憂鬱病의 發病前 社會環境的 要因에 대한 考察

오세원,엄용섭 大韓神經精神醫學會 1980 신경정신의학 Vol.19 No.3

This clinical study was made to investigate the socio-environmental stressors occurring prior to the onset of severe depression in 85 patients who were hospitalized in the Neuro-Psychiatric Department of Chosun University Hospital from September, 1976 until December, 1979. The result were as follows: 1. According to the diagnostic distribution, 54 were cases of "nonendogenous" depression and 31 were cases of "endogenous" depression. Among them, 71% of the endogenous depressives and 28% of the nonendogenous depressive had a past history of deprission. 2. Frequency of the socio-environmental stressors prior to the onset of depressive illness were (1) financial problems(55.3%) (2) conflict among family members(42.4%) (3) failure of patient's children to meet parental expectations(27.1%) (4) failure in job performance or increased responsibities(27.1%) (5) made to face denied reality(25.9%) (6) threat to sexual identity(23.5%) (7) physical illness(22.4%) (8) change in marital relationship(22.4%) (9) damage to social status(12.9%) (10) death of important person(12.9%). 3. Of the patient, 27 cases were male and 58 were fomale. Most of the cases were distributed in the late adulthood range. The more frequent stressors in male patients were financial problems aned failure in job performance or increased responsibilities. In female patients, financial problems, conflict among family members and failure of patient's children to meet parental expectations were the most frequent stressors. 4. The frequency and type of socio-environmental stressors were similar in both the endogenous and nonendogenous groups. Frequency of stressors in the endogenous group was in the order of financial problems(58.0%), failurein job performance or increased reaponsibilities(38.7%), made to face denied reality(35.5%), conflict among family members(25.8%), failure of patient's children to meet parental expectations(25.8%), physical illness(25.8%), threat to sexual identity(25.8%). The frenquency of stressors in the nonendogenous group was in the order of financial proplems(53.7%), conflict among family members(51.8%), failure of patient's children to meet parental expectations(29.4%), threat to sexual identity(22.2%), change in marital relationship(22.2%). 5. Internal psychological reactions to socio-enviromrntal exteranl events seemed to be determined by individual psychopathology and internally-underlying psychological conflict.

Klein-Levin Syndrome 1례의 Lithium carbonate 치료경험

곽태섭,김영훈,엄용섭 大韓神經精神醫學會 1985 신경정신의학 Vol.24 No.1

The Klein-Levin syndrome, first named by Cuitchley and Hoffman, consists of periodic hypersomnia, morbid hunger and unusual mental symptoms. Recently the authors treated a 16-year-old male patient who had suffered from 10 to 15day periods of hypersomnia and intermittent episodic pathological hunger. Therapeutic trials on Carbamazepine and Methylphenidate were unsuccessful. Next we treated him with a daily dose of 900㎎ Lithium carbonate for 5 months. Soon after treatment was discontinued against medical advise, one short period of somnolence reappeared. But reinstitution of Lithium carbonate prevented him from more somnolence for next 8 months. Lithium carbonate seemed to suppress the reemergence of somnolence sufficiently in this case, therefore we report this therapeutic experience with a case of Klein-Levin syndrome.

단기반응성 정신병 환자와 정신분열증 환자의 임상적 비교연구

김철주,장무성,엄용섭 大韓神經精神醫學會 1989 신경정신의학 Vol.28 No.1

To compare the clinical characteristics of brief reactive psychosis with those of schizophrenia, the authors selected 50 patients of brief reactive psychosis meeting with DSM-Ⅲ criteria and 50 patients of schizophrenia meeting with both DSM-Ⅲ and RDC criteria. All patients were admitted to the psychiatric ward of Pusan Paik Hospital from Apr. 1, 1984 to Mar- 31, 1987 The results obtained from this retrospective study were as fellows: 1) Brief reactive psychosis was apparently more common in women(74%) and usually appeared In early adulthood, but had more wider age distribution than schizophrenia. 2) Although their educational levels were lower than that of schizophrenics, the patients of brief reactive psychosis showed better marital and premorbid adjustment than the schizophrenics. 3) In brief reactive psychosis, the premorbid personality was more variable than in schizophrenics and the most vulnerable personality was hystrionic(22%) and dependent(18%). 4) The major psychosocial factors predisposed to the development of brief reactive psychosis were marital or financial crisis(26% ), death or separation(72% ), academic or occupational problems(16%) and health problems(12% ) in order of frequency. 5) On admission, insomnia(92%), emotional turmoil(82%) and hallucination(66%) were more frequent in the patients of brief reactive psychosis than in the patients of schizophrenia. Although the Schneider's first rank symptoms were less frequent in the former, it was surprising that they were present in 32% of them. 6) Almost all of the patients with visual hallucination were reactive psychotic patients and 64% of the hallucinatory Images of them were the deads or ghosts. 7) During the course of admission, the majority(60% ) of the patients of brief reactive psychosis were treated with daily dosage under 200mg of chlorpromazine equivalent.

Carbamazepine과 Phenobarbital이 항정상태의 혈청 Haloperidol 농도에 미치는 영향

정경화,김영훈,엄용섭 大韓神經精神醫學會 1989 신경정신의학 Vol.28 No.2

To investigate the effect of adding carbamazepine or phenobarbital on the steady-state haloperidol levels, we selected 15 chronic psychotic patients who had been in the same psychiatric ward for a minimum of 3 months. All were maintained daily 20㎎ of haloperidol for at least 2 weeks before adding carbamazepine or phenobarbital. Either of these two agents was added to the ongoing haloperidol medication and rapidly increased to therapeutic dosage within 3 days. After plateau dosage was achieved, it was maintained for the next 4 days. The serum haloperidol levels of 7 patients on carbamazepine plus haloperidol and 8 patients on phenobarbital plus haloperidol were determinded with high-performance liquid chromatography before and after the 7 days of concomitant medication. Additionally the clinical changes noted during this period were rated on the Brief Psychiatric Rating Scales. The percent decrease in the steady-state haloperidol levels due to adding carbamazepine for 7 days was between 18% and 64%, and was between 5% and 52%, due to adding phenobarbital. Based upon this study's preliminary findings, the effects of these two agents on serum haloperidol levels were noted to occur within one week. Clinical worsenings found in some patients on carbamazepine plus haloperidol, but it was difficult to document whether carbamazepine-induced reductions of serum haloperidol were the significant factors in the clinical change.

靑年期의 精神力動學的發達과 그 精神病理

嚴龍燮 조선대학교 학생지도연구소 1979 生活指導硏究 Vol.- No.-

간질성 정신병의 임상적 연구

박태수,엄용섭 大韓神經精神醫學會 1986 신경정신의학 Vol.25 No.1

A clinical study of psychoses in epilepsy was performed on 352 patients with epilepsy, who visited at Neuropsychiatry Department, Pusan Paik Hospital, In-Je medical college, from January 1982 to December 1984 for 3 years. Among the patients, 23 cases(6.5%) manifested psychotic states. The psychotic states could be classified into the following 5 types; Schizophrenia like state, DElusional-hallucinatory state, Paranoid state, Manic depressive state, Transient psychotic state. Two cases showed schizophrenia like state which was difficult to differentiate from schizophrenia. There were 12 cases(52.5%) of delusional-hallucinatory state, 4 cases(17.4%) of paranoid state, 3cases(13%) of manic depressive state, and 2 cases(8.7%) of transient psychotic state. Some clinical factors appeared to correlate closely with the psyshotic state. Of the cases with delusional-hallucinatory state, 58% had complex partial seizure and showed temporal spike foci on electroencephalography. However, in the other types of psychoses, there were no significant findings in clinico-electroencephalographic aspect. In 14 cases of the subjects, obvious adhesive perdsonality trait was found, particularly in paranoid state and delusional-hallucinatory state, all of the cases showed the trait and their ability of adaptation to environment was disturbed apparently by the trait. In 13 cases, on the other hand, some psychological precipitating factors were found at onset of the psychotic states. The authors concluded that there were different types of the psychotic state in so-called epileptic psychosis, and there appeared to be different clinical factors, probably relating to occurrence of the psychotic state. Importance of adhesive personality trait and psychological factors at onset was stressed in the psychosis.

15명의 정상 성인 남자에 대한 근육주사 및 경구투여후 Haloperidol의 약력학적 연구

김용관,김영훈,엄용섭 大韓神經精神醫學會 1987 신경정신의학 Vol.26 No.3

Pharmacokinetics of haloperidol were studied after intramuscular and oral administration in 15 healthy male volunteers. 10 mg of haloperidol were administered intramusculary to 9 subjects and the remainders received the same dose of haloperidol orally. In nine subjects, venous blood was sampled at 45, 90, 180, 360, 720, 1440 min. after intramuscular dosing and in six subjects it was done at 90, 180, 360, 720, 1080, 1440 min. after oral dosing. Serum haloperidol levels were determinded by high-performance liquid chromatography with ultraviolet detection. The detection limit of that method was 2ng/ml of haloperidol and the coefficient of variation was 5.4% at 10ng/ml and it was 10.4% at 20ng/ml of heloperidol. In all subjects, data were analyzed by model-independant approaches. Elimination half-life was determined in a model-independant manner by linear regression of the postdistribution. The linear trapezoidal rule was used to calculate area under the curve (AUC). In nine intramuscular subjects, mean elimination half-life was 19.8±8.4 hr and it was 19.8±8.4 hr in six oral subjects. Our results do not demonstrate any differences between the two. Relative bioavailability(F) of oral haloperidol against intramuscular dosing was 47.2%. Because intravenous data were not available in our study, we used ?? and ?? to calculate the value for clearance and volume of distribution. The mean steady-state volume of distribution/?? was 6.8±1.7L/kg and the mean clearance/?? was 5.1±1.5 ml/kg/min. The mean steady-state volume of distribution/?? was 14.3±3.6 L/kg and mean clearance/?? was 5.1±1.5 ml/kg/min.

一定地域社會에 對한 社會 精神醫學的 小考

石在鎬,徐燦洙,金相泰,嚴鏞燮 大韓神經精神醫學會 1967 신경정신의학 Vol.6 No.1

We have researched 1,942 populations in Shin-Hyun Myun, Kirche-Myun and Chang-Sung Po Up, Kir-Che Do, applying Socio-Cultural-familial attitudes Check list Composed of 21 items which were selected from the scales of Eysenck, Moreno, and F.S. Chapin after having proved the Significance of them and Maudesly Medical Questionaires of Eysenck which are Composed of 47 items. After the test material were used as the method of percentage and chi². We only Chose the Significant ones from them. Among the 690 rensident population, 117 persons or 16.96% were registered as neurotic and among the student group, the neurotic ones are 18.46% in high School, 18.37% in middle School. In general, the tendency of neurotics was higher among the fermale than male in its incidence, especially those tendency was conspicuous in student group. In resident group, the neurotic trends were higher among 40s and 50s than 10s or 30s in their age. The Analytic results of interelation between the above reserches and Socio-Cultural-Familial attitudes are as follow; 1) The more open-minded one's attitude to-ward sexual morality, the higher percentage of neurotic trends were listed. 2) The lesser attitude of rootedness to one's native villege, the higher neurotic trends were shown. 3) The more dissatisfied at one's occupation, the more neurotic trends were noticed. 4) The neurotic trends were higher among those who were not conservatives than the attitude of conventionality 5) The more neurotic trends were shown among authoritative attitudes 6) The neurotic trends were more higher in the attitude of those Who wish to live in rural community than urban area. 7) The more favorable attitudes on the western society, the more neurotic trends. 8) In terms of language, higher neurotic trends were shown among those who hope to learn western language. 9) In the attitude toward religion, the neurotic trends were higher in the group of persons selecting the christianity than the oriental ones. 10) In the attitude toward family the neurotic trends were considerably decreased among the group who primarily chose mother than any other members of family. To sum up above results, in view of double orientations at Socio-Cultural-familial attitudes, the neurotic trends were in general higher in the group who are progressive, civilized and cultivated than conservative, conventional and traditional trend in their attitudes.

알콜精神病患者에 對한 臨床的 硏究 : 幻覺內容을 中心으로

尹昌範,高診富,嚴龍燮 大韓神經精神醫學會 1976 신경정신의학 Vol.15 No.2

The author studied mainly the hallucinated phenomena of the 15 alcoholic psychotics who were hospitalized in Dept. of Neuro-Psychiatry, of Medical college, Chosun University, from October of 1972 to October of 1975. The following conclusions were obtained from the studies. 1) In general distribution of age, the average of the alcoholic psychotics was 40.5 years, with a range from 35 to 43 years. The range of age is significant, the alcoholic psychotics being a much more homogenous group. The rate of males to females among the alcoholic psychotics was 15 to 0. 2) This report will concern data from a group of 9 patients (60%) who were diagnosed as Delirium tremens and from 4 patients who were diagnosed as having Alcoholic Hallucinosis (25%) without schizophrenia and from 2 Patients (13%) of Korsakoff's psychosis who is less than others. 3) Alcoholic psychosis is the special disease of men in Korean society but not less and it is the most part in the lower class of the educational, socio-cultural level and the lower income class. 4) Their average of drinking capacity of a day is the 2 bottles (which is filled with 2 HOB) of SOJU (spirits) and 2-3 DOI of MAKOULLI, howerever they used not to get some eatables. 5) I found the light tremulousness (80%), insomnia (93%), night-mare or vivid dreams (53%), itching (47%), retching (33%), sweating (13%), seizure (27%) and blurred vision (20%) to be part of the alcoholic withdrawal syndrome. 6) The most frequent incidence was in the formed visual hallucinations (80%), followed by the formed auditory hallucinations (60%) and haptic hallucinations (58%). 7) In the contents of visual hallucinations, the bug, flea and snake are the most part but few seen the case of a rat. The contents of visual hallucinations in western people is the snake and rat which is the most part, such a difference between western and oriental people should be taken into account of the comparative cultural aspects. 8) Alcholic psychotics gave more responses regards as persecutory and every day affairs. 9) Alcoholic psychotics perceived the phenomena externally to any extent. 10) Alcoholic psychotics frequently thought that the hallucination was real at the time of it's appearance but later in the recovery period expressed recgnition of it's unreality and alcoholic psychotics behaved negatively or ambivalently in majority of cases.

憂鬱病의 社會 精神 醫學的 硏究 : 特히 憂鬱病 發病前 狀況을 中心으로

嚴龍燮 順天鄕大學校 1977 의대논문집 Vol.2 No.-

(1) In this clinical study, It was intended reveal the socio-environmental events occuring prior tu the onset of depressive illness in 22 patients with "endogenous" and 20 patients with "nonendogenous" types of depression who admitted to the Department of Neuropsychiatry, Chosun University Hospital from April 1973 to August 1976. Among 42 depressed patients admitted during the study periods, 18 cases were male and 24 cases were female. (2) Twenty stressful socio-environmental events were empirically selectcd for study becausc of the frequency of their occurence in the recorded material, of these 20, The 14 events that occured most frequent were then subjected to a more intensive analysis. The most frequent socio-environmentel events were defined as follows: 1 Econoniic affairs 2. Failure of children to ineet parent's goal 3. Made to face denied reality 4. Threat to sexual identity 5. Conflict among the extended family mernbers 6. Failure in job performance and increased responsibility 7. Damage to social status 8. Change in marital relationship 9. Death of important person 10. Move 11. Unemployment and Transfer of job 12. Physical illness 13. latrogenic discases 14. Delivery (3) The author found that each patient had multiple stressful events prior to the first symptoms and prior to the breakdown in functioning with a clustering of events occuring in the several months before their breakdown. (4) The male depressive patients had most frequent stressful precipitating factors stemming from social affairs, and the female depressive patients from family affairs. The social factors were mainly caused by economic affairs, by failure of children to meet parent's goal, by failure in job performance, also by increased responsibility, and by making to face denied reality but it is interesting to note that death of important person, move, unemployment, household aftairs, and change of residence were relatively infrequency associated with the onset of a depressive illness. As for the family affairs the stressful precipitating factors were mainly attributed to the threat to sexualidetinty, and conflict among the extended family members. Few were attributed to disease, death, or the parting of the family. (5) After having examined the situations prior to the onset of depressive patients who had a past hidtory of depressive symptoms, most of them had similiar stressful precipitating factors in cases of identical situations. (6) The author noted a constant interaction between external events and internalpsychological reactions to these events in relation to both the stressful preciplating factors and the symptoms examined, and also it was supposed that the internalpsychological reactions were probably determined by the past core conflict and by underlying psychopathology. (7) As for the birth ranking of the depressive patients, many of the male were children of eldest sons, some of them were only sons, and many of the women were the youngest child. (8) The depressive illness was apt to be affected by social class, but especially there were a lot of depressive patients of the lower classes who complained of their guilty feelings.