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정동청(Dong Chung Jung),강웅구(Ung Gu Kang),김용식(Yong Sik Kim) 대한노인정신의학회 2013 노인정신의학 Vol.17 No.2
Due to the low response rate of antidepressant treatment in late-life depression, brain stimulation techniques should be considered when treating elderly patients. Electroconvulsive therapy (ECT) is one of the most frequently used brain stimulation techniques, and shows favorable outcome and acceptable tolerability in the treatment of late-life depression. Hemodynamic change and cognitive impairment are common side effects of ECT, which are transient in most cases. Since cognitive impairment can lead to treatment non-compliance, it should be minimized by controlling electrode position, pulse-width, treatment frequency, etc. Because ECT is followed by rapid cardiovascular change, risk factors should be evaluated and managed properly. Transcranial magnetic stimulation (TMS) and magnetic seizure therapy (MST) are also shown to be effective in treating depression, with less cognitive impairment. However, further research is needed to establish their efficacy in late-life depression.
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조현병 환자에서 Paliperidone Extended Release의 효능, 안전성 및 내약성 : 48주 개방형, 전향적 연구의 24주 중간 분석
최유라,정동청,김은영,김세현,이현정,이남영,장성만,심주철,주은정,김재진,이상혁,정영철,김용식,안용민,Choi, You Ra,Jung, Dong Chung,Kim, Eun Young,Kim, Se Hyun,Lee, Hyun Jeong,Lee, Nam Young,Chang, Sung Man,Shim, Joo Cheol,Joo, Eun Jeong,Kim, Jae 대한생물정신의학회 2013 생물정신의학 Vol.20 No.1
Objectives We investigated the tolerability, safety, and treatment response to flexible-dose paliperidone ER in patients with non-acute schizophrenia in whom previous antipsychotic drugs were ineffective. Methods This 24-week interim analysis of the 48-week multicenter, prospective, open-label study assessed effectiveness using the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Schizophrenia-Severity (CGI-SCH-S) Scale, Personal and Social Performance (PSP) and Drug Attitude Inventory (DAI). Safety and tolerability were assessed using the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS) and Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS). Results Effectiveness was assessed in 169 patients. Significant improvement in the PANSS total score was observed by week-1 and continued until week-24. The response rate was 33%. The CGI-SCH-S and PSP total scores significantly improved during 24 weeks ; however, no change occurred in the total DAI. Fifty-nine percent of patients reported adverse events, of which extrapyramidal symptoms were the most frequent (19.0%). The DIEPSS and LUNSERS scores were improved after 24 week. Conclusions Switching to the flexible-dose paliperidone ER from an ineffective antipsychotic drug was safe, tolerable, and showed a good treatment response in Korean patients with schizophrenia.
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Olanzapine으로 항정신병약물을 교체한 정신분열병 환자에서 주관적 성기능 변화에 영향을 미치는 요인
이현정,윤혜리,HWANGSAMUEL SUK H,김세현,정동청,이남영,김용식,안용민 대한정신약물학회 2011 대한정신약물학회지 Vol.22 No.2
Objective Sexual dysfunction is highly prevalent in both untreated and treated patients with schizophrenia. Sexual dysfunction is a major cause of poor quality of life, negative attitude to therapy and treatment non-compliance. We thereby conducted this study to better understand the predictors of subjective sexual dysfunction. Methods The subjects consisted of 83 patients (46 men; 37 women) who participated in an open label study on switching antipsychotics to olanzapine. All subjects met the Tenth Revision of International Classification of Diseases diagnostic criteria for schizophrenia. To better understand the predictors of subjective sexual dysfunction, we used the Liverpool University Neuroleptic Side-effect Rating scale (LUNSERS), a comprehensive self-rating instrument for assessing and quantifying the subjective adverse events during antipsychotic treatment. All patients were taking antipsychotics at the initiation of the study and were assessed using LUNSERS, the Simpson-Angus Scale (SAS), the Barnes Akathisia Rating scale (BARS), Abnormal Involuntary Movement Scale (AIMS), Clinical Global Impression (CGI), and the Positive and Negative Syndrome Scale (PA-NSS). They were also checked for their serum prolactin levels and vital signs before and after a 6-week treatment with olanzapine. In order to identify the cross-sectional and longitudinal predictors of LUNSERS hormonal side effect, we carried out multiple regression analyses. Results Prolactin levels, LUNSERS hormonal side effect, CGI, PANSS, SAS, AIMS, and BARS decreased after a 6-week treatment with olanzapine. At initial evaluation, cross-sectional predictors of LUNSERS hormonal side effect were red herring and allergic reaction subscale, but after the 6-week treatment with olanzapine, none of the variables were found to significantly predict LUNSERS hormonal side effect. Longitudinal predictors of LUNSERS hormonal side effect were LUNSERS extrapyramidal system side effect and prolactin levels. Conclusion These findings suggested relationships among prolactin, extrapyramidal symptom, motor function and sexual dysfunction. After switching to olanzapine, sexual function of the patients improved subjectively. More studies are warranted as these results have significant implications for quality of life and treatment adherence. 본 연구는 기존의 항정신병약물을 olanzapine으로 변경하여 복용한 정신분열병 환자들을 대상으로 나이, 몸무게, 병력들을 조사하고, 프로락틴 혈중 농도, LUNSERS, CGI, PA-NSS, AIMS, SAS, BARS를 시행하여 주관적인 성기능 장애에 대한 예측인자를 알아보고자 하였다. 6주간의 연구 기간 동안 주관적인 성기능 장애는 호전된 것으로 평가되었으며, 추체외로 증상의 호전 정도가 이에 대한 종적인 예측인자임을 알 수 있었다. 또한 프로락틴의 표준변화량(프로락틴의 혈중 농도 변화량/기저치의 프로락틴 혈중 농도)도 종적인 예측인자임을 알 수 있었다. 그러나, 다른 히스타민 수용체 차단, 콜린성 수용체의 차단, 아드레날린 수용체의 차단과 성기능 장애와는 뚜렷한 연관성을 보이지 않았다. 성기능 장애는 환자의 삶의 질과 치료 결과에 영향을 끼치는 인자로서 더욱 이러한 부작용에 대한 관심과 평가가 필요할 것으로 생각된다.
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