• 생물정신의학
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• 제4권2호
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• pp.272-278
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• 1997

Many investigators are trying to elucidate the pathogenesis of psychiatric disorders on the basis of neuroendocrine responses to stimulation or perturbation. Dexamethasone(DEX) suppression has been the most widely utilized as the prototypical challenge test. Dexamethasone suppression test(DST) has proven to be valuable in diagnosing the depressive spectrum disorder. Reported specificity of diagnosis of depression is relatively high, but sensitivity is limited. Some researchers used the combination of dexamethasone and corticotropin releasing hormone(CRH) in order to improve the sensitivity. They reported that combined DEX/CRH test is more sensitive than DST alone. In this study the authors modified the DEX/CRH test, i.e., we administered the insulin instead of CRH. Total subjects were 28(7 normal controls, 10 manic patients, 11 schizophrenic patients). Subjects were taken DEX(1.5mg p.o.) at 11 p.m., insulin 16 hours later(0.1 unit/kg i.v.). Five blood samples for the determination of cortisol and ACTH were serially drawn at 15 minute interval. The results are as followings : 1) The cortisol and ACTH levels of manic subjects increased following insulin administration. Manic subjects showed higher levels of cortisol and ACTH than schizophrenic and normal control subjects. The cortisol and ACTH levels of schizophrenic and normal control subjects did not show gross changes. 2) The sensitivity of the test was lower than that of reported DEX/CRH test.

• 생물정신의학
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• 제1권1호
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• pp.109-116
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• 1994

연구배경: 정신분열증 환자에서 보이는 인지기능의 장애와 음성증상과의 관계는 아직 정확히 밝혀져 있지 않다. 음성증상을 효과적으로 호전시키는 것으로 알려진 clozapine을 만성 정신분열증 환자들에게 9개월 간 투여하여 인지기능이 호전될 수 있는지 조사하고 임상증상의 호전 정도와 인지기능의 호전정도 사이의 상관 관계를 평가하였다. 방 법: 만성정신분열증 환자(16명)를 대상으로 Wisconsin Card Sorting Test, Digit Span Test 및 Judgment of Line Orientation Test 등의 심리검사를 clozapine 투약 전과 9개월 후 각각 실시하였다. 또한 BPRS를 사용하여 투약전과 9개월 간의 투약 이후의 정신병리를 평가하였으며 이를 신경심리검사 결과와 비교하였다. 결 과: Clozapine은 만성정신분열증 환자의 양성 및 음성 증상을 모두 유의하게 호전시켰다. 신경심리검사 결과 집중력, 단기 기억력, 시각-지각력에는 유의한 호전이 있었으며 집행능력에서도 통계적으로 의의있지는 않으나 호전되는 경향을 보였다(p=0.066). 환자들의 임상증상과 신경심리검사 결과 사이에는 아무런 상관관계도 발견할 수 없었다. 결 론: 만성정신분열증 환자들에서 clozapine 장기 투여를 통해 임상증상은 물론 집중력 및 단기기억력 등 일부 인지기능의 호전을 기대할 수 있으며 특히 보다 정교한 정보처리와 관련되는 집행능력 역시 9개월 이상 장기 치료를 통해서 호전될 수 있음을 시사하였다. 또한 정신분열증 환자에서 나타나는 인지기능의 장애는 임상증상에 의한 2차적 현상이 아니라 하나의 독립된 병리임을 추측할 수 있다. 향후 보다 객관적인 결론을 위하여 타 항정신병약물과의 비교 연구가 지속적으로 필요하다고 본다.

• 생물정신의학
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• 제12권2호
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• pp.143-150
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• 2005

목 적: 많은 연구에서 정신분열병에서 염증반응체계의 활성화와 사이토카인의 변화가 병태생리학적 및 원인적 역할을 하는 것으로 보고되어 왔으며, 여기에는 type 1 Thelper cell(Th1), type 2 T helper cell(Th2), type 3 T helper cell(Th3)의 조절 이상이 제시되고 있다. 본 연구에서는 정신분열병 환자에서 항정신병 약물 치료 전후로 Th1 사이토카인인 interleukin-12(IL-12), Th3 사이토카인인 transforming growth factor-${\beta}1$(TGF-${\beta}1$)의 혈장 농도를 측정하였다. 방 법: 23명의 정신분열병 환자군과 31명의 정상대조군에서 IL-12와 TGF-${\beta}1$ 농도를 측정하였고 정신분열병 환자군에서는 8주간 항정신병 약물로 치료 후 다시 IL-12와 TGF-${\beta}1$의 농도를 측정하였다. 또한 정신분열병 환자군에서 치료전과 8주간 치료 후, 2차례에 걸쳐 Brief psychiatric rating scale(BPRS)를 측정하였다. 결 과: 치료전 IL-12 농도와 TGF-${\beta}1$ 농도 모두 정상대조군보다 환자군에서 유의하게 높게 나타났다. 8주간의 치료 후 TGF-${\beta}1$ 농도는 유의하게 감소하여 정상대조군의 농도와 차이를 보이지 않게 된 반면, IL-12의 농도는 유의하지 않은 감소를 보였다. BPRS 점수의 변화 및 IL-12 및 TGF-${\beta}1$의 농도의 변화 사이에는 유의한 상관관계가 없었다. 결 론: 정신분열병의 병태생리학에 사이토카인의 이상이 관여할 수 있으며, TGF-${\beta}1$이 중요한 역할을 하는 것으로 생각된다.

• 생물정신의학
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• 제16권4호
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• pp.256-265
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• 2009

Objectives : The aims of this study were to assess a) the prevalence of trauma and posttraumatic stress disorder(PTSD) in schizophrenic patients and b) the differences in symptomatology and outcome after 1year treatment between those with and without PTSD. Methods : Twenty eight schizophrenia and schizoaffective disorder patients completed the Positive and Negative Syndrome Scale(PANSS), Life Stressor Checklist-Revised(LSCL-R), Clinician-Administered PTSD Scale(CAPS), Dissociative Experiences Scale(DES), Hamilton Psychiatry Rating Scale for Depression(HAM-D), and Rosenberg Self-Esteem Scale(RSE). Results : Twenty six patients(92.9%) had at least one trauma in their life time. Eleven patients(39.3%) were diagnosed with PTSD. PTSD group had significantly higher scores on HAM-D and DES but lower scores on RSE. PTSD group also had significantly lower score in the baseline PANSS Negative score. Higher CAPS scores were significantly correlated with lower baseline PANSS Negative score and greater change after 1year of PANSS Negative score. Conclusion : These results showed that the prevalences of trauma and PTSD are high in schizophrenic patients and suggested that PTSD and trauma-related symptoms affected the symptomatology and treatment outcome. More research is warranted to better understand the effects of PTSD in schizophrenic patients.

• 생물정신의학
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• 제14권2호
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• pp.122-128
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• 2007

Objectives : The aim of this study was to investigate relationships between psychotic symptoms and cognitive functions in schizophrenia. Methods : The study group was composed of 36 schizophrenic patients. Positive, negative, and disorganization symptoms were assessed using the PANSS. Verbal, visuospatial, attention, memory, and executive functions were assessed using a battery of cognitive tests. Results : Correlation analysis between symptom vs. cognitive measures showed that (a) positive symptoms were significantly correlated with no cognitive measures, (b) negative symptoms were significantly correlated with all cognitive measures, and (c) disorganization symptoms were significantly correlated with executive and memory measures. Correlation analyses between symptom vs. cognitive factors showed that negative-disorganization factor is significantly correlated with executive-memory factor. Conclusion : Significant relationships were confined mostly to frontal symptoms vs. frontal cognitive functions. Thus, the relationships may be mediated mainly by variations in severity of frontal pathology among patients.

• 생물정신의학
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• 제13권3호
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• pp.152-161
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• 2006

Objective : The relationship between the total daily dose of clozapine given and the plasma concentrations of clozapine and its metabolites(N-desmethylclozapine and clozapine N-oxide) and the effect of Glu158Lys (wild-type : Glu, 'H' ; variant : Lys, 'h') and Glu308Gly(wild-type : Glu, 'D' ; variant : Lys, 'd') variation in FMO3 gene on plasma concentrations of clozapine and its metabolites was studied in schizophrenic patients. Methods : Trough plasma concentrations of clozapine and its metabolites were measured in 34 schizophrenic patients receiving clozapine. The genetic variation of 'h' and 'd' in FMO3 were analyzed in 21 among 34 patients. Results : A linear relationship between the total daily dose of clozapine given(mg/kg body weight per day) and the plasma concentrations(nM) of clozapine was revealed by regression analysis(p<0.001) in the 23 patients receiving a constant daily dose of clozapine for 8 days. The plasma molar concentration ratios of clozapine N-oxide/clozapine in 8 subjects with 'hh' or 'Hh' alleles were not different from those in 6 subjects with 'HH' alleles and the plasma molar concentration ratios in 6 subjects with 'dd' or 'Dd' alleles were not different from those in 8 subjects with 'DD' alleles. Conclusion : The effect of Glu158Lys and Glu308Gly variation in FMO3 gene on clozapine metabolism could not be shown.

• 디지털융복합연구
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• 제16권4호
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• pp.157-166
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• 2018

이 연구의 목적은 조현병 환자에 대한 사회 인식을 파악하기 위해 대중 인식이 투영되는 매체라 할 수 있는 영화에서 묘사된 조현병 환자에 대한 인식을 파악하는 것이다. 지난 40년간 상영된 영화 중 조현병 환자가 등장하는 48편의 영상자료와 시나리오를 귀납적 내용분석 방법으로 대인지각, 감정지각, 가족 및 친지의 인식, 그리고 치료대책에 대한 인식을 분석하였다. 그 결과 1995년 이전 영화에서는 조현병 환자를 매우 폭력적이고 위험하며, 가족에게 부담스러운 존재로 인식하고 있었다. 이에 비해 정신보건법이 제정된 1996년 이후 영화에서는 조현병으로 인한 구체적 경험이나 내면적 묘사가 증가하고 치료와 관련된 가족이나 환자의 태도도 보다 적극적으로 묘사되었다. 결론적으로 영화를 통해 본 조현병 환자에 대한 인식은 부정적이고 가족이나 주변 사람에게 부담과 고통을 주는, 피하고 싶은 존재임을 알 수 있었다. 따라서 정신장애에 대한 사회 인식을 개선하기 위해서는 대중 인식에 영향력이 높은 영화를 적극 활용할 필요가 있고, 인식 변화에 영상매체가 미치는 영향에 관한 연구도 시도해볼 수 있겠다.

• 생물정신의학
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• 제13권2호
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• pp.82-94
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• 2006

Objectives : In order to explore effects of board-game therapy for cognitive rehabilitation in patients with schizophrenia, we investigated the change of executive cognitive function over a 2-month period of board-game therapy in patients with schizophrenia. Methods : Two groups of chronic schizophrenic inpatients were participated in this study. One group(n=21) were treated with board-game therapy for 2 months and the other control group(n=19) were not treated. For the evaluation of the executive cognitive function, a Wisconsin Card Sorting Test(WCST) was administered before and after the introduction of the board-game therapy. PANSS score change was also evaluated. Result : At the beginning of this study, there was no significant difference in performance of cognitive function tests, demographical data or clinical severity between both patient groups. After 2 months of treatment with the board-game therapy, the board-game therapy group showed significant improvements of executive cognitive function without any significant change of their schizophrenic symptoms. On the contrary, there was no change in control group. Conclusion : This study showed that a board-game therapy is effective for the enhancement of executive cognitive function in patients with chronic schizophrenia. A board-game therapy could be introduced with ease into psychiatric fields, such as inpatients' or outpatients' clinic wards and day hospital. Our result indicates that the board-game therapy is a promising tool for the enhancement of cognitive function, especially executive cognitive function and helpful for cognitive rehabilitation for schizophrenic patients.

• 수면정신생리
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• 제4권1호
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• pp.96-106
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• 1997

The clinical validity of a korean EEG and EP mapping system(Neuronics) was evaluated with schizophrenic patients(n=20), normal controls(n=19), and 10 patients with central nervous system disease(8 patients with cerebrovascular accident, 1 patient with brain mass, and 1 patient with periodic paralysis). In the normal control group, the pattern of resting computerized EEG with eyes closed showed normal parieto-occipital dominance of alpha wave. Compared with normal controls, schizophrenic patients had more delta activity in the frontal region, and less alpha activity especially in the parieto-occipital region. In most cases patients with cortical organic lesions(n=5) revealed increased delta and theta activity and decreased alpha activity on the lesion areas. These findings were compatible with their MRI and clinical findings. However in the cases of subcortical lesions(n=5) EEG showed various findings which suggest diverse influences of subcortical abnormalities on cortical activities. The P300 of schizophrenic group was smaller and more delayed than those of normal controls. These results are generally compatible with the previous studies using other EEG and EP mapping systems consequenty and suggest that the this EEG and EP mapping system(Neuronics) has clinical validity.

• 생물정신의학
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• 제10권2호
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• pp.107-115
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• 2003

Objective:The purpose of this study was to know about the mechanism of pathogenesis of type 2 diabetes mellitus by using of blood glucose, glucoregulatory factor, insulin resistance in schizophrenic patients receiving antipsychotics. Method:Modified oral glucose tolerance tests were performed in 20 schizophrenic patients receiving haloperidol, risperidone and olanzapine. Insulin, glucagon, C-peptide and cortisol were measured in 0, 15, 45, 75 minutes after glucose loading, and insulin resistance was calculated by HOMA(homeostasis model assessment) method. Result:Olanzapine-treated patients had significant glucose elevation 45 minutes after glucose challenge. Also modest increases in HOMA IR values were detected in patients treated with olanzapine. Conclusion:Olanzapine treatment of non-diabetic patients with schizophrenia can be associated with type 2 diabetes mellitus through the elevation of glucose and insulin resistance. Elevated insulin resistance may be a causative mechanism of type 2 diabetes mellitus in patients receiving olanzapine.