Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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Melatonin for Treatment of Delirium in Hospitalized Patients : Retrospective Trial

입원 환자의 섬망 치료에서 멜라토닌의 효과에 관한 후향적 연구

  • Yang, Jung Woo (Department of Psychiatry, Kyung Hee University Hospital) ;
  • Kim, Jong Woo (Department of Psychiatry, Kyung Hee University Hospital) ;
  • Kang, Won Sub (Department of Psychiatry, Kyung Hee University Hospital) ;
  • Lee, Sang Min (Department of Psychiatry, Kyung Hee University Hospital) ;
  • Kim, Young Jong (Department of Psychiatry, Kyung Hee University Hospital) ;
  • Paik, Jong-Woo (Department of Psychiatry, Kyung Hee University Hospital)
  • 양정우 (경희대학교병원 정신건강의학과) ;
  • 김종우 (경희대학교병원 정신건강의학과) ;
  • 강원섭 (경희대학교병원 정신건강의학과) ;
  • 이상민 (경희대학교병원 정신건강의학과) ;
  • 김영종 (경희대학교병원 정신건강의학과) ;
  • 백종우 (경희대학교병원 정신건강의학과)
  • Received : 2018.09.03
  • Accepted : 2018.10.04
  • Published : 2018.12.31
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Abstract

Objectives : Delirium is one of the most common mental illnesses that can affect cognitive function. Melatonin has been shown to be effective in the treatment of insomnia, and recent studies have shown a protective effect to prevent delirium. This study was conducted to investigate the efficacy of melatonin in delirium patients. Methods : All patients were referred to psychiatric department for insomnia and symptoms of delirium, and were diagnosed delirium by the DSM-5 diagnostic criteria. We compared base line severity of delirium with K-DRS-R-98-R (Korean version of Delirium Rating Scale revised 98) and after taking 2mg of melatonin, retrospectively. The side effects were also identified by referring to the medical records. Results : A total 21 patients had taken melatonin for insomnia and delirious symptoms. The K-DRS-R-98 scores were decreased from $15.24{\pm}2.64$ before treatment to $6.57{\pm}5.42$ after treatment. And CGI-S scores were also decreased from $4.14{\pm}0.48$ before treatment to $2.81{\pm}0.93$ after treatment (p<0.05). Conclusions : This study illustrates the possibility of melatonin as an effective treatment option for delirious symptoms such as disorientation, motor agitation, lability of affect and hallucinations as well as insomnia, with less concerns of drug side effect. Further study with a larger sample and prospective design will be required to confirm these results.

연구목적 섬망은 신체 질환과 같은 기저 의학적 상태의 변화에 의해 나타나는 뇌의 기능장애로 환자의 사망률을 높이고 치매의 위험도를 높이는 등 불량한 예후와 연관되어 있다. 기존 섬망의 치료에 주로 사용된 항정신병약제는 치료 효과에 대한 논란이 있으며 추체외로 부작용 등에 대한 우려가 있다. 따라서 수면 주기 조절 및 섬망 예방효과가 있는 것으로 알려진 멜라토닌 투여를 통해 섬망 호전 정도와 안전성을 조사하고자 하였다. 방 법 불면을 동반한 섬망 증상으로 정신건강의학과에 진료 의뢰되어 멜라토닌 2mg을 투여 받은 환자를 대상으로 의무기록을 통해 섬망 증상의 초기 중증도 및 멜라토닌 투여 후의 섬망 증상 변화 여부를 한국판 섬망 평가척도-98 개정판(K-DRS-R-98)과 CGI-S를 통해 확인하였으며 부작용을 검토하였다. 결 과 총 21명의 환자가 불면을 동반한 섬망 증상으로 멜라토닌을 투여받았다. K-DRS-R-98 심각도 점수는 투약 전 $15.24{\pm}2.64$에서 투약 후 $6.57{\pm}5.42$로 감소하였으며 CGI-S 점수는 $4.14{\pm}0.48$에서 $2.81{\pm}0.93$로 감소하였다(p<0.05). 의무기록 상 부작용은 관찰되지 않았다. 결 론 약물의 기전 상 추체외로 증상과 QTc연장 등의 문제를 유발하지 않는 멜라토닌의 사용은 보다 안정성을 강화하면서 불면에 대한 효과와 함께 섬망을 효과적으로 치료할 가능성을 제시할 것으로 생각된다.

Keywords

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Fig. 1. Comparison of K-DRS-R-98 before and after treatment with melatonin in patients with delirium. p<0.05. K-DRS-R-98 : Korean version of Delirium Rating Scale-Revised-98, pre : pretreatment, post : post-treatment.

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Fig. 3. K-DRS-R-98 sub-scale change. Mean difference of K-DRS-R-98 subscale score from baseline over time after treatment. K-DRS-R-98 : Korean version of Delirium Rating Scale- Revised-98, pre : pre-treatment, post : post-treatment.

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Fig. 2. Comparison of CGI-S before and after treatment with melatonin in patients with delirium. p<0.05. CGI-S : Clinical Global Impression-Severity, pre : pre-treatment, post : posttreatment.

Table 1. Demographic data of patient with delirium

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Table 2. Comparison of K-DRS-R-98 severity score and CGI-S after treatment in patients with initial K-DRS-R-98 severity score was less than 16

JSSCBG_2018_v26n2_112_t0002.png 이미지

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