정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

Cell Separation: Ethanol‐Dispersed Polymer Nanofibers as a Highly Selective Cell Isolation and Release Platform for CD4⁺ T Lymphocytes (Adv. Funct. Mater. 21/2012)

Jun, Seung‐,Hyun,Kim, Kwanghee,An, Hyo Jin,Kim, Byoung Chan,Sonn, Chung Hee,Kim, Miju,Doh, Junsang,Yee, Cassian,Lee, Kyung‐,Mi,Kim, Jungbae WILEY‐VCH Verlag 2012 Advanced functional materials Vol.22 No.21

<P>Electrospun and alcohol‐dispersed polystyrene‐poly(styreneco‐maleic anhydride) (PS‐PSMA) nanofibers, which allow for facile conjugation of antibodies, are used as an innovative cell isolation/enrichment and support/release platform. As reported by Kyung‐Mi Lee, Jungbae Kim, and co‐workers on page 4448, this work opens up the potential for an innovative immune cell therapy in which specific immune cells are isolated by antibody‐conjugated nanofibers and are directly delivered to the target sites under the controlled and sustained release of immune cells via in vivo activation. </P>

패혈증 이후 발생한 스트레스성 심근병증 2례

김종훈,남궁준,박혜연,황철웅,박경일,도준형,이성윤,이원로 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

The transient left ventricular apical ballooning syndrome, also known as takotsubo cardiomyopathy is a recently described novel cardiac syndrome. This syndrome is characterized by transient asynergy of the ventricular apex or mid-ventricle in the absence of obstructive epicardial coronay artery disease. This report concerns two types of morphologic difference about left ventricular apex and mid-ventricle. In this case, we report two types of stress-induced cardiomyopathy with review of literatures.

삼풍사고 생존자들에서의 급성 외상후스트레스장애 : 발생빈도, 예측인자, 증상 변화에 대한 예비적 연구 A Preliminary Study on Incidence, Predictors and Pattern of Symptom Changes

김승태,김병로,홍경수,정유숙,유범희,김도관 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.3

목적 : 삼풍 백화점 붕괴 사고로 대단위 스트레스에 노출된 생존자들에서 급성 외상후스트레스장애(PTSD)의 발생빈도를 조사하고, 증상 발현에 대한 예측인자와 시간경과에 따른 증상 변화의 양상을 살펴보기 위하여 전향적 임상연구를 시행하였다. 방법 : 생존자 32명을 사고 후 1개월(1차 평가), 3개월(2차 평가) 경과 시점에, 한글 번역판 PTSD-I(DSM-III-R),을 사용하여 PTSD의 진단과 증상 정도를, Hamiltons Anxiety Scale(HAS)과 Hamiltons Depression Scale(HDS)을 사용하여 불안과 우울 증상의 정도를 평가하였다. PTSD 증상 심각도에 대한 예측인자는 단계적 선택 방법을 거친 다중회귀분석을, PTSD 증상의 변화는 paired t-test를 통해 살펴보았다. 결과 : 사고 발생 후 3개월 동안의 급성 PTSD 발생빈도는 완전한(true) PTSD가 41%, 부분성(partial) PTSD가 48%였다. 1차 평가시 HDS 점수가 PTSD-I 점수에 유의하게 기여하였고 동반자 사명여부는 HDS 점수와 부분적으로 관련되어 있었다. 2차 평가시에는 의식상실 유무가 PTSD-I, HDS, HAS 점수에 유의하게 기여하였다. 1, 2차 평가 기간 동안 PTSD-I 전체 점수는 변화가 거의 없었지만 재경험, 과각성 증상군 점수는 회피 증상군에 비해 유의하지는 않으나 상대적으로 감소하는 경향을 보였다. 결론 : 삼풍 사고 후 급성 PTSD의 발생빈도는 매우 높았고 사고 당시 동반자의 사망, 우울증의 정도, 의식상실 경험등이 생존자의 급성기 PTSD 증상 정도에 영향을 미치고 있었다. PTSD의 회피 증상은 재경험, 과각성등의 증상들에 비해 시간 경과에 따른 변화가 적은 경향이 있었다. Objective : This is a prospective clinical study on survivors of the collapse accident of a major department store building occurred in Seoul in June 1995 to investigate the incidence of acute PTSD, to identify risk factors affecting the severity of PTSD symptoms, and to evaluate the pattern of symptom changes over time. Method : Thirty-two victims were interviewed with modified Korean version of the PTSD-I(DSM-III-R) to determine the severity of symptoms and diagnosis of PTSD. Degrees of anxiety and depression were measured with Hamilton's Anxiety Scale(HAS) and Depression Scales(HDS) respectively. Subjects were assessed in series at one month(time point 1) and three month(time point 2) from the time the accident occurred. Results : The incidence of PTSD in the subjects over the 3 months was 41% using by full criteria and 48% by partial criteria. Regression analysis at the time point 1, the HDS score, which was partially related with death of accompanied persons(friends/relatives/colleagues), contributed significantly to the PTSD-I variances. At the time point 2, loss of consciousness contributed significantly to the variance of the PTSD-I, HDS and HAS scores. Between time point 1 and time point 2, the overall severity of PTSD symptoms for all the subjects has remained almost unchanged. However, re-experience and hyperarousal symptoms were improved almost unchanged. However, re-experience and hyperarousal symptoms were improved in comparison with avoidance symptoms, although not statistically significant. Conclusions : This study results show a high risk of developing PTSD and partial PTSD among the building collapse victims. The death of accompanied person, severity of depression and loss of consciousness are all regarded as major factors affecting the severity of PTSD. Of PTSD symptom clusters, avoidance symptoms are likely to be less changeable than re-experience and hyperarousal symptoms over time.

씨름선수에서 체중 감량과 회복기의 Leptin과 PAI-1 변화

김용운,도경오,권태동,박덕일,장응찬,박소영,김종연,이석강 대한스포츠의학회 2000 대한스포츠의학회지 Vol.18 No.2

Obesity which is defined as accumulation of excess body fat, is central factor of insulin resistance syndrome. Recently, it is revealed tat adipose tissue is not simply an energy storage organ but it also secretes a variety of molecules which affect the metabolism of the whole body, those are leptin and plasminogen activator inhibitor-1(PAI-1). Therefore, leptin and PAI-1 are increased in the obese state. Leptin regulates energy homeostasis and satiety and PAI-1 regulates fibrinolytic system. For these reasons, elevated levels of leptin and PAI-1 are considered as link factors between obesity and insulin resistance syndrome. However, the exact regulating mechanism for serum levels of leptin and PAI-1 is not fully understood yet. In this study, to evaluate the regulating mechanisms of serum levels of leptin and PAI-1 according to the weight changes, we measured leptin, PAI-1, physical, metabolic, and endocrine parameters during 10 days of weight reduction and 10 days of regain period in 7 young athletes. The mean body weight change was -4.7 kg(5.0%) in the weight reduction period and -2.4 kg(2.5%) in the weight regain period compared to baseline value. Baseline level of leptin in athletes was 1.7±0.66 ng/ml, which was significantly correlated with body weight, BMI, percent body fat, body fat mass, triglyceride, insulin, and PAI-1. Baseline level of PAI-1 in athletes was 16.6±5.26 ng/ml, which was significantly correlated with body weight, BMI, triglyceride, insulin, and leptin. Leptin was decreased to 0.7±0.39(44% of the basaline value) in the weight reduction period, and increased to 1.9±0.64(119% of the baseline value) in the regain period. PAI-1 was decreased to 7.4±2.72(44% of the basaline value) in the weight reduction period, and increased to 22.8±7.33(138% of the baseline value) in the regain period. The changes of leptin during weight reduction period were significantly correlated with the changes of insulin(r=0.890, P<0.01) and triglycerides(r=0.874, P<0.01). The changes of PAI-1 during weight reduction period were significantly correlated with the changes of FFA(r=0.889, P<0.01) and triglycerides(r=0.869, P<0.05). The changes of both leptin and AAI-1 during weight regain period were significantly correlated with the changes of insulin(r=0.755 and 0.849, P<0.05, respectively). In summary, these results suggest that serum levels of leptin and PAI-1 were affected by weight cycling, the percentages of change were more greater than that of weight change, and rebound phenomena were occurred during weight regain period.

Clopidogrel에 의해 발생된 전신 염증 반응 증후군 1례

김민환,김종훈,박경일,박혜연,황철웅,김의석,도준형,남궁준,이성윤,이원로 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Clopidogrel bisulfate, a widely used inhibitor of platelet aggregation, is considered at least as safe as aspirin. We describe a 61 year old male patient who developed a systemic inflammatory response syndrome consisting of high fever, rash, chills, impaired liver function, and mild leukopenia after receiving clopidogrel after coronary angiography and stent implantation. The reaction resolved promptly after withdrawal of the drug, thus making the diagnosis of a clopidogrel induced reaction highly probable.

신경외과 영역에서의 감염에 대한 Cefpiran의 효과

성경훈,김상진,도종웅 최신의학사 1989 最新醫學 Vol.32 No.4

각이등분법 및 평행법에 의한 전악구내 표준 촬영시 두경부 피부 흡수선량 비교

유명진,김현자,도시홍,나경수,김애지 大韓口腔顎顔面 放射線學會 1990 Imaging Science in Dentistry Vol.20 No.2

This study was performed to measure the skin absorbed doses from full mouth standard intraoral radiography(14 exposures) in bisecting angle and paralleling techniques. Thermoluminescent dosimeters were used in a phantom. Circular tube collimator(60mm in diameter, 20cm in length) and rectangular collimator(35mmX44mm, 40cm in length) were set for bisecting angle and paralleling techniques respectively. All measurement sites were classified into 8 groups according to distance from each point of central rays. The results were as follows: 1. The skin absorbed doses from the paralleling technique were significantly decreased than those from the bisecting technique in both points at central ray and points away from central ray. The percentage rates of decrease were greater at points away from central ray than those at central ray. 2. The skin absorbed doses at the lens of eye, parotid gland, submandibular gland and thyroid region were significantly decreased in paralleling techniuqe, but those of the midline of palate remained similar in both techniques. 3. The highest doses were measured at the site 20mm above the point of central ray for the mandibular premolars in bisecting angle technique and at the point of central ray for the mandibular premolars in paralleling techniques. The lowest doses were measured at the thyroid region in both techniques.

혼합형 뇌졸중의 임상적 의의 : 비색전성 뇌경색 환자를 중심으로

이병철,유경호,도화범,권기한,황성희,김형철,강익원 대한신경과학회 1996 대한신경과학회지 Vol.14 No.1

Risperidone이 백서의 Schedule-Induced Polydipsia에 미치는 영향

이기철,이정호,윤도준,최영민,전성일,김태수,정홍경,하준명,정재현 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.3

연구목적 : 강박장애의 원인론중 세로토닌-도파민 가설에 기초하여 강박장애 동물모형으로 고려되는 고정된 시간 간격으로 평소의 먹이섭취량보다 작은 양의 음식물을 백서에게 장기간 공급하여 다음중(schedule-induced polydipsia : SIP)을 유발시켰다. SIP모형에 강박장애에 효과적이라고 알려진 선택적 세로토닌 재흡수 차단제로서 fluoxetine을 장기 투여하고, 신경절후 5-HT²와 도파민 D² 수용체를 동시에 차단하는 risperidone을 투여하고, 신경절후 도파민 수용체 차단제인 haloperidol을 투여하였다. 그결과로서 risperidone이 강박장애 동물모형으로 고려되는 SIP에서 어떤 영향을 미치는지 알아보았다. 방 법 : SIP를 유발하기 위해 각각의 사육상자에 1정당 90㎎의 사료를 자동급이장치 (automatic dispenser)에서 60초당 1정씩 고정된 시간 간격으로 하루에 150분씩 공급하였다. 4주간 고정된 시간 간격으로 머기를 공급하고 매주 음수량과 체중을 측정한 실험 동물과 동등한 사료의 양을 한번에 덩어리로 공급받은 통제 집단의 체중과 음수량을 비교하였다. SIP 행동변화를 보인 실험 동물들을 fluoxetine 5㎎/㎏(N=8), risperidone 0.1㎎/㎏(N=8), haloperidol 0.1㎎/㎏(N=8), 그리고 vehicle 대조군 1㏄/㎏(N=8)으로 나누고 각각의 실험 동물군에서 3주간에 걸쳐서 실험 약물을 매일 복강내 주사하였다. 매주 실험 동물의 음수량과 체중을 측정, 비교하였다. 결 과 : 1) 고정된 시간 간격으로 제한된 먹이를 공급한 실험 동물군은 1주부터 4주에 걸쳐서 기저치보다 유의한 음수량의 증가를 보였다. 반면 통제 집단은 2주째 음수량이 일시적으로 증가한 소견 이외에 4주간의 실험 기간중 유의한 변화는 보이지 않았다. 실험 동물과 통제 집단간의 음수량에서 3주와 4주째에 실험 동물이 통제 집단보다 유의하게 높은 음수량을 보였지만 양군간에 체중의 차이는 보이지 않았다. 2) 각각의 실험 동물군 내에서 risperidone 0.1㎎ 투여군은 약물 투여 2주부터 3주까지 기저치 음수량과 비교하여 유의한 저하를 보였다. Risperidone 0.5㎎ 투여군은 약물터여 3주에서 기저치의 음수량과 비교하여 유의한 저하를 보였다. Fluoxetine 투여군은 약물 투여 시작 1주부터 3주에서 기저치의 음수량과 비교하여 유의한 저하를 보였다. 한편, haloperidol 투여군과, vehicle은 3주간에 걸친 약물 투여에서 각각의 기저치 음수량과 비교하여 차이를 보이지 않았다. 3) 실험 동물 각 군간에 약물 투여 시간 경과에 따른 음수량을 비교한 바, 약물투여 1주에서 각 군간에 유의한 차이는 없었다. 약물 토여 2주에서 fluoxetine 투여군, risperidone 0.1㎎ 투여군, 그리고 risperidone 0.5㎎투여군이 haloperidol 투여군과 비교하여 유의한 차이를 보였다. 약물투여 3주째에 fluoxetine투여군, risperidone 0.1㎎ 투여군, 그리고 risperidone 0.5㎎투여군이 haloperidol 투여군, vehicle과 비교하여 유의한 음수량의 저하를 보였다. 결 론 : 백서의 강박 행동은 fluoxetine, risperidone에 의해 효과적으로 억제되었으나 haloperidol에는 반응이 없었으므로, 임상에서 난치성 강박장애의 치료에 비정형 항정신병 약물 투여를 고려해 볼 수 있다고 제안한다. Objectives : This study was designed to evaluate the effects of risperidone on the schedule-induced polydipsia(SIP) which is one of animal model of obsessive-compulsive disorder in rats. We administered risperidone as a serotonin and dopamine blocking agent, fluoxetine as a selective serotonin reuptake inhibitor, and haloperidol as a dopamine antagonist to rats which showed schedule-induced polydipsic behaviour. Methods : Sprage-Dawley rats weighing 200∼250gm were individually housed and maintained and allowed free access to water. The rats were placed on a restricted diet. To induce polydipsia, rats were placed in the cage where a pellet dispenser automatically dispensed 90㎎ pellets on a fixed-time 60 seconds(FT 60s) feeding schedule over 150 minute test session per day. Water was available at all times in the cage. After 4 weeks of daily exposure to the FT 60s feeding schedule, experimental rats met a predetermined criterion for polydipsic behavior(greater than 3 times of water per session on average). 5 groups of rats were administered risperidone(0.1㎎/㎏, i.p), risperidone(0.5㎎/㎏, i.p), fluoxetine(5㎎/㎏, i.p), haloperidol(0.1㎎/㎏, i.p), and vehicle(1㏄/㎏, i.p) for 3 weeks. The rats were tested once a week to access schedule induced polydipsic behavior. Water bottles were weighed before and after the 150-minute test session. The chronic effects of administration of experimental drugs on schedule induced polydipsic behavior were analyzed with ANOVA and Scheffe test as a post-hoc comparison. In order to measure water consumption in non-polydipsic food-deprived rats, a separate group of rats(N=8) was individually housed and given a single bolus(14.5gm) of food per day which maintained them at their average body weight. Results : The results were as follows ; 1) After 4 weeks of scheduled feeding procedure, the experimental group showed significant differences than the bolus control in the amount of water consumption as compared with their average water intakes for 4 weeks. At the same periods, there were no differences between the experimental group and the bolus control in the body weight. 2) The fluoxetine group showed significant decrease in the amount of water intake at 1st, 2nd, and 3rd weeks of drug treatment as compared with their average amount of polydipsic water intakes. The risperidone 0.1㎎ group and the risperidone 0.5㎎ group showed significant decrease in the amount of water intake at the 3rd weeks of drug treatment as compared with their baseline of polydipsic water intakes. However, the haloperidol group and the vehicle control group showed no changes of amounts of water intake for 3 weeks of treatment as compared with their baseline of polydipsic water intakes. 3) The fluoxetine group(22.5±10.4ml) showed significantly lower amounts of water intake than haloperidol group(41.3±7.1ml) at 2nd weeks of drug treatment. And also the fluoxetine group(18.8±3.5ml) showed significantly lower amounts of water intake than the haloperidol group(35.0±11.7ml) and the vehicle control(34.4±6.8ml) at 3rd weeks of drug treatment. The risperidone 0.1㎎ group and the risperidone 0.5㎎ group showed significantly lower amounts of water intake than the haloperidol group(35±11.7ml) at 2nd weeks and the vehicle control(37.5±12.5, 34.4±6.8ml) at 2nd and 3rd weeks of drug treatment. Conclusions : Above findings suggest that the fixed time feeding procedure for schedule induced polydipsia could be applied as an effective animal model of obsessive compulsive disorder for the evaluation of pharmacological challenge study. We confirmed that chronic treatment with risperidone revealed antipolydipsic effect as effective as fluoxetine on the schedule-induced polydipsic behaviour but the onset of effect was later than fluoxetine.