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.

정신분열병의 인지치료

정영철 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.2

지금까지의 정신증상 특히 망상과 환청에 대한 정신치료적 입장은 긍정도 부정도 아닌 중립적 태도로 충분히 환자의 이야기를 들어주는 지지적 형태의 소극적 치료였다고 볼 수 있다. 그러나 인지치료는 직면이 아닌 범위내에서 논리적이고 경험적 방법을 이용하여 적극적으로 증상의 공략을 추천하는 치료법인 것이다. 이와같은 점에서 인지치료는 정신증상을 직접적으로 다루는 새로운 치료도구라는 의미가 있다. 또한 그 이론과 치료기법이 명료하고 손쉬워서 누구나 조금만 관심을 가지면 시행할 수 있는 강점도 가지고 있다. 그러므로 국내의 많은 정신과 의사들이 정신분열증의 인지치료에 대해 긍정적인 관심을 가짐으로서 이에 대한 임상적 적용 및 연구활동이 활성화 되기를 기대해 본다. There are two kinds of cognitive dysfunction in schizophrenia : one is a cognitive deficit and the other is a cognitive distortion. Cognitive therapy addresses these two issues. First, cognitive deficit means the poor function of attention, information-processing and recalling which may be present as a primary or secondary symptoms. So, the correction of cognitive deficit is important in terms of the rehabilitation of schizophrenic patients and the prevention of illness itself in cognitive-vu1nerable candidates. The treatment programs of cognitive deficit are as follows : attention skills training, letter recognition training, retraction-time task and Wisconsin Card Sorting Test. Secondly, cognitive distortion means the irrational thinking processes which occur to those who have a maladaptive schema. As a result of this, lots of psychiatric symptoms including delusions and hallucinations can be explained depending upon what types of schema and irrational thinking have involved. Specific therapeutic techniques are as follows socratic questioning, peripheral questioning, agreement to differ, tactic withdrawal, alternative explanation, empirical testing and collaborative empiricism. Sound and good therapeutic relationships are essential to the success of cognitive therapy like the other therapeutic approaches. And if we practice cognitive therapy with a systematic manner and impatience, it will be an another valuable therapeutic tool for the management of psychotic symptoms.

한국 傳統마을의 景觀構造에 관한 硏究

鄭英喆 慶一大學校 2002 論文集 Vol.18 No.-

This study aims to find out the landscape structure of Korean traditional village. The traditional village landscape is essentially the cultural landscape which human value, custom and technology are represented through the basic concept of the village. In Korean traditional village, harmony with nature is one of the most important characteristics of architectural considerations. The traditional village forms the scenary cultural landscape through nature and human being, and keeps the symbolic meanings. Korean traditional village landscape was formed through the cultural meaning and activity, natural physical settings.

民間信仰의 方位槪念으로 본 傳統住居의 解釋에 관한 硏究 : based on the Cardinal Points of the Folk Religion

鄭英喆 慶一大學校 1997 論文集 Vol.14 No.2

The aims of this study is to interpret the traditional dwelling house through the cadinal points of the folk religion. This paper explains the interpretation of the traditional dwelling house under the following three subtitles ; dwelling as the image of the cosmos ; dwelling as the center of the world ; dwelling as the subjective space. The traditional dwellings has the prominent characteristic of the image of the cosmos and the center of the world which is regarded the human and the architecture as the microcosmos and communicates the heaven with the earth. The traditional dwellings which aims to harmony and define the human and the nature has the subjective and meaningful space which articulates the nature through the self-systematization.

정신분열증 환자의 친척에서 보인 표출된 감정

정영철,정애자,황익근 大韓神經精神醫學會 1988 신경정신의학 Vol.27 No.3

It has been reported that expressed emotion, a measure of family attitude toward psychiatric patients, is closely related to the relapse of schizophrenics. To test the above mentioned relationship, the authors evaluated expressed emotion of schizophrenic's relatives with six component scales; critical comment, hostility, dissatisfaction, warmth, emotional overinvolvement and guilt. The subjects consisted of three different groups ; relatives of 15 chronic schizophrenia, relatives of 15 subchronic schizophrenia and relatives of 15 neuroses who were admitted to the department of neuropsychiatry of Chonbuk Notional University Hospital. The results were as follows ; 1) 3 Groups were significantly different in frequencies of critical comment. In comparison of other expressed emotion, intensity of hostility and warmth also showed significant difference in all of the compared groups(Table 7). 2) Critical comment was positively correlated to hostility(r=0.93). But hostility was negatively related to warmth (r--0.49). 3) Comparing the high expressed emotion group with the similar studies of other countries, Korea vs California was significantly different at p<.05 X²and British vs California was also different with the statistical significance at p<.01. In addition the mean frequencies of critical comment was lowest in Korea among them.

첫 삽화 정신분열병의 전구증상과 치료 전 경로 : 한국과 중국 연변간의 횡 문화 예비연구 Preliminary transcultural Study between Korea and China

정영철,박태원,유일한,현길용 대한정신분열병학회 2003 정신분열병 클리닉 Vol.6 No.2

亞鉛과 鐵分 同時投與가 白鼠의 鉛中毒에서 δ-ALAD 活性度 및 Hb値에 미치는 影響

鄭榮照,車喆煥 고려대학교 의과대학 1982 고려대 의대 잡지 Vol.19 No.1

An experiment was carried out using the rats fed with tap water containing iron(Fe) and zinc(Zn) in order to observe their effects on lead poisoning. A total of 98 Sprague-Dawley rats were divided into 3 groups: the first group was fed with tap water containing lead(Pb) alone, the second Pb, Zn and Fe together and the third being the control. The results could be summarized as follows: 1. The rats of 3 groups all equally gained body weight during the first 80 days of feeding, but thereafter the Pb group stopped gaining while Pb, Zn and Fe combined group continued gaining as did the control. 2. The blood activity of δ-ALAD in the Pb alone group decreased continuously, reaching a level of 16.7% of the control on the 120th day, while that of the Fe and Zn group sustained its decrease for 100 days and then regained its activity, which attained 70.89% of the control on the 120th day. 3. The blood hemoglobin of the Pb group showed a decrease to 12.81±0.97 g/dl on the 120th day, but the combined one kept decreasing for 100 days, restoring its value up to 15.20±1.67 g/dl on the 120th day being higher than the control, 12.91±0.99 g/dl. The above results indicate that the simultaneous administration of Fe and Zn together exhibits a compensatory effect against lead poisoning.

간 낭종을 동반한 성인 다낭신 환자에서 간 낭종의 감염 1예

정규성,서정철,주기산,김원식,임영국,정종훈,문철웅 朝鮮大學校 附設 醫學硏究所 1993 The Medical Journal of Chosun University Vol.18 No.1

Adult polycystic kidney disease(APKD) usually accompanies with renal and extrarenal manifestations and liver cysts are present in aproximately 30% of patients with APKD. Kidney cysts often accompany with hemorrhage, rupture, infection, however, liver cysts are usually asymptomatic and do not impair liver function. Rare complication of liver cysts in patient with APKD include portal hypertension with bleeding esophageal varices and hepatic failure with encephalopathy. But, in APKD patient, infection of liver cysts without infection of renal cysts is extremely rare. We report a case of infected liver cyst in a patient with APKD who has complained generalized abdominal pain and high fever which was confirmed by ultrasound and aspiration. The patient was treated successfully with repeated aspiration and systemic antibiotics.

정신분열병 환자의 망상에 대한 인지행동치료의 효과

정영철,김재현,은홍배,황익근 대한신경정신의학회 2001 신경정신의학 Vol.40 No.1

연구목적: 정신분열병 환자의 망상에 대한 인지행동치료의 효과를 알아보고자 하였다. 방법: 1999년 6월부터 2000년 9월까지 정신과 병동에 입원된 정신분열병, 정신분열형장애, 그리고 분영정동장애 환자들을 인지행동치료 군과 지지정신치료 군에 무작위 배정하고 10주의 치료기간동안 망상의 확신, 몰두, 그리고 불안의 정도, 증상에 대한 설명방식, 그리고 회복형태를 평가하였으며 두 군간의 결과들을 서로 비교하였다. 결과: 1) 망상의 확신과 불안은 두 군 모두 시간이 지남에 따라 감소하였으나 두 군간에는 유의한 차이가 없었다. 2) 망상의 몰두는 두 군 모두 시간에 따른 감소를 보였고 인지행동치료 군에서 지지정신치료 군보다 현저한 감소가 있었다. 3) 설명방식과 회복형태는 인지행동치료 군에서 지지정신치료 군보다 유의한 긍정적 변화를 보였다. 결론: 인지행동치료는 망상의 몰두, 증상에 대한 설명방식, 그리고 회복형태에 있어서 지지정신치료보다 우수한 치료효과를 가진다. Objectives : The effect of cognitive-behavioral therapy on the delusion in schizophrenic patients was evaluated. Methods : The patients admitted to a psychiatric ward from September 1999 to June 2000 and diagnosed as schizophrenia, schizophreniform disorder, and schizoaffective disorder by DSM-IV were randomly assigned to cognitive-behavioral therapy(CBT) group(n=9) and supportive psychotherapy(ST) group(n=8). During the 10 weeks' treatment period, conviction, preoccupation, and anxiety on delusion, mode of explanation about symptom, and recovery style were regularly measured and compared between groups. Results : 1) As for conviction and anxiety on delusion, the patients from both groups showed gradual reduction over time, but there was no significant difference between groups. 2) As for preoccupation of delusion, patients from both groups showed gradual reduction over time, and the patients on CBT group had a significantly more reduction than ST group. 3) As for mode of explanation and recovery style, CBT group had more marked positive changes than ST group did. Conclusion : Cognitive-behavioral therapy is more effective on preoccupation of delusion, explanatory mode about symptom, and recovery style than supportive psychotherapy.

뇌낭미충증

정상섭,임승철,나영신 한국의학사 1987 診斷과治療 Vol.7 No.6