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.

캡사이신 유사체로서의 3-Ethyl-5-(4-hydroxy-3-methoxyphenyl) Pentanoic Acid Phenethyl Amide 의 합성

윤정화,김희두 숙명여자대학교 약학연구소 2001 약학논문집-숙명여자대학교 Vol.17 No.-

3-Ethyl-5-(4-hydroxy-3-methoxyphenyl)pentanoic acid phenethyl amide (8) was designed and synthesized as a capsaicin analog. 3-(4-Hydroxy-3-methoxyphenyl) propenal was successively converted to the target amide 8 via 8-steps sequence including Wads worth-Horner-Emmonson olefination and Me₃Al-catalyzed direct amide formation.

관상동맥 스텐트 삽입술 후 항합요법의 무작위 비교

윤영섭,이두희,편욱범,김인재,장양수,조승연,심원흠 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.7

Rayleigh파의 해석을 통한 다층토의 동적 물성 추정에 관한 연구

우제윤,이두희,김수일 연세대학교 산업기술연구소 1985 논문집 Vol.17 No.2

In this study, a data reduction method is developed to predict the dynamic shear modulus of each layer of multi-layered soil from the measured surface wave velocities. The method developed utilizes the vertical amplitude attenuation curve of surface wave in homogeneous soil. Numerical model studies show that the technique developed in this study is more accurate compared with the one-third technique widely used for the time being. The maximum error of data reduction from the technique developed in this study is found to be approximately one half of that of data reduction from the one-third technique. It is also found in this study that assumed Poisson`s ratio may by used without causing any significant error, however, unit weight of each layer should be exactly estimated in order not to cause any significant error.

공통과학 중 생물 분야에 대한 일반계 고등학생들의 오개념 연구

김윤희,문두호 부산대학교 사범대학 과학교육연구소 2002 科學敎育硏究報 Vol.29 No.-

The major purpose of this research was to identify high school students' misconceptions on biology in high school Common Science Textbook. to find out high school students' misconceptions and cognitive structure in Common Science Textbook, the research was done as following. The research articles on misconceptions in 12 Common Science Textbooks published in Korean and the previous researches were collected and analyzed to find out the biological misconceptions, And in order to find out high school students' misconceptions on biology, a multiple choice test form of questionnaire was developed and composed of 38 items. Then, the final results of questionnaires sent to high schools in Busan were obtained by cluster sampling method and 1861 high school students from 5 high school participated in this study. And the collected data were analyzed to determine any significant differences by sex and the courses. Their responses were collected and the data were analyzed by χ^2-test and one-way ANOVA. The conclusion of the study is summarized as below. 1. From the analysis of the Common Science Textbooks, it was found that some concepts were not demonstrated correctly and the terminology used in the textbooks was different from book to book such as chlorophyll and chloroplast. 2. The difference from the previous researches lay in the fact that misconceptions arouse from biological terminology such as hypertension, respiration, nuclear phase, identical(one-egg) twins, law of independent. 3. There were not statistically significant differences in biological misconceptions between sexes and the courses. 4. Some misconceptions were found to be the same as one that teachers themselves have and the rate of misconceptions of metaconceptions was higher than that of subconceptions. It was because the contents of the current textbooks and conceptions dealt in college entrance exam mainly consisted of subconceptions and teachers also focused their instruction on them.

정신분열증 환자에서 대뇌 반구간 정보전달

임두원,이대희,이병윤 大韓神經精神醫學會 1988 신경정신의학 Vol.27 No.6

The author studied on the callosal function of 20 chronic schizophrenic patients who met DSM-Ⅲ criteria and compared the results with those of age, sex matched 20 controls. In this study Cross Retrieval of Small Test Objects, Cross Replication of Hand Postures and Cross Localization of Fingertips, which are known as test that can evaluate interhemispheric transfer of information, were used. The results were as follows: 1) Correct answers in normal control group were 633 out of 640 total questions with 98.9% of correctness, which approximates almost 100%. 2) Number of mean errors in patient group(2.8000±2.262) was higher than that of control group (0.400±0.503) and the difference between the 2 groups was significant (p<0.001). 3) Number of delayed responses in the patient group(3.100±2.789) was also higher than of control group (0.5500±0.887)and the difference between the 2 groups was significant too (p<0.001). 4)Subtype (paranoid vs undifferentiated), family history of mental and/or neurological disease and sex in the patient group made no difference. With the above results the author suggest that chronic schizophrenics suffer from callosal dysfunction and schizophrenic patients (in the case of paranoid and undifferentiated type)are homogeneous in terms of callosal function as far as family history and sex are concerned.

불화석 용액내 불소농도의 장기변화와 첨가물의 영향에 관한 실험적 연구

유두선,이광희,최윤주,김대업 大韓小兒齒科學會 1996 大韓小兒齒科學會誌 Vol.23 No.2

The purpose of this study were to measure the solubility of the stannous fluoride experimentally,to find a method for improving the solubility of the stannous fluoride,and to observe the effect of longterm storage of the variation of the concentration of fluoride in the stannous fluoride solutions.By adding such materials as antiseptics,dye,flavor,and tests to solution,the variation of the fluoride concentration was also observed. Ten groups of 0.4% stannous fluoride solutions to which glycerine,sodium chloride,chlorhexidine,dye,flavor,xylitol,and sorbitol were added were prepared.The measurements were carried out by direct calibration. The obtained results were as follows. 1.Effect of adding glycerine as solvent:This solubility of the stannous fluoride increased in the case of adding glycerine.By increasing the glycerin concentration,the fluoride level in stannous fluoride solution also increased. 2.Effect of adding sodium chloride and chlorhexidine.:Comparing to the case of pure water,low fluoride level was measured in case of adding sodium chlorid and high fluoride level was measured in case of adding chlorhexidine. 3.Effect of adding erythrosin as dye and banna essence as flavor.:Adding erythrosin and banna essence didn't affect fluoride level. 4.Effect of adding xylitol and sorbitol.:The effects of xylitol and sorbitol were nearly the same as the effect of adding erythrosin and banna essence.

백서 간재생중 H2B Histone 유전자 발현에 대한 Octamer Binding Transcription Factor의 역할

임규,방재웅,최두식,손미영,이영철,박청,김태동,김영래,박종일,윤완희,박승길,황병두 한국노화학회 2001 한국노화학회지 Vol.11 No.1

성인에서 발병한 과면역글로불린 E 증후군 1예

이재천,박주상,윤지열,정두련,문희범,우준희,류지소 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.1

과민역글로불린 E 증후군은 영유아기부터 반복적인 부비동, 호흡기감염 및 농양의 형성, 습진성 피부 질환 및 혈청 면역글로불린 E의 상승을 보이는 드문 질환이다. 특징적으로 농양은 발열이나 균혈증을 동반하지 않으며, 포도상구균이 흔한 원인균이며, 배농 및 항균제 정주로 효과적으로 치료된다. 향후 병태생리 및 치료에 대한 연구가 필 요하다. 저자들은 성인기에 발병한 반복적인 피하 농양 형성, 습진성 피부질환, 혈청 면역글로불린 E의 상승 등으로 과면역글포블린 E 증후군으로 진단된 증례를 국내 최초로 보고하는 바이다. Hyperimmunoglobulin E syndrome, rarely reported, is a syndrome of hyperimniunoglo-bulinemia E. eczematous skin lesion, and recurrent staphylococcal infections on respiratory system and skin with abscess formation, mostly from early in life. The abscess is not accompamed with fever and bacteremia, that is a characteristic 'cold abscess' We report a case of 56 year-old woman who manifested this syndrome from adulthood. with the review of literatures.

항정신병약물 사용 중인 정신분열병 환자에서 올란자판으로의 교체 방법에 관한 연구(II) : Comparison of Safety 안전성 비교

안용민,권용실,권준수,민성호,박두병,양문정,소형석,송종호,신윤식,우행원,유범희,이홍석,정한용,한창환,김용식 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.5

연구목적: 이 다기관 공동임상연구는 사용 중인 항정신병약물을 ’직접 교체 방법’또는 ’시작-감량 교체 방법’중 한 가지 방법으로 올란자핀으로 교체한 후, 안정성 측면에서 두 교체 방법 간의 비교와 교체후의 변화를 관찰하기 위한 것이다. 방법: 국내 13개 병원의 입원 및 외래에 내원한 환자들 중 ICD-10 지단기준으로 정신분열병에 해당되며, 임상적으로 항정신병약물 교체가 필요한 환자를 대상으로 하였다. 두 가지 교체 방법 중 한 가지를 무작위로 피험자에 적용하였으며, ’직접 교체 방법’에 배정된 경우에는 사용중인 항정신병약물을 일시에 중단하고 10㎎의 올란자핀을 바로 투여하였고, ’시작-감량 교체 방법’에 배정된 경우는 10㎎의 올란자핀 투여하고 2주에 걸쳐서 기존 약물을 감량하여 중단하였다. 올란자핀 사용기간은 총 6주이며, 용량은 5∼20㎎ 범위로 제한하였다. 한정성 평가를 위해서 체중, 생명징후, 자발적인 이상반응 복, 실험실 검사 그리고 Simpson-Angus Scale(SAS), Barnes akathisia rating scale(BARS), Abnormal involuntary movement scale(AIMS). Liverpool University neuroleptic side effect rating scale(LUNSERS)등을 이용하였다. 결과: 총 103명의 정신분열병 환자를 대상으로 하였다. 사용한 올란자핀의 용량, 벤조디아제핀의 병용률, 탈락률과 탈락 사유, 자발적인 이상반응 보고, 생명징후, 실험실 검사 그리고 대부분의 부작용 척도 상에서 임상적으로 의미 있는 차이를 두 교체 방법간에 발견하지 못하였다. 다만 AIMS의 감소는 ’직접 교체 방법’군에서 보다 적었고, 항콜린제의 병용률은 ’시작-감량 교체 방법’군에서 보다 많았다. 기저 상태에서 전체 피험자의 SAS와 BARS 점수는 각각 3.5점과 1.8점이었으며 70% 이상의 피험자가 고프로락틴 혈증을 보였다. 올란자핀으로 교체한 후, SAS, BARS, AIMS 점수의 유의한 감소가 있었으며 고프로락틴 혈증을 보인 피험자 분율도 약 30%이하로 감소하였다. 그러나 교체 방법과 상관없이 올란자핀 교체 후 유의한 체중 증가가 있었다. 결론: 이 연구를 통해 교체 방법에 관계없이 비교적 안전하고 용이하게 올란자핀으로 교체 할 수 있음을 알 수 있었다. 그리고 기존 항정신병약물을 올란자핀으로 교체함으로써 일부 부작용들을 줄일 수 있음을 간접적으로 관찰할 수 있었다. 하지만 이 연구는 여러 제한점과 문제점을 지니고 있기 때문에 보다 체계적인 연구를 통해 검정이 필요하리라 생각된다. Objectives: This multicenter clinical trial involving 13 hospital sites compared the safely of switching to olanzapine between ’direct switching method’ and ’start-tapering switching method’. Method: This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For ’direct switching method’group, previous antipsychotics were abruptly discontinued and 10㎎ of olanzapine was administered, and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20㎎. The safety of switching to olanzapine was measured with vital sings including body weight, adverse events reported spontaneously, laboratory tests, and various scales such as Simpson-Angus Scale(SAS), Barnes Akathisia Rating Scale(BARS). Abnormal Involuntary Movement Scale(AIMS), and Liverpool University Neuroleptic Side Effect Rating Scale(LUNSERS). Results: 103 patients were switched to olanzapine in this study. The comparison between two switching methods did not show any significant difference in the dosage of olanzapine used, the concomitant use of benzodiazepine, the rate and reasons of drop-out, the adverse events, vital signs, laboratory tests, and most scales for measuring side-effects. However, the decrease in AIMS scores was significantly lower in ’direct switching method’ group, and the concomitant use of anticholinergics was comparatively greater in ’start-tapering switching method’ group. At baseline, SAS and BARS scores were 3.5 and 1.8 points respectively, and more than 70% of the subjects showed hyperprolactinemia. After switching to olanzapine, SAS, BARS, and AIMS scores were significantly decreased and the proportion of the patients with hyperprolactinemia was also decreased to less than 30%. However significant weight gain after the treatment of olanzapine was observed regardless of switching method. Conclusion: This study may suggest that switching to olanzapine can be done with relatively high safety regardless of switching methods and olanzapine can significantly decrease some side-effects induced by other antipsychotics.