만성 정신분열병 여성에서 고프로락틴혈증과 골밀도 및 골대사 표지의 상관

원승희(Seung-Hee Won),곽경필(Kyung-Phil Kwak) 대한생물치료정신의학회 2006 생물치료정신의학 Vol.12 No.2

목적 : 정신분열병 환자는 질병 자체와 복용하고 있는 여러 약물들로 인하여 골다공증 및 골절의 위험성이 높다. 고프로락틴혈증은 골다공증을 유발하는 위험요인으로 알려져 있는데, 일부 항정신병약물은 혈중 프로락틴을 증가시킨다. 본 연구는 만성정신분열병 환자에서 지속적인 프로락틴 증가가 골밀도와 골대사 표지에 어떠한 영향을 주는지 그 관련성을 알아보고자 시행되었다. 방법 : DSM-IV 진단기준에 부합되는 만성 정신분열병 가임기(20~45세) 여성 환자 36명을 선별검사 하였다. 모든 대상자들은 최소 1년 이상 한 가지 항정신병약물을 복용하고, 통원치료를 받고 있으며, 최근 1년 이내 골대사에 영향을 주는 병력이 없었다. 환자의 월경력을 미리 조사하여 중기 황체기에 신체계측, 기본 검사실검사, 호르몬, 골대사 표지, 정신병리, 일일 영양소섭취량, 일일 활동량등을 측정하였다. 골밀도는 이중방사선흡수 계측기를 이용하여 원위요골, 요추, 대퇴경골의 골밀도를 측정하여 젊은 정상성인의 평균치와 비교한 T값을 이용하였다. 최종 검사결과 대상자는 프로락틴이 증가한 실험군 16명(리스페리돈 복용 15명, 올란자핀 복용1명)과 프로락틴이 증가하지 않은 대조군 12명(올란자핀 복용 12명)으로 분류되었다. 결과 : 프로락틴 수치는 실험군이 더 높고( t=5.583, p=0.000), 콜레스테롤 수치는 대조군이 더 높았으며(t=-2.107, p=0.046), 에스트라다이올 수치는 실험군 2명만 감소되었고 나머지 대상자 모두는 정상범위이었다. 골밀도 T값이 실험군은 모든 부위에서 감소되었고 대조군은 요추와 대퇴경골에서만 감소되었지만, 두군 간 유의한 차이는 없었다. 단지, 원위요골에서 실험군의 골밀도 T값(-0.16±0.73)이 대조군의 골밀도 T값(0.36±0.66)보다 낮은 경향(t=-1.968, p=0.06)을 보여주었다. 프로락틴과 골밀도 T값 또는 골대사 표지와는 유의한 상관을 나타내지 않았다. 실험군 16명만을 대상으로 시행한 상관분석(r=-0.627, p<0.01)과 전체 피험자를 대상으로 현재 항정신병약물의 복용기간, 프로락틴, 체질량지수를 통제한 부분상관분석(r=-0.418,p<0.05) 모두에서 콜레스테롤과 원위요골의 골밀도 T값 사이에 유의한 음의 상관이 나타났다. 결론 : 만성 정신분열병 여성 환자에서 항정신병약물로 유발된 고프로락틴혈증은 골소실을 증가 시키는 위험요인이었다. 또한, 프로락틴 수치와는 무관하게 콜레스테롤도 위험요인이었다. 이에 반해 에스트로겐은 골소실의 예방요인으로 작용하였다. Objectives:Osteoporosis is regularly mentioned as a possible consequence of treatment with prolactin raising antipsychotic medications. We investigated the association between schizophrenia and a decrease in bone mineral density(BMD) and to get more insight into potential underlying pathophysiological mechanisms. Methods:In a cross-sectional study, we screened 36 schizophrenic outpatient women(age 20-45 years) who were treated with same antipsychotics for at least one year. BMD measurements were performed by dual-energy X-ray absorptiometry(DEXA) in the distal forearm, lumbar spine and femoral neck. We also estimated psychopathology, menstrual regularity, body mass index(BMI), daily nutritional status, daily physical activity, hormones and bone marker (osteocalcin, deoxypyridinoline). As the results of prolactin levels, subjects were classified into two groups; prolactin raising group(PR, 16 subjects) and not raising group(No-PR, 12 subjects). Results:Mean prolactin level in PR was higher than in No-PR and mean cholesterol level in No-PR was higher than in PR significantly. Mean estradiol level was within normal ranges excluding 2 subjects in PR. The proportions of reduced bone mass(osteopenia, osteoporosis) at each sites were 12.5-31.3% in PR and 0.0-25.0% in No-PR. Mean BMD T scores at distal forearm in PR mildly lower than in No-PR( t=-1.968, p=0.06), but those of other sites were not significant differences between two groups. Correlations between prolactin levels and BMD T scores at all sites were not statistically significance. Correlations between the levels of prolactin and bone markers were not significance too. After adjusting for prolactin, BMI and medication period of current antipsychotics variables, statistically significant inverse correlation was observed for cholesterol levels - BMD T scores at the distal forearm. Conclusion:The present results suggest that hyperprolactinemia induced by long-term neuroleptics may be at high risk of reducing BMD and may be counterbalanced with estradiol incompletely in schizophrenic women. In addition, we noticed that cholesterol may be a risk factor in losing bone mass irrespective of prolactin levels.

여성 성기능장애 평가를 위한 한국판 성기능 설문지의 개발 : 신뢰도와 타당도 연구

원승희(Seung-Hee Won),박현숙(Hyun-Sook Park),구현영(Hyun-Young Koo) 대한생물치료정신의학회 2004 생물치료정신의학 Vol.10 No.1

Objectives : To develop a Sexual Function Questionnaire-Korean version(SFQ-K) for measuring the female sexual dysfunction and to verify both reliability and validity of the Korean version. Methods : Data from 320 women residing in Daegu city and Gyungbuk states were collected. 230 women out of all subjects completed a psychometric assessment package which included the SFQ-K, Beck Depression Inventory(BDI) and Satisfaction with Life Scale(SWLS). Brief Index of Sexual Function for Women (BISF-W) was also administered to the other 90 women. Item analysis, split-half reliability, internal consistency reliability, content validity, construct validity and concurrent validity of the SFQ-K were evaluated. Results : 1) 3 items were removed from the English version of SFQ(consist in 31 items) as a results of item analysis, 28 items were selected in SFQ-K. 2) SFQ-K showed high internal consistency(Cronbach's alpha=0.957). 3) SFQ-K demonstrated high spilt-half reliability(Spearman-Brown coefficients r=0.7677-0.951). 4) The principal component analysis for SFQ-K produced the five identical factors explaining 71 429% of total variance. The five domains of female sexual function were sexual response, desire, pain, non-coital sexual activity, satisfaction 5) The total scores of SFQ-K showed a significant correlation with the sexual function factor scores of BISW-F(Person's correlation coefficients r=0.853, p<0.0l) 6) The total scores of SFQ-K showed a weak correlation with the total scores of BDI(Person's correlation coefficients r=-0.260, p<0.01) and SWLS(Person's correlation coefficients r=0.272, p<0.01). Conclusion : SFQ-K is thought to have a good reliability and validity that be used for Korean women subjects.

흰쥐의 수면 및 뇌파에 대한 카페인의 효과

권도훈(Do Hoon Kwon),원승희(Seung-Hee Won),김기민(Ki Min Kim),장수민(Su Min Chang),김상헌(Sang Heon Kim),이만기(Maan Gee Lee) 대한생물치료정신의학회 2006 생물치료정신의학 Vol.12 No.2

카페인은 기저전뇌의 아데노신의 아데노신 수용체의 작용을 차단함으로써 각성을 유발하고 피질에서 서파 활동의 감소를 야기한다. 또한 카페인은 용량-의존적인 각성상태의 증가를 초래한다. 따라서 카페인의 각성 효과는 아데노신의 뇌 조직 내 농도가 증가하여 수면 압력이 상승되어 있고 각성 중추의 활동이 감소된 상태의 각성인 반면, 정상 각성 상태는 아데노신의 농도가 낮아 수면 압력이 없이 각성 중추의 활동이 증가된 상태의 각성으로 생각된다. 이 연구는 이러한 각성의 서로 다른 상태가 피질 영역별 활동의 차이로 나타날 수 있는지 보기 위하여 뇌파의 스펙트럼 분석 방법을 이용하여 활동의 정량화를 시도하였다. 더 나아가 수면박탈로 수면 압력이 증가된 상태에서의 각성과 비교하여 카페인과 아데노신의 상호작용을 고찰하였다. Sprague-Dawley 수컷 쥐 8마리를 마취하에 뇌파 및 근전도 전극을 전두엽, 두정엽, 그리고 목근육에 각각 설치하고, 수술에서 회복된 후 뇌파/근전도 기록을 시작하였다. 기록은 10:30부터 시작하여 17:30까지 수행되었으며 13:30경에 카페인 7.5, 15, 또는 30㎎/㎏을 복강내 주사한 후, 각각의 수면-각성 단계와 그 기간 및 변화 방향을 계산하였다. 수면에 대한 카페인의 주된 효과는 활동각성의 증가와 수면의 감소로 나타났으며, 이 효과는 카페인 용량에 의존적이었다. 활동각성 기간의 증가는 그 단계의 유지기간의 증가로 야기되었고 서파수면의 감소는 서파수면 상태로 변화되는 빈도의 감소에 주로 야기되었다. 활동각성 단계에서 정적각성, 서파수면 단계로 변화가 감소되었고 그 반대로 변화는 증가되었다. 한편 수면박탈은 서파수면의 반동 증가를 초래하지 못했고 활동각성의 유의한 감소를 초래하지 못했다. 그러나 역설수면 기간의 유의한 감소를 초래하였다. 뇌파 스펙트럼 프로파일에서 수면박탈이 델타의 상대적 증가를 초래한 것을 제외하고는 수면박탈과 카페인 투여 모두 알파의 상대적 감소 및 감마의 증가를 초래하였다. 실제 진폭은 전두피질에서 25㎐ 이하 대역에서 감소와 이상 대역에서 증가, 두정피질에서 35㎐ 이하 대역에서 감소와 이상 대역에서 증가를 야기하였다. 주파수 대역별로 델타, 쎄타, 알파의 감소가 있었고 감마의 증가가 있었다. 감마의 증가는 전두피질에서 더 현저하게 나타났다. 결론적으로, 카페인에 의한 각성의 촉진은 수면-각성 상태의 천이를 한 방향으로 가속화함으로써 발생되며 그 방향은 수면박탈에 의한 방향과 반대이다. 따라서 수면박탈에서는 아데노신이 축적되어 수면 압력을 증가시키고, 수면 압력의 증가는 아데노신 수용체 길항제에 의해 차단될 수 있다. 델타 대역의 감소는 본 연구에서 사용한 최소 용량 투여 후 포화되어 최대 효능을 보인다. 이것은 뇌파의 주파수별 파워의 측정이 수면기간이나 각성기간과 같은 행동적 지표보다 더 민감한 방법임을 시사한다. 앞으로 사람에서 사용되는 정도의 카페인 투여에 의한 동물에서 효과를 검증해 보는 것이 생리학적 효과에 대한 이해를 도울 수 있을 것이다. Caffeine induces arousal and reduces slow-wave activity of the cortex by blocking adenosine action on the adenosine receptor. Caffeine induces dose-dependent arousal. Therefore, caffeine-induced arousal may be a different state from an arousal in waking subjects. So we compared EEG spectra between of a state produced by intraperiotoneal caffeine injection and of a state produced by 3-hour sleep deprivation. A total of 8 Sprague-Dawley male rats underwent EEG/EMG recording session from 10:30 to 17:30. They received intraperitoneal caffeine injection(7.5, 15, and 30mg/kg) at 13:30 and some cases received sleep deprivation from 10:30 to 13:30. Caffeine dose-dependently reduced the duration of slow-wave sleep and increased the duration of waking state. The increase of waking state resulted from the increase of maintanence of the state while the reduction of sleep state resulted from the decrease of transition from waking to sleep. Sleep deprivation did not show rebound increase of sleep but it decreased the period of paradoxical sleep. In spectral profile, sleep deprivation increased relative proportion of delta activity and both caffeine and sleep deprivation decreased relative proportion of power in alpha band and increased in gamma band. Caffeine decreased the absolute power of delta and alpha bands and increased absolute power of gamma band which was more prominent in the frontal cortex. In conclusion, caffeine promoted waking state by acceleration of transition to waking state from other states which was reverse in sleep deprivation. Therefore, adenosine may accumulate during sleep deprivation and mediate sleep pressure and caffeine may block its action on the adenosine receptor. The comparison of the spectral profiles indicates that caffeine-induced waking state may differ from normal awake state and from awake state after sleep deprivation.

여성의 성기능과 삶의 만족도에 영향을 미치는 요인

박현숙 ( Hyun Sook Park ),구현영 ( Hyun Young Koo ),원승희 ( Seung Hee Won ) 한국정신간호학회 2004 정신간호학회지 Vol.13 No.4

N/A Purpose: This study was performed to investigate the sexual function and satisfaction with life in women, and find out factors affecting sex function and satisfaction with life in them. Method: The subjects consisted of 281 women. Data were collected through self-report questionnaires which were constructed to include SFQ-K, SWLS, BD1. The data were analyzed by the SPSS/WIN program. Result: The sexual function of women was significantly different according to age, number of children, occupation, education level, monthly income, and menopause. The sexual function of women correlated satisfaction with life, depression, perception of appearance, and perception of sexual attraction. Significant predictors influencing sexual function in women were perception of sexual attraction, age, depression, and number of children, and these predictors account for 19.2% of the variance in sexual function. Significant predictors influencing satisfaction with life in women were depression, perception of appearance, sexual function, and age, and these predictors account for 28.9% of the variance in satisfaction with life. Conclusion: The above findings indicated that the sexual function in women is influenced by physical, psychological, and environmental factors, and is major factors influencing satisfaction with life. Therefore nursing intervention for improving sexual function should be provided for women.

망상을 가지고 있는 정신분열병 환자들에서 나타나는 비약적 결론내리기의 실험적 고찰

이문기(Moon-Ki Lee),임효덕(Hyo-Deog Rim),원승희(Seung-Hee Won),김양태(Yang-Tae Kim) 대한생물치료정신의학회 2011 생물치료정신의학 Vol.17 No.1

Objectives : Delusion is the key symptom that is observed among the patients with schizophrenia. The patients with schizophrenia with delusion symptom tend to have an early conclusion based on the unsatisfying data under the cognitively uncertain circumstances. Such reasoning bias is called as the “Jumping-to-conclusion”. Few studies have been made on the effect of “Jumping-to-conclusion” bias onto delusion in our nation. The present study aimed to review the presence of the reasoning bias of “Jumping-to-conclusion” in the patients with schizophrenia and to investigate the meaningful relationship of such “Jumping-to-conclusion” with patient symptoms and working memories of the patients with schizophrenia.. Methods : The patient group of the present study included 26 patients with schizophrenia who were hospitalized or treated as outpatients in the national bugok hospital. The diagnosis for the schizophrenia was made by 2 medical specialists in the psychiatric department based on the DSM-Ⅳ diagnosis criteria. As the normal control group, 25 normal healthy subjects who could be comparable to the patient group in terms of gender, age, and education year were included. To all participants of the study, bead test and emotional card test were performed, and the computerized Wisconsin card sorting test that can measure the working memories of test subjects was also performed. Results : Compared to the normal group, the schizophrenia patient group made an early conclusion in both of bead test and emotional card test. But the results did not show statistically significant relationship with the PANSS score and with the Wisconsin card sorting test. Conclusion : The present study confirmed the presence of “Jumping-to-conclusion” bias in the patients with schizophrenia and proved that this bias is not related to psychiatric symptoms and to injuries of working memories.

비정신과 의사의 벤조디아제핀 사용에 관한 예비 조사

송진옥(Jin-Ohk Song),조근호(Keun-Ho Joe),원승희(Seung-Hee Won),서정석(Jeong-Seok Seo),문석우(Seok-Woo Moon),김소연(So-Youn Kim) 대한생물치료정신의학회 2006 생물치료정신의학 Vol.12 No.1

저자들은 본 연구를 통해 비정신과 의사들에서 벤조디아제핀의 처방 경향과 벤조디아제핀이라는 약물에 대한 인식 정도를 파악하고자 하였다. 이에 대구, 서울, 충주 소재 3개 대학병원에 근무하는 74명의 비정신과의사를 대상으로 설문조사를 시행하였고, 성별, 연령 혹은 계열(내과계, 외과계 및 기타 계열)에 따른 처방 현황 및 인식 정도를 비교 분석하였다. 연구 결과 비정신과의사들에게 벤조디아제핀이 광범위하게 처방되고 있으며, 각 과별로 다양한 질환에서 환자의 증상에 따라 정신과 약물이라는 특별한 장벽 없이 사용하고 있음을 확인하였다. 또한 현실적인 처방에 있어서는 적정 용량 이내에서 가능한 한 단기간 사용하고자 노력하고 있음도 확인하였다. 벤조디아제핀 장기 처방 영역에 있어서, 계열 별로 어느 정도 차이를 보이는데, 벤조디아제핀의 감량이나 중단을 위한 의사의 시도에 저항하는 환자의 비율에 대한 질문에 있어 내과계 의사는 환자의 36.6%에서, 외과계 의사는 환자의 40.3%에서 그러한 경향이 있다고 응답한 반면, 기타 과목 의사는 12.1%의 환자에서만 그러한 경향이 있다고 응답하였다(χ²=9.79, p=0.007). 또한, 외래 진료 중 벤조디아제핀을 장기 처방 받고 있는 환자를 우연히 발견하는 비율은, 내과계 의사는 진료 중 “벤조디아제핀 장기 복용 중인 사실을 알게 되는 환자의 비율이 내원 환자의 10% 이상에 달한다.”라고 응답한 의사가 8명에나 이른 반면, 외과계 의사나 기타 과목 의사는 각각 1명씩 밖에 없었다. 또한 기타 과목 의사는 “벤조디아제핀 장기 복용 중인 사실을 알게 되는 환자의 비율이 내원 환자의 0.1% 미만이다.” 혹은 “그런 환자가 전혀 없다”라고 응답한 사람이 전체의 63.6%인 7명에 해당하여 약 22%가 그렇게 대답한 내과 의사와는 의미 있는 차이를 보였다. 본 연구 결과, 벤조디아제핀의 처방 및 인식에 있어 연령 혹은 성별에 따른 차이는 없었으나, 약물 선호 경향 및 장기 처방에 관한 인식에 있어 계열 별로 몇몇 문항에서 차이를 보였다. 이는 벤조디아제핀을 장기간 처방함에 있어 의사의 인식 혹은 진료 중 벤조디아제핀의 복용력에 대한 의사의 보다 높은 수준의 주의가 필요하다는 의미일 수 있겠다. Objectives : Nowadays benzodiazepines were expended their usages into diverse area not only by the psychiatrists but also the non-psychiatric doctors. This study was performed to investigate the non-psychiatric doctors' attitude toward benzodiazepines when they prescribe. Methods : 74 doctors with various medical specialties except psychiatry working at one of the following general hospitals were recruited, Daegu catholic university medical center, Kunkuk university Cheung-ju hospital, and Chung-Ang university medical center. 11-item questionnaires were distributed and requested to fill-up, which were about benzodiazepine prescription. The answers were interpreted with χ² analysis. Results : Benzodiazepines were prescribed to manage diverse diseases by non-psychiatric doctors. Alprazolam is the most popular to physician, but diazepam to other doctors including surgeons and others. Symptoms for which benzodiazepines were prescribed showed no differences depending on their specialties. Most of the doctors intended to avoid the administration of benzodiazepine with higher dosages. 36.5% of non-psychiatrists maintained benzodiazepines until the symptoms disappear without considerations about the total administered durations of benzodiazepine. 17.6% of non-psychiatrists discontinue benzodiazepine within 3 months and only 13.5% of them discontinue benzodiazepine with 1 month. Non-psychiatrists reported approximately 33.4% of patients resisted when doctors intend to decrease the benzodiazepine dosage but 62.2% of doctors reported less than 10% of all patients demanded re-escalation of benzodiazepine dosage. Conclusion : Depending on the specialties, the detection rates of benzodiazepine long-term users are varied. It means more surveillance needed to prevent long-term benzodiazepine use.

시지각적 자극의 특성이 이름대기 검사결과에 미치는 영향

손세익(Se Ik Son),배금예(Geum Ye Bae),원승희(Seung-Hee Won),김병수(Byung-Soo Kim) 대한생물치료정신의학회 2016 생물치료정신의학 Vol.22 No.1

Objectives:The 15-item Modified Boston Naming Test in CERAD-K(BNT-KC) is composed of line drawings and has the possibility of lacking accuracy due to visual perceptual ambiguity of the stimulation. In order to minimize this, we developed a revised version of BNT-KC composed of photographic stimulation of the same contents, and compared the diagnostic accuracy of it with the original version. Methods:Pictures of the same objects in the original BNT-KC were taken by camera or downloaded from the internet. One hundred and eighty-four elderly, who visited the memory clinic for the diagnosis of dementia(95 Alzheimer’s dementia(AD), 89 normal), completed both the versions of BNT-KC. Difference in the total score was compared using paired t-test. To verify whether there is a difference with the matched pairs of items, the McNemar’s test was carried out. Area under a receiver operating characteristic curve(AUC) was obtained to compare the performance of each test. Results:There was a significant difference between the total score of the original version and the photographic version of BNT-KC(t=14.26, p<0.001). Eight items, “Cobweb,” “Balloon,” “Bat,” “Traffic light,” “Acorn,” “Pomegranate,” “Funnel,” and “Monk’s hat,” demonstrated significant differences in the McNemar’s test after the Bonferroni correction(p<0.003). AUCs for the diagnosis of AD in the original and photographic versions were 0.696 and 0.705, respectively. AUCs for the identification of moderate to severe AD(CDR 2 or higher) from others were 0.784 for the original version and 0.808 for the photographic version. Conclusion:Characteristics of visual perceptual stimuli influenced the diagnostic accuracy of BNT-KC, especially in the identification of patients with moderate to severe AD. Revision of BNT-KC is required to enhance the diagnostic accuracy for dementia.

조현병 환자에서 비정형 장기지속형 주사제와 경구제의 6개월 추적관찰 기간 효과비교

박찬미(Chan mi Park),박은정(Eun jung Park),이승환(Seung Hwan Lee),김영훈(Young Hoon Kim),정영철(Young Chul Chung),원승희(Seung hee Won),이상규(Sang Kyu Lee),박선철(Seon Cheol Park),배경열(Kyung ryul Bae),최진아(Jin A Choi),최하진(Ha 한국보건의료연구원 2016 근거와 가치 Vol.2 No.2

Objectives: To compare the clinical outcomes between the schizophrenia patients using long-acting injection (LAI) and those using oral agent (Oral). Methods: A prospective multicenter registry conducted at 7 hospitals comparing a one-year treatment effectiveness of LAI to reduce recurrence and to improve medication adherence (MA) and quality of life (QOL). This interim analysis presents data from the first 6 months of the follow-up period. Results: Among a total of 393 patients enrolled in this study, 385 patients (LAI 87, Oral 298) were analyzed as the interim analysis. There were no significant differences in clinical global impression (CGI), global improvement (GI), positive and negative symptom scale (PANSS), and QOL (CGI, P=0.618; GI, P=0.599; PANSS, P=0.289; EuroQol five dimensions questionnaire, P=0.254; Korean version of 4th revision of Schizophrenia Quality of Life Scale, P=0.416; visual analogue scale, P=0.581). LAI was associated with improved doctor’s perspective MA (P=0.021), but no difference was observed in patient’s perspective MA (P=0.355). Recurrence for 6 months occurred in 8 cases (9.2%) of LAI and in 43 cases (14.4%) of Oral. Kaplan-Meier analysis showed that there was no significant difference in time to recurrence after enrollment between LAI and Oral. The multivariate Cox analysis also showed no difference (hazard ratio=1.710; 95% confidence interval=0.758~3.855). Conclusion: In patients with schizophrenia experiencing recurrence, the difference of effectiveness between LAI and oral therapy could not be observed during 6 months of follow-up.

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.

섬망의 병태생리

김휘중,김철진,원승희 대한생물치료정신의학회 1999 생물치료정신의학 Vol.5 No.1

요약 저자들은 섬망의 아형과 병태생리에 대한 연구를 고찰하였다. 섬망 아형 중에 과활동성, 저활동성 아형이 가장 널리 받아들여지고 있고, 병태생리기전은 1가지 이상으로 생각되고 있다. 특정 뇌영역과 신경전달계의 기능장해가 섬망발생에 중요할 것이며, 뇌영역 중에는 전전두부 피질, 우측 뇌반구(특히, 두정엽), 피질하 핵(특히, 우측 시상과 미상)이 중요하며, 신경전달물질 중에는 아세틸콜린과 도파민이 가장 많은 관심을 받아왔다. 그 외에도 세로토닌, GABA, 히스타민, glutamate, 노아드레날린, somatostatin, 베타 엔돌핀, cortisol, cytokine, 세포내 전령계, 뇌대사 등이 연구되고 있다. 끝으로 저자들은 섬망의 병태생리에 대해 제시된 연구방향을 소개하였다. The authors reviewed the studies of subtypes and pathophysiology of delirium. Hyperactive vs. hypoactive is the most widely accepted schema for subtyping delirium, and more than one mechanism may be involved in pathophysiology of delirium. Specific brain areas and disturbances of neurotransmission may play important roles in the occurrence of delirium. Specific brain areas involved are prefrontal cortex, right-hemisphere (especially parietal), and subcortical nucleus(especially right-sided thalamus and caudate). Acetylcholine and dopamine have received most attention, and serotonin, GABA, histamine, glutamate, norepinephrine, somatostatin, beta-endorphin, cortisol, cytokine, intracellular messenger system and brain metabolism are being studied. Lastly, the authors introduced the focus of future research of pathophysiology of delirium presented.