지연성 운동장애 환자에서 뇌 척수액 丫-Aminobutyric Acid 농도에 관한 연구

권준수,김재진,우종인 대한신경정신의학회 1990 신경정신의학 Vol.29 No.6

The present study was undertaken to clarify the role of 丫-aminobutyric acid(GABA) in the pathophysiology of tardive dyskinesia. GABA concentrations in CSF were m easured in 14 schizophrenic patients without tardive dyskinesia, 15 schizophrenic patients with tardive dyskinesia and 18 neurologic patients without psychotic symptoms. In addition, GABA concentrations in CSF and clinical improvement of tardive dyskinesia w ere checked for dyskinetic schizophrenics after 8 weeks of treatm ent with sodium valproate, the GABAergic drug. Results were as follows: 1 ) A significant reduction in CSF GABA levels was observed in dyskinetic schizophrenics compared with the neurologic patients. 2) CSF GABA levels in schizophrenic patients without tardive dyskinesia were not significantly differnet from those in neurologic patients, although the data suggested a decrease in CSF GABA levels in schizophrenic patients. 3) A significant decrease in dyskinetic symptoms occurred with the administration of sodium valproate, associated with increase in CSF levels of GABA. The results of this study can be taken as a strong suggestion that GABA system is involved in the pathophysiology of tardive dyskinesia.

2007 World Psychiatric Association Regional Meeting 을 준비하며

권준수 대한신경정신의학회 2007 신경정신의학 Vol.46 No.1

Harvard 醫科大學 精神科 專攻醫 敎育 參觀記

權俊壽 서울大學校 醫科大學 精神科學敎室 1996 精神 醫學 Vol.21 No.1

정신분열병 환자의 재인 기억 장애에 관한 사건관련전위 연구

권준수,김명선 한국임상심리학회 2003 Korean Journal of Clinical Psychology Vol.22 No.4

Recognition memory and the dissociation of immediate and delayed recognition in schizophrenic patients were investigated using event-related potential (ERP) and a continuous word recognition task. Fourteen schizophrenic patients and 14 age and gender matched control subjects participated. Among 240 stimulus words, 40 words were not repeated, 100 were repeated immediately and 100 were repeated after 5 intervening words. Both schizophrenic and control groups responded faster to words repeated immediately than to words repeated after a delay and to first-presented words. However, schizophrenic patients responded less accurately to words immediately and to words repeated after a delay than the controls. In terms of ERP, schizophrenic patients showed significantly reduced N200, LPC and N400 amplitudes, and a more frontally distributed N200 topography than the controls. For controls, immediate repetition was associated with a large LPC amplitude and the absence of N400, while delayed repetition was associated with a small LPC amplitude and the presence of N400. However, this association between immediate and delayed repetition was not observed in schizophrenic patients. All of these results indicate that schizophrenic patients have recognition memory impairment, the cause of which may range from early encoding, and memory search to late retrieval.

慢性精神分裂病 患者에서 電氣衝擊療法이 腦脊髓液 5-HT와 5-HIAA 濃度에 미치는 影響에 관한 研究

권준수,김기웅,우종인 대한신경정신의학회 1992 신경정신의학 Vol.31 No.5

The effect of a series of ECT treatments on the C SF 5-HT and 5-HIAA concentrations was studied in the 10 patients suffering from chronic treatment-resistant schizophrenia. The clinical improvement of the patients was assessed with BPRS weekly. Total BPRS scores signiflcantiy decreased after a series of ECT treatments. A nd positive, negative, thinking disturbance, withdrawal/retardation and hostility/suspiciousness symptom subscale scores were also decreased significantly after ECT treatments. But anxiety/depression symptom subscale score did not show statistically significant change. The CSF 5-HT concentrations significantly decreased after a series of ECTs. But the CSF 5-HIAA concentrations showed a trend to decrease which was not statistically significant. Percentile improvement on total BPRS score was positively correlated with pre-ECT concentration of CSF 5-HT showed the better clinical improvement. And percentile improvement on total BPRS scores showed significant negative correlation with change in the concentration of 5-HT after ECT treatments. These results suggest that ECT may be effective in the treatm ent of treatment-resistant chomic schizophrenia and, although it’s mechanism is still unknown, may affect the central serotonergic system in schizophrenics, which may be related to the clinical improvement after a series of ECTs.

알리트레티노인 복용과 관련된 가성뇌종양 1예

권준수,염혜리 대한안과학회 2024 대한안과학회지 Vol.65 No.9

목적: 비타민 A 유도체인 알리트레티노인 치료를 받는 환자에서 발생한 가성뇌종양 1예를 경험하였기에 문헌고찰과 함께 보고하고자 한다. 증례요약: 28세 여자 환자가 1-2개월 전부터 간헐적인 좌안의 흐려 보임 및 양안의 시신경유두부종으로 의뢰되었다. 아토피 피부염 및 손습진으로 알리트레티노인(Alitretinoin, 9-cis-retinoic acid, AlitocⓇ; GlaxoSmithKline) 약물치료 중이었고, 안과적 검사상 양안의 시력 저하는 없었지만 시야검사상 양안의 경미한 중심암점, 빛간섭단층촬영에서 양안 망막신경섬유층 두께의 증가가 관찰되었다. 조영증강 안와 자기공명영상에서 후 공막이 편평해진 것 외에 특이병변 없었고 뇌척수액 검사 결과 뇌척수액 개방압력은 220 mmH2O로 측정되었으나 뇌척수액 조성은 정상이었다. 이에 알리트레티노인 복용을 중단하였고 2개월 후 흐려 보임이 호전되었고, 시신경유두부종과 중심암점이 호전되었다. 결론: 알리트레티노인의 사용으로 가성뇌종양이 발생할 수 있으며, 가성뇌종양이 의심되는 환자에서 과거력 및 약물력에 대한 자세한 병력 청취가 필요하다. Purpose: We present a case of alitretinoin-induced pseudotumor cerebri. Case summary: A 28-year-old woman presented with a 1-month history of bilateral papilledema and intermittent blurred vision in the left eye. She had been taking alitretinoin (9-cis-retinoic acid, Alitoc®; GlaxoSmithKline) for atopic dermatitis and hand eczema. Although visual acuity remained intact in both eyes, mild central scotoma was detected bilaterally. Optical coherence tomography revealed increased retinal nerve fiber layer thickness in both eyes. Enhanced magnetic resonance imaging revealed no abnormalities except for bilateral flattening of the posterior sclera. Cerebrospinal fluid exhibited an elevated opening pressure (220 mmH2O) and a normal composition. Following the discontinuation of alitretinoin, the intermittent blurred vision, papilledema, and central scotoma improved significantly within 2 months. Conclusions: Alitretinoin use should be monitored carefully for a potential development of pseudotumor cerebri, particularly in patients with pre-existing risk factors.

일 대학병원에서 정신분열병 외래환자의 약물사용 경향

권준수,김의태,하태현,노규식,최정석,김용식 대한신경정신의학회 2003 신경정신의학 Vol.42 No.6

Objectives:To provide basic data for psychopharmacologic research of schizophrenic patients, we analyzed and characterized prescribing patterns of outpatients with schizophrenia in Seoul National University Hospital (SNUH). Methods:This study is a descriptive and retrospective report. Subjects were outpatients with schizophrenia in SNUH from March 1, 2002 through June 31, 2002. We obtained data of prescriptions and diagnoses from order communication system (OCS). Results:There were 825 outpatients with schizophrenia (476 males and 349 females). 805 schizophrenia outpatients were taking antipsychotics. The total number of antipsychotic prescription was 862. The percentage of taking atypical antipsychotics was 88.1% among total antipsychotic prescription and 11.9% taking typical antipsychotics. Risperidone was prescribed most frequently (39.0%), and the next was clozapine (29.0%). There were 57 cases of antipsychotic polypharmacy. Conclusion:Our results which reflected evidence-based prescriptions in SNUH showed that atypical antipsychotics were replacing typical antipsychotics. But there was a possibility that clinician’s selection of medication was influenced by health insurance policy. Clinical guideline for the treatment of schizophrenia seems necessary for effective pharmacotherapy.

치료 저항성 환청을 호소하는 정신분열병 환자에 대한 반복 경두개 자기자극(rTMS)과 전기충격요법(Modified ECT)의 연속적인 치료 경험 1례

권준수,전홍진,윤탁 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.4

정신분열병에서 치료에 반응하지 않으며 지속되는 환청은 환자에게 매우 불쾌한 감정을 유발할 수 있으며 환청의 내용에 따라 위험한 경우도 있다. 환청에 대한 기능적 뇌영상 연구 결과로 환청이 정상 청각경로의 비정상적인 활성으로 발생하며, 환청이 들리는 동안에 좌측 상부 측두엽 등이 활성화 된다는 사실을 알게 되었다. 본 증례에서는 항정신병 약물에 대한 치료 저항성 환청을 가진 35세 기혼 여자 환자에 대해서, 좌측 상부 측두엽을 국재화한 후 뇌의 국소적 자극이 가능한 Magstim 200장비와 Double cone shaped coil을 이용하여 1HZ slow wave 반복 경두개 자기자극(rTMS)을 가하였다. 항정신병 약물을 유지한 상태에서 최고 100pulse의 총 14회의 자극을 통해 환청의 주관적인 크기의 30% 감소와 정동의 호전을 관찰할 수 있었다. 반복 경두개 자기자극(rTMS)종료 2주 뒤에 추가적으로 시행된 9회의 전기충격요법(ECT)결과 환청이 빠른 속도로 완전히 소실되었다. 치료저항성 환자의 환청에 대한 치료효과는 rTMS보다 ECT가 효과적임을 알 수 있었다. The Persistent auditory hallucinations may provoke the uncomfortable feeling and be dangerous according to its contents in treatment-resistant schizophrenic patients. Previous functional brain imaging studies on suditory hallucinations reported that the abnormal activations of the normal auditory pathway and the activations of the left upper temporal lobe were found while patients were hallucinationg voices. Base on the these findings, we treated a female schizophrenic patient with persistent auditory hallucinations that were treatment-refractory with rTMS and the ECT continuously while she was on the drug treatment. The total amount of pulses applied in each trial ranged from 240 to 1000pulses. Fourteen trials were done and resulted in decrease by 30% in the subject severity of auditory hallucinations and the improvement of the affect. Two weeks after the completion of rTMS trials, nine trials of ECT were administered which leaded to complete disappearance of auditory hallucinations. This result suggest that ECT is more effective than rTMS in treating persistent auditory hallucinations in treatment-resistant schizophrenic patients.

강박장애의 임상양상 - 입원환자의 연구 -

권준수,이동우,윤대현 대한신경정신의학회 1998 신경정신의학 Vol.37 No.2

서울대학교 신경정신과에 강박장애로 입원한 환자중 DSM-Ⅲ-R의 강박장애의 진단기준에 합당한 26명 을 대상으로 후향적으로 의무기록을 조사하여, 강박장애의 현상적 특징, 임상경과, 가족력, 동반질환, 지능검 사 등에 대하여 기술적 분석을 시행하여 다음과 같은 결과를 얻었다. 1) 강박사고는 병적의심, 오염에 대한 강박사고, 대칭과 정확성에 대한 요구, 신체적 강박사고, 성적인 강 박사고, 종교적 내용 및 난폭한 행동에 대한 강박사고의 순서로 많았으며, 2가지 이상의 강박사고를 가진 경 우가 23%였다. 2) 강박행동에는 확인, 씻음, 질문, 대칭과 정확성에 대한 요구, 셈 등의 순서로 많았으며, 2가지 이상의 강 박행동을 가진 경우가 39%였다. 3) 동반된 진단은 우울증, 튜렛증후군, 틱장애, 유뇨증 등이었으며, 동반된 인격장애는 강박성 인격장애, 경계성 인격장애, 피동공격형 인격특질 등이었다. 4) 임상경과로는 순수강박장애보다 다른 동반된 질환을 가진 강박장애군에서 더 나쁜 예후를 보였다. 5) KWIS로 측정된 평균지능지수는 언어성 지수가 동작성 지수보다 월등히 높게 나타났다 This study examined the clinical features of patients with obsessive-compulsive disorders who had been admitted to the Department of Psychiatry, Seoul National Univ. Hospital from 1980 to 1995, using retrospective investigation of medical records. The subjects were 26 patients(male 22, female 4) who were compatible with the criteria of OCD by DSM-Ⅲ-R. The results were as follows: 1) The most common obsessive thinking was pathologic doubt, followed by contamination, need for symmetry, somatic and sexual obsession, religious and aggressive obsession in descending order. Twenty three percent of patients had multiple obsessions. 2) The most common compulsive ritual was checking, followed by washing, need to ask and confess, symmetry and precision, counting in descending order. Thrity nine percents of patients had multiple rituals. 3) Depression, schizophrenia, Tourette’s syndrome and tic disorder were the coexisting disorder with obsessive compulsive disorder. Cormorbid personality disorders in OCD were obsessive personality disorder, borderline personality disorder, schizotypal personality disorder and passiveaggressive personality disorder. 4) The course in OCD with co-existing disorder was worse than that in pure OCD. 5) The verbal IQ was significantly higher than the performance IQ checked by KWIS in obsessive compulsive disorder.

硏修記 : 하바드 의대 정신과 Dr. McCarley's Lab.

權俊壽 서울醫大 1997 精神醫學 Vol.22 No.2