Fluoxetine 병용 투여 후 만성 정신분열증 환자에서 혈장 5-Hydroxyindoleacetic Acid 농도에 따른 Hamilton Rating Scale for Depression의 변화

심세훈,정한용,한선호,Shim, Se Hoon,Jung, Han Yong,Han, Sun Ho 대한생물정신의학회 1996 생물정신의학 Vol.3 No.2

Object : The aim of this study was to examine an association between plasma 5-Hydroxyindoleacetic Acid(HIAA) level and the change of depressive symptom after fluoxetine trial in haloperidol-stabilized schizoprenic in-patients. Method : According to plasma 5-HIM level, 32 patients were classified to either group with high 5-HIAA level(N=11) or that with low 5-HIM(N=11). For each patient, fluoxetine(20mg/day) added to stable haloperidol dose for 6 weeks. The authors measured Hamilton Rating Scale for Depression (HRSD) at baseline, the 2nd week, the 4th week, the 6th week of treatment. Result : 1) Age, duration of illness, number of admission, duration of present admission, dosage of haloperidol between high 5-HIAA group and low 5-HIM group were significantly different. 2) As time went on, the association between the change of depressive symptom and plasma 5-HIAA concentration was not significant. 3) Of depressed group, as lime went an, depressive symptoms were improved significantly in high 5-HIAA group, but not in law 5-HIM group. Conclusion : We suggest that the association between plasma 5-HIAA level and the change of depressive symptoms after fluoxetine trial in haloperidol stabilized schizophrenic in-patients was not significant.

자살을 시도한 우울증 환자에서 혈장 ${\beta}$-Nerve Growth Factor 농도의 변화

심세훈,원성두,이분희,한창수,양종철,권영준,김용구,Shim, Se-Hoon,Won, Seong-Doo,Lee, Bun-Hee,Han, Chang Su,Yang, Jong-Chul,Kwon, Young-Joon,Kim, Yong-Ku 대한생물정신의학회 2006 생물정신의학 Vol.13 No.2

Object : Nerve growth factor(NGF) is a protein involved in neuronal survival and plasticity in the central nervous system, which might play an important role in stress, depression and suicide. This study was performed to determine whether there is an alteration in plasma NGF concentrations in depressed patients with suicidal attempt. Methods : The subjects were 32 depressed patients who attempted suicide and admitted in emergency room. Forty-four hospitalized non-suicidal depressive patients and the 30 normal controls were closely matched with the suicidal group in terms of age and sex. Individuals in all 3 groups were evaluated independently by a semi-structured interview for the purpose of establishing a DSM-IV criteria diagnosis. The severity of depressive symptoms was evaluated using Hamilton depression rating scale(HDRS). The severity of the suicidal behavior was evaluated by Weisman and Worden's risk-rescue rating(RRR) system and the Lethality Suicide Attempt Rating Scale(LSARS). Plasma NGF level was measured by the enzyme linked immunosorbent assay(ELISA) method. Results : There were no statistically significant differences of the plasma NGF levels among groups. LSARS and RRR did not reveal any significant correlation with ${\beta}$-NGF level in suicidal depressive patients. Conclusion : This study do not support an association between ${\beta}$-NGF and suicidal depression. However it is necessary to investigate this association through other route such as postmortem brain.

만성 정신분열병 환자에서의 강박증상에 대한 연구

심세훈(Se Hoon Shim),정한용(Han Yong Jung),한선호(Sum Ho Han) 한국정신병리진단분류학회 2000 精神病理學 Vol.9 No.1

N/A N/A

자살 시도자에서 혈장 Brain-Derived Neurotrophic Factor 농도 저하

원성두,심세훈,양종철,이헌정,이분희,한창수,김계현,김용구,Won, Seong-Doo,Shim, Se-Hoon,Yang, Jong-Chul,Lee, Heon-Jeong,Lee, Bun-Hee,Han, Chang-Su,Kim, Kye-Hyun,Kim, Yong-Ku 대한생물정신의학회 2005 생물정신의학 Vol.12 No.2

Objects:Some studies have suggested that brain-derived neurotrophic factor(BDNF), one of the most important neurotrophins, is involved in pathophysiology of depression and suicide. This study was performed to determine whether there is an abnormality in plasma BDNF concentration in suicidal attempters. Methods:The subjects were 71 suicidal attempters who visited emergency rooms in multi-medical centers. All subjects had been interviewed by using Structured Clinical Interview for DSM-IV(SCID), Hamilton Depression Rating Scale(HDRS), Young Mania Rating Scale(YMRS), and Positive And Negative Syndrome Scale(PANSS). The severity of the suicidal behavior was measured by Lethality of Suicide Attempt Rating Scale(LSARS) and Risk-Rescue Rating(RRR) system. Seventy-one age, sex, and diagnosis matched non-suicidal psychiatric patients who were consecutively admitted to a psychiatric ward during the same period recruited as psychiatric controls. They were drug-naive or drug-free at least more than 2 months. In addition, 80 healthy controls were randomly selected as normal controls. Plasma BDNF level was measured by the enzyme linked immunosorbent assay(ELISA) methods. Results:In overall F-test, differences of the plasma BDNF levels among the groups were statistically significant(F=20.226, p<0.001). In the multiple comparisons(Scheffe), while mean levels of plasma BDNF between normal controls and non-suicidal psychiatric patients were similar(p=0.984), the BDNF levels of suicidal attempters were lower than those of other two groups(p<0.001). LSARS and RRR did not reveal any significant correlations with BDNF levels in suicidal attempters. Conclusion:These results suggest that reduction of plasma BDNF level is related to suicidal behavior and BDNF level may be a biological marker of suicidal behavior.

신경염증과 정신질환

송후림,이화영,심세훈,권영준,Song, Hoo Rim,Lee, Hwa-Young,Shim, Se-Hoon,Kwon, Young-Joon 대한생물정신의학회 2016 생물정신의학 Vol.23 No.1

Neuroinflammation is one of important allostatic loads contributory to the various psychiatric illness. It is mediated mainly by glial cells, which produce both proinflammatory and antiinflammatory cytokines, and the balance of them determines the inflammatory process in the central nervous system. S100 calcium-binding protein B, which is used as an inflammatory marker is also released by glial cells. In the molecular level, oxidative stress contributes to the neuroinflammation. Their disturbances have been revealed in the psychiatric illness and related with the dysregulation of the glutamatergic and monoaminergic systems. There is a possibility to use them as disease markers. The approach for inflammation using antiinflammatory drugs and antioxidants could be connected to the development of disease-modifying treatments. Also, a searching examination about specific subtypes who are vulnerable to inflammation in the patients is required to confirm their efficacy clearly.

자살 시도와 자살 사고 간 반응억제 사건유발전위 비교 연구

김지선,권영준,심세훈,Kim, Ji Sun,Kwon, Young Joon,Shim, Se-hoon 대한불안의학회 2020 대한불안의학회지 Vol.16 No.1

Objective : There have been limited scientific studies differentiating those who attempt suicide from those who think about suicide but do not attempt suicide. Altered event-related potential (ERP) performance, such as GoNogo ERP has been regarded as the neurocognitive processes associated with behavioral inhibition and poor impulse control. The purpose of this study was to investigate the association between Nogo ERP and suicide attempt. Methods : A total of 63 participants (33 participants with suicide ideation and 30 with suicide attempt) were recruited, and performed GoNogo tasks during the electroencephalogram measurement. Depression, anxiety, emotional regulation and impulsivity were evaluated by self-rating scales. The clinical measures and Nogo P3 component were compared between the groups. The correlational analyse was conducted to evaluate the relationship between the clinical characteristics and the Nogo P3 component. Results : Participants with suicide attempt significantly decreased the Nogo P3 amplitudes at the frontal-central electrode than participants with suicide ideation (p=0.004, FDR adjusted p=0.032). In the correlation analysis, the Nogo P3 amplitude at frontal-central electrode was correlated with the total score of the Barrett impulsivity scale (r=-0.383, p=0.002), attentional impulsivity (r=-0.365, p=0.003) and motor impulsivity (r=-0.389, p=0.002) subscales of the Barrett impulsivity scale. Conclusion : These findings suggest that the decreased Nogo P3 amplitude may be one of the candidates of biological marker for poor impulse control in those who attempt suicide.

한국형 우울장애 약물치료 알고리듬 2021 (III) : 소아·청소년

양찬모(Chan-Mo Yang),심세훈(Se-Hoon Shim),박원명(Won-Myong Bahk),우영섭(Young Sup Woo),정종현(Jong-Hyun Jeong),왕성민(Sheng-Min Wang),김원(Won Kim),서정석(Jeong Seok Seo),이정구(Jung Goo Lee),박영민(Young-Min Park),장승호(Seung-Ho J 대한신경정신의학회 2021 신경정신의학 Vol.60 No.3

Objectives The Korean Medication Algorithm Project for Depressive Disorder 2021 (KMAP-DD 2021) was a revision of previous works. The main purpose of the current study was to amend guidelines for the treatment of a major depressive disorder (MDD) for children and adolescents. Methods The survey consisted of 21 questionnaires for children and adolescents. A total of 33 of the 46 experts in child and adolescent psychiatry answered the survey. Results Antidepressant (AD) monotherapy was selected as the 1st line option for MDD with mild to moderate severity. As the 1st line of treatment for MDD severe without psychotic features in children and adolescents, AD monotherapy and AD augmented with atypical antipsychotics (AAP) were recommended. For MDD with psychotic features, AD augmented with AAP was preferred as the 1st line of treatment. Conclusion We developed an algorithm for child and adolescent populations with depressive disorders, more specifically than the KMAP-DD 2017. We expect this algorithm will provide clinicians useful information and help in the treatment of children and adolescents with depressive disorders.

음독 자살 시도와 세로토닌 수용체 2A(T102C) 및 1B(G861C) 유전자 다형성에 관한 연합연구

김동현,권영준,김재우,심세훈,정희연,Kim, Dong-Hyeon,Kwon, Young-Joon,Kim, Jae-Woo,Shim, Se-Hoon,Jung, Hee-Yeon 대한생물정신의학회 2004 생물정신의학 Vol.11 No.2

Objectives:Recently, polymorphisms of several serotonin genes have been suggested to be associated with suicide, but the results are still unclear. We examined whether the T102C polymorphisms of the serotonin 2A receptor gene and the G861C polymorphisms of the serotonin 1B receptor gene were associated with suicidal behavior using drug intoxication. Methods:The subjects were 52 patients who visited emergency room with suicidal behaviors. Fifty controls were selected from healthy volunteers matched for sex and age to the suicide subjects. The polymorphisms were analyzed with TaqMan$^{(R)}$ assay using primers based on previous studies. Results:The T102C polymorphism of the serotonin 2A receptor gene showed no significant difference between the suicidal attempters and controls in both genotype and allele frequency analyses(p=0.179 and p=0.422, respectively). There was no statistically significant difference between the suicidal attempters and the controls in the G861C polymorphism of the serotonin 1B receptor gene and any significant effect of the genotype distributions or the allele frequencies was not observed(p=0.092 and p=0.987, respectively). Conclusion:These findings suggest that the T102C polymorphism in serotonin 2A receptor gene and the G861C polymorphism in serotonin 1B receptor gene are not related to the susceptibility to suicide attempts using drugs. To clarify the genetic influences of the serotonergic system on suicidal behavior, the polymorphisms of other candidate genes in the serotonergic system should be studied with larger numbers of subjects.

정신지체와 주의력결핍 과잉행동장애를 보이는 Noonan 증후군 1예

김원우(Won-Woo Kim),심세훈(Se-Hoon Shim) 대한소아청소년정신의학회 2012 소아청소년정신의학 Vol.23 No.1

Noonan syndrome is characterized by short stature, typical facial dysmorphology, and congenital heart defects. The main facial features of Noonan syndrome are hypertelorism with down-slanting palpebral fissures, ptosis, and low-set posteriorly-rotated ears with a thickened helix. The cardiovascular defects most commonly associated with this condition are pulmonary stenosis and hypertrophic cardiomyopathy. Other associated features are webbed neck, chest deformity, mild intellectual deficit, cryptorchidism, poor feeding in infancy, bleeding tendency, and lymphatic dysplasias. The patient is a 10-year-old boy. He had experienced repeated febrile convulsions. He had typical facial features, a short stature, chest deformity, cryptorchidism, vesicoureteral reflux, and mental retardation. His language and motor development were delayed. When he went to school, it was difficult for him to pay attention, follow directions, and organize tasks. He also displayed behavior such as squirming, leaving his seat in class, and running around inappropriately. Clinical observation is important for the diagnosis, so we report a patient who was diagnosed with Noonan syndrome, mental retardation, and attention-deficit hyperactivity disorder.

남자 정신분열병 환자의 소뇌기능과 정신증상 및 인지기능간의 연관성

김서영,전용호,권영준,정희연,황보영,심세훈,Kim, Seo Young,Jun, Yong Ho,Kwon, Young Joon,Jeong, Hee Yeon,Hwang, Bo Young,Shim, Se Hoon 대한생물정신의학회 2007 생물정신의학 Vol.14 No.3

목 적: 소뇌가 운동조절 뿐아니라 인지기능과 정신과적 증상에도 중요한 역할을 하고있다는 증거들은 많다. 정신분열병에서 소뇌기능은 많은 연구들에서 대뇌고위기능의 조정곤란(Cognitive dysmetria)이라는 개념을 통해 주목 받아왔다. 다시말하면, 전전두엽-소뇌-시상핵-전전두엽 회로의 이상은 정신분열병에서 인지기능의 손상과 임상증상으로 나타날 수 있는 것이다. 본 연구의 주 목적은 남자 정신분열병 환자에서 소뇌기능이상을 ICARS를 통해 반정량적으로 평가하고, 이것이 임상 및 인지기능과 어떤 연관성이 있는지 알아보는 것이다. 방 법: 저자들은 DSM-IV-TR 진단기준에 따라 정신분열병으로 진단된 47명의 남자 정신분열병 환자와 이와 성별과 나이를 맞춘 건강한 대조군 30명을 소뇌의 신경학적 징후를 ICARS로 점수화하여 비교하였다. 반정량적으로 100점의 총점을 가진 ICARS는 자세와 보행, 사지운동기능, 언어장애, 안구운동장애의 4개의 구획으로 나뉜 19개 항목으로 구성되어 있다. 모든 실험군은 한국형 간이정신상태검사(K-Mini Mental status examination, MMSE), 언어유창성 검사(Verbal fluency test), 시계그림검사(Clock drawing test)를 통해 인지기능검사를 받았다. 환자군에서 임상증상의 심각도는 한국형 양성 및 음성 증상 척도Positive and Negative Symptom Scale(PANSS)로 평가하였다. 환자군에서 ICARS의 높은 점수가 추체외로증상이나 지발성운동장애와 같이 약물사용으로 인한 부작용과 관련이 있는지 여부를 확인하기위하여 Abnormal Involuntary Movement Scale(AIMS)를 시행하였다. 실험군과 변수들에서 통계적 유의성을 보기위해 독립표본 t 검증과 편상관분석을 사용하였다. 결 과: 정신분열병 환자들은 대조군에 비해 ICARS-자세와 보행장애, 운동기능, 안구운동장애-에서 유의하게 높은 점수를 보였다. 환자들은 인지기능검사에서도 보다 심각한 손상을 보였다. ICARS 점수와 PANSS로 평가한 환자들의 음성증상 총점과는 유의한 상관관계가 있었으며, 인지기능검사에서는 시계그림검사, 언어유창성 검사가 음성증상과 유의하게 연관이 있었다. 또, 시계그림검사는 ICARS 점수와 연관이 있었다. 정신분열병 환자에서 발병연령, 유병기간 및 AIMS 점수가 줄수있는 혼란변수는 회귀분석을 사용하여 평가하였으며, AIMS 점수는 ICARS의 점수와 연관성을 보이지 않았다. 결 론: 정신분열병은 발달학적 혹은 신경발달학적 질환으로 개념 내려지고 있다. 대부분의 연구자들은 정신분열병을 가진 환자들이 대뇌고위기능의 조정곤란(Cognitive dysmetria)이라고 불리는 전전두엽-시상핵-소뇌회로의 이상으로 인해 고통받고 있다고 하였다. 본 연구에서 저자들은 정신분열병 환자들이 인지기능과 소뇌기능에서 심각한 손상을 가지고 있고, 특히 이것은 환자들의 음성증상의 정도와 상관관계가 있다는 것을 확인하였다. 이 결과는 정신분열병에서 소뇌의 역할에 대해 지지하고 있다. 또, 정신분열병 환자들의 연성신경학적 징후를 평가하는데 있어 ICARS라는, 구조화되어 다른 검사자들에게도 통용될 수 있는 도구를 사용했다는 것에서 의미가 있다고 볼 수 있겠다. 향후 유사한 연구에서는 질병의 경과에 따라 신경학적 징후의 변화에 대해 설명할 수 있기를 기대한다. Objectives:There is increasing evidence that the cerebellum plays an important role in cognition and psychiatric symptoms as well as motor coordination. The concept of cognitive dysmetria has been making cerebellar function in schizophrenia the focus of current studies. In other words, disruption in the corticocerebellum-thalamic -cortical circuit could lead to disordered cognition and clinical symptoms of schizophrenia. The purposes of this study were to determine cerebellar dysfunction in male schizophrenic patients semiquantitatively with ICARS and to investigate the clinical and cognitive correlates of ICARS in patients. Methods:We compared the scores of cerebellar neurologic sign using ICARS in 47 male patients with a DSM-IV-TR diagnosis of schizophrenia with 30 gender and age-matched healthy control subjects. The semiquantitative 100-point ICARS consists of 19 items divided into 4 unequally weighted subscores:posture and gait disturbances, kinetic functions, speech disorders and oculomotor disorders. All subjects were also assessed with cognitive function test. Cognitive functions were evaluated by Korean-Mini Mental Status Examination (K-MMSE), Verbal fluency test, and Clock drawing test. The patients were administered Korea version of Positive and Negative Symptom Scale(K-PANSS) to assess the symptom severity. Results:Schizophrenic patients had significantly higher scores on the ICARS than control subjects with posture and gait disturbances, kinetic functions, and oculomotor disorders. They also showed more significant impairments in cognitive function tests than control subjects. There was a significant correlation between ICARS and negative symptoms of patients. In cognitive function test, Clock drawing test was significantly associated with negative symptoms. In addition, Clock drawing test was negatively correlated with the total score of ICARS. Conclusion:In this study, we confirmed that schizophrenic patients have significant impairments in cognitive and cerebellar function, and that those were related with negative symptoms of schizophrenic patients. These results support a role of the cerebellum in schizophrenia. It is meaningful that we used a structured, and reliable procedure for rating neurological soft signs, ICARS. We hope that future prospective studies using a similar design help that rate of neurological sign should have been visible with the progression of illness.