이중진단을 가진 알코올 의존 환자들의 임상적 특성(II)

성상경(Sang-Kyung Sung):문석우(Seok-Woo Moon):강지언(Gi-Eun Kang),이규항(Kyu-Hang Lee) 한국중독정신의학회 2001 중독정신의학 Vol.5 No.1

Objectives:Abuse of alcohol or drugs can induce, or can result from psychiatric disorders. Any substance of habituation has psychotoxicity and can induce psychiatric symptoms. These symptoms usually disappear after the effect of the substance terminates, but the symptoms can be continued permanently. It is well known that depression, anxiety disorder, and personality disorder very often come together with the alcohol dependence. Therefore, we have selected groups having extra-psychopathology from alcohol dependence patients, and compared their clinical characteristics with patients of alcohol dependence only, to use the characteristics in the therapy. Methods:Among patients hospitalized in a mental hospital from Feb.-June of 1999 for the problem of alcohol dependence, patients diagnosed as alcohol abuse/dependence and dual diagnosis by DSM-Ⅳ were evaluated by the methods of chart review, the questionnaire of demographic characteristics, drinking history, past therapy history, family history, NAST and CAGE. Results:1)Among 179 patients diagnosed to be alcohol dependent during the period, 59 patients (33%) were dually diagnosed and their average age was 42.5±8.5, and 120 patients (67%) were diagnosed to be alcohol dependence only and their average age was 45.6±9.6. In the case of dual diagnosis, the average age diagnosed as alcohol dependence was earlier. The men/women ratio was 169 men:10 women (94.4%:5.5%). Age of first drinking was 20.3 in dually diagnosed patients and 21.2 in alcohol dependence only patients. Therefore, they started drinking in early 20s in both cases. 2) There were notable differences between them in drinking amount, self- recognition of dependence, the number of suicide attempts. 3) There were no statistical significances between them in age of first drinking, drinking period, age of withdrawal symptom experience, preference of alcohol beverage, therapy history, and demographic characteristics except age and gender Though there was no statistical significance in NAST score and the total number of questions of NAST and CAGE, the score and the total number in dual diagnosis were higher than the alcohol dependence only. This result indicates that the dually diagnosed patients recognize symptoms more seriously, and they are high risk group. Conclusions:The dually diagnosed patients among alcohol dependent patients showed higher level of self-recognition, higher score of NAST and CAGE, more number of therapy (recurrence), earlier onset age of alcohol dependence, less average drinking amount, and more suicide attempts. It is therefore believed that the dually diagnosed patients are higher risk group compared to the patients of alcohol dependence only, and it is required to do intensive evaluation and carefully designed therapy.

한국인 남성 알코올 의존증에서 나타난 도파민 D2 수용체의 대립유전자형 빈도

이종섭(Jong Sub Lee),오미희(Mee Hee Oh),이창훈(Chang Hoon Lee),송경순(Kyoung Soon Song),배종훈(Jong Hoon Bae),기선완(Sun Wan Ki),이홍식(Hong Shick Lee),유계준(Kae Joon You) 한국중독정신의학회 1997 중독정신의학 Vol.1 No.1

Dopamine D2 receptor(DRD2) gene is known to have a strong effect on susceptibility of alcohol dependence and to play an important role on appetite such as alcohol seeking behavior. It is known that alcohol induces excitatory effects on dopamine neurons and stimulates brain reward systems by which man craves euphorogenic reward effect of drug(such as alcohol). And it has been suggested that DRD2 has a direct role on alcohol seeking behavior. This study investigated polymorphic patterns of DRD2 gene of Korean male alcohol dependence by restriction fragment length polymorphism(RFLP) and associations of Korean character traits with susceptibility on alcohol. Also, this study examined allelic association of DRD2 gene in various chara cteristics and alcohol-related of alcohol dependence. Subjects of this study consisted of 71 patients with alcohol dependence and 139 healthy male subjects without alcohol dependence for the study of allelic association of DRD2 gene in Korean male alcohol dependence. Allelic association of DRD2 gene between two groups was tested by chi-square test, and those in severity and family history of alcohol dependence, age onset of alcohol drinking, and duration of alcohol drinking history were tested by ANOVA and t-test. The results were as followings; 1) A1A1, A1A2, A2A2 genotype frequency of DRD2 gene in Korean male alcohol dependence were 19.7%, 29.6%, 50.7% and those of control group were 15.8%, 51.8%, 33.1%. There was statistically significant difference between two groups. 2) Ratios of Korean male alcohol dependence with and without A1 allele were 0.49, 0.51 respectively, and those of control groups were 0.67, 0.33 respectively. The difference between two groups were statistically significant. But the difference between two groups on ratio of presence of A2 allele was not statistically insignificant. 3) A1 and A2 allelic frequencies of Korean male alcohol dependence were 0.35 and 0.65 and those of control group were 0.42, 0.58 respectively. So there was no evidence of DRD2 A1 allelic association in Korean alcohol dependence. 4) According to Diagnostic Criteria of National Council on Alcoholism(NCA) on severity alcohol dependence, the genotype of the most severe alcohol dependence was A1A1. on the other hand, the less severe type was A1A2, and the least severe type was A2A2. And A1 and A2 allele frequency of severe alcohol dependence were 0.46 and 0.54 respectively and those of less severe alcohol dependence were 0.18 and 0.72 respectively. Therefore, there was allelic association of DRD2 gene in severity of Korean male alcohol dependence. 5) There were statistically significant differences among subgroups with A1A1, A1A2, A2A2 genotypes on scores of NCA in total patients with alcohol dependence and also significant differences between patients with alcohol dependence with and without A1 allele on scores of NCA. Therefore, there was statistically significant possibility in allelic association of DRD2 gene in NCA scores of patients with alcohol dependence. 6) There were no allelic associations of DRD2 gene in the variable characteristics(age, family history of alcohol dependence, onset age of alcohol drinking, and onset age of alcohol problems). 7) In comparing A1 allelic frequencies of DRD2 gene in this study with those in other studies on various populations, there were no differences statistically among Asians in controls and statistically significant differences, however, in other populations elsewhere. And there were also higher in A1 allelic frequencies in Korean and Japanese with alcohol dependence than the whites. In summarizing above results, there was no allelic association of DRD2 gene in Korean male alcohol dependence, but there was the possibility of A1 allelic association in severity of alcohol dependence. So this study implied that Korean alcohol dependence were influenced by extenal factor like severity of alcohol dependence rather than genetic factor. Therefore

입원한 알코올의존환자의 성격 기질 특성과 음주 특성, 그리고 금주 동기에 대한 연구

김진현(Jin Hyeon Kim),이덕기(Duk Ki Lee),정봉주(Bong Joo Jung),박영민(Young Min Park),김성곤(Sung Gon Kim) 한국중독정신의학회 2012 중독정신의학 Vol.16 No.1

Objectives : The purpose of this study is to investigate personality traits, investigate differences in onset times between the sexes, and compare schizophrenic patients with alcoholic patients using TCI. And we examined the correlation between TCI and drinking characteristics, and TCI and motivational status for abstinence. Methods : We enrolled 169 alcohol de-pendent patients (118 males, 51 females) by DSM-IV criteria, and 86 stable schizophrenic patients (42 males, 44 females) for the control group. We used TCI, SCL-90, AUI, URICA as a self reported questionnaire. We compared the score of those questionnaires of the early onset group with that of the late onset group in the alcohol dependent group. Results: 1) The mean values of Novelty Seeking (NS) and Reward Dependence (RD) were significantly higher in the alcohol dependent group than in the control group (schizophrenic patients). 2) In the alcohol dependent group, the early onset group had significantly higher Novelty Seeking (NS) and Self Directedness (SD) but lower Harm Avoidance (HA) than the late onset group. 3) The mean value of Novelty Seeking (NS) in female alcohol dependent patients was significantly higher than in male patients in the early onset group, and the mean value of NS in females was significantly lower than in males in the late onset group. 4) The mean value of Harm Avoidance (HA) was higher in female alcohol de-pendent patients than in the male patients group, and the late on-set group had a higher mean value than the early onset group. 5) Harm Avoidance (HA) had negative correlation with ‘anxiety related to drinking’, and Reward Dependence (RD) and Cooperativeness (CO) had positive correlation with ‘acknowledgement and awareness of use problem’. 6) The patients with lower Reward Dependence (RD) and Cooperativeness (CO) were included in the lower motivation group. Conclusion : The alcohol dependent patient group was more impulsive and intemperate, and had a stronger tendency to pursue new things than the schizophrenic patient group. Especially, female alcohol dependent patients had a higher tendency to seek stimulation, so they drink alcohol more impulsively, resulting in higher risks of acquiring alcohol-dependence problems earlier than the male alcohol dependent patient group. On the other hand, females who had anxiety and higher avoidant tendency acquired alcohol dependence later in life. Reward Dependence (RD) and Cooperativeness (CO) were related with patient’s motivation, so it will affect the prognosis of the treatment.

한국인 알코올 의존 환자에서 알코올 대사 효소 유전자형 빈도의 남녀 차이

김성곤,김철민,이덕기,황인복,이현숙,김성연,전은숙,송영상,박제민,최병무,김명정 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.2

Objectives : There are a number of preceding epidemiological studies reporting gender differences in the genetic etiology of alcohol dependence. The author investigated gender difference in the frequencies of ADH2 and ALDH2 genoypes between the patients with alcohol dependence and normal control. Methods : The subjects were 141 alcohol dependent patients (104 males, 37 females) and 138 normal control (79 males, 59 females). The frequencies of 1/1 and 1/2+2/2 (2+ afterward) genotypes for ADH2 and ALDH2 were investigated in male and female between alcohol dependence and normal control group. DNA was extracted from WBC in peripheral venous blood and PCR-RFLP method was used out for genotyping. Results : First, the frequency of ADH2 1/1 genotype was significantly higher in alcohol dependent patients than normal control in both genders. Second, while there was no gender difference in the frequency of ADH2 1/1 genotype in normal controls, in the patient group however, the frequency was significantly higher in females than males. Third, in male subjects with alcohol dependence, the frequency of ALDH2 1/1 genotype was significantly higher than in male normal control subjects. On the other hand, in female subjects with alcohol dependence, the frequency of ALDH2 2+ genotype was significantly higher than in female normal control subjects. Conclusion : These results suggest that while the risk of alcohol dependence is predominantly affected by ALDH2 1/1 geno-type in male, the female ADH2 1/1 genotype is mainly associated with the risk of alcohol dependence. This means that there are gender differences in the genetic etiology of alcohol dependence.

Sociodemographic Factors and Comorbidities Associated with Remission from Alcohol Dependence: Results from a Nationwide General Population Survey in Korea

한송이,조맹제,원승희,홍진표,배재남,조성진,박종익,이준영,전홍진,장성만 대한신경정신의학회 2015 PSYCHIATRY INVESTIGATION Vol.12 No.3

ObjectiveaaThe lifetime prevalence of alcohol dependence in South Korea remains higher than other countries. The aim of our study is to identify factors associated with remission from alcohol dependence. MethodsaaData from the Korean Epidemiological Catchment Area-Replication (KECA-R) study were used in our study. The Korean version of the Composite International Diagnostic Interview 2.1 (K-CIDI 2.1) was administered. Remission was defined as having no symptom of alcohol dependence for 12 months or longer at the time of the interview. Demographic and clinical variables putatively associated with remission from alcohol dependence were examined by t-test, chi-square-test and logistic regression analysis. ResultsaaThe lifetime prevalence rate of alcohol dependence was 7.0%. Among them, 3.2% of the subjects were diagnosed with active alcohol dependence in the previous 12 months, and 3.8% were found to be in remission. Subjects in 35- to 44-year-old group, not living with partner group, and lower level of educational attainment group were more likely to be in the active alcohol dependence state. Of the comorbid mental disorders, dysthymia, anxiety disorder, nicotine use, and nicotine dependence were more common among the actively alcohol-dependent subjects. ConclusionaaThere is considerable level of recovery from alcohol dependence. Attention to factors associated with remission from alcohol dependence may be important in designing more effective treatment and prevention programs in this high-risk population.

Relationship between Alcohol Dependence and Depression of Alcohol Dependent Inpatients

보안공학연구지원센터(IJBSBT) 보안공학연구지원센터 2015 International Journal of Bio-Science and Bio-Techn Vol.7 No.5

The purpose of this study was to provide essential data for treatment by analyzing the characteristics of patients with alcohol dependence and the relationship between depression and alcohol dependence. The subjects were 58 patients with alcohol dependence aged 20–70 in a psychiatric hospital. The Alcohol Dependence Scale (ADS) and Beck Depression Inventory (BDI) were used as assessment tools. The collected data were analyzed using SPSS WIN 21.0: a one-way ANOVA was conducted to examine differences in alcohol dependence contingent on the degree of depression and a Pearson's correlation coefficient was calculated to determine the relationship between depression and alcohol dependence. According to the study results, the majority of participants were in their 40s or younger; 35 participants (60.3%) were high school graduates and 19 participants (32.8%) earned more than 2 million won and less than 4 million won. There were significant positive correlation between depression and alcohol dependence (r=.283, p= .031). Alcohol dependence was significantly higher as the degree of depression increased: normal (16.67±13.99), mild depression (18.40 ±11.55), moderate depression (28.00 ± 17.74) (F= 3.99, p= .024). In conclusion, those with severe depression were highly dependent on alcohol and intervention for depression should be incorporated into future treatment for more effective alcohol disease management.

Two Alcoholisms: Abuse And Dependence: Nosology issues from the Epidemiological studies of Alcoholism in Korea

YoungChul Jung,Kee Namkoong 대한신경정신의학회 2005 PSYCHIATRY INVESTIGATION Vol.2 No.1

This article, (1) reviews nosological issues of the distinction between alcohol abuse and alcohol dependence; (2) discusses the Korean epidemiological trends of alcohol abuse and alcohol dependence. Psychiatric epidemiological studies of Korean population that provided clues to the validity and cross-cultural applicability of alcohol abuse and alcohol dependence were reviewed. Alcohol use disorder has been the most common mental disorder in Korea. However, during the last 20 years, the prevalence rates of the two alcohol use disorders have grown in opposite directions. The lifetime prevalence rate of alcohol abuse has fallen from 12.06% to 7.11%, conversely, the lifetime prevalence rate of alcohol dependence has slightly increased from 9.92% to 10.20%. Nosological issues, such as the vulnerability of alcohol abuse to social environments, the hierarchical structure of the DSM-IV and the prevailing Korean concepts of abuse and dependence, were reviewed as factors to be considered in explaining these findings. Alcohol dependence outranks alcohol abuse and is now the main alcohol use disorder in Korea. But, there are still nosological issues that need to be assessed and considered, such as the validity of alcohol dependence in subpopulations and the heterogeneity of the DSM-IV alcohol dependence category.

알코올 의존 환자에서 혈청 아질산염 농도와 일부 생물학적 지표와의 관련성

최인근(Ihn-Geun Choi),신형직(Hyong-Jik Shin),송동근(Dong-Keun Song),고재광(Jae-Kwang Koh),김상국(Sang-Kook Kim),손현균Hyun-Gyun Son),서국희(Guk-Hee Suh) 한국중독정신의학회 2003 중독정신의학 Vol.7 No.2

Objective:Nitric oxide (NO) has been known to be associated with tolerance and preference to alcohol. It has also been known to affect various alcohol drinking behavior, alcohol withdrawal symptoms, and the alcohol-induced brain damage. The purpose of this study was to determine the difference between alcohol dependence group and healthy control group in concentration of the nitrite, a stable metabolite of NO, and it’s relationship to clinical and biochemical markers of alcohol dependence. Methods:Thirty-four subjects diagnosed as alcohol dependence according to DSM-IV diagnostic criteria were evaluated for the clinical characteristics and biochemical markers of alcohol dependence when their CIWA-Ar scores had reached zero after the alcohol withdrawal treatment with benzodiazepine. Thirtyfour healthy controls were also evaluated. Clinical characteristics were evaluated by CAGE and AUDIT questionnaire. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT) and mean corpuscular volume (MCV) were used as the biochemical markers of alcohol dependence. Serum nitrite concentrations were measured by Griess reaction. Results:1) The concentrations of nitrite in alcoholics were not different from those in the controls. 2) There were no significant associations between the nitrite concentration and the clinical and biological markers of alcohol dependence. 3) There was a negative correlation between the nitrite concentration and the days after last drink. Conclusion:These findings suggest that NO may be neither a causative agent nor trait marker of alcohol dependence. Rather, NO may be a state marker of recent alcohol drinking and alcohol withdrawal.

제주도 농촌지역 주민들의 음주습관과 우울증상 및 스트레스

김문두 대한신경정신의학회 2004 신경정신의학 Vol.43 No.1

Objectives:Stress has been known as one of the main reasons for drinking. Depression also is a risk factor for people to have alcohol related problem. Despite of high correlation between depression and stress, little study has been done to see the simultaneous effect of depression and stress to alcohol dependence. We tried to investigate the prevalences of depressive symptom, stress and alcohol dependence among Jeju rural population. Also, we have tried to find a relationship of alcohol dependence with depressive symptom and stress. Methods:The study subjects were 1,086, 531 (48.9%) male and 555 (51.1%) female living in rural Jeju area. We collected data through face-to face interviews in 2002. With the data we investigated the prevalences of alcohol dependence, depression and stress using CAGE, Alcohol use disorder identification test (AUDIT), Beck Depression Inventory (BDI), and Psychosocial Well Being Index Short Form (SF-PWI). Results:1) The prevalence of alcohol dependence in rural Jeju area is 22.3% in male, 3.6% in female. The prevalence of depressive symptom is 14.9% in male, 18.4 in female. The prevalence of moderate distress is 70.8% in male, 67.5% in female. The prevalence of severe distress is 16.7% in male, 26.7% in female. 2) In relationship between stress and alcohol dependence, odds ratio of moderate distress is 7.76 (95% CI 1.86-32.35), severe distress is 17.29 (95% CI 3.95-75.60) in male, and the odd ratio of depressive symptom is 2,96 (95% CI 1.12-7.84) in female. 3) Multiple logistic regression analysis showed that the risk factors for male alcohol dependence were potential stress (OR=8.15 95% CI 1.91-34.65), and stress risk (OR= 22.47 95% CI 4.86-103.704). The risk factor for female alcohol dependence was depressive symptom (OR=3.42 95% CI1.10-10.56). Conclusion:Compared with national survey result, the prevalence of alcohol dependence in rural Jeju area is relatively low. Stress in male, depressive symptom in female proved to be strong risk factors. This suggests that we can apply coping strategies to stress in male alcoholics, and treat depression in female alcoholics for improving their mental health.

알코올 의존에 따른 니코틴 의존과 수면의 질

김현숙(Hyun-Sook Kim),김정우(Jung Woo Kim),남기혁(Gi Hyeok Nam),민성호(Seongho Min),고상백(Sang-Baek Koh),김태희(Tae Hui Kim) 대한사회정신의학회 2018 사회정신의학 Vol.23 No.2

연구목적 : 비흡연자에 비해 흡연자에서 주관적 수면의 질은 저하되어 있다. 니코틴 의존과 수면 질 사이의 상관성에 대한 연구는 제한적이며, 특히 알코올 의존에 따라 비교된 연구도 거의 없다. 이 연구의 목적은 1) 니코틴 의존 특성, 2) 니코틴 의존과 수면의 질 사이의 연관성, 3) 알코올 의존에 따른 니코틴 의존과 수면 질 사이의 연관성을 살펴보고자 한다. 방 법 : 한 지역의 집중 금연 캠프 프로그램에 참여한 193명의 남성 흡연자를 대상으로 하였다. 니코틴 의존의 정도는 Korean Nicotine Dependence Syndrome Scale (이하 NDSS) 로 측정하였으며, NDSS는 ‘추동(Drive)’, ‘우선순위(Priority)’, ‘연속성(Continuity)’, ‘내성(Tolerance)’, ‘정형성(Stereotype)’의 5개 하위 척도로 구성되어 있다. 수면의 질은 Korean version Pittsburgh Sleep Quality Index(이하 PSQI)로 측정하였다. Korean version of Alcohol Use Disorder Identification Test(이하 AUDIT)를 통해 정상 음주군과 알코올 의존군으로 나누어 비교하였다. 니코틴 의존과 수면 질 사이의 연관성은 상관 분석을 하였으며, 연령, 체질량지수, 신체 질환, 알코올 의존, 스트레스를 보정하여 로지스틱 회귀 분석을 시행하였다. 결 과 : 정상 음주군(108명)과 알코올 의존군(85명)의 평균 연령은 58.66±10.29세, 53.45±10.22세였다(p=0.0006). 알코올 의존군은 수면 잠복기가 더 길었으며(1.40±0.87 vs 1.71±0.91, p=0.018), 더 자주 수면 약물을 사용하였다(0.40±0.91 vs 0.13±0.53, p=0.011). 전체 대상자에서 NDSS와 PSQI 사이 유의한 상관성을 보였다(r=0.229, p=0.001). NDSS 하위척도 중 ‘추동’(r=0.185, p=0.01), ‘우선 순위’(r=0.196, p=0.0006), ‘연속성’(r=0.16, p=0.026), ‘내성’(r=0.203, p=0.005) 이 PSQI와 유의한 상관성을 보였다. 그러나 알코올 의존군에서는 NDSS 총점, NDSS 하위 척도와 PSQI 사이 상관성을 보이지 않았다. 로지스틱 회귀 분석시, 전체 대상자와 정상 음주군에서 NDSS 총점과 ‘우선순위’와 ‘내성’ 하위 척도는 PSQI에 영향을 미쳤다. 결 론 : 정상 음주군과 알코올 의존군의 흡연자들에서 수면의 질 저하를 관찰할 수 있었지만, 니코틴 의존과 수면 질 저하의 관련성은 정상 음주군에서만 관찰할 수 있었다. 특히 정상 음주군에서는, 니코틴 의존의 치료 또는 금연이 주관적 수면의 질을 향상시킬 수 있을 것이다. Objectives : Subjective quality of sleep is impaired in smokers compared with non-smokers, but the association between nicotine dependence (ND) and sleep quality (SQ) has not been well-characterized, especially according to alcohol dependence. The objective of this study was to describe 1) the nicotine dependence characteristics, 2) the associations between ND and SQ and 3) the associations between ND and SQ according to alcohol dependence. Methods : We recruited 193 male smokers who had participated in one area’s intensive smoking cessation program. The severity of nicotine dependence was measured with Korean Nicotine Dependence Syndrome Scale (NDSS), which collects data on five subscales including : 1) drive ; 2) priority ; 3) continuity ; 4) tolerance ; and 5) stereotype. To evaluate subjective sleep quality in smokers, Korean version Pittsburgh Sleep Quality Index (PSQI) was used. We divided the group of smokers into the Non-alcohol dependence (NAD) group and the Alcohol dependence (AD) group by Alcohol Use Disorder Identification Test (AUDIT). Associations between ND and SQ were examined in correlation analysis and logistic regression analyses controlling for age, BMI, clinical illness, alcohol dependence, and perceived stress. Results : The mean age of the NAD group (n=108) and the AD group (n=85) was 58.66±10.29 and 53.45±10.22 years (p=0.0006). The AD group had longer sleep latency (1.40±0.87 vs 1.71±0.91, p=0.018) and frequent use of sleep medicine (0.40±0.91 vs 0.13±0.53, p=0.011). The whole participants had significant correlation between the NDSS and the PSQI (r=0.229, p=0.001). Among the NDSS’s subscales, the drive (r=0.185, p=0.01), the priority (r=0.196, p=0.0006), the continuity(r=0.16, p=0.026), and the tolerance (r=0.203, p=0.005) was significantly correlated with the PSQI. However, the AD group had not significant correlation between the NDSS, NDSS’s subscales and the PSQI. Using the logistic regression analysis, the NDSS’s total score, the priority and the tolerance had significant effect on PSQI in the whole participants and the NAD group. Conclusion : Although both NAD and AD group smokers had poor sleep quality, nicotine dependence are associated with poor sleep quality in the NAD group. Treatment of nicotine dependence or quitting smoking may improve subjective sleep quality especially in non-alcohol dependence people.