Clinical Validation of the Psychotic Depression Assessment Scale, Hamilton Depression Rating Scale-6, and Brief Psychiatric Rating Scale-5: Results from the Clinical Research Center for Depression Study

박선철,장은영,김재민,전태연,이민수,김정범,임현우,박용천 대한신경정신의학회 2017 PSYCHIATRY INVESTIGATION Vol.14 No.5

Objective: The aim of this study was to validate the psychotic depression assessment scale (PDAS), which includes the six-item melancholia subscale from the Hamilton depression rating scale (HAMD-6) and the five-item psychosis subscale from the brief psychiatric rating scale (BPRS-5). Data from the Clinical Research Center for Depression (CRESCEND) study, which is a 52-week naturalistic trial, were analyzed. Methods: Fifty-two patients with psychotic depression from the CRESCEND study met our inclusion criteria. The patients underwent the following psychometric assessments: the PDAS, including HAMD-6 and BPRS-5, the clinical global impression scales, the HAMD, the positive symptom subscale, and the negative symptom subscale. Assessments were performed at the baseline and then at weeks 1, 2, 4, 8, 12, 24, and 52. Spearman correlation analyses were used to assess the clinical validity and responsiveness of the PDAS. Results: The clinical validity and responsiveness of the PDAS, including HAMD-6 and BPRS-5, were acceptable, with the exception of the clinical responsiveness of the PDAS for positive symptoms and the clinical responsiveness of BPRS-5 for negative symptoms. Conclusion: The clinical relevance of the PDAS has been confirmed and this clinical validation will enhance its clinical utility and availability.

조현병 진단기준에 대한 정신병리학적 고찰

박선철 대한의사협회 2024 대한의사협회지 Vol.67 No.2

Background: Considering the conterarguement of the optimistic attitude of psychoanalysis and environmental change, the current diagnostic criteria for schizophrenia (i.e., Diagnostic and Statistical Manual of Mental Disorders, 5th edition-text revised [DSM-5-TR], International Classification of Diseases, 11th revision [ICD-11]) are defined under the substantial influences of symptom-based operationalism. The current diagnostic criteria for schizophrenia are occasionally considered as the incorporated characteristic mixtures of the chronicity, positive symptoms, and negative symptoms of Emil Kraepelin, Kurt Schneider, and Eugen Bleuler, respectively. Current Concepts: Concerning the diagnostic criteria for schizophrenia, the two remarkable changes from DSM-IV or DSM-IV-TR to DSM-5 or DSM-5-TR are as follows. First, related to diagnosing schizophrenia, the weighting of Kurt Schneider’s first-rank symptoms has been omitted. Second, the defining subtypes (i.e., paranoid, disorganized, undifferentiated, catatonic, and residual) have also been omitted. In addition, catatonia has been newly considered a semi-independent diagnostic entity in DSM-5 or DSM-5-TR. Therefore, from a psychopathological aspect, the operationally defined diagnostic criteria for schizophrenia display several limitations: First, the oblivion of the concept of formal thought disorder, considered as the fundamental symptom of schizophrenia by the greatest psychopathologists, has been deepened. Second, the current diagnostic criteria for schizophrenia have been partly inconsistent with the disease essentialism model. Discussion and Conclusion: Schizophrenia cases are interconnected with ‘family resemblance’ but not shared by common underlying neurobiological correlates. Herein, in clinical psychiatric practice, with an emphatic approach, phenomenological psychopathology would still be required to evaluate the subjective experiences of an individual with schizophrenia.

Patterns of Antipsychotic Prescription to Patients with Schizophrenia in Korea: Results from the Health Insurance Review & Assessment Service-National Patient Sample

박선철,이명수,강승걸,이승환 대한의학회 2014 Journal of Korean medical science Vol.29 No.5

This study aimed to analyze the patterns of antipsychotic prescription to patients withschizophrenia in Korea. Using the Health Insurance Review & Assessment Service-NationalPatients Sample (HIRA-NPS), which was a stratified sampling from the entire populationunder the Korean national health security system (2009), descriptive statistics for thepatterns of the monopharmacy and polypharmacy, neuropsychiatric co-medications, andprescribed individual antipsychotic for patients with schizophrenia were performed. Comparisons of socioeconomic and clinical factors were performed among patientsprescribed only with first- and second-generation antipsychotics. Of 126,961 patients withschizophrenia (age 18–80 yr), 13,369 were prescribed with antipsychotic monopharmacyand the rest 113,592 with polypharmacy. Two or more antipsychotics were prescribed to31.34% of the patients. Antiparkinson medications (66.60%), anxiolytics (65.42%), moodstabilizers (36.74%), and antidepressants (25.90%) were co-medicated. Patients who wereprescribed only with first-generation antipsychotics (n = 26,254) were characterized bysignificantly older age, greater proportion of male, higher proportion of medicaid, highertotal medical cost, lower self-payment cost, and higher co-medication rates ofantiparkinson agents and anxiolytics than those who were prescribed only with secondgenerationantipsychotics (n = 67,361). In this study, it has been reported substantialprescription rates of first-generation antipsychotics and antipsychotic polypharmacy andrelatively small prescription rate of clozapine to patients with schizophrenia. Since thisstudy has firstly presented the patterns of antipsychotic prescription to schizophrenicpatients in Korean national population, the findings of this study can be compared withthose of later investigations about this theme.

조현병 환자에서 폭력성의 관련요인

박선철,최준호 대한조현병학회 2015 대한조현병학회지 Vol.18 No.1

Therapeutic social environments contribute to the successful treatment and rehabilitation for patients with schizophrenia. However, social stigmata of psychiatric disorder in our society have kept away schizophrenic patients from their recovery and adaptation. Many persons have thought that psychiatric patients are more violent and criminal because of overwhelming prejudice on untreated or mistreated patients with schizophrenia. The purpose of this review is to propose the new and updated fundamentals of our knowledge on the relationship between schizophrenia and violence. In 1980s, many researchers have a belief that rates of criminal behavior vary independently on the rates of mental disorders. The following scientific studies on various population and meta-analyses of relevant data, overall violence rate have been higher in patients with schizophrenia and other psychotic disorders than in healthy controls. Even though schizophrenia and other psychotic disorders are associated with increased risk of homicide, the association has been not attributed to the psychopathology limited to schizophrenia. Most of all, co-occurrence of substance abuse has played an important role in increasing the possibility of violent behavior. The severe violent offending has been inclined to occur during the early period of psychotic episode before beginning the psychiatric treatment. Thus, most of the violent offending of schizophrenia patient can be prevented by prompt therapeutic interventions and treatments.

Prevalence, incidence, and mortality of nontuberculous mycobacterial infection in Korea : a nationwide population-based study

박선철,강민진,강영애 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

Background: The epidemiologic characteristics of nontuberculous mycobacterial (NTM) disease remain largely unknown. This study evaluated the incidence, prevalence, and mortality of NTM infection in a large nationwide population-based cohort in Korea. Methods: We used data of the National Health Insurance Service database, which is an extensive health-related database including most Korean residents. Adults with a primary diagnosis of NTM, as determined by International Classification of Disease-Tenth Revision coding (A31), were identified between 2003 and 2016. The incidence, prevalence, and mortality of NTM infection were analyzed by sex and age. Results: A total of 46,194 individuals had a primary diagnosis of NTM infection. Their mean age was 55.8 years, and 61.1% were women. The overall age-adjusted incidence and prevalence of NTM infection were 6.2 (male 4.5, female 7.6) and 12.0 (male 8.8, female 14.8) per 100,000 population respectively; both tended to increase rapidly between 2003 and 2016. The incidence increased from 1.0 per 100,000 population in 2003 to 17.9 in 2016; the prevalence from 1.2 to 33.3. The incidence and prevalence also increased with age. The 1-year and 5-year mortality rate in population with NTM infection were 4.7% and 17.8% respectively. Conclusion: In Korea, the annual incidence and prevalence of NTM infection increased rapidly over the 14 years of the study period, and were higher in women and elderly. The 5-year mortality rate in population with NTM infection was 17.8%.

성경에 나타난 도 (道)

박선철,박용천 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.4

Objectives : It is interesting that the term "Tao" is seen in the Bible of Korean revised version, because Tao is the essential part of traditional Korean culture. Korean culture has 5000 years of history rooted in the humanitarian ideal that means devotion to the welfare of mankind. Such humanitarian ideal had accepted, digested and finally recreated many religions and ideas without conflict. Because understanding the patient's culture is important in the psychiatric practice, it is worthwhile to compare the Tao in the Bible and in the traditional culture. This will lead us to understand the Bible more accurately, and Un-derstanding the Bible can broaden our view toward the traditional Korean culture. Methods : The authors searched the term "Tao" in the Bible ofKorean Revised Version and compared it with the Biblia Hebrica Stuttgatensia, and Novum Testatum Graece to detect the original expressions of Tao. The meaning of Hebrew or Greek original expressions were compared with English expressions of The Holy Bible, the King James Version. Results : Tao was recorded 85 times in the Bible of Korean Revised Version. The majority of original expressions were "derek" (43 times) in Hebrew Old Testaments, and "hodos" (14 times) in Greek New Testament. The majority of English expressions corresponding to Tao were "way" or "ways" (59 times). "Derek" means the commandments of God. "Hodos" means the way ofJesus Christ. Conclusion : "Derek" and "hodos" commonly mean the righteousness and sanctification required to human with the berith (testament) of God. Tao in the Bible ofKorean Revised Version is similar to Tao in the traditional culture in the viewpoint of enlightenment. Korean psychotherapy can be elaborated further with the acceptance of Westem psychotherapy on the basis of deep understanding of Korean traditional culture, such as Tao.

Does Age at Onset of First Major Depressive Episode Indicate the Subtype of Major Depressive Disorder?: The Clinical Research Center for Depression Study

박선철,박용천,한상우,황태연,김재민,전태연,이민수,김정범,임현우 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.6

Purpose: The purpose of this study was to evaluate the effects of age at onset of the first major depressive episode on the clinical features of individuals with majordepressive disorder (MDD) in a large cohort of Korean depressed patients. Materials and Methods: We recruited 419 MDD patients of age over 18 years from the Clinical Research Center for Depression study in South Korea. At the start of the study, the onset age of the first major depressive episode was self-reportedby the subjects. The subjects were divided into four age-at-onset subgroups:childhood and adolescent onset (ages <18), early adult onset (ages 18‒44), middle adult onset (ages 45‒59), and late onset (ages 60+). Using analysisof covariance (ANCOVA) and ordinal logistic regression analysis with adjustingthe effect of age, the relationships between clinical features and age at onset of MDD were evaluated. Results: There was an apparent, but inconsistent correlationbetween clinical features and age at onset. Earlier onset MDD was significantlyassociated with higher proportion of female gender [adjusted odds ratio (AOR)=0.570, p=0.022], more previous suicide attempts (AOR=0.635, p=0.038), greater number of previous depressive episodes (F=3.475, p=0.016) and higher scores on the brief psychiatric rating scale (F=3.254, p=0.022), its negative symptomsubscale (F=6.082, p<0.0001), and the alcohol use disorder identification test (F=7.061, p<0.0001). Conclusion: Early age at onset may increase the likelihood of distinguishable MDD subtype, and age at onset of the first major depressive episode is a promising clinical indicator for the clinical presentation, course, and outcome of MDD.

근거중심 한국형 우울증 약물학적 치료지침, 개정판 (I) : 항우울제 치료의 초기선택

박선철,성승환,한규만,원은수,이화영,백종우,전홍진,이문수,심세훈,고영훈,이강준,한창수,함병주,최준호,이희영,황태연,오강섭,박용천,이민수,한상우 대한신경정신의학회 2013 신경정신의학 Vol.52 No.4

Objectives The aim of this study is to establish Korean pharmacological treatment guidelines for the initial choice of antidepressant for treatment of moderate or severe depression. Methods The process for establishment of guidelines involved determination of important key questions, selection of 12 international and domestic clinical practice guidelines for depression,drawing of recommendation drafts, and peer review. Results Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), norepinephrine-dopamine reuptake inhibitors (NDRI), and noradrenergic and specific serotonergic antidepressants (NaSSA) were strongly recommended as the first−line antidepressants for treatment of moderate or severe depression. SSRIs were weakly recommended for patients who had problems with tolerability. Consideration of not only efficacy but also provisional adverse effects, drug-drug interactions, history of treatment response, preference, acceptability, cost, comorbid illnesses, and other factors in the choice of first-line antidepressants was strongly recommended. The treatment recommendations for specific clinical features of depression were as follows. SSRIs were weakly recommended for atypical depression. Augmented use of antipsychotics to antidepressants was strongly recommended for psychotic depression. Bupropion and SSRIs were weakly recommended for seasonal depression. Conclusion The results of this study may contribute toward improving the quality of depression treatment by providing clear and definite recommendations for the initial choice of antidepressant for treatment of moderate or severe depression.

만성적인 신체질환이 있는 노인 환자의 우울증 조기발견을 위한 병원기반 모델

박선철,이화영,이동우,한상우,박상호,김여주,최재성,정성원,이소영,나경세,권영준,Park, Seon-Cheol,Lee, Hwa-Young,Lee, Dong-Woo,Han, Sang-Woo,Park, Sang-Ho,Kim, Yeo-Joo,Choi, Jae Sung,Jung, Sung Won,Lee, Soyoung Irene,Na, Kyoung-Sae,Kwon, 대한생물정신의학회 2013 생물정신의학 Vol.20 No.2

The geriatric patients with chronic physical diseases are frequently associated with the continuous clusters of depression including nonpathological sadness, subsyndromal depression, minor depressive disorder, and major depressive disorder. Because of the complex and reciprocal relationships among depression, elderly, and chronic physical diseases, screening approaches with specific nosological methods should be needed in the realm of early detection of depression. Cognitive decline is frequently manifested in geriatric depression with medical or neurological diseases. Also, somatic symptoms of depression or emotional symptoms of physical diseases can play a role as a hampering factor in the early detection of depression. Furthermore, after-care has been regarded as an essential factor of depression screening in the geriatric patients with chronic physical diseases. We reviewed the most popular examples of integrated medicine for depression in primary care. Thus, we propose a general hospital-based model for early detection of depression which includes favorable response loop between screening and therapeutic intervention. Our model can be a basis for evidence-based detection and after-care for depression in the geriatric patients with chronic medical diseases.

2012년 제11회 KSPEN 학술대회 : P-1 ; 중환자실에서 영양지원팀과 조기 경장영양 프로토콜 적용을 통한 경장영양 공급의 개선

박선철,이호선,고신옥,이상국,김송이,정경수,김은영,정지예,강영애,박무석,김세규,장준,김영삼 한국정맥경장영양학회 2012 한국정맥경장영양학회 학술대회집 Vol.2012 No.-

배경 및 목적: 중환자실에서 조기에 경장영양을 시작하는 것은 환자의 임상 경과를 개선하는 것으로 알려져 있다. 본 연구에서는 중환자실에서 영양지원팀의 지원과 조기 경장영양 프로토콜의 적용을 통해 경장영양 공급량을 개선할 수 있는 지에 대해 알아보고자 한다. 대상 및 방법: 2010년 6월부터 2012년 3월까지 세브란스병원 중환자실에 입실한 환자를 후향적으로 분석하였다. 2010년 6월부터 2011년 8월까지 중환자실 입실 후 영양지원팀의 지원 및 조기 경장영양 프로토콜을 적용하지 않은 환자와, 2012년 1월부터 2012년 3월까지 중환자실 입실 후 영양지원팀과 프로토콜을 적용한 환자를 분석하였다. 두 환자군에 대해서 입실 후 10일 동안 경장영양 공급과 영양 상태의 변화 및 임상 결과를 비교하였다. 결과: 총 환자는 93명으로 영양지원팀의 지원과 조기 경장영양 프로토콜을 적용하지 않은 환자 46명과 적용한 환자 47명이었다. 중환자실 입실 후 경장영양을 시작하는 데까지 걸린 기간은 프로토콜을 적용한 군에서 적용하지 않은 군에 비해 유의하게 짧았다(25.4±14.1시간 vs 41.0±38.1시간, p=0.010). 경장영양으로 투여한 열량이 목표 열량에 도달하는 데까지 걸린 기간도 프로토콜을 적용한 군에서 그렇지 않은 군에 비해 유의하게 짧은 결과를 보였다(6.0±2.0일 vs 7.1±1.7일, p=0.019). 영양 상태의 변화와 임상 결과에서는 두 군간 차이를 보이지 않았다. 결론: 중환자실에서 영양지원팀의 지원과 조기 경장영양 프로토콜의 적용을 통해, 경장영양을 시작하는 데까지 걸린 시간과 경장영양을 통해 목표 열량에 도달하는 데까지 걸린 시간을 단축할 수 있다.