Psychopharmacotherapy in Preschooler(일반적 고려사항과 적용)

육기환 대한소아청소년정신의학회 2011 대한소아청소년정신의학회 학술대회논문집 Vol.2011 No.4

소아·청소년 정신장애의 종류

육기환 韓國學校保健學會 1998 韓國學校保健學會誌 Vol.11 No.2

만성 틱장애에서 공존증상에 따른 틱증상의 심각도와 혈장 Homovanillic Acid 와 5-Hydroxyindoleacetic Acid 농도의 차이

육기환,민성길,장순아 대한신경정신의학회 2001 신경정신의학 Vol.40 No.1

연구목적: 틱장애에서는 다른 정신장애가 공존하는 경우가 매우 많은데, 고통을 주는 증상으로 특히 주의력결핍과잉운동증상과 강박증상이 관심을 받아 왔다. 틱장애의 병태생리에 대한 연구에서 도파민계, 세로토닌계, 아드레날린계 등의 중추 모노아민계의 이상이라고 하며 강박증상과 주의력결핍 과잉운동증상도 도파민계, 세로토닌계, 아드레날린계의 이상이라고 하였다. 본 연구는 틱장애 아동군에서 주의력결핍 과잉운동장애나 강박장애의 공존유무에 따라 틱증상의 심각도에 차이가 있는지 알아보고 틱증사의 심각도와 공존증상에 따라 혈장 homovanillic acid(HVA)와 5-hydroxyindoleacetic acid(5-HIAA) 농도에 차이가 있는지 알아보고자 시행되었다. 방법: 본 연구는 50명의 만성 틱장애를 가진 환자를 대상으로 강박장애와 주의력결핍 과잉운동장애를 진단하였고 틱증상과 강박증상과 주의력결핍 과잉운동증상을 각각 Yale global tic severity scale(YGTSS).Leyton obsessional inventory-child version(LOI-CV), Conners parent rating scale로 평가하였으며 high performance liquid chromatography를 이용하여 혈장 HVA와 5-HIAA 농도를 측정하였다. 결과: 틱장애 전체 대상군에서 강박장애나 주의력결핍 과잉운동장애가 공존된 경우 58%였으며 두 장애가공존되어 있어도 틱증상의 정도와 혈장 HVA와 혈장 5-HIAA 농도에 차이는 없었다. 틱 증상의 정도가심할수록 혈장 HVA 농도와 정의 상관관계를 보였으나 혈장 5-HIAA 농도와는 상관성이 없었다. 강박증상의 저항과 방해척도는 혈장 5-HIAA 농도와 역 상관관계를 보였다. 결론: 틱장애에 강박장애나 주의력결핍 과잉운동장애가 공존되어 있어도 틱증상의 심각도에 영향을 주지 않았다. 틱증상의 심각도는 혈장 HVA 농도와 상관관계가 있고 혈장 5-HIAA 농도와는 상관성이 없어 틱증상은 도파민계의 이상과 관련있음이 시사된다. Objectives : Contemporary empirical studies have suggested high rates of comorbid attention-deficit hyperactivity disorder(ADHD) or obsessive compulsive disorder(OCD) in children with tic disorders. Not infrequently, ADHD or OCD is as source of greater impairment than are the tic symptoms. The studies in the pathophysiology of tic disorder have implicated abnormalities of dopamine, serotonin and norepinephrine. The studies in pathophysiology of ADHD or OCD also have implicated abnormalities of dopamine, serotonin and norepinephrine. This study was purposed to examine the differences in tic severities and in the levels of plasma homovanillic acid(HVA) and 5-hydroxyindoleacetic acid(5-HIAA) according to the presence of comorbid ADHD or OCD in patients with chronic tic disorders. Methods : In fifty chronic tic patients, OCD or ADHD was also diagnosed. And then tic symptoms, obsessive-compulsive symptoms, and attention-deficit hyperactive symptoms were assessed using Yale global tic severity scale(YGTSS), Leyton obsessional inventory-child version (LOI-CV), and Conners parent ration scale. The plasma HVA and 5-HIAA levels were measured using high performance liquid chromatography with electrochemical detection method. Results : Fifty-eight percent of the patients with chronic tic disorders had comobid ADHD or OCD. But severities of tic did not differ regardless of the presence of comorbid ADHD or OCD. There was a significant positive correlation between tic severities and plasma HVA levels but none between tic severities and plasma 5-HIAA levels. There was a significant inverse correlation between resistance and interferencd scores and plasma 5-HIAA levels. Plasma HVA levels showed significant positive correlations with plasma 5-HIAA levels. Conclusion : These results showed that tic severities didn't vary according to the presence of comorbidities, and that tic severities were correlated with plasma HVA levels, not with plasma 5-HIAA levels. These results suggested that the pathophysiology of chronic tic disorder was strongly correlated with abnormalities of dopaminergic system.

한국인이 생각하는 나르시시즘(Narcissism)의 개념에 대한 예비연구

이만홍,육기환 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.3

Objects : In order to define different concepts of narcissism in Korean, this study was designed to compare the concept of narcissism by Korean laymen with that of DSM-Ⅲ-R. Methods : 1) Initially, 2 laymen & 4 psychiatric personnel were interviewed and made to describe in free association on narcissism. With these results and the DSM-Ⅲ-R diagnostic criteria of narcissistic personality disorder, we developed a semistructured interview. 2) Using this semistructured interview, authors interviewed 28 key informants(14 laymen, 14 psychiatric residents) an asked them to describe their own understanding of prototypical person of narcissism. Psychiatric residents were comparative subjects to laymen. Results : Laymen thought positively that narcissism was one part of personality, made them achieve self-confidence and a new vitality in life, and consequently made them more enthusiastic in one's work. Narcissism was thught to result in possible difficulties of interpersonal relationships espeually by psychiatric residents. There was a gender difference which concentrated on the differences-men thought level of education, job, success, fame and money more important whereas women took as important factors such as appearance, relationships with one's spouse or lover and his social standing. Men overtly require acceptance by others whereas women self-absorption and intellectual achievement. When one is denied, men directly show aggressive response whereas women show this indirectly and later. Laymen saw narcissism as normal, while some saw it as a personality disorder or mental disorder. Reasons contribute to narcissism were developmental factor and socioenvironmental factor. Conclusions : Concepts and psychopathology of narcissism did not seem little difference between opinions of laymen and DSM-Ⅲ-R. Laymen took narcissism more positively than psychiatric residents. It was taken as part of personality, required for normal development and professional capabilities are above average and have achievement and self-confidence. Narcissism did not require treatment or when necessary it would become better. Results suggested that narcissism has sex difference more or less.

주의력결핍 과잉행동장애 아동에서 공존질환에 따른 OROS-Methylphenidate의 효과와 안전성

윤형준,육기환,전덕인,석정호,홍나래,조성식,홍현주 대한소아청소년 정신의학회 2008 소아청소년정신의학 Vol.19 No.3

Objectives : The purpose of this study is to evaluate the efficacy and tolerability of OROS-Methylphenidate(MPH) in children with Attention Deficit Hyperactivity Disorder(ADHD) according to comorbid psychiatric disorders. Methods : This is an 8-week open label study of OROS-MPH monotherapy. Subjects were 6-12 years of aged 113 children with ADHD. Outcome measures were Korean version parent ADHD rating scale(K-ARS), Korean version Conners parent rating scale(K-CPRS), Clinical Global Impression-Severity and Clinical Global Impression -Improvement. Side effects were monitored with the Barkley’s side effect rating scale. We compared change-over-time of mean scores of outcome measure according to comorbidity of disruptive behavior disorder, depressive disorder, anxiety disorder, and tic disorder. Results : Mean scores of K-ARS and K-CPRS were significantly decreased regardless of comorbidity. Mean doses of OROS-MPH and dropout rate were not different significantly according to comorbidity. For side effects, overall OROS-MPH was well tolerated despite comorbidity. However, children with tic disorder reported higher tics or nervous movements item than those without tic disorder from 2nd week to 8th week. Conclusion: OROS-MPH is efficacious for decreasing the symptoms of ADHD and well tolerated regardless of comorbid psychiatric disorders.

학교폭력 피해 청소년의 정신의학적 후유증에 관한 사례 연구

송동호,육기환,이호분,노경선 대한소아ㆍ청소년정신의학회 1997 소아청소년정신의학 Vol.8 No.2

청소년의 문제행동에 대한 인지행동 집단치료의 효과 : 폭력 행동을 중심으로 Focuced on Violent Behaviors

민성길,이호분,육기환,남궁희승,류경희 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.4

연구목적 : 본 연구는 인지행동적 집단치료를 문제행동을 보이는 청소년에 시행하여 청소년 문제행동과 폭력행동의 감소에 미치는 효과를 평가하고 효과에 영향을 주는 요인을 찾아 청소년 문제행동과 폭력행동에 대한 개입의 모델을 제시하려하였다. 방 법 : 교사들에 의해 문제행동을 보이는 학생으로 의뢰된 27명의 중학교 2학년 남녀학생들에게 15 회기에 걸친 인지행동적 집단치료를 시행하였다. 대조군은 같은 중학교 2학년 남녀 학생 20명으로 이들에게는 치료를 실시하지 않았다. 대상군과 대조군을 치료 전후에 자기기술형 비행척도, 폭력행동척도를 작성하게 하였으며, 담임 교사로 하여금 대상군에게 치료전후에 교사용 문제행동 척도, 문제행동 적발빈도 조사를 실시하였다. 결 과 : 1) 자기기술형 비행 척도, 폭력행동 척도로 평가한 결과 대상군에서는 치료 후에 비행이 유의하게 감소하였으며, 대조군과 비교하였을 때 양군간의 유의한 차이가 있었다. 2) 대상군에 대한 교사용 문제행동 척도, 문제행동 적발 빈도조사에서 치료 전후에 문제행동이 유의한 차이를 보이지 않았다. 3) 치료효과를 조별로 비교하면 자기 기술형 비행척도는 조별로 유의하게 차이를 보였고. 2조는 교사용 문제행동 적발 빈도 조사를 제외한 모든 척도에서 유의한 호전을 보였다. 4) 문제행동의 호전에 영향을 주는 요인은 대상군의 성별, 문제행동정도와 치료자였으며, 폭력 행동의 호전에 영향을 주는 요인은 대상군의 문제행동정도였다. 결 론 : 문제행동을 보이는 청소년을 대상으로 한 인지행동적 집단치료는 그들 스스로 평가한 문제 행동 감소의 효과는 있었으나, 교사가 평가하기에는 유의한 차이가 없었으며, 폭력행동에 대해서 특이한 효과는 보여 주지 못하였다. 하지만 대상군의 성별, 문제행동의 정도, 치료자에 따라서는 문제행동의 감소, 폭력행동의 감소 모두에 효과가 있었다. 이러한 결과는 대상군의 선정과 치료자의 숙련도에 따라서는 인지-행동치료가 청소년 문제행동과 폭력행동에 대한 적절한 치료 모델이 될 수 있음을 시사한다. Objectives : The purpose of this study was to examine the effect of cognitive-behavioral group therapy on improving adolescents' behavioral problems, especially violent behavior. Method : The subjects were 27 middle school students referred by their teachers for behavioral problems. We devided them into 4 teams and treated them for 15 sessions of cognitive-behavioral group therapy. The control group were 20 middle school students who had no cognitive-behavioral therapy. We assessed their behaviors pre-and post intervention by two series of scale, ie. self ratings and teacher ratings. Self ratings included 'misbehavior scales' and 'violent behavior subscale' ; teacher ratings included 'teacher-children rating scale' and 'detection of misbehavior scale'. Result : 1) In self-rating scales, the misbehavior of the subject group decreased more than the coltrol group, but not the violent scale. There were statistically significant group differences of improving effect in misbehavior scales. 2) In teacher rating scales, there was no significant decrease in the behavioral problems of the subject group. 3) By teams there were significant different intervention effects among 4 teams in self rating misbehavior scale. Team 2 improved on all scales except teacher-rating detection of misbehavior scale. 4) Determinant factors of intervention effect on behavioral problems were the degree of baseline behavioral problems, sex of subjects and therapist. Conclusion : The results from this study suggest that cognitive-behavioral group therapy was effective in decreasing the behavioral problems of adolescents. But the effect of therapy depends on sex, the degree of behavioral problems of subjects and the therapist.

Predictors of Suicide Attempts in Clinically Depressed Korean Adolescents

권아혜,송정은,육기환,전덕인,정명훈,홍나래,홍현주 대한정신약물학회 2016 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.14 No.4

We examined predictors of suicide attempts in clinically depressed adolescents in Korea and gender differences in suicidal behavior. In total, 106 adolescents diagnosed with depressive disorder were recruited in South Korea. We assessed various variables that might affect suicide attempts, and used a structured interview for the diagnosis of depression and comorbidities and to evaluate suicidality. Demographic and clinical characteristics of the subjects were compared between suicide attempt and non-suicide attempt groups and we examined significant predictors of suicide attempts. Gender differences in suicidal ideation and suicidal behavior were also analyzed. Among 106 depressed participants, 50 (47.2%) adolescents were classified in the suicide attempt group. Generally, the suicide attempt and non-suicide attempt group shared similar clinical characteristics. The suicide attempt group had more females, more major depressive disorder diagnoses, more depressive episodes, and higher suicidal ideation than the non-suicide attempt group. Suicidal ideation was the only significant predictor of suicidal attempt, regardless of gender. Higher suicidal ideation frequency scores and more non-suicidal self-injurious behaviors were shown in the female suicide attempt group than the male suicide attempt group. It is recommended that suicidal ideation be assessed regularly and managed rigorously to decrease suicide risks in depressive adolescents.

초발 조현병, 만성 조현병과 건강 대조군의 뇌활과 분계섬유줄 연결성 비교

이아리라,윤미림,육기환,최태규,이강수,방민지,이상혁,Lee, Arira,Yun, Mirim,Yook, Ki Hwan,Choi, Tai Kiu,Lee, Kang Soo,Bang, Minji,Lee, Sang-Hyuk 대한생물정신의학회 2019 생물정신의학 Vol.26 No.1

Objectives Disrupted integrities of the fornix and stria terminalis have been suggested in schizophrenia. However, very few studies have focused on the fornix and stria terminalis comparing first-episode schizophrenia (FESZ), chronic schizophrenia (CS), and healthy controls (HCs) with the application of diffusion-tensor imaging (DTI) technique. The objective of this study is to compare the connectivity of the fornix and stria terminalis among FESZ, CS, and HCs. Methods We included the 44 FESZ patients, 39 CS patients and 20 HCs in this study. Voxel-wise statistical analysis of the fractional anisotropy (FA) data was performed using Tract-Based Spatial Statistics to analyze the connectivity of fornix and stria terminalis. In addition, the Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS) were used to evaluate clinical symptom severities. Results There were no significant differences between the FESZ, CS, and HCs in age, sex, education years. The SAPS and SANS scores of the schizophrenia groups showed no significant differences. FA values of the right fornix cres/stria terminalis in the CS group were significantly lower than those in FESZ and HCs. There were no significant differences of FA values of the right fornix cres/stria terminalis between the FESZ and the HCs. Pearson correlation analyses revealed that significant correlation between FA values of the right fornix cres/stria terminalies of the the FESZ group and positive, negative symptom scales, and FA values of the right fornix cres/stria terminalis of the CS group and negative symptom scales. Conclusions This study shows that FA values of the fornix and stria terminalis in the CS were lower than in the FESZ and the HCs. These results suggest that the fornix and stria terminalis can play a role in pathophysiology of schizophrenia. Thus current study can broaden our understanding of the pathophysiology of schizophrenia.

청소년 우울증에서 비자살적 자해에 영향을 주는 심리사회적 요인

예덕해,홍현주,육기환,최혜인,이지은,전진용,박일호,구민성,송정은 대한우울조울병학회 2012 우울조울병 Vol.10 No.2

Objective : The object of our study was to compare the psychosocial and clinical characteristics between depressed adolescents with a history of Non-suicidal self-injury (NSSI) and those without a history of NSSI. Method : We recruited 63 subjects, age 13-18 adolescents who were diagnosed as depressive disorders with Korean version of Kiddie-Schedule for Affective Disorder and Schizophrenia Present and Lifetime Version. Adolescents completed Beck depression inventory, Revised children’s manifest anxiety scale, Beck suicidal ideation Scale, physical abuse and emotional abuse scale. Results : Results showed that suicidal ideation score (21.88, p=0.01), emotional (32.62, p=0.003) and physical (31.70, p=0.001) abuse score were higher in adolescents with a history of NSSI than those without a history of NSSI. Regression analysis indicated that suicidal ideation have a small but significant influence on NSSI event (beta=0.144, p=0.017). Conclusion : Our findings suggested that clinicians should consider the possibility of abuse history and suicidality in adolescents with a history of NSSI.