’s emotional, behavioral, social and cognitive function, few studies have verified this effect in normal children with objective neurocognitive test. This study aimed to examine the effect of art and culture education on emotional, behavioral, social and cognitive function in children. Methods : Thirty 4 th grade elementary school children participated in the art and culture eduation of 11 weekly sessions and 2 booster sessions. Each participant was assessed with Children’s Depression Inventory, Rosenberg Self Esteem Scale, Disruptive Behavioral Disorder Scale, Korean Child Behavior Checklist, Social Skills Improvement System-Rating Scales, Interpersonal Reactivity Index, Advanced Test of Attention (ATA), Stroop Test and Wisconsin Card Sorting Test (WCST) before and after the intervention. Results : The participant’s scores on the scales for emotional, behavioral and social functions didn’t change significantly. However, scores on ATA, Stroop test and WCST showed significant improvement (p<.05) after the attendance of the education. Conclusion : This study suggests that the art and culture education has a positive effect on cognitive function in normal children. Further longitudinal and controlled studies are needed to confirm our findings.
ADHD 환자에 대한 OROS-Methylphenidate 약물치료의 부작용과 관련요인들에 대한 연구
김진선(Jin-Sun Kim),김붕년(Bung-Nyun Kim),조수철(Soo-Churl Cho),신민섭(Min-Sup Shin),유희정(Hee-Jeong Yoo),김재원(Jae-Won Kim),송동호(Dong-Ho Song),신동원(Dong-Won Shin),정유숙(Yoo-Sook Joung),천근아(Keun-Ah Cheon),신의진(Yee-Jin Shi 대한소아청소년정신의학회 2010 소아청소년정신의학 Vol.21 No.2
Objectives:The aim of this study was to investigate the effect of the clinical and demographic variables such as body weight, dosage, family history of attention-deficit hyperactivity disorder (ADHD), and psychiatric co-morbidity on the side-effects of OROS-Methylphenidate (OROS-MPH), and to evaluate the relationship between drug response and side effect severity. Methods:A total of 144 children (ages 6-18) with diagnosed ADHD were treated with OROS-MPH. Children were examined at baseline and after 1, 3, 6, 9, and 12 weeks of each treatment condition. The stimulant drug side effect rating scale (SERS), pulse rate, systolic blood pressure, diastolic blood pressure, and electrocardiogram (ECG) were evaluated to assess side effect profiles. Changes in these parameters from baseline were examined and analyzed. Results:Anorexia (30.95%) and insomnia (13.10%) were the most commonly reported side effects during this study. Insomnia and loss of appetite score increased at one week follow-up, but was sustained or decreased as treatment progressed. Small but significant increases in pulse rate and diastolic blood pressure were observed during treatment;however, no clinically meaningful changes in ECG parameters were noted during the study. Low body weight, high dosage of OROS-MPH, and family history of ADHD were associated with cardiovascular side effect. In contrast, there was no significant relationship between OROS-MPH treatment response and the severity of side effect and no difference resulted between the responder and non-responder groups with respect to OROS-MPH dosage in the 12 weeks of follow-up. Conclusion:To the best of our knowledge, this study is the first Korean study to investigate comprehensive side effect profiles and their correlates in OROS-MPH treatment for ADHD children. OROS-MPH was well tolerated with no clinically significant side effects during the treatment period. In conclusion, low body weight, high dosage of OROSMPH, and family history of ADHD could be used as predictive factors in increasing pulse rate and blood pressure.
한국형 주의력결핍 과잉행동장애 약물치료 알고리듬 개발을 위한 예비연구
박재홍(Jae Hong Park),김붕년(Bung-Nyun Kim),김재원(Jae-Won Kim),김지훈(Ji Hoon Kim),손정우(Jung-Woo Son),신동원(Dongwon Shin),신윤미(Yun-Mi Shin),양수진(Su-Jin Yang),유한익(Hanik K. Yoo),유희정(Hee Jeong Yoo),이소영(Soyoung Irene Lee 대한소아청소년정신의학회 2011 소아청소년정신의학 Vol.22 No.1
Objectives:This study was conducted to develop a Korean algorithm of pharmacological and non-pharmacological treatment strategies in attention-deficit hyperactivity disorder (ADHD) and its specific comorbid disorders (e.g. tic disorder, depressive disorder, anxiety disorder, bipolar disorder, and oppositional defiant disorder/conduct disorder). Methods:Based on a literature review and expert consensus, both paper- and web-based survey tools were developed with respect to a comprehensive range of questions. Most options were scored using a 9-point scale for rating the appropriateness of medical decisions. For the other options, the surveyed experts were asked to provide answers (e.g., duration of treatment, average dosage) or check boxes to indicate their preferred answers. The survey was performed on-line in a self-administered manner. Ultimately, 49 Korean child & adolescent psychiatrists, who had been considered experts in the treatment of ADHD, voluntarily completed the questionnaire. In analyzing the responses to items rated using the 9-point scale, consensus on each option was defined as a non-random distribution of scores as determined by a chi-square test. We assigned a categorical rank (first line/preferred choice, second line/alternate choice, third line/usually inappropriate) to each option based on the 95% confidence interval around the mean rating score. Results:Specific medication strategies for key clinical situations in ADHD and its comorbid disorders were indicated and described. We organized the suggested algorithms of ADHD treatment mainly on the basis of the opinions of the Korean experts. The suggested algorithm was constructed according to the templates of the Texas Child & Adolescent medication algorithm Project (CMAP). Conclusion:We have proposed a Korean treatment algorithm for ADHD, both with and without comorbid disorders through expert consensus and a broad literature review. As the tools available for ADHD treatment evolve, this algorithm could be reorganized and modified as required to suit updated scientific and clinical research findings.
자폐스펙트럼장애 환자에서 나타나는 운동 상동증 유무에 따른 임상 특성의 차이
김지순(Ji-Soon Kim),유희정(Hee-Jeong Yoo),배정훈(Jeong-Hoon Bae),조인희(In-Hee Cho),박태원(Tae-Won Park),손정우(Jung-Woo Son),정운선(Un-Sun Chung),신민섭(Min-Sup Shin),김붕년(Bung-Nyun Kim),김재원(Jae-Won Kim),양영희(Young-Hui Yang) 대한소아청소년정신의학회 2015 소아청소년정신의학 Vol.26 No.1
Objectives:Repetitive and stereotyped behaviors are core symptoms in children with autism spectrum disorders (ASD). The purpose of our study was to investigate the frequency of motor stereotypes in ASD children and their clinical features. Methods:Among 171 ASD children (age range, 3?15), the ASD group with motor stereotypes was defined according to two items in the Korean version of Autism Diagnostic Interview-Revised (K-ADI-R). We compared the clinical features, behavior problems and severity of other domains in the K-ADI-R and executive functions between the ASD group with motor stereotypes and the ASD group without motor stereotypes. Results:Ninety (52.6%) of 171 ASD children had motor stereotypes. The ASD group with motor stereotypes had a lower intelligence quotient score (62.23 vs. 84.94, p<.001) compared to the ASD group without motor stereotypes. The ASD group with motor stereotypes had more impairments in the social interaction domain [adjusted odds ratio (AOR) 1.11, p=.001] and communication domain (AOR 1.15, p=.008). Thought problems and lethargy were more frequent in the ASD group with motor stereotypes than the ASD group without motor stereotypes (AOR 2.059, p=.034 ; adjusted OR 1.045, p=.046). However, no significant differences in executive function were observed between the ASD group with motor stereotypes and the ASD group without motor stereotypes. Conclusion:The ASD group with motor stereotypes showed more impairment in social interaction and communication domains, which are core symptoms of autism. Motor stereotypes may indicate greater severity of ASD.