폐경기 증후군의 생물학적 접근

강병조,이죽내,임효덕,강석헌,Kang, Byung-Jo,Lee, Zuk-Nae,Rim, Hyo-Deog,Kang, Suk-Hun 한국정신신체의학회 1996 정신신체의학 Vol.4 No.1

Hormone replacement therapy in menopausal women has recently been a hot issue in medical fields. The author reviewed the physiology of menopause and discussed the physiological mechanism and biological management of vascular flushing and menopausal depression. The above symptoms are hard to distinguish from those of psychiatric disorders.

이명에 대한 정신의학적 고찰

정성훈(Sung-Hoon Jeong),강석헌(Suk-Hun Kang),이죽내(Zuk-Nae Lee),강병조(Byung-Jo Kang),임효덕(Hyo-Deog Rim) 대한생물치료정신의학회 1997 생물치료정신의학 Vol.3 No.2

이명은 흔하지만 원인을 확인하기 어렵고 치료 또한 정립되어 있지 않다. 환자 중 일부는 일생동안 지속되는 이명으로 우울증상, 수면곤란, 사회·심리적 어려움, 가족 내 갈등 등으로 고통을 받고 있다. 이명과 관련된 장해들이 불가역적이고 이과적 원인에서 기원하였다고 가정되어 왔지만, 많은 연구들은 이명 그 자체는 만성적이지만 이명과 관련된 다양한 장해들은 반드시 그렇지 않으며 부분적으로는 가역적인 정신과 장해일 가능성이 높다고 제안한다. 우울증이 동반될 때 이명에 대한 내성 감소로 강도가 증가되어 이차적인 증상들이 악화된다는 사실은 임상에서 특히 주의해야 할 부분이다. 치료에 있어서도 항우울제 투약 외에도 정서적인 문제를 반드시 다루고 필요하다면 인지-행동요법, 대인요법을 함께 사용하는 것이 바람직하다. Tinnitus is a common symptom in the general population. Tinnitus is associated with hearing difficulties, effects on lifestyle, effects on general health, and emotional difficulties. As hearing threshold increases, there is an exponential increase in the number of tinnitus cases. However, the severity of the tinnitus does not show this clear correlation with hearing loss. There is only a slight correlation between tinnitus seventy and duration, tonal quality, maskability, or number of sounds comprising the tinnitus. These suggest that seventy of tinnitus is closely tied to tinnitus-related disability and that neither of these is determined by the auditory sensation alone. What appears to be irreversible disability of otologic origin may, in part, be reversible disability of psychiaric origin. Tinnitus disability is strongly associated with major depression and suggest that treatment of the concurrent affective illness may reduce disability due to tinnitus. The antidepressant may decreases depression, functional disability, and tinnitus loudness associated with severe chronic tinnitus. It is particularly important to appreciate the difficulties caused by tinnitus because counseling is the most generally applicable form of assistance that can be given at present, where or nor the patient is helped by drugs, tinnitus maskers or biofeedback.

정신과 질환에서의 임상 병기 및 조기 개입

김혜금(Hye-Guem Kim),강석헌(Suk-Hun Kang),천은진(Eun-Jin Cheon) 대한생물치료정신의학회 2016 생물치료정신의학 Vol.22 No.2

There is increasing awareness of the limitations of the current diagnostic system in psychiatry. Clinical staging is another complementary method that make possible to rate the severity of the disease, and to use of appropriate stage-specific evidence-based interventions including early non-invasive intervention. This paper summaried previous studies about the development of clinical staging and the early intervention or prevention by using this staging method in psychiatry. Clinical staging in psychiatry can clarify which people are at risk of psychiatric disease and what novel therapeutic strategies are most likely to successfully achieve remission and reduce the risk of persistence and recurrence for patients in each stage.

가족위기를 동반한 정신과 응급환자에 관한 연구

강석헌,박상운 大韓神經精神醫學會 1989 신경정신의학 Vol.28 No.4

To determine the role of family crisis in the development of psychiatric emergency and to find the clinical characteristics of the patients, the author reviewed hospital records of 422 psychiatric patients who visited the emergency room of Kyungpook University Hospital during the past two years from June 1, 1986 t0 May 31, 1988 The results were summarized as follows; Among the total 422 patients, 139 cases(31.4%) proved to have a history of family crisis ; Most frequent problems were marital conflict(52.6%) and about two thirds of the cases were female in their thirties and twenties. Most of the patients were diagnosed as conversion disorder with characteristic somatization problem. Symptoms of parahysis or paresthesia, altered consciousness and emotional excitement with aggressiveness were commonly found. Only 12.9% of patients could be treated through hospitalization, 7.2% of the patients visited out-patient department and the rest refused the medical advice of follow up visit as out-patient clinic basis. Chinical vignetle of 5 typical cases were also presented. Finally, the author discussed the family crisis of the patients in relation to the Korean cultural value systems in transition and stressed the need for intensive in this field.

한養子의 自己同一性 混亂

姜錫憲 慶北大學校 醫科大學 1974 慶北醫大誌 Vol.15 No.1

The author experienced a therapeutic relationship with a patient of severe identity confusion in an adoptee of 17 year-old high school boy. His major psychopathology revealed a severe depersonalization, regressive behavior as well as grandiose ideations. In his fugue state during acute psychotic break, he wandered around seeking for his 'true parents' and uttered himself several 'incomprehensible remarks', which were characterized by severe time diffusion, and historical as well as geographical dislocation. He had been separated and uprooted from his biological mother in his earliest year of age, and was adopted to his present family with his natural father and foster mother as an eldest grand-son of his family tree. Due to deceptive and secretive family atmosphere with rejecting mother and distant father, he had been deserted since childhood. In his understanding of the identity of the patient, the auther tried to delineate the identity fragments of his father and foster mother. Finally, the author attempted to interpret the contents of the patient's depersonalization phenomena in terms of individual, family dynamics and societal changes.

外傷後神經症에 관한 臨床的 考察

姜錫憲,金映辰 大韓神經精神醫學會 1982 신경정신의학 Vol.21 No.2

The purpose of this study is to delineate some clinical characteristics of post-traumatic or accident neuroses; family and economical back ground, clinical symptomatology and diagnosis, and problems surrounding compensation. The authors collected the clinical records of 99 post-traumatic psychiatric inpatients and outpatients at Kyungpook and Kyemyung University Hospitals and three other private psychiatric clinics at Daegu area, during a period of two years from January 1st, 1979 to December 31, 1980. Out of the 99 post-traumatic cases, 19 cases with organic brain syndromes were excluded in the present study. Of all the 80 cases, 38 cases were interviewed by the authors and 42 by other psychiatrists. The results obtained could be summarized as follows; Of all the 80 post-traumatic cases, the number of male patients was 51 and that of female was 29, the male to female sex ratio being 1.8:1. Slightly over half of them were in their thirties and forties. The educational level of about two thirds of the patients was below middle school. 16% of them were unemployed, and 25% laborers. And majority of them belonged to low social classes. In the psychiatric interview, they showed a variety of difficulties; financial difficulties (25%), interpersonal conflicts (18%), vocational dissatisfaction (9%), and other physical illnesses (4%). Most frequent symptoms of the post-traumatic neurotics were headache (78%), insomnia (43%), dizziness (34%), memory loss (29%), anxiety (25%) and loss of interest (25%). As to the clinical diagnostic classification (ICD-9), 55% was diagnosed as hysteria, 19% as anxiety neurosis, 14% as neurotic depression, 6% as hypochondriasis and 2% as phobic neurosis. The average period of hospitalization was 50.3 days, and the duration from the time of trauma to the first psychiatric visit was 35.5 days in average. Finally, the authors had the impression that the course of post-traumatic neuroses was much influenced by the attitudes of the offenders and the court process of the compensation itself.

哀悼過程과 精神疾患에 關한 硏究

姜錫憲 慶北大學校 醫科大學 1974 慶北醫大誌 Vol.15 No.2

大邱市內 綜合病院 精神科 入院患者 933名 中에서 入院前 1年 以內 家族員의 死別歷을 가진 患者 62名에 대한 全般的 槪觀과 著者가 面接, 治療한 病的哀悼患者 36名의 分析에서 얻은 成績을 다음과 같이 要約 한다. 1. 入院患者의 槪觀 1. 綜合病院 精神科 入院患者 中에서 1年 以內 家族員의 死別歷을 가진 例는 全體의 6.6%에 該當하였다. 2. 性別 및 年齡別로 보면 死別群에서는 對照群(非死別群) 보다 平均 約 3歲가 높고 死別群에서는 30代 前半部의 男子患者가 有意하게 많았다. 3. 臨床診斷別로 보면 憂鬱症(神經症的 및 精神症的)이 對照群의 14.5%에 比해 死別群에서 全體의 38.7% 였고 精神分裂症은 相對的으로 對照群에서 많았다. 4. 死亡者와의 關係를 보면 父母死別이 54%였으며 이 中 男子는 父母死別이 67.7%였고 女子는 36.4%였다 . 5. 死別의 狀況은 豫期치 못한 急死가 半數를 차지하였다. 2. 病的 哀悼患者의 分析 1. 發病樣相, 臨床診斷 및 經過를 보아 病的哀悼患程을 세가지 類型으로 區分할 수 있었다. 1) 急性히스 테리型, 2) 遲延性 憂鬱症型, 3) 精神病的 退行型 2. 病的哀悼患者의 症狀을 1)初期反應, 2)一般的症狀, 3)死亡者와 直接關連된 症狀으로 나누었다. 初期症狀은 衝擊, 拒否的 無感動, 히스테리 症狀 形成 및 精神病的 自我崩壞였다. 一般的 症狀은 不安 및 憂鬱感(100%), 睡眠障碍(64%), 頭痛(47%), 身體疼痛 또는 異常感覺(47%) 呼吸器 係統 症狀(47%), 消化器系統 症狀(31%) 過飮 또는 非行(17%), 그리고 精神病的 退行症狀(28%)를 볼 수 있었다. 死亡者와 直接關聯된 症狀은 ①죽음에 對한 所願, 恐怖 및 自殺企圖 ② 死亡者의 最後疾患과의 症狀同一 視 ③ 過去의 다른 死別에 對한 哀悼의 再現 ④ 死亡者와의 마지막 接觸 또는 臨終場面에 대한 執念 ⑤ 周忌反應(anniversary reaction) ⑥ 葬禮에서의 不適切한 行動 ⑦ 死亡者가 살아있는듯한 感覺 ⑧ 死亡 者에 對한 過度한 理想化 ⑨ 遺品에 對한 病的 態度 ⑩ 憑依症候群 등을 分析, 討論하였다. 3. 病的 哀悼患者의 꿈 內容은 ① 死亡者와의 再結合, ② 功擊 또는 罪責感, ③ 排斥感, ④ 死亡者로부 터의 援護, ⑤葬禮의 反復, ⑥豫言的 主題 등을 分析하였으며 이들이 보고하는 꿈이 가지는 治療的 意義 를 强調하였다. 4. 患者와 나머지 家族員과의 關係는 ①過度한 依存, ②怨望과 攻擊, ③自責 및 隱遁, ④他家族員의 敵 意의 對象, ④兄第間 紛爭의 表面化를 分析하였다. 5. 病的 哀悼患者의 治療는 靜穩劑, 抗憂鬱劑, 電擊療法과 精神治療로써 多少의 效果를 보았다. 精神治 療面에서는 ①强力한 支持 ②家族員의 理解 및 說得 ③死亡者의 代理役割을 할 수 있는 家族員의 現實的 操整 ④哀悼過程의 促進 등을 主眼點으로 하였다. 以上의 硏究 結果를 討論하고 外國의 硏究들과 몇 가지 點에서 比較 檢討하였다. 마지막으로 追後의 이 方面에 關한 硏究의 必要性과 方向을 提示하였다. Of all functional mental illnesses, mourning process is rather unique in that it has a definite cause and assumes a self-limited clinical course as well as its final outcome. In reviewing the literature on the subject, numerous psychiatric studies have been done, however, mostly by Western authors. And these studies are primarily focused on two areas: intensive psychoanalytic case work and extensive clinical study on symptomatology and management of acutely bereaved patients. Furthermore, pathological mourning has also been studied as well by the several authors, again in the Western culture, especially in relating to other mental illnesses. In studying mourning process in particular, cultural climate has to be taken into consideration, as is true in general psychiatric field, culture exerts a great influence on psychiatric symptomatology. There has been practically no systematic study done on the subject in Korean cultural context. This study is aimed at two aspects: Overview on mourning process in relating to mental illness, and intensive clinical analysis of mourning patients among the mentally ill in our culture. A. Overview: Out of 933 psychiatric inpatients admitted in general hospital from January 1967 to August 1974, the bereaved group was studied in comparison with the non-bereaved as a control group, whose diagnosis was matched with the bereaved. B. Intensive Study: A clinical analysis of 35 pathological mourners who have been treated by the author during the last two years. Summary of this study is as follows; A. Overview. 1. Out of 933 psychiatric inpatients, 62 cases (6.6%) were indentified as having history of bereavement within one year prior to their admission. 2. The bereaved was roughly three years older than the non-bereaved and interestingly male patients in bereaved group were predominant in the early thirties. 3. As to the kinship with the deceased, parental loss accounted the most up to 54% and as to the circumstance of dying, nearly half of deaths occured suddenly and unexpectedly. 4. The incidence of affective disorders, particularly neurotic and psychotic depression, was far greater among the bereaved than the non-bereaved:ratio being 2.7:1 B. Clinical Analysis. 1. In view of the onset of symptom, clinical diagnosis and course of the mourning, three rather distinctive types could be identified in the process of pathological mourning: (1) acute hysterical type (2) delayed depressive type, and (3) psychotic regressive type. 2. Clinical symptoms were summarized in respect to (1) initial reaction to bereavement (2) general symptoms and (3) unusual symptoms directly related to the deceased. Initial symptoms were a startling shock, affective numbness, hysterical symptom formation and psychotic breaks, which were sooner or later followed by general symptoms, e.g., anxiety and depression (100%), sleep disturbance (64%), headache or heavy head (47%), painful complaints or abnormal sensation of body parts (46%), respiratory symptoms (47%), digestive symptoms (31%), overdrinking or delinquent behavior (17%) and finally psychotic regressive symptoms (28%). 3. The unique symptoms found in pathological mourning process, i.e., symptoms directly related to the deceased, were summarized as follows; death fear and wish including suicidal attempts, symptom identification with the terminal illness of the deceased, reactivation of another previous mourning, guilty preoccupation with the last contacts with the deceased or terminal scene of dying, anniversary reactions, strange behaviors during the funeral, sense of the deceased being alive, and posession syndrome, etc. Dream contents were analyzed into several themes; the deceased returning alive, aggression and guilt toward and rejection from the deceased, help from the deceased, repetition of the funeral and prophetic dream. The therapeutic significance of dream interpretation was also discussed. 4. The attitude of the pathological mourners toward the rest of family members had become significantly changed as follows; (1) overdependence. (2) aggression and resentment. (3) self-blame and withdrawl, and (4) becoming the target of other family members' hostility as well as reactivation of previously existed family conflicts. 5. In treating the pathologic mourning patient, the following aspects were particularly emphasized for a favorable outcome; (1) strong supportive attitude, (2) activation and acceleration of mourning process, and (3) family intervention. Finally, some of the findings were compared with the studies done in Western culture, and a suggestion was made for the future study on this subject in Korean culture.

Ganser 病候群의 臨床的 觀察

姜錫憲 慶北大學校 醫科大學 1978 慶北醫大誌 Vol.19 No.1

The author reported three cases of Ganser's syndrome; two males in their twenties and forties, and on female, sixties. All three cases had been hospitalized in Kyungpook university hostpital during last three years, and complete psychiatric study with application of clinical psychologic testing in one case was made. The clinical course of three cases was brief and rather episodic in its nature revobering after only around 15 days of treatment respectively with no lasting residue. Typical symptoms of Vorbeireden (approximate answer) and amnesia with loss of personal identity were observed in all three case, while symptoms of ludicrousness in two cases only. Other symptoms included clouding of conicousness, hallucination and depressive mood, etc. As to the precipitating factors, overwhelming emotional upset superimposed by legal problems in t재 male cases, and guilt provoking sexual arousal in the female patient in her sixties could be identified. Finally, the author discussed the hysterical nature of this syndrome with the literature review.

小兒精神科病室의 環境療法 : the milieu therapy

姜錫憲 慶北大學校 醫科大學 1980 慶北醫大誌 Vol.21 No.2

The purpose of this paper is to describe an approach of a short term child psychiatry unit. The paper gives a brief literature riview of milieu therapy, therapeutic community, and children's psychiatric hospitals. Secondly a historical review of the philosophy and structure of the Child Psychiatry Unit at the Mount Sinai Medical Center, New York City, and thirdly, a description of some of the principles which form the basis for the practices on this ward. In conclusion, the author stressed the difference between the milieu therapy of the Child Psychiatry Unit of the Mount sinal Medical Center and that modelled along a developmental/educational paradigm. The therapeutic techniques of the ward varies including ego supportive and ego interpretive methods. The therapeutic activities program of the ward provides for each child to develop his cognitive and social skills. The nursing staff supports the child, helps his social skills and provides for new models of identification. In addition, the method of ego interpretation is a valuable tool that even in a short term treatment provides for ego development and progression by enabling the child to gain some insight and control over some of his instinctual urges.

憂鬱神經症에 관한 臨床的 考察 : 發病誘因을 中心으로

姜錫憲 慶北大學校 醫科大學 1977 慶北醫大誌 Vol.18 No.1

1975年 1月부터 1976年 12月까지 2年間 慶北大學校醫科大學 附屬病院 神經精神科 外來를 訪問한 憂鬱神經症 患者가운데 著者가 診斷的 初診面接을 실시한 97例를 대상으로 憂鬱症의 症狀, 早期父母死別 및 離別歷, 發病誘因에 관한 調査 結果를 다음과 같이 要約한다. 症狀呼訴의 頻度를 보면 身體的 症狀表現이 全體呼訴의 約 50%로서 가장 많았으며 感情障碍가 21%, 思考障碍는 19%였다. 動機面의 呼訴는 8%에 不過하였다. 個別症狀으로서는 頭痛, 注意集中困難 및 記憶力減退, 不安 및 焦燥感, 疼痛呼訴, 不眠, 消化器系統症狀, 疲勞等의 順으로 頻繁하였다. 10歲前에 兩親中 한 사람과 死別 또는 離別歷을 가진 例가 約 22.8%였으며 死別歷만 報告한 例는 8.2%였다. 來院 1年 以內의 發病誘因으로서 가장 높은 比率을 차지하는 것은 家族과 離別 또는 別居와 入試失敗 및 學校適應失敗였다. To evaluate an outline of clinical pictures of depressive neurosis with an emphasis on recent history of life stresses in relatation to symptom onset as well as history of recent and early parental loss, the author reviewed the first diagnostic interview-notes of ninety seven cases of depressive neurosis. All of the cases were interviewed by the author himself during last two years at OPD service of Kyungpook University Hospital, and were diagnosed as primary depressive neurosis. From the review and analysis of the material, the following results could be summarized. The most frequent complaint was related to physical symptom, contributing about 50 per cent, followed by emotional disturbance (21 per cent) and cognitive disorder (19 per cent), and then there followed motivational disorder (8 per cent). The individual item of symptom complaints was as follow in the order of decreasing frequency; headache, concentration difficulty and memory impairment, anxiety and nervousness, painful complaints, insominia, gastrointestinal symptoms and lastly fatigability. The incidence of past history of parental loss by death or separation before age ten was twenty-tree per cent and that of parental loss by death only eigth per cent. Major contributing factors to precipitation of depressive symptoms within one year prior to psychiatric visit were found to be separation or desertion from family, failures of entrance examination and stress in school life.