삼풍사고 생존자들에서의 급성 외상후스트레스장애 : 발생빈도, 예측인자, 증상 변화에 대한 예비적 연구 A Preliminary Study on Incidence, Predictors and Pattern of Symptom Changes

김승태,김병로,홍경수,정유숙,유범희,김도관 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.3

목적 : 삼풍 백화점 붕괴 사고로 대단위 스트레스에 노출된 생존자들에서 급성 외상후스트레스장애(PTSD)의 발생빈도를 조사하고, 증상 발현에 대한 예측인자와 시간경과에 따른 증상 변화의 양상을 살펴보기 위하여 전향적 임상연구를 시행하였다. 방법 : 생존자 32명을 사고 후 1개월(1차 평가), 3개월(2차 평가) 경과 시점에, 한글 번역판 PTSD-I(DSM-III-R),을 사용하여 PTSD의 진단과 증상 정도를, Hamiltons Anxiety Scale(HAS)과 Hamiltons Depression Scale(HDS)을 사용하여 불안과 우울 증상의 정도를 평가하였다. PTSD 증상 심각도에 대한 예측인자는 단계적 선택 방법을 거친 다중회귀분석을, PTSD 증상의 변화는 paired t-test를 통해 살펴보았다. 결과 : 사고 발생 후 3개월 동안의 급성 PTSD 발생빈도는 완전한(true) PTSD가 41%, 부분성(partial) PTSD가 48%였다. 1차 평가시 HDS 점수가 PTSD-I 점수에 유의하게 기여하였고 동반자 사명여부는 HDS 점수와 부분적으로 관련되어 있었다. 2차 평가시에는 의식상실 유무가 PTSD-I, HDS, HAS 점수에 유의하게 기여하였다. 1, 2차 평가 기간 동안 PTSD-I 전체 점수는 변화가 거의 없었지만 재경험, 과각성 증상군 점수는 회피 증상군에 비해 유의하지는 않으나 상대적으로 감소하는 경향을 보였다. 결론 : 삼풍 사고 후 급성 PTSD의 발생빈도는 매우 높았고 사고 당시 동반자의 사망, 우울증의 정도, 의식상실 경험등이 생존자의 급성기 PTSD 증상 정도에 영향을 미치고 있었다. PTSD의 회피 증상은 재경험, 과각성등의 증상들에 비해 시간 경과에 따른 변화가 적은 경향이 있었다. Objective : This is a prospective clinical study on survivors of the collapse accident of a major department store building occurred in Seoul in June 1995 to investigate the incidence of acute PTSD, to identify risk factors affecting the severity of PTSD symptoms, and to evaluate the pattern of symptom changes over time. Method : Thirty-two victims were interviewed with modified Korean version of the PTSD-I(DSM-III-R) to determine the severity of symptoms and diagnosis of PTSD. Degrees of anxiety and depression were measured with Hamilton's Anxiety Scale(HAS) and Depression Scales(HDS) respectively. Subjects were assessed in series at one month(time point 1) and three month(time point 2) from the time the accident occurred. Results : The incidence of PTSD in the subjects over the 3 months was 41% using by full criteria and 48% by partial criteria. Regression analysis at the time point 1, the HDS score, which was partially related with death of accompanied persons(friends/relatives/colleagues), contributed significantly to the PTSD-I variances. At the time point 2, loss of consciousness contributed significantly to the variance of the PTSD-I, HDS and HAS scores. Between time point 1 and time point 2, the overall severity of PTSD symptoms for all the subjects has remained almost unchanged. However, re-experience and hyperarousal symptoms were improved almost unchanged. However, re-experience and hyperarousal symptoms were improved in comparison with avoidance symptoms, although not statistically significant. Conclusions : This study results show a high risk of developing PTSD and partial PTSD among the building collapse victims. The death of accompanied person, severity of depression and loss of consciousness are all regarded as major factors affecting the severity of PTSD. Of PTSD symptom clusters, avoidance symptoms are likely to be less changeable than re-experience and hyperarousal symptoms over time.

한국판 해밀턴 우울증평가척도(K-HDRS)의 확인적 요인 분석

박혜원,이은호,김도관,유범희,이동수,김지혜 大韓神經精神醫學會 2009 신경정신의학 Vol.48 No.1

Objectives The present study was conducted to examine the factor structure of a Korean version of the Hamilton Depression Rating Scale (K-HDRS), and we did so by performing a confirmatory factor analysis (CFA). Methods The data from the 17-item K-HDRS data was obtained from 319 South Koreans who met the DSM-IV Criteria of Major Depressive Disorder. We examined the fit of ten competing models. The CFAs were evaluated in their original first-order structures and in their hierarchically related counterparts. Results The alternative models obtained unsatisfactory fit indices, although the five-factor inter-correlated model (model 5a) demonstrated a relatively good fit to the data. The model 5a also performed better than its hierarchically related counterpart (model 5b). The Modification Indices (MIs) were used to provide a more satisfactory account of the data. The Mls suggested correlations between the unique variances of items (item 1 & 3, item 10 & 15), and these parameters were added to the model 5a. After introducing minor modifications, the 'final' model (5m) yielded an improved model fit. Conclusion This study suggests that the symptoms of depression, as assessed by the K-HDRS, cluster into five factors : anhedonia/retardation, guilt/agitation, bodily symptoms, insomnia and appetite. This study provides evidence for the cross-cultural generalizability of the HDRS, although some refinement of the scale is still required.

기분 장애 환자에서 나타나는 불특정 CAG 삼핵산 반복서열의 확장

손성은,임신원,이소영,황혜진,진동규,박정의,김도관,김이영 대한신경정신의학회 2000 신경정신의학 Vol.39 No.2

연구목적: 기분장애는 그 원인과 발생기전은 아직 밝혀져 있지 않고 있지만, 과거부터 유전적 요인이 질병의 발생과 중요한 연관성을 가지고 있다고 알려져 있다. 특히 양극성 정동장애는 가족력이 있는 경우에 발병될 가능성이 높고, 같은 가족 내에서 발생했을 때 세대가 내려감에 따라서 발병시기가 점차 빨라지며 증세가 심해지는 경향이 있어서 그 유전적 배경에 대해 많은 의문이 있어 왔다. 연구자들은 다양한 증상의 기분장애 환자들의 DNA에서 불특정 CAG 삼핵산 반복(trinucleotide repeat. TNR) 정도를 분석함으로써 TNR 확장이 기분장애의 유전과 관련되는지 살펴보았다. 방법: 환자 군은 DSM-Ⅲ-R 진단기준에 의거하여 양극성 정동장애(N=55), 주요우울장애(N=67) 환자들을 선발하였다. 정상인(N=89)은 정신과적 병력이 없고 다면성 인성검사상 정상의 profile을 나타내는 병원 종사자, 학생 및 건강의학센타 방문자들 중 선발하였다. TNR의 확장은 genomic DNA를 순수분리한 후, (CTG)₁□의 oligonucleotide를 □-□□P-ATP로 방사선 표지하여 반복서열 확장 탐지법(repeat expansion detection)으로 측정하였다. 집단간의 비교를 위해 Mann-Whitney U 검증을 실시하였다. 결과: DNA에서 관찰되는 불특정 CAG 삼핵산 반복 길이의 평균은 양극성 정동장애에서 169.8bp(S.D=58.6), 주요우울장애에서 167.5bp(S.D=63.9)로서 대조군 178.7bp(S.D=56.5)과 비교하였을 때 유의미한 차이는 관찰되지 않았다. 각각의 환자군을 가족력이 있는 군과 없는 환자군으로 나누어 대조군과 비교하였을 때도 유의미한 차이는 관찰되지 않았다. 결론: 불특정 CAG 삼핵산 반복서열 확장이 양극성 정동장애 환자와 주요우울장애 환자들의 유전 양식에 영향을 미친다는 가설을 뒷받침하지 않는다. Objectives: The genetic facotrs have been suggested for the etiology of mood disorders but the mode of inheritance is complex. Increased severity and an earlier onset of the bipolar and major depressive disorder over generations within families(Anticipation) were reported. In order to test the hypothesis that trinucleotide repeat expansions underlie the genetic basis of Bipolar and major depressive disorders, we have analyzed the extent of CAG reapeats in genomic DNA from mood disorder patients. Methods: 55 bipolar disorder, 67 major depressive disorder patients were recruited accord-ing to the DSM-Ⅲ-R criteria. 89 normal controls were recruited from the medical personnel, students and the visitors to the health services center who had no history of psychiatric illness and show normal profile of MMPI. The genomic DNA of patients and controls was analyzed by use of the (CTG)□ oligonucleotide and the repeat expansion detection(RED) method. The Mann-Whitney U test was used to compare the distribution of the number of CAG repeats among the groups. Results: when the bipolar disorder, major depressive disorder patients were compared with the control group, no significant differences were observed. Conclusions: Our results do not support the hypothesis that expanding CAG repeats are causing the observed genetic anticipation in bipolar disorders and major depressive disorders.

제2형 당뇨병 환자에서 적극적 환자 교육이 혈당조절에 미치는 효과

이윤욱,황원선,최선정,이동훈,김도현,이은희,홍은경,노혜림,정윤석,이관우,김현만 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.1

연구배경: 현재까지의 당뇨병 교육에 대한 노력은 제한되었으며, 연구 결과를 보면 식사 조절 교육과 체중 조절 프로그램을 수행한 환자들 중 적극적이고 기간이 긴 교육을 받은 경우, 성공적 결과가 나타남을 알 수 있었다. 자가관리나 체중감량 등의 당뇨병 치료의 중요한 목표는 적극적이고 긴 기간의 교육 없이는 시행되기 어렵다. 본 연구에서는 외래에서 당뇨병 환자를 대상으로 시행할 수 있는 행동 및 식사 교육 등의 적극적 교육 프로그램을 개발하여 제2형 당뇨병 환자들을 대상으로 이들에게 식사 조절 방법에 대한 목표설정과 문제에 직면하였을 때의 해결 방법 등을 교육해서 궁극적으로는 적극적 자아관리에 연결될 수 있도록 도와주는 것을 목적으로 기존의 통상적 교육과 보다 적극적인 교육이 당뇨병 환자의 혈당 조절에 어떠한 영향을 미치는지에 대해 알아보기 위해 다음과 같은 연구를 시행하였다. 방법: 본 연구는 아주대학교 병원 내분비 대사 내과를 처음으로 방문하여 치료받았던 58명의 제2형 당뇨병 환자를 대상으로 하였다. 내원 환자들을 무작위하게 추출하여 진찰권 번호 끝자리에 따라 홀수는 통상적 교육군(conventional education group, CE)과 짝수는 적극적 교육군(intensive education group, IE)으로 나누어 교육하고, 3개월후에 교육의 효과를 평가하였다. 결과: 1) 연구 대상자들의 교육 전과 후의 공복혈당, 식후2시간 혈당 및 HbA_lc 치는 IE군과 CE군 모두 각 그룹 내에서, 유의적으로 감소하였다(p<0.05). IE군에서는 공복혈당이 12.4nmol/L에서 7.7nmol/L로, 식후2시간 혈당이 20.3nmol/L에서 10.9nmol/L으로, HbA_lc치가 9.4%에서 7.0%로 모두 교육 전에 비하여, 교육 후에 감소(p<0.05)하였고, CE군도 공복혈당은 10.9nmol/L에서 9.4nmol/L로, 식후2시간 혈당은 17.1nmol/L에서 14.6nmol/L으로 HbA_lc가 8.5%에서 7.3%으로 모두 교육 후에 감소하였다(p<0.05). 또한, 교육 전에 비하여 교육 후에 공복 혈당 및 HbA_lc치가 감소하는 정도는 IE군에서의 감소가 CE군에 비해 더 현저하였다Op<0.05). 2) 식사에 대한 태도는 3부분으로 나누어 식사에 대한 규칙성, 식사 내용의 균형성, 식사에 대한 태도 등으로 나누어 각각의 점수 및 총점을 비교하였으며 교육 전에 비해 교육 후에 연구 대상자들의 식태도가 향상되었음을 알 수 있었다. 두 그룹간의 차이를 분석한 결과 식사의 균형성 항목에서와 총점에서 유의적으로 두 그룹의 차이를 보여서 IE군에 CE군에 비해 식사의 균형성 측면이 향상되었고, 전체적인 식태도가 좋아졌음을 알 수 있었다(p<0.05). 결론: 비교적 긴 기간은 아니지만 적극적 교육을 받은 당뇨병 환자들이 통상적 교육을 받은 군보다 혈당 및 HbA_lc, 식태도 점수등의 수치의 호전뿐만 아니라 당뇨병 환자의 삶에서 중요한 부분을 차지하는 식사요법 관리 부분에 있어 향상됨을 알 수 있었다. Background: To this date, efforts to develop effective methods for the education of diabetic patients have been limited. The important goal of self-management and weight control for diabetic treatment can not be attained without long and intensive period of education. This study was undertaken to assess the effectiveness of an intensive educational program, of behavior and diet control, which was carried out on subjects with type 2 diabetes, on and out-patient basis. we compared the effectiveness of an intensive education programme with that of a conventional education programme for the self-management of type 2 diabetic patients. Methods: Subjects with type 2 diabetes were randomly selected, and allocated to one of two groups. One group received a conventional education programme of self-management(the CE group), and the second group received an intensive education progammes for three months, after which the effectiveness of the programmes were evaluate. Results: 1) The levels of fasting blood sugar(FBS), postprandial 2 hour blood sugar(PP2h) and HbA1c were significantly lowered in both groups following the intervention(p<0.05). In the IE group, the FBS declined from 12.4nmol/L to 7.7nmol/L, PP2h declined from 20.3nmol/L to 10.9nmol/L, and the HbA_lc showed a similar decline from 9.4 to 7.0% after intervention(p<0.05). In the Ce group, the FBS declined from 10.9 to 9.4nmol/l, the PP2h decreased from 17.1 to 14.6nmol/l, and the HbA_lc also decreased from 8.5 to 7.3% after intervention(p<0.05). The decrease in the FBS and HbA_lc following the educational intervention was more pronounced in the IE group than the CE group(p<0.05). 2) The effectiveness of the education programmes in promoting appropriate dietary behavior in the diabetic subjects was assessed by a scoring system in three parts: a regularity score, a balance score and an attitude score. From a comparative study of the three scores, the patients attitudes were observed to be much improved in both the groups following the intervention compared to before the programmes, but the balance and total scores were significantly higher in the IE group than the CE group(p<0.05). Conclusion: We can conclude that the intensive diabetic education programme is more effective than a conventional programme, not only in improving the patients' levels of glucose, HbA_lc, and dietary score, but also the diabetic patients self-control abilities, promoting behavioral change, and prompting problem solving capabilities in respect to the everyday problems that they have to face throughout their lives(J Kor Soc Endocrinol 18:63∼72, 2003).

Exposure–outcome analysis in depressed patients treated with paroxetine using population pharmacokinetics

Kim, Jung-Ryul,Woo, Hye In,Chun, Mi-Ryung,Lim, Shinn-Won,Kim, Hae Deun,Na, Han Sung,Chung, Myeon Woo,Myung, Woojae,Lee, Soo-Youn,Kim, Doh Kwan Dove Medical Press 2015 Drug design, development and therapy Vol.9 No.-

<P><B>Purpose</B></P><P>This study investigated population pharmacokinetics of paroxetine, and then performed an integrated analysis of exposure and clinical outcome using population pharmacokinetic parameter estimates in depressed patients treated with paroxetine.</P><P><B>Patients and methods</B></P><P>A total of 271 therapeutic drug monitoring (TDM) data were retrospectively collected from 127 psychiatric outpatients. A population nonlinear mixed-effects modeling approach was used to describe serum concentrations of paroxetine. For 83 patients with major depressive disorder, the treatment response rate and the incidence of adverse drug reaction (ADR) were characterized by logistic regression using daily dose or area under the concentration–time curve (AUC) estimated from the final model as a potential exposure predictor.</P><P><B>Results</B></P><P>One compartment model was developed. The apparent clearance of paroxetine was affected by age as well as daily dose administered at steady-state. Overall treatment response rate was 72%, and the incidence of ADR was 30%. The logistic regression showed that exposure predictors were not associated with treatment response or ADR in the range of dose commonly used in routine practice. However, the incidence of ADR increased with the increase of daily dose or AUC for the patients with multiple concentrations.</P><P><B>Conclusion</B></P><P>In depressed patients treated with paroxetine, TDM may be of limited value for individualization of treatment.</P>

기억력 저하를 호소하는 노인들을 대상으로 INM176를 3개월간 임상시험한 후의 치료성적 및 부작용 평가 보고

김지혜,고선규,고효정,권영아,김성환,김재경,김태은,박재우,서민영,송영란,이인수,김도관 大韓神經精神醫學會 2003 신경정신의학 Vol.42 No.2

Objectives : We examined the effects of INM 176 (K-l107) compared with placebo on the cognitive functions of 92 old aged subjects with cognitive impairment. Methods : This was a prospective, 12 week, double-blind, Placebo-controlled clinical trial. The elderly who achieved a score of less than 25 points on the K-MMSE or showed a high risk of Alzheimer's disease from the 7-Minute Neurocognitive Screening Battery were considered to have objective impairment and were selected as subjects for this study. The subjects were randomized to placebo or INM 176 group. The outcome measures were from the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog), the Instrumental Activities ofDaily Living (IADL) and the Korean Geriatric Depression Scale (KGDS) and two kinds of computerized priming tests. After setting the total error score in the Alzheimer's Disease Assessment Scale-Cognitive section (ADAS-cog) as the repeated measurement factor, an analysis of variance of the combined factor design was done between the placebo and INM 176 group. Results : The interaction effect of time (pre- and post-trial) and group (placebo and INM 176 group) was significant in the analysis of the ADAS-cog's total error score. The INM 176 group's total error score in the ADAS-cog decreased significantly (p<0.01), whereas the placebo group showed a slight increase. The mean changes in IADL and GDS from baseline scores favored in the INM 176 group than in the placebo group. Outcome changes ofADAS-cog, IADL, KGDS scores during the 12 week clinical trail ofINM 176 and placebo demonstrated favorable responses in the INM176 administered group. Conclusions : This is a preliminary clinical trial result of INM176 as a memory pill. Based on these results, INM176 may be a candidate molecule for the improvement of cognitive functions, including memory, Further clinical trial should demonstrate its efficacy.

The effect of nanotubular titanium surfaces on osteoblast differentiation.

Kim, Jae-Hyung,Cho, Kwan-Pyo,Chung, Young-Suk,Kim, Ok-Su,Chung, Sung-Soo,Lee, Kyung-Ku,Lee, Doh-Jae,Lee, Kwang-Min,Kim, Young-Joon American Scientific Publishers 2010 Journal of Nanoscience and Nanotechnology Vol.10 No.5

<P>The biological response of fetal rat calvarial cells on a TiO2 nanotubular surface (Ti-NT) was evaluated by cell viability assay, alkaline phosphatase (ALP) activity and reverse transcription polymerase chain reaction (RT-PCR) analysis. The cell viability assay showed no significant difference between the Ti-NT and smooth titanium surfaces (Ti-S). Ti-NT had better cellular responses with regard to the ALP activity and bone-associated markers, such as bone sialoprotein and osteocalcin mRNA than Ti-S. These results suggest that Ti-NT stimulate the differentiation into osteoblasts of fetal rat calvarial cells, potentially contributing to rapid osseointegration.</P>

전측두엽 치매 3례

김이영,김재경,이유리,서만길,우금석,장용이,김지혜,서연림,김상은,김도관 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.6

전측두엽 치매는 치매의 흔한 원인이며 알쯔하이머병과 구별되는 질환이다. 하지만 임상증상에서 인지기능의 현저한 장애가 나타나기 전에 사회적 기능과 인격의 붕괴가 서서히 일어나기 때문에 다른 정신과 질환으로 진단될 수도 있다. 저자들은 3례 전측두엽 치매를 보고하였다. 이 증례들은 전측두엽 치매를 임상 진단으로 고려할 만한 병력과 증상을 가지고 있고, 신경심리학 검사, 대뇌의 자기공명영상과 18F-FDG양성자방출단층촬영술 등의 검사에서 전형적인 전측두엽 치매의 소견을 보였다. 이러한 병력과 임상양상 그리고 객관적인 소견들은 임상에서 전측두엽 치매에 주의를 기울이고 적절하게 진단하는 데 도움이 될 것으로 생각된다. Frontotemporal dementia is a common cause of dementia and distinguished from Alzheimer`s disease. Because its clinical symptoms are characterized by slow progressive social breakdown and change of personality before cognitive impairments become prominent, it may be diagosed as other psychiatric disease. We have presented three cases of frontotemporal dementia. They had typical clinical histories and symptoms which deserve to be considered frontotemporal dementia. They showed appropriate findings of frontotemporal dementia in the neuropsychological tests and brain imaging study with brain magnetic resonance imaging and 18F-FDGpositron emission tomography. Their clinical histories and findings are thought to be helpful for clinician to give attention to and diagnose frontotemporal dementia.

BPSD의 정신증적 증상

金度寬(Doh Kwan Kim) 대한노인정신의학회 2000 노인정신의학 Vol.4 No.1

치매 환자들은 인지기능의 장애와 더불어 행동 심리적증상(behavioral and psychological symptoms of de-mentia, BPSD)들을 경험한다. 치매의 임상경과 중에 발생하는 BPSD는 질병의 경과에 따라 진행되는 신경 세포군의 손상 정도를 반영하기도 하지만, 인지기능의 장애와 서로 영향을 미치게 된다. 치매 환자가 경험하는 인지기능 장애는 그 병의 진행 정도를 반영하는 문제이지만 이로 말미암아 환자와 그 가족들이 고통을 당하지는 않는다. 하지만 BPSD는 치매 환자와 가족을 고통스럽게 하고, 환자의 삶의 질을 현격히 저하시키며, 그들 관계를 소원하게 만들어 치매 환자를 가족에게서 내치는 단초를 제공하기도 한다. 그러므로 치매 환자에서 발생하는 BPSD를 이해하고 적절하게 치료함은 임상의사들에게 대단히 중요한 과제이다. BPSD 중 정신증적 증상의 유병률은 망상(delusion)의 경우 전체 치매 환자들 중 20∼73%, 오식별(misidentification)의 경우 23∼50%, 그리고 환각(hallucination)의 경우 15∼49% 정도에서 관찰된다고 한다. 이 글에서는 치매환자의 임상경과 중 나타나는 BPSD 중 이러한 정신증적 증상의 평가와 원인 그리고 약물학적 치료 및 비 약물학적 치료에 대하여 살펴보았다. Dementia is a multi-dimensional disorder associated with cognitive symptoms, functional impairment, and behavioral and psychological symptoms such as agitation, depression and psychosis. Behavioral and psychological symptoms of dementia (BPSD) are an integral part of the disease process and present severe problems to patients, their families and caregivers, and society at large. BPSD are treatable and are more amenable to therapy than other symptoms or syndromes of dementia. Thus, the recognition and appropriate management of BPSD are important factors in improving our care of dementia patients and their caregivers. Psychotic symptoms presented as delusions, misidentifications, and hallucinations are most prevalent BPSD in Alzheimer’s disease and related dementia. The author has reviewed the clinical feature, etiology, and pharmacological and non-phrmacological management of psychotic symptoms of BPSD.

치매의 원인질환

김도관(Doh Kwan Kim),김재경(Jaegyeong Kim) 대한노인정신의학회 1999 노인정신의학 Vol.3 No.1

Dementia is the clinical syndrome characterized by acquired losses of cognitive abilities severe enough to interfere with daily functioning and the quality of life. More than 50 illnesses, some nonprogressive, can cause dementia. The etiologies of dementia may be grouped as follows : neurodegenerative illnesses, vascular causes, space occupying lesions, traumatic causes, toxic causes, infectious diseases, and metabolic imbalances. Because all types of dementia are treatable, at least with psychosocial interventions, accurate diagnosis is essential to determine the appropriate treatment and to provide information about prognosis, possible genetic risks, and health care planning to the patient and family. This article will review several etiological illnesses of dementia which may be faced frequently by general psychiatrists.