한국판 약물 순응척도의 표준화 연구

장진구,노대영,김찬형 대한정신약물학회 2015 대한정신약물학회지 Vol.26 No.2

Objective Finding out patient’s non-adherence to medication is an important work for treating schizophrenia. The Medication Adherence Rating Scale is a self-report form, which can simply measure medication adherence in psychosis. We evaluated the reliability and validity of the Korean version of Medication Adherence Rating Scale (KMARS). Methods Eighty-one individuals with schizophrenia completed the self-administered questionnaires including KMARS, Brief Adherence Rating Scale (BARS), Korean version of Drug Attitude Inventory-10 (KDAI-10) and Korean version of Medication Adherence Questionnaire (KMAQ). Psychometric properties of the KMARS were analyzed. Results The KMARS has an acceptable internal consistency (α=0.71). The KMARS total scores are moderately correlated with BARS (r=0.44, p<0.01), KDAI-10 (r=0.55, p<0.01) and KMAQ (r=0.62, p<0.01). As the result of factor analysis, the structure of the KMARS is different from original scale, but the KMARS can assess not only adherence behavior but also subjective response to medication. Among the questions item 5, “I take my medication only when I am sick”, should be used carefully, because it has ambiguous meaning in Korean. Conclusion KMARS is a simple and reliable tool for measuring medication adherence in psychosis. 본 연구는 KMARS의 표준화 연구로서 KMARS는 양호한 신뢰도와 공존 타당도를 가진 유용한 순응도 평가 도구인 것으로 검증되었다. 요인 분석 결과 KMARS는 순응행동, 약물에 대한 반응, 약물에 대한 태도의 3가지 요인으로 구성되어 순응도에 영향을 미치는 다양한 요소들을 고려하여 순응도를 평가할 수 있다. 문항 중 ‘나는 아플 때만 약을 먹는다’는 중의적 의미를 갖기 때문에 사용에 주의가 필요하다. KMARS는 시간적 여유가 부족한 외래환경에서 환자의 순응도를 확인하는 편리한 평가 도구로서 활용이 기대된다.

인적자원의 창조적 지식생산모델

장진구,유왕진 한국경영공학회 2002 한국경영공학회지 Vol.7 No.1

조현병 환자에서 항정신병약물 병용요법의 최근 동향

장진구,노대영,김찬형 대한정신약물학회 2013 대한정신약물학회지 Vol.24 No.4

Antipsychotics polypharmacy is a common practice in clinical settings despite the opposition of most guidelines for treatment of schizophrenia. This article reviews the evidence of antipsychotics polypharmacy and summarizes advantages and disadvantages shown in clinical trials. Clinicians choose antipsychotics polypharmacy to control the positive and negative symptoms more effectively especially in treatment resistant patients or to reduce adverse effects. There are some theoretical possibilities that antipsychotics polypharmacy affects a broader range of receptors, enhances D2-receptor blockade and optimizes pharmacokinetic effects. Clinical evidence suggests that clozapine co-administered with risperidone, sulpiride, or amisulpiride reduces psychotic symptoms in treatment-resistant patients and that aripiprazole with other antipsychotics reduces metabolic side effects. On the other hand, antipsychotics polypharmacy is associated with problems such as dose-dependent side effects, metabolic problems, increased mortality and treatment cost. Considering pros and cons, antipsychotics polypharmacy must be started after close scrutiny of the patient’s medication history not just by clinical judgment. Also, changing the regimen from polypharmacy to monotherapy should be considered as a reasonable option to schizophrenic patients in stationary status. 항정신병약물 병용요법은 조현병 임상치료지침들의 소극적 태도에도 불구하고 임상현장에서 높은 빈도로 사용되고있다. 이 종설에서는 항정신병약물 병용요법의 사용배경과이론적, 임상적 근거를 살펴보고 최근 병용요법 사용의 문제점을 정리하였다. 임상의들은 치료저항성 조현병 환자들의증상을 조절하거나 한 가지 항정신병약물을 사용하며 발생하는 부작용을 조절하기 위해 병용요법을 선택하는 경우가 많다. 병용요법의 이론적 근거로는 각 항정신병약물은 특징적인 수용체 길항 및 효현 효과가 있어 병용요법을 통해 D2 수용체를 비롯한 여러 수용체 활성을 변화시킬 수 있다는 점과약동학적 변화를 일으킬 수 있다는 점 등이 있다. 몇몇 무작위대조군 연구들에서 clozapine에 저항을 보인 환자들에게 clozapine과risperidone 혹은 sulpiride, amisulpiride를 병용하는 것의 긍정적 효과가 보고되었으며, aripiprazole의 병용을통해 대사성 부작용을 줄일 수 있는 가능성이 있다고 알려져있다. 그러나 병용요법은 항정신병약물의 총 용량 증가에 따른 부작용이나 대사성 부작용을 증가시키고, 사망률 증가와관련이 있다는 보고도 있다. 따라서, 항정신병약물 병용요법을 적절하게 사용하기 위해서는 환자의 과거 약물 사용력 등을 신중히 검토하여 필요성을 다시 확인하고, 명확한 사용목표를 세워야 한다. 또한, 병용요법을 사용하고 있는 안정기환자들에게서 단독요법으로 약물을 변경하는 것은 합리적인시도일 수 있다.

일 대학병원 정신증 환자에서 항정신병약물 병용요법의 사용

장진구,노대영,안석균,조현상,김찬형 대한정신약물학회 2013 대한정신약물학회지 Vol.24 No.2

ObjectivezzThe practice of antipsychotic polypharmacy is common, despite lack of supporting evidence. The aims of this study were to estimate the prevalence of antipsychotic polypharmacy in a psychiatric university hospital in Korea and find out the clinical factors associated with antipsychotic polypharmacy. MethodszzWe reviewed medical records of the patients discharged from Severance Mental Health Hospital (SMH) for the period of 1, January to 31, December 2010. Patients should be diagnosed as having schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, delusional disorder or psychotic disorder not otherwise specified. ResultszzIn 2010, 260 patients in SMH were prescribed with antipsychotics and 47.3% (n=123) of them were discharged under antipsychotic polypharmacy treatment. The most commonly prescribed antipsychotics for combination therapy was quetiapine (n=64). The most prevalent combination of drugs was risperidone plus quetiapine (n=20). Logistic regression analysis showed that the use of high-dose antipsychotics, first-generation antipsychotics, and long hospital duration were significantly associated with antipsychotic polypharmacy. ConclusionzzAlthough the controlled evidence for efficacy and safety as a strategy remains inconclusive, antipsychotic polypharmacy is a common pharmacological strategy as it is illustrated in our study. Considering high antipsychotic doses related with antipsychotic polypharmacy, careful monitoring of side effect and efficacy is needed. 본 연구 결과 일 대학 정신과 전문병원에서 정신증으로 치료받은 환자들 중 47.3%는 항정신병약물 병용요법을 사용하고 있었다. 병용요법에서 가장 많이 사용된 조합은 quetiapine과risperidone의 조합이었다. 그러나 항정신병약물의 병용요법은 고용량의 항정신병약물의 사용과 밀접한 관계가 있어, 사용시 용량 조절에 주의를 기울일 필요가 있다.

웹 사용자의 실시간 사용 패턴 분석을 이용한 정상 사용자 판별 방법

장진구(Jin-gu Jang),문종섭(Jong Sub Moon) 한국정보보호학회 2016 정보보호학회논문지 Vol.26 No.6

인터넷을 통한 사이버 위협이 증대됨에 따라 개인정보 침해도 지속적으로 발생하고 있다. 악의적인 사용자들은 유출된 개인정보를 도용하여 정상 사용자처럼 해당 웹사이트를 접근하고 불법적인 행동을 할 수 있다. 본 논문에서는 이러한 불법 사용자의 접근을 실시간으로, 효과적으로 탐지하기 위해 정상 사용자의 웹사이트 평시 사용 패턴을 멤버십 분석(membership analysis)과 마르코프 체인 모델(markov chain model)을 기반으로 프로파일링 함으로써, 정상 사용자를 판별하는 방법을 제안한다. 아울러 이러한 프로파일에 시간적인 특성, 즉 시간 가중치(time weight)를 적용하여, 시간적으로 변하는 사용자의 행동을 사용자의 프로파일에 반영한다. 이에 따라 시간에 따른 사용자의 성향을 반영한 결과를 얻을 수 있다. 본 연구를 통해 생성한 사용자별 프로파일을 기반으로 개인정보를 도용한 악의적인 사용자를 적발할 수 있고, 정상적인 사용자이더라도 민감한 정보에 접근하는 것을 방지할 수 있다. 본 연구를 적용한 결과, 정상 사용자에 대해 96%의 높은 판별 정확도를 보여주었다. As cyber threats have been increased over the Internet, the invasions of personal information are constantly occurring. A malicious user can access the Web site as a normal user using leaked personal information and does illegal activities. This paper proposes an effective method which authenticates a genuine user with real-time. The method use the user’s profile which is a record of user’s behavior created by Membership Analysis(MA) and Markov Chain Model(MCM). In addition to, user’s profile is augmented by a Time Weight(TW) which reflects the user’s tendency. This method can detect a malicious user who camouflage normal user. Even if it is a genuine user, it can be determined as an abnomal user if the user acts beyond the record profile. The result of experiment showed a high accuracy, 96%, for the correct user.

중증 정신 질환 환자에서의 약물 순응도 향상

노대영,장진구,김찬형 대한정신약물학회 2012 대한정신약물학회지 Vol.23 No.4

Adherence to treatment in mental health is generally regarded as central for optimizing recovery. However, poor adherence of patients with psychiatric disorders can have devastating consequences such as relapse, rehospitalization and poor quality of life. Adherence problems are likely to be multi-determined and related to different factors in different individuals. Combining subjective and objective quantitative assessment with a more qualitative interview might help assess adherence better in patients with mental illness to determine the presence of adherence problems and investigate their cause. The therapeutic relationship between patient and clinician has been found to be important for treatment adherence. Adherence problems should be regarded not as the result but as the process of the treatments to facilitate the therapeutic alliance. Clinicians and patients need to cooperate with each other in a model of shared decision-making to choose the best treatment option for the specific individual. Psychoeducation might provide information about the risk and benefit of the medication to patients and their family. The collaborative approach is helpful for the clinicians to have an open dialogue about what patients think and perceive about the treatment. 정신과 환자의 치료 순응도 문제는 질환의 경과와 예후 및 삶의 질에 결정적인 영향을 미칠 수 있다. 비순응 및 순응도 저하는 중증 정신 질환의 재발과 환자의 재입원의 가장 흔한 원인 중 하나이다. 순응도는 약물뿐 아니라 환자 개인과 환자를 둘러싼 가족 및 사회 환경의 여러 요인들이 복합적으로 관련되어 있다. 치료자 입장에서 환자의 순응도 파악이 어렵기 때문에 다양한 방법을 활용하여 환자의 치료 순응도를 정확하게 평가하는 것이 우선이다. 순응도 개선을 위해서는 환자 치료자 간의 치료 관계를 긍정적으로 유지하는 것이 중요하며, 순응도 문제를 치료의 결과로 생각하기 보다는 과정으로 받아들이는 태도가 도움이 된다. 또한 공통의 의사결정 과정을 통해 환자 중심의 치료가 이루어져야 한다. 환자 및 환자 가족들을 대상으로 치료 효과 및 부작용에 대한 충분히 교육할 필요가 있다. 또한 치료자는 약물 처방에 관한 환자의 느낌과 태도를 꾸준히 살펴보고, 개방적인 자세로 환자와 소통하려는 노력이 요구 된다.

한국판 저장행동평가척도의 표준화 연구

이혜민,장진구,송후림,이수영,홍민하,김세주,김찬형,Lee, Hye Min,Chang, Jhin Goo,Song, Hoo Rim,Lee, Soo Young,Hong, Minha,Kim, Se Joo,Kim, Chan-Hyung 대한불안의학회 2021 대한불안의학회지 Vol.17 No.2

Objective : The Hoarding Rating Scale-Self-Report (HRS-SR) is a five-item scale that simply assesses the hoarding symptoms. We evaluated the factor structure, reliability, and validity of the Korean version of the HRS-SR (HRS-SR-K). Methods : A total of 144 individuals completed the self-administered questionnaires including HRS-SR-K, Obsessive-Compulsive Inventory-Revised-Korean version (OCI-R-K), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Psychometric properties of the HRS-SR-K were analyzed. Results : The Cronbach's α value for internal consistency of the HRS-SR-K was excellent (Cronbach's α=0.84). The construct validity was analyzed on the basis of principal component analysis and one-factor structure of the original scale was maintained. The HRS-SR-K total score and each item scores were more strongly correlated with the hoarding subscale score in OCI-R-K (convergent validity, r=0.71, p<0.01) than the corresponding scores of nonspecific depression or anxiety measures (discriminant validity). Conclusion : The HRS-SR-K is a simple and reliable self-report scale for examining the severity of hoarding symptoms.

Antipsychotic Prescribing Patterns in First-episode Schizophrenia: A Five-year Comparison

노대영,장진구,Sol Yoon,김찬형 대한정신약물학회 2015 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.13 No.3

Objective: Early treatment choice is critical in first-episode schizophrenia-spectrum disorders. The purpose of this study was to describe prescribing trends of antipsychotics use in patients with first-episode schizophrenia in 2005 and 2010, respectively. Methods: We reviewed the medical records of newly treated patients with schizophrenia from a university psychiatric hospital in 2005 (n=47) and 2010 (n=52). We defined patients as receiving a high antipsychotic dose if their ratio of prescribed daily dose (PDD) to defined daily dose (DDD) was greater than 1.5. Results: The rates of high-dose antipsychotic prescription were 61.7% and 53.8% in 2005 and 2010, respectively. The rates of antipsychotic polypharmacy were 34.6% in 2005 and 34.0% in 2010. The most common first-prescribed antipsychotics were (in descending order of prescription frequency) olanzapine, risperidone, aripiprazole, and haloperidol in 2005 and risperidone, quetiapine, paliperidone, and olanzapine in 2010. High-dose antipsychotics were significantly associated with antipsychotic polypharmacy (odds ratio=23.97; p<0.01). More individuals were treated with mood stabilizers in 2010 than in 2005 (p=0.003). Conclusion: The practice of prescribing high-dose antipsychotics and associated antipsychotic polypharmacy were common even for initial treatment of first-episode schizophrenia in 2005 and 2010. In 2010, the list of the most common first-prescribed antipsychotics changed, and the use of mood stabilizers increased in non-affective schizophrenia.

우울증으로 내원한 진행성 핵상 마비 환자 1례

한서윤,장진구,이수영 대한불안의학회 2023 대한불안의학회지 Vol.19 No.2

Progressive supranuclear palsy (PSP) is rare atypical Parkinsonism accompanied by various psycho-behavioural problems. In this case report, we describe the diagnostic and treatment progress of a 65-year-old PSP patient who visited the psychiatric clinic with a depressed mood and lumbar pain resulting in a suicide attempt. Over the course of 30 months of treatment, typical characteristics of PSP, such as postural instability, dyskinesia, cognitive dysfunction and supranuclear gaze palsy, became prominent, and magnetic resonance imaging and the F-18 FP-CIT positron emission tomography revealed midbrain atrophy and reduced dopamine uptake in the basal ganglia. When treating elderly patients with depression, parkinsonism symptoms such as gait disturbances, frequent falls, tremors, and rigidity should be closely examined. (Anxiety and Mood 2023;19(2):56-60)

Comparison of Aripiprazole and Other Atypical Antipsychotics for Pediatric Bipolar Disorder: A Retrospective Chart Review of Efficacy and Tolerability

오주영,장진구,이승비,송동호,천근아 대한정신약물학회 2013 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.11 No.2

Objective: This study compared the efficacy and tolerability of aripiprazole with that of other atypical antipsychotics by examining patients with pediatric bipolar disorder (PBD) at a child and adolescent psychiatric clinic in a university hospital in Korea. Methods: We reviewed the medical records of 127 pediatric patients with bipolar disorder aged 4-18 years treated at Department of Child and Adolescent Psychiatric, Yonsei University Severance Hospital between January 2010 and October 2011 to collect demographic and clinical data. Using the Clinical Global Impression (CGI) scales, we evaluated levels of severity of and improvements in symptoms at the first, second, third, fourth, and fifth hospital visits. Results: The mean age of patients was 12.29±3.47 years. The sample included 91 (71.7%) male and 36 (28.3%) female patients. Aripiprazole was prescribed to 62 (48.8%) patients, risperidone to 52 (40.9%), quetiapine to 11 (8.7%), and paliperidone to two (1.6%). Patients treated with aripiprazole had lower CGI-Severity (CGI-S) scores than did patients treated with other atypical antipsychotics at the second and third visits. The CGI-Improvement (CGI-I) scores of patients treated with aripiprazole were lower at the second visit. Treatment with atypical antipsychotics was well tolerated, and no serious or fatal side effects were observed. Conclusion: The present retrospective chart review suggests that atypical antipsychotics may be effective and safe for the treatment of patients with PBD. In particular, treatment with aripiprazole may be more effective than treatment with other atypical antipsychotics in the early phase. These results should be verified in future multi-center controlled studies.