精神身?障碍의 病態生理

高京鳳 藥業新聞社 1983 (月刊) 醫藥情報 Vol.1983 No.6

자문조정부서 발족전후 자문의들의 권고에 대한 자문의뢰들의 일치도 비교

고경봉 大韓神經精神醫學會 1991 신경정신의학 Vol.30 No.3

The study was performed to evaluate the effectiveness of psychiatric consultation after organization of the consultation-liaison service. A comparison was made regarding consultees' concordance consultants' recommendations over each period of one year in 1981 and 1986. The finding are as follow : 1) Psychotropic medication showed the highest concordance of all recommendations in each period of 1981 and 1986. However. the concordance rate for psychotropic usage tended to be decreased after organization of the service. 2) The concordance rate for transfer was significantly decreased in spite of increase of consultants' recommendations for transfer after organization of the service. 3) There was no significant difference in the concordance rate for each of psychiatric diagnosis and psychological test during the interim period. 4) The concordance rate for diagnosis was significantly increased after organization of the service. when no psychiatric diagnosis was considered by consultees prior to psychiatric consultation. 5) The concordance rate for transfer was the highest in organic mental disorder and somatoform disorder. whereas it was the lowest in psychosomatic disorder after organization of the service. 6) The concordance rate for transfer in internal medicine was the lowest. in spite of the highest rate of recommendations for transfer in the department among the referring departments after organization of the service. In conclusion. it was found that transfer was more potent source of conflict between consultants and consultees after organization of the consultation-liaison service. It is suggested that transfer should be cautiously recommended for these consultation patients. especially the so-called psychosomatic ones.

정신과 자문환자의 정신과에 대한 인식 및 수용도

고경봉 大韓神經精神醫學會 1987 신경정신의학 Vol.26 No.1

This survey was done to investigate the effect of concept and acceptability of psychiatry in the patients referred for psychiatric consultation on their resistance to psychiatric approach. They were compared with each of the psychiatric outpatients and the general public. In general, the concept of psychiatry in the former is similar to that in both the latter. In its degree, however, such concept in the former is reiatively lower than in the outpatients. It means that motivation of psychiatric treatment and prior contact with psychiatry could highly influence such concept. Those patients consulting a psychiatrist show less acceptability in psychiatric treatment of somatic symptoms than the general public. They also tend to consider primarily their psysicians' recommendation for psychiatric treatment in comparison with the outpatients. So it can be said that their acceptability of psychiatry depends upon their physicians' attitude. In each of three groups of subjects, the concept of psychiatry os markedly different from the concept of mental disorder: a large proportion of people still view psychiatry as dealing with only psychoses, while they view mental disorder as including little psychoses. It suggests that their resistance to psychiatric approach might arise from the misconception of psychiarty rather than of mental disorder. In addition, both the patients consulting a psychiatrist and the general pubic do not understand distinctly the difference between psychiatry and neurology. Thus, it is emphasized that education and guidance are necessary to make them understand psychiatry correctly.

당뇨병환자들의 대응전략

배종훈,고경봉 大韓神經精神醫學會 1988 신경정신의학 Vol.27 No.4

Psychological aspects including coping strategy of 96 patients with diabetes mellitus were investigated. Most of their problems included conflicts due to diet, complications and somatic sysmptoms of the illness. A considerable number of patient. recognized that their illness would have caused negative emotions in those family members. Most of them tended to deny their vulnerabilities except repudiation of others. As their coping strategy, intellectualism, redefinition and compliance were most commonly used, but externalization, tension reduction and isolation were rarely used. There were significant differences in their vulnerabilities and use of coping strategies according to sex, age, level of education and types of the illness. Hopelessness, depression, helplessness and closed time perspective were found to be obstacles to the solution of their problems, whereas only confrontation was noted to be effective in the solution of the problems. It is suggested that by applying these psychosocial aspects to the treatment of diabetes mellitus, the outcomes can be maximized.

암환자들과 비암환자들 간의 질병행동의 비교

고경봉 大韓神經精神醫學會 1991 신경정신의학 Vol.30 No.4

Structured interview was done to make a comparison regarding illness behavior between cancer and noncancer patients. The findings are as follow. 1) The concordance rate for diagnosis was significantly lower in the cancer patients than in the noncancer ones. 2) In both the groups of patients, private clinic was most frequently used as healthseeking source not only at the onset of the first symptom but before final, hospitalization. However, there was no significant difference between both of them in frequency of healthseeking sources. 3) In both of the groups, no significant difference was found with respect to the period of interval between the onset of the first symptom and the first medical treatment provided by physicians. 4) The cancer patients were more likely to report having been told that they suffered from a serious illness than the noncancer patients. 5) The cancer patients tended to inhibit expression of their emotions, in comparison to the noncancer patients. 6) The cancer patients with high inhibition of expression of their emotions reported higher acceptance of psychiatry than those with low inhibition. This suggests that some of the cancer patients perceived their psychiatric problems more seriously, although they did not express them overtly. 7) The cancer patients with serious physical symptoms reported more anxiety, whereas the noncancer patients with serious psychic distress did. 8) Both the groups of patients were more likely to attribute its origins entirely to psychological causes, when stressors were related to onset and/or aggravation of their illness. 9) The cancer patients whose diagnosis was notified to them were more likely to be aware of their symptoms than those whose diagnosis was not. On the other hand, the noncancer patients whose diagnosis was notified to them were less preoccupied with thoughts about disease and less depressed than those whose diagnosis was not. 10) The cancer patients with religion reported less depression than those without religion. However, no significant difference was found in the noncancer patients. It suggests that religion is more likely to play a supportive role in the cancer patients than in the noncancer patients.

출산 전후 여성들 간의 스트레스지각 및 정신병리의 비교

김세광,고경봉 大韓神經精神醫學會 1991 신경정신의학 Vol.30 No.5

A comparison was made between pregnant and postpartum women regarding stress perception and psychopathology, using GARS scale and SCL-90-R. The results were as follows; 1) A considerable number of women in both of the groups were most anxious about probable delivery of a deformed baby during pregnancy. 2) Postpartum women scored significantly higher than pregnant women in stress perception relevant to changes in relationships, sickness or injury, financial, and overall global area. However, there was no significant difference in psychopathology(scores of SCL-90-R) between both of the groups. 3) In pregnant women, age, frequency of pregnancy, dissatisfaction with maternal role, and dissatisfaction with husband correlated positively with both stress perception and psychopathology. Unemployed pregnant women showed significantly more psychopathology than employed women. 4) In postpartum women, poor health status, emotional instability during pregnancy, dissatisfaction with husband, and dissatisfaction with their newborn baby correlated positively with both stress perception and psychopathology. The women after delivery of female bady showed significantly higher stress perception and more psychopathology than those after delivery of male baby. 5) As a source of emotional support, husband was most common in each of the two groups. In conclusion, these results suggest that husband`s emotional support plays an essential role in maintenance of health for both the pregnant and postpartum women. In addition, it is emphasized that the family members and therapeutic team members should pay special attention to their emotional state during pregnancy.

自害痕 장정들에서의 불안 및 우울

고경봉,전우택 대한신경정신의학회 1988 신경정신의학 Vol.27 No.2

Anxiety and Depression in young adults with scars of self-injury were investigated and compared with those in normal subjects, in patients with anxiety state and depressive disorder, using the Leeds scales for self-assessment of anxiety and depression. Scores of depression general scale in those with scars of self-injury were significantly higher than in normal subjects, but the scores of anxiety general scale were not significantly different from each other. Scores of each scale of anxiety and depression in those with scars of self-injury were significantly lower than those in patients with anxiety state or with depressive disorder. As a group, the young adults with scars of self-injury were more depressed than the normal subjects, but less depressed than the patients with anxiety state or depressive diorder. Within the former group, however, only those who inflicted injury on self because of anger or depression, showed significantly higher scores on depression general scale than the normal group. This means that some of those with scars of self-injury show depression but that other cases show little depression. There were significant differences in scores of each scale of anxiety and depression according to severity, site, frequency and time of self-injury. Such characteristics reflect severe psychopathology and high risk of recurrence in self-injury.

Medazepam 및 Cloxazolam 이 가토혈중 주정농도에 미치는 영양에 관한 실험적 연구

高京鳳 大韓神經精神醫學會 1978 신경정신의학 Vol.17 No.4

Medazepam is a diazepam analogue with a 2-ketone omitted, and is used as an antianxiety agent. The drug shows the charateristic taming effect, muscle relaxant and anticonvulsant properties with minimal side effects and low toxicity. The pharmacodynamic aspects of the drug indicated rapid onset of absorption and rapid biotransformation of oral medazepam in men and dogs, with little acumulation in the plasma. It is also found that diazepam is an important metabolite of medazepam in rats and men, showing a major potency in clinical actions. Cloxazolam is a newer menmber of the benzodiazepine derivatives, which possess considerable calming effects. It is suggested that the potentiation of alcohol by some psychotropic drugs may, among other things, increase the risk of traffic accidents. Hence, it is necessary to test all psychotropic drugs for their interaction with alcohol. It has been recently reported that many psychotropic drugs including chlorpromazine and lithium, elevated the blood alcohol level in rabbits. In view of these findings, the author conducted an animal experiment to investigate the efect of medazepam and cloxazolam on blood level of alcohol in rabbits. Material and Method 1. The experimental work was done on mature rabbits of both sexes, weighing about 2 to 3kg. 2. The experimental animals were divided into two groups; the control and the experimental group. 3. The control group was given alcohol alone. 4. The experimental group was divided into 4 subgroups ; a) alcohol plus medazepam, 5mg/kg of body weight, b) alcohol plus medazepam, 10 mg/kg of body weight, c) alcohol plus cloxazolam, 1mg/kg of body weight , and d) alcohol plus cloxazolam, 2mg/kg of body weight. 5. These above groups were further divided into 2 subgroups in which one subgroup was given these drugs respectively for 5 days and another for 5 days and another for 10 days. 6. Each medazepam or cloxazolam was orally given in a single does at a fixed time. The last dose was given one hour and a half before alcohol administration. 7. In all groups 20 vol. % ethanol solution was slowly given in a dose of 5.0ml/kg of body weight for 5 minutes by intravenous route. 8. All of the blood specimens were obtained by cardiac puncture at both 15 and 45 minutes after alcohol administration. 9. The determination of blood alcohol level was made by Cavett's method. Results 1. Alcohol plus medazepam, 5mg/kg of body weight for 5 days. Medazepam caused no significant change in the blood alcohol level at both 15 and 45 minutes after alcohol administration (P>0.05) 2. Alcohol plus medazepam, 5mg/kg of body weight for 10 days. In this group, no significant change was shown in the blood alcohol level at 15 minutes (P>0.05) but significant elevation of blood alcohol level was noted at 45 minutes (P<0.01) after alcohol administration. 3. Alcohol plus medazepam, 10mg/kg of body weight for 5 days. In this group, medazepam elevated the blood alcohol level significantly at 15 minuts (P<0.05) but caused no significant change in the blood alcohol level at 45 minutes (P>0.05) after aslcohol administration. 4. Alcohol plus medazepam, 10mg/kg of body weight for 10 days. In this group, medazepam elevated the blood alcohol level significantly at both 15 (P<0.01)and 45 mimutes (P<0.05) after alcohol adnimistration. 5. Alcohol plus cloxazolam, 1mg/kg of body weight for 5 days. Cloxzolam caused no significant change in the blood alcohol level at both 15 and 45 minutes after alcohol administration(P>0.05) 6. Alcohol plus cloxazolam , 1mg/kg of body weight for 10 days. In this group, no significant change in the blood alcohol level 1 was also shown at both 15 and 45 minutes after alcohol administration(P>0.05) 7. Alcohol plus cloxazolam, 2mg/kg of body weight for 5 days. In this group, significant elevation of the blood alcohol level was noted at both 15 (P<0.005) and 45 minutes(P<0.001)after alcohol administration. 8. Alcohol plus cloxazolam, 2mg/kg of body weight for 10 days. In this group, cloxazolam also caused significant elevation in the blood alcohol level at both 15 (P<0.025) and 45 minutes (P<0.001) after alcohol administration. 9. No statistical significance was obtained in the difference of the blood alcohol level between 5 and 10 day groups when the dose was fixed (P> 0.005). Conclusions 1. Medazepam, when administered orally in a dose of 5mg/kg of body weight daily for 5 or 10 days, did not elevate the blood alcohol level significantly at both 15 and 45 minutes after alcohol administration except for the group administered for 10 days in which significant elevation was noted in the blood alcohol level at 45 minutes. 2. Medazepam, when administered orally in a dose of 10mg/kg of body weight daily elevated the blood alcohol level significantly at both 15 and 45 minutes except for the group administered for 5 days in which there was no significant elevation at 45 minutes. 3. Cloxazolam, when administered orally in a dose of 1mg/kg of body weight daily for 5 or 10 days, did not elevate the blood alcohol level 1significantly at both 15 and 45 minutes after alcohol administration. 4. Cloxazolam, when administered orally in a dose of 2mg/kg of body weight daily for 5 or 10 days, elevated the blood alcohol level significantly at both 15 and 45 minutes after alcohol administration. 5. There was no significant different in the blood alcohol level between 5 and 10 day groups in which a fixed dose of either medazepam or cloxazolam was administered.

정신신체장애환자들의 정신과에 대한 인식 및 수용

고경봉 大韓神經精神醫學會 1987 신경정신의학 Vol.26 No.3

The concept and the acceptance of psychiatry in patients with psychosomatic disorder was compared with those of each group of patients with anxiety state and with major depression. It is aimed at investigating whether or not resistance to psychiatric approach in the former ones is related to their concept of psychiatry and mental disorder. Misconception of psychiatry is noted to be more remarkable than that of mental disorder in all the groups of subjects. The psychosomatic cases recognize difference between psychiatry and neurology better than patients with major depression. The former cases show more emotionally positive response than the latter cases and the general public on diagnosis of mental disorder. And then the psychosomatic cases feel more incredible than cases with anxiety state. In prognosis of mental disorder, the former ones show more negative response than the general public. The extent of acceptance of general psychiatric treatment in the psychosomatic cases tends to be lower than that of each group of patients with anxiety state and with major depression. In acceptance of psychiatric treatment for somatic symptoms, the psychosomatic cases also show more negative response than all the other groups of subjects. It is concluded that resistance to psychiatric approach in psychosomatic cases is due to their underlying psychological motivation rather than their misconception of psychiatry. On the other hand, it can be considered that psychiatric approach depends upon nature of symptoms (either emotional or physical).

인슐린비의존형 당뇨병환자들에서 스트레스지각과 공복시혈당치 및 Glycated Hemoglobin치 간의 관계

전지홍,고경봉 대한신경정신의학회 1994 신경정신의학 Vol.33 No.3

This study was aimed at investigating the relationship of stress perception and psychopathology with the level of fasting blood sugar and glycated hemoglobin. Stress perception and psychopathology were investigated in 50 inpatients with non-insulin dependent diabetes mellitus patients, scores of stress perception and SCL-90-R had no significant correlation with fasting blood sugar level. In these patients, however, concentration of glycated hemoglobin had significantly negative correlation with scores of stress perception related to work, job and school. On the other hand, severity of physical symptoms rated by the patients had no significant correlation with score of stress perception and SCL-90-R, respectively. These results suggested that past severity of diabetes mellitus might decrease stress perception, although its recent severity did not make any influence on stress perception.