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

만성위염 환자들과 위궤양 환자들 간의 스트레스반응, 분노표현 및 감정표현불능증의 비교

고경봉,오승준,이성희,이상인,정재복,Koh, Kyung-Bong,Oh, Seung-Jun,Lee, Sung-Hee,Lee, Sang-In,Chung, Jae-Bock 한국정신신체의학회 2004 정신신체의학 Vol.12 No.1

연구목적: 본 연구는 만성표재성 위염 환자들과 위궤양 환자들을 대상으로 두 환자군 간의 스트레스반응, 분노표현, 감정표현불능증을 비교하기 위해 시행되었다. 방 법: 대상은 소화기내과에 내원한 후 위내시경을 시행하여 만성표재성위염으로 확인된 환자 100명과 위궤양으로 확인된 환자 40명으로 구성되었다. 스트레스반응은 스트레스반응척도 및 Symptom Checklist-90-revised의 불안, 우울, 신체화, 적대감 하위척도에 의해, 분노표현은 분노표현척도에 의해, 감정표현불능증은 Toronto Alexithymia Scale에 의해 각각 평가되었다. 결 과: 만성위염 환자들이 위궤양 환자들보다 스트레스반응척도의 긴장 하위척도 및 신체화 하위척도 점수와 SCL-90-R의 불안 하위척도 점수가 각각 유의하게 더 높았다. 그러나 분노표현 하위척도 및 분노억제 하위척도 점수와 감정표현불능증 전체점수는 2군 간에 각각 유의한 차이를 보이지 않았다. 스트레스반응척도의 신체화 하위척도 점수는 만성위염 환자들에서 여자가 남자보다, 위궤양 환자들에서는 남자가 여자보다 각각 유의하게 더 높았다. 결 론: 이상의 결과들은 만성위염 환자들이 위궤양 환자들에 비해 스트레스반응이 더 현저하고 스트레스에 대한 취약성이 더 높을 가능성을 시사해 준다. 그리고 만성위염 환자들은 여자들에서, 위궤양 환자들은 남자들에서 신체화 경향이 더 높음을 시사한다. 그러나 두 군 간에 분노표현 및 분노억압, 감정표현불능증은 차이를 보이지 않았다. The objective of this study was to make a comparison between chronic superficial gastritis and gastric ulcer patients regarding stress responses, anger expression and alexithymia. The subjects included 100 patients with chronic superficial gastritis and 40 patients with gastric ulcer confirmed by gastroscopy. Stress responses were measured by the Stress Response Inventory(SRI) and anxiety, depression, somatization and hostility subscales of the Symptom Checklist-90-revised(SCL-90-R). Anger expression and anger suppression were assessed by the Anger Expression Scale. The level of alexithymia was assessed by the Toronto Alexithymia Scale(TAS). Multiple regression analysis showed that the patients with chronic gastritis scored significantly higher on tension subscale and somatization subscale of the SRI, and anxiety subscale of the SCL-90-R than those with gastric ulcer. However, no significant differences were found in the score of anger expression and anger suppression subscales and total score of TAS between the two groups. In chronic gastritis patients, women scored significantly higher on somatization subscale of the SRI than men, whereas in gastric ulcer patients, men scored significantly higher on somatization subscale of the SRI than women. These results suggest that chronic gastritis patients are more likely to have higher level of stress responses and higher susceptibility to stress than gastric ulcer patients. In addition, in chronic gastritis patients, women are more likely to somatize than men, but in gastric ulcer patients, men are more likely to somatize than women. However, there were no differences between the two groups in anger expression, anger suppression and alexithymia.

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).

본태성 고혈압환자들과 정상인들 간의 분노의 비교

고경봉,김상준,Koh, Kyung-Bong,Kim, Sang-Jun 한국정신신체의학회 1995 정신신체의학 Vol.3 No.1

본 연구에서는 성인 고혈압환자 50명과 성인 정상인 50명을 대상으로 분노척도를 이용하여 분노의 표현 및 억압정도를 비교하였다. 그리고 양군에서 각각 분노척도점수와 수축기 및 확장기 혈압, 혈청 총콜레스테롤, 고지질 및 중성지방(triglyceride)치 간의 상관성을 조사하였다. 양군의 성별, 연령, 교육수준 및 BMI를 짝짓기하였고 2회 이상 혈압측정과 함께 채혈하여 혈청 총콜레스테롤, 고지질 및 중성지방치를 측정하였다. 고혈압환자군은 정상인들에 비해서 분노억압척도접수가 유의하게 더 높은 반면 정상인들은 고혈압환자들에 비해 분노표현척도접수가 유의하게 더 높았다. 그러나 전체분노척도접수는 양군 간에 유의한 차이가 없었다. 고혈압환자군에서는 분노억압 및 표현척도접수가 혈압, 혈청 총 콜레스테롤, 고지질 및 중성지방치 간에 유의한 상관성이 없으나 정상인들에서는 분노억압척도점수가 수축기 혈압과 유의한 양상관성을 보였다. 고혈압환자군에서 분노표현척도 접수가 남자가 여자보다 유의하게 더 높았고 정상인들에서는 남자가 여자보다 분노표현척도 및 분노전체척도점수가 유의하게 더 높았다. 이상의 결과들은 고혈압환자들이 정상인들에 비해 분노를 더 억압하고 정상인들에서는 분노의 억압이 고혈압을 일으킬 위험이 있음을 시사해 주어 분노의 억압이 고혈압과 관련된다는 기존 결과를 지지해 준다. A comparison was made regarding the extent of anger between 50 hypertensives and 50 normotensives, using anger scale. In addition, correlation was investigated between the extent of anger and biological variables such as systolic and diastolic blood pressure, serum total cholesterol, high density lipoprotein(HDL) and triglyceride in each of both the groups. The two groups were matched to each other regarding age, sex, the level of education and body mass index(BMI). The hypertensives scored significantly higher than normotensives in anger suppression, whereas normotensives scored significantly higher than hypertensives in anger expression. In hypertensives, scores of anger suppression and anger expression did not significantly correlate with blood pressure, serum total cholesterol, HDL and triglyceride, respectively. In normotensives, however, scores of anger suppression correlated positively with systolic blood pressure. Male hypertensives scored significantly higher than female hypertensives regarding anger expression, whereas male normotensives scored significantly higher than female normotensives regarding anger expression and anger total subscale, respectively. These results suggest that hypertensives suppressed more anger than normotensives, and that anger suppression in normotensives was more likely to increase blood pressure, supporting the previous reports that suppressed anger may be related to hypertension.

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.

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.

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.

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.

위암 환자들과 위염 환자들 간의 스트레스지각 및 우울의 비교

고경봉,이상인,이종민,Koh, Kyung-Bong,Lee, Sang-In,Lee, Jong-Min 한국정신신체의학회 1994 정신신체의학 Vol.2 No.1

GARS스트레스지각척도 및 BDI우울척도를 이용하여 위암환자들과 위염환자들 간의 스트레스지각 및 우울의 정도를 비교하였다. 위암환자들의 50%, 위염환자들의 38%가 BDI우울척도에서 우울에 해당되었다. 위암환자군과 위염환자군 간에 스트레스지각점수는 유의한 차이가 없었다. 한편 BDI우울척도점수에 있어서는 통계적으로 유의한 차이가 없었으나 위암환자군이 위염환자군보다 더 높은 경향을 보였다. 위암환자들에서는 정신적 고통의 정도와 우울의 정도가 유의하게 양상관성을 보인 반면 위염환자들에서는 신체증상의 심한 정도와 우울의 정도가 유의하게 양상관성을 보였다. 즉 위암환자들의 우울은 신체증상의 정도보다는 정신적 고통의 정도와 더 밀접하게 관련되는 것으로 나타났다. 양군에서 각각 여자환자들은 남자환자들보다 스트레스지각이 유의하게 더 높았고, 연령은 스트레스지각과 유의하게 음상관성을 보였다. 결론적으로 동일한 장기의 기질적인 병리의 심한 정도가 스트레스지각 및 우울의 정도와 관련되지 않은 것은 위암환자들의 부정이 관련될 가능성이 있다. 따라서 위암환자들의 치료에서 정신사회적 접근 특히 정신과 자문조정활동의 필요성이 강조된다. A comparison was made between gastric cancer and gastritis patients regarding stress Perception and depression, using Global Assessment Recent Stress(GARS) scale and Beck Depression Inventory(BDI). 50% of gastric cancer patients and 38% of gastritis patients were found to be depressed on scores of BDI scale, respectively. There was no significant difference in scores of stress perception between both the groups. However, gastric cancer patients tended to be more depressed than gastritis patients, although the difference is statistically not significant. In the gastric cancer patients, severity of psychic distress showed significantly positive correlation with depression, whereas in the gastritis patients, severity of physical symptoms showed significantly positive correlation with depression. It suggested that depression of gastric cancer patients was more likely to be related to the extent of psychic distress than that of physical symptoms. In each of both the groups, female patients showed significantly higher stress perception than male patients, and age was found to have significantly negative correlation with stress perception. In conclusion, severity of pathology of the same organ was not related to extent of stress perception and of depression in which denial of gastric cancer patients might play a role. Thus, it is emphasized that psychosocial approach is more needed for gastric cancer patients than for gastritis patients.

중환자치료의 정신과적 측면

고경봉 최신의학사 1994 最新醫學 Vol.37 No.6