심각한 소아 ${\cdot}$ 청소년 강박장애로 입원한 환아들의 특징

황준원,유소영,장준환,신민섭,조수철,홍강의,김붕년,Hwang, Jun-Won,You, So-Young,Chang, Jun-Hwan,Shin, Min-Sup,Cho, Soo-Churl,Hong, Kang-E,Kim, Boong-Nyun 대한소아청소년정신의학회 2004 소아청소년정신의학 Vol.15 No.2

연구목적:소아·청소년기 발병 강박장애는 낮은 약물반응, 높은 공존장애율, 강한 유전적 경향성을 가진다고 알려져 왔다. 그러나 현재까지 국내에서 소아·청소년기 발병 강박장애에 대한 연구는 극히 미미하다. 이에 본 연구에서는 서울대학교병원 소아·청소년 정신과 병동에 입원한 강박장애 아동들을 대상으로 임상양상, 유전부하, 약물 반응양상, 퇴원후의 경과등을 조사하여, 심각한 증상을 보이는 소아·청소년 강박장애 군의 특성을 파악하려 하였다. 방 법:최근 9년사이에 서울대병원 소아·청소년 정신과에 입원한 환아 20명(남 16, 여 4)의 자료를 조사하였고 이를 대상으로 임상적 특성을 조사하였다. 진단 및 임상 상의 정확성을 유지하기 위해 의무기록지, 심리학적 보고서, 가족 면담 자료, 간호 보고서를 모두 고려하였고, 퇴원시 확정된 진단을 일차진단으로 하였다. 결 과:1) 환아의 성비는 남성이 4:1로 우위였다. 2) 강박사고에 있어서 가장 흔한 형태는 병적의심이었고, 이어서 더러움에 대한 공포, 공격적 사고, 대칭에의 요구, 성적 강박 사고였다. 강박행동에서 가장 흔한 내용은 확인, 씻기, 숨쉬기, 움직임, 대칭, 반복적 질문, 물건수집, 정신적 강박행동 등이었다. 3) 가장 흔한 공존 장애는 우울증이었고, 그 다음으로는 다른 불안장애, 틱장애, 품행장애, 반항장애였다. 드물게 강박사고에 대한 현실검증력이 손상된 것으로 판단되는 아동도 발견되었다. 4) 정신과 질환에 대한 가족력을 살펴본 결과, 17 가족(85%)에서 2차 친척 중 정신과 장애를 앓는 사람이 발견되었다. 그리고, 강박 스펙트럼 장애로 의심되는 친척을 둔 아동이 전체의 45%(9명)이었다. 5) 약물치료로서 사분의 삼 정도의 환아들(75%)이, SSRI와 항정신병약물을 함께 복용하고 있었고, 치료 반응상 CGI에서 중등도 호전(moderate improved) 이상을 보이는 경우가 75%로 파악되었다. 6) 퇴원 후의 외래 추적 결과, 지속적인 증상의 관해를 보인 경우는 5명(25%)이었고, 부분적인 증상을 가진 채 만성적으로 지속되는 경우가 10명(50%)이었다. 결 론:심각한 소아·청소년 강박장애약물 환아들의 임상상을 국내에서는 최초로 체계적으로 조사하였다. 그 결과, 높은 공존장애율, 높은 정신과장애의 가족력, 높은 항정신병약물 복용을 보이는 것으로 조사되었다. 증상면에서도 공격적-성적 강박사고의 비율이 높았으며, 숨쉬기, 움직이기 등의 특이한 강박행동이 발견되었다. 치료로서 사분의삼 정도의 환아들(75%)이, SSRI와 항정신병약물을 함께 복용하고 있었고, 치료 반응상 CGI에서 중등도 호전(moderate improved) 이상을 보이는 경우가 75%로 파악되었다. Objectives : Child and adolescent onset obsessive compulsive disorder(C-OCD) is known to be associated with poor drug response, high comorbid rate and strong genetic tendencies. Till now studies for C-OCD have been very rare in Korea. We conducted this study to investigate the informations about clinical features, familial psychiatric loading, treatment profiles and course of server C-OCD from the retrospective analysis of inpatient data of Seoul National University Children's Hospital. Method : Retrospective chart review and data analysis was performed. Twenty(male 16 : female 4) patients with final C-OCD diagnosis by DSM-IV at discharge from 1994 to 2002 were found and their medical chart, psychological data, family interview data and nursing reports were collected and analyzed. Results : 1) The sex ratio of C-OCD was male dominant(4:1). 2) Phenomenological, most common obsession was pathologic doubt, contamination fear, followed by aggressive obsession, need for symmetry, sexual obsession, most common compulsion was checking and washing, followed by breathing, movement, symmetry, repetitive asking, hoarding, mental compulsion. 3) Most common comorbid diagnosis was depression. Other axis-I diagnosis associated OCD were anxiety disorder, tic disorder, conduct and oppositional defiant disorder and psychosis. 4) Regarding psychiatric familial loadings, 17 patients(85%) had relatives with psychiatric disorders, OC-spectrum disorders(OCD or OCPD) were found in 9 patients(45%). 5) The majority of patients(75%) have received SSRI and antipsychotics treatment. The response rate above 'moderate improved" by CGI was 75%. 6) During follow-up period in outpatient clinic, five patients(25%) showed continuous complete remission, 10 patients (50%) did residual symptoms with chronic course. Conclusion : This seems to be the first systemic investigation of severe pediatric OCD patients in Korea. The children & adolescents with severe OCD in inpatient-setting showed the high comorbid rate, familial psychiatric loading, and combined pharmacotherapy with antipsychotics, As for symptoms, high rate of aggressive-sexual obsession and atypical compulsions like breathing and moving was reported in this study. Severe pediatric OCD patients, however, responded well to the combined SSRI and antipsychotics regimen.

청소년정서행동발달검사 표준화 연구 자료를 활용한 교사의 학교폭력 피해자 인지도

황준원(Jun-Won Hwang),방수영(Soo-Young Bhang),유한익(Hanik K. Yoo),김지훈(Ji-Hoon Kim),김봉석(Bongseog Kim),안동현(Donghyun Ahn),서동수(Dong-Su Suh),조수철(Soo-Churl Cho),반건호(Geon Ho Bahn),이영식(Young Sik Lee) 대한소아청소년정신의학회 2012 소아청소년정신의학 Vol.23 No.2

Objectives:The current study was conducted in order to investigate teachers’recognition of school bullying using a nationwide database of adolescents in middle and high school in Korea. Methods:Students in the 7th to 12th grades at 23 secondary schools participated in the current study during the fall of 2009. Subjects completed the self-report form of the Adolescent Mental Health and Problem Behavior Screening Questionnaire-II (AMPQII) and Symptom Checklist-90 Revised (SCL-90-R). In addition, relevant teachers used the teachers’ rating scale of the AMPQ-II to report their students’ status. Differences in the number of bullied students between teachers’ recognition and students’ report were explored. Results:A total of 2270 subjects provided relevant responses to the questionnaire. While the one-month prevalence of victimization according to students’ self-reports was 28.9%, the recognized prevalence by teachers was only 10.6%. For prediction of the presence of school bullying according to students’ self reports on the AMPQ-II, item 7 of the teachers’ report on the AMPQ-II showed a sensitivity of 16%, a specificity of 92%, a positive predictability of 44%, a negative predictability of 72%, a false positive rate of 8%, a false negative rate of 84%, and an accuracy of 69%, respectively. No significant differences in subscores of students’ self reports of the AMPQ-II and SCL-90-R were observed between bullied students who were recognized by teachers and those who were not recognized. In stepwise discriminant analysis, classification of teachers’ item 2 and item 7 on the AMPQ-II with respect to school bullying according to students’ reports showed an accuracy of 63.4%. Using this model, 75.2% of non-victimized subjects were classified correctly, while only 35.2% of victimized subjects were classified correctly. Conclusion:Despite the high prevalence in Korea, teachers’ recognition of school violence among their students remains low. Pre-professional and continuing education to improve teachers’ understanding of school bullying and knowledge of effective classroom-based prevention activities should be encouraged.

주의력결핍 과잉행동장애에서 비정신자극제 약물치료

황준원(Jun-Won Hwang) 대한소아청소년정신의학회 2008 소아청소년정신의학 Vol.19 No.2

The aim of this paper is to evaluate the use of non-stimulants, including atomoxetine, bupropion and modafinil, as alternative approaches to the treatment of children with attention-deficit hyperactivity disorder. A comprehensive review of the empirically based literature regarding the efficacy and the safety of the non-stimulants was performed. There is a large and increasing body of data supporting the efficacy and the safety of non-stimulants. Although the treatment effect sizes for non-stimulants may be smaller than those for stimulants, non-stimulants alone have been shown to be effective in the treatment of attention-deficit hyperactivity disorder as well as several comorbidities. These results suggest that non-stimulants are effective in the treatment of attention-deficit hyperactivity disorder. Further studies are needed to improve our understanding of alternative pharmacological medications in the treatment of attention-deficit hyperactivity disorder.

심각한 소아 · 청소년 강박장애로 입원한 환아들의 특징

황준원(Jun-Won Hwang),김붕년(Boong-Nyun Kim),유소영(So-Young You),장준환(Jun-Hwan Chang),신민섭(Min-Sup Shin),조수철(Soo-Churl Cho),홍강의(Kang-E Hong) 대한소아청소년정신의학회 2004 소아청소년정신의학 Vol.15 No.2

주의력결핍 과잉행동장애 치료에서 MTA의 주요 교훈

황준원(Jun-Won Hwang) 대한소아청소년정신의학회 2010 소아청소년정신의학 Vol.21 No.1

Objectives:The current review aimed to describe the major findings of the NIMH Collaborative Multisite Multimodal Treatment Study of Children with Attention-Deficit Hyperactivity Disorder (MTA) with regard to the treatment of children with attention-deficit hyperactivity disorder (ADHD). Methods:We performed a general review of the literature regarding the efficacy of the MTA’s proposed treatments. Results:There is a large and still increasing body of evidence regarding the MTA’s treatment outcomes. We present and discuss details of the findings at each follow-up point. Conclusion:Currently, findings regarding the MTA’s treatments suggest children with combined-type ADHD exhibit significant impairment in adolescence, despite their initial symptom improvement. Further studies, using innovative treatment approaches and targeting specific areas of adolescent impairment, are needed in order to enhance ADHD treatment outcomes.

태양광발전과 연료전지의 하이브리드 시스템

황준원(Jun-Won Hwang),최용성(Young-Sung Choi),이경섭(Kyung-Sup Lee) 대한전기학회 2009 전기학회논문지 P Vol.58 No.4

Because of environmental crisis, researchers are seeking and developing a new, clean, safe and renewable energy. Solar cell energy and fuel cell energy have inestimable development potential. The paper introduces hybrid photovoltaic-fuel cell generation systems supplying a remote power load and hybrid system of solar cell and fuel cell considering the advantages of stable and sustainable energy from the economic point of view. Fuel cell power system has been proven a viable technology to back up severe PV power fluctuations under inclement weather conditions. Fuel cell power generation, containing small land us, is able to alleviate the heavy burden for large surface requirement of PV power plants. In addition, the PV-fuel cell hybrid power system shows a very little potential for lifetime CO₂ emissions. In this paper shows the I-V characteristics of the solar module which are dependent on the power of the halogen lamp and the I-V characteristics of fuel cells which are connected in parallel. Also, it shows efficiency of the hybrid system.

태양광 발전시스템의 온도에 따른 전압-전류 특성

황준원(Jun-Won Hwang),이영(Ying Lee),최용성(Yong-Sung Choi),이경섭(Kyung-Sup Lee) 대한전기학회 2009 대한전기학회 학술대회 논문집 Vol.2009 No.4

In this thesis, output voltage, current and power of solar module were classified by irradiation and module temperature from data of overall operating characteristics collected for one year in order to manage efficient photovoltaic generation system and deliver maximum power. In addition, from these data, correlations between irradiation, module temperature of photovoltaic cell and amount of power given by photovoltaic cell was quantitatively examined to deduce optimization of the design and construction of photovoltaic generation system. The results of this thesis can be summarized as follows. As I-V characteristics according to a temperature range of 10~50[], the area of I-V characteristics were increased with an increase in temperature. Since this area corresponds to the power, output power is thought to have increased with temperature.

중소병원의 재무성과 결정요인

황준원 ( Jun Won Hwang ),박재산 ( Jae San Park ) 경희대학교 경영연구원 2015 의료경영학연구 Vol.9 No.1

This study aims to find determinant factors of small and medium-sized hospital financial performance and to provide information about the possibility of bankruptcy due to the fact of cause of financial aggravation among the small and medium-sized hospitals. We determined surplus and deficit out of financial results and analyzed on primary factors of them. All the financial data extracted from KHIDI Hospital Management Statistics 2009, 2010(Under 300beds hospitals). The major findings as follows; First, among the 100~300beds hospitals, there are large number of hospitals that maintains surplus status or switched from deficit. Second, the primary factors of surplus status among the medium-sized hospitals show increased rate which the numbers of patients(Inpatient), rate of sickbed operation and rate of rotation. Third, the side of financial result, both cost of food supplies and maintenance cost show decreased rate which made supporting evidence of managing ratio of medical production cost effects to management result. Fourth, among the medium-sized hospitals, the quantity of CT and MRI which considered major medical devices is not relevance. Fifth, among the medium-sized hospital, most surplus status hospitals which located in metropolitan area or 201~300beds sized hospitals. This result informed the major environmental factors relevance which certain number of population and traffic expansion, hospital cooperation with other hospitals, specialized medical service and diversification strategy.

일사량에 따른 전압-전류 특성

황준원(Jun-Won Hwang),정종철(Jong-Chul Jeong),김석곤(Seok-Gon Kim),최용성(Yong-Sung Choi),이경섭(Kyung-Sup Lee) 대한전기학회 2009 대한전기학회 학술대회 논문집 Vol.2009 No.7

Solar, as an ideal renewable energy, has inexhaustible, clean and safe characteristics. However, solar energy is an extreme intermittent and inconstant energy source. In order to improve the photovoltaic system efficiency and utilize the solar energy more fully, and the DC current vary with the irradiation, it is necessary to study the characteristics of photovoltaic I-V according to the external factors. This paper presents the analysis of characteristics of photovoltaic I-V according to the irradiation. The results show that the DC current of the photovoltaic system are increased along with the increasing values of irradiation.

아역 연기자에 대한 법적, 제도적 고려사항

황준원(Jun-Won Hwang),김봉석(Bongseon Kim),유희정(Hee-Jeong Yoo),반건호(Geon Ho Bahn) 대한소아청소년정신의학회 2013 소아청소년정신의학 Vol.24 No.2

Child labor is being recognized as the key issue of human rights, and the International Labor Organization and the Convention on the Rights of the Child emphasize that children are individuals with dignity and rights. Male and female child actors belong to a profession with wide public exposure and there is a potential danger of invading classes and roles not matching the developmental stage of the child. In this study, we would like to discuss international and domestic laws and future complementary measures surrounding legal and institutional issues that need to be considered for child actors. Although the basic rights for child workers are stated in the Constitution Article 32 Paragraph 5 and Labor Standards Act Articles 64 through 70, they are insufficient. Following the revised broadcasting deliberation regulations by the Korea Communication Commission and amendment of the Juvenile Protection Law, several changes are taking place in the working environment. In certain foreign places such as California, United States, the economic and educational rights of male and female child actors are being protected. Although legal and institutional frameworks for the male and female child actors are being reinforced, more consistent devices are needed. Consideration for working hours, regulations to keep up with learning while working, and preparation for physical andemotional influences are required to keep up with international changes.