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.

지난 4년간 학회지 "신경정신의학" 심사 평가보고

오병훈,권준수,남궁기,김승현,지익성,김창윤,하규섭,박원명,김성곤,오강섭,김정범,이수정,정한용,이창욱,박용천,이영문,김세주,이병욱 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.5

Four Years Reports of "Journal of Korean Neuropsychiatric Association" during 2001 to 2005 were evaluated by 18 Editorial Board of Korean Neuropsychiatric Association. We investigated the articles to specific fields and rejection rate etc. by different section chiefs. Although several problems concerning review time duration and rejection guideline issues indicated but generally all reviewer processes proved relatively clear and concise criteria. Through these objective and systematic evaluation Processes, "Journal of Korean Neuropsychiatric Association" will develop a good journal.

한국인 직무 스트레스 측정도구의 개발 및 표준화

장세진,고상백,강동묵,김성아,강명근,이철갑,정진주,조정진,손미아,채창호,김정원,김정일,김형수,노상철,박재범,우종민,김수영,김정연,하미나,박정선,이경용,김형렬,공정옥,김인아,김정수,박준호,현숙정,손동국 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.4

Background and Purposes: Over the past three decades, numerous studies performed in Korea have reported that job stress is a determinant risk factor for chronic diseases and work disability. Every society has its own culture and occupational climate particular to their organizations, and hence experiences different occupational stress. An occupational stress measurement tool therefore needs to be developed to estimate it objectively. The purpose of this study is to develop and standardize the Korean Occupational Stress Scale (KOSS) which is considered to be unique and specific occupational stressors in Korean employees. Subjects and Methods: Data were obtained from the National Study for Development and Standardization of Occupational Stress (NSDSOS Project: 2002-2004). A total of 12,631 employees from a nationwide sample proportional to the Korean Standard Industrial Classification and the Korean Standard Occupational Classification were administered. The KOSS was developed for 2 years (2002-2004). In the first year, we collected 255 items from the most popular job stress measurement tools such as JCQ, ERI, NIOSH and OSI, and 44 items derived from the a qualitative study (depth interview). Forty-three items of KOSS, in the second year, were retained for use in the final version of the KOSS by using Delphi and factor analysis. Items were scored using conventional 1-2-3-4 Likert scores for the response categories. Results: We developed eight subscales by using factor analysis and validation process: physical environment (3 items), job demand (8 items), insufficient job control (5 items), interpersonal conflict (4 items), job insecurity (6 items), organizational system (7 items), lack of reward (6 items), and occupational climate (4 items). Together they explained 50.0% of total variance. Internal consistency alpha scores were ranged from 0.51 to 0.82. Twenty-four items of the short form of the KOSS (KOSS-SF) were also developed to estimate job stress in the work setting. Because the levels of the subscales of occupational stress were gender dependent, gender-specific standard norms for both the 43-item full version and the 24-item short form using a quartile for the subscales of KOSS were presented. Conclusion: The results of this study suggest that KOSS might be an appropriate measurement scale to estimate occupational stress of Korean employees. Further and more detailed study needs to be conducted to improve the validity of this scale.

급성기 뇌지주막하출혈에서 Three-Dimensional Computed Tomographic Angiography (3-D CTA)의 유용성

임동준,이훈갑,김봉룡,정흥섭,정용구,이기찬,서중근 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.12

대학생들의 슬관절 신전근 및 굴곡근에 대한 등속성 운동 검사

鄭龍俊 최신의학사 1989 最新醫學 Vol.32 No.4

비화농성 삼출성 복수를 동반하는 질환에서 복막 침생검의 진단적 의의

정종훈,서용태,오덕환,채종구,정춘해,조건국 朝鮮大學校 附設 醫學硏究所 1986 The Medical Journal of Chosun University Vol.11 No.1

Percutaneous needle biopsies of peritoneum with Abrams needle and Cope needle were done un 64 patients with non-purulent exudative ascites, who was admitted to the department of internal medicine, Chosun University hospital, from January 1978 to Deccmber 1983. The diagnostic significance and safety of the needle biopsy was estimated. The results were as follows. 1. Adequate peritoneal tissue for pathological diagnosis was obtained in 53 cases(82.8%) among 64 cases. (Abrams needle 84.8%, Cope needle 80.6%) 2. Definitive diagnosis was obtained in 31 cases among 53 cases (58.6%). (Tuberculosis 23 cases, malignancy 8 cases). 3. As compared final diagnosis with biopsy result, the rate of final diagnosis corresponding with biopsy diagnosis was 58.8% in tuberculosis and 26.3%, in malignancy, but the rate of biopsy diagnosis corresponding with final diagnosis was 100% in both tuberculosis and malignancy. 4. Cases of chronic non-specific inflammation which were diagnosed by biopsy were 13cases(24.5%)among 53 cases, and among these cases, tuberculosis was 69.2% and malignancy 30.8% on final diagnosis and among 53 cases, histologically normal was 9 cases(16.9%) of which 33.3% was tuberculosis and 66.7% was malignancy on final diagnosis. 5. Of the malignant cases on final diagnosis, Positive cytologic examination of ascitic fluid was 16.7% 6. Primary losions of cancerous peritonitis were stomach cancer (38.9%) hepatocellular cancer(22.2%) colon cancer (11.1%) ovarian cancer (11.1%) Pancreatic cancer (5.6%). 7. Complication of percutaneous peritoneal biopsy was local swelling with leakage of ascitic fluid and the accident rate were 36.4,% in Abraham needle and 3.2% in Cope needle.

정수장 급속여과지의 역세척 수위변화와 시간에 따른 세척 효율 평가

정용준,민경석 한국물환경학회 2004 한국물환경학회지 Vol.20 No.6

Both surface wash and backwash are considered as one of the most important methods that can improve the filtration efficiency in the existing water treatment plant. This study has mainly focused on the improvement of filtering efficiency by controlling surface wash and backwash time, and water level before backwash (when drained up to the trough, when drained up to 10 cm above filter bed, and when drained below 10 cm filter bed). Filtration efficiency was shown a little bit of differences depending on the operating conditions like surface wash injection pressure, the distance control between filter bed and the facility, and the types of surface wash. When the water level before backwash was reached up to 10 cm below filter bed after draining, however, the filtration velocity and the turbidity removal efficiency in the filter bed was improved. When the surface wash followed by backwash is longer, it showed a similar result. Because the proper adjustment of surface washing time makes filtration efficiency higher, therefore, it is necessary to set up the backwash time moderately.

만정 뇌경막하혈종에서 술전 CT음영 및 천두폐쇄배액술후 배액량과 재발과의 상관관계에 대한 연구

임동준,박윤관,정용구,김봉룡,정흥섭,이기찬,이훈갑,서중근 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.10

림프구성 뇌하수체염 - 증 례 보 고 -

임동준,정용구,이훈갑,이기찬,서중근 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.11

BAF 공정을 이용한 제직폐수의 재이용

정용준,배종홍,권구호,민경석 한국물환경학회 2004 한국물환경학회지 Vol.20 No.6

An upflow BAF(Biological Aerated Filter) equipped with an expanded clay media was applied to reuse weaving wastewater of water jet loom. The performance of lab-scale biofilter was investigated by the adjustment of EBCTs(Empty Bed Contact Time) and the packing ratio of media, which were changed 1.1 to 3.7hr and 38 to 63%, respectively. In most conditions except 1.1hr of EBCT, BOD, CODcr, SS and Turbidity of the effluent were 1∼4㎎/L, 7∼16㎎/L, 1∼5㎎/L and 5∼14NTU, where their removal efficiencies were 76∼95%, 82∼93%, 63∼94% and 59∼81%, respectively. From the observation of SEM(Scanning Electron Microscope) photographs of porous clay media, it was revealed that this media provided good performance of retaining microbes effectively. In addition, 0.44∼0.49㎏VSS/㎏BOD_(rem). of low sludge reduction was expected. The most efficient back washing cycle and procedure were once per 4 to 9 days and air including collapse-pulsing method, respectively. Therefore, this system can be of use as an weaving wastewater treatment for reuse