Neurocognitive Function Assessment of Traumatic Brain Injury

오병훈,Oh, Byoung Hoon The Korean Society of Biological Psychiatry 1995 생물정신의학 Vol.2 No.2

외상후 뇌손상은 대표적이며, 가장 중요한 신경정신계 질환의 하나이다. 더욱이 외상후 뇌손상 환자들은 각종의 사고 및 산업재해 등으로 인해 그 수가 급증하고 있으며, 특히 인지기능의 장애로 인한 다양한 기질성 정신장애로 고통을 겪게 된다. 따라서 외상후 뇌손상은 손상의 시점에서부터 정확하고 올바른 평가는 물론 손상후의 경과 및 치료대책의 수립에 있어서 체계적이며 종합적인 신경인지기능의 평가는 필수적이다. 왜냐하면 신경인지기능평가는 뇌의 손상부위와 이와 관련된 기능장애 및 행동의 변화에 대한 객관적인 자료를 제시해 주기 때문이다. 신경인지기능 평가의 영역은 지각, 운동기능은 물론 주요인지기능인 기억, 언어, 실행 및 감정조절능력에 이르기까지 다양하며, 외상후 뇌손상환자들은 손상부위 및 정도에 따라 신경인지기능의 장애를 초래하게 된다. 대표적인 신경인지기능평가 도구로는 KWIS, Halstead-Reitan, Luria-Nebraska batteries, 특히 전두엽기능검사인 Wisconsin Card Sorting Test (WCST)를 비롯하여, 현재는 PC/S Vienna Test System 및 Stim등의 각종 전산화 인지기능검사가 개발되어 임상에서 활발히 사용되고 있다. 즉 외상후 뇌손상환자를 위한 신경인지기능평가의 목적은 뇌손상과 관련된 신경인지기능장애를 정확히 평가하여, 환자 개개인에 적합한 인지재활치료 계획을 수립하는데 있다. 물론 여기에는 신경정신상태검사(neuropsychiatric mental status examination)를 통하여 외상 후 뇌손상의 경과 및 예후에 결정적인 영향을 미칠 수 있는 나이, 의식소실 및 외상후 기억 손상 시간의 정확한 측정은 물론 심리 사회 문화적인 상태와 두부외상전 환자의 지적수준 및 사회 적용기능이 함께 평가되어야 할 것이다.

임상 신경심리학적 평가

오병훈,Oh, Byoung Hoon 대한생물정신의학회 1995 생물정신의학 Vol.2 No.1

Clinical neuropsychology which belongs to the necuroscience field is concerned with relationship between human behaviors and the brain structure. Clinical neuropsychology has grown to be a specialized separate field within psychology over the last twenty years. Clinical neuropsychology offers an objective methodology to consider the mind-body interaction and evaluate the behavioral consequences and functional deficits associated with brain lesions. Clinical neuropsychological assessment is composed of cognitive, perceptual, motor and emotional function through various neuropsychological examinations such as Halsted-Reitan and Luria-Nebraska batteries, and computerized neuropsychological test such as PCIS Vienna Test System and Stim. The goals of neuropsychological evaluation are to identify of neuropsychological dysfuncitions, to develop execute and monitor treatment plans, and to make rehabilitation programs. Recently, the neuropsychiatric patients are increasing in number and 15-20% of acute psychiatric patients suffer from organic mental problems. Moreover, clinical neuropsychology has an increasingly important role in both neurobehavioral foundation and clinical application. So, psychiatrists must play a major role in the development of clinical neuropsychology in psychiatry.

만성동통에 대한 정신시체의학적 접근 -생물학적 접근-

오병훈,Oh, Byoung-Hoon 한국정신신체의학회 1995 정신신체의학 Vol.3 No.1

Pain is a complex symptom consisting of a sensation underlying potenial disease and associated emotional state. Acute pain is a reflex biological response to injury, in contrast, chronic pain consists of pain of a mininum of 6 months duration and associates with physical, emotional past experience, economic resources of the patient, family and society. Moreover, chronic pain is characterized by physiological affective and behavioral responses that are quite different than those of acute pain. The different type of stimuli exciting pain receptor are mechanical, thermal and chemical stimli and chronic pain are concerned with three of all stimli. The major three components of pain central(Analgesia) system in the brain and spinal cord are 'periaqueductal gray area of the mesencephalon', 'the raphe magnus nucleus' and 'pain inhibitory complex located in the dorsal horns of the spinal cord'. But unfortunately, the central biochemical mechanisms of chronic pain are not clearly defined. To proper management of chronic pain, comprehensive urderstanding as a psychosomatic aspect and multidisciplinary therapeuti-team approach must be emphasized.

한국노인정신의학의 세계화

오병훈(Byoung Hoon Oh) 대한노인정신의학회 2004 노인정신의학 Vol.8 No.2

The Korean Association for Geriatric Psychiatry was founded in 1994. “2004 IPA Asia Pacific Regional Meeting” was held successfully on 8-11 September in Seoul, Korea. KAGP celebrated its 10th anniversary with the participation on the International Psychogeriatric Association (IPA) Members. Now, it is the time to proceed rapid “globalization”. “Globalization” should be approached to IPA mission and vision such as “to improve the mental health of older people everywhere through education, research, professional development, advocacy, health promotion and service development and increasing multi-disciplinary nature.”

치매의 정신사회적치료

오병훈(Byoung Hoon Oh) 대한노인정신의학회 1997 노인정신의학 Vol.1 No.1

Dementia is the most disabling neuropsychiatric disorder of adulthood. Typical dementia-Alzheimer disease (AD) is progressive and irreversible dementia syndrome characterized by loss of intellectual capacity in many domains, altered behavior, inability to care for oneself, and altimately, neurologic abnormalities. But, unfortunately, the exact cause of dementia is still unknown and in the treatment of dementia, the focus is limited to relieve the cognitive and behavioral symptoms. Among treatment modalities of dementia, biomedical intervention has been emphasized on organic cause, individual pathology and cognitive symptomatology. But, for effective management of dementia, both biomedical and psychosocial factors must be included. Because the most fruitful apporach to developing a clinical response to dementia is an interplay between neurologic impairment and the psychosocial experiences of the dementia patients. However, until recently, little attention has been given to the psychosocial implications of the dementia. Psychosocial intervention enable to quality of human interaction and maintain personal identity. Psychosocial intervention should be a guiding principle in the development and implementation of menagement srtategies. Through the psychosocial intervention, problem behaviors might be understood as evidence of promorbid coping styles, searches for security, or activity patterns associated with previous work roles. In fact, psychosocial intervention based on integrated community services because treatment plan of dementia cannot be conducted in isolation. Psychosocial intervention mainly composed of psychotherapy, day care, nursing home, case management and social care. So, to understand and treatment the dementia, all biomedical factors must be examined and simultaneously psychosocial intervention must be considered for patient and family members and other caregivers.

임상의사가 흔히 실수할 수 있는 노인 약물치료의 사례와 그 대처방안

오병훈(Byoung Hoon Oh) 대한노인정신의학회 2003 노인정신의학 Vol.7 No.1

Psychotropic drug use in the aged from 7-92% in institutional settings and up to 30% in medical settings. And older patients received an average of 5-12 medications per day in general hospitals. I reviewed common errors during psychotropic drug treatment and suggest the proper management guideline. In general, physical illness, medical drugs, drug-drug interactions and age-related physiological changes may alter psychotropic drug pharmacokinetics and it induced the severe adverse reactions from psychotropic agents. To proper management for the elderly patients with psychotropic drug treatment, the clinician must have skilled experiences of the effective drug administration and understand the unique characteristics of elderly individuals. And in addition, geriatric psychiatrist must be emphasized the psychosocial problems that may decrease drug compliance.

조발성 알쯔하이머병 환자에서 3년간 인지기능 및 행동 변화

오병훈(Byoung Hoon Oh),이창일(Chang Il Lee),남윤영(Yoon Young Nam) 대한노인정신의학회 2000 노인정신의학 Vol.4 No.1

Alzheimer's disease (AD) is the most typical progressive and irreversible dementia characterized by loss of intellectual capacity in many domains, altered behavior, inability to care for oneself, and ultimately neurologic abnormalities. In the treatment of AD, the focus is limited to relief of cognitive and behavioral symptoms. But the choice of adequate treatment according to severity level is difficult task for maintaining patient's quality of life. We experienced a case of typical presenile Alzheimer's disease who progressed severe dementia while being treated with cognitive enhancers and psychosocial intervention for three years. In review of this case, we conclude that early detection and active treatment of presenile dementia is most important factor for delaying of progress and decreasing of family burden.

성공적 노화의 개념과 모델

오병훈(Byoung Hoon Oh) 대한노인정신의학회 2004 노인정신의학 Vol.8 No.1

Normal ageing processes composed by biopsychosocial aspects. Successful ageing means the integration and dignity through the maintaining quality of life with good physical status, mental functions and self performances throughout the old age. Normal ageing processes composed by biopsychosocial aspects and will be completed through biopsychosocial and spiritual maturation. Of course, ageing as a physical changes is relatively important compared with ageing as a psychosocial changes because physical illness are serious and will ultimately kill us. But for the maintaining active and creative ageing, we must keep in mind with having positive cognition for ageing and preparing the problems with psychosocial ageing through increasing cognitive functions, role responsibilities and dignity. And also, we should accept even death through holy spiritual life.

기억의 기전

오병훈(Byoung Hoon Oh) 대한임상노인의학회 2002 대한임상노인의학회지 Vol.3 No.4

기억의 과정은 입력(encoding), 저장(storage), 회상(retrieval)의 세 가지 단계로 나누어진다. 이 단계들은 각각 독립적인 과정을 가지기도 하나 서로 연관되어 복합적인 작용을 나타내기도 한다. 이들 기억은 한 개인의 심리적인 상태에 따라 입력, 저장, 회상이 되는 정도나 과정이 변하기도 하며 측두엽을 포함한 뇌의 많은 영역이 기억에 관여하고 있다. 기억은 어떤 방식으로 구분할 수 있는지, 기억에 영향을 미치는 요소로는 어떤 것들이 있는지, 기억과 연관된 뇌의 구조물들은 어떤 것들이며 이들 구조물들은 기억의 어떤 부분에 영향을 미치는지에 대해서 많은 관심이 필요한 시점이다. 현재까지도 기억의 기전에 대해서는 정확히 알려져 있지가 않으나 최근 인지과학의 발전과 함께 기억의 기전에 대해서도 많은 발전이 있었다. 현재까지 알려진 전반적인 기억의 기전에 대해, 이론적 측면과 신경생물학적인 측면으로 나누어서 설명하고자 한다.

Professor Edmond Chiu and Korean Geriatric Psychiatry

Byoung Hoon Oh(오병훈) 대한노인정신의학회 2003 노인정신의학 Vol.7 No.2