조기 정신증의 예방 및 정신사회적 개입 프로그램의 개발

안석균 국립서울병원 정신보건교육·연구센터 2008 정신건강정책포럼 Vol.2 No.1

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조현병 환자에서의 폭력행동

안석균 대한의사협회 2016 대한의사협회지 Vol.59 No.12

Violence in individuals with schizophrenia and other psychotic disorders is known to be higher than in the general population, according to various definitions of violence, although most people with schizophrenia are not violent. Various factors are reported to increase the risk of violence: demographic characteristics such as male gender, young age, and low socioeconomic status; antisocial personality and history of conduct disorder; comorbidity of substance abuse; psychopathological-clinical variables including positive psychotic symptoms, duration of the untreated psychosis, and the first episode of psychosis; and cognitive disorders. There are 3 types of violent patients with schizophrenia: 1) violent patients with a history of conduct disorder prior to the onset of schizophrenia; 2) violent patients in an acute psychotic episode, with no history of conduct disorder prior to the onset of schizophrenia; and 3) chronically violent patients who show no aggressive behavior prior to their thirties and early forties, and then are engaged in serious violence often including homicide. There are some identified triggering factors including exposure to violence, traumatic brain injury, self-harm, unintentional injury, substance intoxication and parental bereavement. The preventive and treatment strategies will be discussed according to the two different pathways of violence that are classified by the history of conduct disorder. A scientific approach is essential to reduce the rates of violent behaviors and potentially related stigma in patients with schizophrenia.

Greater Impairment in Negative Emotion Evaluation Ability in Patients with Paranoid Schizophrenia

안석균,이은,김재진,남궁기,강지인,전종희,석정호,최성환 연세대학교의과대학 2006 Yonsei medical journal Vol.47 No.3

To explore whether or not patients with schizophrenia display a more profound impairment of negative emotion processing, we assessed the implicit evaluation of positive and negative emotional stimuli. Twenty patients with schizophrenia (9 paranoid, 11 non-paranoid) and 22 normal controls were instructed to classify emotional pictures according to the intrinsic valence if the pictures were black and white. If the stimuli were color-filtered, participants were instructed to press the positive/negative response key according to the extrinsic valence (assigned valence of color). The error rates of the color-filtered stimuli were used as dependent measures. Normal controls made more errors on trials of the positive pictures when the correct response was the negative response key than when the correct response was the positive response key. The reverse was true on trials of the negative pictures. Patients with schizophrenia, especially paranoid schizophrenia, committed more errors in trials of the positive pictures when the correct response key was the negative response key. However, the reverse was not true on trials of the negative pictures. These findings suggest that patients with paranoid schizophrenia might suffer from an impaired ability to evaluate negative emotions and have a loosening of association within their negative emotional networks.

긍정적, 부정적 정서 자극에 의해 유발된 P3

안석균,이수정,남궁기,이창일,이은,김태훈,노규식,최혜원,박준모,An, Suk-Kyoon,Lee, Soo-Jung,NamKoong, Kee,Lee, Chang-Il,Lee, Eun,Kim, The-Hoon,Roh, Kyo-Sik,Choi, Hye-Won,Park, Jun-Mo 한국정신신체의학회 2001 정신신체의학 Vol.9 No.2

연구목적: 정상인에서 표정 자극에 의해 유발된 P3가 긍정적, 부정적 정서 범주에 따라 서로 다른지 여부를 알아보고자 하였다. 대상 및 방법: 정상인 12명을 대상으로 표정 사진에 의해 유발된 사건 관련 전위인 P3를 측정하였다. 모든 연구 대상에게 고빈도로 제시되는 비표적 바둑판 모양의 체크보드 자극으로부터 저빈도로 제시되는 표적 정서 자극에 대해 느끼고, 반응하도록 지시하였다. 결과: 정상인에서 부정적 정서 자극에 의해 유발된 P3의 진폭이 긍정적 자극에 의한 경우 보다 유의하게 더 컸다. 결론: 표정 자극에 의해 유발된 P3는 긍정적, 부정적 정서 처리의 정신생리적 지표로서 활용될 가능성이 시사된다. Objects : The aim of this study was to determine whether the P3 elicited by the negative emotional stimuli is different to that by positive stimuli. Methods : We measured the event-related potentials, especially P3 elicited by the facial photographs in 12 healthy subjects. Subjects were instructed to feel and respond to the rare target facial photographs imbedded in frequent non-target checkerboards. Results : We found that amplitude of P3 elicited by negative emotional photographs was significantly larger than that by the positive stimuli in healthy subjects. Conclusion : These findings suggest that P3 elicited by facial stimuli may be used as a psychophy-siological variable of the emotional processing.

Photoinduced Topographical Feature Programmed in Azobenzene-Functionalized Liquid Crystalline Elastomers

안석균,Timothy White 한국고분자학회 2016 한국고분자학회 학술대회 연구논문 초록집 Vol.41 No.1

P3HT-PLA Molecular Bottlebrushes: Synthesis, Aggregation and Self-Assembly

안석균 한국고분자학회 2017 한국고분자학회 학술대회 연구논문 초록집 Vol.42 No.2

항정신병 약물 비복용 정신분열증 환자의 99m-Tc-ECD SPECT로 측정한 국소뇌혈류량과 증상과의 관계

민성길,이종두,전덕인,안석균 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.3

정신분열증에서 양성 및 음성증상은 각기 독립적인 차원으로 기저의 병태생리, 신경 회로 기질 역시 다를 것이라고 제안되어 왔는 바, 양성증상은 전두엽과 해마복합체의 연결 경로의 이상으로, 음성증상은 전두엽과 기저 신경절 회로의 이상으로 야기된다고 제시된 바 있다. 따라서 본 연구에서는 양성 및 음성증상차원과 전두엽, 기저신경절, 시상 및 내·외측 측두엽의 국소뇌혈류량과의 관련성을 규명하고자 하였다. 항정신병 약물 비노출 혹은 비투여 정신분열증 환자를 대상으로 안정 상태에서 SPECT를 촬영하여 국소뇌혈류량을 구하였고, 이를 PANSS로 평가한 양성 및 음성 증상차원의 점수와의 상관관계를 관찰하였다. 연구결과 1) 양성증상차원의 점수는 고전두엽의 상대적 혈류 지표와 양의 상관관계를 보였으며, 내측 측두엽의 상대적 혈류 지표와는 음의 상관관계를 보였다. 2) 음성증상차원의 점수는 저전두엽의 상대적 혈류 지표와 양의 상관관계를, 기저신경절 및 시상의 상대적 혈류 지표와는 음의 상관관계를 보였다. 정신분열증에서 양성증상차원은 전두엽과 해마 복합체 등의 내측 측두엽의 연결 회로 구조물과 관련되어 있을 가능성이 있으며, 또한 음성증상차원은 전두엽-기저신경절 경로의 구조물과 연관되어 있을 가능성이 시사된다. 향후 임상 증상을 세분화하여 정신병적 증상차원, 혼란 증상차원 및 음성증상차원의 세 가지 차원과 국소 뇌혈류량과의 관련성을 규명하는 연구가 필요하다고 생각된다. Symptom profiles in schizophrenia consists of positive and negative symptom dimensions which are considered to be related to different underlying pathophysiologies and neural substrates. The purpose of the study was to identify the possible relationship between relative regional cerebral perfusion and positive and negative symptom dimension in unmedicated patients with schizophrenia. Twenty-seven unmedicated patients with schizophrenia(13 patients who were antipsychotic drug-naive and 14 patients who had been drug-free for at least 1 week) were included in the study. Regional cerebral perfusion was studied with the single-photon emission computed tomography(SPECT). Symptom dimensions were assessed with positive and negative syndrome scale(PANSS). The scores of each symptom dimension were correlated with regional cerebral perfusion. The results were 1) positive symptom dimension score was significantly related to decreased perfusion in the medial temporal lobe and increased perfusion in the frontal lobe, 2) negative symptom dimension score was significantly related to decreased perfusion in the basal ganglia, thalamus and increased perfusion in the frontal lobe. These results suggest that positive symptom dimension is associated with the dysfunction of the link between the frontal lobe and the medial temporal lobe and that negative symptom dimension is related with the impairment of frontal-basal ganglia circuit.

정신분열병 환자에서 Haloperidol이 99m-Tc-ECD SPECT로 측정한 국소뇌혈류량에 미치는 영향

천근아,이종두,민성길,김세주,안석균 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.4

연구목적 : 정신분열병 환자에서의 뇌혈류량은 약리학적 상태를 포함한 다양한 요소들에 의하여 영향을 받는다. 항정신병약물이 국소뇌혈류량에 미치는 영향에 관한 많은 연구가 행해져 왔으나 항정신병약물의 종류와 노출기간, 약물용량의 차이로 인해 다양하고도 상반된 결과를 보여왔다. 따라서 본 연구에서는 정신분열병 환자에서 항정신병약물의 종류와 노출기간을 통제한 상태에서 약물 투여시 국소뇌혈류량의 변화를 관찰하고자 하였다. 방 법 : 항정신병약물 비노출(antipsychotic drug-naive) 정신분열병 환자 18명과 haloperidol을 투여받은 환자 19명을 대상으로 안정 상태(resting state)에서 SPECT를 촬영하여 국소뇌혈류량을 측정한 후 두군 사이의 상대적 뇌혈류량을 비교하였다. Haloperidol은 D2 수용체에 비교적 선택적으로 작용하고 활성대사산물이 적기 때문에 실험약물로 선택되었고 약물노출기간은 1∼3주동안으로 제한하였다. 결 과 : 우측 저측두엽, 좌측 저전두엽, 좌·우측 기저신경절, 좌측 시상에서의 상대적 평균 혈류지표는 halo-peridol 투여군에서 비노출군에 비해 유의하게 증가되어 있었다. 또한 좌·우측 두정-후두엽과 우측 두정엽에서의 상대적 평균 혈류지표도 haloperidol 투여군에서 비노출군에 비해 유의하게 증가되어 있었다. 반면 좌측 저측두엽의 상대적 평균 혈류지표는 haloperidol 투여군에서 항정신병약물 비노출군에 비해 유의하게 감소되어 있었다. 그러나 우측 저전두엽, 우측 시상, 좌·우측 고측두엽, 좌·우측 고전두엽, 좌측 두정엽에서 두 군 사이의 상대적 평균 혈류지표는 유의한 차이를 보이지 않았다. 결 론 : 정신분열병 환자에서 항정신병약물이 국소뇌혈류량에 영향을 미치며, 항정신병약물 투여상태가 뇌혈류량 측정시 고려되어야할 중요한 변수임을 시사한다. Objectives : Regional cerebral blood flow(rCBF) in schizophrenics is confounded by various factors including medication status. Previously, there have been numerous studies regarding the effects of antipsychotics on rCBF. However, these works have shown contradictory and inconsistent findings due to the different of type, dose and exposed duration of antipsychotics. The aim of this study was to observe the effect of antipsychotic medication on rCBF and exposed duration of antipsychotics under control. Methods : Eighteen drug-naive schizophrenics and 19 schizophrenics medicated with halo-peridol were included in the study. Regional cerebral blood flow was assessed with single-photon emission computed tomography(SPECT) under a resting state. Relative rCBF was compared between two groups. Haloperidol was selected as the antipsychotic drug as it has relatively selective action at the D2 receptor and less active metabolites. Exposed duration was limited from one to three weeks. Results : Haloperidol-medicated schizophrenic patients had a significantly greater increase of relative cerebral perfusion in the right inferior temporal lobe, left inferior frontal lobe, both basal ganglia, left thalamus, both parieto-occipital lobes, and right parietal lobe than drug-naive schizophrenic patients. Haloperidol-medicated schizophrenic patients had a significant decrease of relative cerebral perfusion in left inferior temporal lobe. However, no significant differences in relative rCBF were found between drug-naive and haloperidol-medicated schizophrenic patients in right inferior frontal lobe, right thalamus, both superior temporal lobes, both superior frontal lobes, and left parietal lobe. Conclusion : These findings suggest that antipsychotics affect regional cerebral blood flow, and antipsychotic medication status must be considered in the relative rCBF studies of schizophrenic patients.

기술뉴스

안석균(편집자) 한국고분자학회 2018 고분자 과학과 기술 Vol.29 No.3

만성 정신분열병 환자에서 전산화 인지재활프로그램(REHACOM)을 이용한 주의력 훈련의 효과

안석균,오병훈,현명호,유계준 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.1

Objective : The authors study evaluated the effect of a cognitive rehabilitation program designed to enhance the attention skill of chronic schizophrenics. Methods : Dependent variables included measures of perceptual sensitivity and response criterion derived from the Vigilance test of Vienna test system. Each of 10 subjects received 10 sessions of repeated training with computer-aided cognitive rehabilitation program(REHACOM). Eleven subjects were assigned to a control group. All subjects were rated on measures of positive and negative symptoms before training. Results : Significant changes on the outcome measures were observed following attention training. Conclusion : It is suggested that cognitive rehabilitation with chronic schizophrenics should stress the possibility of remediating deficiencies in basis abilities, such as attention.