두부 외상 후 섬망의 자문 정신 의학적 고찰

김현철,이상철,김도훈,이상규,홍승관,손봉기,Kim, Hyon-Chul,Lee, Sang-Chul,Kim, Do-Hoon,Lee, Sang-Kyu,Hong, Seung-Gwan,Son, Bong-Ki 한국정신신체의학회 2004 정신신체의학 Vol.12 No.1

연구목적: 두부 외상은 신체적 후유 증상뿐 아니라 다양한 정신 증상을 야기한다. 본 연구에서는 두부 외상 후 섬망을 보이는 환자들을 대상으로 정신과 자문을 실시하고 과다행동 증상의 유무 등의 임상 양상과 회복 기간과의 관련성에 대해 평가하고자 하였다. 방 법: 1998년부터 2002년까지 두부 외상을 주소로 신경외과에 입원한 환자들 중 섬망이 발생하여 정신과에 자문 조정이 의뢰된 45명의 환자를 대상으로 하였다. 섬망 발생 4주 후 추적 자문에서 섬망의 회복 여부에 따라 완전 관해 된 군 및 잔류 증상이 남아 있는 군으로 나누고, 두 군간의 차이를 과다행동 유무와 사회 인구학적 변수, 두부 외상 부위의 빈도에 따라 살펴보았다. 결 과: 첫 자문 주소에서 과다 행동 유무에 따라 분류해 보았을 때 4주 후의 섬망의 관해와 유의미한 관계를 보였다(p<.01). 섬망의 잔류 증상이 남아 있는 군은 완전 관해 된 군에 비해 중환자실 입원 기간 및(p<.05), 전체 입원 기간이 길었다(p<.01). 섬망 발생 4주 후 잔류 증상이 남아 있는 군은 완전 관해된 군에 비해 사고보험과의 관련성이 많았으며(p<.05), 신경 영상학적 조사에서 피질 하 회백질의 손상의 여부와 유의미한 관계를 보였다(p<.05). 결 론: 본 연구를 통해 첫 자문 의뢰 시 과다행동 유무에 따라 섬망의 회복 기간에 유의한 차이가 있었다. 또한 섬망의 회복 기간이 지연될수록 재원기간이 길어짐을 알 수 있었다. 향후 두부 외상 후 섬망 환자의 정신과적 개입에 있어 과다행동의 유무를 비롯한 임상 변수들에 대한 다각적인 연구가 필요할 것으로 사료된다. Objectives: Delirium after head trauma results in various cognitive and behavioral dysfunction. This study aimed at developing and validating a predicitive model for clinical improvement after delirium based on precipitating factors during hospitalization Method: Data were collected on 45 patients who developed delirium after head trauma using 5 year retrospective design, based on reviews of medical charts including psychiatric consultation reports. The differences of the group who sustained residual symptoms of delirium(The RS group) and the group of full recovery(The FR group) at 4 week follow-up visits were compared by motoric type of delirium, socio-demographic variables, neuroimaging variables and clinical variables of interest. Result: There was significant difference in reason for initial consultation between two groups, in terms of hyperactivity(p<.01). The presence of compensation claim, subcortical gray matter lesion was significantly associated with the RS group(p<.05). Total length of intensive care unit(ICU) admission and of hospital stay were significantly longer in RS group than FR group(p<.01). Conclusion: This study shows that hyperactivity on initial consultation, compensation claims, specific brain lesion were altogether significant factors in explaining prolonged duration of delirium after head trauma. A simple predictive model based on the presence of precipitating factors might be used to identify delirious patients at high risk for prolonged cognitive dysfunction. Early psychiatric intervention would be required for evaluating efficacious management and shortening admission period.

주요 우울증에서 혈중 Cytokine과 임상적 호전과의 관계

김현철,이상규,김도훈,손봉기,Kim, Hyon Chul,Lee, Sang Kyu,Kim, Do Hoon,Son, Bong Ki 대한생물정신의학회 2003 생물정신의학 Vol.10 No.1

Object : Currently, the alteration of cytokine system has been known to play an important role in regard to depressive symptom. We focused on the relationship between immunological parameters and clinical improvement in major depressive disorder. Method : Data were collected on 26 patients with major depressive disorder using a 8-week prospective follow-up design. After 8-week treatment period with fluoxetine, patients were classified into a response group and a non-response group according to their psychopathological outcome as evaluated by Hamilton Depression Rating Scale. The differences of the immunological parameters between pre-treatment phase and post-treatment phase were compared among patients. The difference of those was also compared within each phase among them. The relationship between socio-demographic variables, depression, cytokine, mononuclear cells was examined by correlation analysis. Multiple regression analyses were performed to explore the predictors of clinical improvement of major depressive disorder. Result : Pre-treatment levels of IL-$1{\beta}$ in the response group were significantly higher than those in the non-response group. Pre-treatment levels of IL-$1{\beta}$ of all patients and in the response group were positively correlated with pre-treatment monocyte counts. Patients with subsequent remission showed significantly lower IL-6 values at baseline than those with non-response. Post-treatment values of IL-6 did not differ significantly among the patients. The correlation test showed more frequent relations among cytokines and mononuclear cells in the response group than in the non-responder group. Especially, serum level of IL-6 in pre-treatment phase was only significantly correlated with HAMD score after 8-week treatement phase, while other cytokines and mononuclear cells were not. Pretreatment level of IL-6 was of paramount importance in predicting clinical improvement of depressive symptom. Conclusion : The immune system of major depressive disorder patients might dichotomize the patients into subsequent responders and non-responders. Immune system might be of great influence on the clinical improvement of major depressive disorder. The mode of interaction between depression and cellular immune function and the mediators responsible for the cytokine production need to be studied further.

뇌졸중 후 삶의 질에 영향을 미치는 요인

김현철(Hyon Chul Kim),김도훈(Do Hoon Kim),김세주(Se Joo Kim),문유선(Yoo Sun Moon),김홍철(Heung Cheoul Kim) 대한노인정신의학회 2003 노인정신의학 Vol.7 No.1

Objectives:The cerebrovascular diseases including stroke have become prevalent in Korea, ranking first as the cause of death in the aged. The quality of life (QOL) in stroke patients has been studied with growing interest since every aspect of life after stroke is influenced by the sequelae of this illness. This study aimed at 1) describing QOL of stroke patients and 2) identifying predictors of two month QOL after the event in stroke survivors. Method:WHO QOL scale was used to evaluate two month QOL after the stroke in 69 ischemic stroke patients. Data on age at the stroke event, sex, education level, brain MRI (magnetic resonance imaging) findings, symptoms of depression and anxiety, and neurologic disabilities were collected. Analyses were performed to explore the predictors of two month QOL. Results:Stroke survivors with higher number and volume of frontal cortex lesions had lower two month QOL. Also, patients with more severe subcortical gray matter lesions had significantly lower two month QOL. Stroke patients with depression at the event had lower two month QOL than patients without depression. Conclusion:Lesions in frontal cortex and subcortical gray matter hyperintensities on MRI T2 images and depression in acute phase were of paramount importance in predicting two month QOL. Accurate and prompt neurologic and psychiatric interventions are required to improve QOL after stroke.

조합형 글자꼴 디자인에 관한 연구

김현철,김용우,최영규 서울保健大學 1996 論文集 Vol.16 No.1

Combination letter forms have a plastic problem and a study on this has not progressed until now. Thus this study will propose a reform measure for the design of combination letter forms on the basis of the principle of "Unity of Variety." The height of a final on the end of korean orthographic syllable applied to the proportion by harmonic progression or the proportion principles including an irrational number as a substitute of the plastic problem for combination letter forms give the diversity and the uniformity, It is unstandable as the letter form having rhythmic property when connecting this. The reform measure of combination letter forms applied to this "Unity of Variety" is as follows : 1) The proportion principles gives it the rhythmic expression, while the existing combination letter forms with no consistency have people feel a rejection symptoms. 2) This letter forms have the harmony with uniformity and variety properly, while the completion forms give emphasis to the uniformity excessively. 3) The size are different between the many stroke and the small number of stroke, which have high readability. 4) The distance between "하" and "ㄴ" become narrower with a final on the end of korean orthographic syllable having small stroke make its height lower. The letter with many stroke like "ㄹ" having its height higher make high readability. 5) Applying the serif role of alphabet which gives the simplicity and the arrangement of charaters to the serif of combination letter forms provide the uniformity and the readability as it is possible to read it as a connected line, not distinguishing as a character by a character.

급성 뇌졸중 환자에서 우울 및 불안 증상에 영향을 미치는 요인

김세주,김도훈,최낙경,김현철,문유선,김흥철,정찬승 대한노인병학회 2003 대한노인병학회지 Vol.7 No.3