정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

선택적 함구증 환자에서의 Fluoxetine 치험

송동호,박민숙,남수용,육기환,노경선,이홍식 대한소아ㆍ청소년정신의학회 1997 소아청소년정신의학 Vol.8 No.2

작업효율을 만족하고 작업량 평준화를 고려한 작업자할당 방법에 관한 연구

이홍철,안재명,김성식 한국경영과학회 1997 韓國經營科學會誌 Vol.22 No.4

The problem addressed in this paper is to minimize the deviations of workloads assigned to worker and to maximize the total utilizations(degree of skill) between workers and machines simultaneously. Each worker can handle the set of machines with the different degree of skill and each machine has the workloads needed to be processed. Also, each worker has to be assigned to at least one machine with the minimum workload deviation. This problem can be formulated as a preemptive goal programming with generalized assignment constraints. The proposed algorithm consists of two phases. First, a capacitated circulation network is constructed to assign the workers to machines with the maximum total utilizations while considering workloads balance. Then, a refinement process is applied to the split machines to satisfy the feasibility condition. The real industrial application in a plastic extrusion manufacturer is included along with several computational experiments.

만성 정신분열증 환자의 인지기능에 미치는 Clozapine 효과

이홍식,정미정,김지현 大韓神經精神醫學會 1994 신경정신의학 Vol.33 No.5

Objects : Prior reviews have indicated that antipsychotic drugs may impair planning ability and memory but otherwise may even improve attention and reaction time performance. This study was performed to evaluate the effect of clozapine on cognitive functions and psychopathology in chronic schizophrenic patients. Methods : Neuropsychological tests such as Wisconsin Card Sorting test, Digit Span test and Judgment of Line Orientation test were applied to 21 chronic schizophrenic patients and 15 normal controls. The schizophrenic patients were retested with the same instruments after 3 monthes of treatment period with clozapine. Psychopathology was assessed in the same patients before initiation of clozapine and at 12 weeks using BPRS. Results : Cognitive impairment was found in each measure of executive function, attention, short-term memory and visual perception ability as compared with the normal controls. After 12 weeks of clozapine treatment, signigicant improvement occured in attention, short-term memory and visual perception ability as well as psychotic symptoms including both positive and negative symptoms, but had little effect on executive functions. Conclusion : Short-term treatment with clozapine may possibly improve parts of cognitive functions of chronic schizophrenics, and these effects can contribute to increase capacity for work and social function.

항파상풍 톡소이드 주사후 항파상풍 항체 역가

이한식,하영록,구홍두,장석준,심호식,김승환,이정운 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Objective : Tetanus decreased in prevalence since the systemic vaccination began in 1940s. Despite of the improvement in treatment like critical care with ventilatior or antibiotics, the mortality rate resides around 45%. Currently the tetanus prevention protocol recommends immunization in infancy and boosters every tenth years. Thereafter the immunization with toxoid only or toxoid plus immunoglobulin injections is recommended according to the type of injury. In most of ED in Korea, only tetanus immunoglobulin is given without any basis. Previously we proved the effect that passive immunization with the immunoglubulin 250 IU last long for only a month. At this time we measured the effect of the active immunization with toxoid and its effect was compared to the effect of the tetanus immunoglobulin to find out the logical tetanus prevention after an injury. Method: 20 healthy adult volunteers were injected with tetanus toxoid and their anti-tetanus antibody titers measured before the injection, 1 week and 4 weeks after the inection. No volunteers have taken any medication for chronic illness(e.g. hepatits, tuberculosis) or had an tetanus immunization or booster in the last 6 months. Antibody titers were measured by IMMUNOZYM??-TETANUS and t-test was performed on the results, Results: 1. Total 20 volunteers(12 males and 8 females) were participated. 2. Subjects` ages were 21 to 44 years old and there were no relevance to the antibody titer. 3. The antibody titers of before the anti-tetanus toxoid injection and 1 week, 4 weeks after the injection revealed significant difference and the antibody titers of the first and the forth week after the injection also showed a significant difference. Conclusion: Currently in Korea, the tetenus immunoglobulin 250 IU given alone as tetanus prevention was injected, but it did not elevate the anti-tetanus antibody titer for 4 weeks where as tetanus toxoid injected intramuscularly did significantly. Therefore, tetanus toxoid should be given on the dirty injuries with additional tetanus immunoglobulin injection to accomplish the correct method of tetanus, tetanus toxoid prevention.

치료저항 만성 정신분열증 환자에서 Clozapine과 Haloperidol의 치료효과에 대한 비교

이홍식,김찬형,이희상,남궁기,송동호,이영문,한은선 大韓臨床藥理學會 1993 臨床藥理學會誌 Vol.1 No.2

만성 정신분열증 환자에 있어 Clozapine 투여에 의한 비정형적 Prolactin반응

이홍식,김찬형,기선완 대한신경정신의학회 1994 신경정신의학 Vol.33 No.3

Objects : Typical antipsychotic drugs robustily increase prolactin both in rodents and in man. Unlike in rodents, Meltzer(1989) found that acutely administered clozapine did not increases serum prolactin levels in schizophrenia and his preliminary data suggested that prolactin levels might even be reduced during clozapine treatment. Methods : We investigated the serum prolactin levels in chronic schizophrenics, who were assigned to clozapine(N=28) or haloperidol(N=20) for eight weeks. Blood samples were obtained biweekly during the study period, and serum prolactin concentrations were measured by standard double-antibody radioimmunoassay. Results : The serum prolactin levels were not changed in the schizophrenic patients to whom clozapine had been administrated, otherwise marked increases in serum prolactin level were observed in the haloperidol treatment group. Conclusion : Our results suggest that clozapine differs from typical antipsychotics(e.g., haloperidol) in its failure to produce serum prolactin elevation in schizophrenic patients.

스테로이드 정신증 : 증례보고 및 문헌 고찰 Case report and brief review

이홍식 최신의학사 1984 最新醫學 Vol.27 No.10

SM55C鋼의 降伏强度가 破壞特性에 미치는 影響에 관한 實驗的 硏究

崔鎔湜,李洪吉 成均館大學校 科學技術硏究所 1986 論文集 Vol.37 No.1

In this paper, an experimental program was carried out to investigate the effect of yield strength on the fatigue crack growth behavior and fracture toughness of the heat treated SM55C steel. The fatigue tests were conducted by the standard fatigue test method described in ASTM Standard E647-81. Also, the K_IC tests Were conducted by the standard plane strain fracture toughness test method described in ASTM Standard E399-81. The following conclusions were derived from the experimental study. 1. The fracture properties (K_IC, R_sc, ΔK_th, m, C, ΔKc) of SM55C steel are influenced by the yield strength of the steel. 2. If the yield strength (σγ) increases, the K_Q increases and the R_sc decreases. 3. If the yield ratio (σγ/σ_B) increases, the K_Q and the R_sc decrease. 4. The fatigue crack growth rate decreases temporarily with the increasing of yield strength. 5. If the yield strength(σγ) increases, the ΔK_th and the ΔKc increase.

당뇨 백서 골결손부에 매식된 산호성 생체재료의 조직학적 반응

박현식,이상한,신홍인 慶北大學校 齒科大學 1992 慶北齒大論文集 Vol.9 No.1

당뇨병 환자에 있어 골결손부를 회복시키기 위한 골대체용 이식체로서의 coralline hydroxyapatite인 RHA 및 MPC의 임상적 응용가능성을 알아보고자, streptozotocin(60㎎/㎏, i. p.)으로 유도된 당뇨백서 및 정상 백서 각 24마리의 하악체에 직경 0.4㎝ 크기의 골결손부를 형성하고, RHA 및 MPC를 각 군별로 이식하여, 술 후 1, 2, 3, 4주째에 회생시켜 통법에 따라 H & E 조직 슬라이드를 제작, 각군의 골성회복 정도를 광학현미경으로 비교 검경한 바 다음과 같은 소견을 얻었다. 1. 각 군 공히 실험전기간에 걸쳐 특기할 염증 및 이물반응을 보이지 않았다. 2. 실험 초기의 섬유성 유약 결체조직내 섬유아세포 및 조골아세포의 분화 증식상은 당뇨군에 비해 정상군에서 보다 활발하였다. 3. 신생골과 이식체간의 직접적인 골성 유합은 실험 2주 이후 명확했으며, 당뇨군에 비해 정상군에서, 그리고 RHA 이식군에 비해 MPC 이식군에서 보다 양호하였다. 4. RHA 입자와 달리 MPC 입자는 미약하나마 골성치환상을 나타내었다. 5. 이식체를 중심으로 형성된 신생골의 성숙정도는 정상군 및 당뇨군간 대차가 없었다. 이상으로 소견으로 정상적인 경우에 비해 골성회복 정도가 다소 미약하고, 지연될 수 있으나, 당뇨환자에 있어서도 coralline biomaterial은 우수한 골대체용 인공재료로 사용될 수 있을것으로 사료되었다. This study has done to evaluate the effect of coralline biomaterials(Replamine-form hydroxyapatite: RHA and Madreporic coral: MPC) as a bone substitute in diabetic conditioned rats. Granular type of RHA and MPC were implanted in artificial mandibular bone defect measuring 0.4㎝ in diameter in 24 normal rats and 24 diabetic rats induced by streptozotocin(60㎎/㎏, i, p.). After implantation of these materials, histologic findings were studied at 1 week interval for 4 weeks with particular attention to new bone formation and its remodelling. The results were as follow: 1. In all groups, there were no evidence of specific inflammatory and/or foreign body reaction. 2. The early healing by fibrous connective tissue was more favorable in normal group than in diabetic group without difference between RHA implanted group and MPC group. 3. The direct union between implanted granules and now bone was noted after 2 weeks in all groups, but the degree of which was most favorable in MPC implanted normal group and followed by RHA implanted normal group, MPC implanted diabetic group and RHA implanted diabetic group in descending order. 4. The sign of replacement of MPC granules by new bone was noted in normal group, but which was not remarked in RHA implanted groups. 5. There was no specific difference in maturity of new bone around both implanted granules between normal and diabetic groups Above findings suggest that coralline hydroxyapatite especially MPC be able to use as a good bone substitute, although the degee of bony healing in diabetic condition may be somewhat mild and delayed than in normal condition.