반복적 스트레스가 흰쥐의 Opioid성 신경전달에 미치는 영향

사공정규,이광헌,김진성,구본훈,이종범,하정희 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.3

연구목적: 반복적인 스트레스에 노출된 실험동물에서 opioid성 신경전달의 변화양상을 검색하고 내인성 opioid peptide의 변화양상을 알아보기 위하여 본 연구를 시행하였다. 방 법: 본 연구에서는 웅성 흰쥐에게 하루 2시간, 2주간의 반복적인 부동화 스트레스를 가한 후 뇌의 각 부위에서 opioid 수용체의 mu-, delta- 및 kappa- 아형의 최대결합력 및 친화력의 변화 양상을 관찰하였다. 결 과: 반복적 부동화 스트레스 노출군에서는 대조군에 비하여 delta-아형 수용체의 수가 시상하부(hypo-thalamus) 및 선조체(striatum)에서 증가하였다. 본 연구결과 관찰된 선조체에서의 delta-아형 수용체의 상향조절과 관련지어 delta-아형 수용체의 내인성 효현제인 enkephalin의 뇌조직 내에서의 활성도를 검색하였을 때, 반복적 스트레스 노출군에서는 대조군에 비하여 그 함량이 감소하였다. 이러한 뇌조직내 enkephalin 활성도 감소 현상은 수용체 변화와 상응하게 시상하부 및 선조체에서 관찰되었으며, 이러한 수용체의 조절 현상은 내인성 수용체 효현제인 enkephalin의 활성도의 감소에 따른 생체의 적응 현상으로 해석되었다. 결 론: 이상의 결과로부터 반복적인 스트레스는 opioid 수용체 delta-아형을 상향조절하였으며, opioid 수용체 delta-아형의 내인성 효현제의 활성도를 감소시킴을 관찰하였다. Objectives : Research into emotional or behavioral stress typically focuses upon the hypothalamic-pituitary-adrenal axis. It is well established that the hypothalamic-pituitary-adrenocortical axis is subject to inhibitory control by opioids in a variety of animal species including pigs. Exposure to acute stress induces the upregulation of opioid receptors and the release of endogenous peptides which mediate the stress-induced analgesia. There is some literature substantiating that repeated stress can lead to changes in opioidergic neurotransmission. However, the changes are highly variable. This study was designed to observe the modulatory effect of repeated immobilization stress on opioidergic neurotransmission. Methods : Male Sprague-Dawley rats weighing 150-200g were forced to suffer immobilization stress for 2 hours on each of 14 successive days. Then we examined the maximum binding capacity and affinity of each opioid subtypes(mu, delta, kappa). Results : Repeated immobilization stress increased the binding of [³H]DPDPE on the delta-subtype opioid receptor in the striatum and hypothalamus. Saturation experiments followed by scatchard analyses of the results showed an increase in the density of delta-subtype opioid receptors, but the affinity of the delta-subtype opioid receptor remained unchanged. Repeated immobilization stress reduced enkephalin activity of striatum and hypothalamus. Conclusions : From these results, it could be concluded that repeated immobilization stress up-regulated the delta-subtype opioid receptors and reduced the activity of enkephalin, an endogenous ligand for the delta-subtype opioid receptor.

섬망 치료에 있어서 Quetiapine과 Risperidone의 효과 비교

사공정규,정성원 대한생물치료정신의학회 2011 생물치료정신의학 Vol.17 No.2

본 연구에서는 최근에 개발된 비전형 항정신병 약물인 quetiapine이 섬망의 치료에 효과가 있는지와 비전형 항정신병 약물인 risperidone과 효과의 차이가 있는지 평가하고자 하였다. 총 71명의 환자가 본 연구 대상에 포함되었고 CGI, K-DRS, K-DRS-R-98, K-MMSE를 평가 도구로 하여 치료 전과 치료 일 주일 후 측정한 전체 점수를 비교하였다. 부작용에 대한 평가도구로는 ESRS 점수를 치료 전후에 비교하였다. 연구 결과 두 군 모두에서 일주일 후 측정한 CGI-S, K-DRS, K-DRS-R-98, K-MMSE에서 통계학적으로 유의한 차이를 보였다. 두 군 간 치료전후의 통계학적인 차이는 보이지 않았다. 부작용은 두군 모두에서 나타나지 않았다. 이번 연구에서 quetiapine은 섬망 환자의 치료에 있어 risperidone과 동등한 효과를 보이고 부작용이 적어 섬망 환자의 치료에 안전하게 사용할 수 있을 것으로 기대된다. Objectives:It has been shown that risperidone, an atypical antipsychotics, has effectiveness for treatment of delirium as good as haloperidol and has less side effects than haloperidol. Quetiapine also has less extrapyramidal side effects and has effectiveness for treatment of delirium. The aim of this study was to investigate whether quetiapine is effective for the treatment of delirium compared with risperidone. Methods:All subjects(71 patients) were randomized to receive either risperidone(35 patients) or quetiapine(36 patients) with fixed dose at the first day of treatment. Then, all subjects received either medications with flexible doses according to judgement on clinical status of patients. The effectiveness was evaluated using Clinical Global Impression-Severity(CGI-S), Korean version of Delirium Rating Scale(K-DRS), Korean Mini Mental Status Examination(K-MMSE), and Korean version of Delirium Rating Scale-Revised-98. Results:There was no significant difference between both groups in the baseline K-DRS, K-DRS-R-98, K-MMSE and CGI scores. At the seventh day of the treatment, K-DRS, K-DRS-R-98 and CGI scores were significantly improved from the baseline both in the quetiapine and risperidone treatment group. Conclusion:Quetiapine is effective for treatment of delirium.

미래의 항우울제

사공정규,이민수 대한생물치료정신의학회 2011 생물치료정신의학 Vol.17 No.2

Recent advances in research on depression have confirmed that it is common, chronic, recurrent and disabling mental disorder. The treatment of depression has gained growing importance because of its major impact on the patient’s wellbeing, personal and social achievements. Recently, as an increasing number of antidepressants of various types continue to be developed for the treatment of depression, psychopharmacotherpy is the major approach to depression in clinical setting. Unfortunately, there are clear limitations to the currently approved pharmacotherapies of depression, including the fact that they are all essentially monoamine based, have modest efficacy and a relatively slow onset of efficacy, and suffer from significant tolerability issues. Recently, several promising hypotheses of depression and antidepressant action have been formulated. These hypotheses are based on dysregulation of hypothalamic-pituitaryadrenal(HPA) axis, neurotrophic mechanisms, glutamate, neurokinin, phosphodiesterase, cytokines. This article reviews these most promising novel mechanisms that are not represented in compounds currently approved for depression in either the United States or Europe and that may represent the future of the psychopharmacologic treatment of depression.

정신보건관련인력의 정신질환자에 대한 태도 연구

사공정규,송창진,손인기 東國大學校 2000 東國論叢 Vol.39 No.-

Attitudes of the health personnel toward the mentally ill affect the development and utilization of the community mental health program and reintegration of the mentally ill into society. Therefore the authors carried out a survey of attitudes toward mentally ill in the health personnel by measuring Community Attitudes to the Mentally Ⅲ Inventory(CAMI). The purpose of this survey was to get basic data to develop plan and strategy of community mental health in Pohang city. The results were as follows : (1) The health personnel of Pohang community showed positive attitude of 'Benevolence' and 'Community mental health ideology' and negative attitude of "Authoritarianism' and 'Social restrictiveness'. Therefore community mental health project in Pohang city will be established and activated easily. (2) The male group had more authoritative, less community mental health oriented attitude. (3) the more aged group had more authoritative, social restrictive attitude. (4) the unmarried group had less authoritative, social restrictive attitude. (5) The lower educated group had more authoritative, social restrictive and less benevolent, community mental health oriented attitude. (6) Monthly income 1-2 million Won group had more authoritative, social restrictive attitude, less community mental health oriented attitude. (7) The respondents who have never met mentally ill had less community mental health oriented attitude. (8) The respondents who themselves had used mental health services more benevolent, less authoritative, social restrictive attitude. From the above results, authors propose that planning of mental health project be necessary containing information and education for negative group and making resource for positive attitude group.

주의력결핍 과잉행동장애 아동의 연령에 따른 특성비교

정영철,이종범,박형배,정성덕,성형모,사공정규 대한생물치료정신의학회 2001 생물치료정신의학 Vol.7 No.1

Objectives : This study is to verify the developmental changes of ADHD symptoms and functions with aging from 7 to 12 year-old. Method : The subjects of this study were 120 children(108 boys and 12 girls) who were diagnosed as ADHD by DSM - IV at department of neuropsychiatry of Yeungnam University Medical Center. Multidementional tests(K-ABC, ADDES-HV, CAP, CPT, KPl-C, WCST) were carried out to evaluate the change of ADHD symptoms and functions. Results : In K-ABC, children with ADHD showed statistically significant increased "Reading and Understanding" ability(p<.001) with age. In ADDES-HV, They showed decreased inattention (p<.05) and hyperactivity(p<.05) but, not showed significant change of impulsivity symptom with age. In CAP, They showed decreased hyperactivity(p<.001) and inattention (p<.05) and lower total score(p<.05) with age. their result were similar with ADDES-HV. In CPT, They showed decreased hit reaction time(p<.001) and hit reaction time standard errors(p<.01) and variability of standard errors(p<.05) with age. In KPI-C, They showed decreased anxiety(p<.01), depression(p<.001), somatization(p<.05), delinquency(p<.05) and hyperactivity(p<.01) with age. Social relationship(P<.05) was improved, as well as decreased psychoticism(p<.05) and autism (p<.001). In WCST, They showed increased completed categories(p<.001), total corrects(p<.001) and fewer total errors (p<.001) with age. Conclusion : Above findings indicate that symptoms of inattention and hyperactivity in school-aged ADHD children tend to decline with age, but age was less associated with decline in impulsivity symptom . In additions, Their executive functions were improved notably and they appeared stability of emotion, close social relationship and decreased delinquency.

주의력 결핍 과잉 운동장애에 대한 Methylphenidate의 임상 효과

사공정규,박형배,이종범 大韓神經精神醫學會 1994 신경정신의학 Vol.33 No.2

The objectives of this study were to evaluate the effect of methylphenidate on attention deficit hyperactivity disorder, using child attention problem checklist to 42(male : 29, female : 13) attention deficit hyperactivity disorder patients from March 1992 to February 1993. The results were as follows : There was significant improvement on symptoms in the scores rated by teachers in 7th & 28th day after methylphenidate administration compared to baseline score(p<0.05) and 28th day score showed significant improvement compared to 7th day scores(p<0.05). There was significant improvement on symptoms in the scores rated by parents in 28th day after methylphenidate administration compared to baseline score(p<0.05) and 28 th day score showed significant improvement compared to 7th day score. In single administration of methylphenidate in Sunday morning, there was significant improvement on symptoms in morning score compared to afternoon score(p<0.05). In the administration of methylphenidate of same dosage, the 7th day rating score of teacher showed significant improvement on symptoms compared to the Sunday morning rating score of parents(p<0.05) and the 28th day comparision was also showed signigicant improvement on symptoms in the scores rated by teachers compared to the scores rated by parents(p<0.05).

동국대 경주병원에서의 정신과 자문 현황

이광헌,사공정규 동국대학교 경주대학 1998 東國論集 Vol.17 No.1

1997년 1월 1일부터 1997년 12월 31일까지 1년동안 동국대학교 경주병원 입원환자 11988명중 정신과에 의뢰된 132명중에서 병록지를 통한 조사가 가능했던 118명을 대상으로 조사분석한 결과 다음과 같은 결과를 얻었다. 1) 전체 입원 환자에 대한 자문율은 1.10%였고, 남자가 더 많았으며, 연령별 분포는 남녀 모두 30대(24.6%)가 가장 많았고, 40대(17.0%), 50대(17.0%) 순이었고, 60대 이상의 노인들이 25.4%로 이전의 연구들에 비해 많았다. 2) 자문의뢰과는 내과가 50.8%로 가장 많았고, 신경외과(14.4%), 신경과(10.2%), 정형외과(9.3%) 순서였다. 과별입원환자에 대한 자문율에서는 재활의학과(7.02%), 신경외과(2.50%), 신경과(2.33%), 내과(2.32%) 순으로 나타났다. 월별로 살펴보면 9월, 6월, 11월, 4월이 많았고, 10월, 2월, 8월이 자문의뢰가 가장 적었다. 3) 자문의뢰된 이유는 불안, 우울 등의 감정적인 문제가 있는 경우(23.7%)와 알콜 및 약물남용 문제, 이학적 이상 소견 없이 신체증상이 지속되는 경우 등의 순으로 나타났다. 의뢰 환자들의 주증상으로는 위장관계(39.0%)와 두부와 중추신경계(26.3%)가 가장 많은 것으로 나타났다. 4) 자문전에 향정신성 약물이 사용되고 있던 경우는 38.1%였으며, 항불안제가 가장 빈번히 사용되었다. 5) 자문후 진단은 기질성 장애(42.5%)와 우울장애(26.2%)가 많은 것으로 나타났다. 6) 자문의의 권고사항은 약물치료가 92.3%로 가장 많았으며, 가장 많이 처방된 약물은 항우울제와 항불안제였다. 이상의 소견들에 대해 국내외의 자료들과 비교 검토하였다. To obtain relevant data on current trends of psychiatric consultation in a general hospital, the authors reviewed 118 cases of inpatients who referred for psychiatric consultation from January 1. 1997 to December 31. 1997 at the Dongguk University Kyongju Hospital. The results were as follows: 1) The overall consultation rate was 1.1% of all inpatients, and age distribution was heavily concentrated at the age of 30's, 40's and 50's. 2) A majority of referrals came from the department of internal medicine(50.8%) and department of neurosurgery(14.4%). 3) The most common reason of psychiatric consultation were to evaluate excessive emotional reactions(23.8%), while the most frequent symptoms of the referred patients where those related to gastro-intestinal systems(39.0%). 4) The rate of psychotropic drugs use prior to psychiatric consultation was 38.1% and the most frequently prescribed ones were antianxiety drugs(47.3%). 5) Organic mental disorders(42.5%) and depressive disorders(26.2%) were the most common diagnoses given after psychiatric consultation. 6) Use of psychotropic drugs was the most frequent recommendations given after psychiatric consultation.

주의력 결핍 과잉행동장애 아동의 평가를 위한 정지신호 과제의 적용

시현석,이종범,박형배,사공정규,송창진,배진우 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.1

연구목적 및 방법 : ADHD환아에 있어 뇌의 전두엽의 기능인 실행기능 중 특히 억제기능을 가장 잘 측정하는 것으로 알려진 정지신호과제를 사용하여 실제로 정지신호를 ADHD환아에게 적용하였을 때 정상 아동과 비교하였을 때 ADHD의 전두엽의 실행기능 중 억제 기능의 이상을 실질적으로 반영하는 검사인지, 증상의 정도와 수행결과는 어떤 연관성을 보이는지, 현재 가장 널리 사용되고 있는 연속수행 검사와는 어떤 차이를 보이는지, 과잉행동의 유무와 수행의 연관성은 어떠한지 그리고 부가적으로 정지신호과제의 ADHD진단에 있어서의 판별력은 어느 정도인지를 알아보기 위해 본 연구를 시행하였다. 전두엽의 기능을 반영하는지와 임상에서의 유용성을 알아보기 위해 ADHD군 40명과 대조군 18명을 대상으로 연구하여 다음과 같은 결과를 얻었다. 결 과 : 대조군과 ADHD군의 비교에서는 정지신호과제의 수행 성적은 상대적 종결속도의 Z점수(ZRFT)와 블록당 평균 지연시간(mean delay×block), 그리고 일차 반응시간(primary-RT)에 있어서 유의한 차이가 있는 것으로 나타났다(p<0.05), ADHD군과 대조군의 연속수행검사(CPT)의 수행에 있어 유의한 차이가 나는 변인은 없었다. 또한 두 검사간의 상관성에 있어서는 정지신호반응시간(SSRT)와 CPT의 정반응시간이 그리고 primary-RT와 일차반응시간의 표준 편차(primary-SD)가 CPT의 민감도와 정반응시간과 상관성이 있는 것으로 나타났다(p<0.05). 정지신호과제 수행과 한국형 주의력결핍 장애 평가 척도 - 가정판(ADDES-HV)과의 상관도에서는 유의한 상관성을 나타낸 것은 없었다. 나이와 지능에 따른 정지신호과제의 경향분석에서 유의하게 경향성을 나타낸 것은 지에 따른 차이에서는 primary-SD였으며 나이에 따른 차이에서는 SSRT였다(p<0.05). 여기에서 지능과 primary-SD와의 관계는 지능이 증가함에 따라 감소하다 어느 정도에서 더 이상 감소하지 않았으며, 나이와 정지신호반응시간과의 관계는 나이가 증가함에 따라 반응시간이 짧아지다가 어느 정도에서 더 이상 감소하지 않는 추세를 보였다. 정지신호과제의 판별력 검증에서 mean delay×block과 primary-RT가 가장 높은 판별력(각각 75%)을 나타냈으며 그 외 억제율(P-inhibit)은 63.89%, SSRT는 58%, ZRFT는 67%, primary-SD는 58%의 판별력을 보였다. ADDH 환아를 대상으로 과잉행동이 있는 군과 없는 군으로 나누어 수행의 정도를 비교하였다. 여기에서는 두 군 사이에 유의한 차이가 있는 변인은 없었다. 결 론 : 이러한 결과로 볼 때 정지신호과제가 국내에서 사용된다면 향후 임상에서의 ADHD의 선별검사로서 뿐만 아니라 연구에 있어서도 기여하는 바가 크다고 생각된다. Objectives and Methods : The purpose of this study was to examine availabilities of stop-signal task as a screening test for ADHD and as a research tool. Stop-signal task was applied to 40 ADHD patients and 18 normal children. Followings are the results of this study. Results : There were significant differences between ADHD group and control group in ZRFT, mean delay×block and primary-RT of stop-signal task performance(p<0.05). There was no significant difference in results of continuous performance test. SSRT of stop-signal task had significant correlation with hit reaction time of continuous performance test, and primary-RT and primary-SD with attentiveness and hit reaction time of continuous performance test. There was no significant correlation between scores of ADDES-HV and stop-signal task performance. In change of primary-SD according to intelligence, primary-SD decreased as intelligence increased but made plateau after IQ 110, and in change of SSRT according to age, SSRT decreased as intelligence increased but made plateau after 10 year-old. In discriminant ability, mean delay×block and primary-RT showed highest discriminant ability(each 75%). In addition P-inhibit showed 63.89%, SSRT showed 58%, ZRFT showed 67%, and primary-SD showed 58% in discriminant ability. There was no significant difference in stop-signal task performance between ADHD with hyperactivity and ADHD without hyperactivity. Conclusions : In this point of view, stop-signal task was proved to be useful research tool for attention deficit hyperactivity disorder as well as useful screening test tool.

Comparison of Effectiveness between Aripiprazole and Risperidone for Treating Delirium in Hospitalized Patients

Jeong-Kyu Sakong(사공정규),Young-Hoon Han(한영훈),Sung-Won Jung(정성원) 대한생물치료정신의학회 2011 생물치료정신의학 Vol.17 No.1

목적:비전형 항정신병 약물인 리스페리돈이 섬망 치료에서 부작용이 적고 효과적이라고 알려져 있다. 아리피프라졸도 항콜린성 및 추체외로계 부작용이 적은 비전형적 항정신병 약물 중 하나이지만 섬망 치료에 대해 입증된 연구는 적다. 본 연구는 아리피프라졸이 섬망 치료에 대해 효과적인지 조사해 보고자 하였다. 방법:43명의 섬망 환자를 무작위로 2군으로 나누었으며 투약 첫날에는 리스페리돈 1㎎, 아리피프라졸 5㎎을 투여하였으나 둘째 날부터는 임상상태에 따라 자유롭게 용량을 조절하였다. 리스페리돈 환자 27명과 아리피프라졸 환자 16명이 연구에 포함되었으며 이중맹검법을 사용하여 비교하였다. 비교는 치료전과 치료 일주일 Clinical Global Impression-Severity(CGI-S), 한국판 섬망평가척도(Korean version of Delirium Rating Scale ; K-DRS), 간이정신상태검사(Korean Mini Mental Status Examination; K-MMSE), 한국판 섬망평가척도(Korean version of Delirium Rating Scale-Revised-98 ; K-DRS-R-98), 추체외로계증상 평가척도(Extrapyramidal Symptom Rating Scale ; ESRS)의 점수를 사용하였다. 결과:리스페리돈과 아리피프라졸 두군 모두에서 치료 전후의 CGI-S, K-DRS, K-DRS-98의 점수가 통계적으로 의미 있는 차이를 보였다(p<0.05). 하지만 아리피프라졸 치료군의 경우 리스페리돈 치료군에 비해 차이를 보이지는 않았다. 결론:아리피프라졸이 섬망 치료에 있어 리스페리돈과 유사한 효과가 있을 것으로 기대된다.

경상북도 거주 노인의 정신건강과 자살 위험인자에 관한 연구

김정령(Jeong Ryeong Kim),이광헌(Kwang Hun Lee),김상규(Sang Kyu Kim),곽경필(Kyung Phil Kwak),사공정규(Jeong Kyu Sakong) 대한생물치료정신의학회 2021 생물치료정신의학 Vol.27 No.3

Objectives:The purpose of this study was to identify suicide risk factors among elderly residents in Gyeongsangbuk-do and to reveal the relationships between them. In addition, the differences in suicide risk factors were analyzed between the cognitively impaired group and the cognitively normal group. Methods:We investigated 20,127 elderly over 65 years of age, from January 2019 to December 2019. Participants were asked to complete a questionnaire survey. Cognitive function, depression, anxiety, sleep disturbance, and suicidal ideation data were assessed using a Korean version of the Mini-Mental Status Examination for Dementia Screening (MMSE-DS), Short Geriatric Depression Scale for Korean version (S-GDS), Geriatric Anxiety Inventory (GAI), Athens Insomnia Scale (AIS), and Scale for Suicidal Ideation (SSI). Data were analyzed using the chi-squared test and logistic regression analysis to examine suicide risk factors and the relationships between them. Furthermore, differences in suicide risk factors according to cognitive function were examined. Results:Age, cognitive function, depression, anxiety, and sleep disturbance were identified as suicide risk factors among elderly residents in Gyeongsangbuk-do. Depression was the factor that increased risk of suicide the most, followed by anxiety, impaired cognitive function, sleep disturbance, and 65-74 years of age. In addition, depression increased risk of suicide by 1.86 times in the cognitively impaired group. Conclusions:Among elderly residents in Gyeongsangbuk-do, depression was the factor that contributed the highest risk for suicide. More active prevention and treatment measures for depressive symptoms should be implemented in the cognitively impaired group.