신경아교세포와 조현병

원승희,Won, Seunghee 대한생물정신의학회 2015 생물정신의학 Vol.22 No.2

In the past decade, structural, molecular, and functional changes in glial cells have become a major focus in the search for the neurobiological foundations of schizophrenia. Glial cells, consisting of oligodendrocytes, astrocytes, microglia, and nerve/glial antigen 2-positive cells, constitute a major cell population in the central nervous system. There is accumulating evidence of reduced numbers of oligodendrocytes and altered expression of myelin/oligodendrocyte-related genes that might explain the white matter abnormalities and altered inter- and intra-hemispheric connectivities that are characteristic signs of schizophrenia. Astrocytes play a key role in the synaptic metabolism of neurotransmitters ; thus, astrocyte dysfunction may contribute to certain aspects of altered neurotransmission in schizophrenia. Increased densities of microglial cells and aberrant expression of microglia-related surface markers in schizophrenia suggest that immunological/inflammatory factors are of considerable relevance to the pathophysiology of psychosis. This review describes current evidence for the multifaceted role of glial cells in schizophrenia and discusses efforts to develop glia-directed therapies for the treatment of the disease.

정신분열병 환자에서 골밀도 변화와 관련 위험요인

원승희 대한생물치료정신의학회 2004 생물치료정신의학 Vol.10 No.1

Osteoporosis is dearly a serious public health problem in the general population, resulting in considerable morbidity and mortality. Lifestyles of individuals with schizophrenia are at increased risk for osteoporosis and fractures for several reasons, including lack of exercise, poor nutritional status, cigarette smoking, and alcohol drinking. Some antipsychotic medications may further increase the risk of fractures by causing dizziness, orthostatic hypotension, polydipsia, and falls. But obesity could play a protective role. Of particular concern is the impact of prolactin-elevating antipsychotic medications since the elevated prolactm may have direct and indirect inhibitory effects on osteoblastic function. Preliminary surveys have indicated that schizophrenic patients also may have elevated rates of osteoporosis and pathological fractures, Dossibly resulting in part from the long-term administration of antrpsy-chotic agents-that produce hyDerprolactrnernia and secondarily lower estrogen and testosterone levels. Although the effects of antipsychotics on prolactin have been well studied, effects upon borne mineral density have received little attention despite of the important implications. Clinicians should address with their schizophrenic patients general health issues such as cigarette smoking, diet. daily activity and medication, which may contribute to osteoporosis. The magnitude of decreased bone mineral density and the ensuring increased susceptibility to osteoporosis and fractures is higher in women with schrzophrenia than in men with schizophrenia Therefore, the loss of menses in a woman treated with prolactin-elevating medications should raise the concern of hypoestrogenism and should be given a test for bone mineral density. The author reviewed osteoporosis and relative risk factors in schizophrenic patients for preyention and early treatment for osteoporosis.

韓國版 强迫尺度의 開發을 위한 豫備研究 — Modified Leyton Obsessional Inventory의 信賴度 및 妥當度 檢證 一

元勝喜,姜秉祥 대한신경정신의학회 1995 신경정신의학 Vol.34 No.2

As a self-reporting scale evaluating obsessional symptom, the M odified Leyton Obsessional Inventory is being used, which was developed by Cooper(1970) and modified and complem ented by Frankel et al(1986). To develop a Korean version o f obsessional scale, the author conducted a study on the reliability and validity through translation suitable to the Korean situation o f the Modified Leyton Obsessional Inventory. Thirty-four persons diagnosed as obsessive compulsive disorder(O CD ) by means of DSM-III-R were designated as the patient group and the control group consisted of 261 medical school students. The followings are the results of the study : the correlational coefficient of the total scores in the test-retest realiability was a relatively high of 0.85(p<0.001) ; in Cronbach’s a, both showed a high internal consistency with 0.9432 for the patient group and 0.9429 for the co ntrol; in the test of the reliability using the half-split method, the reliability conefficients by even and odd num bers showed high corelations o f 0.90 and 0.84 respectively - all these showed statistical significance. The patient group showed a significantly high score, in the com parison of the total scores between the patient group, 97.62± 35.75,and the control, 50.07± 24.71(p<0.05). In the distribution of frequencies in the total scores, 70 above accounted for 66.5% in the patient group and 19.5% in the control, a significant difference. In the relationship between scores and total scores of each scale of M.M.P.I.,both the patient and the control groups showed high corelation in ‘P t’ and ‘Sc’ items. Both groups also showed significantly high corelation in ‘Si’ • ‘M a’ • ‘P a’ • ‘H s’ items. As a reslut of factor analysis by the Varimax rotation, 9 factors were extracted. The 9 factors accounted for 64.0% of common variance explained and Factor I (obsession) takes up 32.5 %. In further studies, more variegated groups and patient groups should be taken as the subjects of study for a sustained study on fixing the cutoff level to differentiate OCD and standardization as against the norm al group of people. It is also recommended that studies on the validity together with various scales to diagnose more correct OCD should be carried out

韓國版 强迫尺度의 開發을 위한 豫備硏究 : Evaluation of the Reliability and Validity Modified Leyton Obsessional Inventory의 信賴度 및 妥當度 檢證

姜秉祚,元勝喜 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.2

As a self-reporting scale evaluating obsessional symptom, the Modified Leyton Obsessional Inventory is being used, which was developed by Cooper(1970) and complemented by Frankel et al(1986). To develop a Korean version of obsessional scale, the author conducted a study on the reliability and validity through translation suitable to the Korean situation of the Modified Leyton Obsessional Inventory. Thirty-four persons diagnosed as obsessive compulsive disorder(OCD) by means of DSM-Ⅲ-R were designated as the patient group and the control group consisted of 261 medical school students. The followings are the results of the study : the correlational coefficient of the total scores in the test-retest realiability was a relatively high of 0.85(p〈0.001) ; in Cronbach's α, both showed a high internal consistency with 0.9432 for the patient group and 0.9429 for the control ; in the test of the reliability using the half-split method, the reliability conefficients by even and odd numbers showed high corelations of 0.90 and 0.84 respectively - all these showed statistical significance. The patient group showed a significantly high score, in the comparison of the total scores between the patient group, 97.62±35.75, and the control, 50.07±24.71(p〈0.05). In the distribution of frequencies in the total scores, 70 above accounted for 66.5% in the patient group and 19.5% in the control, a significant difference. In the relationship between scores and total scores of each scale of M.M.P.L, both the patient and the control groups showed high corelation in ‘Pt’ and ‘Sc’ items. Both groups also showed significantly high corelation in ‘Si’·‘Ma’·‘Pa’·‘Hs’ items. As a result of factor analysis by the Varimax rotation, 9 factors were extracted. The 9 factors accounted for 64.0% of common variance explained and Factor(obsession) takes up 32.5%. In further studies, more variegated groups and patient groups should be taken as the subjects of study for a sustained study on fixing the cutoff level to differentiate OCD and standardization as against the normal group of people. It is also recommended that studies on the validity together with various scales to diagnose more correct OCD should be carried out.

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.

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.

정신분열병, 기분장애와 보르나 바이러스

정성훈,원승희,김상헌 대한생물치료정신의학회 1998 생물치료정신의학 Vol.4 No.2

Borna disease virus is a unique neurotropic agent that appears to have a predilection for the limbic area of the brain. In some animal species, it can produce a behavioral syndrome characterized by aggressive and passive phases. These two characteristics has suggested the relationship between schizophrenia, mood disorder and Borna disease virus. Borna disease virus can infect human brain tissue possibly contributing to the pathophysiology of specific human neuropsychiatric disorders. The authors reviewed several articles suggesting an association of Borna disease virus with schizophrenia and mood disorder.

强迫障碍와 人間組織適合性抗原

秋東鎬,元勝喜,姜秉祚 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.1

A HLA-typing(HLA-A, B, C, DR, DQ) was conducted on 35 patients diagnosed as obsessive compulsive disorder(OCD) based on the DSM-Ⅲ-R criteria for a comparison with HLA of the normal controls. The normal controls consisted of 30 healthy medical students for HLA-A, B, C and 136 healthy persons for HLA-DR, DQ. The Tearasaki method was used for HLA-A, B, C and PCR method, for HLA-DR, DQ. The frequencies of HLA for both OCD patients and the normal controls were compared by means of the Gart and Nam statistical analysis method and the P value was corrected by multiplying the tested antigen numbers, to avoid the Type 1 error. When compared with the normal controls, HLA-B(60) was found significantly high in frequencies among OCD patients(p〈0.05), with significantly low levels in HLA-DR(p〈0.01) and DQ(6) (p〈0.0001). The corrected P value found only DQ(6)(0.0005) to be significantly low. This leads DQ(6) to be indicative of the possibility of a genetic marker. A further study, howerever, is required on unmedicated, on a larger pool of subjects.

관해기 I형 양극성장애 환자와 발병하지 않은 일차 친족에서 신경인지의 결함

김도훈,원승희,김지우,조수현 대한신경정신의학회 2013 신경정신의학 Vol.52 No.5

Objectives Neurocognitive dysfunction may provide a marker of underlying neuropathology and disease vulnerability in bipolar disorder. The aim of this study was to identify the differences and the profiles of cognitive deficits in euthymic bipolar patients and first-degree relatives of bipolar probands. Methods Twenty four unaffected first-degree relatives of probands with bipolar I disorder (BD) were included in the study as an equal number of remitted BD patients and healthy controls who were matched on age, sex, years of education, and general intelligence. Cognitive assessments were performed using the Digit Span Test, Continuous Performance Test, Rey Auditory & verbal Learning Test, Complex Figure Test, Verbal Fluency Test, Wisconsin Card Sorting Test, and Finger Tapping Test. The effect of subsyndromal symptomatology was controlled. Results Patients showed significantly worse performance than healthy control subjects in several measures of attention, working memory, verbal learning and memory, visual memory (delayed recall), and verbal fluency (category). Relatives showed significant impairment in working memory. No differences were observed in sustained attention, cognitive flexibility, and psychomotor performance. Conclusion Findings of our study suggest that the deficit in working memory could be a potential endophenotypic marker of genetic vulnerability to BD. Verbal learning and memory impair ment appears to be more related to the fully developed BD