경두개 자기자극술의 실제

최지욱(Jee Wook Choi),정범석(Bum Seok Jeong) 대한생물치료정신의학회 2005 생물치료정신의학 Vol.11 No.1

Practical efficacy of transcranial magnetic stimulation (TMS) except in the treatment of major depressive disorder is unclear although the knowledge is growing. Hear we provide a review of the therapeutic evaluation and application of TMS in psychiatric clinical field. Many articles suggested the possibility of the use of TMS as a single or add-on therapeutic tool in both major depressive disorder and posttraumatic stress disorder. TMS will be used as a tool of the measurement of therapeutic effect of drug. Double blinded, randomized, placebo-controlled studies are needed to use TMS as an objective measurement tool or add-on therapeutic tool in psychiatric fields.

정신분열병의 최신 뇌영상 연구

정범석,최지욱,Jeong, Bum-Seok,Choi, Jee-Wook 대한생물정신의학회 2011 생물정신의학 Vol.18 No.2

Neuroimaging studies in schizophrenia have remarkably increased and provided some clues to understand its pathophysiology. Here, we reviewed the neuroimaging, studies including volume analysis, functional magnetic resonance imaging (MRI) and diffusion tensor imaging, and findings in both early stage schizophrenia and high-risk group. The reviewed studies suggested that the brain with schizophrenia showed both regional deficits and dysconnectivity of neural circuit in the first episode, even high-risk group as well as chronic schizophrenia. Multimodal neuroimaging or combined approach with genetic, electro-or magneto-encephalographic data could provide promising results to understand schizophrenia in the near future.

MMPI 분석도구로서 인공신경망 분석과 로지스틱 회귀분석의 비교

이재원,정범석,김미숙,최지욱,안병은,Lee, Jaewon,Jeong, Bum Seok,Kim, Mi Sug,Choi, Jee Wook,Ahn, Byung Un 대한생물정신의학회 2005 생물정신의학 Vol.12 No.2

Objectives:The purpose of this study is to 1) conduct a discrimination analysis of schizophrenia and bipolar affective disorder using MMPI profile through artificial neural network analysis and logistic regression analysis, 2) to make a comparison between advantages and disadvantages of the two methods, and 3) to demonstrate the usefulness of artificial neural network analysis of psychiatric data. Procedure:The MMPI profiles for 181 schizophrenia and bipolar affective disorder patients were selected. Of these profiles, 50 were randomly placed in the learning group and the remaining 131 were placed in the validation group. The artificial neural network was trained using the profiles of the learning group and the 131 profiles of the validation group were analyzed. A logistic regression analysis was then conducted in a similar manner. The results of the two analyses were compared and contrasted using sensitivity, specificity, ROC curves, and kappa index. Results:Logistic regression analysis and artificial neural network analysis both exhibited satisfactory discriminating ability at Kappa index of greater than 0.4. The comparison of the two methods revealed artificial neural network analysis is superior to logistic regression analysis in its discriminating capacity, displaying higher values of Kappa index, specificity, and AUC(Area Under the Curve) of ROC curve than those of logistic regression analysis. Conclusion:Artificial neural network analysis is a new tool whose frequency of use has been increasing for its superiority in nonlinear applications. However, it does possess insufficiencies such as difficulties in understanding the relationship between dependent and independent variables. Nevertheless, when used in conjunction with other analysis tools which supplement it, such as the logistic regression analysis, it may serve as a powerful tool for psychiatric data analysis.

인공신경망을 이용한 알코올 의존 선별 검사의 유용성

이 재 원(Jae-Won Lee),최지욱(Jee-Wook Choi) 한국중독정신의학회 2005 중독정신의학 Vol.9 No.2

Objectives:Alcohol screening test using direct questionnaire had the risk of high false negative. The aim of this study is the development of a reliable and feasible alcohol dependence screening test using Multiphasic Minnesota Personality Inventory (MMPI) and artificial neural network analysis (NN). Methods:The subjects, 191 inpatients with alcohol dependence and 148 normal controls, were randomly assigned into learning group and testing group. Both neural network and logistic regression formula for screening alcohol dependence were acquired using both the conventional MMPI 13 scales and MMPI 73 scales including additional 60 scales in learning group (56 alcoholics and 44 normal controls). The MMPI scales of remained testing group, 140 alcoholics and 104 normal controls, were tested with two LR formula (13 and 73 MMPI scales) and two learned NN (13 and 73 MMPI scales) whether each subject is alcohol dependence or not. The sensitivity and specificity, and area under the curve of 4 analysis methods, LR or NN using 13 or 73 MMPI scales were calculated and compared. Results:When using conventional MMPI 13 scales, the sensitivity, specificity, and area under the curve (AUC) of LR and NN were 71.1% vs. 57.8-75.6%, 62.5% vs. 48.1-60.6%, 0.668± 0.036 vs. 0.577±0.037-0.716±0.034, respectively. But, in the case of using 73 MMPI scales including 13 conventional scales, the sensitivity, specificity, and area under the curve (AUC) of LR and NN were 79.3% vs. 83.0-93.3%, 67.3% vs. 67.5-81.7%, 0.733±0.034 vs. 0.765±0.033-0.855±0.027, respectively. Conclusion:When using 73 MMPI scales, the sensitivity and specificity of NN were higher than that of NN using 13 scales or LR using 13 or 73 scales. The test using NN using 73MMPI scales is a useful alcohol dependence screening tool. It is suggested that the application of NN in screening another substance use disorder or game addiction might be useful.

정신분열병환자에 있어서 식후에 관찰되는 비정형 항정신병약물과 관련된 음식 갈망 회로 : 기능적 자기공명영상 연구

정범석(Bum Seok Jeong),이창화(Chang Hwa Lee),홍성균(Sung Kyoon Hong),최지욱(Jee Wook Choi),김지웅(Ji-Woong Kim),이선우(Sun Woo Lee) 대한생물치료정신의학회 2006 생물치료정신의학 Vol.12 No.2

목적 : 음식을 충분히 섭취한 정신분열병 환자에서 비정형 항정신병 약물 관련 음식 갈망 뇌 구조물 탐색. 방법 : 배고픔을 배제한 음식에 대한 갈망만의 뇌회로를 탐색하기 위해 음식을 충분히 섭취한 상태에서 음식물과 무생물 사진을 비정형 항정신병 약물을 복용 중인 정신분열병 집단 및 정상 대조 집단에게 수동적으로 보여주면서 기능적 뇌영상을 촬영하였다. 자극 파라다임은 24초짜리 세 블록으로 구성된 음식물 혹은 무생물 사진들로 구성된 블록 디자인을 사용하였다. 집단 별음식 갈망 관련 뇌 회로, 두 집단 간 음식 갈망 관련 뇌 활성도 차이, 뇌 활성도와 임상 변인과의 상관관계를 SPM2를 이용하여 분석하였다. 결과 : 식후에 촬영한 기능적 자기공명 영상 연구 결과 정신분열병 집단이 비정형 항정신병 약물을 복용함에도 불구하고 음식물 자극 및 음식 갈망 관련 회로의 활성도가 상대적으로 저조하였다. 시상 및 시상 하부의 활성도는 현재 약물의 복용 기간과 유의미한 역상관관계를 보였다. 결론 : 체중 혹은 음식 갈망을 증가시킨다고 알려진 비정형 항정신병 약물을 복용하더라도 음식을 충분히 섭취할 경우 음식 갈망 관련 뇌 활성도가 정상 대조 집단에 비해 증가하지 않으며, 항정신병 약물 관련 체중 증가 혹은 입맛 당김 현상이 지속적으로 약물을 복용에 따라 감소하게 되는 현상이 시상하부의 활성의 점차적 감소와 관련 있음을 시사한다. Objectives:To explore the neural correlates of antipsychotics related food craving in schizophrenic patients Methods:A T2<SUP>*</SUP>-weighted echoplanar imaging sequences obtained were used to collect 120 BOLD images during the passive seeing of food paradigm after meal. The food paradigm was consisted of three blocks of food pictures and three blocks of pictures of natural thing in both ten healthy volunteers and schizophrenic patients having second generation antipsychotics. The imaging data were investigated to find differences in the food cue and craving related network between healthy volunteers and schizophrenic patients after meal. The relationship between food cue or craving related neural activity and clinical variable was explored. Activation maps were acquired by means of the random effect model using SPM2. Results:Less extensive food cue and craving related regions were activated in schizophrenic patients having second generation antipsychotics after meal. Neural activities of both hypothalamus and thalamus were correlated with the prescribed duration of current antipsychotics. Conclusions:This study demonstrated that schizophrenic patients' brain is less respond to food cue after meal even though they are having second generation antipsychotics. The decrease of hypothalamic activity could explain the plateau phenomenon or decrease of both food craving and body weight according to persistent second generation antipsychotic medication.

정신분열병의 선택적 주의력 저하의 보상 기전

최지욱,정범석,김지웅,김성윤,권준수,전덕인,김창윤 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.6

Objectives : This study investigated the compensatory neural correlate of selective attention deficit in schizophrenics Show-ing near-normal performance. Methods : A 'modified Stroop' was developed that can be used measure the response time during functional imaging. An event-related functional magnetic resonance imaging study was carried out in 10 clinically stabilized schizophrenics and 10 healthy controls during the performance of a 'modified Stroop'. In the 'modified Stroop', the subjects were required to respond with a two-button mouse to whether or not the color of a subsequent word corresponded to one of T-shirt. The significantly activated brain regions were investigated in a voxel-wise Mest of the Stroop load. Results : Schizophrenics, compared with healthy controls, showed poorer response time, but had similar accuracy. Compen-satory activation in the right inferior frontal gyms (IFG) was observed in schizophrenics. The left paracingulate sulcus was less activated in the schizophrenics than in the healthy controls. Conclusion : These results suggest that, in schizophrenics showing a normal accuracy during the Stroop, selective attention deficits might be related to the left paracingulate sulcus as well as the anterior cingulate. In addition, their deficits may be compensated with the right IFG.

첫 입원치료 받은 정신분열병 환자들의 삶의 질 추적 연구

한오수,이철,최지욱,홍진표,김창윤 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.6

울산의대 서울중앙병원 정신과에서 첫 입원 치료를 받고 퇴원하여 2년 혹은 5년이 경과한 정신분열병과 기타 정신병 108명 중 최종 73명(응답을 66%)을 대상으로 Heinrichs등이 고안한 삶의 질 척도(Quality of Life Scale)를 사용하여 현재의 삶의 질을 평가하여 다음과 같은 결과를 얻었다. 첫째, 삶의 질 측면 4가지 측면인 대인관계, 직업적 역할, 정신내적 요소, 및 일상적인 물건 및 행동 모두에서 삶의 질이 전반적으로 저하되어 있음을 관찰할 수 있었다. 대인 관계 영역 중 가족 구성원과의 인적 관계 항목은 다른 항목에 비해 상대적으로 만족도가 높았다. 둘째, 정신분열병군의 삶의 질은 기타 정신병군에 비해 대부분의 삶의 질 항목에서 유의하게 낮은 것으로 나타났다. 셋째, 2년 경과군과 5년 경과군 사이 삶의 질은 유의한 차이를 보이지 않았다. 발병 초기 삶의 질 저하가 상당기간 유지됨을 시사하였다. 넷째. 퇴원 후 삶의 질에 영향을 미치는 변인으로는 첫 입원 치료 기간이 유의한 역상관관계를 보였으며 또한 다변량 회귀 분석에 있어서도 같은 결과를 보였다. 이는 초기 치료에 대한 반응 정도가 부분적으로는 향후 삶의 질을 예측할 수 있음을 시사한다. 기타 첫 입원 당시의 연령, 교육 수준. 사회경제적 수준, 첫 입원하기까지의 이환 기간, 첫 입원 당시 Global Assessment of Functioning 입원 치료시 약물용량 등은 삶의 질과 유의한 상관관계를 보이지 않았다. Objectives : One object of this study is to provide a descriptive level of qua1ity of life(QOL) in a group of the first admired schizophrenic patients through interviews being performed after two or five yeah of fo11ow-up, and comparing them with patients in psychotic disorders other than schizophrenia. Another object is to identify clinical variables on the first admission which correlate to QOL factors, after two or five years of fo11ow up. Methods : A total of 73 subjects of the first admitted patients with schizophrenia(n=57) and psychotic disorders other than schizophrenia(other psychotic disorders group, n= 16) were selected. A Quality of Life Scale(QLS) measuring 21 items of life variables was used. Demographic and psychiatric data were obtained through medical records and psychiatric interviews. Results : Schizophrenia group(n=57) showed moderate decrease(mean 3.7 of 6) in all aspect of quality of life. However, the schizophrenia group displayed a relatively high score in relations with household members(mean=5.2) only among 21 QOL items. Comparison to other psychotic disorders group(n= 16), schizophrenia group showed a significant decrease in almost all aspects of QOL. No significant difference was obtained between the 2 year(n=27) and the 5year(n= 30) group. Duration of the first admission showed a significant correlation with current quality of life in the schizophrenic group. Conclusions : The significantly decreased score of quality of life suggests the need for careful observation and therapeutic concern for the early stage of schizophrenia. The schizophrenic group's relatively high score in relations with household members in this period may provide the importance of rehabilitation to improve their quality of life. Duration of the first admission may be a useful predictor of their subsequent quality of life.