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.

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.

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.

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.

憑依 症候群 二例 : 精神力動學的 症例硏究 A Psychodunamic Case Study

姜錫憲 최신의학사 1972 最新醫學 Vol.15 No.8

Two cases of possession syndrome in female patients were presented: both possessed by deceased figures, i.e., one by her mother-in-law, the other by herfater. After analysis of acute psychotic associations and dream materials presented by both patients during therapeutic sessions, the individual psychodynamics were summarized as follows: The central conflicts of both patients were Oedipal ones, which had been analyzed through precipitatating events, features of psychopathological manifestations and dream materials reported by them. The possession processes and the resulting psychopathology of both patients were interpreted as a fantastic wish-fulfilment of their unconscious incestuous drives. In view of intrafamilial psychodynamics, by being the powerful figures after possession, they now also seem to function as an unconscious representative of their weak husbands, who had been oppressed by their mother substitutes since childhood. Various aspects of identification mechanism, which considered to be oral incorporative in nature, were discussed. During initial stages of therapeutic contacts, the transference phenomena of both patients to the therapist were characterized by their identifying the latter with their omnipotent possessed figures. In a discussion about defensive and therapeutic aspects of whole pictures of possession processes, the author was impressed as follows: in the case of mother-in-law as the possessed, its main pictures revealed manipulative and defensive against surrounding persons, while in the case of father as the possessed, the course of illness corresponded to a delayed and dramatic mourning process.

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 慶北醫大雜誌 Vol.15 No.2

長期服役因의 適應過程

姜錫憲 慶北大學校 醫科大學 1976 慶北醫大雜誌 Vol.17 No.1

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 慶北醫大雜誌 Vol.18 No.1

哀悼反應과 靑少年 非行

姜錫憲 慶北大學校 醫科大學 1977 慶北醫大雜誌 Vol.18 No.2