일반적 의학적 상태로 인한 섬망

김시경(Sie-Kyeong Kim) 대한노인정신의학회 2008 노인정신의학 Vol.12 No.2

Delirium is the most common psychiatric syndrome found in the hospital setting and a common cause of mortality and morbidity in physically ill patients, but clinician often do not recognize when their patients are delirious. The main pathophysiology of delirium is biochemical alterations in CNS such as cholinergic, dopaminergic, serotonergic, noradrenergic, glutamatergic and GABAergic dysfunction. However, various processes of inflammatory response, physiologic stress, oxidative failure, dehydration and electrolyte imbalance can influence brain chemistry and functioning in delirium due to general medical conditions such as cardiovascular disease, pulmonary disease, hip fracture, infectious disease, liver disease, renal disease and advanced cancer. If we get to understand the pathogenesis that result disordered brain function that cause delirium, we will be able to find more specific and tailored treatment tools of this complex syndrome.

응급실에 내원한 급성 히스테리 반응의 진단 특성

김시경(Sie Kyeong Kim),신철진(Chul Jin Shin),김재신(Jae Jin Kim),이상익,정인원(In Won Chung) 한국정신병리진단분류학회 1998 精神病理學 Vol.7 No.2

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ALDH2 유전형과 정신사회 스트레스가 대학생의 음주 행동 변화에 미치는 영향

김시경(Sie-Kyeong Kim),이상익(Sang-Ick Lee) 한국중독정신의학회 2008 중독정신의학 Vol.12 No.1

Objectives:The purpose of this study is to investigate the relation of the ALDH2 genotype with life events in order to provide data on biological and psychosocial factors related to problem drinking in early adulthood. Methods:The subjects were 150 young adults who were sampled from 534 people who had been determined genotype ALDH2 and had completed the previous research as freshmen in 2000. Through 6 years of followup observation, we reevaluated demographic and psychosocial variables including the pattern of drinking and life events, and compared the results with the results of the previous re-search. Results:During the 6-year period, the frequency of drinking decreased but physical response to drinking worsened and problem drinking behavior partially increased. In addition, the preventive effect of the D allele against problem drinking de-creased with the higher number of life events. Conclusion:Al-though the frequency of drinking decreased, pathological drink-ing was suspected in some of the subjects who had the D allele. The results of this study suggest that the number of life events has an impact on the preventive effect of D allele of ALDH2 against problem drinking. This explains part of the genetic and environmental factors affecting problem drinking behavior in early adulthood.

주부 우울증의 정신병리, 스트레스 특성과 경과

김시경 ( Sie Kyeong Kim ) 한국정신병리진단분류학회 2006 精神病理學 Vol.15 No.1

Objectives: This study aimed to examine the characteristics of married women complaining of depressive symptoms by assessing their psychopathology, life event stress, stress perception and coping skills, and to analyze the effects of those characteristics on outcomes after 12 months. The results are expected to provide basic data for testing the diagnostic validity of housewife depression. Method: The subjects were 52 housewives who visited the psychiatric outpatient clinic of Chungbuk National University Hospital with depressive symptoms during March to August 2005. After a psychiatric interview, the subjects filled a Korean version of symptom checklist-90-revision, life experience survey and stress perception questionnaire and ways of coping skills I checklist, and they were compared with a control group of 60 healthy women. After 12 months, the changes of subjective depressive feelings were evaluated through face-to-face or telephone interviews. Results: Depression group had higher academic qualifications than before, and while the cases of conversions or somatizations decreased but emotional symptoms such as anxiety and depression increased. Major stressors had been diversified from family problems to social problems. Although active coping skills increased, passive coping skills did not decreased. Psychopathological factors and negative life events were closely related to subjective depressive feelings measured after 12 months. Conclusions: With the development of society, stress factors and the psychopathology of housewives with depression are being modernized. However, the stress perception and coping skills look to follow the characteristics of traditional society. The progress of housewife depression was significantly affected mainly by early psychopathology and negative life event.

초기 성인기 우울증에 대한 유전적, 환경적 요인의 영향

김시경,이상익,신철진,손정우,엄상용,김헌,Kim, Sie-Kyeong,Lee, Sang-Ick,Shin, Chul-Jin,Son, Jung-Woo,Eom, Sang-Yong,Kim, Heon 대한생물정신의학회 2008 생물정신의학 Vol.15 No.1

우울 장애는 유전적 요인과 함께 환경적 요인이 복합적으로 작용하는 정신 장애이다. 본 연구에서는 세로토닌 체계와 연관된 유전적 요인과 생활사건과 같은 환경적 요인이 초기 성인기 우울 장애 발현에 미치는 영향을 조사함으로써 우울 장애의 원인론에 있어 유전자${\times}$환경 상호작용을 설명할 수 있는 자료를 제시하고자 하였다. 534명의 대학 신입생을 종적으로 추적 조사하여 생활사건 빈도와 중요도, 우울 척도와 불안 척도를 조사하였으며 전화 면담을 통해 DSM-IV 우울 장애 여부를 확인하였다. 최종적으로 150명이 연구에 포함되었으며 이전 연구로 확인된 TPH1 유전형과 함께 보관되어 있던 대상군의 DNA를 이용하여 SNaPshot$^{TM}$ 방식으로 TPH2, 5HTR2A 유전자를 추가 분석하였다. 유전자 정보와 생활사건 특성이 우울 증상에 미치는 영향을 확인하기 위해 로지스틱 회귀 분석과 상관 분석, 카이 자승 분석을 사용하였다. TPH1 유전형 중 C 대립 유전자가 존재하지 않는 집단과 달리 C 대립 유전자가 존재하는 집단에서는 생활사건 빈도가 우울 장애 유발에 유의한 영향을 미쳤다. 이러한 영향은 다른 대립 유전자나 유전형을 보이는 집단에서는 관찰되지 않았다. 본 연구의 결과는 TPH1 유전형은 생활사건 이후 우울 장애 발생의 유의미한 예측 요인임을 시사한다. 이는 우울 장애의 유전${\times}$환경 상호작용에 TPH1 유전자가 작용하고 있음을 제시한다. Objectives : The authors purposed to present data for explaining gene-environmental interaction causing depressive disorder by examining the effects of genetic factors related to the serotonin system and environmental factors such as stressful life events in early adulthood. Methods : The subjects were 150 young adults(mean age 25.0${\pm}$0.54), a part of 534 freshmen who had completed the previous study of genotyping of TPH1 gene. We assessed characteristics of life events, depression and anxiety scale and checked if they had a depressive disorder with DSM-IV SCID interview. Along with TPH1 A218C genotype confirmed in previous study, TPH2 -1463G/A and 5HTR2A -1438A/G genes were genotyped using the SNaPshot$^{TM}$ method. Results : In comparison with the group without C allele of TPH1 gene, the number of life events had a significant effect on the probability of depressive disorder in the group with C allele. Other alleles or genotypes did not have a significant effect on the causality of life events and depressive disorder. Conclusion : The results of this study suggest that TPH1 C allele is a significant predictor of onset of depressive disorder following environmental stress. It means that the TPH1 gene may affect the gene-environmental interaction of depressive disorder.

ADH1B와 ALDH2 활성 조합이 젊은 한국인의 음주 행동에 미치는 영향

박재영,김시경,이상익,Park, Jae-Young,Kim, Sie-Kyeong,Lee, Sang-Ick 대한생물정신의학회 2010 생물정신의학 Vol.17 No.1

Objectives : It is well-known that Korean people show distinctive drinking behaviors depending on the gene polymorphisms of alcohol metabolizing enzymes. This study examined the gene polymorphisms of ALDH2 and ADH1B and their combination on the drinking behaviors of Korean young adults. Methods : Through a follow-up survey performed for a cohort consisting of 551 university freshmen for six years, the authors attempted to identify genetic factors affecting drinking behaviors. In 2000, drinking behaviors and scores of CAGE questionnaires were assessed and ALDH2 gene polymorphism was determined with PCR-RFLP. In 2006(n= 150), AUDIT-K was assessed in addition to the above and gene polymorphism of ADH1B was determined through SNaPshot$^{TM}$ method. Results : While ALDH2*2 allele was associated with increased degree of drinking in 2000 and 2006. When both enzymes were active, the possibility to be classified into the risk group for alcohol dependence such as AUDIT-K(>12), and CAGE(>2) was high. Conclusion : The ALDH2 genotype had a significant effect on drinking behavior and degree of drinking during early adulthood. However, the combination of the active form of ADH1B and the active form of ALDH2 can be risk factor for problem drinking.

과민성 대장증후군의 병인론에 대한 고찰: 생물정신사회 모델의 이해와 한계

최영락,이상익,김시경,Choi, Young-Rak,Lee, Sang-Ick,Kim, Sie-Kyeong 한국정신신체의학회 2005 정신신체의학 Vol.13 No.1

연구목적 : 저자는 과민성 대장증후군을 가진 환자들의 병인론에 대한 문헌고찰을 통해 과민성 대장증후군을 생물정신사회 모델로 이해하고 그 한계를 알아보고자 한다. 방법: 저자는 1977년부터 2003년까지의 과민성 대장증후군에 대해 Pub-Med와 Kisep에 등록된 문헌을 고찰하였다. 결과: 과민성 대장증후군은 단일 병인론으로 설명될 수 없으며, 생물정신사회 모델은 과민성 대장증후군의 이해에 대해 새로운 관점을 제공하였다. 과민성 대장증후군에서 생물정신사회 모델의 생물학적 요인, 정신적 요인, 사회적 요인들은 서로 상호 작용하고 있고 각기 다른 정도로 기여하며, 영향을 미치고 있다. 세 요인들은 과민성 대장증후군에서 증상의 형성, 악화. 지속에 영향을 미치고 있으며 병인론, 증상경과, 치료결과에 중요한 역할을 하고 있다. 그러나 세 요인들을 치료에 적용하는 데는 많은 어려움을 가지고 있다. 결론: 생물정신사회 모델은 과민성 대장증후군을 가진 환자들을 이해하는데 기여하였으나, 치료적 적용에는 한계를 보이고 있다. 생물정신사회 모델은 실재적인 활용에 많은 한계가 있으므로 생물정신사회적 관점에 대한 보다 진보된 연구가 필요할 것이다. Objectives The author aimed to investigate and understand the limitations of the biopsychosocial model for irritable bowel syndrome by reviewing the priorly reported etiologies in patients with irritable bowel syndrome(IBS). Methods The author reviewed all possible previous studies related to the investigation regarding IBS in the Pub-med & Kisep database from 1977 to 2003. Results : It was impossible that patients with IBS were diagnosed and traced to a single etiology. So, the biopsychosocial model was suggested to be a new paradigm for IBS. Biological, psychological and social factors are interplaying and contributing to the biopsychosocial model affecting each other, thus affecting the biopsychosocial model. Three factors were necessary for understanding the etiology, process of symptoms and clinical outcome of IBS by virtue of their key roles in the developing, precipitating and perpetuating of the illness. However, any treatment application for those three factors faces many obstacles to be overcome. Conclusion : The biopsychosocial model contributed relatively much to the explanation but little to the treatment application of patients with IBS. Therefore, because there seems to be little practical use at present, the author believes biopsychosocial aspects should be researched further.

재활치료 환자 보호자의 불안감과 우울감에 대한 향기치료의 효과

권영문,이상익,김시경,손정우,신철진,최영락,Kwon, Young-Moon,Lee, Sang-Ick,Kim, Sie-Kyeong,Son, Jung-Woo,Shin, Chul-Jin,Choi, Young-Rak 한국정신신체의학회 2005 정신신체의학 Vol.13 No.1

연구목적: 본 연구는 재활치료 환자를 간병하며 불안감과 우울감을 보이는 보호자에게 향기치료를 적용하여 향기치료 효과에 대한 객관적인 자료를 제공하고자 하였다. 방법: 충북대학교병원 재활의학과에서 물리치료중인 환자 보호자 70명에게 Beck 불안척도와 Beck 우울 척도를 시행하였다. Beck우울 척도상 10점 이상을 보이는 42명을 대상군으로 오렌지 치료군, 라벤더 치료군과 대조군 세군으로 나누어 램프 확산법으로 4주간 향기치료를 하였다. 최종적으로 40명에 대한 향기치료 전후의 Beck불안 척도, Hamilton 불안 평정 척도, Beck 우울 척도, Hamilton 우울 평정 척도, 행복지표 그리고 자아존중감 척도를 평가하였다. 결과: 오렌지 치료군은 대조군에 비해 Beck 우울 척도의 점수 변화에서 유의한 차이를 보였다. 라벤더 치료군은 대조군에 비해 Beck 불안 척도, Beck우울 척도와 행복지표의 점수 변화에서 유의한 차이를 보였다. 결론: 본 연구 결과는 오렌지향유 향기치료는 우울감에, 라벤더향유 향기치료는 불안감과 우울감에 효과가 있음을 시사한다. The aim of this study was to assess effects of aromatherapy on anxiety and depression of caregivers for patients in rehabilitation therapy and to provide basic data for the aromatherapy. Beck Anxiety Inventory(BAI) and Beck Depression Inventory(BDI) for the preliminary assessment of anxiety and depressive mood were administered to caregivers for patients in rehabilitation therapy in Chungbuk National University Hospital. Forty two out of seventy subjects who got scores above 10 in BDI were selected. Forty two Participants were divided into orange group, lavender group and control group. They had got the aromatherapy by using the lamp diffusion method for 4 weeks. Only forty participants completed a trial. Effects of the aromatherapy were measured using BAI, Hamilton Anxiety Rating Scale(HAM-A), BDI, Hamilton Depression Rating Scale(HAM-D), Self Esteem Scale(SES) and Index of Wellbeing(IOWB) before and after the aromatherapy. Orange group showed significant difference in the change of BDI scores compared with control group. Lavender group showed significant difference in the mean change of BAI, BDI and IOWB scores compared with control group. These results suggested that aromatherapy with orange oil was effective for depression and the aromatherapy with lavender oil was effective for anxiety as well as depression.

20대 한국 직장인의 음주 심각도에 대한 직무 스트레스와 BDNF 유전자 다형성의 역할

김보아,이상익,김시경,신철진,손정우,홍주봉,남영우,주가원,Kim, Bo-Ah,Lee, Sang-Ick,Kim, Sie-Kyeong,Shin, Chul-Jin,Son, Jung-Woo,Hong, Joo-Bong,Nam, Yeong-Woo,Ju, Ga-Won 대한생물정신의학회 2012 생물정신의학 Vol.19 No.2

Objectives : The aim of this study was to examine the effects of brain-derived neurotrophic factor (BDNF) genetic polymorphism and job stress on the severity of alcohol drinking. It was hypothesized that individuals with the Met/Met BDNF genotype would be more vulnerable than those carrying the Val allele. Methods : Participants were 133 healthy Korean adults (mean age $28.2{\pm}1.1$). Job stress and the severity index of drinking were investigated through self-reported questionnaires. BDNF (rs6265) gene was genotyped. Results : There was no significant association between job stress and the severity of alcohol drinking. Although the severity of alcohol drinking was not associated with BDNF genetic polymorphism, there was a significant difference in men according to genotype and job stress. Men with homozygous BDNF Met allele were more severe in alcohol drinking when job stress was high, less severe in alcohol drinking when job stress was low than those carrying the Val allele (F = 4.47, p = 0.038). Also higher level of job stress was correlated with higher severity of alcohol drinking in men homozygous for BDNF Met allele (rs = 0.620, p = 0.005). Conclusions : These findings suggest the possibility that Met allele could have differential susceptibility, with men homozygous for BDNF Met allele being more susceptible to both more adverse and less adverse environmental influences.

알코올 의존 환자에서 삼대립 세로토닌 수송체 유전자 다형성과 생활사건 스트레스가 우울증에 미치는 영향

장현정,이상익,김시경,신철진,손정우,주가원,박재영,지경환,이상구,Jang, Hyun-Chung,Lee, Sang-Ick,Kim, Sie-Kyeong,Shin, Chul-Jin,Son, Jung-Woo,Ju, Ga-Won,Park, Jae-Young,Jee, Kyung-Hwan,Lee, Sang-Gu 대한생물정신의학회 2012 생물정신의학 Vol.19 No.2

Objectives : The purpose of this study is to investigate the relationship between the triallelic serotonin transporter gene and stressful life events to determine their effect on depression with alcohol dependence. Methods : Ninety-five hospitalized patients with alcohol dependence (73 male, 22 female) were enrolled in this study. Thirty-two (33.7%) of the total patients were diagnosed with major depressive disorder and dysthymic disorder by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV. The characteristics of stress were evaluated using the stressful life events scale, and depressive symptoms were assessed using the depression scale (Beck Depression Inventory, BDI). Alcoholism with depression (n = 32) and alcoholism without depression (n = 63) were genotyped for the triallelic serotonin transporter gene ($L_A$ : higher expressing allele, $L_G$/S : lower expressing allele). Results : There was no significant difference in the allele frequency between the depression group and the non-depression group (${\chi}^2$ = 0.345, p = 0.619). $L_G$/S alleles had more comorbid depression in the higher score of stressful life events scale [Mental-Haenszel (MH)-${\chi}^2$ = 4.477, p = 0.034]. But there was no significant difference in the comorbidity according to the scores from the stressful life event scale in the $L_A$ alleles (MH-${\chi}^2$ = 0.741, p = 0.399). In the results, alcohol-dependent individuals with $L_G$/S alleles had more comorbid depression than those with $L_A$ alleles when they had experienced severe stressful life events (MH-odds ratio = 2.699, p = 0.028). Conclusions : These results suggest that there is no direct relationship between triallelic serotonin transporter gene and depression in the alcohol dependent patients. But alcohol dependent individuals with the lower expressing alleles of the serotonin transporter gene were more susceptible to depression than those with the higher expressing alleles in response to stressful life events.