도덕적 손상의 연구동향과 심리치료 및 상담에 주는 함의

권창모(Kwon, Changmo),손은령(Son, Eunyoung) 한국재활심리학회 2020 재활심리연구 Vol.27 No.4

도덕적 손상은 참전 경험으로부터 개념화된 이후 최근 들어 해외 학계에서 더욱 활발히 연구되고 있다. 참전군인을 만나온 임상가들이 도덕적이고 명예로운 규범이 위배 됨으로써 뒤따르는 내적 고통을 통찰한 이후로 도덕적 손상은 심리적 외상에 대한 보완적 또는 대안적 접근으로 발전되어 왔다. 최근에는 사회복지, 윤리, 영성 등 다양한 영역에서 ‘민간’에 적용한 이론 및 실천적 논의가 전개 중이다. 예컨대 코로나바이러스감염증-19 의료 인력의 도덕적 손상 노출이 다뤄지고 있다. 그러나 국내에서는 근래 들어서야 도덕적 손상이 소개되기 시작하였고 그나마 도덕적 손상의 개념과 연구동향을 심도 있게 고찰한 문헌은 거의 없다. 주된 실천 영역인 심리치료 및 상담에 적용하여 논의한 경우는 더욱이 찾아볼 수 없다. 이에 본 연구는 학술연구정보서비스(RISS)를 통해 해외 85건과 국내 5건의 관련 문헌을 선별하여 연구동향 및 주요 내용을 체계적으로 제시하였다. 도덕적 손상의 정의, 외상 후 스트레스 장애와의 관계, 측정, 개입 등 핵심적인 하위 주제들을 살폈고 이로부터 심리치료 및 상담에 함의되는 바를 논의하였다. 또한, 참전 외상의 심리적 재활을 넘어 최근의 확장된 논의를 고려함으로써 도덕적 손상에 대한 국내 학계의 관심을 촉진하고 다양한 조력직에 해당할 실천적 의미를 조명하고자 하였다. With its conceptualization from combat experiences, moral injury(MI) is now an internationally burgeoning field of research. Since clinicians treating war veterans had found inner wounds among them as an aftermath of betrayals of their moral codes and values, MI has been developing as an complementary or alternative approach to psychological trauma. Accordingly it expands into various disciplines such as social work, ethics and spirituality with discussions applied to civilian life. MI exposure in medical folks dealing with COVID-19 is a recent example. Internally, however, MI remains on its initial stage of research and practice. Thorough reviews are rarely found and the same with entailed discussions focused on psychotherapy or counseling. Thus, current review examined total 85 foreign studies and 5 domestic studies searched through Research Information Sharing Service(RISS), resulting in MI’s research trend in a systematic manner from its original context through to interventions. Following implications centered on psychotherapy and counseling were not necessarily limited to veterans’ psychological rehabilitation but included wider discussions relevant to various helping professions.

루푸스 환자에서 심혈관계 위험인자로서 경동맥 내막 중막 두께의 유용성

권창모 ( Chang Mo Kwon ),홍영훈 ( Yeong Hoon Hong ),이충기 ( Choong Ki Lee ) 대한류마티스학회 2005 대한류마티스학회지 Vol.12 No.4

전신성 홍반성 루푸스는 심근경색, 뇌졸중 등 심혈관계 합병증이 주요한 사망 원인으로 되어있다. 루푸스 환자에서 심혈관계 합병증을 증가시키는 원인으로 전통적인 죽상경화증 위험인자 외에 총 스테로이드 사용량, 신장 침범 유무, 자가항체 등이 알려져 있다. 본 연구에서는 CIMT를 이용하여 정상인과 비교하여 루푸스 환자에서 CIMT 증가 여부를 확인하고 이를 루푸스 환자의 심혈관계 합병증 위험인자로 사용할 수 있는지 보고자 하였다. 대상은 나이와 성별을 고려한 48명의 루푸스 환자와 32명의 건강 대조군으로 양 군 모두 B mode 초음파를 이용하여 경동맥 원위부 혈관벽의 내막-중막 두께를 측정하였으며 경동맥 내막-중막 두께에 영향을 줄 수 있는 나이, 체질량지수, 총콜레스테롤, 저밀도 지질단백, 고밀도 지질단백, 중성지방, 총 스테로이드 투여량, SLEDAI score 등을 조사하였다. 루푸스 환자군에서 CIMT는 정상대조군에 비해 유의하게 증가되어 있었으며, 환자군에서 CIMT는 나이와는 상관관계가 있었으나, BMI, SLEDAI score, ESR, 스테로이드 사용량, 유병기간, 보체, 항ds-DNA 항체 등의 다른 임상변수와는 연관성이 없었다. 루푸스 환자에서 죽상경화증의 발생이 스테로이드 사용량과 기간, 신질환 유무, 질병 활동도가 복합적으로 관여하겠지만 심혈관계 합병증이 없는 루푸스 환자에서 정상인에 비해 증가된 CIMT를 가진다는 결과가 실제로 향후 심혈관계 합병증의 발생에 어떤 의미를 가지는지에 대한 연구가 필요하리라 생각한다. Objective: The purpose of this study was to investigate the complication using carotid intima media thickness (CIMT) as an indicator for atherosclerosis and to verify the risk factors in systemic lupus erythematosus (SLE) patients compared with those of control group. Methods: The study recruited 48 asymptomatic SLE and 32 healthy control group. These are examined by B-mode ultrasound (Acuson(TM) SequoiaC256 8 MHz linear transducer) to measure the CIMT at the far wall of the common carotid artery. A wide range of contribution factors to CIMT including age, body mass index, lipid profile, total cumulative steroid dose, SLEDAI, and proteinuria were considered. Results: Although the results of CIMT in both groups were within normal limit (In healthy adult 0.25∼1.5 mm, values >1.0 mm often regarded as abnormal), the mean CIMT in patient group was 0.721±0.162 mm, which was thicker than that of control group with 0.5219±0.096 mm (p<0.001). In multiple regression analysis, only age showed significant contribution to CIMT (p<0.01). Disease duration, SLEDAI and serum lipids were of no statistical significance with CIMT. Conclusion: We were to elucidate the advance of atherosclerosis with measuring CIMT and assess factors associated with SLE. Even if the results of CIMT in both groups were within normal range, it is significant that the arterial thickening is more advanced in SLE than that of healthy control. Further studies based on CIMT are needed to screen and prevent cardiovascular complications from disease progression.

개방처우제도의 개선방안에 관한 연구

권수진(Kwon, Soo-jin),권창모(Kwon, Chang-mo),오영근(Oh, Young-keun) 한국형사법무정책연구원 2018 형사정책연구원 연구총서 Vol.- No.-

형사정책과 사법제도에 관한 평가 연구 (XI)

권수진(Kwon, Soo-jin),한민경(Han, Min-kyung),권창모(Kwon, Chang-mo),주영수(Choo, Young-soo) 한국형사법무정책연구원 2017 형사정책연구원 연구총서 Vol.- No.-

전신성 홍반성 루푸스에서 고용량 경정맥 당질코르티코이드로 치료된 단백질 소실성 장질환 1예

이규형 ( Kyu Hyung Lee ),권창모 ( Chang Mo Kwon ),김현도 ( Hyun Do Kim ),윤대영 ( Dae Young Yun ),이재웅 ( Jae Yoong Lee ),홍영훈 ( Yeong Hoon Hong ),이충기 ( Choong Ki Lee ) 영남대학교 기초/임상의학연구소 2005 Yeungnam University Journal of Medicine Vol.22 No.2

Generalized edema and hypoalbuminemia are relatively common presenting manifestations in many clinical situations. The differential diagnosis of hypoalbuminemia include: Kwashiorkor, synthetic dysfunction of the liver, and excessive protein loss as in nephrotic syndrome. In systemic lupus erythematosus (SLE), hypoalbuminemia and generalized edema are most commonly due to protein loss associated with lupus nephritis; gastrointestinal involvement is uncommon, and therefore protein loss through the gastrointestinal tract is quite rare. We report a case of a protein losing enteropathy (PLE) associated with SLE. The patient was referred to our hospital for generalized edema, arthralgia and facial rash. After clinical evaluation, the patient met the criteria for the SLE diagnosis; hypoalbuminemia with general edema was consistent with a protein losing enteropathy. After two weeks of therapy with parenteral high dose glucocorticoid, the patients was improved in laboratory findings as well as clinical symptoms.

국내 유통기업의 CPFR 적용 사례연구

이도현(Do Hyun Lee),권창모(Chang Mo Kwon),이영훈(Young Hoon Lee) 한국SCM학회 2006 한국SCM학회지 Vol.6 No.1

전신성 홍반성 루푸스 환자의 자율 신경 장애

김성동 ( Seong Dong Kim ),류동환 ( Dong Hwan Ryu ),이정훈 ( Jeong Hoon Lee ),권창모 ( Chang Mo Kwon ),홍영훈 ( Young Hoon Hong ),이충기 ( Choong Ki Lee ) 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.3

Objective: To investigate the prevalence of autonomic dysfunction and to evaluate the relationship between autonomic dysfunction and clinical parameters in patients with systemic lupus erythematosus (SLE). Methods: Fifty-eight patients with SLE who met the American College of Rheumatology criteria for SLE and forty-five healthy controls were selected at our hospital. Cardiovascular autonomic nervous function (CAN) test, including heart rate variation in deep breathing, Valsalva maneuver and orthostatic change and blood pressure response to standing, handgrip, was done in patient group and controls. Erythrocyte sedimentation rate (ESR), antinuclear antibody, anti-dsDNA antibody, complete blood count, complement and disease duration of patients were retrospectively reviewed and disease activity was assessed by Mexican SLE disease activity index (MEX-SLEDAI). Results: The frequency of parasympathetic damage was 51.7% in patients with SLE and 15.6% in controls. There was significant difference between 2 groups in heart rate variation in deep breathing. No significant correlations were observed between autonomic dysfunction and ESR, antinuclear antibody, anti-dsDNA antibody, thrombocytopenia, complement, disease duration of patients, but there was slightly positive correlation between number of abnormal parasympathetic function test and MEX-SLEDAI (r=0.32, p<0.05). Conclusion: The prevalence of autonomic dysfunction was high in SLE patients and there was high frequency in patients with high disease activity. Prospective studies are needed to determine the clinical significance of autonomic dysfunction in the morbidity and mortality of SLE.

치료 중인 전신성 홍반성 루푸스 환자에서의 지질대사 변화

이정훈 ( Jung Hoon Lee ),은미정 ( Mi Jung Eun ),이상진 ( Sang Jin Lee ),이상희 ( Sang Hee Lee ),김태우 ( Tae Woo Kim ),김용길 ( Yong Kil Kim ),권창모 ( Chang Mo Kwon ),이규형 ( Gui Hyung Lee ),홍영훈 ( Young Hoon Hong ),이충기 ( C 대한내과학회 2004 대한내과학회지 Vol.67 No.3

류마티스 관절염 환자에서 발생한 괴저성 농피증 1예

류동환,권창모,이정훈,홍영훈,이충기 영남대학교 의과대학 2003 Yeungnam University Journal of Medicine Vol.20 No.1

Pyoderma gangrenosum is uncommon neutrophilic dermatosis characterized by richness of the mature neutrophilic polynuclear dermal infiltrate. Pyoderma gangrenosum is associated with variable diseases, most commonly inflammatory bowel disease, hematological diseases, malignancies, but it is reported rarely in rheumatoid arthritis. We report a case of pyoderma gangrenosum in rheumoid arthritis patient. A 50-year-old woman admitted to our hospital due to painful pretibial ulcerative skin lesions. She had been treated as rheumatoid arthritis for 8 years. At admission. body temperature was 36.5℃ and other vital sign was unremarkable. Physical examination revealed right pretibial ulceration, multiple pustules on left pretibial area and both palms. Laboratory studies revealed WBC count 7,600/uL (neutrophils 60.3%, eosinophil 3.2%), hemoglobin 11.4 g/dL, platelet count 319,000/uL, ESR 65 mm/hour. Other lab findings were also unremarkable. Skin biopsy was done, which showed dense dermal infiltrate of neutrophils and wound culture were negative. By 8 weeks after systemic high dose corticosteroid (1 mg/kg/day), cyclosporine A (5 mg/kg/day), sulfasalazine 2 g therapy, symptoms and skin ulceration were being improved. Without skin relapse, she is followed up our hospital with low dose corticosteroid and sulfasalazine.

전신성 홍반성 루프스에서 고용량 경정맥 당질코르티이드로 치료된 단백질 소실성 장질환 1예

이규형,권창모,김현도,윤대영,이재웅,홍여훈,이충기 영남대학교 의과대학 2005 Yeungnam University Journal of Medicine Vol.22 No.2

Generalizes edema and hypoalbuminemia are relatively common presenting manifestations in many clinical situations. The differential diagnosis of hypoalbuminemia include; Kwashiorkor, synthetic dysfunction of the liver, and excessive protein loss as in nephrotic syndrome. In systemic lupus erythematosus (SLE), hypoalbuminemia and generalized edema are most commonly due to protein loss associated with lupus nephritis; gastrointestinal involvement is uncommon, and therefore protein loss through the gastrointestinal tract is quite rare. We report a case of a protein losing enteropathy (PLE) associated with SLE. The patient was referred to out hospital for generalized edema, arthralgia and facial rash. After clinical evaluation, the patient met the criteria for the SLE diagnosis; hypoalbuminemia with general edema was consistent with a protein losing enteropathy. After two weeks of therapy with parenteral high dose glucocorticoid, the patients was improved in laboratory findings as well as clinical symptoms.