알코올 의존 환자에서 혈청 콜레스테롤 농도와 충동-공격성과의 상관관계

천영훈(Young-Hoon Cheon):노승호(Seung-Ho Rho) 한국중독정신의학회 2000 중독정신의학 Vol.4 No.1

Objective:The purpose of this study was to examine the relationship between impulsivity-aggressiveness and serum cholesterol level in patients with alcohol dependence. Method: The authors examined fifty-nine male patients with alcohol dependence who had been admitted to Wonkwang Neuropsychiatric Hospital between April, 1999 and October, 1999 except who had apparent other major psychiatric disorders, personality disorders, cognitive impairment, or severe physical disorders (e.g., liver cirrhosis, hereditary lipid metabolic disorders, pancreatitis) which need intense medical care. The patients were divided into two groups according to the Irwin’s criteria and assigned to Type Ⅰ and Type Ⅱ. And also the patients were divided into three groups by the level of serum cholesterol, in order to compare the characteristics between lower group (lower 1/3 of serum cholesterol level in total group) and higher group (upper 1/3 of serum cholesterol in total group). We examined serum cholesterol level at 2 weeks after the admission. Alcoholism Screening Test (AST-F;rated by patient’s family, AST-P;rated by patient), Impulsivity scale (Imp-F;rated by patient’s family, Imp-P;rated by patient), Brief Anger-aggression Questionnaire (BAQ), and Overt Aggression Scale (OAS) were used to measure the patient’s impulsivity and aggressiveness. Results:Serum cholesterol level and scores for impulsivity-aggressiveness were compared between subgroups. 1) Type Ⅱ showed significantly higher score on AST-F than Type I (p<.01), but there’s no significant difference on AST-P. AST-F score was significantly higher than ASP-P score in Type Ⅱ (p<.01), but there’s no significant differences in Type Ⅰ. 2) Type Ⅱ showed significantly higher score on Imp, BAQ and OAS (p<.05, p<.01, p<.01), as well as significantly lower serum cholesterol level (p<.01) than Type Ⅰ. 3) The lower-cholesterol group showed significantly higher score on Imp (p<.01) and BAQ (p<.01) than higher-cholesterol group. Fog OAS, lower-cholesterol group showed clear tendency tohave higher score than highercholesterol group but failed to reach statistical significance. Conclusion:The results suggest that there are significant relationship between low serum cholesterol level and impulsivity in patients with alcohol dependence. This finding suggest that serum cholesterol level may be available as a biological marker of impulsivity in patients with alcohol dependence. But more systematized studies should be needed supporting the correlation between serum cholesterol level and impulsivity in patients with alcohol dependence.

알코올성 치매

천영훈(Young-Hoon Cheon),조근호(Keun-Ho Joe),김대진(Dai-Jin Kim) 대한노인정신의학회 2012 노인정신의학 Vol.16 No.2

Chronic alcohol use may have direct or indirect neurotoxic effects on the brain that can lead to cognitive impairment. However, the precise relationship between alcohol and dementia remains unclear. There are several epidemiological studies suggest that the protective effect of light-moderate alcohol drinking in dementia. But obviously the heavy alcohol drinking can lead to brain dam-age and increase the risk of various types of dementia. The clinicopathological issues and criteria regarding so-called ‘alcoholic de-mentia’ remain under debate. Alcohol-induced persisting amnestic disorder, alcohol-induced persisting dementia, and Wernicke-Korsakoff syndrome (thiamine deficiency) may constitute distinct disease entities, but they may also share some common features. Based on this theory, Oslin and colleagues proposed the broader diagnostic scheme and criteria for Alcohol Related Dementia (ARD), which may include cases of Wernicke-Korsakoff syndrome and also other cases of dementia that appear to be alcohol-re-lated. In pathogenesis of the alcoholic dementia, the chronic exposure to ethanol results in the adaptive up-regulation of NMDA re-ceptor sensitivity, which can result in an increased vulnerability to glutamate induced excitotoxicity. Despite the clinical importance of ARD, few medical treatments for ARD have been proposed and studied. Most of all, the gold standard of the treatment in alco-holic dementia is the maintaining abstinence. Some therapeutic trials with cholinesterase inhibitors (donepezil and rivastigmine) and memantine (NMDA receptor antagonist) have been conducted for the patients with Wernicke-Korsakoff syndrome and alco-hol-related dementia, and these studies reported favorable outcomes. Especially memantine can be a more effective agent in the treatment of alcoholic dementia because of anti-craving effect reported in several studies.

병무청 징병검사 수검자에서 문신과 정신병리의 관계

이현기,천영훈,백영석,이혜진,이상열,Lee, Hyun-Ki,Cheon, Young-Hoon,Paik, Young-Suk,Lee, Hye-Jin,Lee, Sang-Yeol 대한불안의학회 2014 대한불안의학회지 Vol.10 No.1

Objective : This study was aimed to discover the correlation between those getting tattoos and their psychopathology relating to their delinquent behavior and emotional problems. Methods : Data for this study was collected from 19-year-old men who were receiving a physical examination for conscription at the Military Manpower Administration. 400 data sheets were collected among them. All of the subjects were evaluated on the following measures : sociodemographic variants, Juvenile delinquency scale, State-trait anger expression inventory, Beck depression inventory, State-trait anxiety inventory, and Positive affect and negative affect schedule. Results : In comparison with those without tattoos, those with a tattoo scored higher in the scales that were related to delinquency, anger, depression, and negative emotion. Furthermore, there were positive correlations between the number of tattoos and the scores for the Juvenile delinquent tendency and behavior scale as well as on the, State-trait anxiety scale. Conclusion : Those with tattoos had experienced anger, anxiety and depression more strongly in comparison with those without tattoos. These results recommend that tattooed males should be evaluated more on their regarding psychopathology compared to those without tattoos.

합병증을 동반한 Clozapine-유발성 무과립구증의 치료경험 1예

천영훈,박민철 대한신경정신의학회 2000 신경정신의학 Vol.39 No.2

연구목적: 37세 남자 정신분열병 환자에게 clozapine을 투여하던 중 발생한 합병증을 동반한 무과립구증을 granulocyte-colony stimulating factor(G-CSF), 항생제, 스테로이드를 사용하여 치료하였다. 증례: Clozapine 투여시작 51일째 발열을 동반한 무과립구증이 발생하였으며 내과로 전과하여 무균실에서 강력한 항생제 및 G-CSF를 투여하였다. G-CSF 투여 후 혈액학적 소견은 정산화되었으나 이후 CK, LDH, BUN, Creatinine, AST, ALT 등의 효소들이 증가하는 가운데 39℃까지 오르는 발열, 전신부종 및 근강직 증세들이 발생하여 신경이완제 악성증후군이 시사되었다. 뒤이은 검사에서 지속적인 creatinine 의 상승과 함께 백혈구 증다증, fibrinogen degradation factor(FDP) 양성 반응 등 급성 신부전증 및 파종성 혈관내응고병증으로의 이행이 의심되었으며 steroid 제재 투여 후 제반 검사 소견 및 전반적인 상태가 호전되는 경과를 취했다. 무과립구증의 발생 후 혈액학적 소견을 비롯한 제반 검사 소견들이 정상으로 회복되는 데는 22일이 경과했다. 결론: Clozapine으로 인한 무과립구증의 예방 및 치료를 위해 무과립구증의 예견인자를 파악하고, 철저한 혈액학적 감시를 수행하는 것이 필요하며 일단 무과립증이 발생하면 clozapine 중단과 함께 적절한 예방적 항생제와 G-CSF의 조기 투여가 필요하다. The authors reported a case of clozapine-induced agranulocytosis that combined with serious complications in a 37-years-old male patient with chronic schizophrenia. Clozapine-induced agranulocytosis developed on Day 51 of clozapine treatment. The patient was transferred to hematologic department and then treated by massive antibiotics in aseptic room. After the injection of G-CSF, WBC count increased to the normal range. But the day after the normalization of WBC count, patient's general condition was worsened with fever and mild rigidity, and also CK, LDH, BUN/Cr, and LFT was increased. The patient's elevated laboratory findings with those of physical signs and symptoms suggested the neuroleptic malignant syndrome and acute renal failure. Eventually steroid was administered to the patient, and then patient's general condition and laboratory findings were normalized. We suggest that the identification of risk factors and careful regular blood monitoring is the best method for the prevention of clozapine-induced agranulocytosis. After the onset of clozapine-induced agranulocytosis, clozapine should be disontinued immediately and proper antibiotic therapy with administration of G-CSF should be done, as soon as possible. And we emphasize the importance of the education and the establishment of therapeutic relationship with patients and their family also.

Combined Antitumor Chemotherapy in a Refractory Schizophrenic Receiving Clozapine

Lee, Sang-Yeol,Cheon, Young-Hoon,Rho, Seung-Ho,Lee, Kuy-Haeng,Park, Min-Cheol 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.1

Clozapine을 투여 받고 있는 정신분열병 환자에게 항암제 병합투여는 clozapine과 항암제 모두의 무과립구증 유도 가능성 때문에 권고되지 않고 있다. 그러나 무과립구증 치료에 granulocyte-colony stimulating factor(G-CSF)가 소개된 이후로, G-CSF는 항암제 또는 Clozapine과 연관된 무과립구증의 치료에 사용되어 왔다. 저자들은 clozapine을 투여 받고 있던 치료 불응성 정신분열병 환자에서 성선간질 종양이 발견되어 항암제와 병합 치료하던 중 발생한 무과립구증을 G-CSF를 이용하여 성공적으로 치료한 1예를 보고하는 바이다. Clozapine과 항암제 병합 투여 전의 혈액학적 소견은 정상이었으며, 항암제 치료를 받는 도중 발생한 무과립증은 G-CSF 치료에 의해서 회복되었다. 본 증례는 clozapine 유지 치료 중이던 치료 불응성 정신분열병 환자에서 종양이 발생한 경우, clozapine에 대한 치료 효과가 좋았고 clozapine과 항암제 치료전의 혈액학적 소견이 정상이었다면, 종양 전문의사와 정신과 의사에 의해서 혈액학적 추적조사를 지속해 나가면서, 무과립구증 발생을 예견하여, G-CSF 사용을 고려하는 경우에 clozapine 치료를 유지해 갈 수 있다고 조심스럽게 제안한 증례이다. It has been known that clozapine treatment combining with cytotoxic antitumor therapy for schizophrenia is not recommended because both drugs have agranulocytosis as their side effect. Since the introduction of granulocyte colony-stimulating factor(G-CSF), it has been used to treat agranulocytosis or granulocytopenia associated with antitumor chemotherapy or clozapine. We report a case with schizophrenia on clozapine treatment who developed agranulocytosis following combined cytotoxic chemotherapy for a sex-cord stromal tumor which was successfully treated with G-CSF. The hematological status before combining with antitumor chemotherapy had been within normal range, and agranulocytosis following the antitumor chemotherapy returned to normal after treatment with G-CSF. This suggests that clozapine could be administered in combination with cytotoxic antitumor agents if the following indications are met : normal hematological status before starting antitumor chemotherapy, carefully monitoring hematological status by oncologist and psychiatrist, and prepared G-CSF administration when agranulocytosis is anticipated.