CPAP 사용으로 유발된 조증 삽화 1예

나해란,강은호,유범희,Na, Hae-Ran,Kang, Eun-Ho,Yu, Bum-Hee 대한불안의학회 2008 대한불안의학회지 Vol.4 No.2

저자들은 심한 수면 무호흡증을 가진 성인 남자에서,CPAP 치료 후 조증 및 경조증 삽화가 유발된 증례를 보고하였다. 본 증례는 정신과적 병력 및 가족력이 없던 환자에게서 CPAP 치료 후 조증 삽화와 경조증 삽화가 연속해서 유발된 첫 번째 보고이다. 환자는 CPAP 치료 시작 직후부터 약 한달 동안 기분 고양감과 목적지향 활동의 증가를 보이다가 2~3일만에 정신병적 증상이 동반된 조증 삽화를 보였다. 또한 퇴원 후 투약을 지속하면서 다시 CPAP치료를 한 직후 경조증 삽화로 추정되는 일련의 기분 및행동 변화가 나타났다. 따라서 이 환자의 조증 삽화와 경조증 삽화로 추정되는 기분 변화는 CPAP 치료로 유발되었을 가능성이 있다고 판단되었다. 폐쇄성 무호흡증이 심하여 CPAP 치료가 처방되는 경우에 임상의들은 정신과적 질환의 기왕력이나 위험 인자가 없는 환자에서도 조증상태가 발생할 수 있는 가능성에 대해 유의하여야 하고, 주기적으로 객관적인 척도를 사용하여 기분 변화 정도를 점검할 필요가 있다. 특히 CPAP 사용 후 특별한 이유 없이 행동 변화나 기분 고양의 정도가 심해질 때는 조증 가능성을 의심해 보아야 할 것으로 사료된다. Continuous positive airway pressure (CPAP) has been known as a safe and effective therapy for the patients with obstructive sleep apnea (OSA). Previous studies on CPAP treatment have often reported significant improvement in mood state in those patients. However, there are very few reports on its potential to induce manic or hypomanic episode in the patients with OSA. We report a case of 34-year-old patient with OSA who developed manic and hypomanic episodes consecutively after CPAP treatment with facial mask. We suggest that CPAP treatment could induce a manic or hypomanic episode in patients with obstructive sleep apnea.

The Genetic Basis of Panic Disorder

나해란,강은호,이재헌,유범희 대한의학회 2011 Journal of Korean medical science Vol.26 No.6

Panic disorder is one of the chronic and disabling anxiety disorders. There has been evidence for either genetic heterogeneity or complex inheritance, with environmental factor interactions and multiple single genes, in panic disorder’s etiology. Linkage studies have implicated several chromosomal regions, but no research has replicated evidence for major genes involved in panic disorder. Researchers have suggested several neurotransmitter systems are related to panic disorder. However, to date no candidate gene association studies have established specific loci. Recently, researchers have emphasized genome-wide association studies. Results of two genome-wide association studies on panic disorder failed to show significant associations. Evidence exists for differences regarding gender and ethnicity in panic disorder. Increasing evidence suggests genes underlying panic disorder overlap, transcending current diagnostic boundaries. In addition, an anxious temperament and anxiety-related personality traits may represent intermediate phenotypes that predispose to panic disorder. Future research should focus on broad phenotypes, defined by comorbidity or intermediate phenotypes. Genome-wide association studies in large samples, studies of gene-gene and gene-environment interactions, and pharmacogenetic studies are needed.

Factors Influencing Skin Tolerability to the Rivastigmine Patch in Patients with Alzheimer’s Disease

나해리,박문호,김상윤,양동원,최성혜,양현덕,양영순,한현정,이정석,윤영철,고성호,김정은,구본대,김희진,박경원,김은주,윤보라,박기정 대한치매학회 2015 Dementia and Neurocognitive Disorders Vol.14 No.1

Background and Purpose The one-day rivastigmine patch is reportedly well tolerated and has minimal side effects. However, Asian patientsshow more side effects than those in Western countries. We evaluated tolerability of the rivastigmine patch in South Korean patientswith Alzheimer’s disease (AD) and the specific factors affecting adverse events of the skin. Methods A 6-month, open labeled, multi-centered, observational study was carried out in 440 patients with probable AD from July 2009to September 2010 (NCT01312363). Results A total of 25.9% of the patients experienced adverse skin events at the rivastigmine patch application site and 17.0% discontinuedtreatment due to adverse events at the skin application site. The most common adverse events were itching and erythema. Patients with an allergichistory and users of electric heating appliances reported skin discomfort. Older age was associated with discontinuing treatment. Conclusions These results suggest that the rivastigmine patch induced some adverse skin events and may contribute to understanding andimproving skin tolerability to the rivastigmine patch.

이중언어자에서 보인 두 형태의 실어증 : 증례보고 A Case Report

나해리,이정욱,박성민,박수열,권순용,이현정 대한치매학회 2004 Dementia and Neurocognitive Disorders Vol.3 No.2

Since many people in Korea know more than one language, bilingual aphasia is an important line of research in clinical and theoretical neurolinguistics. Nowadays we meet many people who speak other languages along with Korean, who are immigrants from foreign countries, especially from China. Differential recovery of language affected by an aphasic deficit is documented. In the present work, we introduced a patient with bilingual aphasia who showed different recovery patterns in Korean and Chinese. A 66-year-old man was presented with language disturbance and right hemiplegia. On past medical history, he had received a hematoma evacuation through burr-hole due to left basal ganglia hemorrhage. After the event, he showed nearly global aphasia in Korean, but he showed minimally preserved language function on comprehension and fluency in Chinese. This result suggests that aphasia in bilingual subject may show different pat-terns of recovery between two languages.

연탄재를 활용한 도자기 소지 개발

나해리,이현수,이지연 한국폐기물자원순환학회 2017 한국폐기물자원순환학회지 Vol.34 No.5

Coal briquette ash is an inorganic and non-combustible material. Although coal briquette ash is mainly composed of SiO2, Al2O3, and is an acceptable raw industrial material (containing Fe2O3, K2O, MgO, CaO, TiO2, and Na2O), it is merely considered waste and is exploited as a building material for concrete admixtures and bricks. Because mullite (3Al2O3 2SiO2), which coal briquette ash contains, is a stable compound with a crystalline structure, it plays essential roles in its fracture strength and bending strength. This study serves the purpose of developing environmentally friendly, economical clay bodies through the use of coal briquette ash as a substitute for kaolin to provide Al2O3 and SiO2. We also investigated the seed effects during sintering process by feeding mullite directly into clay bodies. The results show that in 1,300°C heat, a mixture of 40% coal briquette ash, 40% feldspar/limestone (8 : 2), and 20% clay indicates a fracture strength value of 525 kgf/cm2, an absorption rate of 0.72%, burning shrinkage of 11.5%, and an average bending strength of 0.6 cm, which is superior to other clay bodies. The addition of coral briquette ash in clay bodies promoted mullite formation and grew as mullite acted as a seed. In addition to the developing clay bodies, it can also make an oatmeal-colored glaze to widen the spectrum of its usability. This study will help resolve waste problems, reduce environmental pollution, and raise economic value by using coal briquette ash as a raw material for ceramics. Clay bodies made with coal briquette ash are expected to continuously contribute to the development of the ceramics industry with upcycling effects.

한국인 치매환자에서의 리바스티그민 패취 사용 경험; 예비 연구

나해리,강현석,김상석,한설희 대한치매학회 2009 Dementia and Neurocognitive Disorders Vol.8 No.1

While rivastigmine transdermal patch has consistently demonstrated better tolerability and similar efficacy compared to conventional rivastigmine capsules in clinical studies; it has not been specifically evaluated in Korean dementia patients. From February to November 2008, 94 patients with dementia and mild cognitive impairment (MCI) were treated with rivastigmine transdermal patch at Konkuk University Hospital and Bobath Memorial Hospital. To evaluate the safety and tolerability in Korean patients with dementia and MCI, we reviewed the clinical data of the patients. The participating subjects were diagnosed as Alzheimer’s disease (n= 34), mild cognitive impairment (n=5), vascular dementia (n=26), Parkinson’s disease dementia (n=13), dementia with Lewy body (n=3), frontotemporal dementia (n=2) and other types of dementia (n=11). All of the patients were followed within 3 months (90±14 days), in terms of evaluating adverse events. Adverse events occurred in 11 cases (11.7%) and adherence of the patch was good in 91 cases (96.8%). Most of the participants showed clinical improvement similar to other acetylcholinesterase inhibitors (AchEIs). The most common adverse effects were skin-related problems including simple skin irritation, itching sensation, erythematous lesion, patch marks (contact dermatitis) and even severe symptoms mixed with all of the above (allergic contact dermatitis), occurred in eight cases (8.5%). Gastrointestinal (GI) discomfort was reported in two cases (2.1%). Among patients who stopped rivastigmine transdermal patch, six patients (6.3%) withdrew due to adverse events. Rivastigmine transdermal patch provides a good tolerability profile in treating Korean patients with the various subtypes of dementia and may be effective for the improvement of cognitive function in Korean patients with Alzheimer’s disease. While rivastigmine transdermal patch has consistently demonstrated better tolerability and similar efficacy compared to conventional rivastigmine capsules in clinical studies; it has not been specifically evaluated in Korean dementia patients. From February to November 2008, 94 patients with dementia and mild cognitive impairment (MCI) were treated with rivastigmine transdermal patch at Konkuk University Hospital and Bobath Memorial Hospital. To evaluate the safety and tolerability in Korean patients with dementia and MCI, we reviewed the clinical data of the patients. The participating subjects were diagnosed as Alzheimer’s disease (n= 34), mild cognitive impairment (n=5), vascular dementia (n=26), Parkinson’s disease dementia (n=13), dementia with Lewy body (n=3), frontotemporal dementia (n=2) and other types of dementia (n=11). All of the patients were followed within 3 months (90±14 days), in terms of evaluating adverse events. Adverse events occurred in 11 cases (11.7%) and adherence of the patch was good in 91 cases (96.8%). Most of the participants showed clinical improvement similar to other acetylcholinesterase inhibitors (AchEIs). The most common adverse effects were skin-related problems including simple skin irritation, itching sensation, erythematous lesion, patch marks (contact dermatitis) and even severe symptoms mixed with all of the above (allergic contact dermatitis), occurred in eight cases (8.5%). Gastrointestinal (GI) discomfort was reported in two cases (2.1%). Among patients who stopped rivastigmine transdermal patch, six patients (6.3%) withdrew due to adverse events. Rivastigmine transdermal patch provides a good tolerability profile in treating Korean patients with the various subtypes of dementia and may be effective for the improvement of cognitive function in Korean patients with Alzheimer’s disease.

건강한 독거노인에게서 회복탄력성의 외로움에 대한 사회적 지지의 매개 효과

나해인,최소연,엄태림,김태희 대한노인정신의학회 2019 노인정신의학 Vol.23 No.2

Objective:This study aims to identify the impact of social support on the relationship between loneliness and resilience for the elderly who are mentally sound, financially stable and living in a single household setting. Methods:A sample of 197 mentally healthy (Mini-Mental State Examination for Dementia Screening ≥-1.5 standard deviation and Geriatric Depression Scale <10) community-dwelling elderly 65 years of age or older was recruited. Multidimensional individual and interpersonal resilience measure, Medical Outcomes Study Social Support Survey, and University of California, Los Angeles Loneliness Scale were used followed by structured face to face interviews. Descriptive statistics, t-test, analysis of variance, Pearson correlation, and stepwise regression analysis were used for data analysis. Results:The mean score of Resilience was 70.7 (±11.7)/111, social support was 60.2 (±21.4)/95, and Loneliness was 38.5(±11.9)/80. For the Resilience, there was a statistically significant correlation between loneliness (r=0.56, p<0.01) and social support (r=0.72, p<0.01). Hierarchical analysis shows that social support completely mediates the effect of resilience on loneliness. Stepwise regression analysis represents affection emotional support and positive social interaction have the highest descriptive power. Conclusion:In conclusion, social support fully mediates the impact of resilience on loneliness. The findings suggest developing social support intervention programs, especially which can give emotional support and positive social interaction, is effective and crucial to decrease loneliness for elderly who are living alone.

주택화재보험 활성화 방안

나해인,Na, Hae-In 한국화재보험협회 1999 防災와 保險 Vol.80 No.-

How MBTI affects successful life

나해란 ( Hae-ran Na ) 대한피부과학회 2024 대한피부과학회 학술발표대회집 Vol.75 No.1

중증 대뇌반구경색 환자의 사망률과 초기 예후인자

나해리,강우열,정승철,유경호,마효일,이병철 대한노인병학회 2001 대한노인병학회지 Vol.5 No.2