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세로토닌 재흡수 억제제에 대한 아리피프라졸 및 부프로피온 부가요법의 우울증 세부증상에 대한 효과 비교 : 다기관, 개방표지, 무작위 연구
이가원,이광헌,박영우,이종훈,구본훈,이승재,성형모,천은진,Lee, Ga-Won,Lee, Kwang-Hun,Park, Young-Woo,Lee, Jong-hun,Koo, Bon-Hoon,Lee, Seung-Jae,Sung, Hyung-Mo,Cheon, Eun-Jin 대한불안의학회 2017 대한불안의학회지 Vol.13 No.2
우울증은 높은 유병률을 가지며 심각하고 만성화 될 수 있는 질병이다. 환자가 증상 없이 기능적 회복이 되어 일상을 영위하기 위해 임상가는 단독요법 이상의 치료 전략이 필요하다. 본 연구에서 SSRI와 aripiprazole 또는 bupropion 부가 요법은 우울증의 증상 호전을 보였다. SSRI와 aripiprazole 부가 요법은 우울증의 전반적 점수의 호전뿐 아니라 세부척도의 핵심 증상에서 bupropion 병합 요법에 비해 더 의미 있는 변화를 보였다. 또한 두 약제 모두 핵심 우울증상이라 할 수 있는 개별증상(우울한 기분, 일과 활동, 정신적 불안)에서 가장 큰 변화를 보였다 Objective : The purpose of this study was to examine the effects of adjunctive aripiprazole versus bupropion on specific symptoms of depression. Methods : Data were from 6-week, randomized, prospective, open-label multi-center study in 103 patients with major depressive disorders. Participants were randomized to receive aripiprazole (2.5-10 mg/day) or bupropion (150-300 mg/day) for 6 weeks. Change in four subscales of the 17-item Hamilton Depression Rating Scale (HAM-D17) that capture core depression symptoms was determined, and change in individual HAM-D17 items was also assessed. Changes in three composite subscales-anxiety, insomnia, and drive were also examined. Results : Within-group change in the four core subscales was large [effect size (ES)=1.30-1.47] and it was similar to that in the HAM-D17 total score. Differences between aripiprazole and bupropion were significant for each of the four core subscales and the HAM-D17 total score favored aripiprazole (p<0.001). On three composite scales, both treatments caused substantial changes in anxiety (within-group ES=1.10 (aripiprazole) vs. 1.00 (bupropion)], insomnia (ES=0.75 vs 0.50), and drive (ES=1.17 vs 1.15). Conclusion : This results suggested that both aripiprazole and bupropion adjunctive therapies with selective serotonin reuptake inhibitors resulted in significant and clinically meaningful changes in core symptom subscales for depression.
리스페리돈(Risperidone)을 투약 중인 정신분열병 환자에서 지프라시돈(Ziprasidone)으로 교체 투약 시 보이는 임상적 및 대사적 이득에 대한 전향적 개방 연구
이종훈(Jong Hun Lee),송진옥(Jin Ok Song),이승재(Seung Jae Lee),정성원(Sung Won Jung),구본훈(Bon Hoon Koo),이광헌(Kwang Heun Lee) 대한생물치료정신의학회 2009 생물치료정신의학 Vol.15 No.1
Objectives:The purpose of this study was to assess clinical effectiveness and metabolic benefits by switching from risperidone to ziprasidone in chronic stable schizophrenic patients. Methods:A total of 19 patients taking risperidone were switched to a 12-week, open label, flexible dose(80- 160㎎/day) of ziprasidone. Current psychiatric status was evaluated by Positive and Negative Syndrome Scale(PANSS), Clinical Global Impression(CGI), and Global Assessment of Functioning(GAF). Drug induced abnormal movements were assessed using various scales. Laboratory tests including lipid profiles, HbA1c, fasting plasma glucose and electrocardiography were carried out. Results:Of the 19 enrolled patients, 14 patients(73.7%) completed the study. Mean daily dose were 6.1±2.0㎎ for risperidone at the baseline and 123.1±8.1㎎ for ziprasidone at the end point of the study. Significant improvements were found on PANSS negative subscale scores(p<.05), with trends towards improved positive and psychopathology subscale scores. Among metabolic parameters, mean total cholesterol, triglyceride, and free fatty acid showed significant improvements(all ps<.05). In line with these findings, mean body weight and hip size significantly decreased from baseline(each p<.05). Regarding tolerability, frequency and severity of abnormal movements were not significantly different between two drugs. The ECG results showed no significant change from baseline in the QTc interval. Conclusion:Our findings supported the use of ziprasidone as a good option for the treatment of stable yet partially resolved outpatients with schizophrenia who has been taking risperidone continually, with benefits in efficacy particularly negative symptoms, reduction of body weight as well as hip size, and improvements in metabolic risk factors.
배나리(Na-lee Bae),이광헌(Kwang-hun Lee),이관(Kwan Lee),곽경필(Kyung-phil Kwak) 대한노인정신의학회 2015 노인정신의학 Vol.19 No.2
Objective:This study was aimed to investigate the efficacy of cognitive training in community-dwelling elderly, and to sup-port mental health care system for the elderly. Methods:We investigated 1,994 and aged over 65 years elderly visiting senior center from April 2014 to July 2014. Their de-mographic data was investigated. Cognitive functions were evaluated by Korean Version of Mini Mental Status Examination for Dementia Screening (MMSE-DS) and Global Deterioration Scale. Quality of life was evaluated by Korean Quality of Life-Alzheim-er’s Disease (KQoL-AD) and depression by Short Korean Form of Geriatric Depression Scale. Before and after cognitive training, we analysed these data. Results:MMSE-DS, KQoL-AD were significantly higher in score after the cogintive training than before of that (p<0.001). SGDS-K were significantly lower in score after the cognitive training than before of that (p<0.001). Conclusion:Cognitive training resulted in improvement in cognitive functions, quality of life and depression for community-dwelling elderly. These results suggest that future mental health care policy has to consider the importance of community-dwelling elderly.
김문범(Moon Beom Kim),이광헌(Kwang-Hun Lee),이관(Kwan Lee),곽경필(Kyung-Phil Kwak) 대한생물치료정신의학회 2018 생물치료정신의학 Vol.24 No.3
Objectives:The purpose of this study was to investigate the prevalence and risk factors of suicidality among community-dwelling elderly. Methods:The participants were 2,201 elderly people whose ages were over 65. The participants were asked to complete questionnaires, including Mini International Neuropsychiatric Interview(MINI), module C, Short Geriatric Depression Scale of Korean version(SGDS-K), Korean Geriatric Anxiety Inventory(K-GAI), The Korean Health Status Measure for Elderly V 1.0, Korean version of Mini-Mental Status Examination for Dementia Screening(MMSE-DS). Their sociodemographic factors were investigated. The data were analyzed using the chi-square test and the logistic regression test to examine the relationship between suicidality and participants’ risk factors. Results:The prevalence rate of suicidality was 23.3%. In multiple logistic regression, depressive symptoms (OR=3.301, 95% CI : 2.453-4.440), anxiety symptoms(OR=3.289, 95% CI : 2.515-4.303), low physical function (OR=1.606, 95% CI : 1.229-2.098), no spouse(OR=1.571, 95% CI : 1.037-1.690), elderly aged 80 years or older (OR=1.506, 95% CI : 1.094-1.740) were independently associated with suicidality. Conclusion:Suicidality in community-dwelling elderly was quite high, particularly related to depressive symptoms. The results of this study can be useful for development of community-based prevention and management programs for suicidality.
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.
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.