정신분열병 환자의 우울증에서 Paroxetine과 삼환계 항우울제 병용치료

심주철,공보금,박정환,윤영란,신재국,김정익,안동성,김용관,차인준,김영훈 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.4

저자들은 마산동서병원에 입원중인 우울증이 동반된 정신분열증 환자 10명을 대상으로 사용중인 항정신병약물에 paroxetine과 저용량의 삼환계 항우울제를 6주간 병용투여한 후 우울증상에 대한 효과와 치료의 안전성 및 약물상호작용을 알아보았다. Paroxetine은 고정량의 항정신병약물과 삼환계 항우울제에 부가하여 일일 20㎎을 6주간 병용하게 하였으며, 임상상태는 HDRS, HARS, UKU Side Effect Rating Scale등의 평가척도를 사용하여 평가하였다. 또한 약동학적 약물상호작용은 삼환계 항우울제들의 혈장농도를 HPLC로 측정하여 분석하였다. 결과는 다음과 같다. 1) 10명의 전체 대상환자에서의 HDRS 평균점수는 TCA와 paroxetine 병용투여 6주후에 통계적으로 유의하게 감소되었다. 이중 40%의 환자에서는 병용투여 6주후에 HDRS 점수상 50% 이상의 감소를 보여, 일부의 환자들에서는 정신분열병에 동반된 우울증상의 치료에 소량의 삼환계 항우울제와 paroxetine의 병용치료가 효과가 있음을 확인하였다. 2) 두 명의 환자에게서 심각한 약물독성이 발생하였다. 이중 한 명은 삼환계 항우울제의 높은 혈중농도로 인한 항콜린성 위기(anticholinergic crisis) 소견을 보였으며, 다른 한 명은 인지기능 및 의식수준은 명료하였으나 망상과 환각증상이 약화되는 소견을 보였다. 따라서 본 연구에서 시도된 복합적 약물치료의 경우, 삼환계 항우울제의 혈중농도의 측정을 포함한 세심한 임상적 추적이 필요하다고 생각된다. 3) 기저치의 amitriptyline과 그 대사물인 nortriptyline의 농도합. imipramine과 대사물인 desipramine의 농도합은 각각 47.8-226.5ng/㎖. 80.5-395.6ng/㎖였으며 일반적으로 이들 약물들의 단독사용시에 문헌에 보고된 혈중농도를 훨씬 상회하고 있었다. 이는 병용투여된 항정신병 약물 약시 강력한 CYP2D6 효소억제제로서 기저치의 삼환계 항우울제들의 혈장농도를 이미 상당히 증가시켰던 것으로 판단되며, 그러한 결과로 인해 본 연구에서는 paroxetine이 이전의 문헌보고들과는 달리 뚜렷하게 삼환계 항우울제들의 혈장농도를 증가시키지 못하였다. 본 연구는 SSRI와 삼환계 항우울제의 병합 투여가 우울증의 개선 효과를 빠르게 하고, 치료역을 넓히고, 약물상호작용의 결과 paroxetine이 삼환계 항우울제의 혈중농도를 증가시킨다는 기존의 연구결과를 이용하여 정신분열병 우울증상의 치료에 parotextine과 소량의 삼환계 항우울제를 병용하는 방법을 시도해 본 연구이다. 저자들은 이러한 약물치료가 일부의 환자들에게서 효과가 있음을 관찰하였으나, 항정신병약물과 삼환계 항우울제를 병용투여 할 경우는 물론 이에 paroxetine과 같은 선택적 세로토닌 재흡수 억제제를 병용할 경우 복합약물상호작용의 결과로 약물독성의 위험성이 크며 세심한 주의가 필요함을 경험하였다. Depression is well-known to comorbid with several psychiatric disorders. Many schizophrenics also suffer from depression in the course of their illness. Combined therapy of SSRI and tricyclic antidepressants were reported to have benefits in some depressed patients. Paroxetine, a potent CYP2D6 inhibitor, increases the blood levels of tricyclic antidepressant markedly. Using paroxetine, we tried this combined therapy in the treatment of depressive symptoms in 10 chronic schizophrenic inpatients and evaluated its efficacy and drug interactions between paroxetine and tricyclic antidepressants. The following results were obtained : 1) The mean score of Hamilton's Depression Rating Scale(HDRS) was reduced significantly after 6 weeks-trials of this combined therapy for the mild depressive symptoms in 10 chronic schizophrenics. In four patients, 50% or more reductions in the scores of HDRS were noticed at final evaluation. 2) Two among our 10 subjects experienced severe toxic behavioral problems. Anticholinergic crisis with toxic confusion due to high blood levels of tricyclics was found in one patient and the other showed rapid clinical deterioration in his psychotic symptoms such as delusion and hallucination without any consciousness alternation. 3) Baseline plasma levels of tricyclics before adding paroxetine were higher than expected in our chronic schizophrenic subjects maintained with their antipsychotic medications. Several antipsychotics were also known as a potent CYP2D6 inhibitors and to increase the blood levels of tricyclics. Because the blood levels of tricyclics had already increased significantly by the use of antipsychotics, adding paroxetine to antipsychotics and tricyclic antidepressant in our subjects could increase the blood levels of tricyclics not so much as previously reported in the literatures.

정신과 영역에서의 신경펩타이드 자극검사

심주철,김용관 대한생물치료정신의학회 1995 생물치료정신의학 Vol.1 No.2

Many interesting concepts and hypothesis have been advanced with regard to functional role of neuropeptide in psychiatric field. Although the findings of neuropeptide test in psychiatric disorder have helped to elucidate pathophysiological mechanism, they have not provided us with a suitable biological marker. There are no consistent findings for any of neuropeptide challenge test that we haved discussed in terms of their value in differentiating between psychiatric disorders. But many findings have proved to be more valuable as a measure of pathophysiology and as a correlated of treatment response and illness course than a biological marker of the illness. There is a definite need for continuing study in neuropeptide itself, factors influencing neuropeptide, as well as a need to definite underlying genetic processes.

정신분열병 환자 가족을 위한 한 정신교육적 가족치료 모형의 효과

이영호,심주철,이상경,서영수,김용관,김규수,김영훈 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.3

연구목적 : 본 교실에서 정신분열병 환자 가족을 대상으로 시행 중인 장기 정신교육적 가족치료모형을 소개하고, 이모형이 가족의 대처방식과 우울증상, 환자가 자각하는 가족의 정서적 지지와 우울증상, 재입원율 및 사회재활상태에 미치는 영향을 평가하였다. 방 법 : 연구대상은 DSM-IV 진단기준에 의해 정신분열병으로 진단받고 외래 통원치료를 받고 있는 환자와 그 보호자였다. 교육군은 전체 19회 교육 중 최소 ⅔이상 참여한 11명의 환자와 가족이었고 비교육군은 부산소재의 종합병원에서 가족교육을 받지 않고 통원치료만을 받았던 11명의 환자와 가족이었다. 정신교육적 가족치료 모형의 효과는 가족의 대처방식과 우울증상, 환자가 자각하는 가족의 정서적 지지와 우울증상, 재입원율, 사호재활 실태로 나누어 평가했다. 평가도구는 The Ways of Coping Checklist의 국내번안용, Family Emotional Support Questionnaire for Transaction. Beck Depression Inventory를 이용했다. 재입원율 및 사회재활 실태에 대한 평가는 환자 및 가족과의 면담을 통해 조사했다. 결 과 : 본 연구의 정신교육적 가족치료 모형 실시 후 가족의 대처방식 중 적극적 대처는 교육군운 의미있게 증가한 반면 비교육군에서는 변화가 없었다. 소극적 대처 교육군은 의미있게 감소했으나 비교육군에서는 변화가 없었다. 가족치료모형 실시 전 가족들은 양군 모두 심한 우울증상을 갖고 있었다. 가족치료모형 실시 후 가족의 우울증상은 교육군에서 감소, 비교육군은 증가를 보였으나 통계적 유의성은 없었다. 환자가 지각하는 가족의 정서적 지지 평가척도점수는 교육군은 의미있는 증가를 보였으나 비교육군에서는 변화가 없었다. 환자의 우울증상의 교육군에서는 현저한 감소를 보인 반면 비교육군은 상반되게 증가했다. 가족의 적극적 대처가 환자가 자각하는 정서적 지지의 증가 및 우울증상 감소와 의미있는 상관관계를 나타냈다. 또한 교육군의 환자들이 비교육군의 환자들보다 장기가족교육 종료시점과 9개월 경과 후의 추적 평가에서 재입원율이 현저히 낮았고, 사회재활상태도 좋았다. 결 론 : 본 연구에서 실시된 장기 가족교육모형은 가족의 대처방식을 향상시키고, 우울증상의 감소를 가져오며, 환자가 자각하는 가족의 정서적 지지 향상 및 우울증상의 호전을 가져오고, 재입원율의 저하 및 사회재활의 향상을 보이는 것으로 나타났다. Objectives : This study was performed to introduce a psychoeducational family therapy model for the families of schizophrenic patient and to investigate the effect of this model on the changes in coping style and depressive symptoms of the family members, and in perception of emotional support by families and depressive symptoms of patients. Methods : Subjects were schizophrenic out-patients, who fufilled DSM-IV diagnostic criteria, and their families. The members of "education group" were 11 families and patients who participated in more than two thirds of 19 sessions of the program. The members of "non-education group" were 11 families and patients who had no experience of family education and were treated in a general hospital in Pusan. Clinical ratings were performed using by The Ways of Coping Checklist, Family Emotional Support Questionnaire for Transactions, and Beck Depression Inventory. Results : Coping style was changed positively, in education group but not in non-education group. The depressive symptoms of families were decreased in educated group and increased in non-educated group, although there were no statistical significance. In education group, patients felt much better emotional support by their families than patients in non-education group did. At the same time, their depressive symptoms were significantly reduced. The patients from education group were on more successful rehabilitation than those from non-education group were. Conclusion : Our results suggest that this psychoeducational family therapy model would be helpful to induce the positive changes in coping styles and reduce the depressive symptoms of family members, and it could also induce the reduction of depressive symptoms of schizophrenic patients and help their rehabilitation.

난포기 및 황체기에 있어서 돼지 난관 협부 평활근의 neurotransmitter들의 수축효과에 대한 estradiol-17β및 progesterone의 영향

이민기,노규진,심철수,남윤정,김주현,최상용 慶尙大學校 1991 論文集 Vol.30 No.2

The effects of estradiol-17β or progesterone on the contractility of neurotransmitters on pig oviductal isthmic smooth muscle were investigated. The motility of the isolated smooth muscle was recorded by using physiological recording system. The results were summarized as follows : 1. The contractility induced by histamine or prostaglandin F2α was depressed by the pretreatment of estradiol-17β but was not by the preteatment of progesterone in follicular or luteal stage. 2. The contractility induced by acetylcholine was depressed un follicular stage but excited in luteal stage by the pretreatment of estradiol-17β or progesterone. 3. The contractility induced by norepinephrine was depressed by the pretreatment of progesterone in follicular stage but was excited by the pretreatment estradiol-17β in luteal stage.

실제 증기 건도 예측 모델의 비교

김지민,박주용,이지수,이성우,심재우 한국공업화학회 2003 응용화학 Vol.7 No.1

Three representative models for the reediction of true mass fraction of steam were compared and analyzed to determine most appropriate model that can used to predict the Critical Heat Flux (CHF) for flow of wate in uniformly heated vertical tubes, The models studied were Kroeger & Zuber's [1]. Levy's[2] and Jafri et al.'s[3]. for the comparison. 188 data points from Becker et al.[4] (10 MP a data) were selected as a representative sample from the CHF database that contains a total of 8.912 data points. In case of Kroeger & Zuber vs. Jafri et al., the average error was 0.33% and the root mean square error was 2.47%. In case of Levy vs. Jafri et al., the average and root mean square errors were 1.66%, 2.67% respectively. Jafri et al.'s model can be applied to both uniform and non-uniform heated tubes because it is in a from of rate equation that can easily be used for calculating the true fraction of steam along the length of tube.

균일 가열 수직 원형관에서의 일반화된 임계열유속 예측 상관식 개발

이성우,박주용,이지수,심재우 한국공업화학회 2004 응용화학 Vol.8 No.1

A new generalized CHF (Critical Heat Flux) correlation was suggested for water flow in uniformly heated vertical round tubes. The parametric ranges of experimental data were as follows : 0..101≤p (pressure) ≤ 20.679 MPa, 9.92 ≤ G (mass flux) ≤ 18,619.39 lg/㎡s, 0.00102 ≤ D (diameter) ≤ 0.04468 m, 0.03 ≤ L (length) ≤ 4.97 m, -609.33 ≤ Inlet subcooling ≤ 1,655.34 kJ/kg, 0.11 ≤ q_(c) (CHF) ≤ 21.41 MW/㎡, and -0.87 ≤ X_(e) (exit qualities) ≤ 1.58. The new correlation was based on the local condition hypothesis. The new correlation was compared with 4 existing CHF correlation from world literature that claimed to have comparatively good predictions. The results of this study showed that prediction of CHF by the new correlation was in very good agreement with 8,951 experimental CHF data points composed of 12 different sources[1]. The new correlation predicted CHF better than the other ones with average error of -1.34% and root mean square error of 13.44%.

섬유상 활성탄에서 페놀계 유도체의 속도흡착특성

이지수,김지민,박주용,이성우,심재우 한국공업화학회 2004 응용화학 Vol.8 No.1

Adsorption characteristics of phenolic compounds by activated carbon fiber have been investigated. Accurate description of kinetic adsorption that can predict the behavior of adsorption equipment it very important in many industrial areas, particularly in environmental applications. In this study, adsorption behavior of phenolic compounds was predicted by the use of Freundlich and Langmuir isothermal adsorption equation. In addition, a two parameter curve fit was used for the comparison. The equilibrium kinetic constant was predicted by Langmuir equation and maximum amount of adsorption was obtained from each isothermal equation. About 40% of substrates were removed within 5 minutes from the initial state of adsorption.

동박적층판 구조에 대한 냉각효율의 예측

이지수,김지민,박주용,이성우,심재우 한국공업화학회 2004 응용화학 Vol.8 No.1

To produce high quality PCB (Printed Circuit Board). CCL (Copper Clad Laminate) that can result in uniform quality is very important. Research and studying the temperature distribution and stress analysis within CCL may not be sufficient. In this study, the temperature distribution of CCL with a separator construction was measured and it was compared with a simulation result. It was found that the separator thickness influenced temperature distribution within CCl. The application of separator was the most effective means of enhancing cooling performance and laminated in a copper-steel-copper separator was effective in uniform cooling.

인쇄회로기판 제조 공정에 대한 냉각판 구조의 영향

이지수,김지민,박주용,이성우,심재우 한국공업화학회 2004 응용화학 Vol.8 No.1

Because of strong demand of compacted consumer electronics and rapid improvements in the miniaturization of electronic devices, compact or high density multi-layered PCBs (Printed Circuit Board) production facility with high productivity is being actively sought out. In the cooling process of lamination, it is very important to diminish the temperature deviation within the epoxy resin with respect to the position of press. In this study, we measured the temperature distribution of cooling process for CCL (Copper Clad Laminate) manufacturing. As the result, temperature change in the first plate was bigger than the one in the sixth plate. Much higher efficiency of cooling was observed when copper separator was used compared to the cooling at the natural convection state. In addition, when cooled by the copper plate, the temperature deviation between plates in CCL went up to maximum of 9 degrees.

활성탄의 종류에 따른 P-Chlorophenol의 Kinetic 흡착 특성에 관한 연구

김지민,이성우,이지수,박주용,심재우 한국공업화학회 2003 응용화학 Vol.7 No.1

Adsorption characteristics of P-Chlorophenol on Activated Carbon Fiber (ACF) and Granular Activated Carbon (GAC) were investigated. The influence of initial P-Chlorophenol concentration on rate of adsorption was studied. The adsorption rate of activated carbon fiber was much higher than the granular activated carbon. The kinetic coefficients of adsorption process of P-Chlorophenol on each carbon were determined experimentally and used in the model to predicted the adsorption The adsorption experimentally and used in the model to predicted the adsorption. The adsorption prediction on ACF required a modification of adsorption amount (qm) of Freundlich's equilibrium adsorption to predict accurately in the model used.