입원중인 정신분열중환자의 약물거부 一투약거부자와 순웅자의 비교

윤진상,김중원 대한신경정신의학회 1988 신경정신의학 Vol.27 No.1

Hospitalized patients with schizophrenic disorder may directly refuse their offered antipsychotic medication. This study was designed to compare the refusers with the compliers in relation to some of the potential risk factors contributing to the refusal. The factors included in the present study were 1) sociodemographic characteristics, 2) the level of psychopathology by the BPRS, 3) the level of satisfaction with therapeutic team and ward environment, 4) the schedule of drug administration,5) the side effects requiring readjustment of the drug, and 6) the subjective response to current medication. 23 hospitalized psychiatric patients who overtly refused antipsychotic medication, and who according to DSM-111 were diagnosed as suffering from schizophrenic disorder,were recognized as the refusers. A sample of 23 compliers, who willingly accepted antipsychotic medication, was matched for age(± 5 years), sex, diagnosis, treatment ward and length of current hospitalization (±7days). The data was mainly collected by the investigator’ s semistructured interview with the patients and by review of medical records. The resurlts were as follow. 1) There was no significant difference in education, marital status, illness duration, frequency of previous psychiatric hospitalization, and type of admission between the two groups. 2) Raings on the BPRS showed the refusers were significantly (p<0.01) more symptomatic than the compliers. The refusers had significantly higher scores on the BPRS for anxiety (p〈0. 05), emotional withdrawal (p<0.005), depressive m ood(p<b.05), hostility (p< 0.05), uncooperativeness( P<0.00l), motor retardation (p<0.05), and blunted affect (p < 0 .0 l). 3) Although there was no significant difference in the level oi satisfaction with therapeutic team and ward environment between the two groups, both groups in general demonstrated satisfaction with the therapeutic team and dissatisfaction with ward environment. 4) Comparison of the prescribed neuroleptic dose per day in Chlorpromazine equivalents for the refusers and compliers showed no significant difference, while the total number of tablets and the frequency of administration each day were significantly (p<0.05, respectively) greater and more frequent in the refusers than in the compliers. 5) Severe side effects requiring readjustment of the current drugs were significantly (p<0.05) more frequently identified in the refusers than in the compliers. 6) Subjective response to their current antipsychotic medication was dysphoric in both groups, but significantly (p<0.05) more dysphoric in the refusers than in the compliers. In summary, our study reveals that drug refusal may result not only from the irrational symptoms of the patients, but also from their reasonable objections. So these findings need to be considered in order to enhance the understanding of durg refusal. In so doing, we might not only improve the clinical aspect of prevention and management of drug refuser, but also safeguard the patientf s rights both to receive and to refuse medication.

건강한 한국 성인에서 ALDH2 유전형에 따라 Metadoxine(Alcotel)이 알코올의 약동학 및 약역학에 미치는 영향

윤진상,윤보현,이용복,신일선,정재성,정원태,시영화 전남대학교 약품개발연구소 2000 약품개발연구지 Vol.9 No.1

Objectives : Mctadoxine is known to have accelerated the metabolism of alcohol in previous studies with Caucasian subjects. The purpose of this study was to evaluate the effects of metadoxine on alcohol pharmacokinetis and pharmacodynamics in normal Korean adults according to the low-Km aldehyde dehydrogenase(ALDH2) genotypes. Methods : Twenty healthy male volunteers(half with active ALDH2*1/*1 : active group, the other with inactive ALDH2*1/*1 : inactive group) were selected by genotyping. In a double-blind, counterbalanced design, can subject ingested 0.5g of alcohol per ㎏ of body weight with pretreatment of metadoxine or placebo on 2 acparate occasions. Blood alcohol concentration by breathanalyzer(BrAC), vital signs, negative physiological response and performance function using a battery of tests(critical flicker fusion threshold : CFFT, choice reaction time : CRT, compensatory tracking task : CTT and digit-symbol substitution : DSS) were measured at baseline and repeatedly over 3-hour period after intake of alcohol. Results : Among the pharmacokinetic parameters, Vmax and Km were significantly increased with pretreatment of metadoxine in both the active and inactive ALDH2 groups, but the ratio of Vmax/Km was decreased. In terms of pharmacodynamics, the pretreatment of metadoxine produced a significant improvement of performance such as CFFT and DSS in the active ALDH2 group, but did not in the inactive ALDH2 group. Conclusions : It may be concluded that metadoxine has little effect on alcohol metabolism in both groups with respect to phamacokinetics on the basis of BrAC. The pharmacodynamic results, however, indicated that metadoxine might be partially effective in counteracting the impairing effects of alcohol on the performance in the active ALDH2 group.

전기경련요법 기간 중 약물사용

윤진상 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.5

Except a few well-defined interactions, there is considerable uncertainty about the interactions between electroconvulsive therapy(ECT) and psychotropic and medical pharmacological agents used during ECT course mainly because the interaction with ECT has not been adequately tested at any stage in drug development. Most of the available knowledge on ECT-drug interactions in human are based on clinical experience and inferred from animal studies. This article reviews ECT-drug interactions in terms of safety and/or efficacy rather than theoretical issues to be helpful for clinical practitioners. Drugs are divided into three categories : psychotropic and medical pharmacological agents taken by patients prior to initiation of the ECT course and agents given in conjunction with ECT to modify the seizure itself or the effects of the seizure.

항정신병약물에 의한 부작용의 치료전략

윤진상,신일선,Yoon, Jin-Sang,Shin, Il-Seon 대한생물정신의학회 1998 생물정신의학 Vol.5 No.2

항정신병약물에 의한 부작용의 치료전략은 예방이 최우선이며, 그 다음이 조기발견 및 이에 대한 적절한 치료이다. 항정신병약물의 부작용을 강조하는 이유는, 약물에 대한 부정적 인상을 강화시키려는 데 있지 않고, 약물의 치료적 효과를 극대화시키려는 데 있다. 이를 위해서는 약물의 속성과 환자의 특징을 고려한 약물의 선택과 사용뿐만 아니라, 부작용에 대한 면밀한 이해와 이에 대한 치료전략을 숙지해야 한다. While the therapeutic efficacy of antipsychotic drugs is not in doubt, a variety of undesirable side effects are common. They can be a disincentive to good compliance with treatment, resulting in increased possibilities for relapse and hospitalization. They can be distressing and disabling and thus interfering with patient safety and quality of life. Furthermore, they may be counter-therapeutic by exacerbating the condition that the drug was prescribed for. In this article, we will provide an overview of management of antipsychotic- induced side effects, with a particular emphasis on the most common side effects as well as less common but serious side effects. In addition, some practical issues regarding the management of side effects will be discussed.

아침형과 저녁형 사람에서 야간의 졸리움, 수행 및 체온의 비교

윤진상,국승희,신일선,신만식,최영,이무석,이형영 大韓睡眠-精神生理學會 1994 수면·정신생리 Vol.1 No.1

항우울제의 임상사용을 위한 실제적 지침 : 주요 우울증을 중심으로

윤진상,Yoon, Jin-Sang 대한생물정신의학회 1994 생물정신의학 Vol.1 No.1

Several different classes of antidepressants(ADs) with newer drugs becoming available have been used for the phamacological management of a broad spectrum of mental disorders, among which depressive disorder is most commonly indicated. Successful clinical use of ADs requires a complete understanding of the psychopharmacological properties of ADs and on accurate knowledge of patients, characteristics based on clinical experience and theoretical framework. This paper aims at providing some practical information on the clinical use of ADs to assist clinicians in treating patients with major depression. The author describes (1) different classes of ADs and their presumed mechanisms of action, (2) clinical characteristics of ADs focusing on side-effect profiles, (3) some issues arising during the treatment course such as : a) pretreatment tasks, b) choice of ADs, c) therapeutic drug dose and monitoring of drug concentration, d) three stages of treatment and e) strategies in refractory depression and (4) ADs in special patient groups.

거짓말이더라도

윤진상 한국지역사회연구소 1991 지역사회 Vol.9 No.-

지역사회거주 노인에서 한국어판 세계보건기구 장애평가조사표의 개발

윤진상,김재민,신일선,양수진,정태길,이형영 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.1

Objectives : This study aimed to develop the Korean version of World Health Organization Disability Assessment Schedule II (WHODAS II-K) with community dwelling elderly population. Methods : The WHODAS II-K was administered to 1204 community residents aged 65 or over in two areas of Kwangju, South Korea, in 2001. For assessing 'health condition', data on physical illness, depression (Korean version of Geriatric Mental State Schedule B3), and cognitive dysfunction (Korean version of Mini-Mental State Examination) were collected. For evaluating 'contextual factors', informations on demographic charactehstics (age, gender, living area, marital state, and religiou), socio-economic status (education, type of accommodation, number of room, previous occupation, and current employment), and social network were obtained. Results : WHODAS II-K showed high levels of internal consistency, split-half reliability, and inter-rater and test-retest reliabilities. In the correlation analyses, scores on the WHODAS II-K were significantly correlated with the unfavorable conditions in the all variables on health condition and contextual factors. Partial correlations of scores on the WHODAS II-K with health condition were significant even after controlling for contextual factors. Conclusion : The WHODAS II-K is a reliable and valid instrument for assessing disability in elderly population since it reflects physical illness, depression, and cognitive impairment, which are common in elderly.

주정중독에 동반된 우울증의 치료에서 Paroxetine과 Amitriptyline의 이중맹 비교 : 치료초기 2주 동안의 행동학적 부작용

윤진상,윤보현,최태석,김용범,이형영,Yoon, Jin-Sang,Yoon, Bo-Hyun,Choi, Tae-Seok,Kim, Yong-Bum,Lee, Hyung-Yung 대한생물정신의학회 1996 생물정신의학 Vol.3 No.2

본 연구는 주정중독에 동반된 우울증 환자의 치료에서 적어도 행동학적 부작용의 관점에서는 PAR이 AMI보다 우수함을 증명하였다. 이러한 PAR의 행동학적 효과의 우수성은 환자의 삶의 질을 향상시키고 결국 치료결과를 높이는데 관여하리라고 생각된다. Objective : It has been proposed that cognition and related aspects of mental functioning are decreased in depression as well as in alcoholism. The objective of the study was to compare behavioral side effects of paroxetine and amitriptyline in depressed patients accompanied by alcoholism. The focused comparisons were drug effects concerning psychomotor performance, cognitive function, sleep and daytime sleepiness during the first 2 weeks of treatment. Methods : After an alcohol detoxification period(3 weeks) and a washout period(1 week), a total of 20 male inpatients with alcohol use disorder (DSM-IV), who also had a major depressive episode(DSM-IV), were treated double-blind with paroxetine 20mg/day(n=10) or amitriptyline 25mg/day(n=10) for 2 weeks. All patients were required to have a scare of at least 18 respectively on bath the Hamilton Rating Scale far Depression(HAM-D) and Beck Depression Inventory(BDI) at pre-drug baseline. Patients randomized to paroxetine received active medication in the morning and placebo in the evening whereas those randomized to amitriptyline received active medication in the evening and placebo in the morning. All patients performed the various tasks in a test battery at baseline and at days 3, 7 and 14. The test battery included : critical flicker fusion threshold for sensory information processing capacity : choice reaction time for gross psychomotor performance : tracking accuracy and latency of response to peripheral stimulus as a measure of line sensorimotor co-ordination and divided attention : digit symbol substitution as a measure of sustained attention and concentration. To rate perceived sleep and daytime sleepiness, 10cm line Visual analogue scales were employed at baseline and at days 3, 7 and 14. The subjective rating scales were adapted far this study from Leeds sleep Evaluation Questionnaire and Epworth Sleepiness Scale. In addition a comprehensive side effect assessment, using the UKU side effect rating scale, was carried out at baseline and at days 7 and 14. The efficacy of treatment was evaluated using HAM-D, BDI and clinical global impression far severity and improvement at days 7 and 14. Results : The pattern of results indicated thai paroxetine improved performance an mast of the lest variables and also improved sleep with no effect on daytime sleepiness aver the study period. In contrast, amitriptyline produced disruption of performance on same tests and improved sleep with increased daytime sleepiness in particular at day 3. On the UKU side effect rating scale, mare side effects were registered an amitriptyline. The therapeutic efficacy was observed in favor of paroxetine early in day 7. Conclusion : These results demonstrated thai paroxetine in much better than amitriptyline for the treatment of depressed patients accompained by alcoholism at least in terms of behavioral safety and tolerability, furthermore the results may assist in explaining the therapeutic outcome of paroxetine. For example, and earlier onset of antidepressant action of paroxetine may be caused by early improved cognitive function or by contributing to good compliance with treatment.

항정신병 약물치료하에서 주관적 안녕감을 평가하는 한국형 척도의 개발

윤진상,국승희,이형영,이철,백인호 대한신경정신의학회 2000 신경정신의학 Vol.39 No.6

연구목적 : 본 연구의 목적은 1994년 Naber 등이 개발한 38문항의 '항정신병 약물치료하에서 주관적 안녕감을 평가하는 자가평정척도(a self-rating scale to measure subjective well-being under neuroleptic tre-atment : SWN)'를 문항수를 줄이고 문항내용을 수정하여 한국형으로 개발하고자 하였다 방 법 : 204명의 정신분열병 환자들에게 22문항의 KmSWN과 General Health Questionnaire/Quality of Life-12(GHQ/QL-12)를 실시하였고, 사회인구학적 및 임상적 특징을 조사하였다. 자료분석에는 척도에 대한 반응과 정보가 신뢰로운 176명의 자료를 포함시켰다. 첫째, KmSWN의 신뢰도와 타당도를 평가하였다. 둘째, KmSWN총점과 사회인구학적 및 임상적 특징의 관계를 조사하였다. 끝으로 KmSWN의 총점을 예측하는 변인들을 알아보기 위해 KmSWN총점과 유의한 상관이 있는 변인들을 독립변인으로 하고 KmSWN총점을 종속변인으로 하여 단계적 중다회귀분석을 실시하였다. 결 과 : 22문항의 KmSWN중 세문항은 내적 일치도가 낮아서 추후분석에서 제외되었다. 19문항의 KmSWN(KmSWN-19)은 반분신뢰도(.91), 문항간 상관의 평균(.38), 내적 일치도(Cronbach alpha .92)가 높았다. 요인분석에서는 '불만족', '신체 및 정신기능', '정서조절 및 자기통제'의 3개요인이 추출되었다. KsSWN-19총점과 GHQ/QL-12총점간의 상관은 -.83으로 공존타당도가 높았다. 사회인구학적 및 임상적 특징중 연령, 용돈, 사회경제적 수준, 과거 입원횟수, 투약에 대한 순응 투약에 대한 만족도는 KmSWN-19 총점과 정적 상관이 있었던 반면, 질병의 심도, 파킨슨 증상의 심도, 지연성 운동장애의 심도, 투약횟수 및 투약을 빠뜨린 횟수는 KmSWN-19 총점과 부적 상관이 있었다, 단계적 중다회귀분석결과, KmSWN-19총점을 유의하게 예측하는 변인은 투약의 만족도, 투약을 빠뜨린 횟수 및 용돈이었으며, 변량의 24%를 설명하였다. 결 론 : KmSWN-19는 정신분열병 외래환자의 주관적 안녕감을 측정하는 자기평정척도로서 신뢰롭고, 타당하며 실용적임이 확인되었다. 아울러 KmSWN-19는 항정신병 약물과 관련한 주관적 안녕감에만 특이한 척도가 아니라, 척도에 응답할 수 있는 모든 정신분열병 환자나 기타 정신증 환자들에게 적용할수 있는 일반적 척도임이 시사되었다. 한편, KmSWN-19총점에 대해 독립변인들의 설명변량이 크지 않는 점을 주관적 안녕감 혹은 삶의 질의 평가에서 개인의 가치나 신념, 성격특성 같은 개인내적 특성을 고려해야 할 필요성이 있음을 시사한다. Objective : The purpose of this study was to develop the Korean modification of SWN(KmSWN), based on the original 38-item SWN(a self-rating scale to measure subjective well-being under neuroleptic treatment)by Naber et. al. In 1994, but containing the reduced number of items and the modified content. Methods: The KmSWN with 22 items and General Health Questionnaire/Quality of Life-12(GHQ/QL-12) were administered to 204 out-patients with schizophrenia. Also, their socio-demographic and clinical characteristics were investigated. Data analyses were conducted based on 176 patients whose responses to the scale, as well as whose related informations, were reliable. First, the reliability and validity of KmSWN were assessed comprehensively. Second, the relationships between the total score of KmSWN and the sociodemographic and clinical characteristics were examined. Finally, in order to identify the predictable variables on the total score of KmSWN, the stepwise multiple regression analysis was conducted, where the inde-pendent variables were already shown significant correlations with the total score of KmSWN. Results : Three of 22 items of KmSWN were excluded from the following analysis due to their poor internal consistency. KmSWN comprised with 19 items(KmSWN-19) showed high levels of spilt-half reliability(.91), mean of inter-item correlations(.38) and internal consistency (Cronbach alpha .92). Factor analysis of the KmSWN-19 revealed that a three-factor solution accounted for 100% of total explained variance. The three factors were interpreted as 'diss-atisfaction','physical and mental functioning', 'emotional regulation and self-control', The concurrent validity of KmSWN-19 with GHQ/QL-12 was very high(-.83). Of the socio-demographic and clinical characteristics, age, disposable money, socioeconomic level, number of previous hospitalizations, compliance with medication and satisfaction with medication were positively correlated with the total score of KmSWN-19, while severity of illness, severity of parkinsonism, severity of dyskinesia, administration frequency of medication and omission number of medication were negatively correlated. However, the total score of KmSWN-19 was not correlated with medication, the omission number of medication and the disposable money were significantly contributed to the total score of KmSWN-19, and they explained 24% of the variance. Conclusions : The above findings indicated that KmSWN-19 was a reliable, valid and pra-ctical self-rating scale to measure subjective well-being in out-patients with schizophrenia. Moreover, KmSWN-19 seemed to be a general scale applicable to all the schizophrenic or other psychotic patients if they were able to complete it, rather a specific scale only for the patients undergoing the neuroleptic treatment. Based on the results of the predictable variables on the total score of KmSWN-19, one may argue that intra-individual characteristics such as value, belief and personality traits, although they were not evaluated in this study, should be considered in assessing subjective well-being or the quality of life.