정신분열병과 기분장애에서 초발의 계절성 : Mainly in Paranoid Schizophrenia and Bipolar I Disorder 망상형 정신분열병과 양극성장애 1형을 중심으로

이범정,윤도준,오동열 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.6

본 연구의 목적은 정신신분열병과 기분장애에서 1) 초발의 계절성이 있는 지의 여부 2) 초발의 계절에 따른 인구통계학적 인자와 임상적 인자의 차이를 알아보기 위해 본 연구를 시도하였다. 1994년 3월부터 1995년 2월까지 국립서울 정신병원에서 입원치료를 받았던 DSM-IV 진단기준의 모든 정신분열병 환자와 1994년 3월부터 1996년 2월까지 역시 같은 병원에서 입원치료를 받았던 DSM-IV 진단기준의 모든 기분장애 환자중, 대상수의 문제로 망상형 정신분열병 52명과 양극성장애 1형 44 명을 최종 대상으로 하였다. 연구방법은 병록지를 검토하여 초발의 계절과 인구통계학적 인자와 임상적 인자를 조사하였다. 그리고 초발의 계절상과 초발 계절에 따른 인구 통계학적 인자와 임상적 인자의 차이를 알아보았다. 본 연구의 결과는 다음과 같다. 1) 망상형 정신분열병에서 초발의 계절적 특성이 없었다. 2) 양극성 장애 1형에서의 초발은 봄에 절정을 이루는 계절적 특성을 보였다. 3) 양극성장애 1형중, 조중 삽화로 초발한 경우에는 초발의 계절성을 찾을 수가 없었다. 4) 양극성 장애 1형에서 첫 조증 삽화에서는 통계적으로 유의하지 않았으나 봄과 여름에 발병이 많은 경향을 보였다. 5) 망상형 정신신분열병 양극성 장애 1형에서 초발 계절에 따른 인구통계학적 인자와 임상적 인자의 차이를 발견할 수 없었다. This study aimed 1) at determining the seasonal pattern of the first onset and 2) at examining different demographic and clinical factors by the seasonality of first onset, forshizophrenia, mood disorder and subtypes of each diagnosis. Finally, the 52 subjects with paranoid schizophrenia were selected from all patients who fulfilled DSM-IV criteria for schizophrenia who had been admitted to the National Seoul Mental Hospital from March 1994 to February 1995. And the 44 subjects with bipolar I disorder were selected from all patients who fulfilled DSM-IV criteria for mood disorder who had been admitted to the hospital from March 1994 to February 1996. This study was done by reviewing the hospital records about season of the first onset, demographic factors(sex, age, occupation, educated period, religion, marital status, residence and socioeconomic status) and clinical factors(age at the (first onset, duration of illness, family history, length of admission, frequency of admission and treatment result). The seasonal pattern of the first onset and the different demographic and clinical factors by the season of the first onset in paranoid shizophrenia and bipolar I disorder were analyzed. The results were as follows : ' 1) There was no significant seasonal variation of the first onset for paranoid schizophrenia. 2) There was a significant seasonal variation of 7he first onset with a maximum in spring for bipolar I disorder. 3) There was no significant seasonal variation of the first onset in the case of bipolar I disorder that began with the manic episode. 4) There was nonsignificant seasonal tendency to peak in spring/summer in the case of the first manic episode for bipolar I disorder. 5) There were no significant differences in demographic and clinical factors by the season of the first onset for paranoid schizophrenia and bipolar I disorder.

양극성 장애에서 1형과 2형 환자 간의 임상 양상 비교

백지현,박동연,박해정,최정미,최지선,노지혜,이동수,홍경수 대한신경정신의학회 2009 신경정신의학 Vol.48 No.4

Objectives Whether bipolar II disorder (BP-II) is simply a milder form of bipolar I disorder (BP-I) or a valid diagnostic category that could be separated from BP-I, is an issue still under consideration. Investigations exploring differential clinical and biological features of the two conditions are needed to resolve the controversies. This study aimed to obtain a comprehensive view of differences in clinical course and symptoms characteristics between BP-I and BP-II. Methods 44 BP-I and 26 BP-II patients were assessed using the Diagnostic Interview for Genetic Studies (DIGS), Korean version. Demographic data, age at onset, number of (hypo) manic/ depressive episodes, the duration of illness, polarity at onset, seasonality, rapid cycling, atypical depression and symptom profiles of each episode were evaluated. Results BP-II patients experienced depressive episodes more frequently than BP-I patients after illness onset (U=240.5, p=0.008). More BP-II patients showed seasonality (34.9% vs. 61.5%) and a rapid cycling course (4.5% vs. 18.2%). When comparing symptom profiles of manic/hypomanic episodes, irritable mood, decreased sleep need, inattention, reckless behavior, arrogant/provocative attitude and frequent outbursts of anger were less encountered in BP-II patients. In depressive episodes, leaden paralysis and psychomotor agitation were more frequently observed in BP-II patients. There was no significant difference between the two groups in psychotic symptoms of depressive episode. Conclusion BP-I and BP-II disorders showed differences in clinical courses and symptom profiles. BP-II disorder seems to be less severe than BP-I disorder with regard to the intensity of manic symptoms, but more severe with respect to frequencies of depressive episodes. These results provide additional evidence supporting the distinction of BP-I and BP-II as separate diagnos-tic categories that might have different genetic profiles and/or biological mechanisms. 본 연구는 1형 양극성 장애 환자와 2형 양극성 장애 환 자에서 직접 면담을 통해 광범위한 증상 및 질병 경과를 평가하여 비교하였다. 그 결과, 2형 양극성 장애는 1형 양 극성 장애에 비해 우울 삽화의 재발이 더 잦았고, 급속 순환 형과 계절적 주기성을 보이는 비율도 더 높았다. 두 군은 또한 (경)조증 삽화 및 우울 삽화에서 나타나는 증상 양상 에 있어서도 차이를 보였다. 이러한 결과는 향후 원인론적, 치료적 접근에 있어서 1형과 2형 양극성 장애를 독립된 대 상으로 접근하는 것이 타당할 수 있음을 시사해 주었다.

제 1 형 양극성 장애 입원 환자에서 비정형 항정신병약물의 사용:자연적 연구

박원명,배치운,채정호,이정국,전태연,김광수,유태열 대한신경정신의학회 2001 신경정신의학 Vol.40 No.6

연구목적: 본 연구는 제 1 형 양극성 장애 입원 환자에서 자연적인 치료 환경하에서 risperidone과 olanzapine의 효능 및 안전성 등을 평가하기 위하여 시도되었다. 방 법: 제 1 형 양극성장애로 진단되어 기분안정제와 함께 risperidone 혹은 olanzapine이 1개월 이상 병합투여된 입 원환자 56명을 대상으로 의무기록을 검토하여 인구학적 자료, 약물학적 자료, 효능 및 안전성 등을 평가하였다. 결 과: CGI와 GAF 점수에 따른 제 1 형 양극성 장애에 대한 risperidone과 olanzapine의 효능은 두 약물간 차이 가 없었으나 부작용 측면에서 서로 다른 성상을 보였다. 결 론: 제한적이기는 하지만 risperidone과 olanzapine은 모두 자연적인 통상적 입원 치료 상황하에서 제 1 형 양 극성 장애 환자들에게 효과적으로 사용할 수 있는 약물이었다. 향후 제 1 형 양극성 장애에서 이들 약물의 효 능과 안정성에 대한 보다 체계적이고 통제된 모형의 전향적인 연구가 이루어져야 하겠다. Objectives:This study was conducted to evaluate the prescription patterns, overall efficacy, and safety of atypical antipsychotics for inpatients with bipolar I disorder. Methods:Inpatients with bipolar I disorder, who had received adjunctive treatment with olanzapine or risperidone, beyond 1 month, along with mood stabilizers were selected for a retrospective study. The charts of those patients(N=56) were reviewed for the details of efficacy, safety, and other pharmacological variables of the two drugs. Results:Olanzapine and risperidone showed equivalent efficacy by the evaluation in accordance with clinical global impression scale(CGI) and global assessment of functioning scale(GAF) score. Different side effect profiles were noted between two drugs. Conclusion:These limited results suggested that the efficacy and safety of risperidone and olanzapine were similar for the treatment of inpatients with bipolar I disorder. Prospective controlled study for efficacy and safety of risperidone and olanzapine in the treatment of bipolar I disorder should be conducted in future

제1형 양극성 장애와 Lymphotoxin Alpha 유전자 단일염기 다형성 연관 연구

김상하,전태연,Kim, Sang-Ha,Jun, Tae-Youn 대한생물정신의학회 2012 생물정신의학 Vol.19 No.3

Objectives : Proinflammatory process has been implicated as an underlying mechanism of bipolar disorder and schizophrenia. Previous studies have suggested a possible role of lymphotoxin alpha (LTA) gene in the development of schizophrenia and have prompted further investigation in bipolar patients. Association of the LTA +252A/G polymorphism with susceptibility to bipolar I disorder itself as well as with vulnerability among a subset of psychotic bipolar patients were tested. Methods : DNA extraction was done by a standard method and genotyping was carried out by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in 114 Korean patients with bipolar I disorder and 202 healthy controls. SPSS v18.0 was used for statistical analysis. Comparisons of the genotype and allele distributions in LTA +252A/G polymorphism were made using a chi-square test. The genotype and allele associations were also evaluated using odds ratio (OR) and 95% confidence interval (CI). Statistical significance was accepted when p was < 0.05. Results : No significant association was found between the LTA +252A/G polymorphism and bipolar disorder. However, LTA +252G allele was present with significantly higher frequency among bipolar patients with psychotic features compared to those without (${\chi}^2$ = 4.69, p = 0.034, OR = 2.495, 95% CI = 1.069-5.827). Conclusion : The results suggest that the allele LTA +252G of the polymorphism may be associated with the psychotic subset of bipolar disorder but not with bipolar I disorder itself. Adequately powered subsequent studies should be conducted.

양극성장애 I형의 장기적인 경과 및 순환 형태

이황빈,임선진,유남희 대한우울조울병학회 2014 우울조울병 Vol.12 No.3

Objectives: We evaluated the clinical characteristics, longitudinal courses and the cycle-length patterns of patients with bipolar I disorder. Methods: We assessed one hundred twenty patients (n=120) with bipolar I disorder by retrospective medical records review. Single manic, continuous and rapid cycling courses were excluded. Results: There were some differences in longitudinal course of patients with bipolar I disorder according to gender and the index episode. Manic onsets were more frequent in men (53.4%), whereas depressive onsets were more frequent in women (51.6%). The age of onset in mixed or hypomanic onset group (16.0±0 yrs, 20.0±2.4 yrs) were younger than in manic (24.6±7.3 yrs) or depressive (25.7±7.5 yrs) onset group. Initial manic episode was more related to later mania, whereas initial depressive episode was more related to later depression. Consistent findings of progressive shortening of cycle were not observed. Conclusion: The type of the index episode appears to have gender-related clinical differences. Age of onset is different according to the index episode. The index episode seems to influence the predominant polarity of the bipolar I disorder in each individual patient. The cycle-length patterns were not progressive cycling over time, nor gradual lengthening in later episodes in this study.

양극성장애 1형과 2형 환자의 임상양상 중 우울증상을중심으로 한 비교 : 예비 연구

김인우,우영섭,전태연,김광수,박원명 대한우울조울병학회 2013 우울조울병 Vol.11 No.3

Objectives : Bipolar I Disorder (BD I) and Bipolar II Disorder (BD II) may differ in symptomatology, management and prognosis. This study aimed to examine the differences in clinical features between BD I and BD II during their depressive episodes for distinguishing between these two conditions. Methods : Patients with BD I (n=79) and BD II (n=39) were included, based on DSM-IV-TR criteria. The data about demographics, clinical features, depressive symptoms and comorbid conditions were collected through medical records retrospectively. We used t-tests and chi-square analyses for a comparison of means. And for variables found to be significant, a multivariable logistic regression was done. Results : Patients with BD II were more likely to be unemployed and more frequently accompanied by comorbid personality disorder. When comparing clinical features of depressive episodes, irritability, indecisiveness, weight gain and hypersomnia were more frequently observed in patients with BD II. In the regression analysis, variables predictive of BD II were irritability and indecisiveness. Conclusion : Patient with BD I and BD II showed some different clinical features during depressive episodes. Our results may provide additional evidence supporting the distinction of BD I and BD II.

Quetiapine 치료 중 발생한 무증상 갑상선 기능저하증 1례

나경세,김용구,Na, Kyeong-Sae,Kim, Yong-Ku 대한생물정신의학회 2007 생물정신의학 Vol.14 No.1

Quetiapine is an atypical antipsychotic drug with a benign side effect profile. However, recent studies have reported that thyroid dysfunction is associated with quetiapine treatment. The authors report a patient with DSM-IV bipolar I disorder who developed subclinical hypothyroidism during quetiapine treatment. The patient showed no significant clinical symptoms, but only abnormal thyroid function test findings including antithyroglobulin antibody. The abnormal thyroid function test findings were normalized after discontinuation of quetiapine. The subclinical hypothyroidism developed during quetiapine treatment may be associated with autoimmune process.