기분부전장애 환자군과 주요우울장애 환자군의 신경인지학적 기능 비교

강이헌,함병주,차지현,이민수,Kang, Rhee-Hun,Ham, Byung-Joo,Cha, Ji-Hyun,Lee, Min-Soo 대한생물정신의학회 2002 생물정신의학 Vol.9 No.2

Neurocognitive research focusing on cognitive deficits in Depression has resulted in several important but yet potentially contradictory findings. Much literature documents the presence of significant neurocognitive impairments in depressive patients. Studies have shown that dysthymic disorder patients demonstrate a diffuse pattern of cognitive impairment which is frequently indistinguishable from that of focal braindamaged patients. Some reports have suggested that there is a focal pattern of deficit, such as anterior cingulate dysfunction, frontal lobe impairment, or dysfunction of the temporal-limbic cortex. The aim of this study is to evaluate the neurocognitive functions in dysthymic disorder patients, and to compare the functions with those of major depressive disorder patients. The subjects are 17 dysthymic disorder patients. And their neurocognitive functions are compared with those of 23 major depressive episode patients. Patients with a history of neurologic disease, alcohol dependence, substance abuse and mental retardation are excluded. They are assessed with a part of Vienna Test System which is computerized neurocognitive function tests and can evaluate attention, eductive ability, reproductive ability, visuoperceptual analysis, vigilance, visual immediate memory, the speed of information-processing, judgement, and fine motor coordinations. There are no other specific difference between two groups, except the result of cognitrone test. This study provides information about the neurocognitive functions and some difference between major depressive disorder patients and carefully diagnosed dysthymic disorder patients.

한국형 우울증 임상진료지침 개발(II)

강이헌,김수영,이민수,Kang, Rhee-Hun,Kim, Soo-Young,Lee, Min-Soo 대한생물정신의학회 2006 생물정신의학 Vol.13 No.4

Depression has been causing huge direct and indirect losses to people's health because of its high prevalence, various clinical patterns, drug reaction and diverse courses different among individuals, but its treatment has not been systematic but dependent on individual clinicians' experience and knowledge. To correct this problem, it has been highly necessary to develop clinical guidelines defined as "systematically developed statements to assist practitioners' and patients' decisions about appropriate healthcare for specific clinical circumstances." Currently, countries throughout the world are making efforts to establish evidence-based guidelines among different levels of guidelines and to evaluate and test them. Although such efforts have been unsatisfactory in Korea because of several constraints including lack of high-quality RCT, the Korean Depression Clinical Practice Guideline has started to develop evidence-based guidelines, which are established through strictly designed processes. Thus, the present study purposed to review methods adopted in the development processes and to present the processes of developing the evidence-based guidelines clearly and transparently.

도파민 D2 수용체 다형성과 보상의존성 성격특성과의 관련성

강이헌,이헌정,곽강호,김린,이민수,서광윤,Kang, Rhee-Hun,Lee, Heon-Jeong,Kwak, Kang-Ho,Kim, Leen,Lee, Min-Soo,Suh, Kwang-Yoon 대한생물정신의학회 2004 생물정신의학 Vol.11 No.1

Background:The dopaminergic genes have been implicated with some personality traits. Many recent studies indicated that there is a correlation between D2 dopamine receptor gene(DRD2) polymorphisms and the personality traits. The purpose of this study is to investigate a possible association between DRD2 gene (TaqI A, TaqI B) polymorphism and personality traits. Methods:The subjects were consisted of 173 blood-unrelated young female Koreans with a mean age(${\pm}SD$) of 13.88(${\pm}0.29$) years. These volunteers were recruited from one of the junior high schools in Seoul and were tested by the Korean version of the Temperament and Character Inventory(TCI). Genotyping of the DRD2 polymorphisms by PCR methods were carried out. Two DRD2 gene polymorphisms were classified and individually assessed as follows:TaqI A1+ vs A1-, TaqI B1+ vs B-. The associations between the TCI scores and TaqI A, TaqI B polymorphisms were assessed by Student's t-test. Results:In the 173 subjects, the allele frequencies of the DRD2 TaqI A1, TaqI B1 alleles ranged from 0.42 to 0.43, and these results are quite different from the ranges of 0.15-0.20 in the case of a Caucasian population. The genotype frequencies of DRD2(TaqI A1, TaqI B1) variants showed no significant deviation from the Hardy-Weinberg equilibrium. RD4(dependence vs. independence) of Cloninger's TCI, a sub-dimension of Reward Dependence, was significantly higher in the subjects having DRD2 less frequent alleles than those without these alleles. Conclusion:This study suggests that the female subjects carrying the less frequent DRD2 alleles exhibited higher reward-dependent personality trait compared to those without these alleles.

주요우울장애에서의 전기경련요법

이화영,강이헌,이민수,Lee, Hwa-Young,Kang, Rhee-Hun,Lee, Min-Soo 대한생물정신의학회 2008 생물정신의학 Vol.15 No.2

Major depressive disorder(MDD) is one of the most common diseases with serious health consequences such as increased morbidity, disability, and mortality. Electroconvulsive therapy(ECT) has been used as a treatment for mental disorder since the 1930s. A growing number of recent publications support the conclusions that ECT is an effective and safe treatment for depressed patients. Dosing strategies, frequency, safety, side effects and efficacy of ECT in MDD will be considered. ECT may be an alternative to treatment with antidepressants.

지역사회 기혼 여성의 우울 증상에 영향을 미치는 변인 : 가족내 관계 만족 변인 및 갈등대처 방식을 중심으로

이경미,최윤경,강이헌,이민수 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.2

연구목적 본 연구는 지역사회 기혼 여성의 우울 증상을 사회적이고 대인관계적 측면에서 이해하고자 하는 맥락에서 살펴보고자 하였다. 방법 00시에 거주하는 기혼여성 632명을 대상으로 하여 Beck 우울증 척도, 결혼 전반적 불만족 척도, 자녀불만족 척도, 갈등 대처 방안 척도 등을 실시하였다. 통계방법으로는 기술통계분석, 상관, χ²검증, 일원변량분석, 단계적 중다회귀분석, 위계적 회귀분석을 사용하였다. 결과 학력, 수입, 부모의 관계, 학대경험, 시부모 관계만족, 결혼불만족, 자녀불만족, 이성적 대처, 감정 · 행동표출, 회피 행동에서 우울수준에 따른 집단간 차이가 유의미하였다. 또한 이들 변인 중 결혼불만족이 현재 우울증상에 대한 설명력이 가장 큰 것으로 나타났고, 다음으로 자녀불만족, 회피 행동, 시부모 관계만족 순이었다(총설명변량=36.1%). 갈등대처방식 중 이성적 대처와 회피가 가족관계 만족변인과 우울을 잠정적이지만 유의미하게 매개하는 것으로 나타났다. 결론 지역사회 기혼 여성의 상당수가 우울 증상을 경험하고 있어 이에 대한 치료적 개입이 시급하며 특히 부부 관계를 포함한 가족 관계에 대한 탐색 및 접근이 필요한 것으로 나타났다. 특히 갈등대처방식이 유의미하게 관계 만족과 우울을 매개하므로, 우울증의 치료에 있어 효과적인 갈등 대처 방식 및 사회적 문제 해결 기술을 포함시킴으로써 치료 효과를 높일 수 있을 것으로 시사된다. Objectives : The purposes of this study were to investigate depressive symptoms among married women and to their Understand depression through social and interpersonal factors. Methods : The subjects were consisted of 632 married women who lived in 00 city. They completed the Beck Depression Inventory, Marital Global Distress Scale, Dissatisfaction with Children Scale, and Conflict-coping Method Scale. Descriptive statistics, correlation, χ²-test, ANOVA, step-wise regression, and hierarchical regression were applied to analyze the data. Results : ANOVA analysis showed the differences in education, income, experience of abuse, parent-in-law relationship, marital global distress, dissatisfaction with children, rational coping, emotion/action-expression coping, and avoidant coping among the non-depressive group, mildly depressive group, and depressive group. Step-wise regression showed that the variance of the current depressive symptoms was accounted for by marital global distress, dissatisfaction with children, avoidance coping method, and satisfaction with parent-in-law (total account=36.1%). It was found that the rational coping method and avoidance coping method significantly mediated the relationship between the satisfaction with family relation and depressive symptoms. Conclusion : Therapeutic interventions for the married women experiencing depressive symptoms showed include their marital relationship. Based on the finding that the conflict coping methods mediated the association between the depressive symptoms and the family relation satisfaction, the effective conflict coping skills or social problem solving skills should be included in the interventions for married women.

한국인 주요우울증 환자에서의 세로토닌 5A 수용체의 유전자 다형성 및 Citalopram 치료반응과의 관련성

심진현,백종우,오정웅,강이헌,이화영,이민수,Shim, Jin-Hyun,Paik, Jong-Woo,Oh, Jeung-Woong,Kang, Rhee-Hun,Lee, Hwa-Young,Lee, Min-Soo 대한생물정신의학회 2008 생물정신의학 Vol.15 No.4

Objectives : Some reports have suggested that 5-HT5A polymorphism allelic association was associated with depression, however, there has been no report about relationship between the 5-HT5A gene and antidepressant response. We conducted the association study of the 5-HT5A receptor gene polymorphisms (-19G/C,12A/T) and response to citalopram in Korean patients with major depressive disorder(MDD). Methods : A total of 106 patients with major depressive disorder were included in this study. The patient's symptoms were measured by 21-item Hamilton Depression Rating Scale(HAMD) at baseline, week 1, week 2, week 4 and week 8 during citalopram treatment. A Responder to citalopram was defined by 50% reduction of total HAMD scores. To analyze genetic polymorphisms, a polymerase chain reaction based method was used. Results : At week 8, responders were 62, non-responders were 44. No significant differences of genotypes or allelic association in 19G/C and 12A/T polymorphisms were observed between responsive and non-responsive patients. Conclusion : These results do not support the hypothesis that this polymorphism of the HT5A receptor gene is involved in the therapeutic response to citalopram.

한국인 우울 장애 환자에서 Brain-Derived Neurotrophic Factor(BDNF)의 유전자 다형성과 항우울제의 장기 치료 반응

구재우,이화영,백종우,강이헌,이민수,Koo, Jae-Woo,Lee, Hwa-Young,Paik, Jong-Woo,Kang, Rhee-Hun,Lee, Min-Soo 대한생물정신의학회 2006 생물정신의학 Vol.13 No.3

Objective : Since some studies have shown that the brain-derived neurotrophic factor(BDNF) has an important role in the pathophysiology of depression, this study investigated the relationship between BDNF genetic polymorphism and the long-term outcome of the antidepressant treatment. Method : One hundred and eight patients with major depressive disorder were evaluated for the long-term outcome(up to 3 years) of antidepressant treatment. The severity and improvement of depression were assessed with the Clinical Global Impression(CGI) Scale. The genotypes of BDNF 196A/G polymorphism in the patients were determined using Restriction Fragment Length Polymorphism(RFLP). Result : The genotypes of 128 patients were investigated and 95 patients of those have been evaluated for 3 years. No significant differences were noted comparing three-genotype groups for CGI scales at baseline, 4 weeks, 8 weeks, 1 year, 2 years and 3 years. Conclusion : This result shows that BDNF polymorphism investigated in this study was not associated with the long-term outcome of the antidepressant treatment. However, further studies with another BDNF polymorphism should be needed.

주요우울증 환자에서 세로토닌 6(5-HT6) 수용체 C267T 다형성과 Citalopram 치료반응에 대한 연구

한상우,임세원,오강섭,강이헌,이민수,Hahn, Sang-Woo,Lim, Se-Won,Oh, Kang-Seob,Kang, Rhee-Hun,Lee, Min-Soo 대한생물정신의학회 2007 생물정신의학 Vol.14 No.4

The serotonin 6(5-HT6) receptor gene is a candidate gene for influencing the clinical response to treatment with antidepressants. The purpose of this study was to determine the relationship between the C267T polymorphism in the 5-HT6 receptor gene and the treatment response to citalopram in a Korean population with major depressive disorder(MDD). Methods : Citalopram was administered for 8 weeks to the 90 patients who completed study. 21-item Hamilton depression rating scale(HAMD-21) was used as a outcome measure. Results : We found that the genotype, allele, and allele-carrier distributions did not differ significantly between MDD patients and normal controls. A main effect of an interaction of genotype with time on the decrease in the HAMD-21 score during the 8 weeks study period was not found. ANOVA revealed no significant effects of the C825T polymorphism on the decrease in the HAMD-21 score at each time period. Conclusions : These results suggest that the C267T polymorphism in the 5-HT6 receptor gene is not associated with the treatment response to citalopram.

Evidence-Based, Non-Pharmacological Treatment Guideline for Depression in Korea

박성철,오홍석,오동훈,정승아,나경세,이화영,강이헌,최윤경,이민수,박용천 대한의학회 2014 Journal of Korean medical science Vol.29 No.1

Although pharmacological treatment constitutes the main therapeutic approach for depression, non-pharmacological treatments (self-care or psychotherapeutic approach) are usually regarded as more essential therapeutic approaches in clinical practice. However, there have been few clinical practice guidelines concerning self-care or psychotherapy in the management of depression. This study introduces the ‘Evidence-Based, Non-Pharmacological Treatment Guideline for Depression in Korea.’ For the first time, a guideline was developed for non-pharmacological treatments for Korean adults with mild-to-moderate depression. The guideline development process consisted of establishing several key questions related to non-pharmacologic treatments of depression, searching the literature for studies which answer these questions, assessing the evidence level of each selected study, drawing up draft recommendation, and peer review. The Scottish Intercollegiate Guidelines Network grading system was used to evaluate the quality of evidence. As a result of this process, the guideline recommends exercise therapy, bibliotherapy, cognitive behavior therapy, short-term psychodynamic supportive psychotherapy, and interpersonal psychotherapy as the non-pharmacological treatments for adult patients with mild-to-moderate depression in Korea. Hence, it is necessary to develop specific methodologies for several non-pharmacological treatment for Korean adults with depression.

가족 환경이 아동의 자기 개념에 미치는 영향

이소영(Soyoung Irene Lee),정한용(Han-Yong Jung),백종우(Jong-Woo Paik),강이헌(Rhee-Hun Kang),이민수(Min-Soo Lee) 대한사회정신의학회 2006 사회정신의학 Vol.11 No.1

목 적: 본 연구에서는 초등학생들을 대상으로 자기 개념과 가족 환경을 평가하여 가족이 아동의 자기 개념 형성에 영향을 미치는지 알아보고자 하였다. 방 법: 과천시에 거주하는 초등학교 1학년부터 6학년 학생 1,500명에게 한국판 소아자기개념척도와 한국판 가정환경척도를 평가하도록 한 후, 자기 개념과 가족 환경 간의 상관관계를 알아보았고 가족 환경이 자기 개념에 미치는 영향을 알아보기 위해 회귀 분석을 실시하였다. 결 과: 총 1,338명(남=666명;여=672명)의 결과를 분석한 결과, 가족 환경의 결합력, 지적 및 학업상태 그리고 조직화 영역이 아동의 자기 개념과 정적 상관관계를, 그리고 가족의 갈등은 부적 상관관계를 나타내었다. 특히 가족의 결합력은 아동의 자기 개념 변이의 18.2%를 설명하였다. 결 론: 초등학생들의 자기 개념은 가족 구성원들과의 관계 속에서 다양하게 표현되고 있다. 따라서 아동의 자기 개념을 평가할 때에는 아동의 가족 체계에 대한 이해가 함께 이루어져야 한다. 가족의 결합력과 지적이고 문화적인 활동을 추구하는 경향은 자녀의 자기 개념에 긍정적인 영향을 미치고, 가족의 갈등은 부정적인 영향을 미친다. Purpose:The purpose of this study was to evaluate the influence of family on the self concept of elementary school children by assessing the family environment and children’s self concept. Methods:1,500 elementary school children from grade one to six living in Gwacheon city were instructed to complete the Korean Form of Piers-Harris Children’s Self Concept Scale(K-PHCSCS) and Family Environment Scale(K-FES). Correlational and regression analyses were used to evaluate the relationship between family environment and self concept. Results:Cross-sectional analyses of 1,338 children(666 male, 672 females) indicated that among the K-FES subscales, cohesion, intellectual-cultural orientation, and organization were positively correlated to the self concepts of the children, and the conflict subscale was negatively correlated. Particularly, the family cohesion accounted for 18.2% of the variance in the child’s self concept rating. Conclusion:The self concept of the elementary school children are variably expressed within the context of the relatedness between the family members. Therefore, appreciation of the family system should be included when assessing the self concept of the children. The cohesion and the intellectual and cultural orientation of the family impact positively on the self concept of the offsprings, while the family conflict has an negative impact.