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수면다원검사의 정도관리 : 한국에서의 경험 및 제언 A Korean experience and critical suggestions
정도언 한국의료QA학회 1994 한국의료질향상학회지 Vol.1 No.1
Polysomnography is an essential methodology for diagnosing and following up sleep disorders and doing researches on human steep. Sleep medicine, mainly with the utilization of polysomnographic techniques, has developed itself as one of the promising fields in the 21st century medicine. Korea is not an exception in importing and developing sleep medicine into the conventional medicine. However, it still remains to be clarified what polysomnography is for and how it should be done, considering the relatively recent introduction of sleep medicine into Korea. The author, being a board-certified sleep medicine specailist, having experienced spreading out sleep medicine within Korea for the past four years, and having recently set up a major sleep study facility in Korea at Seoul National University Hospital, attempts in this introductory critical article to review the essential issues related to quality assurance in polysomnographic study of human sleep. Also, unconditional introduction of “automated” sleep scoring system, which has been found to have significantly reduced reliability in various studies including the author's own, is critically reviewed. The author suggests that quality assurance and training program should be initiated and established by a responsible sleep medicine-related organization such as the Korean Association of Sleep Medicine and Psychophysiology.
鄭道彦,禹鍾仁,李定均,趙普衍,高昌舜,金勇一 大韓神經精神醫學會 1982 신경정신의학 Vol.21 No.2
A case of a female Manic Depressive Illness patient with goitrous hypothyroidism is presented. After ten and half months of lithium maintenance therapy starting during her first psychiatric admission, she was admitted again due to acute recurrent manic episode. On admission, she complained of easy fatigability and cold intolerance, and thyroid gland was palpable and enlarged in moderate degree. Thyroid function test revealed markedly increased TSH and moderately decreased thyroxine levels. TRH stimulation test showed an exaggerated response. Needle biopsy specimen revealed chronic lymphocytic and immune complex thyroiditis. However, antithyroglobulin and antimicrosomal antibodies were negative. In pretreatment thyroid evaluation on her first admission, neither goiter nor thyroid function abnormality was detectable and no signs of underlying thyroid disease or hereditary predisposition to hypothyroidism were present. Within three weeks of discontinuation of lithium, goiter was no more palpable and within five weeks, thyroid function test returned to normal range. The possibility that patients with underlying thyroiditis may be particularly susceptible to a rapid onset of lithium-induced hypothyroidism is discussed.
소아정신과에 내원한 경련성질환 아동 및 청소년에 관한 연구
정도언 大韓神經精神醫學會 1985 신경정신의학 Vol.24 No.2
국립서울정신병원 소아정신과 외래에서 5년 7개월간에 진료받은 경련성질환 아동 및 청소년 총 114명에 대해 병록지조사법으로 연구후 다음과 같은 결론을 얻었다. 1. 연구대상 114명은 동일기간의 소아정신과 외래환자 총 650명의 17.5%를 차지해 경련성질환 진료가 소아정신과 외래에서 큰 비중을 차지하고 있음을 알 수 있었다. 2. 경련발작 외에 행동, 사회성, 정서 및 학습제반에 걸쳐서 다양한 장애를 보였으나 외래에서 시행한 주된 치료는 약물요법이었다. 3. 약물요법에서 초진직후부터 두가지 이상의 항경련제를 투여한 경우가 전체의 62.3%였으며 단독약물요법이 32.5%로 항경련제의 일반적 사용원칙에 위배되는 경우가 60%이상으로 초기나 중기 발달 단계에 있는 아동이나 청소년에게서 장애를 초래할 가능성을 배제할수 없었다. 4. 항경련제 투여후 행동이나 정서의 장애를 나타낸 예에서는 공통적으로 phenobarbital 이나 primidone을 투여 받고 있었기에 그 약리작용에 의해 행동이나 정서의 변화가 온 것으로 판단되었으며 그런 경우 맹목적인 항정신약물 투여보다는 항경련제의 대체가 바람직할 것으로 생각된다. 소아나 청소년의 경련성질환은 그 시기로 보아 발달상의 위기로 받아들여져야 하고 경련발작 자체의 약물치료에만 치중할 것이 아니라 그 환아의 행동, 정서, 인지, 학습 및 사회성 등 제반 발달이 정상적으로 이루어지도록 포괄적 치료가 시행되어야 한다. 이를 위해서는 정신과의사의 역할이 중요하며 경련성질환을 단순히 신경질환이라는 입장보다는 행동과학적 입장에서 다루어야 할것이다. 114 subjects (children and adolescents) with convulsive disorder were studied retrospectively, based on their medical records. They constituted 17.5% of the total child psychiatry outpatients seen for 5 years and 7 months. Besides the seizure attacks, various kinds of conduct, emotional, social and learning disturbances were reported, however, the treatment done in the outpatient clinic was exclusively drug therapyoriented. In anticonvulsant drug therapy, more than two kinds of anticonvulsants were prescribed in 62.3% of the study subjects. Especially in children and adolescents, it may affect the ongoing normal developmental processes adversely. While on treatment with anticonvulsants, 19 subjects were reported to develop some hyperkinetic behavior, personality change, destructive behavior and memory impairment. In most cases, it was estimated to be the effect of phenobarbital and/or primidone commonly administered to them. Antipsychotic drugs were prescribed to some of them to control the conduct problems but it is somewhat undesirable due to the antipsychotics' potential action to lower the seizure threshold and to cause tardive dyskinesia if used on a long term basis. Rather, it is recommended that the suspected anticonvulsant be substituted. Convulsive disorders in children or adolescents should be regarded as a 'developmental crisis' and they should be treated comprehensively, not in terms of a simple neurological disorder. Normal developmental progress should be fully encouraged.