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김찬형 대한방사선방어학회 2022 대한방사선방어학회 학술발표회 논문요약집 Vol.2022 No.04

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

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.

한국 일 농촌지역 노인의 약물사용 및 건강상태에 대한 역학적 조사

김찬형,신승철,이호영,유계준 최신의학사 1990 最新醫學 Vol.33 No.10

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.

복합유기용제에 노출된 근로자들의 스트레스지각 및 정신병리

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

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.

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.

선량계수와 기준모의체(제2분과)

김찬형 대한방사선방어학회 2014 대한방사선방어학회 학술발표회 논문요약집 Vol.2014 No.11

조현병 환자에서 자살 시도 및 폭력성과 임상 증상과의 관련성

김찬형,전진용,구민성 대한불안의학회 2024 대한불안의학회지 Vol.20 No.2

Objective : To evaluate the association between suicidality with violent hostility and psychopathology in schizophrenia. Methods : Seventy nine schizophrenic patients were interviewed and evaluated regarding their psychopathology with Positive and Negative Symptom Scale (PANSS). Suicidal attempt number, suicidality (ideation, plan or attempts), and hostility with violent acts in patients were also investigated. Results : In schizophrenic patients, suicidal attempts were significantly correlated with positive symptoms (r=0.336, p=0.002) and general symptoms (r=0.26, p=0.021). Their suicidality was also significantly correlated with all psychopathology (p=0.000). In addition, their hostility was associated with psychopathology, especially in those with positive symptoms (r=0.29, p=0.01). Conclusion : Suicidal attempts and violent behaviors showed association with psychopathology in schizophrenia. This suggests that symptoms of schizophrenia need to be treated as early as possible. (Anxiety and Mood 2024;20(2):49-53)

Association Between the Frailty Index and Clinical Outcomes after Coronary Artery Bypass Grafting

김찬형,강윤진,김지성,손석호,황호영 대한심장혈관흉부외과학회 2022 Journal of Chest Surgery Vol.55 No.3

Background: This study investigated the predictive value of the frailty index calculated using laboratory data and vital signs (FI-L) in patients who underwent coronary artery bypass grafting (CABG). Methods: This study included 508 patients (age 67.3±9.7 years, male 78.0%) who underwent CABG between 2018 and 2021. The FI-L, which estimates patients’ frailty based on laboratory data and vital signs, was calculated as the ratio of variables outside the normal range for 32 preoperative parameters. The primary endpoints were operative and medium- term all-cause mortality. The secondary endpoints were early postoperative complications and major adverse cardiac and cerebrovascular events (MACCEs). Results: The mean FI-L was 20.9%±10.9%. The early mortality rate was 1.6% (n=8). Postoperative complications were atrial fibrillation (n=148, 29.1%), respiratory complications (n=38, 7.5%), and acute kidney injury (n=15, 3.0%). The 1- and 3-year survival rates were 96.0% and 88.7%, and the 1- and 3-year cumulative incidence rates of MACCEs were 4.87% and 8.98%. In multivariable analyses, the FI-L showed statistically significant associations with medium-term all-cause mortality (hazard ratio [HR], 1.042; 95% confidence interval [CI], 1.010–1.076), MACCEs (subdistribution HR, 1.054; 95% CI, 1.030–1.078), atrial fibrillation (odds ratio [OR], 1.02; 95% CI, 1.002–1.039), acute kidney injury (OR, 1.06; 95% CI, 1.014– 1.108), and re-operation for bleeding (OR, 1.09; 95% CI, 1.032–1.152). The minimal p-value approach showed that 32% was the best cutoff for the FI-L as a predictor of all-cause mortality post-CABG. Conclusion: The FI-L was a significant prognostic factor related to all-cause mortality and postoperative complications in patients who underwent CABG.

강박장애 환자에서 I-123 IPT SPECT로 측정한 기저 신경절 도파민 운반체 밀도

김찬형,구민성,천근아,유영훈,이종두 대한신경정신의학회 2003 신경정신의학 Vol.42 No.2

Objectives:It has been suggested that dopamine as well as serotonin were related to the pathophysiology of obsessivecompulsive disorder (OCD). Thus, many studies were performed to nivestigate brain regions and their association with dopamine in OCD patients. Recently, we have been able to monitor the density of the dopamine transporter (DAT) in the basal ganglia using I-123N-(3-iodopropen-2-yl)-2β-carbomethoxy-3beta-(4-chlorophenyl) tropane (I-123 IPT) SPECT, to evaluate the activity of the presynaptic dopamine function. In present study, we investigated the DAT density of the basal ganglia using I-123 IPT SPECT in patients with OCD. Methods:Fifteen patients with OCD and nineteen normal control group were included in this study. We performed brain SPECT 2 hours after the intravenous administration of I-123N-(3-iodopropen-2-yl)-2β-carbomethoxy-3beta-(4-chlorophenyl) tropane (I-123 IPT) and carried out both quantitative and qualitative analyses using the SPECT, which were reconstructed for the assessment of the specific/nonspecific DAT binding ratio in basal ganglia. We then investigated the correlation between the severity of OCD symptoms assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the specific/nonspecific DAT binding ratio of basal ganglia. Results:Patients with OCD showed a significantly increased specific/nonspecific DAT binding ratio in right basal ganglia compared with normal controls and did not show a significantly increased specific/nonspecific DAT binding ratio, and an increased tendency in the specific/nonspecific DAT binding ratio in left basal ganglia (Rt:Z=2.584, P=0.009, Lt:Z=1.873, P=0.060). We found no significant correlation between the total scores of the Y-BOCS and the specific/nonspecific DAT binding ratio of basal ganglia. Conclusions:The data of this study suggest that dopamine in basal ganglia plays an important role in fronto-subcortical circuit, which are already known as a site of the pathophysiological mechanism of OCD.