소화기 증상을 보이는 소아 정신신체 질환에 대한 정신과적 고찰

유한익,백경원,Yoo, Hanik K.,Paik, Kyoung-won 대한소아소화기영양학회 2009 Pediatric gastroenterology, hepatology & nutrition Vol.12 No.suppl1

Gastrointestinal (GI) symptoms in children and adolescents are influenced by diverse psychiatric components such as psychosocial stresses, familial environment, school-related situations, and comorbid psychiatric conditions. Absolutely psychiatric symptoms of pediatric patients are also affected by problems of GI system. Lots of symptoms including anorexia, dyspepsia, nausea and so on are commonly originated from either GI or psychiatric causes or both. Sometimes the negative interactions between GI and psychiatric problems aggravate the severity and eventually decline the functions of children and adolescents with GI symptoms. We summarized the common GI and psychiatric conditions which have GI and psychiatric associations. To a clinician who manages pediatric GI disorders, psychiatric considerations can be beneficial to understand the clinical manifestations of patients and to find the way to relieve them. This short and somewhat superficial review may help to have a bird's-eye view on this topic.

한국인 자폐스펙트럼장애에서 Glutamate Receptor, Ionotropic, N-methyl-D-Aspartate 2B(GRIN2B) 유전자 다형성-가족기반연구

유희정,조인희,박미라,유한익,김진희,김순애,Yoo, Hee Jeong,Cho, In Hee,Park, Mira,Yoo, Hanik K.,Kim, Jin Hee,Kim, Soon Ae 대한생물정신의학회 2006 생물정신의학 Vol.13 No.4

목 적: 본 연구의 목적은 자폐스펙트럼장애를 가진 아동들과 그 부모로 이루어진 trio를 대상으로 이 장애와 NMDA 수용체 유전자, 그 가운데 GRIN2B 유전자와의 관련성을 규명하고자 하는 것이다. 방 법: 발달지연을 주소로 가천의대 길병원과 경상대학교병원 소아정신과 외래를 내원한 아동을 선별 대상으로 하였다. DSM-IV 진단체계를 이용하여 2명의 소아정신과 의사가 자폐 스펙트럼 장애로 진단한 아동이 일차적인 연구 대상으로 선별되었다. 선별된 아동과 부모들에게는 한국판 자폐증 진단 관찰 스케줄(Autism Diagnostic Observation Schedule, 이하 ADOS) 및 자폐증 진단 면담-개정판(Autism Diagnostic Interview-Revised, 이하 ADI-R)를 실시하였다. PCR-RFLP법을 이용, GRIN2B 유전자에서 모두 4개의 단일 염기 다형성을 분석하였다(rs7301328, rs1806201, rs1805247, rs1805502). 각각의 SNPs에 대한 allelic association 을 평가하기 위하여 TDT 방법이 시행되었으며, 이를 통해 자폐장애 아동이 부모로부터 후보유전자의 특정 alleles들을 유의하게 더 많이 전달받았는지의 여부를 관찰한 뒤 McNemar chi-square test(df=1)에 의거하여 분석하였다. 결 과: 1) 연구 대상군의 특성 : 총 126명의 자폐 스펙트럼장애 아동과 그들의 생물학적 부모가 최종 분석 대상에 포함되었다. 전체 대상자 중 109명(86.5%)이 남아였으며 여아는 17명(13.5%)으로, 남아 대 여아의 비율은 6.41:1이었다. 대상군의 진단 분포는 자폐장애 107명(85.1%), 달리 분류되지 않는 전반적 발달장애(PDD, NOS) 17명(13.5%), 아스퍼거 씨 장애(Asperger's disorder) 2명(1.6%)이었다. 대상군 아동의 평균 연령은 $71.9{\pm}31.6$개월(range : 26~185개월)이었으며 한국판 사회성숙도 검사로 측정된 평균 사회지수(Social Quotient)는 $61.2{\pm}20.6$(range : 23.1~126), 측정 가능한 아동들의 평균 지능은 $65.0{\pm}27.7$(range : 25~126)이었다. K-CARS 점수는 $31.5{\pm}5.4$(range 18.5~46)로 나타났다. 2) 유전자 분석 : 분석한 GRIN2B 유전자의 4개 SNPs 가운데 하나의 SNP(rs1805247)에서 의미 있는 allelic transmission의 차이를 보였다. 이 SNP에서 transmission ratio(transmitted alleles/non-transmitted alleles)는 A allele과 G allele에서 각각 2.03과 .49로, A allele이 G allele에 비해 부모로부터 환자군에게 더 빈번하게 전달(preferential transmission) 되었음이 확인되었다(TDT ${\chi}^2$=12.89, p=.0003). 이는 Bonferroni correction 후에도 여전히 유의미한 수준을 유지하였다(p=.0009). 기타 3개의 SNP(rs7301328, rs1806201, rs1805502) 들에서는 의미 있는 transmission의 차이가 나타나지 않았다(p<.05). 결 론: 본 연구에서 GRIN2B 유전자의 단일유전자 다형성과 자폐스펙트럼장애 사이에 유의한 연관성을 보였다. 이는 glutamate NMDA 2B수용체 유전자가 이 질환의 발생에 관여할 가능성을 시사하는 것이라 생각된다. Objectives : Autism is a complex neurodevelopmental spectrum disorder with a strong genetic component. Previous neurochemical and genetic studies suggested the possible involvement of glutamate N-methyl-D-aspartate(NMDA) receptor in autism. The aim of study was to investigate the association between the NMDA2B receptor gene(GRIN2B) and autism spectrum disorders(ASD) in the Korean population. Methods : The patients with ASD were diagnosed with Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule based on DSM-IV diagnostic classification. The present study was conducted with the detection of four single nucleotide polymorphisms(SNPs) in GRIK2 and family-based association analysis of the single nucleotide polymorphisms in Korean ASD trios using transmission disequilibrium test (TDT). Results : One hundred twenty six patients with ASD and their biological parents were analyzed. 86.5% were male and 85.1% were diagnosed as autistic disorder. The mean age was $71.9{\pm}31.6$ months(range : 26-185 months). We found that rs1805247 showed significantly preferential transmission(TDT ${\chi}^2$=12.8, p<0.001) in ASD. Conclusion : One SNP in GRIN2B gene was significantly associated with ASD in the Korean population. This result suggests the possible involvement of glutamate NMDA receptor gene in the development of ASD.

주의력결핍 과잉행동장애 남아의 증상과 부모의 주의력결핍 과잉행동 증상 및 인격 양상과의 관련성

신승우(Woo-Seung Shin),최혜라(Hye-Ra Choi),김건우(Kynwoo Kim),이중선(Joong-Sun Lee),박수빈(Subin Park),홍진표(Jin Pyo Hong),유한익(Hanik K. Yoo) 대한소아청소년정신의학회 2009 소아청소년정신의학 Vol.20 No.1

Objectives : This study was conducted to investigate the association between the symptoms of boys with attention-deficit hyperactivity disorder (ADHD) and the attention-deficit hyperactivity symptoms, temperament and character patterns of their parents. Methods : Forty-five boys with ADHD and who met the DSM-IV criteria were evaluated by using the ADHD rating scale (ADHD-RS), and their parents completed the Korean Adult ADHD scale (K-AADHDS) and the Temperament and Character Inventory (TCI). Results : The parental K-AADHDS scores were not associated with the ADHD-RS total score and the subscale scores of their siblings. The most potent variable related to the ADHD-RS total score was the maternal self-directedness, and the second was the maternal persistence. The maternal self-directedness was the variable that was most correlated with the hyperactivity/impulsivity subscale scores of the ADHD-RS. Conclusion : The results suggest that the paternal ADHD symptoms may not be related to the ADHD symptoms of boys with ADHD. Higher maternal self-directedness and persistence may decrease overall the ADHD symptoms of these boys, and higher maternal self-directedness itself may predict lower hyperactivity/impulsivity symptoms of the boys with ADHD.

국내 아동 및 청소년 주의력 평가를 위한 종합주의력검사의 표준화 연구

유한익(Hanik K. Yoo),이중선(Jungsun Lee),강성희(Sung Hee Kang),박은희(Eun Hee Park),정재석(Jaesuk Jung),김붕년(Boong-Nyun Kim),손정우(Jung-Woo Son),박태원(Tae Won Park),김봉석(Bongseok Kim),이영식(Young Sik Lee) 대한소아청소년정신의학회 2009 소아청소년정신의학 Vol.20 No.2

Objectives: This study was conducted in order to develop and obtain the nonnative data of the computerized Comprehensive Attention Test(CAT) in Korean children and adolescents. It also aimed to evaluate the reliability and validity of the CAT. Methods: We developed the computerized CAT which includes the selective attention task, the sustained attention to response task, the flanker task, the divided attention task, and the spatial working memory task. We investigated the test-retest reliability and the construction validity of this computerized version by using the data from 21 children, and gathered the nonnative data of 9l2 subjects, aged 4 to 15 years, dwelling in the Metropolitan Seoul area in 2008. Results: No statistical differences between means of the tests and retests of the CAT were observed. The mean of the correlation coefficient of the test-retest scores was 0.715. The results from the factor analyses explained 51.7% of the cumulative variance. In addition, the nonnative data for all of the CAT subtests were obtained. Conclusion: The computerized CAT can be used as a reliable and valid tool in both clinical and research settings for Korean children and adolescents with or without neuropsychiatric conditions such as attention deficit.

국내 제주지역 초등학생 읽기 및 수학 학습장해 유병률 연구

유한익(Hanik K. Yoo),허한나(Han-nah Huh),홍인화(In Hwa Hong),김중훈(Jung Hun Kim),김희정(Hee-Jung Kim),조성진(Seong-jin Cho),양수진(Su-Jin Yang),정재석(Jae-suk Jung) 대한신경정신의학회 2018 신경정신의학 Vol.57 No.4

Objectives This study investigated the prevalence of reading and mathematical learning disabilities of students at primary schools in Jeju Island, South Korea. We examined major causes of learning disabilities including reading disorder, mathematical disorder, attention deficit, and other causes including socioemotional factors. Methods We conducted screening processes to 659 participants (340 male, 51%) in 4 elementary schools in Jeju Island. To identify the causes of learning problems, 84 children were administered tests such as the Korean-Wechsler Intelligence Scale for Children-fourth edition, the Comprehensive Learning Test-Reading/Math, and the Comprehensive Attention Test. Results This study found that 13% of elementary school students in the Jeju region had learning disabilities. Among learning disabilities, specific reading and mathematical disorders accounted for 9% of study subjects. In addition, 2% of participants had intellectual impairment and 1% had other causes such as socioemotional factors. 65% of children with learning disabilities and 74% of children with reading or mathematic disorders had concurrent attention deficit disorder. 68% of children with reading disorders also had comorbid mathematical disorder. Conclusion The prevalence, causes, and comorbidity of reading and mathematical learning disabilities of students in Jeju Island, South Korea did not differ from those in foreign countries. Because most learning disabilities are complex, comprehensive evaluations and tailored interventions are necessary to help children with learning disabilities.

소아청소년정신과 영역의 약물치료

유한익(Hanik K. Yoo),백경원(Kyoung Won Paik) 대한소아청소년정신의학회 2008 소아청소년정신의학 Vol.19 No.2

Although the scientific evidence is not entirely supportive, atypical antipsychotics have been used widely for the treatment of children and adolescents with mental illnesses as alternatives to typical antipsychotics which have more serious unwanted adverse effects than atypical neuroleptics. On the basis of clinical experiences and research data, atypical antipsychotics have been prescribed for adolescents with schizophrenia, manic or mixed episodes of bipolar disorders, tic disorders, aberrant behaviors in pervasive developmental disorders, and impulsive or violent behaviors in disruptive behavior disorders. Due to their efficacy and relatively more tolerable side effects, the use of atypical antipsychotics has become increasingly popular in child and adolescent psychiatry. However, we should pay attention to the limitations associated with short-term clinical experiences and the lack of well-designed controlled studies, especially in terms of adverse effects including those involving metabolic processes.

국내 아동 및 청소년 난독증 진단을 위한 종합학습능력평가도구-읽기의 표준화 연구

유한익(Hanik K. Yoo),정재석(Jaesuk Jung),이은경(Eun Kyung Lee),강성희(Sung Hee Kang),박은희(Eun Hee Park),최인욱(InWook Choi) 대한소아청소년정신의학회 2016 소아청소년정신의학 Vol.27 No.2

Objectives: The aim of this study was to develop the computerized Comprehensive Learning Test-Reading (CLT-R) to evaluate the cognitive processes and achievements related to their basic reading ability and identify dyslexia in children and adolescents in South Korea. We also obtained the normative data and evaluated the reliability and validity of the test. Methods: We developed the CLT-R, including the word attack/nonword decoding, paragraph reading, sound blending, nonword repetition, rapid automatized naming, letter-sound matching, visual attention, orthography awareness, and digit span tests, for the purpose of diagnosing dyslexia. We investigated the reliability and validity of the tests and gathered the normative data from 399 subjects (male 48.9%), aged 5-14 years, from the last grade in kindergarten to middle school, dwelling in Seoul and Gyeonggi Province, South Korea. Results: No statistical differences were observed between the means of the tests and retests of the CAT. The mean of the correlation coefficient of the test-retest scores was 0.85. According to the construct validity test calculated by principal constant analysis using the oblique rotation method, 4 factors explained 70.0% of the cumulative variances. In addition, the normative data were obtained for all of the CLT-R subtests. Conclusion: The computerized CLT-R can be used as a reliable and valid tool to evaluate the reading achievement and reading related cognitive process in Korean children and adolescents in schools, clinics, and research institutes.

국내 주의력결핍 과잉행동장애 아동 및 청소년에서 메타데이트CD의 임상증상 및 신경인지기능 개선 효과에 대한 개방 연구

유한익(Hanik K. Yoo),김봉석(Bongseog Kim),정유숙(Yoo Sook Joung),반건호(Geon Ho Bahn),송동호(Dong Ho Song),안동현(Dong Hyun Ahn),이영식(Young Sik Lee) 대한소아청소년정신의학회 2011 소아청소년정신의학 Vol.22 No.4

Objectives:This study aimed to investigate the efficacy and safety of Metadate CD (MCD) when given to Korean children and adolescents with attention-deficit hyperactivity disorder (ADHD). We also explored the effects of the drug on diverse neurocognitive functions. Methods:Ninety-one subjects with ADHD (mean age 8.6±2.2 years) were recruited at 6 outpatient clinics in Seoul, Korea. We used the ADHD Rating Scale (ARS), Clinical Global Impression (CGI), and comprehensive attention test (CAT) to measure the drug?s effects. Results: After 0.92±0.32mg/kg/day of MCD were administered for 57.4±7.6 days, there was a 48.5% reduction in the mean total ARS scores (p<.001). Fifty-seven subjects (64.8%) showed either much improved or very much improved outcomes on the CGI-Improvement scale. The CGI-Severity scale also decreased from an average of 4.7 to an average of 2.9 (p<.001). Errors and response time standard deviations of the CAT, sustained attention test-to-response tasks, the flanker test, and divided attention test scores decreased after treatment (p<.05). The forward memory span of the spatial working memory test scores increased (p<.05). Thirty-five patients (39.8%) experienced side effects, of which the most common were headache (14.8%), nausea (12.5%), and anorexia (9.1%). Conclusion:This open-label study suggests that MCD is effective and safe in improving the symptoms and neurocognitive functions of Korean children and adolescents with ADHD.

읽기장애 개입프로그램의 효과성 개방형 연구

유한익(Hanik K. Yoo),허한나(Hannah Huh),조민지(Minji Jo),이현주(Hyunju Lee),홍인화(In-Hwa Hong),김중훈(Jung Hun Kim),양수진(Su-Jin Yang),정재석(Jaesuk Jung) 대한신경정신의학회 2021 신경정신의학 Vol.60 No.2

본 연구에서는 읽기장애로 진단된 학령기 아동들을 대상으로 일선 교사들이 학교 현장에서 읽기장애 개입을 시도하고 그 효과성을 검증하고자 하였다. 그 결과, 단어 수준의 읽기 정확성과 유창성이 향상되었으며, 이런 현상은 난독형에서 가장 두드러졌다. 반면 읽기장애 이해형에서는 개입 효과가 관찰되지 않았다. Objectives This study investigated the effectiveness of the intervention program for elementary school students with reading disorders. Methods The intervention program focused on phonological awareness, phonics, and decoding training applied individually to 25 children with a reading disorder by the teachers in charge for four months. To measure the efficacy, this study evaluated the word reading accuracy, fluency, and the related cognitive functions, including phonemic awareness, phonics, and rapid automatized naming using the Computerized Comprehensive Learning Test-Reading before and after the program. Results After the intervention, improvements were observed in the following: the reading fluency score and fluency percentile in the word attack test; reading accuracy rate, fluency score, and fluency percentile in the nonword decoding test; fluency score and fluency percentile in the rapid automatized naming tests; accuracy rate in the letter-sound matching test; accuracy rate in the nonword repetition test. On the other hand, there was no significant difference in the paragraph reading fluency test. According to the subtypes of reading disabilities, children with dyslexic or mixed types improved after the intervention. Conclusion Reading accuracy and fluency of school-aged children with reading disorders improved through the intervention program by the schoolteachers.

남자 고등학생들의 아침-저녁형 수면 양상과 주간 졸음, 피로도와의 관련성

강시현,유한익,정석훈,김창윤,Kang, Shi Hyun,Yoo, Hanik K.,Chung, Seockhoon,Kim, Chang Yoon 대한수면의학회 2012 수면·정신생리 Vol.19 No.2

목 적: 일 고등학교 학생들을 대상으로, 일주기 리듬을 아침-중간-저녁형으로 구분하여, 각 유형 간에 야간 수면 패턴의 차이를 살펴보고, 주간 졸림 및 피로 정도를 비교해 보았다. 방 법: 일 남자 고등학교 2학년 전체 학생 501명을 대상으로 자가설문조사를 하였다. 아침-저녁형 평가를 위한 한국어판 조합척도(Korean translation of composite scale : KtCS), 주중 기상 시 어려움(difficulty awakening), 주중 기상 시 졸린 정도(morning drowsiness), 주간 졸림 척도(Epworth sleepiness scale, ESS), 피로 정도 척도(Fatigue severity scale, FSS)를 이용하였다. 결 과: 저녁형(5시간 36분, SD=63.3분)이 중간형(6시간 11분, SD=61.8분, p<0.001)이나 아침형(6시간 23분, SD=61.8분, p=0.029)에 비해서 주중 평균 수면시간이 유의하게 짧았다. 저녁형은 주중에 매일 낮잠을 자는 비율(16.8%, p<0.001), 카페인 섭취 비율(58.8%, p<0.001), 코골이 비율(18.5%, p=0.037)이 유의하게 높았다. 저녁형은 주간 졸림 정도(8.7, SD=3.2, p<0.001)와 피로도(4.4, SD=1.2, p<0.001)에서 중간형이나 아침형보다 더 높은 점수를 보였다. 결 론: 저녁형 학생들은 주중에 수면패턴이 불규칙하고, 가장 심한 수면 부족을 겪고 있으며, 낮잠 빈도가 높았다. 저녁형은 주간 졸림 정도가 더 심하고, 심한 주관적인 피로감을 보고하였다. 수면 유형 평가 및 동반 수면 질환 여부 검사 등 학생들의 수면 양상에 대한 적절한 관심과 교육, 적극적인 개입이 필요할 것으로 생각된다. Objectives: Individuals differ in their biological rhythms. This study investigated the association between the morningness-eveningness and sleep patterns, daytime sleepiness and fatigue in Korean male adolescents. Methods: Participants were 501 eleventh grade male students ($16.9{\pm}0.2$ years of age) in one male high school in Seoul. Each student completed the Korean translation of composite scale (KtCS), Epworth sleepiness scale (ESS), Fatigue Severity Scale (FSS) and a questionnaire about their sleep schedule. Results: The evening group had shorter weekday sleep time than the intermediate (p<0.001) or morning group (p=0.029). The evening group had more daytime napping (16.8%, p<0.001), high rate of caffeine use (58.8%, p<0.001) and snoring (18.5%, p=0.037). The evening group showed more daytime sleepiness (8.7, SD=3.2, p<0.001) and severe fatigue (4.4, SD=1.2, p<0.001) than the intermediate or morning group. Conclusion: Adolescents with eveningness have higher problems in weekday sleep, daytime sleepiness and fatigue. An intervention program for sleep problem in these adolescents should be considered.