주의력결핍 과잉행동장애 아동에서 Methylphenidate 투여 전후 [123I]IPT SPECT로 측정한 기저 신경절 Dopamine Transporter Density

천근아,유영훈,남궁기,김찬형,이종두 대한신경정신의학회 2003 신경정신의학 Vol.42 No.1

Objectives:ADHD has been known as psychiatric disorder in childhood associated with dopamine dysregulation. The symptoms of ADHD can be treated with methylphenidate, a potent blocker of the dopamine transporter (DAT). In present study, we investigated DAT density using I-123N-(3-iodopropen-2-yl)-2β-carbomethoxy-3beta-(4-chlorophenyl) tropane ([123I]IPT SPECT) in children with ADHD before and after treatment with methylphenidate. Methods:Seven drug-naive children with ADHD and eight normal children were included in the study and performed SPECT 2 hours after an intravenous administration of [123I]IPT. All children with ADHD reperformed [123I]IPT SPECT after treatment with methylphenidate (0.7 mg/kg/d) during about 8 weeks. SPECT data reconstructed for the assessment of specific/ nonspecific DAT binding ratio of the basal ganglia were compared between before and after treatment methylphenidate. We investigated correlation between the change of ADHD symptom severity assessed with ADHD rating scale-IV and specific/ nonspecific DAT binding ratio of basal ganglia. Results:Children with ADHD had a significantly greater increase of specific/nonspecific DAT binding ratio of right basal ganglia than normal children (Right:z=2.085, p=0.037;Left:z=1.506, p=0.132). Under treatment with methylphenidate in all children with ADHD, specific/nonspecific DAT binding ratio of both basal ganglia decreased significantly greater than before treatment with methylphenidate (Right:t=3.239, p=0.018;Left:t=3.133, p=0.020). However, no significant correlation between the change of ADHD symptom severity scores and specific/nonspecific DAT binding ratio of the basal ganglia were found. Conclusions:The data of this study using methylphenidate in children with ADHD support the complex dysregulation of the dopaminergic neurotransmitter system in children with ADHD

비만 아동의 정서 및 성격적 요소와 체중 감량 동기간의 연관성

천근아,배성철,이동환,남궁기 대한신경정신의학회 2003 신경정신의학 Vol.42 No.5

Objectives:The aim of the present study was to evaluate the relationship between the psychosocial variables such as emotional, character and motivation factors for weight loss in children with obesity. Methods:Thirty seven children between the ages of 7 and 12 who had entered the summer camp pngram for childhood obesity and their parents participated in this study. The questionnaire for eating habit and life style of the child, the Child Behavioral Checklist (CBCL), and the Child Character Inventory (CCI) were completed by parents. The children with obesity completed the Child Depression Inventory (CDI) and the Parental Bonding Instrument (PBI). We evaluated their motivation to lose weight with the Weight Loss Readiness Test (WLRT). Then, we analyzed correlation between the psychological variables and the items of the WLRT. Results:The‘emotional instability’ in the CBCL was correlated significantly with the item of‘emotional eating’ of the WLRT (r=0.336, p=0.042), and the‘vharm avoidance’ of the CCI was negatively correlated significantly with the item of‘exercise patterns and attitudes’ of the WLRT (r=-0.047, p=0.014). However, no significant correlation was found between each of the severity scores of the depressive symptoms assessed with the CDI and the other psychological variables, and each of the six items of the WLRT. Conclusion:Our findings suggest that the emotional instability and the‘harm avoidance’ of the CCI of the children are related to the motivation for weight loss in childhood obesity

주의력결핍 과잉행동장애에서 도파민 운반체 유전자의 10-Repeat Allele Homozygosity와 [123I]IPT SPECT로 측정한 도파민 운반체 밀도가 Methylphenidate 치료 반응에 미치는 영향

천근아,유영훈,김재원 대한신경정신의학회 2004 신경정신의학 Vol.43 No.2

Objectives:The symptoms of attention-deficit/hyperactivity disorder (ADHD) can be treated with methylphenidate, a potent blocker of the dopamine transporter (DAT). The homozygosity of the 10-repeat allele at dopamine transporter gene (DAT1) seems to be associated with a poor response to methylphenidate (MPH) in children with ADHD. In present study, we investigated association between DAT density using I-123N-(3-iodopropen-2-yl)-2β-carbomethoxy-3beta-(4-chlorophenyl)tropane ([123I]IPT SPECT) and the homozygosity for 10-repeat allele at DAT1, and response to MPH in children with ADHD. Methods:Eleven drug-naive children with ADHD were included in the study and treated with MPH for about 8 weeks. After the genotyping and SPECT were performed, we compared DAT density between ADHD children with and without the homozygosity for the 10-repeat allele at DAT1 and investigated correlation between the homozygosity for the 10-repeat allele and response to MPH. Results:ADHD children with 10/10 genotype (n=7) had a significantly higher DAT density in basal ganglia than the children without 10/10 genotype (n=4)(Right:z=-2.65, p=0.008;Left:z=-2.65, p=0.008). We found that while only 28.6% (2/7) of the subject with 10/10 genotype showed good response (≥50% improvement) to MPH treatment, 100% (4/4) of the subjects without 10/10 genotype showed good response to MPH treatment (χ2 test:F=5.238, df=1, p=0.022). Conclusion:Our findings support an association between homozygosity for the 10-repeat allele at DAT1 and the DAT density assessed in vivo and correlation between the homozygosity for the 10-repeat allele and poor response to MPH.

Drug-Native Tourette 장애 아동에서 [123I] IPT SPECT로 측정한 기저 신경절 Dopamine Transporter Density 양상

천근아,유영훈 대한신경정신의학회 2002 신경정신의학 Vol.41 No.4

연구목적: 뚜렛 장애가 기저 신경절 presynaptic dopamine 신경계의 기능 이상으로 인한 dopamine 과잉분 포와 연관이 있다는 증거는 많다. 본 연구는 Dopamine transporter density가 dopamine 신경 말단 의 dopamine의 농도와 비례한다는 전제하에 Dopamine transporter density 영상을 보는 I-123- IPT brain SPECT를 이용하여, 약물 비노출(drug-naive) 뚜렛 장애 아동에서 기저 신경절 Dop􀀐 amine transporter density 양상을 알아보고자 하였다. 또한 뚜렛 장애의 틱증상 심각도와 Dopamine transporter density와의 연관성을 알아보고자 하였다. 방 법: 연구대상은 8명의 뚜렛 장애 아동(mean age=9.75±1.98세)과 6명의 정상 대조군(mean age=10.33 ±2.88세)이었다. 8명의 뚜렛 장애 아동 모두 이전에 틱증상 억제 약물을 투여받은 적이 없는 약물- 비노출 상태였다. 뚜렛 장애군과 정상 대조군 모두를 대상으로 I-123 IPT를 정맥주사 후 2시간 후 에 SPECT를 촬영하였으며 그 영상을 분석하여 좌, 우측의 기저 신경절의 특이결합/비특이결합 비율 을 구한 후, 각 군간의 차이를 정량적으로 분석하였다. 뚜렛 장애 아동의 틱증상과 Dopamine tra􀀐 nsporter density와의 연관성을 알아보기 위하여 YGTSS로 측정한 틱증상 총점과 좌, 우측 기저 신 경절 특이결합/비특이결합 비율의 상관관계를 알아보았다. 결 과: 약물 비노출(drug-naive) 뚜렛 장애 아동(n=8)과 정상 아동(n=6)의 좌, 우측의 기저신경절의 특이 결합/비특이결합 비율을 비교해 본 결과 우측 기저 신경절의 특이결합/비특이결합 비율에서는 유의한 차이가 없었다. 그러나 좌측 기저 신경절의 특이결합/비특이결합 비율에서는 약물 비투여 뚜렛 장애 아동군이 정상 아동군보다 유의하게 높은 것으로 나타났다(z=-2.453, p=0.013). 뚜렛 장애 아동의 틱증상 심각도와 좌, 우측 기저 신경절 특이결합/비특이결합 비율과의 상관관계에서는 유의한 연관성 을 보이지 않았다. 결 론: 뚜렛 장애 아동군이 정상 아동군에 비하여 좌측 기저 신경절의 Dopamine transporter density가 유의하게 증가되어 있는 것을 알 수 있었다. 이러한 결과는 뚜렛 장애의 병태생리와 연관된 기저 신 경절 presynaptic dopamine 기능 이상으로 인한 dopamine 과잉 분포에 대한 가설을 지지한다고 볼 수 있다

양극성 장애의 소아 청소년기 및 조기 진단은 환자에게 어떤 도움을 주는가?

천근아 대한우울조울병학회 2006 우울조울병 Vol.4 No.2

비만 환자 증례를 통한 Workshop : 증례 2: 뚱보라고 놀림에 시달리는 어린이 ; 소아 비만의 행동요법

천근아 대한비만학회 2002 The Korean journal of obesity Vol.11 No.1S

청소년 비만의 정신과적 합병증과 행동수정요법

천근아 대한비만학회 2004 대한비만학회 학술대회 Vol.- No.-

소아 비만의 행동요법

천근아 대한비만학회 2002 The Korean journal of obesity Vol.11 No.부록 1

알코올 사용장애 환자의 자녀들에 대한 정신의학적 접근

천근아 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.6

This article reviewed the literature covering the last 30 years on the psychopathology, variable risk factors and protective factors associated with children of alcoholics (COAs). COAs can present with externalizing problems, such as attention deficit hyperactivity (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD), and internalizing problems, such as depression and anxiety. COAs also can show with difficulties in intelligence, learning, language, and temperament. All COAs, however, are not associated with psychopathology and cognitive problems and future alcohol and substance related disorder. Although investigators agree that COAs are at higher risk for developing psychiatric illness and alcohol use disorders than children of non-alcoholics, problems with alcohol and psychopathology are not an inevitable consequence of COAs status. Recent research has identified numerous biological, psychological, and social factors associated with a family history of alcoholism thatmay play a role in determining COAs' outcome. The risk factors and protective factors associated with COAs have been used as a foundation for preventive and treatment intervention. Researcher and clinician should understand how COAs cope to parental alcoholism, Program for COAs should include the basic components of information, problem- and emotion-focused coping skills, and social and emotional support. School setting are most common intervention sites, but family and broad-based community programs also have shown promisein COAs prevention. More rigorous studies are needed to understand better the complex ways children with parental alcoholism.

뇌전증 동반 발달성질환

천근아 대한소아청소년정신의학회 2012 대한소아청소년정신의학회 학술대회논문집 Vol.2012 No.5