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.

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.

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

최근 호르몬 대치요법으로 갱년기 증상들만 없어질 뿐 아니라 심장질환, 골다공증 등의 예방은 물론이고 젊음의 유지 및 삶의 질이 높아지자 산부인과 의사는 물론이고 정신과 의사들도 갱년기 증상에 대해서 다시 더 많은 관심을 갖게 되었다. 그리하여 저자는 일반 정신과 의사들이 갱년기 증상을 이해하는데 도움을 주기 위하여 갱년기 증상중 정신과와 관련이 있는 열성홍조와 갱년기 우울증을 중심으로 다음과 같은 몇 가지 점을 문헌고찰을 통하여 재검토하였다. 갱년기 및 폐경기의 정의. 갱년기의 생리(난소의 노화, 주간 율동의 변화, 초일주기 율동의 변화, 시신경교차 상부핵의 일주기 율동의 변화), 혈관운동성 홍조(정의와 병태생리, 원인, 진단, 치료), 갱년기 우울증(정의, 원인, 치료) 등을 재고찰하여 보았다. 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.

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.

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.

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.

退院한 精神分裂症患者의 便紙

姜秉祚,姜錫憲 大韓神經精神醫學會 1972 신경정신의학 Vol.11 No.2

Letters from 12 discharged schizophrnics are analyzed in its form content, and psychodynamics. Fourty letters from one of schizophrenic girl to her therapist has been studied intensively as a model case. Results: 1) Some features of schizophrenic letters are well corresponded with characteristic modes of primary process. 2) The whole process of letter writing was interpreted as on-going psychotherapeutic one based on intense, positive parental transference, The nature of this transference was analyzed and discussed in comparison with general features of transference in schizophrenia. 3) The authors also discussed several aspects of therapeutic significance of letter-writing itself, and stressed its usefulness as a tool of therapy in schizophrenic patients.

꿈 分析을 통한 精神治療 修練

申明淑,姜錫憲 大韓神經精神醫學會 1983 신경정신의학 Vol.22 No.2

정신치료의 修練을 目的으로 著者들을 포함한 7명의 수련의가 Supervisor의 주제하에 1981년 3월부터 11월까지 8개월간 慶北醫大 神經精神醫學 敎實에서 週1回 90分間 19回의 꿈 分析時間을 시도하였다. 19回의 錄音된 꿈 분석 資料를 정리하고 參加者들의 反應을 設問紙로 조사하고 集團討論을 거쳐 다음의 결과를 要約한다. 參加者 전원은 꿈 분석시간이 정서적으로 유익한 同察精神治療의 經驗으로 느꼈다. 참여자들의 轉移現象은 權威者를 둘러싼 兩價感情이 주류를 이루었고 이는 꿈 분석을 주도한 Supervisor의 現實的 役割이 크게 작용함을 알았다. Supervisor는 자신의 逆轉移感精을 과다한 꿈 解釋으로 방어할려는 경향이 있음을 자각하게 되었다. 꿈 분석시간에 참가한 수련의 전원은 정신치료의 基本槪念 습득에 도움이 되었다고 反應하였고 특히 꿈 해석의 技法을 배우는데 유익하였다고 보고하였다. 19회의 꿈 분석시간에 보고된 전체꿈 수는 122개였으며 이들 꿈을 몇가지의 주제별로 분류해보면 依存·獨立의 葛騰(26%), 敵愾心과 功擊心의 表現(21%), 無力 또는 無能感(15%), 兩價感情(8%), 排斥感(5%), 憂혈(3%) 등이었다. 꿈 내용에 있어서 수련기관이 그 배경으로 등장하는 경우가 전체 꿈의 32%나 되었으며 따라서 수련의의 정신과 수련에 따른 갈등의 一面을 表現, 解消되거나 現實的 調整이 가능한 예가 많았다. 이상에서 볼때 集團 꿈 分析時間이 정신치료 수련에 유용하게 利用될 수 있다고 본다.정신치료의 修練을 目的으로 著者들을 포함한 7명의 수련의가 Supervisor의 주제하에 1981년 3월부터 11월까지 8개월간 慶北醫大 神經精神醫學 敎實에서 週1回 90分間 19回의 꿈 分析時間을 시도하였다. 19回의 錄音된 꿈 분석 資料를 정리하고 參加者들의 反應을 設問紙로 조사하고 集團討論을 거쳐 다음의 결과를 要約한다. 參加者 전원은 꿈 분석시간이 정서적으로 유익한 同察精神治療의 經驗으로 느꼈다. 참여자들의 轉移現象은 權威者를 둘러싼 兩價感情이 주류를 이루었고 이는 꿈 분석을 주도한 Supervisor의 現實的 役割이 크게 작용함을 알았다. Supervisor는 자신의 逆轉移感精을 과다한 꿈 解釋으로 방어할려는 경향이 있음을 자각하게 되었다. 꿈 분석시간에 참가한 수련의 전원은 정신치료의 基本槪念 습득에 도움이 되었다고 反應하였고 특히 꿈 해석의 技法을 배우는데 유익하였다고 보고하였다. 19회의 꿈 분석시간에 보고된 전체꿈 수는 122개였으며 이들 꿈을 몇가지의 주제별로 분류해보면 依存·獨立의 葛騰(26%), 敵愾心과 功擊心의 表現(21%), 無力 또는 無能感(15%), 兩價感情(8%), 排斥感(5%), 憂鬱(3%) 등이었다. 꿈 내용에 있어서 수련기관이 그 배경으로 등장하는 경우가 전체 꿈의 32%나 되었으며 따라서 수련의의 정신과 수련에 따른 갈등의 一面을 表現, 解消되거나 現實的 調整이 가능한 예가 많았다. 이상에서 볼때 集團 꿈 分析時間이 정신치료 수련에 유용하게 利用될 수 있다고 본다. Seven psychiatric residents have experienced 19 successive series of group dream sessions as a method of psychotherapy training. The dream sessions were conducted by the senior author (psychotherapy supervisor) in the department of neuropsychiatry, Kyung-Pook University Hospital, and the sessions lasted for 8 months' duration from March to November, 1981. Each dream session ran for 90 minutes on the weekly one time basis. Dream sessions primarily consisted of reporting manifest dreams of all participants, of freely associating to the dream images, and of discussing the materials. The supervisor tried to interpret the dream material psychotherapeutically. All dream sessions were tape-recorded. The presupposed purpose of group dream sessions was to experience the psychotherapeutic situation and to understand basic concepts of dynamic psychotherapy as well as to have insight into their own emotional problems. To evaluate the effects of dream sessions, the authors reviewed all the recordings of the dream sessions after 10 months after the termination of the sessions. In addition, the authors had individual interviews and one group discussion with all participants to evaluate the after effects. A questionnaire composed of 32 items was applied to the participants of analyzing the data of the experience. The results could be summarized as follows; All participants of the group dream session agreed that the experience was a kind of insight group psychotherapy with highly emotional atmosphere; each session had been rather terse and characterized by lack of verbal exchange, but was followed by extra group talking when the supervisor was absent. Main subjects of and emotional conflicts among the participants. The nature of the transference of the participants was colored by the authority problem toward the supervisor; the reason for this could be partly explained by the fact that the supervisor also serves as a real figure (director of the psychiatric department). The supervisor himself gained insight into his own countertransference of domineering tendency, which manifested in the form of excessive and sometimes rather critical interpretations. The total number of manifest dreams reported during 19 sessions was 122, which counted 1 dream for each member in a session. As to the contents of the manifest dreams, the author could identify several categories of central themes; dependence-independence conflicts(26%), expression of hostility and aggressive impulse(21%), helplessness(15%), overt ambivalence(8%), feeling of rejection(5%), depression(3%), and others. It is interesting that the pictorial background in the manifest dreams frequently showed the training hospital; around one third of all dreams. Accordingly, the members could express various emotional conflicts of the psychiatric training and the conflicts could by worked through. Finally, the reaction to the dream session was particulary impressive in that their previous concepts about psychotherapy became vividly clear from their own experience of dream sessions; in terms of the basic concepts of the unconsious, transference, resistence and others. The authors felt that the group dream sessions could be a useful tool for learning and teaching dynamic psychotherapy.

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.