강박장애 환자의 지능과 신경심리검사 소견

김찬형,이성훈,김지웅,이희상,김경희,이홍식,Kim, Chan-Hyung,Lee, Sung-Hoon,Kim, Ji-Woong,Lee, Hee-Sang,Kim, Kyung-Hee,Lee, Hong-Shick 대한수면의학회 1998 수면·정신생리 Vol.5 No.2

목적 : 저자들은 강박장애 환자의 대뇌기능을 알아보기 위해 신경심리검사 바테리를 이용하여 정상대조군과 비교하였다. 방법 : 강박장애군(12명)과 연령 및 교육을 짝짓기한 정상대조군(17명)에게 신경심리검사 바테리를 시행하였다. 결과 : K-WAIS 검사상 전체지능은 강박장애군 115.2(${\pm}9.9$), 정상대조군 111.8(${\pm}8.4$)로 양군간에 유의한 차이가 없었다. 그러나 언어성 지능의 경우 강박장애 환자군($118.0{\pm}10.6$)이 정상대조군($110.3{\pm}9.4$)보다 유의하게 높았으나(P=0.049), 동작성 지능은 강박장애군($108.4{\pm}11.7$)이 정상대조군($114.4{\pm}11.2$)보다 낮은 경향을 보였다. 양군간의 소검사 항목점수를 비교하면 tactual performance test의 전체시간에서 강박장애군(15.26분)이 정상대조군(9.56분) 보다 유의하게 길었으며(P=0.028), 양손 수행에서도 강박장애군(0.16)의 수행이 정상대조군(0.38) 보다 유의하게 떨어졌다(P=0.047). 전체적인 Halsted Reitan 손상지수도 강박장애군($3.17{\pm}2.1$)이 정상대조군($1.31{\pm}1.8$) 보다 유의하게 높았다(P=0.019). 웨슬러 기억검사의 시각회상에서도 강박장애군($12.3{\pm}1.6$)이 정상대조군($13.4{\pm}0.9$)에 비해 기능이 유의하게 떨어졌다. 결론 : 강박장애 환자는 정상대조군에 비해 공간구조 인지기능의 장애, 과잉된 언어 및 집중력을 보이고 있고, 이는 강박장애 환자의 언어기능과 공간구조 인식기능의 불균형이 강박장애 환자의 정신병리와연관 될 수 있음을 시사한다. 향후 강박장애 환자에서 신경 심리 검사상 보이는 이상소견이 강박장애의 특정적인 소견인가, 치료경과에 따라 선경 심리검사상의 이상소견이 영향을 받는가에 대한 연구가 이어져야할 것으로 생각된다. Objectives : This study was aimed to investigate the differences in intelligence and neuropsychological test findings between patients with obsessive-compulsive disorder(OCD) and normal controls, and to find out brain functions. Methods : To examine the brain functions, Halsted Reitan neuropsychological test, computerized neuropsychological test, Wechsler Memory scale and K-WAIS were applied. Subjects of this study consisted of 12 patients with OCD and 17 normal controls who were matched for age, handedness and education year. Results : The verbal intelligence of OCD was significantly higher than that of normal controls. But there was no significant difference in total and performance intelligence between groups. The total time of tactual performance test in OCD was significantly delayed than that in normal controls. Also the visual recall of Wechsler memory scale in OCD was more impaired than that in normal controls. Conclusion : These findings support that visual-spatial memory, which is related to basal ganglia, is impaired in OCD.

상법상 실제운송인의 손해배상책임에 관한 비판적 고찰과 입법론

김찬형,KIM, Chan-Young 한국무역상무학회 2016 貿易商務硏究 Vol.69 No.-

Under the Korean legal system, as an actual carrier is not the contractual party to the contract for carriage of goods by sea, it has been tortiously liable for the damage to, or loss of cargo, should there be the negligence by its part. However, the Rotterdam Rules introduces a revolutionary liability regime for the actual carrier. According to the Rotterdam Rules, the liability of the actual carrier is same with that of a contractual carrier with the result that a shipper is entitled to bring the direct action to the actual carrier, as well as the contractual carrier on the same basis. Nevertheless, it is expected to take long time for the new approach in respect of actual carrier's liability to be confirmed by many countries, and furthermore most of shipping countries including Korea still adopt the Hague-Vis by Rules where the shipper is not allowed to bring the direct action to the actual carrier. This study reviews on whether or not the alteration of actual carrier's liability based on Rotterdam Rules would be reasonable, considering the current Korean legal system. Furthermore, this study, whilst recognizing that the overall introduction of the new liability regime is somewhat premature, suggests the imposition of contractual liability to the actual carrier from a long-term perspective. Having in mind that the article 809 of the Korean Commercial Act allows the shipper to bring the direct action to the shipowner only in the case that a time charterer is the contractual carrier, this study explores a method to apply the contractual liability to the actual carrier in the case that a slot charterer or freight forwarder is the contractual carrier, in order to establish the uniform liability system.

만성 정신분열증 환자에서 Clozapine의 치료반응과 혈장 Homovanillic Acid 및 5-Hydroxyindoleacetic Acid 농도와의 관계

김찬형,이홍식,김광현,유계준,Kim, Chan-Hyung,Lee, Hong Shick,Kim, Kwang Hyeon,Yoo, Kae Joon 대한생물정신의학회 1997 생물정신의학 Vol.4 No.1

본 연구는 27명의 만성 정신분열증 환자들을 대상으로 비정형적 항정신병 약물인 clozapine을 8주간 투여하여 임상증상 치료반응(PANSS와 CGI 척도 이용)과 혈장 대사물(혈장 HVA 농도, 5-HIAA 농도 및 HVA/5-HIAA 농도비 측정) 변화와의 상관관계를 알아보고, 아울러 clozapine 치료 반응군과 치료 비반응군간의 약물투여전 기준 혈장 대사물과 clozapine투여 8주후 대사물의 변화율을 비교하여 혈장 대사물 농도가 clozapine 치료의 예측인자로서 가능성이 있는 가를 알아 보기 위하여 시행되었다. 전체 연구대상군에서 clozapine 투여기간에 따른 혈장 HVA 농도, 5-HIAA 농도는 각각 유의한 감소가 있었으나, 혈장 HVA/5-HIAA 농도비는 유의한 변화가 없었다. 전체 연구대상군에서 clozapine 투여 8주 후 혈장 HVA 농도변화율, 혈장 5-HIAA 농도변화율, 혈장 HVA/5-HIAA 농도비 변화율 각각과 8주후 정신병리(PANSS 양성척도점수, 음성척도점수, 일반정신병리척도 점수, 전체점수) 변화율과의 상관분석결과 혈장 HVA 변화율은 PANSS 양성척도점수 변화율, 일반정신병리척도 점수 변화율, 그리고 전체점수의 변화율과 각각 유의한 정 상관성이 있었으며, 반면 혈장 5-HIAA 농도 변화율은 PANSS 음성척도점수 변화율과 유의한 정 상관성이 있었다. 전체 연구대상군에서 clozapine 투여 8주 후 혈장 HVA 농도변화율은 PANSS 양성척도 항목중 특히 망상 및 환각행동 항목점수의 변화율과 각각 유의한 정 상관성이 있었으며, PANSS 음성척도 항목중에서는 대화흐름 및 자발성 결여 항목점수의 변화율과 유의한 정 상관성이 있었다. 혈장 5-HIAA 농도 변화율은 PANSS 음성척도 항목 중 둔마된 정동, 빈약한 신뢰감 항목 점수의 변화율과 각각 유의한 정 상관성이 있었다. Clozapine 투여 8주 후 PANSS 전체점수가 20% 이상 감소되고 CGI 심도점수가 경도 이하인 경우를 치료반응의 기준으로 정의했을 때, 전체 27명의 대상환자 중 48%(13명)가 치료반응군이었다. Clozapine 치료 반응군(N=13명)과 치료 비반응군(N=14명)의 비교에서 약물투여 전 기준 혈장 HVA 농도와 기준 혈장 HVA/5-HIAA 농도비는 치료 반응군이 유의하게 높았으며, 기준 혈장 5-HIAA 농도는 양 군 간의 유의한 차이가 없었다. Clozapine 치료반응군의 경우 약물투여 8주 후 혈장 HVA 농도가 40.3% 감소하고, 치료 비반응군은 혈장 HVA 농도가 3.1% 증가하여 양군 간의 유의한 차이를 보였다. Clozapine 투여 8주 후 혈장 5-HIAA 농도변화율과 혈장 HVA/5-HIAA 농도비 변화율은 치료반응군과 비반응군 간에 각각 유의한 차이가 없었다. 이상의 연구결과는 만성 정신분열증 환자에서 clozapine의 항정신병효과 중 양성증상은 도파민 길항효과와 관련이 있고, 음성증상은 세로토닌 길항효과와 관련이 있음을 시사하였다. 또한 만성 정신분열증 환자에서 약물투여 전 혈장 HVA 농도와 약물투여 후 혈장 HVA 농도변화가 각각 clozapine의 치료반응 예측인자로서 이용 가능성이 있음을 시사하였다. This study was done to examine changes of plasma homovanillic acid(HVA), 5-hydroxyindoleacetic acid(5-HIAA), and HVA/5-HIAA ratio during an 8-week clozapine trial and to investigate the relationship between the plasma monoamine metabolites and treatment responses. Twenty-seven chronic schizophrenic patiens were treated for 8 weeks with clozapine. The psychopathology was assessed at baseline just clozapine trial and then every 2 weeks until the end of 8-week clozapine treatment using the Positive and Negative Syndrome Scale(PANSS) and the Clinical Global Impression scale(CGI). The plasma HVA and 5-HIAA levels were measured also biweekly using high preformance liquid chromatography with electrochemical detection method. Plasma HVA and 5-HIAA levels were significantly decreased during a 8-week clozapine treatment, although plasma HVA/5-HIAA ratio showed no significant change. The changes of plasma HVA levels were in significant correlations with the changes of PANSS positive scores, of general psychophathology scores, and changes of total socres. The changes of plasma 5-HIAA levels were in signfificant correlations with the changes of PANSS negative scores. But the changes of plasma HVA/5-HIAA ratio had no significant correlation with any PANSS subscale score changes. 48% of the patients treated with clozapine was categorized as responders, who showed at least a 20% decrease in PANSS total socre and a CGI severity score of mildly ill or less(${\leq}3$) at the end pint of the study. The baseline plasma HVA levels and HVA/5-HIAA ratio were significantly higher in responders(N=13) than in nonresponders (N=14). But no significant difference in baseline levels of plasma 5-HIAA was found between responders and nonresponders. At the end point of the study, there was significant difference in the change of plasma HVA between responders(40.3% decrement) and nonresponders(3.1% increment). But no signficant differences in the change of plasma 5-HIAA and the change of plasma HVA/5-HIAA ratio between responders and nonresponders were observed. These results suggest that the antipsychotic effect of clozapine on positive symptoms may be associated with dopaminergic blocking activity, and that on negative symptoms may be associated with serotonergic blocking activity. The baseline plasma HVA levels and the change of HVA levels from baseline may be useful predictors of treatment response with clozapine.

정신과 영역에서의 신경심리학 - 신 경 증 -

김찬형,이성훈,Kim, Chan-Hyung,Lee, Sung-Hoon 대한수면의학회 1995 수면·정신생리 Vol.2 No.2

The goal of neuropsychological tests is to identify the neuropsychological dysfunction in psychiatric disorders such as organic mental disorders and schizophrenia, to develop the exe-cutive and monitor treatment plan and to make a cognitive rehabilitation program. Also, it will provide a more useful information that neurpsychological tests will be applied to neurotic out-patients in combination with conventional psychological test. However, many researches should be performed to further clarify the usefulness of neuropsychological test in neurosis.

강박장애의 병태생리와 치료에 있어 세로토닌의 역할

김찬형,Kim, Chan-Hyung 대한생물정신의학회 1997 생물정신의학 Vol.4 No.2

The clinical efficacy of serotonin reuptake inhibitors such as clomipramine in the treatment of obsessive compulsive disorder(OCD) has fueled interest in the neurobiological basis of this illness. OCD is responsive exclucively to potent serotonin reuptake inhibitors clomipramine, fluoxetine, fluvoxamine, sertraline, and paroxetine and this point forms the important evidence supporting a cental role for serotonin in the pathogenesis of the disorder. Other serotonergic medications such as lithium, buspirone, trazodone, or fenfluramine may be useful as adjuvant treatments in treatmentrefractory OCD and adjuvant antipsychotics are useful in tic disorders, personality disorders, and psychotic disorders. This paper reviews results of treatment studies, investigations of biological markers, and neuroendocrine challenges and implications for the role of serotonin in pathophysiology and treatment of OCD.

The Biological Treatment of Obsessive Compulsive Disorder

김찬형,구민성,Eun-Joo Kim 대한정신약물학회 2010 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.8 No.2

Obsessive-compulsive disorder (OCD) is a mental disorder characterized by obsession, in which intrusive thoughts or images that cause anxiety and stress are repeated, and by compulsion, in which behaviors aimed at reducing such anxiety are repeated. In this paper, drug treatment for OCD is described based on randomized controlled trials (RCTs) and open-label trials listed in PubMed (www.pubmed.gov; US National Library of Medicine, National Institutes of Health). In addition, we will summarize recent challenges in the treatment of obsessive-compulsive disorder.

Clinical Predictors of Drug Response in Patients with Obsessive-Compulsive Disorder

김찬형,Jae-Wook Jeong,Eun Ju Kim,Yoon Shick Shin,Ho Suk Suh,이홍식,구민성 대한정신약물학회 2011 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.9 No.1

Objective: The aim of this study was to evaluate which clinical variables might influence the antiobsessional responses to proserotonergic drugs in a sample of patients with obsessive-compulsive disorder (OCD). Methods: Two hundred forty-nine patients with DSM-IV OCD under-gone mean 13-month treatments with selective serotonin reuptake inhibitors. According to the treatment response, defined as a reductions of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) total score ≥35%, patients were divided into two groups. Results: One hundred fourteen patients responded to the treatment and the other one hundred thirty five patients did not. Responders had a significant long duration of medication in YUMC OCD clinic, short total duration of past treatment in other institutes, and higher frequency of drug naïve cases and lower baseline Y-BOCS scores. Conclusion: The pre-treatment factors including total duration of past treatment, drug naïve or not, baseline OCD symptoms and the factor of duration of the treatment may influence drug treatment response in OCD patients.

복합유기용제에 노출된 근로자들의 스트레스지각 및 정신병리

김찬형,고경봉,Kim, Chan-Hyung,Koh, Kyung-Bong 한국정신신체의학회 1993 정신신체의학 Vol.1 No.1

저자들은 GARS(Global Assessment of Recent Stress)척도와 SCL-90-R(Symptom Checklist-90-Revision)을 사용하여 동일한 산업장에서 유기용제에 노출된 근로자들과 노출되지 않은 근로자들 간의 스트레스지각과 정신병리를 비교하였다. 유기용제 노출군은 비노출군보다 일-직장, 대인관계의 변화, 질병 및 상해, 경제적 문제, 그리고 전체적인 스트레스지각점수에 있어서 유의하게 더 높았다. 정신병리에 있어서는 유기용제노출군이 비노출군보다 신체화척도점수에 있어서만 유의하게 더 높았다. 그러나 유기용제에 노출된 기간과 정신병리 간에는 유의한 차이가 없었다. 양군 모두에서 여자는 남자보다 정신병 리가 유의하게 더 현저하였고, 연령은 정신병리와 유의하게 음 상관성을 보였다. 이상의 결과들은 유기용제노출군이 비노출군보다 스트레스지각 및 정신병리가 더 현저함을 시사해 준다. 따라서 기업주는 물론 보건정책 수립자들이 유기용제에 노출되는 근로자들의 건강 특히 정신건강에 대해 관심을 기울여야 할 것이다. A comparison was made between workers exposed to organic solvents and those not exposed to them regarding stress perception and psychopathology, using GARS scale and SCL-90-R. The exposed group scored significantly higher than the non-exposed group in stress perception relevant to job-wort changes in relationship, sickness or injury, financial, and overall global area. The exposed group was significantly higher in somatization scale than the non-exposed group. However, there was no significant correlation between duration of exposure and psychopathology. In each of the groups. female workers showed more psychopathology than male ones. Age showed significantly nagative correlation with psychopathology. These results suggest that the exposed group shows higher stress perception and more psychopathology than the non-exposed group. Thus. it is emphasized that health policy makers as well as employers should pay more attention to health. espcially mental health for the workers exposed to organic solvents.

감정표현 평가 시스템 개발 및 실험적 적용

한기완(Kiwan Han),김광욱(Kwanguk Kim),구정훈(Jeonghun Ku),장희정(Hee Jeong Jang),박준영(Junyoung Park),김인영(In Young Kim),김재진(Jae-Jin Kim),김찬형(Chan Hyung Kim),김선일(Sun I. Kim) 한국HCI학회 2006 한국HCI학회 학술대회 Vol.2006 No.2

6 MV 광자빔에 대한 MicroLion 액체이온함의 특성 연구

최상현,허현도,김성훈,지영훈,김금배,김우철,김헌정,신동오,김찬형,Choi, Sang-Hyoun,Huh, Hyun-Do,Kim, Seong-Hoon,Ji, Young-Hoon,Kim, Kum-Bae,Kim, Woo-Chul,Kim, Hun-Jeong,Shin, Dong-Oh,Kim, Chan-Hyeong 한국의학물리학회 2011 의학물리 Vol.22 No.4

최근 PTW사에서는 물등가물질로 구성되어 있고, 측정체적(sensitive volume, $0.002cm^3$)이 매우 작은 MicroLion 액체이온함을 내놓았다. 본 연구의 목적은 외부방사선 치료용 광자빔에 대해 MicroLion 액체이온함의 선량선형성, 선량률의존성, 공간분해능, 그리고 출력인수와 같은 선량측정학적 특성을 조사하는 것이다. 이 결과를 Semiflex 이온함($0.125cm^3$), Pinpoint 이온함($0.015cm^3$), 다이오드 검출기($0.0025mm^3$)의 결과와 비교분석하여 소조사면 측정에 적절한지를 평가하고 자 하였다. Varian clinac 2300 C/D의 6 MV 광자빔에서 측정하였으며, MP3 물팬톰(PTW, Freiburg)을 이용하였다. 공간분해능은 반음영(penumbra)을 측정하여 평가하였으며, $0.5{\times}0.5cm^2$에서 $10{\times}10cm^2$까지 다양한 조사면에 대하여 측정하였다. 출력인수는 $0.5{\times}0.5cm^2$에서 $40{\times}40cm^2$에 대하여 측정하였다. 선량에 따른 MicroLion 액체이온함의 측정값은 선형적인 비례성을 보였다. 그러나 선량률은 100 MU/min와 600 MU/min에 의한 측정값의 차이가 최대 5%의 차이를 보였으며, 선량율이 커질수록 출력선량이 작아지는 결과를 보였다. 공간분해능의 경우 조사면 $0.5{\times}0.5cm^2$에서 $10{\times}10cm^2$까지의 측방선량분포 비교에서 Semiflex 이온함을 제외한 다른 모든 검출기들의 경우 2% 이내에서 일치하였다. 출력선량은 $2{\times}2cm^2$에서 $10{\times}10cm^2$ 조사면에서 Semiflex 검출기 대비 모든 검출기가 2% 이내에서 잘 일치하였다. 연구 결과 MicroLion 액체이온함은 물등가물질로 이루어져 있으며, 감응 면적이 매우 작기 때문에 소조사면에서 매우 유용할 것으로 사료된다. Recently PTW developed a MicroLion liquid ionization chamber which is water_equivalent and has a small sensitive volume of $0.002cm^3$. The aim of this work is to investigate such dosimetric characteristics as dose linearity, dose rate dependency, spatial resolution, and output factors of the chamber for the external radiotherapy photon beam. The results were compared to those of Semiflex chamber, Pinpoint chamber and Diode chamber with the sensitive volumes of $0.125cm^3$, $0.03cm^3$ and $0.0025cm^3$, respectively and evaluated to be suitable for small fields. This study was performed in the 6MV photon energy from a Varian 2300 C/D linac accelerator and the MP3 water phantom (PTW, Freiburg) was used. Penumbras in the varios field sizes ranged from $0.5{\times}0.5cm^2$ to $10{\times}10cm^2$ were used to evaluate the spatial resolution. Output factors were measured in the field sizes of $0.5{\times}0.5$ to $40{\times}40cm^2$. Readings of the chamber was linearly proportional to dose. Dose rate dependency was measured from 100 MU/min to 600 MU/min, showed a maximum difference of 5.0%, and outputs decreased with dose rates. The spatial resolutions determined with comparing profiles for the field sizes of $0.5{\times}0.5cm^2$ to $10{\times}10cm^2$ agreed between every detector except the Semiflex chamber to within 2%. Outputs of detectors were compared to that of Semiflex chamber and showed good agreements within 2% for every chamber. This study shows that MicroLion chamber characterized by a high signal-to-noise ratio and water equivalence could be suitable for the small field dosimetry.