약물과 성기능

민성길,송동호 최신의학사 1986 最新醫學 Vol.29 No.11

뚜렛 장애의 임상적 연구

민성길,신동원,노경선 대한소아청소년정신의학회 1997 소아청소년정신의학 Vol.8 No.1

정신과 의뢰에 대한 임상적 연구

민성길,조강주 大韓神經精神醫學會 1977 신경정신의학 Vol.16 No.2

A clinical study was done with 307 inpatients (1.84% in all patients) referred for psychiatric consultation in Yonsei Medical Center for last one year. Referral was common in 20-49 year age group and male to female ratio was almost equal. Most of referrals came from the department of internal medicine (table 1). The reasons of referrals were general evaluation and managment of the patients. Primary diagnosis before consulation were mostly physical ones, and drug intoxication due to suicidal attempt, G-I disorders, convulsive disorders, heart disorders and head traumas were the major problems. But psychiatrist made psychiatric diagnosis in 95.6%, and depressive neurosis, hysterical neurosis, involutional melancholia and psychosomatic disorders were most common (table 2), and thought physical diseases concurrent with psychiatric diseases in 66.3% (table 3). In general, depression was found to be an important and most common psychiatric problem complicated with physical diseases. Psychiatric problems were commonly correlated with the disorders of G-I, nervous and cardiovascular systems and especially the depression with G-I disorders. The data appeared to reflect the general tendency of physicians not to accept the opinions of psychiatrists on the diagnosis and management except psychotropic medication. Psychiatric consultation liaison service is important in collaboration between psychiatry and medicine in comprehensive patient care and teaching the psychosomatic aspects of the diseases.

Lorazepam 남용 6례

민성길 大韓神經精神醫學會 1982 신경정신의학 Vol.21 No.1

With brief review of literatures on abuse of benzodiazepines, the author reported 6 cases of lorazepam abuse and discussed their characteristic clinical features. Of 6 cases, 5 were females and daily dosages of lorazepam were 20 to 150mg and durations of abuse were 6 months to 7 years. Their premorbid personality was characterized by dependence, introversion, social isolation and sensitivity. They had begun to abuse the drug mainly due to anxiety, insomnia and neurotic somatic symptoms soon after object loss such as death of significant persons. Accordingly, it seemed that abuse resulted from defense against object loss and from oral gratification. As combined substances, alcohol, analgesics, diuretics and psychostimulants were reported in some of the patients. All the patients said that they had to take the drug and had to increase the dosage to relieve anxiety, insomnia, and neurotic somatic symptoms, but some of the patients expected or experienced some euphoric effect from lorazepam. Though the dosage was very heavy and the duration of abuse wa??? extended, no significant physical side effects or complications were found in any of them except drowsiness and weakness that could be found with therapeutic dose. Tolerance seemed to develop in relatively short time and the main reason seemed to be strong oral craving, culminating to psychological dependence rather than physical dependence. On withdrawal, severe anxiety, insomnia and somatic symptoms as headache and agitation have developed in all patients, which were considered as rebound phenomena. In addition, rigidity and tremor around mouth and extremities, paresthesia, perspiration, impulsive destructive behavior, depression, and psychosis-like menifestations which could be considered as true withdrawal symptoms have developed in some patients who had taken larger does of about 100mg a day. Most of them have been treated in hospital with medically supportive treatment, complete discontinuation of lorazepam and medication of tricyclic antidepressants and phenothiazines against possible withdrawal symptoms The treatment result was succeseful on a short term but in long term perspective, prognosis may be less favourable. The clinical feature of lorazepam abuse seems not to be so different from general feature of other benzodiazdpine abuses.

우울증에서 보는 신체증상에 관한 연구

민성길,김경희 大韓神經精神醫學會 1978 신경정신의학 Vol.17 No.2

Two hundred and one inpatients with diagnosis of depressive neurosis, involutional melancholia and psychotic depression (including depression of manic-depressive psychosis) who had been found free from physical illness were studied for their somptoms in relation to diagnosis, sex, age, precipitating factor, premorbid personality and coexisting psychological feature. Average number of somatic symptoms recorded in charts was 4.8 (SD 1.56) per patient. Females and patients with depressive neurosis and involutional melancholia complained more somatic symptoms. Insomnia was most common and was significantly associated with loss-separation. Headache was more common in men and was significantly associated with obsessive personality, hostility, anxiety and depressive ideas. But somatic pain was more common in women and neurotic depression, and was significantly associated with hostility. Paresthesia was more common in involutional melancholia but otherwise was similar to somatic pain. Fatigability was more common in men and neurotic depression and was significantly associated with schizoid personality and fear for disease-death. Dizziness was more common in women and was associated with anxiety. Indigestion-anorexia was the second most common and complained more by women and depressive neurotics and was significantly associated with obsessive and schizoid personality, stress-frustration and with various emotional disturbances. Dyspnea and palpitation were similar to gastrointestinal complaints but were associated significantly with hostility. These result suggest that the choice of somatic symptoms in depression is influenced by some psychodynamic factors, and that more complaints of visceral systems, especially of gastrointestinal system may be characteristic for korean patients.

Alprazolam의 항불안 및 항우울 효과에 대한 이중맹 치험

민성길,이호영,연규월 大韓神經精神醫學會 1986 신경정신의학 Vol.25 No.1

Forty-seven out patients with generalized anxiety disorder by DSM-Ⅲ criteria were randomly assigned to receive ether alprazolam or placebo. The dosage of alprazolam was 1.5 to 2.0㎎ per day and treatment period was 2 weeks. Clinical evaluation with Hamilton's anxiety scale and depression scale were done on the double blind basis before(baseline) and after treatment. The changes from baseline were compared between placebo and active drug groups. The result of study showed that alprazolam produced significantly more clinical improvement than did placebo in both anxiety and depression. The side effects as anticholinergic effects were not reported for alprazolam as well as placebo. Tolerance and withdrawal symptoms were not noted during the study period of 4 weeks.

뚜레장애 환자의 가족력에 관한 연구

민성길,이혜련 大韓神經精神醫學會 1989 신경정신의학 Vol.28 No.5

Semi-structured Interviews were perfomed with 56 patients with Tourette's disorder and their 208 first-degree relatives to collect informations about family history of Tourette's disorder, chronic motor tic disorder, chronic vocal tic disorder, obsessive-compulsive disorder and attention deficit-hyperactivity disorder. Of 56 patients, 12 (21.4%) had positive family history of Tourette's disorder and/or chronic tic disorders in their first-degree relatives, and 31 patients (55.4%) had some family history in extended family membrers including first-degree relatives. Fifteen (7.21%) of 208 first-degree relatives had either Tourette's or chronic tic disorders. These findings of higher risk of those disorders in family members of Tourette's patients suggest that Tourette's disorder is inherited and is genetically related to chronic tic disorders. It was also found that 14 (6.73%) of 208 first-degree relatives had obsessive-compulsive disorder. This is relatively high incidence comparing that of general population, suggestmg the possible genetic relationship between Tourette's disorder and obsessive-compulsive disorder. However, only 5 (2.40%) of 208 first-degree relatives had attention deficit-hyperactivity disorder, suggesting that attention deficit-hyperactivity disorder may not be genetically related with Tourette's disorder.

뇌기능과 창의적 사고의 개발

민성길 연세대학교 신과대학·연합신학대학원 1999 연세대학교 연신원 목회자 하기 신학세미나 강의집 Vol.- No.19

Benzodiazepine계 약물의 사용과 의존성

민성길 大韓神經精神醫學會 1991 신경정신의학 Vol.30 No.3

The world-wide use of benzodiazepine increased steadily until the late 1970's. Since then. as the abuse of and dependence on benzodiazepine became public knowledge. the prescription of benzodiazepine by physicians has become conservative. In Korea. however. the number of prescriptions seems to be continuously increasing. Recently, the dependence and withdrawal symptoms with the therapeutic dose of benzodiazepion has been noted to be as severe and dangerous as those in chronic abuse with larger doses. The severity of benzodiazepine dependence and withdrawal symptoms seems to be related to the pharmacokinetic characteristics of the drug. The previously most popular one was diazepam. and lorazepam is most popular these days. Author has also described the nature of benzodiazepine dependence and withdrawal symptoms. the techniques for withdrawing benzodiazepine and guidelines recommended by experts for the prevention of benzodiazepine dependence. i.e., avoiding unnecessary chronic treatment.

항정신병 약물 비복용 정신분열증 환자의 99m-Tc-ECD SPECT로 측정한 국소뇌혈류량과 증상과의 관계

민성길,이종두,전덕인,안석균 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.3

정신분열증에서 양성 및 음성증상은 각기 독립적인 차원으로 기저의 병태생리, 신경 회로 기질 역시 다를 것이라고 제안되어 왔는 바, 양성증상은 전두엽과 해마복합체의 연결 경로의 이상으로, 음성증상은 전두엽과 기저 신경절 회로의 이상으로 야기된다고 제시된 바 있다. 따라서 본 연구에서는 양성 및 음성증상차원과 전두엽, 기저신경절, 시상 및 내·외측 측두엽의 국소뇌혈류량과의 관련성을 규명하고자 하였다. 항정신병 약물 비노출 혹은 비투여 정신분열증 환자를 대상으로 안정 상태에서 SPECT를 촬영하여 국소뇌혈류량을 구하였고, 이를 PANSS로 평가한 양성 및 음성 증상차원의 점수와의 상관관계를 관찰하였다. 연구결과 1) 양성증상차원의 점수는 고전두엽의 상대적 혈류 지표와 양의 상관관계를 보였으며, 내측 측두엽의 상대적 혈류 지표와는 음의 상관관계를 보였다. 2) 음성증상차원의 점수는 저전두엽의 상대적 혈류 지표와 양의 상관관계를, 기저신경절 및 시상의 상대적 혈류 지표와는 음의 상관관계를 보였다. 정신분열증에서 양성증상차원은 전두엽과 해마 복합체 등의 내측 측두엽의 연결 회로 구조물과 관련되어 있을 가능성이 있으며, 또한 음성증상차원은 전두엽-기저신경절 경로의 구조물과 연관되어 있을 가능성이 시사된다. 향후 임상 증상을 세분화하여 정신병적 증상차원, 혼란 증상차원 및 음성증상차원의 세 가지 차원과 국소 뇌혈류량과의 관련성을 규명하는 연구가 필요하다고 생각된다. Symptom profiles in schizophrenia consists of positive and negative symptom dimensions which are considered to be related to different underlying pathophysiologies and neural substrates. The purpose of the study was to identify the possible relationship between relative regional cerebral perfusion and positive and negative symptom dimension in unmedicated patients with schizophrenia. Twenty-seven unmedicated patients with schizophrenia(13 patients who were antipsychotic drug-naive and 14 patients who had been drug-free for at least 1 week) were included in the study. Regional cerebral perfusion was studied with the single-photon emission computed tomography(SPECT). Symptom dimensions were assessed with positive and negative syndrome scale(PANSS). The scores of each symptom dimension were correlated with regional cerebral perfusion. The results were 1) positive symptom dimension score was significantly related to decreased perfusion in the medial temporal lobe and increased perfusion in the frontal lobe, 2) negative symptom dimension score was significantly related to decreased perfusion in the basal ganglia, thalamus and increased perfusion in the frontal lobe. These results suggest that positive symptom dimension is associated with the dysfunction of the link between the frontal lobe and the medial temporal lobe and that negative symptom dimension is related with the impairment of frontal-basal ganglia circuit.