• 생물정신의학
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• 제18권4호
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• pp.254-259
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• 2011

Objectives The aim of this study was to assess variations in caudate volume according to dopamin receptor D2/ankyin repeat and kinase domain containing 1 (DRD2/ANKK1) Taq 1a polymorphisms in young healthy adults and to evaluate the relationship between caudate volumes and psychiatric symptoms as measured by the Brief Psychiatric Rating Scale. Methods Genetic information regarding DRD2/ANKK1 Taq 1a and T1-weighted brain magnetic resonance images were acquired from 30 young healthy adults. Automatic segmentation of caudate was performed using the FreeSurfer program. Results Individuals with A2 homozygotes of DRD2/ANKK1 Taq 1a polymorphisms (n = 10) had greater right caudate volumes compared to those with A1 allele (s)(18.4% greater ; p = 0.019). Right caudate volumes were negatively associated with total scores of the Brief Psychiatric Rating Scale (${\beta}$=-0.50 ; p = 0.016). Conclusions Our findings suggest the possibility that DRD2/ANKK1 Taq 1a polymorphisms may underlie the psychiatric symptoms by influencing the structure of the right caudate.

• 생물정신의학
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• 제26권1호
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• pp.14-21
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• 2019

Objectives Thyroid hormone deficiency during the neurodevelopmental period can impair brain development and induce psychiatric symptoms. This study examined the association between thyroid dysfunction and the severity of symptoms in schizophrenia patients, and the treatment response of patients with schizophrenia. Methods Three hundred thirty-eight schizophrenia patients, with no prior history of thyroid disease or taking medication associated with it, were studied. We assessed the blood thyroid hormone level, the Brief Psychiatric Rating Scale (BPRS) scores on the day of admission and discharge, admission period, dose of administered antipsychotics, and the number of antipsychotic combinations. The collected data were subsequently analyzed using the Kruskal-Wallis test and Pearson's chi-square test. Results The percentage of schizophrenia patients who presented with abnormal thyroid hormone level was 24.6%. High total triiodothyronine (TT3) (p = 0.003), low TT3 (p = 0.001), and high free thyroxine (fT4) (p < 0.001) groups showed a higher BPRS score on admission than did the normal thyroid hormone group, while thyroid stimulating hormone (TSH) levels were not significantly correlated with the severity of symptoms. Furthermore, thyroid hormone was not associated with the treatment response assessed by the rate of BPRS score reduction, admission days, use of clozapine, and dose of antipsychotics. Conclusions The TT3 and fT4 hormone levels were significantly associated with the severity of symptoms in schizophrenia patients. These relations suggested that thyroid dysfunction may be associated with the severity of schizophrenia. And hence, further analysis of the results of the thyroid function test, which is commonly used in cases of psychiatric admission, is required.

• 생물정신의학
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• 제8권1호
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• pp.140-146
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• 2001

In clinical setting, treatment-refractoriness, medication induced tardive dyskinesia and amenorrhea in chronic schizophrenia are frequently problematic. However, there are few guideline solving these problem available to clinicians. The goal of this study was collecting clinical data on clinical effectiveness and predictors of response of switching to olanzapine. We attempted to switch to olanzapine from risperidone and clozapine in chronic 31(risperidone 17, clozapine 14) schizophrenia and schizoaffective disorder patients suffering from sustained symptoms, weekly blood monitoring, medication induced tardive dyskinesia and amenorrhea. Previous antipsychotics dosage was gradually decreased for 2 or 3weeks, at the same time olanzapine dosage was gradually increased. At baseline, after 1 week, after 2 weeks and after 4 weeks we checked Brief Psychiatric Rating Scale, Clinical Global Impression Scale, Sympson-Angus Rating Scale, Barnes Akathisia Rating Scale and followed up after 12 months. Successful switch after 4 weeks was achieved in 25 patients(clozapine 9(64.2%), risperidone 16(94.1%)). Overall, mean BPRS and CGI scores increased significantly. Successful maintenance after 12 months was achieved in 17 patients(clozapine 5(35.7%), risperidone 12(70.5%)). Overall, mean BPRS and CGI scores increased significantly too. Switching to olanzapine from other atypical antipsychotics is recommendable in chronic schizophrenia with treatment refractoriness and drug induced side effect.

• 생물정신의학
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• 제28권2호
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• pp.70-77
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• 2021

Objectives Our study aimed to present the distinctive correlates of formal thought disorder in patients with schizophrenia, using the Clinical Language Disorder Rating Scale (CLANG). Methods We compared clinical characteristics between schizophrenia patients with (n = 84) and without (n = 82) formal thought disorder. Psychometric scales including the CLANG, the Brief Psychiatric Rating Scale (BPRS), the Young Mania Rating Scale (YMRS), the Calgery Depression Scale for Schizophrenia (CDSS) and the Word Fluency Test (WFT) were used. Results After adjusting the effects of age, sex and total scores on the BPRS, YMRS and WFT, the subjects with disorganized speech presented significantly higher score on the abnormal syntax (p = 0.009), lack of semantic association (p = 0.005), discourse failure (p < 0.0001), pragmatics disorder (p = 0.001), dysarthria (p < 0.0001), and paraphasic error (p = 0.005) items than those without formal thought disorder. With defining the mentioned item scores as covariates, binary logistic regression model predicted that discourse failure (adjusted odds ratio [aOR] = 5.88, p < 0.0001) and pragmatics disorder (aOR = 2.17, p = 0.04) were distinctive correlates of formal thought disorder in patients with schizophrenia. Conclusions This study conducted Clinician Rated Dimensions of Psychosis Symptom Severity (CRDPSS) and CLANG scales on 166 hospitalized schizophrenia patients to explore the sub-items of the CLANG scale independently related to formal thought disorders in schizophrenia patients. Discourse failure and pragmatics disorder might be used as the distinctive indexes for formal thought disorder in patients with schizophrenia.

• 생물정신의학
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• 제15권2호
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• pp.92-100
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• 2008

Objectives : The purpose of this study was to investigate 1) the neuropsychological deficits with major depressive disorder(MDD) in depressed state and 2) the changes of neuropsychological dysfunctions during depressed episodes and remitted periods in the MDD group. Methods : 12 patients with MDD and 70 normal controls who were diagnosed and classified by DSM-IV and SCID-IV interview participated in this study. The psychopathology was measured using the Hamilton rating scale for depression(HAM-D) and Brief Psychiatric Rating Scale(BPRS). The memory function, executive function, and sustained attention were measured by a trained psychologist using the Korean version of Memory Assessment Scale(K-MAS), Wisconsin Card Sorting Test(WCST), and Vigilance(VIG) and Cognitrone (COG) in Vienna Test System. After 6 weeks of treatment, we retested the cognitive tests in order to measure the cognitive functions in remitted states. Results : Patients with MDD achieved significantly lower score in sentence immediately recall, verbal memory score and total memory score of the K-MAS, total errors of the WCST, response time of Vigilance and response time at "Yes" response of Cognitrone than normal controls at baseline. After 6 weeks of medication, the psychiatric symptoms in the patient group were attenuated, and most of the neuropsychological functions including attention, memory, and frontal/executive function were improved except for response time of Cognitrone. Conclusions : This study provides evidence for distinct neuropsychological deficits in patients with MDD on their depressed states and remitted periods. The impairment on response time remains after remission, and this would be a trait marker of major depressive disorder.

• Journal of Hospice and Palliative Care
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• 제12권4호
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• pp.177-193
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• 2009

완화의학에서 환자의 평가는 치료의 의사결정과 그 결과에 이르기까지 중요한 역할을 한다. 평가도구의 사용 목적은 이를 환자 진료에 반영하여 개개인 환자와 가족들에 대한 돌봄의 질을 높이는 데 있다. 환자의 기능 상태와 통증 및 비 통증 증상을 평가하는 다양한 단일 영역 및 다차원 평가 척도들이 사용 가능하며, 삶의 질을 측정하는 다양한 도구들이 존재한다. 삶의 질이나 증상 측정에서 우월하다고 추천되는 단일 도구는 없는 실정이다. 도구마다 측정하는 시간의 틀이 다르고, 특성이 다르므로 사용 목적과 상황에 따라 적절한 도구를 선택하여야 한다. 여명 예측을 위해서는 예후 지수의 병용이 권고되는 추세이고, 웹을 기반으로 하는 예측 프로그램들도 등장하였다. 예후지수로는 최근 우리나라에서 다기관 연구를 통해 개발한 객관적 예후지수가 임상적인 여명 예측을 포함하지 않으면서 새로운 객관적인 예후 요인을 반영하여, 누구나 쉽게 사용이 가능하다. 완화의학 입문자의 경우 상대적으로 사용이 용이한 도구가 좋다. 따라서 기능의 평가에는 Eastern Cooperative Oncology Group 기능지수를 사용하고, 통증에서는 10점만점의 숫자 통증 등급(Numeric Rating Scale) 도구를 활용하면서 초기 통증 평가로는 간이 통증 조사지를 추천한다. 여러 가지 증상을 한꺼번에 측정하기 위해서는 숫자 등급으로 직접 물어보거나 혹은 M.D. Anderson 증상조사지(the Korean version of MD Anderson Symptom Inventory) 설문지를 사용하기 바란다. 삶의 질을 평가하는데에는 European Organization Research and Treatment Quality of Life Questionnaire Core 15 for Palliative Care, 예후 지수로는 객관적 예후 지수(Objective Prognostic Score)를 사용하기를 권한다. 향후 완화의학에서 평가도구의 발전방향은 국제 공동 연구의 활성화와 디지털 기기를 통한환자 보고의 전산화이고, 머지않은 앞날에 우리나라에도 이러한 경향이 도입될 것이다.

• 생물정신의학
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• 제17권2호
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• pp.94-102
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• 2010

Objectives : Eye movement desensitization and reprocessing(EMDR) is a novel, time-limited psychotherapy originally developed for treatment of psychological trauma. The effectiveness of this therapy has been validated only for posttraumatic stress disorder ; however, EMDR is often applied to other psychiatric illnesses, including other anxiety disorders and depression. This pilot study tested the efficacy of EMDR added to the routine treatment for individuals with acute stage schizophrenia. Methods : This study was conducted in the acute psychiatric care unit of a university-affiliated training hospital. Inpatients diagnosed with schizophrenia were randomly assigned to either three sessions of EMDR, three sessions of progressive muscle relaxation(PMR) therapy, or only treatment as usual(TAU). All the participants received concurrent typical treatments(TAU), including psychotropic medication, individual supportive psychotherapy and group activities in the psychiatric ward. The Positive and Negative Syndrome Scale(PANSS), the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale were administered by a clinical psychologist who was blinded to the patients' group assignment. Results : Forty-five patients enrolled and forty patients(89%) completed the post-treatment evaluation. There were no between-group differences in the withdrawal rates of patients during the treatment or at the three-month follow-up session. All three groups improved significantly across each of the symptomatic domains including schizophrenia, anxiety, and depressive symptoms. However, a repeated measures ANOVA revealed no significant differences among the groups over time. Effect size for change in total PANSS scores was also similar across treatment conditions, but effect size for negative symptoms was large for EMDR(0.60 for EMDR, 0.39 for PMR and 0.21 for TAU only). Conclusion : These findings supported the use of EMDR in treating the acute stage of schizophrenia but the results failed to confirm the effectiveness of the treatment over the two control conditions in three sessions. Further studies with longer courses of treatment, more focused target dimensions of treatment, and a sample of outpatients are necessary.

• 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.

• 동의신경정신과학회지
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• 제27권3호
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• pp.147-155
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• 2016

Objectives: Schizophrenia is a serious disease that influences not only the patients themselves but also their family and the society. In this case, we employed art therapy and Korean traditional medicine for treating a schizophrenia patient.Methods: The patient was diagnosed with schizophrenia, and the main complaints were hallucination, visual hallucination and catatonic behavior. We treated the patient with art therapy and Korean traditional medicine including acupuncture, moxa and herbal medicine. We used the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS) for assessment.Results: After treatment, clinical symptoms were improved and the BPRS and PANSS scores were decreased, especially the scores for anxiety, depression and poor rapport.Conclusions: Combined treatment with art therapy and Korean traditional medicine can be effective for treating chronic schizophrenia.

• 동의신경정신과학회지
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• 제26권4호
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• pp.349-356
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• 2015

Objectives: Schizophrenia is difficult to treat effectively and the antipsychotics used have many side effects. However, few studies have focused on the combined treatment of Korean and Western medicine as an alternative. In this study, we reported an inpatient with chronic schizophrenia who was treated by a combination of Korean and Western medicine. Methods: We experienced a case of a diagnosed schizophrenia patient as whose chief complaint was avolition, diminished emotional expression and hallucination. The patient was treated with Western medicine and Korean traditional treatment including acupuncture, moxa and herbal medicine. The Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS) were used for assessment. Results: After treatment, symptoms involving avolition, diminished emotional expression and hallucination were improved; furthermore, the scores of the BPRS and the PANSS were decreased by approximately 50%, respectively. In addition, there were no notable side effects. Conclusions: The combined treatment of Korean and Western medicine can be an effective and well-tolerated treatment modality for patients with chronic schizophrenia.