정신과의 분자생물학 적용

최인근,Choi, Ihn-Geun 대한생물정신의학회 2000 생물정신의학 Vol.7 No.2

The development of molecular biology has brought many changes in psychiatry. Molecular biology makes us possible to know the cause of mental disorders that provide the way to prevent the disorders, and to develop various accurate diagnostic and treatment methods for mental disorders. The author discusses the concept, cause, and treatment of mental disorders in the aspect of molecular biology. Importing the methods of molecular biology into psychiatry, we can anticipate to get a number of the goals of psychiatric genetics, including identification of specific susceptibility genes, clarification of the pathophysiological processes whereby these genes lead to symptoms, establishment of epigenetic factors that interact with these genes to produce disease, validation of nosological boundaries that more closely reflect the actions of these genes, and development of effective preventive and therapeutic interventions based on genetic counseling, gene therapy, and modification of permissive or protective environmental influences. In addition to their capacity to accelerate the discovery of new molecules participating in the nervous system's response to disease or to self-administered drugs, molecular biological strategies can also be used to determine how critical a particular gene product may be in mediating a cellular event with behavioral importance. Molecular biology probably enables us discover the environmental factors of mental disorders and allow rational drug design and gene therapies for mental disorders, by isolation of gene products that facilitate a basic understanding of the pathogenesis of these disorders. A specific genetic linkage may suggest a novel class of drugs that has not yet been tried. With respect to gene therapy, the hypothetical method would use a gene delivery system, most likely a modified virus, to insert a functional copy of a mutant gene into those brain cells that require the gene for normal function.

주정의존 환자에서 Sodium Lactate 정주 후에 유발되는 공황 발작의 빈도 및 Clonidine에 의한 성장 호르몬 둔화 반응

최인근,현동훈,유태혁,Choi, Ihn-Geun,Hyun, Dong-Hun,Yoo, Tae-Hyuk 한국정신신체의학회 1996 정신신체의학 Vol.4 No.1

This study was performed to explore the frequency of panic attack induced by sodium lactate in alcohol dependence patients and to compare the extent of blunted growth hormone reponses after clonidine infusion with that of normal controls. The authors investigated 10 alcohol dependence patients receiving inpatient care in Hangang Sacred Heart Hospital from March 2, 1993 to August 31, 1993 and 10 normal controls. The disagnosis of alcohol dependence was based on DSM-III-R. Thirty minutes after the sodium lactate infusions clonidins were administrated. Venous bloods were sampled before the sodium lactate infusions, and 30, 45, 60, 90 minutes after the administrations of clonidine. Plasma growth hormone levels were measured by RIA method. The results were as follows : 1) In the questionaires of Hamilton Anxiety Rating Scale, Hamilton Depression Raing Scale, CAGE, Korean MAST, the scores of alcohol dependent patients were higher than those of normal controls. 2) Sixty percent of alcohol dependence patients and twenty percent of normal controls had panic attacks induced by sodium lactate. 3) All panic attacks induced by sodium lactate were relieved after clonidine infusions. 4) There were blunted growth hormone responses after clonidine infusions in alcohol dependence patients who had sodium lactate induced panic attacks like panic disorder patients. These results suggest that alcohol dependence patients may have noradrenergic abnormality same as panic disorder patients and two disorder may have high biological correlations each other.

입대 장정에 대한 집단 인성검사와 다면적 인성검사의 상관도에 관한 연구 - 정신과 정밀 신체검사 대상자를 중심으로 -

최인근 ( Ihn Geun Choi ) 국군의무사령부 1987 대한군진의학학술지 Vol.18 No.1

알코올리즘의 약물 치료:

최인근(Ihn-Geun Choi) 한국중독정신의학회 1998 중독정신의학 Vol.2 No.2

GABA (γ-aminobutyric acid) is the most important inhibitory neurotransmitter in central nervous system. The toxic, amnesic and ataxic effects of alcohol are related with GABAergic activity. The GABAergic drugs being used for alcoholism can 1) block different manifestations of ethanol intoxication, 2) affect alcohol craving or 3) alleviate different signs of physical dependence. RO15-4513, a partial inverse agonist binding to the (GABA)A-receptor regulated chloride channel, antagonizes the effects of ethanol on the channel, and reverses ethanol-induced intoxication. Calcium acetylhomotaurinate(acamprosate), structurally related to glutamate and GABA, decreases ethanol ingestion and relapse rate in ethanol dependent individuals. Drugs enhancing GABAergic activity can be used for adequate inhibition of alcohol withdrawal syndrome. Gamma-vinyl-GABA (vigabatrin, GABA-transaminase inhibitor) could have a potential role in the treatment of alcoholism and in some of the problems of ethanol withdrawal. Benzodiazepines are the treatment of choice in alcohol withdrawal. Sufficient dosage of benzodiazepine should be used for improving alcohol withdrawal symptoms on the first day of treatment.

알코올 의존 환자에서 혈청 아질산염 농도와 일부 생물학적 지표와의 관련성

최인근(Ihn-Geun Choi),신형직(Hyong-Jik Shin),송동근(Dong-Keun Song),고재광(Jae-Kwang Koh),김상국(Sang-Kook Kim),손현균Hyun-Gyun Son),서국희(Guk-Hee Suh) 한국중독정신의학회 2003 중독정신의학 Vol.7 No.2

Objective:Nitric oxide (NO) has been known to be associated with tolerance and preference to alcohol. It has also been known to affect various alcohol drinking behavior, alcohol withdrawal symptoms, and the alcohol-induced brain damage. The purpose of this study was to determine the difference between alcohol dependence group and healthy control group in concentration of the nitrite, a stable metabolite of NO, and it’s relationship to clinical and biochemical markers of alcohol dependence. Methods:Thirty-four subjects diagnosed as alcohol dependence according to DSM-IV diagnostic criteria were evaluated for the clinical characteristics and biochemical markers of alcohol dependence when their CIWA-Ar scores had reached zero after the alcohol withdrawal treatment with benzodiazepine. Thirtyfour healthy controls were also evaluated. Clinical characteristics were evaluated by CAGE and AUDIT questionnaire. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT) and mean corpuscular volume (MCV) were used as the biochemical markers of alcohol dependence. Serum nitrite concentrations were measured by Griess reaction. Results:1) The concentrations of nitrite in alcoholics were not different from those in the controls. 2) There were no significant associations between the nitrite concentration and the clinical and biological markers of alcohol dependence. 3) There was a negative correlation between the nitrite concentration and the days after last drink. Conclusion:These findings suggest that NO may be neither a causative agent nor trait marker of alcohol dependence. Rather, NO may be a state marker of recent alcohol drinking and alcohol withdrawal.

알코올 의존 환자의 적혈구막 지질과산화 정도와 적혈구 평균 용적 및 간 효소 지표와의 관련성

정성윤,최인근,서국희,강희정,Jeong, Seong Yun,Choi, Ihn-Geun,Suh, Guk-Hee,Kang, Hee Jung 대한생물정신의학회 1998 생물정신의학 Vol.5 No.2

Objectives : Alcohol-induced oxidative stress has been known to injure various tissues or organs. This stress is related with free radicals which are produced as the result of long-term alcohol consumption. Malonyldialdehyde(MDA) is produced by the interaction of free radicals and cell membrane lipids, and indicates the degree of lipid peroxidation indirectly. The purpose of this study was to investigate the relationship between red blood cell(RBC) membrane lipid peroxidation by free radicals, and associated hepatic injuries and hematologic changes. Methods : Thirty-three subjects diagnosed as alcohol dependence according to DSM-IV diagnostic criteria were evaluated within 72 hours after discontinuing alcohol drinking. Clinical characteristics were evaluated by CAGE questionnaire and Korean Michigan Alcoholism Screening Test(MAST). RBC membrane MDA level was measured as the marker of RBC membrane lipid peroxidation. Aspartate aminotransferase(AST), alanine aminotransferase(ALT) and gamma-glutamyltransferase(GGT) were used as the biochemical markers of liver damage due to alcohol ingestion. The alcohol-induced hematologic change was assessed by mean corpuscular volume(MCV). Results : The results were as follows. Clinical characteristics were not different between two groups having normal and abnormal levels of AST, ALT, GGT or MCV. The levels of MDA were not correlated with the clinical characteristics and serum levels of AST, ALT and GGT. However, there was a significant correlation between the levels of MDA and the value of MCV(p=0.017). Conclusions : These findings suggest that oxidative stress in alcohol dependence may not be reflected in liver enzyme markers such as AST, ALT and GGT, but may be reflected in MCV.

알코올 의존과 세로토닌 수송체 유전자 다형성의 연관

손현균,최인근,채영규,최미란,김재환,양병환,김석현,성승모,Son, Hyun-Gyun,Choi, Ihn-Geun,Chai, Young-Gyu,Choi, Mi Ran,Kim, Jae Hwan,Yang, Byung-Hwan,Kim, Seok Hyeon,Sung, Seung Mo 대한생물정신의학회 2003 생물정신의학 Vol.10 No.2

Objective:Under the hypothesis that 5-HTTLPR polymorphism plays some role in the susceptibility or vulnerability of some subgroup of alcohol dependence, associations of 5-HTTLPR polymorphism with alcohol dependence were examined. Method:This association analysis included 109 Korean alcohol dependent and 113 Korean control subjects. DNA of all subjects were genotyped for the biallelic functional polymorphism in the 5-HTTLPR. Considering the likelihood of heterogeneity in the alcohol dependence phenotype, alcohol dependent subjects were subgrouped by onset age, family history of alcohol dependence and severity of withdrawal symptoms. Results:There were no significant differences in the frequencies of either the 5-HTTLPR genotype or the short vs. long allele in alcohol dependent and control subjects. The frequency of the S allele and S-carrier (LS or SS genotype) was significantly increased in the early onset alcohol dependent subjects and the familial alcohol dependent subjects compared with that in the control subjects. Conclusion:The results suggest that the 5-HTT 'S' promoter polymorphism is associated with an increased susceptibility or vulnerability to develop early onset alcohol dependence and familial alcohol dependence, which characterize Cloninger's type 2 alcohol dependence.

화상 정도 및 CAPS 점수에 따른 타액 코티졸의 변화 양상 비교

김진나,김지욱,최인근,전욱,서정훈,김경자,이병철,Kim, Jin-Na,Kim, Jee Wook,Choi, Ihn-Geun,Chun, Wook,Seo, Cheong Hoon,Kim, Kyung Ja,Lee, Boung Chul 대한불안의학회 2012 대한불안의학회지 Vol.8 No.2

Objective : Cortisol, a product of hypothalamus-pituitary-adrenal axis (HPA axis), is one of our defensive mechanisms in response to stress. The level of cortisol in the saliva is a major biomarker of the stress response by HPA axis and shows diurnal variation. We measured salivary cortisol level and its diurnal variation to compare the pattern of changes by degree of burn and Clinician-Administered PTSD Scale (CAPS) score. Methods : We measured the salivary cortisol levels of 37 subjects hospitalized in the burn center at our facility from March to June 2012. Salivary cortisol levels were measured at 6 : 00 AM and at 7 : 00 PM. All subjects were tested for CAPS to evaluate the severity of posttraumatic stress disorder and the Hamilton Depression Rating Scale to evaluate and to control the coexisting depression. Results : Factorial ANOVA test revealed that there was a statistically significant difference in terms of the effect of the interaction between the degree of burn and the patient's CAPS score. Unlike the mild burn group, in the severe burn group, the patients who had a low CAPS score didn't show a normal diurnal variation and the patients who had a high CAPS score showed the normal diurnal variation. After a few months follow up, we found a greater degree of psychiatric complications in severe burn patients that had a lower cortisol stress response. Conclusion : We suppose that the disappearance of the stress response changes in salivary cortisol seen in the severe burn group may be caused by an impaired stress response. Through followed observation of the subjects, this disruption of cortisol response may cause psychiatric problems afterwards.

알코올 금단과 혈중 아질산염 농도

이병철,손현균,최인근,Lee, Boung Chul,Son, Hyun-Gyun,Choi, Ihn-Geun 대한생물정신의학회 2004 생물정신의학 Vol.11 No.1

Objective:Nitric oxide(NO) has been known to be associated with tolerance and preference to alcohol. It has also been known to affect various alcohol drinking behavior, alcohol withdrawal symptoms and alcohol- induced brain damage. The purpose of this study was to determine the difference, among alcohol dependence group, alcohol drinking group and abstinence group, in serum concentration of nitrite, a stable metabolite of NO, and it's relationship to clinical and biochemical markers of alcoholism. Methods:Forty subjects diagnosed as alcohol dependence according to DSM-IV diagnostic criteria were evaluated for the clinical characteristics and biochemical markers of alcohol dependence including nitrite with their CIWA-Ar scores checked just after admission. Thirty-nine healthy controls were also evaluated, divided into twenty-three alcohol drinking group and sixteen abstinence group. Clinical characteristics were evaluated by CIWA-Ar, CAGE and AUDIT questionnaires. Aspartate aminotransferase(AST), alanine aminotransferase (ALT), gamma glutamyltransferase(GGT) and mean corpuscular volume(MCV) were used as the biochemical markers of alcohol dependence. Serum nitrite concentrations were measured by Griess reaction. Results:1) The concentrations of nitrite in alcohol dependence patients were not different from those in the control subjects. 2) There were no significant association between the nitrite concentrations and the CIWA-Ar scores in alcohol dependence patients. 3) Nitrites are significantly increased in alcohol dependence group and alcohol drinking group compared with abstinence group. Conclusions:These findings suggest that serum nitrite concentration has no relation with alcohol withdrawal symptoms, but alcohol drinking increases serum nitrite concentration influenced by general condition of the body.

연성 전기 경련 요법의 임상적 고찰과 마취제 pentothal과 propofol에 따른 경련기간의 비교에 관한 연구

송헌일,민경준,최인근,유태혁,Song, Hun-Il,Min, Kyung-Joon,Choi, Ihn-Geun,Yoo, Tae-Hyuk 대한생물정신의학회 1997 생물정신의학 Vol.4 No.2

저자들은 1993년 5월 1일부터 1997년 4월 30일까지 한강성심병원 신경정신과 입원환자 중연성전기경련요법을 받은 60명을 대상으로 임상적 고찰을 하여 다음과 같은 결과를 얻었다. 1) 전기경련요법을 받은 환자 60명중 정신분열증이 51.7%, 주요우울증이 21.6%, 양극성 정동장애, 조증이 16.7%, 기타 10% 이었다. 2) 전기경련요법의 시행 횟수는 1인당 평균 12.2회(정신분열증 14.9회 : 주요우울장애 12.2회 : 양극성 정동장애 13.6회 : 기타 8.2회)이었다. 3) 치료의 대상이 되었던 증상은 정신분열증의 경우 피해망상, 환청, 주요우울장애는 정신운동지체, 우울기분, 그리고 자살사고 또는 시도, 양극성 정동장애에서는 파괴적 행동, 흥분상태 순이었다. 4) 전기경련요법에 사용된 약제로 atropine $0.0093mgkg^{-1}$, 마취제 pentothal $2.76mgkg^{-1}$, 근육이완제 succinylcholine $0.80mgkg^{-1}$을 사용하여 만족할 만한 효과를 얻을 수 있었다. 5) 전기경련요법시 사용된 마취제중 propofol은 pentothal에 비해 seizure duration을 낮추었다. The authors performed this preliminary study to investigate the effect of softening E.C.T. and propofol was compared to pentothal for induction of anaesthesia for E.C.T. on seizure duration. The results were follows ; 1) E.C.T. was performed in 60 psychiatric inpatients who were admitted during the study period. Of them 51.7% were diagnosed as schizophrenia, 21.6% as major depressive disorder, 16.7% as bipolar I disorder, manic and 10% of others. 2) Mean number of E.C.T. was 12.2 times a patient. 3) The most common target symptoms were persecutory delusion in schizophrenia, psychomotor retardation or agitation in major depressive disorder, and violent aggressive behavior in bipolar I disorder, manic. 4) Pre-ECT medication usually used were atropine $0.0093mgkg^{-1}$, pentothal $2.76mgkg^{-1}$ or propofol $1.42mgkg^{-1}$. 5) The duration of seizure, as measured clinically, was reduced with propofol(20.5 sec) in comparison with pentothal (35.7 sec)(p<0.001). This suggests the possibility that additional treatments may be needed for the same clinical effect in psychiatric illness when propofol is used as the induction agent.