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경두개 자기 자극(Transcranial Magnetic Stimulation)의 신경정신과적 응용
채정호,전태연 대한신경정신의학회 2001 신경정신의학 Vol.40 No.1
연구목적: 두부 표면에서 유도시킨 국소 자기장 파동을 이용하여 두뇌 피질을 자극할 수 있도록 하는 새로운 비침습적 시술 방법인 경두개 자기 자극(Transcranial Magnetic Stimulation: 이하 TMS)은 중추 및 말초 신경계의 전도도, 시가 정보 처리, 언어, 기억, 감정 및 운동 등 다양한 두뇌 기능을 국재화하는 데에 널리 사용되고 있으며 특히 두뇌 피질을 국소적으로 자극할 수 있다는 특징으로 인해 여러 신경정신과적 질환의 새로운 치료 방법으로도 이용될 수 있다는 가능성이 대두되고 있다. 본 논문은 TMS의 발달과정, 기전 및 신경정신과적 응용에 대한 광범위한 문헌 검색과 정리를 통하여 그 현황과 미래를 개괄하려는 목적으로 작성되었다. 방법: 현재까지 출간된 영어로 작성된 논문을 검색하여 정리하였으며 TMS를 실제 시행한 경험이 풍부한 전문가들과 논의를 하였다 결과: TMS는 신경정신과적 질환의 행동적 신경심리를 이해하고 두뇌의 병태생리적 회로를 조사하는데에 중요한 도구가 될 것이며 우울증을 비롯한 신경정신과적 질환의 새로운 치료방법이 될 수 있는 가능성이충분하다. 결론: 두되-행동간의 관계를 연구하는 데에 TMS가 매우 유용할 것이며 TMS의 효능과 안정성을 확고하게하는 다양한 향후 연구가 지속적으로 필요할 것이다. Objectives : Transcranial magnetic stimulation(TMS) is a new, noninvasive procedure of a localized pulsed magnetic field to the surface of the head to cause a depolarization of neurons in the brain cortex underneath. The magnetic field(Magnetic) is generated by passing current pulses by conducting coil, held close to the scalp so that the field is passing the skull (Transcranial) and is focused in the cortex(Stimulation). Here we provide a summarized review of the methodology of TMS and its application to research and therapeutics in the field of neuropsychiatry. Methods : We described the history, procedures, basic researches, clinical applications, safety issues, mode of action, and future of TMS using literature review and interview with experts. Results : The earlier clinical uses of TMS had been restricted to the field of neurology where it was used to examine the central and peripheral nervous conduction. However this technology has been widely used to map various brain functions such as visual information processing, language, memory, emotion, and movement. The ability to excite local areas of brain cortex has raised the possibility of the use of TMS as a novel therapeutic tool for various psychiatric disorders. Conclusion : TMS is a relatively new and noninvasive method to investigate regional brain activity and to treat several psychiatric diseases. Further work is necessary to firmly establish the efficacy and safety of this promising tool.
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외상후 스트레스 장애의 지속노출치료 : 교통사고 피해자 증례 보고 1례
채정호,김하경 한국인지행동치료학회 2005 인지행동치료 Vol.5 No.1
외상후 스트레스 장애(posttraumatic stress disorder: 이하 PTSD)는 매우 흔한 질환이나 치료에 잘 반응하지 않고 만성화되는 경향이 높으며 다른 장애와 동반되는 경우가 많아 만성적으로 대인 관계와 사회적 기능에 장애를 초래하는 심각한 질환이다. 현존하는 PTSD 치료법 중 정신사회적 접근으로는 인지행동치료가 가장 효과적이라는 데 일치된 의견을 보이고 있으며, 1990년대에 외상에 초점을 맞추는 지속노출치료(prolonged exposure: 이하 PE)가 도입되어 여러 PTSD 집단에서 장단기적인 효과가 있음이 입증되고 있다. 본 증례의 경우 41세의 교통사고 피해자로 수 년 이상 충분한 기간의 약물치료와 정신과적 가료에도 불구하고 임상 증상과 기능 장애가 지속되었으나 12회기의 PE 시행에 따라 임상 증상은 물론 극심한 회피로 인해 초래되었던 일상생활의 장애들이 호전되는 등의 효과를 거두었다. 상당한 시간과 노력이 소요되는 PE를 국내 임상 현장에서 전반적으로 시행하기는 어려울 지라도 이에 대한 관심과 지속적인 시도가 필요할 것이다. Post-traumatic stress disorder (PTSD) is a highly prevalent disorder with impairment of functions in important areas of daily life and high rates of comorbidity. As many studies for pathophysiology of PTSD have been carried out, there is an increasing body of knowledge about various treatment strategies. Nevertheless, even after treatment the majority of patients continue to have substantial residual symptoms for long time. Several recent meta-analyses show that exposure therapy is a well established and one of the most effective psychological treatment for PTSD. Among them, recently introduced prolonged exposure therapy (PE) is thought to lead to permanent change in the pathologic trauma memory and hence to have durable gains through emotional processing. A 41-years-old married woman who was a victim of traffic accident and had severe PTSD symptoms over 3 years with appropriate pharmacotherapy and psychiatric management was enrolled for PE. With 12 session focusing imaginal exposure and in vivo exposure, which deals reprocessing her distorted and dysfunctional cognition, her PTSD symptoms were greatly improved and her daily function was markedly improved. Further application and wide use of PE in PTSD may have beneficial effect in managing this chronic condition to be difficult to treat.
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채정호,Chae Jeong-Ho 대한불안의학회 2005 대한불안의학회지 Vol.1 No.1
Several contributing factors have been proposed for expression of excessive anxiety. Behavioral inhibition, activation of amygdala, and genetic vulnerability interchangeably affect each other. Only few studies have addressed the differences and similarities in anxiety between animal and human. The consensus is that individual vulnerability is a main factor for the expression of anxiety, although the interaction of environmental stressors and biological characteristics is involved in the presentation of anxiety. Further work is required to investigate how the interaction between stress and diathesis can affect responsiveness of stress and anxiety in animal and human. Here, the author reviews the findings regarding differences and similarities in both animal and human studies. Knowing the reciprocal relationship between the environment (stressors) and individual vulnerability or resilience, the proper understanding of anxiety and anxiety disorders would be possible.
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비정형 항정신병 약물 치료 이후 발생한 비만과 당뇨가 Amisulpride 투여 후 호전된 환자 1예
채정호,정영은,김원,박원명,전태연,김광수 대한정신약물학회 2004 대한정신약물학회지 Vol.15 No.2
Newer atypical antipsychotics have many benefits compared with conventional antipsychotics. However it has been known that atypical antipsychotics are associated with drug-induced weight gain and dibetes mellitus. Obesity and diabetes mellitus may be problematic side effects to patients with schizophrenia because they can cause many medical problems and also drug compliance which is important to prognosis can be reduced by those adverse effects. We present here a male patient, aged 26 year-old, who was treated with risperidone, olanzapine, quetiapine subsequently and gained weight by 32 kilograms (almost 50% increase) during four year-long treatment and diagnosed as having diabetes mellitus. We switched the antipsychotics to amisulpride at the day of admission and increased the dosage to 800mg. At discharge after 34 days after admission, His psychotic symptoms were considerably improved and blood glucose level at fasting time was stabilized within acceptable range. And he also lost weight by 5 kilograms after admission. Amisulpride would be a relatively appropriate choice of drug in patient with atypical antipsychotics induced weight gain and/or diabetes mellitus.
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