전기경련치료의 마취를 위한 실제적 문제들

윤탁,김용식,이남영,김세현,최준권,이정혁,정인원,Youn, Tak,Kim, Yong Sik,Lee, Nam Young,Kim, Se Hyun,Choi, Jun Gwon,Lee, Jeoung Hyuk,Chung, In Won 대한생물정신의학회 2017 생물정신의학 Vol.24 No.3

Electroconvulsive therapy (ECT) has been recognized effective as primary or secondary treatments for major psychiatric disorders including depression and schizophrenia, as well as psychiatric emergency such as suicide, food refusal and catatonia, and so on. Medicines used in anesthetic induction for ECT, cause various reactions in autonomous, hemodynamic, and neuromuscular systems. The anesthetics also affect the duration, threshold, and intensity of seizures evoked with electric stimuli, and thus modify the seizure quality in ECT. Individual characteristics of age, sex, weight, comorbid physical disorders, and medications should also be considered for optimal clinical response after ECT. When preparing for anesthesia, adequate anesthetic agents and muscle relaxants, and rapid recovery should be carefully considered. We conducted a case-series study to address practical issues that are frequently encountered during ECT anesthesia with reviews of updated journals in order to provide practical helps to clinicians who are preparing ECT for their patients.

폐쇄성 수면무호흡증에서 지속적 상기도 양압술 시행이 교감신경계 활성도에 끼치는 영향 : 심전도 스펙트럼 분석

윤탁,박해정,김의중,정도언,Youn, Tak,Park, Hae-Jeong,Kim, Eui-Joong,Jeong, Do-Un 대한수면의학회 2000 수면·정신생리 Vol.7 No.1

Objectives: Obstructive sleep apnea syndrome(OSAS) is known to be associated with the changes of autonomic nervous system (ANS). Nasal continuous positive airway pressure(nCPAP) treatment was found to correct abnormal ANS changes in OSAS but it remains to be further clarified. We aimed to assess the effects of nCPAP on ANS manifested on electrocardiogram, using spectrum analysis in the subjects with OSAS. Methods: Digital polysomnography was performed in 18 patients with OSAS(mean age $43.7{\pm}16.6$ years ; 17 males, 1 female ; mean respiratory disturbance index (RDI) $48.6{\pm}20.9$) for one baseline and another CPAP nights. From each night, 300 continuous beats of ECGs without artifact were chosen from both stage 2 sleep and REM sleep and they were used for power spectrum analysis. We compared between baseline and CPAP nights the heart rate variability including VLF(very low frequency power), LF (low frequency power), HF(high frequency power), R-R means, R-R variance, and LF/HF ratio, using Wilcoxon signed ranks test. Results: In all patients, nCPAP proved to be effective in relieving apneas and snoring. During nCPAP night compared with baseline night, decreases in VLF(p<0.05), LF(p<0.01), and R-R variance(p<0.05) were found in stage 2 sleep, and decreased LF(p<0.05) was found in REM sleep. No significant differences in each sleep stage were found in other variables between the two nights. Conclusion: Our findings suggest that OSAS increases the activity of sympathetic nervous system and nCPAP application effectively decreases the activity. And nCPAP does not appear to influence the parasympathetic nervous activity in OSAS.

혈중산소포화도검사를 이용한 폐쇄성 수면무호흡증의 흡증의 진단

윤탁,박두흠,최광호,김용식,우종인,권준수,하규섭,정도언,Youn, Tak,Park, Doo-Heum,Choi, Kwang-Ho,Kim, Yong-Sik,Woo, Jong-Inn,Kwon, Jun-Soo,Ha, Kyoo-Seob,Jeong, Do-Un 대한수면의학회 2002 수면·정신생리 Vol.9 No.1

Objectives: The gold standard for diagnosing obstructive sleep apnea syndrome (OSAS) is nocturnal polysomnography (NPSG). This is rather expensive and somewhat inconvenient, however, and consequently simpler and cheaper alternatives to NPSG have been proposed. Oximetry is appealing because of its widespread availability and ease of application. In this study, we have evaluated whether oximetry alone can be used to diagnose or screen OSAS. The diagnostic performance of an analysis algorithm using arterial oxygen saturation ($SaO_2$) base on 'dip index', mean of $SaO_2$, and CT90 (the percentage of time spent at $SaO_2$<90%) was compared with that of NPSG. Methods: Fifty-six patients referred for NPSG to the Division of Sleep Studies at Seoul National University Hospital, were randomly selected. For each patient, NPSG with oximetry was carried out. We obtained three variables from the oximetry data such as the dip index most linearly correlated with respiratory disturbance index (RDI) from NPSG, mean $SaO_2$, and CT90 with diagnosis from NPSG. In each case, sensitivity, specificity and positive and negative predictive values of oximetry data were calculated. Results: Thirty-nine patients out of fifty-six patients were diagnosed as OSAS with NPSG. Mean RDI was 17.5, mean $SaO_2$ was 94.9%, and mean CT90 was 5.1%. The dip index [4%-4sec] was most linearly correlated with RDI (r=0.861). With dip index [4%-4sec]${\geq}2$ as diagnostic criteria, we obtained sensitivity of 0.95, specificity of 0.71, positive predictive value of 0.88, and negative predictive value of 0.86. Using mean $SaO_2{\leq}97%$, we obtained sensitivity of 0.95, specificity of 0.41, positive predictive value of 0.79, and negative predictive value of 0.78. Using $CT90{\geq}5%$, we obtained sensitivity of 0.28, specificity of 1.00, positive predictive value of 1.00, and negative predictive value of 0.38. Conclusions: The dip index [4%-4sec] and mean $SaO_2{\leq}97%$ obtained from nocturnal oximetry data are helpful in diagnosis of OSAS. CT90${\leq}$5% can be also used in excluding OSAS.

정량화 뇌파(QEEG)의 임상적 이용

윤탁,권준수,Youn, Tak,Kwon, Jun-Soo 대한수면의학회 1995 수면·정신생리 Vol.2 No.1

Recently, the methods that measure and analyze brain electrical activity quantitatively have been available with the rapid development of computer technology. The quantitative electroencephalography(QEEG) is a method of computer-assisted analyzing brain electrical activity. The QEEG allows for a more sensitive, precise and reproducible examination of EEG data than that can be accomplished by conventional EEG. It is possible to compare various EEG parameters each other by using QEEG. Neurometrics, a kind of the quantitative EEG. is to compare EEG characteristics of the patient with normative data to determine in what way the patient's EEG deviates from normality and to discriminate among psychiatric disorders. Nowadays, QEEG is far superior to conventional EEG in its detection of abnormality and in its usefulness in psychiatric differential diagnosis. The abnormal findings of QEEG in various psychiatric disorders are also discussed.

노인 기질성 정신장애 환자의 급성 정신증상에 대한 리스페달 사셰와 할로페리돌 근주의 효과 비교

윤탁,Youn, Tak 대한생물정신의학회 2007 생물정신의학 Vol.14 No.2

Objectives : The purpose of present study was to investigate the effect, safety and tolerability of risperdal sachet(oral solution) with lorazepam tablet versus intramuscular haloperidol and lorazepam injection for management of acute psychotic symptom in the elderly with organic mental disorder. Methods : Total 37 patients who have dementia, medical or physical diseases, associated with acute psychotic symptom were randomly assigned to oral treatment with 1mg of risperdal sachet(oral solution) plus 1mg of lorazepam(N=17) or to intramuscular treatment with 2.5mg of haloperidol plus 2mg of lorazepam (N=20). The change of CGI scores was used for the evaluation of efficacy. Results : Mean score improvements at 15, 30, 60, and 120 minutes after treatment were statistically significant at each time point in both groups(p<0.001) and were similar in both groups(p=0.189). Conclusion : A single oral dose of risperdal sachet(oral solution) plus lorazepam was as effective and tolerable as parenterally administered haloperidol plus lorazepam for the rapid control of acute psychotic symptom in the elderly with organic mental disorder.

정신분열병 환자의 인지 기능 재활에 대한 보드게임 요법의 효과 분석

윤탁,정안순,Youn, Tak,Jeong, An-Soon 대한생물정신의학회 2006 생물정신의학 Vol.13 No.2

Objectives : In order to explore effects of board-game therapy for cognitive rehabilitation in patients with schizophrenia, we investigated the change of executive cognitive function over a 2-month period of board-game therapy in patients with schizophrenia. Methods : Two groups of chronic schizophrenic inpatients were participated in this study. One group(n=21) were treated with board-game therapy for 2 months and the other control group(n=19) were not treated. For the evaluation of the executive cognitive function, a Wisconsin Card Sorting Test(WCST) was administered before and after the introduction of the board-game therapy. PANSS score change was also evaluated. Result : At the beginning of this study, there was no significant difference in performance of cognitive function tests, demographical data or clinical severity between both patient groups. After 2 months of treatment with the board-game therapy, the board-game therapy group showed significant improvements of executive cognitive function without any significant change of their schizophrenic symptoms. On the contrary, there was no change in control group. Conclusion : This study showed that a board-game therapy is effective for the enhancement of executive cognitive function in patients with chronic schizophrenia. A board-game therapy could be introduced with ease into psychiatric fields, such as inpatients' or outpatients' clinic wards and day hospital. Our result indicates that the board-game therapy is a promising tool for the enhancement of cognitive function, especially executive cognitive function and helpful for cognitive rehabilitation for schizophrenic patients.

강박 장애의 정량화 뇌파 소견

윤탁,권준수,조맹제,김용식,이부영,Youn, Tak,Kwon, Jun Soo,Cho, Maeng-Je,Kim, Yong Sik,Rhi, Bou-Yong 대한생물정신의학회 1996 생물정신의학 Vol.3 No.2

The quantitative EEGs of obsessive-compulsive disorder patients were analyzed using spectral analysis and compared to age and sex-matched controls. The subjects were 19 patients(men=15, women=4) suffering from obsessive-compulsive disorder(DSM-III-R). Absolute power, relative power and interhemispheric asymmetry of EEG were used to compare obsessive-compulsive disorder patients with controls. In order to fit the EEG data to a normal distribution, a log transformation of power values of every bandwidth in each deviation was calculated prior statistical analysis. The Wilcoxon rank test was performed to compare obsessive-compulsive group to the control group. In obsessive-compulsive disorder, abnormalities of quantitative EEGs are prominent in fronto-central. These results ore compatible with other brain imaging studies of obsessive-compulsive disorder and suggested that fronto-central area plays an important role in the pathophysiology of obsessive-compulsive disorder.

난폭하고 공격적인 행동을 보이는 치료저항성 정신분열병 환자의 Risperidone 장기 지속형 주사제를 이용한 치료 사례

윤탁 대한정신약물학회 2007 대한정신약물학회지 Vol.18 No.3

Aggressive and violent behaviors are an important problem in psychiatric department. Treatment-resistant schizophrenia with aggressive and violent behavior is more and more growing problem in treatment and management. A 45-year-old treatment-resistant schizophrenic male patient with aggressive and violent behavior was treated with long-acting injectable risperidone, added to previous antipsychotic medication. After adding long-acting injectable risperidone, his violent and aggressive behavior had been much improved. Patient’s poor drug compliance was also improved, which is associated with frequent seclusion or restraint, and sedation induced by antipsychotic injection. This case shows the benefit of long-acting injectable risperidone, for aggressive and violent schizophrenic patient with treatment-resistant feature. In addition, this case proposed that the difficulty of administering antipsychotics to uncooperative patients with any cause, such as none of insight for diseases or aggressive and violent behavior, is added to the definition of drug compliance or adherence. 본 증례는 치료저항성 정신분열병 환자의 폭력적이고, 공격적인 행동과 투약에 비협조로 인하여 적절한 치료가 어려운 경우에 risperidone 장기 지속형 주사제를 사용하여 증상을 완화시키고, 다른 경구용 항정신병약물의 효과를 증진시킬 수 있도록 하여, 환자의 증상 조절을 용이하게 해준 증례이다. 만성정신병원에서 적지 않게 치료 받고 있을 본 증례와 유사한 환자 뿐만 아니라, 여러 이유로 치료저항성 정신분열병 환자로 잘못 분류되어질 수 있는 환자들에게 본 치료 사례는 도움이 될 것이다.

정신분열병 환자에서 40Hz 뇌 사건관련전위에 관한 연구 : 분석 방법론적 측면

윤탁,박해정,강도형,김명선,김재진,권준수,Youn, Tak,Park, Hae-Jeong,Kang, Do-Hyung,Kim, Myung-Sun,Kim, Jae-Jin,Kwon, Jun Soo 대한생물정신의학회 2001 생물정신의학 Vol.8 No.2

Backgrounds : Gamma band oscillatory activity is considered to be related to cognitive functions and illustrates that the concept of event-related oscillations bridges the gap between single neurons and neural assemblies. An event-related gamma oscillation is the time-locked responses of specific frequency, and can be identified by computing the amplitude frequency characteristics of the averaged event-related potentials(ERPs) after stimulation. Objectives : We purposed to present experimental paradigm to investigate ${\gamma}$-band oscillation activities from the recording of ERPs by using auditory oddball paradigm and investigate the difference of ${\gamma}$-band activity between schizophrenia and normal controls. Methods : The ERPs resulting from auditory stimuli with oddball paradigm in a group of schizophrenics(n=11), and also a group of age-, sex-, and handedness matched normal controls, were recorded by 128 channel EEG. The ${\gamma}$-band oscillatory activities were calculated by using time-frequency wavelet decomposition of the signal between 20 and 80Hz. The ${\gamma}$-band oscillatory activities of both groups were compared by t-test. Results : The ${\gamma}$-band oscillatory of the leads Fz, Cz, and Pz of both groups were represented well in the time-frequency maps. Significant increases of the ${\gamma}$-band activity in normal controls compared with schizophrenics were observed around 160 msec, 350 msec, and 800 msec after stimulation. Conclusions : Our results suggested that the increment in ${\gamma}$-band oscillatory activity during cognitive operations and decreased ${\gamma}$-band activity in schizophrenics may be associated with the cognitive dysfunctions and the pathophysiology of the schizophrenia.

표준치료에 반응하지 않는 진행성 신세포암환자를 대상으로 시행한 저용량 전처치 동종조혈모세포이식의 효과

윤탁,이근육,나임일,송은기,신현춘,윤성수,이종석,박선양,김병국,이정희,최성준,이제환,이규형 대한내과학회 2004 대한내과학회 추계학술발표논문집 Vol.2004 No.1