Comparison of Effectiveness between Aripiprazole and Risperidone for Treating Delirium in Hospitalized Patients

Jeong-Kyu Sakong(사공정규),Young-Hoon Han(한영훈),Sung-Won Jung(정성원) 대한생물치료정신의학회 2011 생물치료정신의학 Vol.17 No.1

목적:비전형 항정신병 약물인 리스페리돈이 섬망 치료에서 부작용이 적고 효과적이라고 알려져 있다. 아리피프라졸도 항콜린성 및 추체외로계 부작용이 적은 비전형적 항정신병 약물 중 하나이지만 섬망 치료에 대해 입증된 연구는 적다. 본 연구는 아리피프라졸이 섬망 치료에 대해 효과적인지 조사해 보고자 하였다. 방법:43명의 섬망 환자를 무작위로 2군으로 나누었으며 투약 첫날에는 리스페리돈 1㎎, 아리피프라졸 5㎎을 투여하였으나 둘째 날부터는 임상상태에 따라 자유롭게 용량을 조절하였다. 리스페리돈 환자 27명과 아리피프라졸 환자 16명이 연구에 포함되었으며 이중맹검법을 사용하여 비교하였다. 비교는 치료전과 치료 일주일 Clinical Global Impression-Severity(CGI-S), 한국판 섬망평가척도(Korean version of Delirium Rating Scale ; K-DRS), 간이정신상태검사(Korean Mini Mental Status Examination; K-MMSE), 한국판 섬망평가척도(Korean version of Delirium Rating Scale-Revised-98 ; K-DRS-R-98), 추체외로계증상 평가척도(Extrapyramidal Symptom Rating Scale ; ESRS)의 점수를 사용하였다. 결과:리스페리돈과 아리피프라졸 두군 모두에서 치료 전후의 CGI-S, K-DRS, K-DRS-98의 점수가 통계적으로 의미 있는 차이를 보였다(p<0.05). 하지만 아리피프라졸 치료군의 경우 리스페리돈 치료군에 비해 차이를 보이지는 않았다. 결론:아리피프라졸이 섬망 치료에 있어 리스페리돈과 유사한 효과가 있을 것으로 기대된다.

조증의 계절성

사공정규(Jeong-Kyu Sakong) 대한생물치료정신의학회 2009 생물치료정신의학 Vol.15 No.1

“Seasonality” is a term that connotes the degree to which a symptom or behaviour changes with the seasons. A seasonal pattern of mood disorder has been of interest to clinicians since antiquity. Although there is ample evidence that manic episodes of bipolar disorder can have a seasonal pattern for centuries, most extensively studied area of seasonality relates to major depression. Recently, many people are trying to branch out into interests of the seasonality of mania. In this article author reviewed current studies on the seasonality of mania and picked out the main points in the seasonality of mania.

한국판 정신과적 진단 선별 질문지(Psychiatric Diagnostic Screening Questionnaire; PDSQ)의 진단적 타당도

최정식 ( Jeong Shik Choi ),김희철 ( Hee Cheol Kim ),정성원 ( Sung Won Jung ),이은정 ( Eun Jung Lee ),성형모 ( Hyung Mo Sung ),사공정규 ( Jung Kyu Sakong ),신임희 ( Im Hee Shin ),김정범 ( Jung Bum Kim ) 한국정신병리진단분류학회 2009 精神病理學 Vol.18 No.1

Objectives: Although many tools have been developed to diagnose mental disorders so far, it has not been easy to administer because it is necessary to undergo training for the professionals as well as time required to administer those tools. The Psychiatric Diagnostic Screening Questionnaire; PDSQ, developed by Zimmerman et al, 2001, is self-reporting test for screening DSM-IV axis I disorders in clinical settings, and it is well known for its simplicity and availability. This study compared Korean PDSQ with Mini-International Neuropsychiatric Interview(M.I.N.I.-Plus) for their diagnostic availability, as a part of standardization of Korean version. Methods: The samples were 320 patients, who were selected from 3 university hospitals in Daegu and Kyoungbook for K-PDSQ and Mini-International Neuropsychiatric Interview(M.I.N.I.-Plus). The diagnostic correspondence, sensitivity, specificity and administering time were evaluated for PDSQ as well. Results: For the diagnostic correspondence of PDSQ, Cohen`s kappa coefficient was .69 between PDSQ and MINI-Plus. The administering time was 19.3±12.9min, which was similar to the M.I.N.I.-Plus` minutes. The sensitivity was higher than 90% in most of the 13 PDSQ subscales(MDD; 100%, PTSD; 75%, Bulimia Nervosa; 100%, OCD; 68%, Panic Disorder; 93%, Psychosis; 59%, Social Phobia; 98%, Alcohol Dependence/Abuse; 94%, Drug Dependence/Abuse; 100%, Agoraphobia; 83%, GAD; 88%, Somatoform Disorder; 100%, Hypochondriasis; 96%), and the AUC(area under the curve) values of them were above 0.79(MDD; 0.91, PTSD; 0.82, Bulimia Nervosa; 1.00, OCD; 0.80, Panic Disorder; 0.94, Psychosis; 0.79, Social Phobia; 0.87, Alcohol Dependence/Abuse; 0.96, Drug Dependence/Abuse; 1.00, Agoraphobia; 0.92, GAD; 0.81, Somatoform Disorder; 0.99, Hypochondriasis; 0.97). Conclusion: PDSQ showed significant diagnostic correspondence. time-efficiency and high level of sensitivity and specificity. PDSQ is considered to be useful diagnostic tool before the first interview of the patients for the screening of DSM-IV Axis I diagnosis because it is simplicity and reliability.

경상북도 거주 노인의 정신건강과 자살 위험인자에 관한 연구

김정령(Jeong Ryeong Kim),이광헌(Kwang Hun Lee),김상규(Sang Kyu Kim),곽경필(Kyung Phil Kwak),사공정규(Jeong Kyu Sakong) 대한생물치료정신의학회 2021 생물치료정신의학 Vol.27 No.3

Objectives:The purpose of this study was to identify suicide risk factors among elderly residents in Gyeongsangbuk-do and to reveal the relationships between them. In addition, the differences in suicide risk factors were analyzed between the cognitively impaired group and the cognitively normal group. Methods:We investigated 20,127 elderly over 65 years of age, from January 2019 to December 2019. Participants were asked to complete a questionnaire survey. Cognitive function, depression, anxiety, sleep disturbance, and suicidal ideation data were assessed using a Korean version of the Mini-Mental Status Examination for Dementia Screening (MMSE-DS), Short Geriatric Depression Scale for Korean version (S-GDS), Geriatric Anxiety Inventory (GAI), Athens Insomnia Scale (AIS), and Scale for Suicidal Ideation (SSI). Data were analyzed using the chi-squared test and logistic regression analysis to examine suicide risk factors and the relationships between them. Furthermore, differences in suicide risk factors according to cognitive function were examined. Results:Age, cognitive function, depression, anxiety, and sleep disturbance were identified as suicide risk factors among elderly residents in Gyeongsangbuk-do. Depression was the factor that increased risk of suicide the most, followed by anxiety, impaired cognitive function, sleep disturbance, and 65-74 years of age. In addition, depression increased risk of suicide by 1.86 times in the cognitively impaired group. Conclusions:Among elderly residents in Gyeongsangbuk-do, depression was the factor that contributed the highest risk for suicide. More active prevention and treatment measures for depressive symptoms should be implemented in the cognitively impaired group.

아로마테라피 손 마사지가 입원 노인의 수면 및 우울에 미치는 효과

김양희,김영철,사공정규,Kim, Yang-Hee,Kim, Youn-Chul,SaKong, Jeong-Kyu 대한예방한의학회 2009 대한예방한의학회지 Vol.13 No.3

Objectives : To evaluate the effects of aroma hand massage on sleep disturbance and depression in hospitalized elderly patients. Methods : The data was collected using questionnaires from the subjects who were admitted to the G Medical Hospital in Daegu from 7 July to 12 July, 2008. A total of 23 subjects were selected. The subjects were applied with the aroma hand massage to both hands using a solution diluting four drops of lavender oil in jojoba oil 10cc. Aroma hand massage was given for 10 minutes, one time a day, during 5 days. Results : There was statistically significant improvement on the Korean sleep scale(t=-7.614, p=0.000) and on the Geriatric Depression Scale Short Korea Version(GDSSF-K)(t=3.444, p=0.002). Conclusions : aroma hand massage is an effective therapeutic intervention for decreased sleep disturbance and depression. Therefore, aroma therapy and hand massage by therapeutic intervention is recommended for improving psychological and physiological functions in hospitalized elderly patients.

호텔 종사자들에서 불안 및 우울과 24시간 활동혈압 관련성

배준호(Jun-Ho Bae),사공정규(Jeong-Kyu Sakong),김상규(Sang-Kyu Kim) 한국농촌의학 지역보건학회 2011 농촌의학·지역보건 Vol.36 No.3

이번 연구는 일개 사업장 근로자를 대상으로 24시간 활동혈압에 따른 고혈압군과 정상군의 불안과 우울정도를 비교하고 불안증상과 우울증상에 따른 혈압 양상을 비교 분석하고자 하였다. 일개 사업장 근로자 107명을 대상으로 2009년 12월 10일부터 2010년 3월 20일까지 사업장을 방문하여 BAI와 BDI로 불안과 우울정도를 조사하였고 임상혈압과 24시간 AMBP로 활동혈압을 측정하였다. 임상혈압과 24시간 AMBP에서 고혈압군과 정상군의 BAI와 BDI 점수는 모두 유의한 차이가 없었지만, 우울증상군에서 정상군보다 야간 이완기혈압 비강하 발생위험도가 6.85배 (CI 1.50-30.01)높았다. 고혈압 치료를 시작하거나 치료 중인 환자에서 치료순응율을 향상시키고 심혈관계 질환 예방을 위해서는 심리적인 중재도 필요하다고 판단되어진다. Objectives: Anxiety and depression are known to be associated with hypertension, and blood pressure can vary spontaneously throughout the day. The aim of this study was to evaluate anxiety, depression and 24-hour ambulatory blood pressure (24-h ambulatory BP) in employees at their worksite. Methods: A total of 107 volunteers among 136 employees at a hotel in Gyeongju, Korea were enrolled in this study between December 2009 and March 2010. The Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI) were used to assess anxiety and depression, respectively. Blood pressure was measured using a 24-h ambulatory BP monitoring system. Results: No significant differences in either BAI or BDI scores were found when hypertensive individuals were compared to normotensive individuals. The frequency of diastolic non-dipper was significantly higher in individuals with depressive symptoms compared to those without (p<0.05). Depression was significantly associated with diastolic non-dipper (OR: 6.85, 95% CI: 1.50-30.01). Conclusions: The results of this study indicate that depression should be considered when deciding upon blood pressure control regimens, and appropriate additive psychotherapy may be beneficial in the treatment of hypertensive patients.

일 대학병원 정신과 외래를 방문한 우울증 환자에서의 하지불안증후군

이도윤(Do-Yun Lee),사공정규(Jeong-Kyu Sakong),곽경필(Kyung-Phil Kwak),한영훈(Young-Hoon Han),손용표(Yong-Pyo Son),박창증(Chang-Jeung Park),원승희(Seung-Hee Won),이광헌(Kwang-Hun Lee) 대한생물치료정신의학회 2011 생물치료정신의학 Vol.17 No.1

Objectives : This study was designed to investigate the clinical characteristics, relationship with antidepressants and incidence of restless legs syndrome(RLS) in depressed outpatients. Methods : Total 160 adult patients(male 32, female 128) of psychiatric outpatient were enrolled in this study. We use the diagnostic criteria of International RLS Study Group(IRLSSG) for RLS. Also WHO quality of life scale abbreviated version(WHOQOL-BREF), Hamilton Depression Rating Scale-17(HAM-D) and Pittsburgh Sleep Quality Index(PSQI) was used to investigate the relationship between RLS and depression severity, quality of life, sleep quality. Results : In 39(24.4%) out of the total 160 patients were diagnosed as having RLS. Among those 39 RLS patient, 19 patients(48.7%) was reported to have developed their RLS after starting depression treatment. The RLS group showed higher PSQI and HAM-D scores(p=0.02, p<0.01) and lower WHOQOL-BREF score(p=0.06) compared to those of non-RLS. Compared to those of non-RLS group, the bupropion group showed a significantly low rate of RLS group (p=0.043) and the venlafaxine group showed a significantly high rate of RLS group(p=0.018). HAM-D score 7 or more group caused RLS 4.5 times compared those of less than HAM-D score 7 group. Conclusion : In this study, depressed outpatients showed high incidence rate of RLS and RLS had influence on sleep quality, depression severity and quality of life. Moreover, certain antidepressants had potential to induce RLS. Therefore, these results suggest that appropriate treatment for depression is required to clinicians and development of RLS from depressed patients should be carefully monitored. Further research about the relationship between antidepressant and RLS is also necessary.

우울증 환자 가족들의 심리적 스트레스에 관한 연구 : 정신분열병 환자 가족과 비교

김진희,이은정,정성원,성형모,사공정규,김정범,Kim, Jin-Hee,Lee, Eun-Jeong,Jung, Sung-Won,Sung, Hyung-Mo,SaKong, Jeong-Kyu,Kim, Jung-Bum 대한불안의학회 2010 대한불안의학회지 Vol.6 No.1

Objective : This study compared the psychological stresses of depressed patients' families with those of schizophrenic patients' families. We investigated the influence of depressive patients' clinical features and their families' demographic characteristics on the families' depressive symptoms and stresses. Methods : Participants were 23 family members of depressed patients and 20 family members of schizophrenic patients. We measured the patients' clinical features (duration of illness, number of previous hospitalizations, and satisfaction with medication), and each family member's socioeconomic status and psychological characteristics (depressive mood, anxiety, family stress, and stress response), analyzing the data via independent t-test, chi-square test, and correlation and hierarchical multiple regression analyses. Results : The depressed patients' average clinical global impression (CGI) was significantly higher than that of the schizophrenic patients. The depressed patients' family members showed stress responses significantly higher than those of schizophrenic patients' family members. Furthermore, in depressed patients, frequency of hospitalization was positively correlated with family members' stat anxiety. For both patient types, family stress was positively correlated with the patient's severity of illness and the family's state anxiety, trait anxiety, and stress response ; socioeconomic status was positively correlated with the family's depressive symptoms ; the family's state anxiety positively correlated with the family's trait anxiety and stress response ; and the family's trait anxiety positively correlated with the family's stress response. Socioeconomic status predicted the family's depressive symptoms, and socioeconomic, illness severity and stress response predicted family stress. Conclusion : These findings suggest that both depressed patients' families and schizophrenic patients' families suffer from psychological stress. The study data also have important clinical implications, in that families of depressed patients need psychiatric intervention, as well as the patients themselves. In particular, family intervention should focus on psycho-education and stress coping strategies.

지역사회 거주 노인의 우울과 자살사고에 관한 연구

박창증(Chang-Jeung Park),곽경필(Kyung-Phil Kwak),사공정규(Jeong Kyu Sakong),이광헌(Kwang-Hun Lee) 대한생물치료정신의학회 2013 생물치료정신의학 Vol.19 No.2

Objectives:This study was aimed to investigate the difference of depressive symptom and suicide ideation according to socioeconomic state in community dwelling elderly. Methods:We investigated 835 elderly subjects including 445(53.3%) of home visit health service group and 390 (46.7%) of senior center group from April 2013 to May 2013. Their demographic and socioeconomic data were investigated. Depressive symptoms were evaluated by the Korean form of the Geriatric Depression Scale(KGDS) and suicide ideation was evaluated by the Beck’s Scale for suicide ideation(SSI). Using these data, we analyzed associated factor with depressive symptom and suicide ideation. Results:The prevalence of depressive symptom was 41%. The prevalence of depressive symptom in home visit health service group(59.3%) was significantly higher than that of senior center group(22.0%)(p<0.001). The prevalence of suicide ideation in home visit health service group(15.3%) was significantly higher than that of senior center group (3.3%)(p<0.001). Depressive symptom(Odd ratio : 8.59, 95% CI : 4.49-16.40), living alone(Odd ratio : 1.72, CI : 1.01-2.94), no exercise(Odd ratio : 1.69, 1.01-2.83), no current occupation(Odd ratio : 3.41, CI : 1.16-10.07) were associated with suicide ideation independently. Conclusions:In this study, home visit health care service group in low socioeconomic elderly had higher prevalence of depressive symptom and suicide ideation than that of standard elderly. These results suggest that future mental health care policy has to consider the importance of low socioeconomic community dwelling elderly.

정신과 거역 퇴원 환자들의 외래 추적 치료에 대한 순응도와 관련된 요인

한영훈(Young Hoon Han),이도윤(Do Yun Lee),손용표(Yong Pyo Son),박창증(Chang Jeung Park),이광헌(Kwang Hun Lee),사공정규(Jeong Kyu Sakong),곽경필(Kyung Phil Kwak) 대한사회정신의학회 2010 사회정신의학 Vol.15 No.1

연구목적: 이 연구는 정신과 입원 환자 중 거역 퇴원을 한 환자들을 대상으로 어떠한 요인이 퇴원 후 외래 추적 치료에 대한 순응도에 영향을 미치는가에 대해 알아보고자 하였다. 방 법: 2006년부터 2009년까지 4년 동안 동국대학교 경주병원 정신과에서 거역퇴원을 한 163명의 환자들의 진료기록부를 조사하여 퇴원 후 외래 추적 치료를 나온 군과 나오지 않은 군으로 나누고, 외래 추적 치료를 나온 군을 다시 6개월 이상 추적 치료가 지속되는 군과 지속 되지 않는 군으로 나누어 각 군에 영향을 미칠 수 있는 요인들을 비교분석하였다. 결 과: 거역퇴원 후 외래 추적 치료에 한 번도 나오지 않은 환자는 43명이었고 한번이라도 나온 환자는 120명이었다. 그 중 6개월 이전에 외래 추적 치료를 중단한 환자는 49명이었으며 6개월 이상 치료를 지속하는 환자는 71명이었다. 외래 추적 치료의 여부에 영향을 미치는 요인은 거역퇴원의 이유와 거역퇴원 당시의 환자의 상태, 입원 기간이었다. 환자가 환자의 병을 부정하거나 치료에 불만족하여 거역퇴원을 한 경우는 외래 추적 치료가 잘 되지 않았고, 퇴원 당시의 상태가 좋거나 입원 기간이 긴 경우에는 외래 추적이 잘 되었다. 이러한 요인들 가운데 6개월 이상 외래 추적 치료가 지속되는 것에 영향을 주는 요인은 입원 기간뿐 이었다. 이러한 요인 외에 진단명, 사회 인구학적 특성, 입원 경로, 입퇴원 요일, 주치의 성별 및 연차 등 어떤 것도 외래 추적 치료에 영향을 주지 못했다. 결 론: 거역퇴원 환자의 외래 추적 치료에 환자의 병에 대한 인식과 입원 기간이 큰 영향을 미친다는 것을 알 수 있었다. 실제 임상 에서 거역퇴원 환자라 하더라도 외래 추적 치료를 잘 받을 수 있도록 하는 치료진의 노력이 필요할 것이다. Objective:The purpose of this study is to research factors which affect Outpatient department(OPD) follow up and consistency in psychiatric inpatients discharged against medical advice from psychiatric hospitalization. Methods:The subjects in this study were 163 patients who were discharged against medical advice from Department of Neuropsychiatry at Dongguk University Hospital between January 1, 2006 and December 31, 2009. Patients were divided into two groups:patients who came for OPD follow up treatment and patients who did not. The group of patients who came for OPD follow up treatment was then subdivided into two groups:a group with patients who continuously came for OPD follow up treatment for more than 6 months and a group with patients who were lost be-fore 6 months. After classifying the patients, we compared and analyzed the factors which could influence each group. Results:After being discharged against medical advice, 43 patients did not show up for OPD follow up treatment at all and 120 patients came for OPD follow up treatment more than once. 49 patients were lost before 6 months and 71 patients continued to come for OPD follow up treatment for more than 6 months. Factors that affected OPD follow up treatment were the reasons for the patient’s discharge against medical advice, result of treatment and the duration of psychiatric hospitalization. When the reason for discharge against medical advice was complete denial of illness or dissatisfaction with staffs, patients were not well followed up at the OPD. On the other hand, when result of treatment was good at the time of discharge or when the duration of psychiatric hospitalization was long enough, patients were well followed up at the OPD. Among these factors, duration of psychiatric hospitalization was the only one that could affect the continuance of OPD follow up treatment for more than 6 months. Apart from these reasons, diagnosis, so-ciodemographic characteristics, mode of admission, day of admission, day of discharge and gender or grade of doctor did not influenced the OPD follow up treatment. Conclusion:Insight of their own psychiatric illness and the duration of psychiatric hospitalization affected OPD follow up treatment in patients who were discharged against medical advice. In clinical application, even if patients are discharged against medical advice, psychiatrist should make efforts to get those patients to receive OPD treatment.