항정신병약물들에 의해 유발된 Torsade de Pointes 1례

신유호,오동재,장환일,Shin, You-Ho,Oh, Dong-Jae,Chang, Hwan-Il 대한생물정신의학회 1994 생물정신의학 Vol.1 No.1

항정신병약물 perphenazine 20mg/day, chlorpromazine 100mg/day. trifluoperazine 15mg/day 등을 투여중인 정신분열증 42세 여자 환자에서 심실성 빈맥의 하나인 torsade de pointes이 나타난 사례를 보고한다. 본 환자는 항정신병약물을 복용하여 오던 중 여러차례 실신과 호흡곤란을 경험하였으며, 심전도상에 QT 간격의 연장과 함께 다양한 모양의 QRS 파를 동반한 심실성 빈맥의 소견이 있어 torsade de pointes을 의심할 수 있었다. 심혈관계에 영향이 적은 항정신병약물인 haloperidol로 바꾼 후 부정맥의 소견이 없다가 퇴원 후 haloperidol을 증량하는 과정에 흉부 불편감, 실신의 증상과 함께 QT 간격의 연장이 다시 발생하여 torsade de pointes이 나타난 원인이 항정신병약물 때문이라는 것을 확인할 수 있었다. 항정신병약물을 사용중인 환자에서 발생하는 급사의 원인으로 심실성 빈맥이 가장 흔하게 제기되고 있다. 따라서 항정신병약물을 처방하는 임상의들은 이에 대한 충분한 지식과 주위가 필요할 것으로 생각된다. We report a case of antipsychotics induced torsade de pointes in a 42-year-old female schizophrenic patient. The patient had taken perphenazine 20 mg/day, chlorpromazine 100 mg/day, and trifluoperazine 15 mg/day irregularly for about 8 years. She experienced syncope and a few difficulties in breathing. On EKG(electrocardiography), QT interval was delayed and polymorphic QRS complexes and ventricular tachycardia were observed. Following a switch of the antipsychotics to haloperidol, known to have fewest effects on the cardiac rhythms among antipsychotics, the arhythymias disappeared. However after discharge, as dose of haloperidol was increased, the symptoms such as chest discomforts and syncopes reappeared. We concluded that the torsade de pointes was developed by antipsychotics. The most common cause of sudden death in patients receiving antipsychotic treatment appears to be ventricular tochycardia. Therefore, clinician should be well aware of the possible side effects of antipsychotics and be cautious in prescribing such drugs to their patients.

신체화에 따른 질병행동의 특성에 관한 연구

송지영,염태호,오동재,조성욱,Song, Ji-Young,Yum, Tae-Ho,Oh, Dong-Jae,Cho, Seong-Wook 한국정신신체의학회 1997 정신신체의학 Vol.5 No.2

목적: 한국인의 질병행동 특성에는 전통적인 질병개념, 신체화경향 및 각종 사회문화적 요소와 복합적으로 관련되어 있다. 이에 신체화 기전을 근본으로 한 신체형환자의 질병행동의 특성을 파악하여 여기에서 얻은 결과를 향후 치료에 활용해 보고자 하였다. 방법: 환자군은 DSM-IV에 의거하여 신체형장애로 진단된 환자 29명이었고, 대조군은 질병대조군으로서 골절 및 급성질환에 의해서 수술받은 환자 57명으로 하였다. 양군에서 임상증상의 특성과 통증의 유무 및 통증정도측정(Visual Analogue Scale) 상태불안(Spielberger의 Anxiety State Inventory), 우울정도 측정(Beck's Depression Inventory), 스트레스정도(Psychosocial Stress Scale)를 재고, 그리고 질병행동의 특성은 질병행동 평가 설문인 illness Behavior questionnaire(IBQ)를 한국어로 번역하여 신뢰도를 검증한 후에 검사도구로 이용하였다. 결과: 신체형장애 환자는 대조군에 비해 증상기간이 길고 (71.8+64.3개월), 나이가 많았으며(39.0+10.2세), 측정당시의 통증정도($1.0{\pm}2.0$, p<0.05)는 낮았다. 과거력상 신체질병이 상대적으로 많았고, 불안$(50.9{\pm}10.7)$과 우울정도(20.3+9.5)가 높았다. 그러나 스트레스의 정도는 비슷하였다. IBQ의 척도중에 건강염려증$(5.2{\pm}2.6)$, 질병확신(3.1+2.0) 그리고 정서장애 척도$(3.0{\pm}1.6)$는 환자군에서 의미있게 높았으나(p<0.05), 심리적인 관심 대 신체적인 관심, 감정억제, 부정 및 짜증 척도에서는 양군에서 비슷하였다. 결론: 신체형장애 환자는 병에 대한 두려움과 질병확신에 의해서 신체증상에 더욱 집중하며, 이는 과거의 신체질환 병력, 잦은 신체검사와 병원방문과 같은 행동특성과 관련된다. 이들이 급성 신체질환자보다 스트레스정도가 높지도 않으면서 불안과 우울의 정도가 크다는 것은, 신체형장애환자의 신체화기전에 정서장애가 중요한 요소임을 보여 주는 것이라고 생각한다. 행동증후군으로서의 신체형장애를 파악하는 데에 있어서 질병행동의 평가는 중요하며, 앞으로 한국어로 번역되고 신뢰도가 확립된 IBQ는 질병행동의 특성을 아는데 뿐만 아니라 신체형장애와 기타의 질환과 구별하는 도구로 유용하게 쓰일 수 있다고 사료된다. Abnormal illness behavior in patients with somatoform disorders were known formed by their traditional disease concepts and somatization-prone socio-cultural factors. The authors evaluated the characteristics of abnormal illness behavior in patients with somatoform disorders(who had somatization) by using abnormal illness behavior questionnaire. Methods : 29 somatoform disorders(SD) and 57 disease controls were compared by clinical characteristics, severity of pain, state anxiety(by Spielberger's State & Trait Anxiety Inventory), depression(by Beck's Depression Inventory) and level of psychosocial stess(by DSM-III-R). The illness behavior was measured by illness Behavior Questionnaire(IBQ). Results SD group had longer period of somatic symptoms with less severity in pain. The degree of anxiety and depression were higher in SB compared with controls. However, the degree of psychosocial stress was almost same between both groups. In IBQ, SD showed higher scores in general hypochondriasis, disease conviction, and affective disturbance subscales compared to control group. Conclusion: High disease conviction and hypochondriacal nature revealed by IBQ seemed to be a role in making somatization by way of somatic focusing and hypervigilance. And those tended to lead patients visit hospital frequently and report various somatic complaints. Evaluating abnormal illness behavior in somatoform disorders would be not only helpful in understanding the natures of somatoform disorders but also useful differentiating SD with other psychiatric conditions.

동통을 가진 신체형장애 환자에서 감정표현능력과 압통역치

송지영,김태수,오동재,윤도준,염태호,Song, Ji-Young,Kim, Tae-Soo,Oh, Dong-Jae,Yoon, Doh-Joon,Yum, Tae-Ho 한국정신신체의학회 1994 정신신체의학 Vol.2 No.1

저자들은 동통을 가진 신체형장애 환자들에서 물리적인 외부자극에 대한 지각과 외부자극에 따른 언어행동의 관계성을 파악하기 위해서 본 연구를 시행하였다. 환자 34명 (남 10, 여 24)과 건강대조군 37명 (남 19, 여 18)을 대상으로, 물리 적 자극에 대한 지각도의 측정은 압통역치 측정기(algometer)를 이용하였으며, 감정표현능력의 측정은 Toronto Alexithymia Scale을 이용하였다. 한편 신체증상의 정도와 부모-자녀 결합형태검사를 시행하였다. 전체환자의 81.4%는 6개월이상 증상을 지속적으로 많이 호소하는 만성화 특성을 보였다. 그리고 alexithymia의 정도, 신체증상 호소정도, 압통역치가 모두 환자군에서 유의하게 높았다. 그리고 환자군의 44.1%는 alexithymia라고 할 수 있었다. 한편 압통역치와 alexithymia간에 유의한 상관성은 없었다. 결론적으로, 동통을 가진 신체형장애환자들이 정상인에 비해 외부 동통자극에 덜 민감하며, 이는 병의 만성화와 관련되는 것 같다. 이들은 또 외부자극에 따른 적절한 감정표현능력도 떨어져 있는 경우가 많은데, 이것은 신체화의 한 조건이 되며, 한편으로는 정신치료적 접근을 방해하는 한 요소가 될 수 있음을 시사한다. The authors investigated the relationship between the response to the external stimulation and ability of verbal behavior in the patients with somatoform disorder who have pain. The subjects consisted of 34 patients(male 10, female 24) and 37 normal controls(male 19, female 18). Pressure pain thesholds were measured by algometer and alexithymia was assessed by Toronto Alexithymia Scale(TAS). Somatization Scale of SCL-90R and Parental Bonding Instrument were also used. It was shown that 82.4% of the patients had chronic somatic complaints. The mean values of TAS, degree of somatic symptoms and pressure pain thresholds were significantly higher in the patient group than in the normal controls. 44.1% of the patients was considered alexithymia group and there was no correlation between scores of alexithymia and value of pressure pain thresholds. In conclusion, the patients with somatoform disorder who had pain were dull in pain perception to external physical stimulation. This result suggested that their low perception of pain could be closely related with chronicity of illness. And the Poverty of verbal expression of inner emotion was suggested to be one of the factors affecting somatization and difficulty in psychotherapy.

여성 신체형장애의 신체증상 호소와 부족한 산후조리

박용철,송지영,최봉근,박종학,오동재,임옥근,김종우,Park, Yong-Chul,Song, Ji-Young,Choe, Bong-Keun,Park, Jong-Hack,Oh, Dong-Jae,Lim, Ok-Geun,Kim, Jong-Woo 한국정신신체의학회 2008 정신신체의학 Vol.16 No.2

Background : It was not uncommon authors as psychiatrists faced women patients with somatoform disorders who expresses their symptoms has been started after the poor adherence to 'Doing the month' practices (DMP). DMP is known as a traditional ritual for Korean postpartum women. Aims : This study is an cultural approach to explore the practices of Korean women during the postpartum period are related with the formation of somatoform disorders. Methods : 41 multipara women with somatoform disorders diagnosed by DSM-IV criteria and 91 healthy normal control were enrolled. Subjects were given scales of SOM scale of SCL-90R, Somatic Symptom Scale-Korean version, Korean 'Doing the month' practices Scale(40 items), Postpartum Sick Scale(14 items), Beck Depression Scale and State Anxiety Scale. Results : 1) The period of DMP less than one week were prevalent in the patients group(43.9%) compared to the control group(7.9%, p<0.01). 2) The period of DMP after the abortions showed no difference between two groups. 3) Subjective rate for their poor DMP was significantly high in the patients group(73.2%) compared to the control group(33.0%), and the patients group showed high score in Postpartum Sick Scale as well(4.1, 1.6 respectively). 4) Poor DM was negatively correlated with SOM scale of SCL-90R(correlation coefficient r=-0.47, p<0.01). Conclusion : Poor DMP may make a crucial role for their heath condition after the deliveries and which would be one of the major factors of the somatoform disorders in Korean women. And postpartum physical symptoms after the poor DMP could be last long enough to be diagnosed as somatoform disorders. By understanding the cultural nature of the somatization phenomena the doctor-patient relationship could be enhanced. 연구목적 : 신체형 장애를 가진 한국 여성에서, 과연 산후조리를 잘 못한 것이 신체화 형성의 요인이 되는지를 알아보고자 하였다. 방법 : 대상자에게 반구조화된 설문지를 통하여 산후 조리와 관련된 내용에 대해 직접 면담하고, 이와 동시에 자가 평가 질문지를 작성하도록 하였다. 자가 평가도구로는 산후조리 평가지, SCL-90R의 SOM척도, 한국판 신체 증상목록, 산후병증상 평가지, Beck depression Inventory(BDI), State trait anxiety inventory(STAI), Visual analogue scale(VAS)을 사용하였다. 결과 : 환자군이 대조군에 비해 산후조리 기간이 짧았으며, 산후조리 평가 점수(K-DMP)가 낮았으며 본인이 평가한 산후조리의 만족도도 낮았다. 현재의 신체증상에 대한 이유에 대해 환자군에서는 43.9%, 대조군에서는 33.3%가 산후조리 때문이라고 답하였다. 산후조리 점수(K-DMP)와 신체화척도(SOM) 사이에는 유의미한 부적 상관관계를 보였다(Pearson correlation : r=-0.476, p<0.01). 다변량 회기 분석에서 현재 신체증상(SOM)에 대해 과거 산후 풍 정도와 산후조리 점수, 이 2가지 요인이 영향력을 가짐이 나타났다. 결론 : 부족한 산후조리는 이후의 신체화 형성과정에 영향을 주는 요인인 것으로 보인다.

경희 - 프랑크푸르트 임상검사 ( Kyung Hee - Frankfurter Beschwerde Fragebogen ) 의 표준화 연구

김정규(Jung Kyu Kim),장환일(Hwan Il Chang),염태호(Tae Ho Yum),송지영(Ji Young Song),윤도준(Doh Joon Yoon),정우승(Woo Syng Jeong),오동재(Dong Jae Oh) 한국정신병리진단분류학회 1993 精神病理學 Vol.2 No.1

N/A N/A

국군○○병원 정신과 입원환자의 추적조사

반건호,오동재 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.2

Objects : This study was aimed at 1) the comparison between rejoin and CD groups and 2) the rate of diagnostic agreement and evaluation on discharge between psychiatrists in the army hospitals. Method : This study was designed to follow up 150 inpatients in the department of Neuropsychiatry of 00 Armed Forces Hospital(abbreviated as field hospital) or evacuated via that field hospital from July 1, 1991 to December 31, 1992. They were soldier below the rank of sergeant first class. Results : Among 150 patients, 99 soldier rejoined their unit after proper treatment(abbreviated as rejoin group) and 51 patients were discharged from the service(abbreviated as CD group, compassionate discharge group) in field hospital, evacuation hospital or general hospitals. The rate of onset of psychiatric illness before enlistment was 58.8% in CD group. In rejoin group, 75.7% had the onset of psychiatric illness before private first class. In diagnosis, adjustment reaction and conversion disorder patients were 73.7% in rejoin group. In CD group, almost all were epileptics, major depressions, personality disorders, or mental retardations. Average duration of hospitalization was 76.9±54.6 day in all subjects. There was a statistically significant difference, especially for general hospital(F=32.6176, df=2, p〈.01). Evaluation on discharge was as follows : 1) 34.0% were discharged from the service because of psychiatric illness. 2) 27.3% were expected to serve without further psychiatric symptoms or problems. 3) Even though it is not resolved, 26.7% were expected to serve. The rate of diagnostic agreement between doctors in field-evacuation-general hospital was 84.2%. Conclusion : We have to keep in mind that 58.8% of CD group began to show their psychiatric symptoms and 49.0% had psychiatric problems prior to enlistment. The critical period for the rejoin group was from the beginning of private to private first class. The average duration of hospitalization in the army was longer than that of civilian hospitals. One of the main reasons was due to the characteristic of the evacuation system in the army. With due regard to the evluation on discharge and the rate of diagnostic agreement, army doctors, especially psychiatrists, were excellent at diagnosing and treating the psychiatric patients.

Lithium 유지치료 중 발생한 갑상선기능저하증의 임상지침을 위한 연구(I) : Clinical Importance of Antithyroid Antibody 항갑상선 항체의 임상적 중요성

김진우,장환일,송지영,조성욱,윤도준,양기영,오동재 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.6

This study is a cross-sectional one for clinical reference of hypothyroidism during lithium maintenance therapy, focusing on antithyroid antibody. Thyroid function including T₃,T₄,TSH, thyroid microsomal antibody, and thyroglobulin antibody were evaluated in 60 patients, given the diagnosis of bipolar disorder by DSM-Ⅲ-R criteria. Thirty-five patients had never previously received lithium and the remaining 25 patients were on chronic lithium treatment(mean 22 months). A visible or palpable goiter was not found in any patient. No case of symptomatic hypothyroidism was observed, but subclinical hypothyroidism was present in 16% of patients on lithium, conpmared with 5.7% in the pre-lithium group. The prevalence of antithyroid antibody was 32% in the lithium group, and 8.6% in the pre-lithium group. The difference of prevalena rate was statistically significant(p<0.05). In antibody-positive lithium-treated patients, the mean age was 41 years and the prevalance of thyroid antibody was higher in women. And the subclinical hypothyroidism was more prevalent in antibody-positive patients than in antibody-negative patients. But the prevalence of antithyroid antibody did not significantly correlate with the duration of lifhium treatment in this study. This study shows that the thyroid function test including microsomal antibody and thyroglobulin antibody is very important for early detection of the hypothyroidism when treating bipolar patients with lithium.

동성 강간 피해자에서 발생한 외상후 자극 장애 1례

장환일,반건호,이혁,오동재 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.1

While the homosexual rape is not rare in Korea, but there has not been but one report about that. Authors reported a 21-year-old man had post-traumatic stress disorder after being raped by a roommate. When he was 18 years old, he was raped by a roommate in high school dormitory. He had symptoms of post-traumatic stress disorder after the accident. As time went by, he partially recovered. When he was recruited by the army, he had to sleep with men, which reminded him of the previous rape experience. He had acute psychotic symptoms and panic attacks. After environmental manipulation, supprotive pschyotherapy and pharmacotherapy, he improved. As we reviewed studies about female rape victims, we noticed that the psychological responses of a male homosexual rape victim were similar to that of female rape victims and that when the victim was forced to confront the situation which remind of the accident, he relapsed (or exacerbated).

정신분열증의 사건관련유발전위에 대한 연구(Ⅰ) : 정신분열증 환자의 사건관련유발전위 P3 in the Schizophrenics

오동재,장환일 大韓睡眠-精神生理學會 1994 수면·정신생리 Vol.1 No.1

精神分裂病에서 血漿 Cyclic Adenosine 3', 5' -Monophosphate(Cyclic AMP)에 關한 硏究

田珍叔,張煥一,吳東財 大韓神經精神醫學會 1986 신경정신의학 Vol.25 No.2

The authors estimated plasma cyclic AMP in 10 schizophrenic patients who had not received neuroleptic treatment and who had received neuroleptic treatment for 2 weeks, and 6 normal volunteers. 1)Though slightly lower than controls, plasma cyclic AMP in schizophrenics(15.95±3.23 pmol/100㎖)(mean±standard error)was not significantly different from controls. 2)2 weeks after medication with neuroleptics, the plasma cyclic AMP in schzophrenics(13.35±1.16 pmol/100㎖)was lower than drug-free groups, but there is no statistical significance. 3)Plasma cyclic AMP in males(20.00±6.10 pmol/100㎖ in schizophrenics, 11.17±1.45 pmol/100㎖ in males) were somewhat higher than controls, but there is no statistical significance.