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RISS 인기검색어
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- 저자 : 홍강의(Kang-E Hong) (검색결과 103 건)
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홍강의,김수정,Hong, Kang-E.M,Kim, Soo-Jeong 대한수면의학회 1996 수면·정신생리 Vol.3 No.2
Since REM sleep was found to be closely related with dream, efforts have been made to find the neurophysiological mechanism and the psychological meaning of dream. However, since most researchers have paid attention to dreams of adults, there are relatively few studies devoted to those of developing children. In the prevent study, we reviewed the previous studies and hypotheses about sleep and dream in various aspects and summarized the characteristics of sleep and dream of children in developmental domain as followings. (1) Sleep development : Across childhood, sleep architecture and sleep-wakefulness cycles are progressively changed toward the patterns of adult. They become similar to adult patterns only in their adolescence. Thus, the sleep event sconsidered as abnormal in adults may be normal in children. (2) Dream development : First, the content and meaning of the dream change with increasing age and develop in parallel with children's ego function, especially cognitive developmental stages. Second, for the children, the reality and the dream are on the continuous spectrum of 'reality-imitation-play-fantasy-dream'. Third, dreaming is the pure assimilation process for the children and through dreaming they can adapt and accomodate the reality without emotion.
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오경자,이혜련,홍강의,Oh, Kyung-Ja,Lee, He-Len,Hong, Kang-E 대한소아청소년정신의학회 1991 소아청소년정신의학 Vol.2 No.1
아동기 심리장애의 표현양상에서의 성별차이를 알아보기 위하여 정신과 진료기관에 내원한 환자 834명을 부모설문형식의 CBCL을 통하여 평가한 후, 그 자료를 남녀별로 각각 요인분석하여 행동장애 증후군을 구성하였다. 그 결과 공격, 과잉활동, 비행, 사회적 위축, 정서불안정, 그리고 신체증상의 여섯 개 요인은 남녀 공통으로 얻어졌으나, 강박, 우울 등의 내면성 증후군과 정신병의 임상적 특징을 나타내는 요인은 남녀간에 상당히 다른 양상을 보였다. 공통적으로 얻어진 여섯 요인들의 경우에도, 그 핵심이 되는 문제행동들은 남녀가 공유하고 있었으나, 그 밖에 측면에서는 남아와 여아 집단은 서로 다른 특징을 보였다. 이같은 문제행동 증후군에서 성별차이는 행동양식에 대한 성역할 고정관념과 관련되어 논의 되었다. In an attempt to study sex differences in child behavior disorders, 834 clinic-refered children(582 boys and 252 girls) between the ages of 6 to 11 were assessed using CBCL parental form and the data were factor analysed to form empirically derived syndromes for each sex. The analyses yielded eight behavior disorder syndromes for boys and ten, for girls. Six syndromes(aggressive, hyperactive, delinquent, social withdrawal, emotional lability, physical complaints) were found in both sexes while obsessive, depressive and psychotic syndromes were organized differently in boys and girls. There were also considerable differences in item composition of the six syndromes common to box sexes, suggesting that clinical features of common behavior disorders such as aggression and hyperactiveity might be different for boys and girls despite their apparent similarity. The results were discussed in terms of culturally shared attitudes and beliefs concerning sex differences in behaviors.
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손창호,신민섭,홍강의,정오언,Sohn, Chang-Ho,Shin, Min-Sup,Hong, Kang-E,Jeong, Do-Un 대한수면의학회 1996 수면·정신생리 Vol.3 No.1
Obstructive sleep apnea syndrome(OSAS) in childhood is unique and different n-om that in adulthood in several aspects, including pathophysiology, clinical features, diagnostic criteria, complications, management, and prognosis. Characteristic features of childhood OSAS in comparison with the adult form are the variety of severe complications such as developmental delay, more prominent behavioral and cognitive impairments, vivid cardiovascular symptoms, and increased death risk, warranting a special attention to the possible diagnosis of OSAS in children who snore. However, the childhood OSAS is often neglected and unrecognized. We, therefore, report a case of very severe OSAS in a 5-year-old boy who was sucessfully treated with continuous positive airway pressure(CPAP) treatment. Interestingly, the patient was comor-bid with the attention deficit hyperactivity disorder. Prior to the initial visit to us, adenotonsillectomy had been done at the age of 4 with no significant improvement of apneic symptoms and heavy snoring. On the initial diagnostic procedures, marked degree of snoring was audible even in the daytime wake state and the patient was observed to be very hyperactive. Increased pulmonary vascularity with borderline cardiomegaly was noted on chest X-ray. The baseline polysomnography revealed that the patient was very sleep-apneic and snored very heavily, with the respiratory disturbance index(RDI) of 46.9 per hour of sleep, the mean SaO2 of 78.8%, and the lowest SaO2 of 40.0%(the lowest detectable oxygen level by the applied oxymeter). The second night polysomnography was done for CPAP titration and the optimal pressure turned out to be $8.0\;cmH_2O$. The applied CPAP treatment was well tolerated by the patient and was found to be very effective in alleviating heavy snoring and severe repetitive sleep apneas. After 18 months of the CPAP treatment, the patient was followed up with nocturnal polysomnography(baseline and CPAP nights) and clinical examination. Sleep apneas were still present without CPAP on the baseline night. However, the severity of OSAS was significantly decreased(RDI of 15.7, mean SaO2 of 96.2%, and the lowest SaO2 of 83.0%), compared to the initial polysomnographic findings before initiation of long-term CPAP treatment. Wechsler intelligence tests done before and after the CPAP treatment were compared with each other and surprising improvement of intelligence(total 9 points, performance 16 points) was noted. Clinically he was found to be markedly improved in his attention deficit hyperactive behavior after CPAP treatment, but with minimal change of TOVA(test of variables of attention) scores except conversion of reaction time score into normal range. On the chest X-ray taken after 18 months of CPAP application, the initial cardiopulmonary abnormalities were not found at all. We found that the CPAP treatment in a young child is very effective, safe, and well-tolerated and also improves the co-morbid attention deficit hyperactive symptoms. Overall, the growth and development of the child has been facilitated with the long-term use of CPAP. Cardiovascular complications induced by OSAS have been also normalized with CPAP treatment. We suggest that early diagnosis and active treatment intervention of OSAS in children are crucial in preventing and ameliorating possible serious complications caused by repetitive sleep apneas and consequent hypoxic damage during sleep.
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심각한 소아 ${\cdot}$ 청소년 강박장애로 입원한 환아들의 특징
황준원,유소영,장준환,신민섭,조수철,홍강의,김붕년,Hwang, Jun-Won,You, So-Young,Chang, Jun-Hwan,Shin, Min-Sup,Cho, Soo-Churl,Hong, Kang-E,Kim, Boong-Nyun 대한소아청소년정신의학회 2004 소아청소년정신의학 Vol.15 No.2
연구목적:소아·청소년기 발병 강박장애는 낮은 약물반응, 높은 공존장애율, 강한 유전적 경향성을 가진다고 알려져 왔다. 그러나 현재까지 국내에서 소아·청소년기 발병 강박장애에 대한 연구는 극히 미미하다. 이에 본 연구에서는 서울대학교병원 소아·청소년 정신과 병동에 입원한 강박장애 아동들을 대상으로 임상양상, 유전부하, 약물 반응양상, 퇴원후의 경과등을 조사하여, 심각한 증상을 보이는 소아·청소년 강박장애 군의 특성을 파악하려 하였다. 방 법:최근 9년사이에 서울대병원 소아·청소년 정신과에 입원한 환아 20명(남 16, 여 4)의 자료를 조사하였고 이를 대상으로 임상적 특성을 조사하였다. 진단 및 임상 상의 정확성을 유지하기 위해 의무기록지, 심리학적 보고서, 가족 면담 자료, 간호 보고서를 모두 고려하였고, 퇴원시 확정된 진단을 일차진단으로 하였다. 결 과:1) 환아의 성비는 남성이 4:1로 우위였다. 2) 강박사고에 있어서 가장 흔한 형태는 병적의심이었고, 이어서 더러움에 대한 공포, 공격적 사고, 대칭에의 요구, 성적 강박 사고였다. 강박행동에서 가장 흔한 내용은 확인, 씻기, 숨쉬기, 움직임, 대칭, 반복적 질문, 물건수집, 정신적 강박행동 등이었다. 3) 가장 흔한 공존 장애는 우울증이었고, 그 다음으로는 다른 불안장애, 틱장애, 품행장애, 반항장애였다. 드물게 강박사고에 대한 현실검증력이 손상된 것으로 판단되는 아동도 발견되었다. 4) 정신과 질환에 대한 가족력을 살펴본 결과, 17 가족(85%)에서 2차 친척 중 정신과 장애를 앓는 사람이 발견되었다. 그리고, 강박 스펙트럼 장애로 의심되는 친척을 둔 아동이 전체의 45%(9명)이었다. 5) 약물치료로서 사분의 삼 정도의 환아들(75%)이, SSRI와 항정신병약물을 함께 복용하고 있었고, 치료 반응상 CGI에서 중등도 호전(moderate improved) 이상을 보이는 경우가 75%로 파악되었다. 6) 퇴원 후의 외래 추적 결과, 지속적인 증상의 관해를 보인 경우는 5명(25%)이었고, 부분적인 증상을 가진 채 만성적으로 지속되는 경우가 10명(50%)이었다. 결 론:심각한 소아·청소년 강박장애약물 환아들의 임상상을 국내에서는 최초로 체계적으로 조사하였다. 그 결과, 높은 공존장애율, 높은 정신과장애의 가족력, 높은 항정신병약물 복용을 보이는 것으로 조사되었다. 증상면에서도 공격적-성적 강박사고의 비율이 높았으며, 숨쉬기, 움직이기 등의 특이한 강박행동이 발견되었다. 치료로서 사분의삼 정도의 환아들(75%)이, SSRI와 항정신병약물을 함께 복용하고 있었고, 치료 반응상 CGI에서 중등도 호전(moderate improved) 이상을 보이는 경우가 75%로 파악되었다. Objectives : Child and adolescent onset obsessive compulsive disorder(C-OCD) is known to be associated with poor drug response, high comorbid rate and strong genetic tendencies. Till now studies for C-OCD have been very rare in Korea. We conducted this study to investigate the informations about clinical features, familial psychiatric loading, treatment profiles and course of server C-OCD from the retrospective analysis of inpatient data of Seoul National University Children's Hospital. Method : Retrospective chart review and data analysis was performed. Twenty(male 16 : female 4) patients with final C-OCD diagnosis by DSM-IV at discharge from 1994 to 2002 were found and their medical chart, psychological data, family interview data and nursing reports were collected and analyzed. Results : 1) The sex ratio of C-OCD was male dominant(4:1). 2) Phenomenological, most common obsession was pathologic doubt, contamination fear, followed by aggressive obsession, need for symmetry, sexual obsession, most common compulsion was checking and washing, followed by breathing, movement, symmetry, repetitive asking, hoarding, mental compulsion. 3) Most common comorbid diagnosis was depression. Other axis-I diagnosis associated OCD were anxiety disorder, tic disorder, conduct and oppositional defiant disorder and psychosis. 4) Regarding psychiatric familial loadings, 17 patients(85%) had relatives with psychiatric disorders, OC-spectrum disorders(OCD or OCPD) were found in 9 patients(45%). 5) The majority of patients(75%) have received SSRI and antipsychotics treatment. The response rate above 'moderate improved" by CGI was 75%. 6) During follow-up period in outpatient clinic, five patients(25%) showed continuous complete remission, 10 patients (50%) did residual symptoms with chronic course. Conclusion : This seems to be the first systemic investigation of severe pediatric OCD patients in Korea. The children & adolescents with severe OCD in inpatient-setting showed the high comorbid rate, familial psychiatric loading, and combined pharmacotherapy with antipsychotics, As for symptoms, high rate of aggressive-sexual obsession and atypical compulsions like breathing and moving was reported in this study. Severe pediatric OCD patients, however, responded well to the combined SSRI and antipsychotics regimen.
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