주의력결핍 과잉행동장애에서 파탄적 행동장애의 공존과 약물치료

강제욱(Je Wook Kang),박은진(Eun Jin Park),김성찬(Seong Chan Kim),신의진(Yee-Jin Shin),신윤미(Yun-Mi Shin),정재석(Jaesuk Jung),천근아(Keun-Ah Cheon),육기환(Ki-Hwan Yook) 대한소아청소년정신의학회 2012 소아청소년정신의학 Vol.23 No.S

Disruptive behavioral disorders [oppositional defiant disorder (ODD) and conduct disorder (CD)] are common comorbid disorders in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). ODD/CD may be comorbid up to 60% of children and adolescents with ADHD. Comorbid ODD and CD symptoms can have a significant impact on the course and prognosis o f patients with ADHD. Stimulant medications have shown effectiveness in treating both core ADHD symptoms and oppositional symptoms. Assessment and management of comorbid disruptive behavioral symptoms is an essential part in evaluation and treatment of ADHD patients. Further research is needed to investigate the efficacy and safety of various behavioral and medication regimens for ADHD, comorbid ODD and CD and to examine the relationships between ADHD, comorbid ODD and CD.

청소년의 스마트폰 사용시간과 우울증상 및 자살의 관계

강제욱(Je-Wook Kang) 대한사회정신의학회 2019 사회정신의학 Vol.24 No.2

연구목적 : 본 연구에서는 스마트폰 과의존이 청소년기의 우울감과 자살사고에 미치는 영향을 알아보고자 하였다. 방 법 : 2017년에 실시한 제 13차 청소년 건강행태 온라인조사의 원시자료를 사용하여 54,603명의 자료를 최종 분석하였다. 사회인구학적 정보와 정신사회적 요인을 평가하기 위해 우울감, 자살생각과 계획, 시도 등을 주요 변수로 사용하였다. 그리고 스마트폰 사용 시간을 주중과 주말로 나누어 각각의 특성을 분석하였다. 결 과 : 주중 스마트폰 사용시간이 300분이상인 청소년은 14.4%, 주말 스마트폰 사용시간이 480분 이상인 청소년의 비중이 18.2%로 나타 났다. 또한 주중 300분 이상 스마트폰을 사용하는 청소년의 경우 60분 이하로 사용하는 집단보다 우울증상의 위험성이 1.56배(OR= 1.56 ; 95% CI, 1.43~1.71 ; p<0.01) 높게 나타났으며, 자살사고도 유의하게 높아지는 것으로 나타났다(OR=1.23 ; 95% CI, 1.08~ 1.39 ; p<0.01). 주말 스마트폰 사용의 경우 480분 이상 스마트폰을 사용하는 경우, 우울증상의 위험성이 1.41배 증가하였고(OR= 1.41 ; 95% CI, 1.30~1.53 ; p<0.01), 자살사고도 유의하게 증가하는 것으로 나타났다(OR=1.16 ; 95% CI, 1.03~1.31 ; p=0.02). 반면 주중 평균 120~180분 사용하는 청소년의 경우에는 자살계획의 위험성이 감소하였으며(OR=0.84 ; 95% CI, 0.70~1.00 ; p=0.05), 주말 평균 240~300분 사용하는 경우에도 자살 사고의 위험성이 낮아지는 결과를 보였다(OR=0.87 ; 95% CI, 0.78~0.98 ; p=0.02). 결 론 : 본 연구의 결과를 토대로 살펴 볼 때 스마트폰 사용은 청소년기의 우울감과 자살사고에 긍정적, 부정적인 영향을 미치는 것으로 나타났다. 이러한 결과를 통해서 적절한 청소년기의 스마트폰 사용시간에 대한 합리적인 가이드라인을 세우는 데 도움이 될 것으로 생각된다. Objectives : The purpose of this study was to investigate the effects of smartphone dependence on adolescent depression and suicide. Methods : Data from 54,603 people were finally analyzed using raw data from ‘the 13th Korea Youth Risk Behavior Web-based Survey (KYRBWS)’ conducted in 2017. In order to evaluate psychosocial factors, depression, suicidal idea, planning and attempts were used as the main variables. The characteristics of each smartphone were analyzed by dividing smart-phone usage time into weekdays and weekends. Results : Adolescents who used smartphones for 300 minutes or more during the week showed 1.56 times higher risk of depression (OR=1.56 ; 95% CI, 1.43-1.71 ; p<0.01) than those who used less than 60 minutes. Incidents of suicide idea were also significantly higher (OR=1.23 ; 95% CI, 1.08-1.39 ; p<0.01). In the case of weekend smartphone use, the risk of depression increased by 1.41 times (OR=1.41 ; 95% CI, 1.30-1.53 ; p<0.01). Incidents of suicide idea were also significantly higher (OR=1.16 ; 95% CI, 1.03-1.31 ; p=0.02). On the other hand, adolescents who used 120-180 minutes on weekdays, had a lower risk of suicide planning (OR=0.84 ; 95% CI, 0.70-1.00 ; p=0.05). Also, risk of suicide idea was also lower when using the weekend for 240-300 minutes (OR=0.87 ; 95% CI, 0.78-0.98 ; p=0.02). Conclusion : This study provide mixed results between smartphone use time and mental health problem. This findings can offer better understanding and providing guideline to adolescent with using smartphone.

치매 진단에서 포괄적 신경심리검사의 유용성

이동우(Dong Woo Lee),강제욱(Je Wook Kang),유승호(Seung Ho Ryu),이강준(Kang Joon Lee),한은주(Eun Joo Han),정한용(Han Yong Jung) 대한노인정신의학회 2006 노인정신의학 Vol.10 No.1

Objectives : The rapid increase of elderly people with dementia poses a strategy for effective management of dementia. The recent progress in pharmacotherapy of dementia have overcome the past therapeutic nihilism, and gives the hope that dementia can be managed by early diagnosis and early intervention. Accordingly, the use of comprehensive neuropsychological test for early diagnosis is emphasized. Methods : In this study, we tried to evaluate the necessity and the usefulness of comprehensive neuropsychological tests in the diagnosis of dementia, by reviewing the guidelines for dementia, the researches about comprehensive neuropsychological tests, and by asking the experts about the necessity and the usefulness of comprehensive neuropsychological tests. Results : As a result we came to know that there are many tests which comprehensively covers the cognitive domains, and can be performed in relatively short time. The guidelines recommend that the use of comprehensive neuropsychological tests should be decided by the clinician. Many experts were the same opinion. Conclusion : There are many useful comprehensive neuropsychological tests, the use of which should be decided by the clinician.

성인 여성 성추행 피해자들의 정신적 증상 : 강간 피해자들과의 비교

김연수,김성진,공보금,강제욱,문정준,전동욱,이상민,주현빈,정도운,Kim, Yeon-Sue,Kim, Sung-Jin,Kong, Bo-Geum,Kang, Je-Wook,Moon, Jung-Joon,Jeon, Dong-Wook,Lee, Sang-Min,Ju, Hyun-Bin,Jung, Do-Un 한국정신신체의학회 2016 정신신체의학 Vol.24 No.2

연구목적 최근 검찰청 보고에 의하면 성폭력 피해자 중 강간 피해자는 17.1%이지만 성추행 피해자는 78.0%로 강간 피해자보다 그 수가 많았다. 이러한 성추행 피해자들에게도 심각한 정신적 증상이 다수 발생한다는 국외 보고가 있음에도 불구하고 이를 보고한 국내 연구는 없다. 따라서 본 연구는 성추행 성인 여성 피해자들의 정신적 증상을 조사하였고, 아울러 강간 피해자들의 이러한 증상들의 정도와 비교분석 하였다. 방 법 성폭력 발생 후 3개월 이내에 부산 스마일센터를 방문한 58명의 성인 여성 성폭력 피해자들이 대상자들이었다. 인구 통계학적 및 성폭력 관련 변인에 대하여 설문지를 이용하여 후향적으로 조사하였으며, 정신적 증상 중, 우울, 불안 증상의 심각도와 Posttraumatic stress disorder(PTSD) 유무는 Beck Depression Inventory (BDI), Beck Anxiety Inventory(BAI), Impact of Event Scale-Revised(IES-R) 자가보고형 척도를 이용하여 조사하였다. 결 과 총 58명 중 성추행 피해자는 36명(62.1%), 강간 피해자는 22명(37.9%)이었다. 성추행 피해자들 중 80.6%가 중등도 이상의 우울 증상, 83.3%가 중등도 이상의 불안 증상, 그리고 94.4%가 PTSD선별검사에서 유의미한 결과를 보였고, 이러한 정신적 증상에 대한 강간 피해자들에서의 비율(각각 95.5%, 95.5%, 95.5%)과 유의미한 차이가 없었다. 결 론 성추행 피해자들 또한 강간 피해자들만큼 대다수에서 우울, 불안 및 PTSD 증상이 동반되었다. 이러한 결과는 성추행 피해자들에서도 피해 초기부터 정신적 증상에 대한 적절한 평가와 조기 치료가 이루어져야 한다는 것을 시사한다. Objectives : According to the recent Korean National Police Agency report, rape victims were 17.1%, but sexual molestation victims were more than the rape victims by 78.0%. Despite many international reports about the occurrence of severe psychiatric symptoms in sexual molestation victims, there is no domestic research. Therefore in this study, we investigated psychiatric symptoms of sexual molestation victims, and we also compared it with psychiatric symptoms in rape victims. Methods : 58 women who visited Busan Smile Center within 3months after sexual violence were the study subjects. Questionnaire about sociodemographic and sexual violence related characteristics were retrospectively investigated. Of the psychiatric symptoms, Beck Depression Inventory(BDI), Beck Anxiety Inventory(BAI) for severity of depression and anxiety, and Impact of Event Scale-Revised(IES-R) to check the presence of posttraumatic stress disorder(PTSD) symptoms were used. Results : Of 58 sexual violence victims, sexual molestation victims were 36(62.1%) and rape victims were 22(37.9%). In sexual molestation victims, 80.6% had more than moderate severity of depression, 83.3% had more than moderate severity of anxiety, and 94.4% had significant scores at PTSD screening test. Compared with rape victims' psychiatric symptoms(each 95.5%, 95.5%, 95.5%) there were no significant difference. Conclusions : The majority of sexual molestation victims were also accompanied by depression, anxiety and PTSD symptoms as rape victims. There results suggest that appropriate assessment and early treatment for psychiatric symptom must be made in the early stage of injury in sexual molestation victims.

조현병 환자에서 QT 간격 지연과 흡연의 연관성

박민경(Min-Kyung Park),심주철(Joo-Cheol Shim),공보금(Bo-Geum Kong),강제욱(Je-Wook Kang),문정준(Jung-Joon Moon),신혜경(Hye-Kyung Shin),김현정(Hyun-Jung Kim),김정민(Jung-Min Kim),오민경(Min-Kyung Oh),정도운(Do-Un Jung) 대한생물치료정신의학회 2012 생물치료정신의학 Vol.18 No.2

Objectives:Abnormalities in the QT interval have been associated with an increased risk of ventricular arrhythmias and sudden cardiac death. However, there is no clear correlation between cigarette smoking and QT interval prolongation in schizophrenia. The purpose of this study is to evaluate the effects of cigarette smoking on the QT interval and estimate the prevalence of prolonged QT interval in schizophrenic patients who take antipsychotics. Methods:We studied 106 schizophrenic patients taking antipsychotics and age- and sex-matched 106 people in control group. A prolonged QTc interval was defined as >450 msec in men and >470 msec in women. The demographic data and clinical characteristics of subjects were collected from medical records. The correlations between QTc interval and other variables were assessed using a regression analysis. Results:There was no significant association between cigarette smoking and QT interval. The mean QT interval was not significantly influenced by antipsychotic dose and type of antipsychotics. However, there was significantly prolonged QT interval in schizophrenic patients(421.1±25.7 msec) compared to control group(412.1±17.1 msec) (p=0.003). The prevalence of prolonged QT interval in schizophrenic patients was 6.6%(7 of 106 patients). Five patients( 71.4%) were smoker and six patients(85.7%) had obesity. By contrast, nobody had a prolonged QT interval in control group. Conclusions:The prevalence of prolonged QT interval was relatively high among middle aged schizophrenia patients. And there was significantly prolonged QT interval and higher body mass index in schizophrenia patients.

소아 청소년 정신건강 선별검사 및 치료 연계 효율성에 대한 연구

김효진(Hyo-Jin Kim),조수철(Soo-Churl Cho),김재원(Jae-Won Kim),강제욱(Je-Wook Kang),신민섭(Min-Sup Shin),김효원(Hyo-Won Kim),윤명주(Myung-Ju Yun),이경영(Kyong-Young Lee),강연주(Yun-Ju Kang),김붕년(Boong-Nyun Kim) 대한소아청소년정신의학회 2009 소아청소년정신의학 Vol.20 No.3

Objectives:This study evaluated the effectiveness of school-based mental health screening and treatment linkage programs, focusing on attention-deficit hyperactivity disorder (ADHD) and adolescent depression. Methods:All 11,158 children and adolescents aged 8-14 years in Seoul received a school-based mental health screening, consisting of the Korean versions of the ADHD rating scale and the Child Behavior Checklist (CBCL), for ADHD, and the Center for Epidemiological Studies Depression Scale (CES-DS) and the Suicidal Ideation Questionnaire-Junior (SIQ-JR), for depression. The high-risk children’s and adolescents’ diagnoses were confirmed using the Diagnostic Interview Schedule for Children-IV (DISC-IV). Treatment linkage programs were managed by the Seoul Metropolitan Community Mental Health Center (Program 1), the Seoul Metropolitan Office of Education (Program 2), or the Dongjak District Office of Education (Program 3). We estimated and compared the referral rates of the three programs. Results:Program 1 screened and referred 22.9% of ADHD youths to mental health services, Program 2, 68.8%, and Program 3, 40.0%. Program 1 screened and referred 22.8% of depressed youths to mental health services, Program 2, 53.8%, and Program 3, 88.9%. Key elements for successful screening and referral programs were an effective school/community mental health center/Office of Education network, the parents’ financial support and perception of their child’s mental health status as being problematic, and the teachers’ active engagement. Conclusion:This is the first study investigating the effectiveness of school-based mental health screenings’ linkage to treatment for primary and middle school students in Korea. An effective network for community mental health and improvements in parents’ and teachers’ perceptions regarding mental health are needed for more successful treatment linkage.

조현병 환자에서 정신병리와 인지 기능과의 연관성

김성진(Sung-Jin Kim),심주철(Joo-Cheol Shim),공보금(Bo-Geum Kong),강제욱(Je-Wook Kang),문정준(Jung-Joon Moon),임지섭(Ji-Seop Lim),김임규(Im-Gyu Kim),김연수(Yeon-Sue Kim),오민경(Min-Kyung Oh),정도운(Do-Un Jung) 대한생물치료정신의학회 2013 생물치료정신의학 Vol.19 No.2

Objectives:Cognitive dysfunction is one of the major symptoms of schizophrenia, and has a diverse effect on the prognosis and course of schizophrenia. Several studies have been done about the correlation between cognitive dysfunction and clinical symptoms of schizophrenia, but the results of those studies were not clear. This study was performed to confirm the correlation between cognitive dysfunction and clinical symptoms of schizophrenia. Methods:We studied 117 patients with schizophrenia. We assessed clinical symptoms and the cognitive function of the patients, and analyzed the statistical correlation between clinical symptoms and the cognitive function. For clinical symptoms, Positive and Negative Syndrome Scale(PANSS), Clinical Global Impression-Severity(CGI-S) and Hamilton Depression Rating Scale(HDRS) were performed. For cognitive function, Digit Span Test, Visual Span Test, Stroop Color Word Test(SCWT), Continuous Performance Test(CPT), Wisconsin Card Sorting Test(WCST), and Digit Symbol Substitution Test(DSST) were performed. Results:There was significant correlation between CPT and clinical symptoms. The WCST revealed that Categories Achieved(CA) have significant correlation with disorganization symptoms among 5-factor model of PANSS (p<0.05). DSST revealed that the total score(p<0.01), negative syndrome(p<0.01), general psychopathology(p<0.01) among 3 kind major area classification of PANSS and disorganization symptoms of 5-factor model of PANSS(p<0.001) have significant correlation. Conclusion:This study revealed the correlation between the cognitive function and a part of clinical symptoms in patients with schizophrenia, as shown through the CPT, WCST and DSST.

조현병 환자의 인지기능 및 심리사회적 요인과 직업재활과의 연관성

김현정(Hyun-jung Kim),김성진(Sung-Jin Kim),공보금(Bo-Geum Kong),강제욱(Je-Wook Kang),문정준(Jung-Joon Moon),전동욱(Dong-Wook Jeon),서영수(Young-Soo Seo),하태민(Tae-Min Ha),정성수(Sung-Soo Jung),정도운(Do-Un Jung) 대한생물치료정신의학회 2014 생물치료정신의학 Vol.20 No.2

Objectives:This study was performed to assess the effect of cognitive function on occupational rehabilitation and to review the clinical and psychosocial factors that may affect occupational rehabilitation in patients with schizophrenia. Methods:A total of 58 patients were enrolled and divided into three groups : group of occupational rehabilitation (n=18), day-care(n=19), and out-patient care(n=21). For the cognitive function assessment, the Korean version of the MATRICS Consensus Cognitive Battery(MCCB) and the Korean version of the UCSD Performance-based Skills Assessment (UPSA) were performed. To assess clinical symptoms, the Positive and Negative Syndrome Scale, the Korean version of the Personal and Social Performance Scale(PSP), and the Clinical Global Impression–Schizophrenia scale(CGISCH) were performed. For the psychosocial factors assessment, the Korean Insight Scale for Psychosis and the Korean Version of 4th Revision of Schizophrenia Quality of Life Scale were performed. Results:On the MCCB, the occupational rehabilitation group showed higher scores than the day-care group in the verbal learning and social cognition domains. On the UPSA, the occupational rehabilitation group showed higher scores than the day-care group in the communication domain. No significant difference was found between the groups in the total scores of these cognitive function tests. On the CGI-SCH and PSP, the occupational rehabilitation group revealed better outcomes than the other groups. Conclusion:The schizophrenia patients with occupational rehabilitation had higher cognitive functions on some subscales, which may reflect social cognitive functions, and higher CGI-SCH and PSP scores.

자살 임박 시기 알코올 사용과 자살 기도의 특성

김임규(Im-Gyu Kim),임지섭(Ji-Seop Lim),공보금(Bo-Geum Kong),강제욱(Je-Wook Kang),문정준(Jung-Joon Moon),전동욱(Dong-Wook Jeon),김성진(Sung-Jin Kim),김현정(Hyun-Jung Kim),정도운(Do-Un Jung) 대한생물치료정신의학회 2016 생물치료정신의학 Vol.22 No.1

Objective:The aim of this study was to analyze the clinical characteristics of individuals who used alcohol at the time of attempting suicide. Methods:We divided 143 individuals who attempted suicide by consuming drugs into two groups on the basis of their blood alcohol concentration level: drinker group(n=79) and non-drinker group(n=64). We compared epidemio¬logical characteristics and suicidal behavior between the groups by using the Suicidal Intent Scale(SIS) and the Risk Rescue Rating Scale(RRRS). In addition, we administered the Glasgow Coma Scale(GCS) and the Acute Physiology and Chronic Health Evaluation-II(APACHE-II) to evaluate the medical lethality of the individuals who attempted sui¬cide. We used Student’s t-test, Pearson’s correlation analysis, and multiple linear regression to analyze the data. Results:The drinker group scored lower on the SIS’s planning subscale than the non-drinker group did(p=0.022). The drinker group’s blood alcohol concentration levels were negatively correlated with the rescue potential of their suicidal attempt(p=0.031) and the APACHE-II score(p=0.003). Higher blood alcohol concentration levels predicted poorer medical outcomes measured by the APACHE-II(p=0.004). Conclusion:Our findings support the notion that alcohol use increases suicidal impulsivity, decreases rescue po¬tential, and worsens medical outcomes. Therefore, suicide prevention programs need to include education and counseling about the risks associated with alcohol use.

조현병 장애 등급 평가와 한국판 University of California San Diego 실행에 기초한 기술평가 척도의 유용성

김유나(You-Na Kim),정도운(Do-Un Jung),강제욱(Je-Wook Kang),문정준(Jung-Joon Moon),전동욱(Dong-Wook Jeon),김성진(Sung-Jin Kim),이윤호(Yoon-Ho Lee),박성용(Sung-Young Park),이충열(Chung-Yeal Lee) 대한생물치료정신의학회 2018 생물치료정신의학 Vol.24 No.2

Objectives:The purpose of this study was to supplement the evaluation criteria for the schizophrenia disability grading system through a standardized test. Methods:Patients with schizophrenia were divided into three groups according to their Global Assessment Function(GAF) scores, which correspond to the disability grade of schizophrenia. We evaluated and compared the functional outcomes of patients with schizophrenia belonging to different severity groups. We performed the UCSD Performance-Based Skills Assessment(UPSA) and GAF to assess functioning in daily life, and the Positive and Negative Syndrome Scale(PANSS) and Clinical Global Impression-Schizophrenia Scale(CGI-SCH) to assess clinical symptoms. One-way analysis of variance was used for comparison between the three groups. The correlation between UPSA and other scale scores was analyzed by Pearson’s correlation coefficient. Results:A total of 117 patients were enrolled in this study. Of these, 46 were mild, 38 were moderate, and 33 were severe group. Significant differences in UPSA scores were identified between groups. The UPSA score was 71.54±14.12, 60.66±17.97, and 48.65±18.55 points for the mild, moderate, and severe group, respectively(p<0.001). The PANSS score was 53.83±15.67, 69.48±12.52, and 95.33±17.17 points for the mild, moderate, and severe group, respectively(p<0.001). The CGI-SCH score was 2.57±0.89, 3.08±0.94, and 4.18±1.01 points for the mild, moderate, and severe group, respectively(p<0.001). In addition, GAF, PANSS, and CGI-SCH showed a significant correlation with UPSA(correlation coefficient: 0.557, -0.497, and -0.570, respectively). Conclusion:The UPSA is a useful tool for assessing functions of daily living in patients with schizophrenia, and can be used to systematically measure the functional ability of patients according to their disability grade.