공황장애 환자에서 인지행동치료의 약물 감량 효과

최영희,김경미,박기환,윤혜영 대한정신약물학회 2003 대한정신약물학회지 Vol.14 No.4

Objective : The purpose of this study is to determine whether CBT is effective in tapering or discontinuing medication regardless of the type of medication and its maintenance effects after long-term follow up. Method : 224 patients meet DSM-IV criteria for panic disorder with or without agoraphobia completed 12 weekly sessions of Panic Control Therapy (PCT; Barlow et al.). 80 patients who were using benzodiazepines alone and 144 patients who were using benzodiazepines and Antidepressants were measured with several screening scales at the pre- and post-treatment. The scales were Beck Depression Inventory (BDI), Spielberg State Anxiety Inventory (STAI-State), Spielberg Trait Anxiety Inventory (STAI-Trait), Body Sensation Questionnaire (BSQ), Agoraphobic Cognition Questionnaire (ACQ), Anxiety Sensitivity Index (ASI), Panic Belief Questionnaire (PBQ). These patients were assessed at 3 months, 6 months, 12 months of follow up and they were also assessed for their medications, panic frequency, and End-State Functioning. Results : After the completion of PCP, both benzodiazepines alone group and benzodiazepines and antidepressants combination group showed significant improvement (P<0.001) in all the results of 7-self reported questionnaires. 54% of patients discontinued their medication and 90.9% of patients were in HES at post-treatment. 70 % of patients were in HES at 3 month, 6 month, and 12 month follow up. The patients who could not discontinue medication also tapered their medication afterwards. The rate of discontinuing medication was significantly higher for the patients using benzodiazepines alone (86.3%) than patients using combination of benzodiazepines and antidepressants (56.3%). Conclusion : These findings support cognitive behavioral therapy can replace medication and these effects seem to last long. 목 적:공황장애 환자들에 대한 인지행동치료가 치료 약물의 종류와 무관하게 약물을 중단하는데 도움을 주며, 장기간에 걸쳐 호전 상태를 유지할 수 있는지 여부를 검증하기 위해 이 연구를 시행하였다. 방 법:DSM-Ⅳ 진단에 따라 공황장애로 진단 받고 약물치료중인 24명의 환자를 대상으로 12회기 집단 인지행동치료를 실시하였다. 인지행동치료 전 복용 약물을 벤조다이아제핀계 약물 복용 군 80명과 벤조다이아최영희 등 375 제핀과 항우울제 병합요법군 144명의 환자군으로 나누어, 치료 전과 후에 시행한 Beck Depression Inven -tory(BDI), Spielberg State Anxiety Inventory(STAI -State), Spielberg Trait Anxiety Inventory(STAI-Trait), Body Sensation Questionnaire(BSQ), Agora-phobic Cognition Questionnaire(ACQ), Anxiety Sen -sitivity Index(ASI), Panic Belief Questionaire(PBQ)의 결과를 분석하였다. 또한, 3개월, 6개월 12개월 추적조사를 통해 각 약물군별 약물복용 여부와 최종상태기능(End-State Fungtioning)을 평가하여 분석하였고, 12개월 추적조사기간동안 약물 복용양 변화와 약물군별 차이, 최종상태기능 사이의 관계를 분석하였다. 결 과:인지행동치료 전 사용 약물의 종류와 상관없이, 인지행동치료 이후 모든 임상 변인이 통계적으로 유의미하게 향상되었다. 인지행동치료 직후, 대상군의 54%의 환자들이 약물을 끊었고 이들 중 90.9%가 상위 최종 상태를 유지되고 있었으며, 3개월, 6개월, 12개월 추적조사에서 이들의 약 70%는 여전히 상위최종상태를 유지하고 있었다. 또한 약물 복용을 중단하지 못한 환자들도 지속적으로 약물 복용을 감량하여 3개월 뒤에는 약 6%, 6개월 및 12개월 추적조사 시에는 약 68%의 환자가 약물 복용을 중단하였고 이들 역시 약 70%에서 상위최종상태를 유지하고 있었다. 벤조다이아제핀 단독 투여군의 경우 86.3%의 환자가 인지행동치료 이후 약물복용을 중단하여 이후 추가적인 약물복용이 필요하지 않았으며 이들의 약 70%는 약물 복용 없이 상위최종상태를 유지하고 있었고, 2.7%만이 약물 감량 이후 재복용 하였다. 반면 벤조다이아제핀계 약물과 항우울제 병합요법군은 57.0%의 환자가 인지행동치료 이후 약물복용을 중단하여 지속적으로 약물복용을 하지 않았다.

Lamivudine Therapy Exacerbates Bilirubinemia in Patients Underlying Severely Advanced Hepatitis

최영희,이창호,고명숙,한현주,김상건 한국독성학회 2017 Toxicological Research Vol.33 No.4

Lamivudine belongs to the set of antiviral agents effective against hepatitis B virus infection. Given case reports on liver injuries after certain antiviral agent treatments, this study examined the effects of lamivudine on alanine aminotransferase (ALT) and total bilirubin (TB) using a medical system database. A total of 1,321 patients taking lamivudine alone or with others were evaluated using laboratory hits in an electronic medical system at Seoul National University Hospital from 2005 through 2011. The patients were grouped according to prior ALT results: G#1, ALT < 40 IU/L; G#2, 40 IU/L ≤ ALT < 120 IU/L; G#3, 120 IU/L ≤ ALT < 240 IU/L; and G#4, ALT ≥ 240 IU/L. In G#1 and G#2 patients, lamivudine or adefovir treatment decreased ALT and TB compared to prior values. In G#3 and G#4 patients with three times the upper limit of normal (ULN) ≤ ALT < 15 times the ULN, both ALT and TB were decreased after treatment with lamivudine alone, or adefovir following lamivudine therapy, indicating that lamivudine therapy ameliorated liver functions. However, in G#4 patients who experienced severely advanced hepatitis (ALT ≥ 15 times the ULN, or ≥ 600 IU/L), lamivudine augmented TBmax (6.3→13.3 mg/dL) despite a slight improvement in ALT (839→783 IU/L), indicative of exacerbation of bilirubinemia. Patients who used adefovir after lamivudine also showed a high incidence of hyperbilirubinemia when they experienced severely advanced hepatitis. Treatment with adefovir alone did not show the effect. In conclusion, lamivudine may increase the risk of hyperbilirubinemia in patients with severely advanced hepatitis, implying that caution should be exercised when using lamivudine therapy in certain patient populations.

간호대상자의 사회화과정에 대한 이해

최영희 대한간호협회 1983 대한간호 Vol.22 No.5

임진왜란중의 대명사대에 대하여

최영희 한국사학회 1964 史學硏究 Vol.- No.18

귀선(龜船)에 관한 몇 가지 문제점

최영희 한국과학사학회 1979 한국과학사학회지 Vol.1 No.1

형질전환 생쥐에서 Bovine $\beta$-Casein/Bovine Growth Hormone 재조합 유전자의 유전적 안정성에 관한 연구

최영희,오건봉,강용국,방남수,서길웅,이경광,이철상 한국동물번식학회 1998 Reproductive & developmental biology Vol.22 No.3

To investigate the fidelity of transgene transmission and expression, we produced transgenic mice carrying bovine $\beta$-casein/bovine grwoth hormone(bGH) fusion gene and examined transmission efficiency and expression level of the transgene in the founders and their progeny. The transgene was composed of 1.8 kb bovine $\beta$-casein promoter and 2.1 kb bGH gene. Ten transgenic mice were produced. Milk and mammary gland were collected from eight transgenic lines at 10-day lactation and a, pp.ied to Western and Northern blot analyses. The bGH expression was detected in four of them. The concentrations of bGH in milk were highly variable from 4$\mu\textrm{g}$/ml to 600$\mu\textrm{g}$/ml depending on the lines. The bGH mRNA level in mammary gland was closely correlated with the bGH concentration in milk in each transgenic line. These results indicated that bGH transgene expression was a, pp.opriately regulated in the mammary gland and secreted into milk in transgenic mice. By using two transgenic lines(#2, #7) secreting a considerable amoung of bGH into their milk, the inferitance and maintenance of transgenic phenotype were assessed in successive four generations. The mean transmission frequencies of transgene in lines #2 and #7 were 34% and 40%, respectively. The bGH concentration in milk were 80, 240, 120, 60$\mu\textrm{g}$/ml in each G0(generation 0), G2, G3, G4 generation of line #2 and 600, 1600, 860, 900$\mu\textrm{g}$/ml in each G1. G2, G3, G4 generation of line #7. These results demonstrated that bovine $\beta$-casein/bGH gene was stably transmitted from generation to generation in a Menelian fashion in trasgenic mice and consistenly expressed in their milk throughout the generations, although there was a little variation in the transmission frequency and expression level of the transgene between generations.

광학적 반사률이 적용된 단순평면패턴 도광판 모델의 시뮬레이션

최영희,마혜준,최은서,신용진 한국물리학회 2009 새물리 Vol.59 No.2

We proposed two-layered light guiding model having partial reflectivity to expect the performance of designed light guiding panel. Simplified inner scatterer based light guiding panel has different reflectivity on each surface without any absorption. On the surface, the Gaussian scattering happens at every reflection. From the simulation results, linear pattern provided similar average brightness (231 cd/mm2) to experimental results (211 cd/mm2) in the condition of 40 % reflectivity and 60% transmissivity. But in the case of curved pattern, there are big discrepancy from the experimental value of 429 cd/mm2. The detailed simulational and experimental research for the effect of optical reflectivity of each surface including absorption property could provide more exact expectation to the designed light guiding panel. 본 연구는 도광판(LGP: Light Guide Panel) 성능 예측을 위한 방법으로 반사율과 투과율을 부여하고 산란모델을 적용된 두 개의 층이 적용된 전산모사 모델을 제시하고자 한다. 단순평면패턴의 두 개의 층에 각각 반사율과 투과율을 변화시켰고 흡수율은 0%로 고정하였다. 단순평면패턴의 광학적 특징으로는 가우시안 산란모델을 적용하였다. 연구 결과 선형패턴의 경우 반사율이 40%이고 투과율이 60%인 단순평면패턴에서 평균휘도 값이 231 cd/mm2로 실험치 211 cd/mm2과 유사하게 나왔다. 그러나 같은 반사율과 투과율에서 곡면패턴의 경우엔 실험치의 429 cd/mm2의 평균 휘도값과 많은 차이점으로 보였다. 따라서 반사율과 투과율 이외에 흡수율과 산란체들의 산란모델에 대한 더욱 많은 연구가 필요하다.

아차산성 출토 고대 기와의 검토

최영희,서봉수 한국기와학회 2018 한국기와학회 학술대회 발표자료집 Vol.2018 No.12

UHF 신호를 이용한 딥러닝 기반의 부분방전 탐지시스템 설계

이정일(Jeong-Il Lee),김진형(Jin-Hyung Kim) 한국조명·전기설비학회 2020 한국조명·전기설비학회 학술대회논문집 Vol.2020 No.7

[대표 동화] 봄을 파는 가게

최영희 아동문학평론사 2015 兒童文學評論 Vol.40 No.3