한국형 양극성 장애 약물치료 알고리듬 2022: 노인

추일한,박원명,우영섭,정종현,윤보현,서정석,양찬모,김원,이정구,심세훈,정명훈,전덕인,박성용,손인기,김문두 대한신경정신의학회 2022 신경정신의학 Vol.61 No.4

Objectives The fifth revision of the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was undertaken to provide more precise guidelines for clinicians. In this study, we evaluated treatment strategies recommended by the KMAP-BP 2022 for theelderly patients with bipolar disorder. Methods The review committee comprised eighty-seven psychiatrists with vast clinical experience in treating bipolar disorders, who completed a survey. An expert consensus was obtained on pharmacological treatment strategies for elderly patients with bipolar disorders. The executive committee analyzed the data and discussed the results to produce the final algorithm. Results In elderly patients with bipolar disorders, the first-line treatment option for manic episodes is monotherapy, with atypical antipsychotics or mood stabilizers, and a combination of a mood stabilizer and atypical antipsychotics. The first-line treatment option for depressive episodes was a combination of a mood stabilizer and atypical antipsychotics, monotherapy with atypical antipsychotics or a mood stabilizer or lamotrigine, and a combination of atypical antipsychotics or a mood stabilizer with lamotrigine. Conclusion In the KMAP-BP 2022, the recommendation for treatment options for elderly patients with bipolar disorder, has been newly introduced. We expect that this algorithm would provide valuable information for the treatment of elderly patients with bipolar disorder

경도인지장애 대상 운동-인지 영양 융합 프로그램 개발 : 예비 연구

추일한(IL Han Choo) 대한노인정신의학회 2020 노인정신의학 Vol.24 No.2

Objective: Mild cognitive impairment (MCI) is transition state between cognitively normal and Alzheimer’s disease (AD) dementia. Physical exercise (PE) and cognitive training (CT) are known to have effect on risk factor reduction on AD prevalence. This study aimed to explore combined PE and CT, named as Exercise-Cognitive Cooking Program (ECCP) influencing on cognition, physical function, and cerebral cortical thickness or volume in MCI subjects. Methods: Eleven MCI patients participated who were randomized into experimental group (EXP, n=5) and control group (CTR, n=6). EXP subjects were given ECCP sessions, 3 times a week for 6 months. And CTR participants had regular daily activity similar before. Baseline and follow-up assessments of neuropsychological tests, physical function, and brain MRI were performed for all subjects. Results: There were no significant difference between EXP and CTR in baseline, follow-up, and differences between two assessments. However, CTR had significant fasting blood sugar increase (effect size, ES=0.8; p=0.03) and systolic/diastolic blood pressure decrease (ES=0.7, p=0.04; ES=0.6, p=0.04). EXP showed significant decrease of trace length and velocity in Romberg test (ES=1.0, p=0.04; ES=1.0, p=0.04), and increase of chair stand times in 30 seconds (ES=1.1, p=0.04). MRI results showed that CTR had significantly decreased cortical thickness in right precuneus (ES=0.5, p=0.04) and decreased volume in bilateral inferior parietal and cuneus (ES=0.5, p=0.04; ES=0.2, p=0.04). Conclusion: This preliminary study suggest that ECCP for 6 months might have possibility of preventive effect on MCI progression to AD.

시각 즉각 회상 검사를 이용한 지역사회 경도인지장애 조기발견

추일한(IL Han Choo) 대한노인정신의학회 2021 노인정신의학 Vol.25 No.1

Objective: Mild cognitive impairment (MCI) is transitional state between cognitively normal and dementia. It is not easy to detect MCI patient early in the community. This study aimed to detect MCI early performing learning memory tests of neuropsychological test domains in the community sample. Methods: Overall 7,307 individuals were already registered with Korean version of Mini-Mental Status Examination for Dementia Screening (MMSE-DS) evaluation. It was conducted across all 5 districts of Gwangju, Republic of Korea from April 1, 2020 to September 30, 2020. As first step, we screened them applying inclusion criteria of age, sex, education adjusted norm based MMSE Z score between -1.5 and 0, and MMSE delayed recall score less than 2. And second assessments of neuropsychological tests and clinical diagnosis with visit were performed. We examined whether verbal and constructional learning memory tests can improve the detection of MCI by receiver operating curve (ROC) analysis. Results: Clinical diagnosis finally defined 100 amnestic MCI, 8 non-amnestic MCI and 6 cognitively normal (CN). Visual immediate and delayed recall test had the highest ROC overall accuracy of 79.2% (95% confidence interval 67.8-90.6%) differentiating MCI from CN. Conclusion: Our study suggests that visual immediate recall test might be time saving and cost-effective in addition to accuracy to early detect MCI in the community.

지역사회 기억상실 경도인지장애 조기발견을 위한 2가지 다단계 프로그램 비교

추일한(IL Han Choo) 대한노인정신의학회 2020 노인정신의학 Vol.24 No.1

Objective: Amnestic mild cognitive impairment (aMCI) has high conversion risk to dementia. However, it is not easy to detect aMCI patient early in the community. This study aimed to compare two-step and three-step program for early detection of aMCI in the community. Methods: Overall 5,155 persons participated who were already registered with Korean version of Mini-Mental Status Examination for Dementia Screening (MMSE-DS) evaluation. It was conducted across 5 all districts of Gwangju, Republic of Korea from Jan 1, 2018 to March 31, 2018. As first step, we screened them applying inclusion criteria of age, sex, education adjusted norm based MMSE Z score between -1.5 and 0. Second evaluations which are not included in two-step program, were done by telephone interviews with asking subjective memory complaints and 5 word lists recall tests. And third assessments of neuropsychological tests and clinical diagnosis with visit were performed. Author compared two-step program and three-step program for aMCI diagnostic rate. Results: Two multi-step programs had no significant difference on aMCI diagnostic rate (p=0.81). Conclusion: Our study suggests that two multi-step programs are similar for early detection of aMCI in the community.

안동지역의 농업현황과 U.R.대책

김용균,추일 安東大學校 農業科學技術硏究所 1994 農業科學技術 硏究論文集 Vol.1 No.-

농산물 수입 개방화에 따른 현재 우리 농업의 현실을 농업의 비중이 높은 안동지역을 중심으로 농민들로 부터 직접 얻은 설문을 토대로 분석하였다. 이 지역은 주로 밭농사가 주요 농업이었고 특히 사과의 경지면적이 풍산읍을 제외하고 조사 지역 대부분에서 높았다. 각 농가의 주요 작물은 고추, 벼, 사과, 수박, 참깨 등의 순으로 많이 재배하는 것으로 나타났다. 조사 지역별로 볼 때 풍산은 수박이 주요 작물이며 임하면과 와룡면에서는 담배, 대마, 약초 등의 특용 작물이 주요한 작물로 조사되었다. 농업 종사 노동력은 조사지역 모두에서 50세 이상이 70%를 보여 고령화 현상을 보여 주었다. 주요 작물에 따른 이 지역의 병 발생은 과수의 부패병, 부란병, 탄저병, 점무늬 낙엽병, 벼의 도열병과 잎집무늬 마름병, 채소의 고추 탄저병과 역병, 수박의 탄저병과 역병, 담배의 TMV 등이 가장 큰 병해로 나타났으며 해충으로는 벼의 이화명충, 멸구, 과수의 응애, 진딧물, 채소의 진딧물과 배추좀나방 등이었다. 농산물 수입 자유화에 의한 가격 하락 등의 문제로 경쟁력상실, 농민들의 정보 부족, 농업 노동력의 노인층화 등으로 심각한 문제가 제시되고 있다. 그러나 사과와 특용 작물에서는 어느 정도 경쟁에 희망을 가지고 있는 것으로 나타났다. 그 밖에, 이 지역의 특산물 재배와 유기농법에 의한 생산을 의견으로 제시하고 있다. 이러한 설문조사결과 UR타결이후 국제화, 개방화시대에 우리나라 농업이 지속적으로 발전할 수 있는 길은 농산물의 생산비를 낮추고 소비자의 기호와 욕구에 맞는 고품질의 농산물을 공급하는데 최선을 다하고 농업 생산성 향상을 위해 새로운 품종 개발, 안전한 농산물을 안정적으로 생산할 수 있는 저공해 천연생물농약 개발, 생산된 농산물의 부가가치를 향상시키는 방법의 개발, 계열화된 유통의 개선으로 농업구조를 개혁하여야 한다. 병·해충의 방제는 종합 방제대책을 수립하여 철저히 예방토록 조치하겠고 연구소와 지도소, 농민이 혼연일치되는 체계적 영농의 실현이 이루어질수 있도록 노력하여야겠고 농사에 필요한 정보의 신속하고 정확한 전파가 요구된다. 수입자유화로 인한 농업에 종사하는 농민의 좌절감을 없애고 희망을 줄 수있는 유망작물 및 대응방향을 시급히 설정 농민에게 새로운 희망과 자신감을 앙양시켜야겠다. 50세이상의 연령의 농업경영자에 의해 유지되고있는 우리의 농업의 문제를 해결 위한 농업 후계자의 적극적 육성으로 인력보충 및 우수젊은이의 농업부문 흡수 역시 시급하다.

지역사회 기억상실형 경도인지장애 조기발견 프로그램 개발 : 예비 연구

추일한(IL Han Choo) 대한노인정신의학회 2018 노인정신의학 Vol.22 No.2

Objective:Mild cognitive impairment (MCI) has high conversion risk to dementia. However, it is not easy to detect amnestic MCI patient early in the community. This study aimed to evaluate the three-stage design for early detection of amnestic MCI in the community. Methods:Overall 4,385 persons participated who were already registered with Mini Mental Status Examination (MMSE) evaluation. It was conducted in Nam-Gu district, one of the 5 districts of Gwangju, Korea from Jan 1, 2017 to May 31, 2017. We first screened them applying inclusion criteria of over 5-year education and age, gender, education adjusted norm based MMSE Z score between -1.5 and 0. Second stage assessments were done by telephone interviews with asking subjective memory complaints and 5 words list recall tests. And 3rd stage evaluation of neuropsychological tests and clinical interview with visit were performed. Results:We screened 456 of the 4,385 persons and 2nd stage included 51 of the 211 participants telephone interview completed. Twenty-four individuals visited clinic center for 3rd stage evaluation. We finally diagnosed 17 MCI including 16 amnestic MCI and 1 non-amnestic MCI. Conclusion:Our three-stage evaluation detected 16 amnestic MCI patients of the 4,385 community dwelling persons with primary screening of MMSE. Our study suggests that this three-stage performance could be effective for early detection of amnestic MCI in large sample community.

흰쥐에서 Chloramphenicol에 의해 유도된 불면에 대한 전기경련충격의 효과

추일한,김정수,홍승철,한진희,이성필 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.5

연구목적 : 수면인자의 하나로 밝혀진 muramyl peptide가 사람을 포함하여 여러 포유동물종에서 분리되었는데 이는 박테리아의 세포벽을 형성하고 있는 peptidoglycans의 구성성분으로 macrophage의 작용으로 생체에서 형성되어 수면을 유도한다고 알려져 있다. 이를 뒷받침하는 근거로는 사람과 쥐에서 항생제를 사용하면 수면이 감소한다는 연구결과가 있었으며 이는 장내 세균의 감소로 인한 결과로 생각되고 있다. 또한 전기경련충격(ECS)는 동물실험에서 서파수면(slow wave sleep)의 증가와 역설수면(paradoxical sleep)을 감소시킨다고 보고되었다. 저자들은 이제까지 연구되지 않았던 항생제 투여로 야기된 동물의 불면증에 대한 ECS의 효과를 조사하고자 한다. 방 법 : Sprague-Dawley 수컷 흰쥐 12마리에 뇌파(EEG)를 측정할 수 있는 장치를 단 다음 제1일째 baseline EEG를 측정하고 다음날을 chloramphenicol을 투여하여 불면을 유발시켰으며 제3일째는 6마리는 대조군으로 사용하고 나머지 6마리는 실험군으로 사용하여 전기경련충격을 시행함으로써 이에 대한 수면인자들을 통계적으로 비교 분석하였다. 결 과 : Chloramphenicol 투여 후 총 수면시간(t=3.757, p=0.003)이 감소하였고 수면인자별로는 주간 서파수면(t=4.944, p=0.000)과 주간 역설수면(t=3.887, p=0.003)도 감소하였다. 또한 불면상태에서 전기경련충격 후 실험군의 경우 대조군에 비해 전체 수면(t=-0.830, p=0.426)은 증가하는 경향을 보이고 야간 서파수면(t=-3.863, p=0.003)과 야간 역설수면(t=-2.458, p=0.034)이 유의하게 증가하였다. 결 론 : 이상의 결과로 볼 때 항생제에 의하여 유도된 불면이 전기경련충격에 의하여 향상됨을 확인할 수 있었고 대부분의 정신과 환자들이 호소하고 있는 불면증에 대한 기전을 알아내는 기초적 역할을 할 수 있을 것으로 기대되며 정신과 영역에서 흔히 사용되는 전기경련충격의 수면에 대한 관계를 이해하는데 도움을 줄 수 있을 것으로 기대된다. Objectives : Muramyl peptide derived from bacterial cell wall has been identified as one of several endogenous sleep-promoting factors. Several studies have shown that the administration of antibiotics decreased sleep amount as well as bacterial colony numbers in rats. Electroconvulsive shock(ECS) has been widely used in the treatment of many psychiatric disorders, including depression, bipolar disorder, and some cases of schizophrenia. However exact mechanism of ECS on the normal or psychiatric condition is not well understood so far. Previous studies indicated that ECS has diverse effects on sleep parameters both in the human and animal subjects. However, there was no report to examine the relationship between effects of ECS and sleep in the antibiotic imposed animal subjects. Therefore the author studied the effects of ECS on chloramphenicol-induced insomnia in rats. Methods : Twelve Sprague-Dawley strain rats were divided into control(N=6) and experimental group(N=6). The sleep-wake activity was recorded continuously for consecutive three days(baseline, day 1 and day 2). On day 1, both groups were intraperitoneally injected with chloramphenicol 150mg/kg. On day 2, the control group was intraperitoneally injected with chloramphenicol 150mg/kg only, whereas experimental group received ECS an hour after they were injected with chloramphenicol 150mg/kg. Results : 1) Chloramphenicol administration decreased light period slow wave sleep(SWS)(t=4.944, p=0.000) and paradoxical sleep(PS)(t=3.887, p=0.003) as well as total SWS(t=2.98, p=0.012) and total PS(t=4.391, p=0.001). 2) ECS increased dark period SWS(t=-3.863, p=0.003) and dark period Ps(t=-2.458, p=0.034) as well as total dark period sleep(t=-4.302, p=0.002). Conclusion : These results suggest that ECS may be effective to reverse chloramphenicol-induced insomnia in rats. Furthermore, chloramphenicol-induced insomnia in rats could be a useful animal model for the future sleep research.

뇌 영상 검사를 이용한 알쯔하이머병 조기 진단 : 최근 MRI 및 PET 연구를 중심으로

추일한(IL Han Choo) 대한노인정신의학회 2008 노인정신의학 Vol.12 No.1

Alzheimer's disease (AD) is the most common form of dementia. Because any antidementia treatment is not likely to reverse existing neuronal damage but rather to slow disease progression, early diagnosis is an important approach to identifying candidates for antidementia drug applications before the dementing process causes permanent brain damage. Neuroimaging could be the best alternative to pathologic confirmation of AD with biopsy that is invasive to subjects or post-mortem evaluation. In this manuscript, author summarized recent studies for early diagnosis of AD using neuroimaging techniques that have relatively high spatial resolution of regional volumetry using three dimensional magnetic resonance imaging (MRI), Fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), Diffusion tensor imaging, and PET imaging of Alzheimer pathology with ligand. Moreover, author comments the future direction for early diagnosis of AD using neuroimaging.

노년기 우울 증상 평가에서 주관적 척도와 객관적 척도 간 상관성 연구

박채린,추일한 대한노인정신의학회 2023 노인정신의학 Vol.27 No.1

Objective: The aim of this study was to investigate the correlation between subjective and objective depression rating scale for the elderly with depressive symptoms. Methods: Thirty three outpatients aged more than 55 with depressive symptoms were assessed with the Patient Health Questionnare-9 (PHQ-9) and the Montgomery-Asberg Depression Rating Scale (MADRS). Similar items from each scale were paired to investigate their correlations. The level of agreement between the PHQ-9 and the MADRS was also assessed for subjects by using discrepancy-score. Results: Correlation between total scores of the PHQ-9 and the MADRS was significant (r=0.85, p<0.001). There were significant correlations between the paired items except for the item about volition. These results were the same in the group whose total education years are 7 or more. However, in the group whose total education years are 6 or less, there was no significant correlation between the paired items about sleep, concentration and volition. Conclusion: These results demonstrate that using the PHQ-9 in elderly patients is reliable and education level might be considered when interpreting the scale.

성폭력 사건 특징에 따른 폭력 빈도에 관한 연구

박정인,추일한,김승곤,김상훈,박상학,황경화,박운영 대한신경정신의학회 2013 신경정신의학 Vol.52 No.5

Objectives Sexual assaults are increasing in the world. They are frequently associated with violence of verbal or physical force and threat. The aim of this study is to investigate frequency of violence according to characteristics of sexual assault. Methods Eighty two female sexual assault victims were referred to the psychiatric clinic from Gwangju One-Stop Service Center between Sep. 4, 2006 and Dec. 31, 2012. We compared the frequency of violence, including verbal or physical force and threat according to characteristics of sexual assault : sexual assault type ; relationship with perpetrator ; time lag to visit one-stop center ; assault location. Results According to the results, 58.5% (n=48) of subjects had experienced violence before the sexual assaults. Compared to rape (50.9%), indecent (76.0%) showed more frequent violence ; and stranger assailant (81.8%) showed greater frequency of violence than acquaintance (50.0%). Victims who visited the One-stop center within 24 hours (76.7%) had greater exposure to violence than those who visited after 24 hours (48.1%). Regarding assault location, violence frequency was higher in other locations (65.7%) than in accommodations (26.7%). Conclusion Our results suggest that frequency of violence before sexual assaults could be influenced by their characteristics.