애착의 관점에서 본 중독

이계성(Kye-Seong Lee),김대진(Dai-Jin Kim),신정호(Jong-Ho Shin),신상은(Sang-Eun Shin),이명지(Myung-Ji Lee) 한국중독정신의학회 2007 중독정신의학 Vol.11 No.1

Studies of addiction or substance abuse gave us much information about the neurobiology of reward and reward circuit. This review showed the possibility that the mesocorticolimbic pathway was primarily evolved to mediated ethologically relevant cues, such as a social attachment appeared important in maternal behavior in rats and pair bonding in monogamous voles. Specifically in the mesocorticolimbic pathway, activation of D2 receptor seemed to mediate drug addiction and the hedonic properties of social bond formation. A circuit linking the anterior hypothalamus (medial preoptic area) to the ventral tegmental area and the nucleus accumbens shell might be especially im-portant in mediating motivation and the rewarding properties of social interaction. The neuropeptides oxytocin and vasopressin released by social attachment & pair bonding appear to be critical linking social signals to the mesocorticolimbic circuit. In the aspect of attachment, returning the role of reward circuit that have been hijacked by addiction to where it bleongs is important part of being treat patients with drug addition. It could be the one way to help patient to feel happiness and security through reconnecting human relationships, by developing new trustworthy bonding to rely on and by restoring relationship among family to intimacy and closeness.

정신질환 및 알코올/약물 사용 관련 범죄자에 대한 치료적 개입

이계성(Kye-Seong Lee),천영훈(Young-Hoon Chon) 한국중독정신의학회 2016 중독정신의학 Vol.20 No.1

Mental illness and alcohol/drug use disorder are chronic brain diseases that repeat relapse and recovery. Therefore, mental illness and alcohol/drug use-related repetitive offences could not be prevented by the punishment alone of the traditional criminal justice system without being accompanied by system-atic therapeutic intervention. The objective of this article was to propose an active participation and cooperation with stake-holders of criminal justice system for treating mental illness and alcohol/drug use-related offences.

알코올 의존 환자의 병식과 인지기능

이계성(Kye-Seong Lee),신정호(Jung-Ho Shin) 한국중독정신의학회 2009 중독정신의학 Vol.13 No.1

Objectives:The purpose of this study is to explore the proposition that, by the evaluation of neuropsychological test, chronic alcohol use can be pinpointed as a cause for frontal lobe dysfunction and that this dysfunction has relationship with both denial and insight level. Methods:We enrolled 55 patients who were admitted as inpatients in alcohol treatment programs at Incheon Christian Hospital. The subjects were evaluated according to sociodemographic and clinical characteristics. After 3 weeks of detoxification, denial and insight level were measured, and neuropsychological test including the following were administered:the Korean version of Wechsler Adult Intelligence Scale (k-WAIS) for assessing Intelligence Quotient (IQ) and the EXIT (Executive Intelligence Test) which consists of stroop, verbal fluency, figural fluency, and auditory verbal learning test for assessing Executive Intelligence Quotient (EIQ). Results:Mean IQ was 96.16 and EIQ was 86.25. But EIQ was decreased from an assumed premorbid level more than that of IQ. According to insight level poor insight group showed lower EIQ but not on IQ. And among subtests medial mand interference stroop and fig-ural fluency showed the difference. Insight level was positively correlated with the denial. And EIQ and particularly among sub-test figural fluency showed correlation with insight level but not in case of IQ and other subtests. Through simple regression test, EIQ can explain Insight level about 15.3%. Conclusion: Cognitive impairment, especially executive dysfunction was identified. Denial itself is not correlated with cognitive function tho-ugh. It seems that the more patient gaining insight, the more they admit their denial. The fact that Insight level is much more correlated with performance of EIQ, especially figural fluency test, than IQ reflect that Insight level is much more correlated with function of frontal lobe, particularly right hemisphere. Given this condition, level of cognitive function could be one of the factor that can evaluate a capacity for rehabilitation of patient, and concern over the need of neuroprotection from chronic alcohol use as well as cognitive rehabilitation as a part of alcoholism treatments should be increased.

긴장성두통과 편두통의 바이오피드백 치료

박주언,이계성,신상은,Park, Joo-Eon,Lee, Kye-Seong,Shin, Sang-Eun 한국정신신체의학회 2006 정신신체의학 Vol.14 No.1

연구목적 : 두통은 일생 동안 90% 이상의 사람들이 경험하게 되는 임상 증후군이다. 이 논문은 긴장성두통과 편두통의 현재의 개념과 바이오피드백 치료 및 이완요법에 대해 요약하였다. 방법: Pubmed/Medline 검색에 포함된 용어는 바이오피드백(biofeedback), 이완(relaxation), 생리적(physiological), 행동적 (behavioral), 비약물의 (nonpharmacological), 두통(headache), 긴장성두통(tension-type headache), 그리고 편두통(migraine)이었다. 검색되지 않은 저술 중 적절한 논문과 바이오피드백을 수행하는 전문가의 의견도 포함시켰다. 결과 : 두통은 바이오피드백 및 이완요법을 포함한 행동치료적 개입에 의해 치료될 수 있는 정신생리장애(psycho-physiological disorder)로 볼 수 있다. 두통에서 이러한 치료들을 통해 임상적 호전을 보인다는 보고들이 지속되고 있다. 또한, 환자에게 실제 적용 시 고려할 점도 제시하였다. 결론: 바이오피드백 치료와 이완요법은 단독 또는 약물치료와 함께 두통 환자에게 제공될 수 있는 효과적인 치료법으로 제안된다. Objectives : Headache is a clinical symptom that more than 90% of all individuals experience during their life time. This article provides a current concept of tension-type and migraine headaches and summarizes the effects of biofeedback treatment and/or relaxation techniques. Methods : The following terms were used for Pubmed/Medline search : biofeedback, relaxation, physiological, behavioral, nonpharmacological, headache, tension-type headache, and migraine. A review of references from relevant literature was also conducted to collect reports not identified in the Pubmed/Medline search. Interviews with experts on biofeedback were also included in this review. Results : Headache is a psychophysiological symptom that can be treated by some behavioral interventions including biofeedback and relaxation. Literatures on biofeedback and/or relaxation have consistently reported significant therapeutic effects on headaches. Important factors that we have to consider, when we apply to headache patients with biofeedback and relaxation techniques, were also presented. Conclusion : The available evidence suggests that biofeedback and relaxation techniques are effective treatments for the patients with headaches and can be provided to the patients as monotherapy or combination therapy with medication.

한국판 전두엽 기능 평가 검사(Frontal Assessment Battery;K-FAB)의 신뢰도와 타당도 연구

정여진(Yeo-Jin Chung),이계성(Kye-Seong Lee),신상은(Sang-Eun Shin),김현주(Hyun-Ju Kim),성경화(Kyung-Hwa Sung) 한국중독정신의학회 2009 중독정신의학 Vol.13 No.2

The Frontal Assessment Battery (FAB) is a short cognitive and behavioral battery, comprising six subtests, for the bedside screening of global executive dysfunction. This study determined the reliability and validity of the Korean version of the FAB (K-FAB) among psychiatric patients. We enrolled 69 subjects with various psychiatric diagnosies, including alcohol dependence, and concurrently administered. Kim’s Frontal-Executive Function Neuropsychological Test (K-FENT). Forty-four subjects completed both the K-FENT and Wisconsin Card Sorting Test (WCST). Two physicians independently conducted the K-FAB. Eeach rater was blind to score of other rater. We compared the total K-FAB score to the K-FENT and WCST results to determine its concurrent validity. Finally, we obtained receiver operating characteristic (ROC) curves to determine the optimum cut-off score. The internal consistency was sufficient (Cronbach’s alpha=0.797), and the K-FAB scores were highly correlated bet-ween the two raters. The total K-FAB score correlated significantly with EIQ (r=0.665, p<0.01), the summary score of the Executive Intelligence Test (EXIT). It also correlated with total number of correct responses, perseverative errors, and total number of catergories completed in WCST. At the cut-off value 13, the K-FAB showed good sensitivity (80%) and specificity (69%). The K-FAB is a useful and easy bedside test for screen-ing frontal-executive functional impairments in a variety of psychiatric patients.

알코올 의존 환자 가족의 공동의존에 영향을 미치는 요인과 이에 따른 가족의 대처방식

선지영(Jee-Young Sun),이계성(Kye-Seong Lee),신상은(Sang-Eun Shin),박주언(Ju-Eon Park) 한국중독정신의학회 2006 중독정신의학 Vol.10 No.2

Objectives:The purpose of this study is to investigate the level and affecting factors of codependence & relationship with how to cope with patient in the family of alcoholics. Method:The subject were 60 family members of patients with alcohol dependence. All subjects were assessed by questionnaire about the demographic data, Children of Alcoholics Screening Test (CAST), Korean Version of Alcohol Use Disorders Identification Test (AUDIT-K), the Korean Version of Checklist from Codependents Anonymous (CCA-K), Spouse Sobriety Influence Inventory (SSII). Alcohol related characteristics of patients were surveyed through chart review and interview with family members. Results:First, the level of codependence among family with alcohol dependence was 93.3%. Among the characteristics of family, only the number of male brothers had significant positive relation with codependence. The presence of job among family members related with codependence & had significant positive relationship with how to cope with patients. Second, among the characteristics of patients, many factors that reflects severity of alcohol dependence had significant positive relationship with codependence & how to cope with patients. Conclusion:Our result support that codependence was the stress response came from in the relation with alcohol dependent patients because alcohol related characteristics of patients highly related with codependence compared to the characteristics of family members such as family history of alcohol. In the aspect of treatment, codependence should be considered, we have to help the family members to increase capacity how to cope with patients.

알코올 의존 : 화학적 뇌손상

양재효(Jae-Hyo Yang),이계성(Kye-Seong Lee),신상은(Sang-Eun Shin),이명지(Myung-Ji Lee),성경화(Kyung-Hwa Sung) 한국중독정신의학회 2008 중독정신의학 Vol.12 No.1

Objectives:The purpose of this study is, by the evaluation of a neuropsychological test, to identify how severe executive cognitive function impairment in chronic alcoholism compares to that of traumatic brain injury (TBI). Methods:42 alcoholic patients and 41 TBI patients, matched for age, educational level, premorbid IQ, and executive cognitive score, were enrolled in this study. Korean versions of the Wechsler Adult Intelligence Scale (k-WAIS) and EXIT (Executive intelligence test) were ad-ministered for both groups. Results:In between-group com-parison, the decrease of IQ (Mean=-5.45/-11.12, p=.010) and EIQ (Mean=-17.98/-32.46, p=.002) from the estimated pre-morbid level in the TBI subjects were significantly higher than that of alcoholic subjects. The decrease of IQ and EIQ of alcoholic subjects reached 49.01% and 55.39%, respectively, compared with that of TBI subjects. Subtest TBI subjects, with the exception of figural fluency (Mean=21.14/17.68, p=.094), showed statistically significant poor performance on the Stroop test (Sim-ple : Mean=22.16/48.44, p=.000 ; Medial : Mean=33.14/ 56.44, p=.002 ; Interference : Mean=43.52/73.71, p=.001), verbal fluency (Mean=20.07/15.05, p= .025), and the auditory verbal learning test (Recognition:Mean=11.36/8.54, p=.000; Recall:Mean=7.00/4.27, p=.000). In within-group comparison, IQ and EIQ significantly decreased from the estimated premor-bid level in both groups (IQ:p=.000, EIQ:p=.000), but EIQ decreased more than that of IQ in both groups (Alcoholic:p=.000, TBI:p=.000). Conclusion:This study supports the “frontal lobe hypothesis” and shows that chronic alcoholism could lead to more serious executive function impairment than we expected. Given this condition, concern about the need of cognitive rehabilitation should be increased.

국내 음주자들을 대상으로 한 한국어판 의존 심각도 척도(Severity of Dependence Scale-Alcohol, SDS-Alcohol)의 신뢰도, 타당도 및 절단점

려원기(Won Gi Yeo),이계성( Kye-Seong Lee) 한국중독정신의학회 2013 중독정신의학 Vol.17 No.2

Objectives : To develop the Korean version of Severity of Dependence Scale for Alcohol drinkers (SDS-Alcohol-K) with the Korean population as a screening tool. Methods : Appropriate translation processes of SDS into Korean, including back translation process were performed. 50 alcohol dependence patients and 50 control subjects were recruited in this study. Korean ver-sion of SDS, AUDIT, CAGE and DSM-IV based diagnosis were administered. By using collected data, the reliability and validity of SDS-Alcohol-K were evaluated. Optimal cut-off points for alcohol dependence and hazardous drinking were determined by area under the Receiver Operating Characteristic (ROC) curve. Results : Data confirmed high internal consistency and test-retest reliability of SDS-Alcohol-K. Principal components analysis showed that the SDS-Alcohol-K scores lie on a single dimension. Pearson correlation coefficient of SDS-Alcohol-K with AUDIT and CAGE were 0.896 and 0.859, respectively, and significant correlation was shown. The optimal cut-off points selected were 4 for alcohol dependence and 2 for hazardous drinking. Conclusion : The results suggest that SDS-Alcohol-K is simple but valid and reliable tool for screening of alcohol dependence.

알코올 의존 환자의 병식수준과 방어기제의 관계

김기철(Ki-Chul Kim),이계성(Kye-Seong Lee):정 건(Gun Jung),신상은(Sang-Eun Shin) 한국중독정신의학회 2004 중독정신의학 Vol.8 No.2

Objectives:The purpose of this study estimate level of insight and defense mechanisms in alcoholic patients and investigate the relationship between insight level and defense mechanisms in them. Method:The subjects participated in this study were 94 alcoholic patients who were diagnosed as alcohol dependence by DSM-IV and admitted to Incheon Christian Hospital and EunHei Hospital between November, 2003 and February, 2004. The subjects were surveyed by questionnaire about the sociodemographic data, HAIS, Ewha Defense Mechanism Test and Ways of Coping checklist. Results:First, we compared the defense mechanisms between the fair insight group and the poor insight group the fair insight group had significant higher scores than poor insight group in projection, identification, somatization, actingout, regression, controlling, rationalization, dissociation. Second, we evaluated the average scores of each defense mechanisms acting-out had the highest average score among the defense mechanisms. Second was denial, third was show-off. And then, we grouped the defense mechanisms by maturity level, fair insight group had significant higher scores than poor insight group in immature and neurotic level. In the Ways of Coping Checklist, fair insight group had higher scores than poor insight group in emotion-focused coping rather than problem-focused coping. Conclusion:The fair insight group had relatively higher scores using projection, identification, somatization, acting-out, regression, controlling, rationalization, dissociation and emotionfocused coping than poor insight group. These results may reflect the characteristics of fair insight group which they show some reality as they begin to have insight but at the same time, they have difficulty in admitting the reality when they are confronted with it.

알코올의존 환자의 퇴원 후 외래 치료 충실도

노재원(Jae Won Noh),이계성(Kye-Seong Lee) 한국중독정신의학회 2013 중독정신의학 Vol.17 No.2

Objectives : The purpose of this study is to evaluate the treatment adherence of alcoholic patients after participating in an inpatient alcoholism group treatment program at a general hos-pital. Methods : We conducted chart reviews of 1017 patients, who had been admitted under the diagnosis of alcohol dependence according to DSM-IV-TR from January, 1998 to December, 2007 in Incheon Christian hospital. Subjects were divided into two groups, depending on group therapy (GT) attendances. Demographic characteristics, alcohol-related clinical characteristics and treatment processes were evaluated. Results : Due to the limited information available, we included only a final of 476 patients in our study. There are no significant differences in demographic characteristics except for the gender ratio and socioeconomic status between two groups, but the rate of experience of delirium tremens and family history of alcoholism were significantly high in GT attendance group. GT attendance group showed better results in total numbers of visit in the out-patient department (OPD), the mean duration of OPD follow up, 1 month OPD visit, 1-3 months OPD visit, 1-6 month OPD visit than those of Non-GT attendance group, and they had statistic significances. However, the 1-9 months OPD visit and 1-12 months OPD visit didn’t show any statistical significanc-es, although there were higher rates in GT attendance group. Conclusion : The results suggest that inpatient alcoholism group therapy has a positive effect on treatment adherence. It lasts at least for 6 months.