사회불안장애 인지행동집단치료에서의 치료 반응자 특성 연구: 초기 지표와 치료변화 양상을 중심으로

임수지,김소정,권정혜 한국임상심리학회 2016 Korean Journal of Clinical Psychology Vol.35 No.2

Cognitive behavioral therapy (CBT) is recommended as the treatment of choice for social anxiety disorder (SAD). Despite the well-demonstrated efficacy of CBT, response rates to CBT for SAD are not high; non-response rates are as high as 25~64%. Therefore, finding indicators of treatment response and differences between responders and non-responders seems important for the development of more efficacious treatment. The purpose of this study was to examine indicators of treatment response and compare treatment responders and non-responders to cognitive behavioral group therapy (CBGT) for Koreans with SAD. Thirty-nine individuals who completed 12 sessions of CBGT for SAD were classified as either treatment responders or non-responders according to their post-treatment scores on the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) and to the median SPS and the SIAS change scores. Treatment responders were defined as those who showed over the median change scores and significant symptom reduction in social anxiety from clinical level to non-clinical level. According to the results, there were no significant differences in demographic and diagnostic characteristics between treatment responders and non-responders in the SPS and the SIAS. However, there were differences in the severity of social interaction anxiety at the beginning of treatment between SPS responders and SPS non-responders and somatic symptoms at the beginning of treatment between SIAS responders and SIAS non-responders. In addition, there were significant differences in the patterns of self-focused attention changes during treatment of SPS responders and SPS non-responders even when controlling for initial group differences. The SIAS responders showed a greater reduction in dysfunctional beliefs and probability judgment bias and the cost judgment bias.

치료 전 바이러스 농도가 낮고 조기바이러스 반응이 있는 유전자 1형 만성 C형간염은 24주 페그인터페론과 리바비린 치료도 가능할 수 있다

문성수 ( Sung Soo Moon ),강현구 ( Hyoun Gu Kang ),서정아 ( Jeong Ah Seo ),정은욱 ( Eun Uk Jung ),이상헌 ( Sang Heon Lee ),박성재 ( Sung Jae Park ),이연재 ( Youn Jae Lee ),설상영 ( Sang Yong Seol ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.1

Background/Aims: The standard treatment for chronic hepatitis C infected with hepatitis C virus (HCV) genotype 1 is a combination of pegylated interferon alfa and ribavirin over a 48 weeks period. It is unclear if 24 weeks treatment is possible for patients showing a rapid virological response (RVR) without compromising the sustained virological response (SVR) in Korea. Methods: Between June 2005 and September 2008, among patients chronically infected with the HCV genotype 1 who were treated with pegylated interferon alfa subcutaneously once weekly plus ribavirin based on body weight, 55 patients who had low pretreatment viral load (<600,000 IU/mL) and RVR were enrolled. A total of 55 patients were divided into 24 weeks treatment group (n=29) and the standard treatment group (n=26). The HCV RNA was quantitatively assessed before treatment, and after 12 weeks of treatment, and also qualitatively assessed after 4 weeks of treatment, at end of treatment (24 weeks), and 24 weeks after end of treatment. RVR was defined as undetectable HCV RNA at the 4 weeks of treatment. Results: Among the 55 patients, SVR was achieved in 100% (29/29) of the patients in 24 weeks treatment and 96.2% (25/26) of the patients in the standard treatment (p=0.473). Conclusions: HCV genotype 1 infected patients with a low baseline HCV RNA concentration who become HCV RNA negative at week 4 may be treated for 24 weeks without compromising sustained virlolgical response. However, an additional trial will be needed to optimize the treatment duration. (Korean J Gastroenterol 2010;56:33-38)

한국인 주의력결핍 과잉행동장애 아동에서 도파민 D4 수용체 유전자의 Variable Number of Tandem Repeats (VNTR) 다형성과 Methyphenidate 치료 반응간의 연관성

천근아,김붕년,조수철,김재원,황준원,신민섭,홍강의 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.6

Objectives : In the present study, we investigate the association between homozygosity of the 4-repeat allele (4/4) at the DRD4 and the response to the treatment with MPH in Korean children with ADHD. Methods : The present study included 71 children with ADHD (8.231.78 years) from two children's psychiatric clinics in South Korea. All drug-naive children with ADHD were treated with MPH for about 8 weeks. The subjects who showed improvement of over 50% compared with the baseline ARS score after 8 weeks of treatment were termed as the 'good response' group. The subjects who showed an improvement of less than 50% were considered as the 'poor response' group. After genotyping for DRD4 were performed, we investigated correlation between homozygosity for 4-repeat allele at DRD4 and the response to MPH treatment. Results : We found that while 79.5% (31/39) of the subjects with homozygosity of 4-repeat allele at DRD4 showed good response to MPH treatment, 68.8% (22/32) of the subjects without homozygosity of 4-repeat allele at DRD4 showed poor response to MPH treatment according to ARS scores assessed by their parents (χ²= 16.762, df= 1, p<0.01). We also found that while 61.5% (24/39) of the subjects with homozygosity of 4-repeat allele at DRD4 showed good response to MPH treatment, 87.5% (28/32) of the subjects without homozygosity of the 4-repeat allele at DRD4 showed poor response to MPH treatment according to ARS scores assessed by their teachers (χ²= 17.698, df= 1, P<0.01). Conclusion : Our findings support an association between the homozygosity of 4-repeat allele and a good response to MPH in ADHD of Koreans.

공황장애에서 Paroxetine 치료반응을 예측할 수 있는 생물학적 지표

박주언,유범희 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.2

Objectives : Previons studies reported altered beta-adrenergic receptor (βAR) responsiveness in panic disorder, but few studies reported to see the effect of pharmacotherapy on βAR function in panic patients. This investigation examined βAR responsiveness in patients with panic disorder before and after pharmacotherapy with paroxetine. Methods : After assessment using the Anxiety Disorder Interview Schedule for DSM-FV, 27 acute panic patients whose illness duration did not exceed 1 year were assigned to 12 weeks of paroxetine treatment. Twenty seven normal control subjects with no previous history of major medical and psychiatric illnesses were matched by age, sex, exercise, and body mass index. The Hamilton rating scaIe for anxiety (HAM-A), Hamilton rating scale for depression (HAM-D), Spielberger state-trait anxiety inventory-State (STAI-S) and Trait (STAI-T), acute panic inventory (API), anxiety sensitivity index (ASI), and Beck depression index (BDI) were performed to assess clinical states in the panic patients before and after treatment. The HAM-A, HAM-D, STAI-S and STAI-T, and BDI were also performed in the normal control subjects. We measured the βAR density (Bmax), affinity (l/Kd), and sensitivity (cyclic AMP ratio of isoproterenol-stimulated cAMP to basal cAMP)in all subjects. Results : Panic patients showed much lower scores of the HAM-A, STAI-S, STAI-T, API, ASI, HAM-D, and BDI after 12 weeks ofparoxetine treatment than those before the treatment. There was no significant difference in the means of Bmax and cAMP ratio between control subjects and panic patients before and after the treatment. However, Pretreatment Kd(R²=0.314, β=-0.876, p=0.001) and Bmax (R²=0.230, β=-0.575, P=0.019) significantly accounted for API scores after the treatment and change of Bmax according to the treatment accounted for the improvement of anxiety sensitivity (R²=0.353, β=0.594, P=0.015). The pretreatment Kd value was significantly higher in the panic patients compared with that of control subjects (78.35≥26.20 vs. 59.15≥29.33, p=0.014), which was significantly reduced after the treatment (79.43≥26.83 vs. 56.38≥28.79, p=0.002). The pretreatment Kd value significantly accounted for the improvement of API scores (R²=0.316, β=0.562, p=0.029) and the decrease in trait anxiety (R²=0.246, β=-0.513, P=0.025). Conclusion : In acute panic patients, only βAR affinity was reduced before the treatment, which was contrary to our ex-pectation. Decreased ,βAR affinity was normalized after paroxetine treatment. Decreased βAR affinity and increased βAR density before the treatment predicted good treatment response in acute panic patients. Thus, βAR affinity and density could be useful biological markers that predict the treatment response of paroxetine in panic disorder.

Identification of Patients with Recurrent Epithelial Ovarian Cancer Who Will Benefit from More Than Three Lines of Chemotherapy

설애란,임가원,정주연,김세익,이마리아,김희승,정현훈,김재원,박노현,송용상 대한암학회 2022 Cancer Research and Treatment Vol.54 No.4

Purpose This study aimed to identify patients who would benefit from third and subsequent lines of chemotherapy in recurrent epithelial ovarian cancer (EOC). Materials and Methods Recurrent EOC patients who received third, fourth, or fifth-line palliative chemotherapy were retrospectively analyzed. Patients’ survival outcomes were assessed according to chemotherapy lines. Based on the best objective response, pati-ents were divided into good-response (stable disease or better) and poor response (progressive disease or those who died before response assessment) groups. Survival outcomes were compared between the two groups, and factors associated with chemotherapy responses were investigated. Results A total of 189 patients were evaluated. Ninety-four and 95 patients were identified as good and poor response group res-pectively, during the study period of 2008 to 2021. The poor response group showed significantly worse progression-free survival (median, 2.1 months vs. 9.7 months; p < 0.001) and overall survival (median, 5.0 months vs. 22.9 months; p < 0.001) compared with the good response group. In multivariate analysis adjusting for clinicopathologic factors, short treatment-free interval (TFI) (hazard ratio [HR], 5.557; 95% confidence interval [CI], 2.403 to 12.850), platinum-resistant EOC (HR, 2.367; 95% CI, 1.017 to 5.510), and non-serous/endometrioid histologic type (HR, 5.045; 95% CI, 1.152 to 22.088) were identified as independent risk factors for poor response. There was no difference in serious adverse events between good and poor response groups (p=0.167). Conclusion Third and subsequent lines of chemotherapy could be carefully considered for palliative purposes in recurrent EOC patients with serous or endometrioid histology, initial platinum sensitivity, and long TFIs from the previous chemotherapy regimen. Purpose This study aimed to identify patients who would benefit from third and subsequent lines of chemotherapy in recurrent epithelial ovarian cancer (EOC).Materials and Methods Recurrent EOC patients who received third, fourth, or fifth-line palliative chemotherapy were retrospectively analyzed. Patients’ survival outcomes were assessed according to chemotherapy lines. Based on the best objective response, patients were divided into good-response (stable disease or better) and poor response (progressive disease or those who died before response assessment) groups. Survival outcomes were compared between the two groups, and factors associated with chemotherapy responses were investigated.Results A total of 189 patients were evaluated. Ninety-four and 95 patients were identified as good and poor response group respectively, during the study period of 2008 to 2021. The poor response group showed significantly worse progression-free survival (median, 2.1 months vs. 9.7 months; p < 0.001) and overall survival (median, 5.0 months vs. 22.9 months; p < 0.001) compared with the good response group. In multivariate analysis adjusting for clinicopathologic factors, short treatment-free interval (TFI) (hazard ratio [HR], 5.557; 95% confidence interval [CI], 2.403 to 12.850), platinum-resistant EOC (HR, 2.367; 95% CI, 1.017 to 5.510), and non-serous/endometrioid histologic type (HR, 5.045; 95% CI, 1.152 to 22.088) were identified as independent risk factors for poor response. There was no difference in serious adverse events between good and poor response groups (p=0.167).Conclusion Third and subsequent lines of chemotherapy could be carefully considered for palliative purposes in recurrent EOC patients with serous or endometrioid histology, initial platinum sensitivity, and long TFIs from the previous chemotherapy regimen.

Cognitive Factors for Predicting Treatment Response in Schizophrenic Patients: One-Year Follow-Up Study

Yong-Ku Kim,Ae-Ra Lee,Ji-Won Hur,윤호경,Bun-Hee Lee,고영훈 대한신경정신의학회 2008 PSYCHIATRY INVESTIGATION Vol.5 No.2

Objective: This study was conducted to investigate the cognitive factors that can longitudinally predict the response to treatment in patients with schizophrenia. Methods: The subjects were 49 patients with schizophrenia who were newly hospitalized in an acute psychiatry ward and had not been treated with medication for at least 8 weeks prior to the study. The symptoms and cognitive functions of the patients were evaluated at baseline before treatment (T0), at eight weeks after treatment (T1), and one year after treatment (T2). Clinical symptoms were assessed using the PANSS, and cognitive functions were estimated using the Vigilance Test, Cognitrone Test, Wisconsin Card Sorting Test (WCST), and the Korean version of the Memory Assessment Scales (K-MAS). Results: The patient group showed marked impairments in cognitive function when compared to the normal group, but the patients’ clinical symptoms and cognitive functions improved after drug treatment. The patients also showed consistent improvement in verbal and nonverbal memory function as time progressed. Furthermore, there was a significant correlation between clinical symptoms and cognitive functions in the patient group. The cognitive variables that best predicted treatment response and prognosis were total errors on the WCST and immediate list recall component of the K-MAS. It was also shown that the number of total errors on the WCST was a better cognitive predictor than the number of errors in immediate recall. Conclusion: The results of the present study show that the neurocognitive functions of patients with schizophrenia can be stabilized with treatment intervention, that treatment response is related to improvement in cognitive function, and that cognitive domains, especially executive function, can predict treatment response and prognosis in patients with schizophrenia.

HBV : PE-003 ; Clinical efficacy of entecavir therapy and predicting factors associated with treatment response in nucleoside-naive patients with chronic hepatitis B

( Beom Hee Kim ),( Beom Yong Yoon ),( Seok Hyun Kim ),( Eaum Seok Lee ),( Heon Young Lee ),( Byung Seok Lee ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-

Background: The aim of this study was to characterize the treatment response to entecavir and to examine the factors affecting that response. Methods: A total of 87 naive chronic hepatitis B patients treated with entecavir (0.5 mg daily) for at least 48 weeks were consecutively enrolled from May 2006 to May 2011. The virologic response (HBV DNA <2,000 copies/mL), biochemical response (ALT ≤ upper limit of normal), HBeAg loss and seroconversion were retrospectively analyzed. Results: The cumulative rates at 12, 24, 48, 96 and 144 weeks were 54.7%, 74%, 84.4%, 94.8% and 98.3%, respectively, for the virologic response; 54.7%, 74%, 84.4%, 94.8% and 98.3% for the biochemical response; 57.1%, 63.6%, 70.1%, 74% and 80.5% for HBeAg loss; and 55.8%, 59.3%, 63%, 64.3% and 68.1% for HBeAg seroconversion. The independent predictors associated with HBV DNA PCR negativity were an absence of HBeAg at baseline and early virologic response (HBV DNA <2,000 copies/mL after 12 weeks of therapy, p = 0.001) in a multivariate analysis. The independent factor predicting HBeAg loss was found to be early virologic response (p = 0.000) in a multivariate analysis. Conclusions: Entecavir induce excellent biochemical and virologic responses in naive chronic hepatitis B patients. Early virologic response was an independent factor for predicting HBV PCR negativity and HBeAg loss, early virologic response would be useful as a predictor of long-term treatment response of entecavir.

HBV : PE-003 ; Clinical efficacy of entecavir therapy and predicting factors associated with treatment response in nucleoside-naive patients with chronic hepatitis B

( Beom Hee Kim ),( Beom Yong Yoon ),( Seok Hyun Kim ),( Eaum Seok Lee ),( Heon Young Lee ),( Byung Seok Lee ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1

Background: The aim of this study was to characterize the treatment response to entecavir and to examine the factors affecting that response. Methods: A total of 87 naive chronic hepatitis B patients treated with entecavir (0.5 mg daily) for at least 48 weeks were consecutively enrolled from May 2006 to May 2011. The virologic response (HBV DNA <2,000 copies/mL), biochemical response (ALT ≤ upper limit of normal), HBeAg loss and seroconversion were retrospectively analyzed. Results: The cumulative rates at 12, 24, 48, 96 and 144 weeks were 54.7%, 74%, 84.4%, 94.8% and 98.3%, respectively, for the virologic response; 54.7%, 74%, 84.4%, 94.8% and 98.3% for the biochemical response; 57.1%, 63.6%, 70.1%, 74% and 80.5% for HBeAg loss; and 55.8%, 59.3%, 63%, 64.3% and 68.1% for HBeAg seroconversion. The independent predictors associated with HBV DNA PCR negativity were an absence of HBeAg at baseline and early virologic response (HBV DNA <2,000 copies/mL after 12 weeks of therapy, p = 0.001) in a multivariate analysis. The independent factor predicting HBeAg loss was found to be early virologic response (p = 0.000) in a multivariate analysis. Conclusions: Entecavir induce excellent biochemical and virologic responses in naive chronic hepatitis B patients. Early virologic response was an independent factor for predicting HBV PCR negativity and HBeAg loss, early virologic response would be useful as a predictor of long-term treatment response of entecavir.

Physiological Predictors of Treatment Response to Biofeedback in Patients With Panic Disorder

조성제,윤인영,김지수,이민지,박혜연 한국정신신체의학회 2023 정신신체의학 Vol.31 No.1

Objectives:Biofeedback is a useful non-pharmacological treatment for panic disorder (PD), but no studies have identified physiological markers related to the treatment response. This study investigated predictors of the treatment response for biofeedback in patients with PD. Methods:A retrospective study based on the electronic medical records of 372 adult patients with PD was performed. Patients received biofeedback treatment at least once, and physiological markers including heart rate, heart rate variability, respiratory rate, skin conductance, skin temperature, and electromyography were collected before the treatment began. The patients were classified as responders or non-responders based on the change in Clinical Global Impression-Severity (CGI-S) score. Results:The response rate to biofeedback treatment was 30.4%. Multivariable logistic regression analysis revealed that a higher CGI-S score at baseline and fewer benzodiazepine prescriptions were associated with a better response to biofeedback treatment. According to subgroup analyses, the baseline CGI-S score, dose of benzodiazepines, and skin conductance are candidate predictors of the response to biofeedback treatment in men, while only baseline disease severity was associated with the treatment response in women. Conclusions:The present results suggest that skin conductance may be target marker and predictor for biofeedback in male patients with PD.

Effect of Pharmacotherapy with Paroxetine on Biofeedback Measurement Variablesin Patients with Panic Disorder

Han Wook Ryu,Moon Sun Koo,Bum-Hee Yu 대한정신약물학회 2004 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.2 No.1

Much effort has been made to find reliable indicators predicting the treatment response in subjects with panic disorder. The objective of this study was to determine the effect of pharmacotherapy on the biofeedback measurement variables in patients with panic disorder. We recruited 38 patients with panic disorder (M; 25, F; 13) being treated in the Samsung Medical Center, who were diagnosed by the ADIS-IV (Anxiety Disorder Interview Schedule-IV), and 33 normal control subjects (M; 21 F; 12). The panic patients were treated with paroxetine for 3 months. All of the subjects were assessed by means of forearm and frontal electromyography (EMG), electrodermal response (EDR), and peripheral skin temperature in the baseline, stress, and recovery phases using the Procomp & Biograph biofeedback instrument. Psychological measures, viz. the Hamilton anxiety rating scale(HAM-A), Hamilton depression rating scale (HAM-D), Beck depression inventory (BDI), Spielberger state-trait anxiety inventory(STAI-S, STAI-T), and Anxiety sensitivity index (ASI), were also assessed. All measurements were performed at the beginning of the study and after 3 months of paroxetine treatment. The panic patients had significantly higher scores on the psychological measures, viz. the HAM-A, HAM-D, BDI, STAI-S, STAI-T, and ASI (all p values<0.001) before treatment. After 3 months of treatment, the panic patients showed a significant improvement as compared to the baseline EDR (z=-2.824, p=0.005), stress EDR (z=-2.691, p=0.007) and recovery EDR (z=-3.416, p=0.001). They also showed a significant improvement in terms of the HAM-A, HAM-D, BDI, STAI-S, STAI-T, and ASI (all p values <0.001) after treatment. The electrodermal response, which is one of the biofeedback measurement variables, was found to be a possible indicator predicting treatment response in panic disorder.