강박증 환자에서의 인격장애 공존병리에 관한 연구

이동우,강웅구,류인균,정도언,조맹제,우종인,김용식,권준수 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.3

연구목적 : 강박증의 동반인격장애에 관한 연구들은 기존의 개념과 달리 강박성 인격장애와 강박증 간에는 특이적인 관계가 없으며, 강박증 환자들은 다양한 인격장애를 동반한다는 결과를 보여주었다. 그러나 이러한 연구들은 동반 인격장애에 관한 기술적인 분석에 그쳤고, 강박증 환자군의 임상 증상과 동반 인격장애 양상간의 연관성에 관한 분석을 시행하지 않았다. 본 연구의 목적은 강박증 환자군에서의 동반 인격장애를 평가하고 강박증 환자의 다양한 증상과 동반 인격특성 간의 연관성에 대해 연구하는 것이다. 방 법 : DSM-IV의 강박증의 진단기준을 만족하는 59명의 환자군과 32명의 정상대조군을 대상으로 인격장애 질문지를 적용한 후 4∼6점의 절단점을 기준으로 인격장애의 진단이 내려졌다. 먼저 환자군과 정상대조군 간의 특정 인격장애 빈도의 차이를 알아보기 위하여 Fisher's exact test를 시행한 후, 두집단 간에 유의한 차이가 있는 것으로 밝혀진 인격장애 척도 점수에 미치는 Y-BOCS,BDI,BAI점수의 영향을 알아보기 위하여 다중선형회귀 분석을 시행하였다. 결 과 : 1) Fisher's exact test 결과 강박증 환자군은 정상 대조군에 비해 경계성 인격장애(18.6%vs 0%, p=0.007). 회피성 인격장애(55.9% vs 18.8%, p=0.001), 우울성 인격장애(40.7% vs 0%, p=0.000)의 비율이 유의하게 높았다. 2) 다중선형회귀분석 결과 Y-BOCS 점수 (t=2.10, p=0.043)와 BAI점수(t=2.60, p=0.014)는 경계성 인격장애 점수에 유의한 영향을 주는 것으로 나타났다. 또한 BAI점수(t=3.23, p<0.003)는 회피성 인격장애 저수에, BDI점수 (t=3.08, p=0.004)는 우울성 인격장애 점수에 유의한 영향을 주는 것으로 나타났다. 결 론 : 강박증 환자군은 정상 대조군에 비해 회피성 인격장애, 우울성 인격장애, 경계성 인격장애의 동반율이 높고, 강박증이 경계성 인격장애의 심각도에 유의한 영향을 미치는 것으로 사료된다. The purpose of this study was to assess the comorbid axis-Ⅱ disorders of obsessive compulsive disorder(OCD) patients and to investigate the relationship between symptoms of OCD and the comorbid personality traits. The subjects were 59 patients who met DSM-IV criteria for obsessive-compulsive disorder and 32 normal controls. All subjects completed personality Disorder Questionnaire-IV(PDQ-IV). The patients completed Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI), and were rated with Yale-Brown Obsessive Compulsive Scale(YBOCS). The results were as follows. 1) The OCD patients showed significantly higher prevalence of avoidant, depresssive and borderline personality disorder(p<0.01) compared to controls. 2) The BAI score had significant effect on the avoidant personality score(t=3,23, p<0.003). The BDI score had significant effect on the depressive personality score(t=3.08, p=0.004). The YBOCS(t=2.10, p=0.043) and BAI(t=2.60, p=0.014) scores had significant effects on the borderline personality score. We found that OCD patients had higher prevalence of avoidant, depressive, and borderline personality disorders. We also found that obsessive-compulsive symptoms have significant effect on the severity of borderline personalty traits. We suggest that it would be very helpful to consider Axis-Ⅱ disorders for managing patients with obsessive-compulsive disorder.

정신분열병환자에서 Haloperidol 투여에 따른 치료반응과 혈장 Homovanillic Acid 농도 및 혈장 Haloperidol과 Reduced Haloperidol농도와의 관계에 대한 연구

이상익,권준수,우종인 大韓神經精神醫學會 1992 신경정신의학 Vol.31 No.3

In order to develop a more effective therapeutic guidelines for haloperidol treatment, the authors measured plasma haloperidol(HP), reduced haloperidol (RH) and homovanillic acid (HVA) levels in 14 schizophrenic patients and analyzed their relationship to therapeutic response. The plasma homovanillic acid levels were further evaluated to see whether it can be adopted as a predictive biological marker reflecting therapeutic response of haloperidol. The measurement of plasma haloperidol, reduced haloperidol and HVA levels were carried out with high performance liquid chromatography(HPLC) and the therapeutic reponses were assessed with Brief Psychiatric Rating Scale(BPRS) every week before and during the administration of haloperidol for 5 weeks. The results of this study are as follows. 1) There was no significant changes on the plasma HVA levels after haloperidol administration as a whole. But in higher pHVA group(baseline plasma HVA level≥4.5ng/ml), the plasma HVA levels were significantly decreased after haloperidol administration, and in lower pHVA group(baseline plasma HVA level〈4.5ng/ml), the plasma HVA levels were significantly increased compared to baseline plasma HVA levels. 2) Total BPRS scores were continuouly and significantly decreased from 1st week to 3rd week after haloperidol administration not only in total subject, but also in higher pHVA group and lower pHVA group. 3) There was significant correlation between baseline plasma HVA levels and clinical improvement(percentile improvement) at 3rd week in higher pHVA group. But no significant correlation was found between baseline plasma HVA levels and clinical improvement in total subject or in lower pHVA group. 4) Hyperbolic correlation was observed between plasma haloperidol level and plasma RH level(Km=33.11ng/ml). 5) There were no statistically significant correlations between clinical improvement and plasma haloperidol level, plasma RH level and RH/HP ratio in any of the total subject, higher pHVA group and lower pHVA group. 6) The changes of plasma HVA levels after haloperidol administration were not significantly correlated with plasma haloperidol level, plasma RH leel and RH/HP ratio in any of the total subject, higher pHVA group and lower pHVA group.

정신분열병환자의 혈장 Homovanillic Acid와 3-Methoxy-4-Hydroxy-Phenylglycol 농도비와 임상적 변수와의 관계

김종훈,이인상,한규희 대한생물치료정신의학회 2000 생물치료정신의학 Vol.6 No.2

The homovanillic acid(HVA) and 3-methoxy-4-hydroxyphenylglycol(MHPG) , the metabolites of dopamine and norepinephrine, in plasma were measured to examine the monoaminergic contribution to the psychopathology of schizophrenic illness. The relationship between HVA/MHPG ratio and clinical variables, such as positive-negative subgroup, age, onset age, duration of illnesstreatment and presence of family history. Twenty-five patients with schizophrenia after washout of neuroleptics were recruited for this study. The mean value of HVA/MHPG ratio was 2.15 in total patients with schizophrenia. Subjects were divided to two groups as high and low ratio group. No statistical differences were found between the high and low raio group in areas of clinical variables. However there appeared bimodal distribution in histogram. One group(n=21) showed the approximate normal distribution, another small group(n=4) distributed discretely beyond the ratio value 3. All of the patients of small group were positive schizophrenia. This finding suggests the possibility of clustering the schizophrenic illness biologically. In the near future the authors will try to confirm this finding in expanded numbers of subjects and in conjunction with 5-HIAA, another interesting monoaminergic metabolite.

精神分裂病에서의 血小板 Monoamine Oxidase 活性度와 血漿 Estradiol, Progesterone 및 Testosterone의 相關關係에 關한 硏究

金種億,李定均,禹鐘仁,朴贊雄 大韓神經精神醫學會 1984 신경정신의학 Vol.23 No.1

The hypothesis that certain central dopaminergic systems may be overactive in schizophrenia has quite generally accepted by many investigators. Studies of monoamine oxidase (MAO), the major degradating enzyme of biogenic monoamine, have provided a focus for recent biological in schizophrenia. This study was set up to determine the alteration of platelet MAO activity and its sexual differences, the change of plasm sex hormone levels and the correlation between platelet MAO activity and plasma sex hormone levels, in 130 schizophrenics, comparing with 197 normal healthy subjects. Platelet MAO activity was determined fluorometrically by the modified method of Kraml, measuring the deamination of kynuramine to 4-OH quinoline, and was expressed as nanomoles of quinoline produced per milligram of platelet protein per hour. At the same time, plasma estradiol, progesterone and testosterone levels wers determined by radioimmunoassay technique, Following results were obtained. 1. Platelet MAO activity is not different in acute schizophrenics, but is low significantly in chronic schizophrenics (63.7% of normal control group). 2. Platelet MAO activity is lower in male chronic schizophrenics(56.06% of control group) than female(64.69%), and the sex difference is significant. 3. Plasma estradiol level is significantly low in male chronic schizophrenics(71.82%). 4. The correlation coefficient between platelet MAO activity and plasma sex hormone levels reveal negative correlation between platelet MAO activity and plasma testosterone level in female chronic schizophrenics. From the results of the study, it is strongly suggested that the sex difference of platelet MAO activity in chronic schizophrenia is related to the alteration of plasma sex hormone levels.

흰쥐의 뇌, 척수 및 신경절에서 내장기관과 관련된 신경원의 추적에 관한 미세형태학적 연구 -Ⅰ. 부교감 운동신경 세포체의 표지부위

이창현,최종림,오인균,정동인,송창호,이무삼 대한해부학회 1996 Anatomy & Cell Biology Vol.29 No.4

血淸 Lithium 濃度와 腦脊髓液 Lithium 濃度와의 相關關係

金載軫,李相益,金辰圭,崔范,禹鍾仁 서울醫大 1990 精神醫學 Vol.15 No.2

抗精神病藥物이 血淸 Dopamine-β-Hydroxylase 活性度에 미치는 影響 : 慢性 精神分裂病患者를 中心으로

薛玹旭,禹鍾仁,李定均 大韓神經精神醫學會 1983 신경정신의학 Vol.22 No.2

To investigate the effect of antipsychotic drugs directly, the serum dopamine-beta-hydroxylase activty was measured before and after three weeks' washout period in chronic schizophrenics. Total number of subjects were eighty-two chronic schizophrenics, consisting of forty-eight male and thirty-four female patients. The diagnostic criteria was based on DSM-Ⅲ and duplicated assay was applied by modified Udenfriend method. The results were as follows; 1. After three weeks' washout period, the serum dopamine-beta-hydroxylase activity was 13.50±2.12 in male, 11.72±2.12 in total patients. Serum dopamine-beta-hydroxylase activity of female patients were significantly lower than in male patients.(p<0.001) 2. The range of serum dopamine-beta-hydroxylase in total patients was from 8.45 to 18.45㎛ol/min/1, which is relatively small compared with previous reports in the literature. 3. During the three weeks' washout period, the percent change was -8.81±17.35% in male (p<0.01), 1.94±20.92% in female(N.S), and -4.35±19.64%(p<0.05) in total patients compare to the serum dopamine-beta-hydroxylase activity of three weeks' washout period. The difference between male and female(p<0.02) is not clear. 4. During the three weeks' washout period, the absolute value of percent change was 16.48±10.36% in male, 17.71±13.93% in female, and 16.57±11.40% in total patients. (all, p<0.001) 5. The percent change of serum dopamine-beta-hydroxylase activity did not seem to be related to the type of drugs, dose of drugs, age, hospital duration, duration of illness, and the presence of active symptom. 6. In summary, the current findings suggest that the interpretation of data indicating low serum dopamine-beta-hydroxylase activity in medicated schizophrenics should be made with caution.

甲狀腺炎과 Lithium 治療에 의한 甲狀腺機能低下症

鄭道彦,禹鍾仁,李定均,趙普衍,高昌舜,金勇一 大韓神經精神醫學會 1982 신경정신의학 Vol.21 No.2

A case of a female Manic Depressive Illness patient with goitrous hypothyroidism is presented. After ten and half months of lithium maintenance therapy starting during her first psychiatric admission, she was admitted again due to acute recurrent manic episode. On admission, she complained of easy fatigability and cold intolerance, and thyroid gland was palpable and enlarged in moderate degree. Thyroid function test revealed markedly increased TSH and moderately decreased thyroxine levels. TRH stimulation test showed an exaggerated response. Needle biopsy specimen revealed chronic lymphocytic and immune complex thyroiditis. However, antithyroglobulin and antimicrosomal antibodies were negative. In pretreatment thyroid evaluation on her first admission, neither goiter nor thyroid function abnormality was detectable and no signs of underlying thyroid disease or hereditary predisposition to hypothyroidism were present. Within three weeks of discontinuation of lithium, goiter was no more palpable and within five weeks, thyroid function test returned to normal range. The possibility that patients with underlying thyroiditis may be particularly susceptible to a rapid onset of lithium-induced hypothyroidism is discussed.

Nortriptyline 청소율과 Metoprolol 산화대사능과의 상관관계

정원석,장인진,이경훈,신상구,우종인,박찬웅 大韓臨床藥理學會 1993 臨床藥理學會誌 Vol.1 No.2

치매 선별을 위한 한국어판 간이 Blessed 검사의 신뢰도 및 타당도

이동영,윤종철,이강욱,주진형,김기웅,이정희,우종인 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.6

연구목적: 저자들은 치매 환자의 임상 진료 및 역학적 조사 연구에서 간편하면서도 유용하게 사용될 수 있는 치매 선별용 인지기능 검사 도구인 Short Blessed Test(SBT)를 한국어로 번안하고, 번안된 검사에 대한 신뢰도와 타당도를 검증함으로써 한국어판 SBT(SBT-K)를 개발하고자 하였다. 방 법: 번역-역번역의 과정을 거쳐 번안된 SBT-K를 The Korean Version of Blessed Dementia Scale-Activity of Daily Living(BDS-ADL-K)및 Clinical Dementia Rating Scale(CDR)과 함께 치매환자 224명과 정상인 191명에게 시행하고, 이들 중 324명(치매환자 157명, 정상인 167명)에 대해서는 The Korean Version of Consortium to Establish a Registry of Alzheimer`s Disease-Mini-Mental State Examination(CERAD-MMSE-K)를 함께 시행하였다. SBT-K의 신뢰도 확인을 위해 Crohnbach alpha 값의 산출과 함께 평가자간 일치도 및 1개월간격 검사-재검사 일치도를 검증하였다. 타당도 확인을 위해 SBT-K 점수와 CERAD-MMSE-K, BDS-ADL-K 및 CDR 점수와의 상관성을 검증하고, 각 절단점에 대한 민감도 및 특이도를 산출하였다. 아울러 Receiver Operator Characteristic(ROC)곡선분석을 통해 최적절단점을 구하고 CERAD-MMSE-K와의 진단적 효율성을 비교 검증하였다. 결 과: 1) SBT-K는 높은 내적 일치도와 함께 우수한 평가자간 및 검사-재검사 신뢰도를 보였다. 2) SBT-K는 CERAD-MMSE-K, BDS-ADL-K 및 CDR과 유의한 상관관계를 보였으며, ROC 곡선 분석을 통해 추정된 최적 절단점(10/11) 에서의 민감도와 특이도가 각각 0.85, 0.90으로 높게 나타났다. 3) ROC 곡선의 Area Under Curve(AUC) 분석결과 SBT-K는 CERAD-MMSE-K와 치매선별도구로서 대등한 진단적 효율성을 보였다. 결 론: 이상의 연구결과를 통해 SBT-K는 높은 신뢰도와 타당도를 가지고 있으며, 치매선별을 위해 간편하면서도 유용한 인지기능 평가 도구임이 확인되었다. We aimed to develop the Korean version of Short Blessed test(SBT-K)by analyzing its reliability and validity, showing its usefulness as a dementia screening instrument. The translation, including back translation procedure, was carried out, keeping the basic structure of SBT. SBT-K. The Korean Version of Blessed Dementia Scale-Activity of Daily Living(BDS-ADL-K) and Clinical Dementia Rating Scale(CDR) were administered to 224 dementia patients and 191 control subjects, and The Korean Version of Consortium to Establish a Registry of Alzheimer`s Disease-Mini-Mental State Examination(CERAD-MMSE-K) was to 157 patients and 167 controls. The correlation of SBT-K scores between two rates, correlation between the test and retest after one month, and its internal consistency were analyzed. To verify the concurrent validity of SBT-K, its correlation with each test: CERAD-MMSE-K, BDS-ADL-K, and CDR was analyzed. The sensitivity and specificity for each cut-off point of SBT-K were calculated and the Receiver Operator Characteristic(ROC) curve analysis was done to get its optimal cut-off point. SBT-K was found to have significantly high internal consistency, inter-rater reliability, and test-retest reliability. The significant correlation of SBT-K with each test described above was also shown. Its optimal cut-off point was estimated as 10/11, and the sensitivity and specificity were 0.85 and 0.90, respectively. The ROC curve analysis indicated that the diagnostic efficiency of SBT-K was comparable with CERAD-MMSE-K. We conclude that SBT-K has not only high reliability, but also usefulness as a screening instrument for dementia.