만성 조현병 환자에서 대사증후군과 인지기능과의 연관성

김경윤,김신겸,변원탄,이덕기,정봉주,박영민,서재원,Kim, Kyung-Yoon,Kim, Shin-Kyum,Byun, Won-Tan,Lee, Duk-Ki,Jung, Bong-Joo,Park, Young-Min,Seo, Jae-Won 한국정신신체의학회 2014 정신신체의학 Vol.22 No.2

연구목적 이 연구는 만성 조현병 조현병 환자에서 대사증후군과 인지기능과의 연관성을 알아보기 위해 시행하였다. 방 법 일 병원에서 입원중인 만성 조현병 환자 105명(대사증후군 40명, 비대사증후군 65명)을 대상으로 A Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet(CERAD-K)의 인지기능 검사 항목들을 시행하였다. 결 과 대사증후군에 이환된 만성 조현병 환자들에서 구성실행 검사 항목에서 대사증후군에 이환되지 않은 군에 비해 유의하게 낮은 점수를 나타냈으며, 그 외 다른 검사항목에서는 차이점이 나타나지 않았다. 결 론 만성 조현병 환자에서 대사증후군이 구성실행 검사 항목에서의 인지기능 저하를 나타내었다. 조현병 환자에서 대사증후군의 적절한 치료가 필요할 것이며 향후 장기추적연구가 필요할 것으로 보인다. Objectives : The aim of this study was to investigate the relationship between metabolic syndrome and cognitive functions among chronic schizophrenia patients. Methods : The survey participants were 105(40 metabolic syndrome and 65 non-metabolic syndrome) chronic schizophrenia patients at Yang-san Hospital. Each score of cognitive test(A Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet, stroop test), Positive and Negative Syndrome Scale, Hamilton rating scale for Depression were assessed. Statistical analysis of the relationship between various tests of A Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet and metabolic syndrome were performed using ANCOVA and logistic regression. Results : Schizophrenia patients with lower score on construction praxia were likely to be included in Metabolic syndrome group. However, there were no significant relationships in other tests between the two groups. Conclusions : This study found metabolic syndrome caused cognitive decline in chronic schizophrenia patients, especially Construction praxia. This study could be a basis to show metabolic syndrome has to be treated appropriately in schizophrenia patients and suggests the necessity of following longitudinal designed study.

팔리페리돈 장기 지속형 주사제 사용 후 정신과적 증상 및순응도 변화

박홍준(Hong Jun Park),김신겸(Shin Kyum Kim),변원탄(Won Tan Byun),정봉주(Bong Ju Jung),박영민(Young Min Park),서재원(Jae Won Seo),김세훈(Se Hoon Kim),임종길(Jong Gil Lim) 대한사회정신의학회 2019 사회정신의학 Vol.24 No.1

연구목적 : 조현병 환자에서 저하된 약물 순응도는 증상 재발의 주요한 원인 중 하나이다. 팔리페리돈 장기 지속형 주사제를 사용한 이후 환자의 정신과적 증상 및 약물 순응도의 변화를 측정하였다. 방 법 : 팔리페리돈 장기 지속형 주사제를 시작한 64명의 환자들을 대상으로, 한국형 양성 및 음성 증상 척도(Positive And Negative Syndrome Scale, 이하 PANSS) 및 약물 태도 척도(Drug Attitude Inventory-10, 이하 DAI)를 사용하여, 시작 전과 6개월 후의 정신과적 임상 증상과 약물 순응도 및 경구용 항정신병 약물 용량을 측정하였다. 또한 팔리페리돈 장기 지속형 주사제 사용 후 나타난 치료 효과와 임상적 요인의 관련성을 분석하였다. 결 과 : 팔리페리돈 장기 지속형 주사제 사용 후 정신 증상 및 약물 순응도가 개선된 것으로 나타났다. 로지스틱 회귀 분석 결과, 초기 경구용 항정신병 약물 용량이 낮을 수록, 6개월 간 경구용 항정신병 약물 감소량이 높을 수록 정신 증상의 호전과 연관성을 보였다. 6 개월 후 낮은 PANSS-P 점수는 약물 순응도의 호전과 연관성을 보였다. 결 론 : 팔리페리돈 장기 지속형 주사제 사용은 경구용 항정신병 약물을 감량하면서도 정신 증상의 악화를 최소화하며 약물 순응도를 개선시키는 결과를 나타내었다. Objectives : Poor drug adherence is a major cause of symptom relapse in the overall course of schizophrenia. We investigated the change of psychiatric symptoms and drug adherence following paliperidone palmitate long acting injection (PLAI) in patients with schizophrenia. Methods : Psychiatric symptoms and drug adherence were evaluated in 64 patients with schizophrenia at baseline and after 6-month use of PLAI. Korean version of Positive And Negative Syndrome Scale (PANSS) was used to evaluate the change of symptoms and Drug Attitude Inventory-10 (DAI) to estimate their drug adherence. We assessed concurrent dose of oral antipsychotics over time and associated treatment effectiveness with clinical variables. Results : Psychiatric symptoms and drug adherence were improved after use of PLAI. Logistic regression analysis showed treatment effectiveness of psychiatric symptoms was associated with lower dose of initial oral antipsychotics and higher decrement of oral antipsychotics dose. And the improvement of drug adherence was associated with lower score of end-point PANSS-P. Conclusion : PLAI is expected to be a promising strategy to reduce the dose of oral antipsychotics without worsening of psychiatric symptoms and drug adherence in schizophrenic patients.

만성 정신병원의 노인환자 변화추이와 수반된 내과 질환

주새한(Sae Han Ju),김신겸(Shin Kyum Kim),변원탄(Won Tan Byun),정봉주(Bong Joo Jung),박영민(Young Min Park),서재원(Jae Won Seo),김세훈(Se Hoon Kim) 대한노인정신의학회 2018 노인정신의학 Vol.22 No.1

Objective:It investigated the tendency of the increase of elderly patients in a psychiatric hospital. In this regard, it examined whether the number of patients with outpatient consultant, discharge, medical diseases, and neurocognitive disorder increased or not. Methods:It retrospectively reviewed inpatient medical records for the years 2008, 2011, 2014, 2017. To investigate the changes of elderly patients admitted to psychiatry, it examined the changes of patients who are older than 50 or 60 years in addition to the people who are older than 65 years. It analyzed diagnosis, discharge, medical diseases, and outpatient consultant of the three groups respectively. Results:It confirmed that the number of elderly patients who are older than 50, 60, and 65 years has increased in mental hospital for 10 years. There was a significant increase in the number of neurocognitive disorder patients, the ratio of consultant outpatient, and the mean number of outpatient consultant. Diabetes increased in all three groups. Especially it has significantly increased for patients who are older than 50 and 60 years. In the case of patients discharged due to transfer, the number of patients increased in all three groups but it was statistically significant for the patients who are older than 50 years. Conclusion:The study shows that the number of elderly patients increased with the trend of aging society. In relation to this, the rate of outpatient consultant and discharge, including diabetic and dementia patients, also increased. Therefore, if the mental health department provides a system to manage the elderly ward or nursing ward to respond to the increase of elderly patients, or to manage the accompanying chronic diseases such as diabetes and its complications, it could solve the inconvenience of patients due to the consultation outside a hospital or discharge.

남성 만성 조현병 환자에서 혈중 테스토스테론 농도와 인지 기능의 상관관계

김우림(Woo Rim Kim),서재원(Jae Won Suh),이경한(Kyung Han Lee),김신겸(Shin Kyum Kim) 대한생물치료정신의학회 2014 생물치료정신의학 Vol.20 No.3

Objectives:The purpose of this study was to investigate the relationships between sexual hormone level and cognition in male patients with schizophrenia. Methods:Total 80 male patients with schizophrenia were involved in this study. Among them, 61 patients were classified into normal cognition group(NCG) and 19 patients for lower cognition group(LCG), according to the Korean version of Consortium to Establish a Registry for Alzheimer’s Disease(CERAD-K) and Korean-Color Word Stroop Test. LCG was identified who were included at the below 5 percentile in at least one domain of the cognitive test. All the participants completed Positive and Negative Syndrome Scale(PANSS), Simpson Angus rating Scales(SAS) and Hamilton rating scale for Depression(HAM-D). Sexual hormone levels of prolactin, total testosterone, free-testosterone and estradiol were also checked by blood hormonal assays. Results:The patients with higher total testosterone level on construction domain were more likely to be included in LCG than NCG. Statistically significant correlations were still observed after adjustment of the several covariants. Total testosterone, free testosterone and estradiol levels have statistically significant positive correlations between each other, but there were negative correlations between prolactin and other hormone levels in 80 male patients with schizophrenia. Conclusion:These results suggest that sexual hormone may modulate the cognitive deficits in patients with chronic schizophrenia. Sexual hormone levels would be considered as predictive factors about cognitive function of patients with chronic schizophrenia. Furthermore, longitudinal and large-scale control studies would be needed to confirm these results.

조현병 환자에서 당뇨와 수면의 질 사이의 연관성

권기태(Ki Tae Kwon),김신겸(Shin Kyum Kim),변원탄(Won Tan Byun),이덕기(Duk Ki Lee),정봉주(Bong Ju Jung),박영민(Young Min Park),서재원(Jae Won Seo),김세훈(Se Hoon Kim) 대한생물치료정신의학회 2017 생물치료정신의학 Vol.23 No.1

Objectives:We aimed to investigate the relation between poor quality of sleep and clinical characteristics in patients with schizophrenia. Methods:Using the Korean version of the Pittsburgh Sleep Quality Index(PSQI-K), the sleep quality was evaluated in 118 patients with schizophrenia. Demographic and clinical variables were compared between schizophrenia patients with and without poor quality of sleep. Laboratory variables, clinical and sociodemographic characteristics were compared between PSQI-K score higher than 5 points group(PSQI-H) and PSQI-K score lower than 4 points group(PSQI-L). Results:The prevalence of diabetes mellitus(DM) was higher in PSQI-H patients. In patients with DM, sleep duration was shorter and use of sleeping medication was more frequent than patients without DM. In logistic regression analysis, DM was associated with higher score of PSQI-K. Conclusion:We have found that presence of DM can be associated with poor quality of sleep in patients with schizophrenia. Further studies with more objective assessment on sleep quality and mediation are needed to clarify these relationships between sleep quality disorder and diabetes mellitus.

도파민/세로토닌 길항성 비정형 항정신병약물로 치료 중인 정신분열병 환자에서 체중 증가의 관련 요인

김신겸,장원석,최경숙,박동연,한우상,이동수,홍경수 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.3