Clinical impact of admission hyperglycemia on in-hospital mortality in acute myocardial infarction patients

Kim, Eun Jung,Jeong, Myung Ho,Kim, Ju Han,Ahn, Tae Hoon,Seung, Ki Bae,Oh, Dong Joo,Kim, Hyo-Soo,Gwon, Hyeon Cheol,Seong, In Whan,Hwang, Kyung Kuk,Chae, Shung Chull,Kim, Kwon-Bae,Kim, Young Jo,Cha, Kwa Elsevier 2017 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.236 No.-

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Acute hyperglycemia on admission is common in acute myocardial infarction (AMI) patients regardless of diabetic status, and is known as one of prognostic factors. However, the effect of hyperglycemia on non-diabetic patients is still on debate.</P> <P><B>Methods</B></P> <P>A total of 12,625 AMI patients (64.0±12.6years, 26.1% female) who were enrolled in Korea Acute Myocardial Infarction Registry-National Institute of Health between November 2011 and December 2015, were classified into 4367 diabetes (65.4±11.6years, 30.4% female) and 8228 non-diabetes (63.3±13years, 23.9% female). Patients were analyzed for in-hospital clinical outcome according to admission hyperglycemic status.</P> <P><B>Results</B></P> <P>In diabetic patients, independent predictors of in-hospital mortality were old age, high HbA<SUB>1</SUB>C, pre-Thrombolysis In Myocardial Infarction (TIMI) flow 0, left ventricle ejection fraction<40%, cardiogenic shock and ventricular tachycardia. In non-diabetic patients, independent predictors of in-hospital mortality were old age, high admission glucose (≥200mg/dL), pre TIMI flow 0, failed percutaneous coronary intervention, low left ventricle ejection fraction<40%, cardiogenic shock, stent thrombosis and decreased Hb≥5g/dL. In hospital mortality was significantly higher in diabetic patients compared to non-diabetic patients (5.0% vs. 3.4%, <I>p</I> <0.001). However, non-diabetic patients with hyperglycemia have significantly higher mortality compared to diabetic patients (17.4% vs. 7.2%, <I>p</I> <0.001). Comorbidity including cardiogenic shock (<I>p</I> <0.001), cerebral hemorrhage (<I>p</I> =0.012), decreased Hb≥5g/dL (<I>p</I> =0.013), atrioventricular block (<I>p</I> <0.001) and ventricular tachycardia (<I>p</I> =0.007) was higher in non-diabetic with hyperglycemia than in diabetic patients.</P> <P><B>Conclusions</B></P> <P>These findings underscore clinical significance of admission hyperglycemia on in-hospital mortality in non-diabetic AMI patients.</P>

간경변증 환자의 정신과적 특성 및 아임상적 간성뇌병증 진단을 위한 연구 : 인지기능 및 유발전위를 중심으로 Cognitive Functions and Evoked Potentials

유승호,이소영,김진세,변관수,정인과 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.5

연구목적 : 본 연구는 명백한 간성뇌병증이 없는 간경변증 환자에서 불안, 우울기분 및 삶의 질 등 정신과적 특징과 신경심리학적인 결손의 양상을 밝히기 위해서 고안되었다. 그리고 아임상적 간성뇌병증의 평가에서 체성감각 유발전위 검사의 역할을 연구하고자 하였다. 방 법 : 간경변증으로 진단된 41명의 환자군과 정상 대조군 31명을 대상으로 하였다. 이들에서 우울기분 및 불안을 평가하기 위해 Beck Depression Inventory와 State & Trait Anxiety Inventory를 시행하였고 삶의 질의 평가를 위해 Health-related Quality of Life Questionnaire를 시행하였다. 또한 어휘검사, 숫자외우기 검사, 토막짜기 검사, 숫자기호 바꿔쓰기 검사 및 선로잇기 검사 A와 B 등 간단하지만 포괄적인 인지기능검사를 시행하였다. 또한 41명의 환자군 중에서 인지기능검사 결과에 의거하여 분류된 13명의 아임상적 간성뇌병증군(SHE군)과 11명의 아임상적 간성뇌병증이 아닌 간경변증 환자군(non-SHE군) 그리고 8명의 정상 대조군에서 체성감각 유발전위를 측정하였다. 결 과 : 간경변증 환자는 정상인에 비해서 우울기분과 특성불안이 유의하게 증가하였다. 또한 건강과 관련된 일상생활의 삶의 질의 수준이 정상인보다 저하되었고, 특히 주의력과 각성이 요구되는 행동에서 수행이 저하되었다. 또한, 간경변증 환자는 숫자기호 바꿔쓰기 검사와 선로잇기 검사에서 정상 대조군보다 저하된 수행을 나타내었다. 또한 이러한 인지기능검사를 통해서 진단한 아임상적 간성뇌병증군에서 6개월 추적조사를 하였을 때, 명백한 간성뇌병증의 빈도가 아임상적 간성뇌병증이 아닌 군보다 유의하게 높았다. 체성감각 유발전위 소견은 N65 잠복기와 N20-N65 IPL의 경우 SHE군, non-SHE군 및 정상 대조군 사이의 유의한 차이가 있었다. 특히 N65는 SHE군만이 정상 대조군과 유의한 차이가 있었고 N95는 숫자기호 바꿔쓰기 검사 및 선로잇기 검사 A와 유의한 상관관계가 있었다. 결 론 : 간경변증 환자에게 우울 및 불안 등 정서적인 어려움에 대한 실제적인 관리 및 삶의 질을 높일 수 있는 치료적 접근이 고려되어야 하겠다. 또한 숫자기호 바꿔쓰기 검사와 선로잇기 검사가 아임상적 간성뇌병증의 조기 진단에 민감하고 유용한 도구로 생각되어 간경변증 환자에서 정례적으로 적용시키는 것이 간경변증 환자의 관리에 도움을 줄 수 있을 것으로 생각된다. 마지막으로, 본 연구에서의 체성감각 유발전위 소견은 간경변증 환자에서 아임상적 간성뇌병증 환자의 진단 및 연구에 중요한 의미를 지닌다고 생각된다. Objectives : This study was designed to elucidate the psychiatric characteristics and nature of the neuropsychological deficits associated with subclinical hepatic encephalopathy(SHE) in patients with non-alcoholic liver cirrhosis. And also the authors prospectively studied the role of somatosensory evoked potentials(SEP) in the assessment of SHE. Methods : Beck Depression Inventory(BDI) for measuring depression, State Trait Anxiety Inventory(STAI) for measuring anxiety, and Health-related Quality of Questionnaire(HQLQ) for measuring quality of life were administered the 41 non-encephalopathic liver cirrhosis patients(NELC) group and 31 carefully matched normal controls. And a prospective study to compare the performance of NELC group and normal controls on a short but comprehensive cognitive tests was conducted. After several cognitive, NELC group was divided into two groups, SHE group and non-SHE group by results of digit symbol substitution test(DSST) and/or trail making test(TMT) A and B. And then median nerve evoked cortical responses in 13 SHE patients group, 11 non-SHE patients group, and 8 normal controls were recorded for latencies of N13, P16, N20, P25, N30, P45, N65, and P95. And also responses for N13-N20 interpeak latency(IPL) and N20-N65 IPL were recorded. Results : There were significant differences between the NELC group and normal controls on BDI, trait anxiety scales in STAI, and almost all HQLQ except for the cognitive function, social interaction and life satisfaction(p<0.05). The NELC group exhibited poor performance in DSST, TMT A and TMT B compared with normal controls(p<0.05). As 17 NELC patients had abnormal cognitive test results, 41.5% of cirrhotic patients had SHE. In SEP assessment, NELC group with SHE and without SHE had higher N20-N65 IPL and only NELC group with SHE had higher N65 latency compared with normal controls(p<0.05). Conclusion : This study suggests that the patients with liver cirrhosis exhibit relatively selective deficits in complex attentional and fine motor skills, with preservation of general intellectual ability, memory, language and visuospatial perception. DSST, TMT A and TMT B seem to be useful screening tests for the detection of SHE. And also it is expected that late components and N20-N65 IPLs of SEP are helpful in the assessment of SHE.

공황 장애 환자에서 부모-자녀 결합 형태와 성격 요인에 관한 연구

윤혜진,이현수,정인과 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.6

In order to investigate the relationship between personality factors and parents-child bonding patterns influencing the development of panic disorder, we in Gu-Ro hospital studied 39 patients with panic disorder with 16 Personality Factor Questionnaire(16PF) and Parental Bonding Instrument. The results were as follows : 1) Higher overprotection scores and lower caring scores were noted in PBI. In 16PF higher desurgency, shyness, praxernia, guilt-proneness, liberalism and anxiety were observed. 2) Maternal overprotection was positively correlated with dominance, shyness, conservatism and maternal caring was positively correlated with dominance, high superego, suspiciousness, shrewdness. Paternal overprotection was positively correlated with self-control. Paternal caring was positively correlated with high intelligence, stableness and was negatively correlated with anxiety. Paternal overprotection and caring were negatively correlated with each other. Maternal overprotection was positively correlated with Paternal overprotection. 3) Groups classified by parental bonding pattern indicated that affectionless control(group Ⅳ) was correlated with more negative aspects of personality factors. These findings suggest than panic disorder patients have highly overprotection and low caring parents and that they have negative aspects of personality factors. Such negative aspects of personality factors seem to be related with their negative parent-child bonding patterns.

우울증 환자에서의 약물치료에 따른 Dexamethasone 억제검사의 변화에 관한 연구

김승현,정인과,곽동일 大韓神經精神醫學會 1986 신경정신의학 Vol.25 No.4

In this study the authors observed changes in response to the dexamethasone suppression test (DST) in depressed patients receiving antidepressants. Among 20 subjects.15 were major depression and 5 were bipolar depression. The 8 of 20 subjects showed psychotic features, and 12 of them did not show any psychotic features at all. All subjects underwent weekly DSTs with simultaneous clinical ratings (Hamilton Rating Scale for Depression-HRSD), both at the day of admission and during treatment. Dexamethasone (Decadron. 1㎎)was administered orally at 11 PM on the day of admission and every Wednesday during subsequent weeks. The results of this study were as follows: 1) The 7 of 20 subjects (35%) were categorized as nonsuppressors and 13 (65%) were as suppressors. 2) There were no significant differences in age, sex, body weight, depressive subtype (unipolar vbipolar), length of admission, HRSD scores at admission and discharge, and clinical outcome between nonsuppressors and suppressors. 3) The results of DST were higher predictably among nonsuppressors than suppressors at the time of admission, but not significant difference at the time of discharge between these subgroups 4) The result of DST were higher among subjects with psychotic features at the time of admission. However, there were no significant differences in DST results at the time of discharge and frequency of nonsuppressive response for DST between these subgroups. 5) There was significant correlation statistically between weekly post-DST cortisol levels in plasma and simultaneous HRSD scores among nonsuppressors, but no significant correlation among suppressors.

Fluoxetine 투여후 발생한 추체외로증후군 3례

이정호,이기철,곽동일,정인과,남민 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.2

The selective serotonin reuptake inhibitor fluoxetine is one of the most frequently prescribed drugs for the treatment of depression and other psychiatric disorders. In the few years, there have been several reports of adverse effects encountered during coadministration of fluoxetine with or without other psychotropic drugs. We experienced three cases of extrapyramidal symptoms were developed when admini-stered fluoxetine alone and with neuroleptics. We conclude that there is a probable or possible causal relationship between fluoxetine and extrapyramidal side effects. The pathogenesis of such adverse reactions, which may be hetero-geneous, is unknown, but it has been suggested that they might be caused by serotonergically mediated inhibition of dopaminergic transmission. From reports in those cases, it appears that fluoxetine alone may be associated with extrapyramidal side reactions. Furthermore the potential for increased levels of concomitant psychotropic medicines and increased side effects, should be borne in mind.

향정신성 약물이 혈청 지질, 지단백 및 아포지단백 농도에 미치는 영향

유승호,정인과,곽동일 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.3

향정신성 약물의 장기투여는 지방대사에 미치는 영향으로 인해 체중증가 및 심혈관계 질환과 관련이 있다고 알려져 있다. 따라서 본 연구는 향정신성 약물이 심혈관계질환의 위험요소로 알려진 혈청 지질, 지단백 및 아포지단백에 미치는 영향을 조사하고자 하였다. 고려대학교 의과대학 부속 구로병원 정신과에서 치료받은 환자로 신체질환의 별력이 없으며 최소한 3개월 이상 항성신병약물이나 항우울제로 치료받지 않은 화자들을 대상으로 항정신병약물, TCA 및 SSRI를 투여하였다. 약물 투여전과 투여 2주, 4주, 8주, 그리고 12주에 결쳐서 혈청 총 콜레스테롤, HDL-C, LDL-C, apo A, apo B 그리고 Lp(a)를 각각 측정한 결과는 다음과 같다. 1) 항정신병약물 투여군에서 약물 투여전보다 총 콜레스테롤이 증가하는 경향성을 보이고 HDL-C가 감소하는 경향성을 보였으나 통계적으로 유의하지는 않았다. 2) TCA 투여군에서 총 콜레스테롤의 경우 기준치와 비교해서 4주, 8주, 12주에서 각각 유의한 증가를 보였으며, LDL-C은 8주째 유의한 증가를 보였다. 또한 apo A는 12주째에 유의한 증가를 보였고, apo B는 8주째에서 유의한 증가를 보였다. 3) SSRI 투여군에서 총 콜레스테롤 농도는 4주, 8주, 12주에서 각각 유의한 증가를 보였고, apo B는 8주째에 유의한 증가를 보였다. 4) 약물투여후 각대상군간의 시간경과에 따른 변화를 상호 비교하여보면, 총 콜레스테롤은 약물에 상관없이 시간경과에 따라 유의하게 변화하는 양상을 보였으나 세가지 약물간에 유의한 차이를 보이지 않았다. 결론적으로 향정신성 약물은 혈청 지질, 지단백 및 아포지단백 농도에 영향을 미치는 것으로 보인다. 따라서 정신과 영역에서도 심혈관계 질환의 위험요소를 지닌 군은 이들 약물투여에 대한 주의와 관심이 필요할 것으로 사료된다. Objectives : Several studies suggest that psychotropic drugs may affect on lipid metabolism and body weight. And the differences of levels of serum lipids were observed in patients with several psychiatric disorders. Hence, in order to elucidate the effects of psychotropic drugs on serum lipid, lipopretein and apolipoprotein, the authors estimated the serum lipid profile in the psychopharmacological treatment. Methods : Thirty six patients with schizophrenia and 42 patients with depressive disorder of anxiety disorder were recruited from the inpatient psychiatric units and withdrawn from all psychotropic drugs at least for 3 months. The levels of serum total cholesterol, high-density lipoprotein cholesterol(HDL-C), triglyceride, apolipoprotein A, apolipoprotein B, and lipoprotein(a) were measured before the treatment and after 2,4,8 and 12 weeks of the treatment. Results : No statistically significant change was found on all serum lipid profiles in the antipsychotics group. However, the changes on serum total cholesterol, low-density lipoprotein(LDL-C), apolipoprotein A, and apolipoprotein B from the baseline to the following weeks have been observed in tricyclic antidepressants group. And the serum total cholesterol and apolipoprotein B have been observed to be changed from the baseline to the following weeks in the selective serotonin reuptake inhibitors group. The changes on serum lipoprotein(a) were proved not to be statistically significant during all the psychotropic drugs treatment. Conclusion : These results implicate that all psychotropic drugs might affect on the lipid metabolism, especially for tricyclic antidepressants. Therefore, this implication could be important in clinical situation because the changes on serum lipid profiles may be related to the cardiovascular disease especially in psychiatric patients with the cardiovascular risk factor.

교대근무자의 우울과 불안 및 면역기능

정치경,정인과,조숙행,서광윤,남민 大韓産業醫學會 1997 대한직업환경의학회지 Vol.9 No.3

This study was performed to investigate the relationship of anxiety, depression and immune function in the day workers and shift workers. To evaluated psychological problems and immune response encountered by shift workers, peripheral lymphocyte cell, State-Trait Anxiety Inventory and Beck Depression Inventory were administered to 63 workers, including 32 shift workers and 31 day workers. The results were as follows: 1. Mean score of Beck Depression Inventory for depression was significantly higher in shift workers than in day workers. 2. No significant difference of mean score of Trait Anxiety Inventory was demonstrated between two groups, however, mean score of State Anxiety Inventory was significantly higher in shift workers than in day workers. 3. The number of lymphocytes, T-lymphocytes, helper T-cell, helper to suppressor T-cell ratio and Null cell in shift workers were significantly lower than those in day workers, however, no significant difference for the number of B-lymphocytes, suppressor T-cell were observed between two groups. From the above results, it suggested that the shift work have changes depression, state anxiety and decrease part of the celluar lymphocyte immune functions.

24시간 혈중농도와 신배설률을 이용한 리튬 치료량 예측법의 평가비교

곽동일,정인과,김진세 大韓神經精神醫學會 1992 신경정신의학 Vol.31 No.4

Cooper's method using 24 hour serum lithium level and Norman's method using renal lithium clearance after a single loading dose were compared to determine which predicted therapeutic lithium dose better. The author concluded the Norman's method was superior after evaluating the accuracy, the rapidity, and the utility of the two methods. And the author suggest the availability of the predicting methods to overcome the limitations of lithium therapy, such as the narrow range of therapeutic level, the time-consumption reaching therapeutic level, and the individual variation of therapeutic dose. The summary of results were as follows : 1) In Cooper's method, the objects included in the acute therapeutic level, 0.80∼1.20mEq/l, were only 10 of 19 objects after taking prdeicted lithium dose. 2) In Norman's method, the objects included in the acute therapeutic level were all of 19 objects, and the actual serum lithium level, 0.80∼1.15mEq/l, were predicted with average error ±4.89%.

정신병환자에서 집단정신치료와 싸이코드라마의 치료요인 비교

윤성철,이후경,정인과,이규항,함 웅,차정화 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.3

목 적 : 본 연구에서는 정신병환자를 대상으로 실시한 집단정신치료와 싸이코드라마에 작용하는 치료요인을 조사하여, 그 치료적 특성들을 비교하기 위한 목적으로 이루어졌다. 방 법 : 1996년 9월부터 1997년 5월까지 낮병원에 참여한 환자를 대상으로 하였다. 대상자는 총 35명의 정신병환자로 남자 22명, 여자 13명이었다. 동일한 낮병원 환자들에게 집단정신치료와 싸이코 드라마를 각각 시행한 후, 13가지 치료요인 척도를 사용하여 집단정신치료의 구성원, 싸이코드라마의 주인공, 싸이코드라마의 관객에 작용하는 치료요인의 순위를 각각 조사하였다. 이 세 집단을 모두 상위기능 집단과 하위기능집단으로 나누어 치료요인을 비교하였다. 상위와 하위기능집단은 낮 병동에서의 생활, 치료 프로그램에 참여하였을 때의 태도, 치료자와 면담하였을 때의 모습을 기준으로 하여 낮병원 치료팀 모임에서 치료자들의 합의에 의해 결정하였다. 각각의 치료 요인은 평균점수를 산출하여 치료 요인의 순위를 매겼으며, 이 순위에 의해 집단정신치료, 싸이코드라마의 주인공, 싸이코드라마의 관객에 작용하는 치료요인의 특징을 비교하였다. 결 과 : 본 연구에서 나타난 치료요인에 대한 특정적인 결과는 다음과 같다. 1) 싸이코드라마에서 주인공은 기능수준에 관계없이 모두 “카타르시스”와 “일차 가족 집단의 교정적 감정 경험”을 매우 중시하였다. 2) 싸이코드라마에서 주인공은 상위기능집단의 경우 “치료자의 조언”을 하위기능집단의 경우 “구성원의 조언”을 중시하였다. 3) 싸이코드라마에서 관객은 기능수준에 관계없이 모두 “치료자와의 동일시” 와 “구성원과의 동일시”를 매우 중시하였으며, 또한 보편성을 중시하였다. 4) 상위기능집단의 경우 집단정신치료 싸이코드라마의 관객 및 주인공에서 “대인관계학습”을 중시하였으며, 특히 집단정신치료에서 “대인관계학습”을 매우 중시하였다. 5) 하위기능집단에서 싸이코드라마의 주인공과 집단정신치료에서 모두 “사회화 기술의 발달”을 중시하였다. 결 론 : 본 연구의 결과를 종합하여 다음과 같이 제안할 수 있다. 먼저 집단정신치료나 싸이코드라마를 환자에게 시행할 때 치료자가 치료요인을 고려하여 치료를 진행하는 것이 효과적일 것으로 생각된다. 다음으로 집단정신치료와 싸이코드라마는 모두 동일하게 중요한 치료법으로 실제 임상에서 널리 이용하는 바람직한 것으로 생각된다. 마지막으로 집단정신치료와 싸이코드라마의 기법을 서로 혼합하여 사용한다면 매우 효과적인 치료법이 될 수 있을 것으로 생각된다. Objective : This study was performed to investigate the therapeutic factors of group psychotherapy and psychodrama which were applied to psychotic patients, and to compare the therapeutic characteristics of two therapies. Methods : The subjects of this study were patients of a day hospital from September 1996 to May 1997. The subjects were composed of 35 psychotic patients(22 males, 13 females). Both of group psychotherapy and psychodrama were done to the patients of the day hospital. After these therapeutic factors were checked by the members of group psychotherapy, the protagonists of psychodrama, and the audience of psychodrama using 13 therapeutic factors scale. All three groups divided into higher functioning group and lower functioning group by mutual consent of the therapists in the treatment team meeting according to the patient's life of the day hospital, the attitude in programs, and the state during the interview with the therapist. And then therapeutic factors of higher and lower functioning group were compared. By the mean score of each therapeutic factor the rank of therapeutic factors was decided. By these ranks we compared the important therapeutic factors on the members of group psychotherapy, the protagonists, and the audience. Results : The results were as follows : 1) The protagonists of psychodrama set a very high value on “catharsis” and “the corrective recapitulation of the primary family group”, regardless of their functional level. 2) The protagonists with a higher function set a higher value on “guidance of therapists”, while those who had a lower function set a higher value on “guidance of members”. 3) The audience of psychodrama set a very high value on “identification with therapists”, “identification with members”, and set a high value on “universality”. 4) The higher functioning group of the group psychotherapy, the audience, and the protagonists set a high value on “interpersonal learning”, especially the patients of group psychotherapy set a very high value on “interpersonal learning”. 5) The lower functioning group of the protagonists and the group psychotherapy set a high value on “development of socializing techniques”. Conclusion : From the results of this study, we can draw some suggestions. First, if therapists take the above-mentioned therapeutic factors into consideration during the sessions of group psychotherapy or psychodrama, they can obtain more effective therapeutic outcome. Second, it is desirable that both group psychotherapy and psychodrama should be used more extensively as important methods of treatment in clinical settings. Third, the combination group psychotherapy and psychodrama would be more effective than the separate application of each therapy.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.