비심인성 흉부 불편감을 가진 대상자에서 컴퓨터 기반 인지행동치료의 효과성 : 문헌 검토와 새로운 프로토콜 제안

류인균,김정윤,김지은,Lyoo, In Kyoon,Kim, Jungyoon,Kim, Jieun E. 대한생물정신의학회 2019 생물정신의학 Vol.26 No.1

Since non-cardiac chest discomfort (NCCD) can result in substantial healthcare burden and lower quality of life, interventions such as cognitive behavioral therapy (CBT) have been investigated for the relief of NCCD. In this review, we aimed to summarize the evidence on the efficacy of the CBT for the treatment of NCCD while introducing a newly-developed computerized CBT program for NCCD. Studies applying CBT to individuals with NCCD were searched for from both English and Korean electronic databases. Among 37 studies, 11 randomized controlled trials, 4 case-control studies, 1 case series, and 2 review articles were eligible for this review. Efficacy of conventional CBT for NCCD was shown in a series of studies as most of them reported improved symptom severity of NCCD or NCCD-related anxiety. However, a substantial variability existed among these studies in participants, treatment procedures and durations. High attrition rates were also reported in these studies on conventional CBT. Computerized CBT could be an alternative to the conventional CBT as it can be standardized and more easily accessible, but it was only reported in one previous study. In addition to the literature review, we presented a newly-developed computerized CBT program for NCCD which may overcome some of the limitations of conventional CBT. A computerized CBT could be an alternative treatment of NCCD, however, need further studies on its usefulness.

Prevalence of DSM-III-R Axis II Personality Disorders in College Women with Bulimia Nervosa

류인균,이주남,조맹제,조두영,이부영,Lyoo, In-Kyoon,Lee, Joo-Nam,Cho, Maeng-Je,Cho, Doo-Young,Rhi, Bou-Yong KOREAN ACADEMY OF SLEEP MEDICINE 1999 수면·정신생리 Vol.6 No.1

목 적 : 본(本) 연구(硏究)는 신경성(神經性) 거식증(拒食症)을 가지고 있는 여대생(女大生)의 DSM-III-R상(上)에 근거한 인격장애(人格障碍)의 빈도(頻度)를 정상대조군(正常對照群)과 비교(比較) 조사하는 것을 목적(目的)으로 한다. 방 법 : Structured Clinical Interview for DSM-III-R을 사용(使用)하여 신경성 거식증을 가지며, 동시에 다른 I 축(軸) 정신장애(精神障碍)를 가지고 있지 않은 62명의 식이장애(食餌障碍) 연구대상군을 모집(募集)하였으며, 같은 도구(道具)를 사용하여 어떠한 I 축(軸) 정신장애(精神障碍)를 가지고 있지 않은, 동수(同數)의 연령(年齡), 성별(性別) 대조군을 모집(募集)하였다. 인격장애(人格障碍)의 빈도(頻度)의 조사를 위해서는, 면접도구(面接道具)인 '인격장애(人格障碍) 진단면접검사(診斷面接檢査)'(Revised Diagnostic Interview for Personality Disorders)와 설문검사(設問檢査)인 '인격장애(人格障碍) 설문검사(設問檢査)'(Personality Disorder Questionnaire-Revised)를 동시에 사용하여 진단적(診斷的) 신뢰도(信賴度)를 높였으며, 특히 경계선(境界線) 인격장애(人格障碍)의 진단(診斷)을 위해서는 '경계선(境界線) 인격(人格) 진단면접검사(診斷面接檢査)'(Diagnostic Interview for Borderlines)를 추가(追加)로 사용하였다. 또한 일반적인 인구역학적 변수(變數)의 조사와 함께 신경성 거식증환자에서 흔히 관찰되는 우울증상(憂鬱症狀)의 평가를 위하여 Beck 우울평가도구(憂鬱評價道具)(Beck Depression Inventory)를 사용하여 우울증(憂鬱症)의 정도를 평가하였다. 결 과 : 신경성 거식증군은 정상대조군과 적 : 본(本) 연구(硏究)는 신경성(神經性) 비교(比較)하여 유의(有意)하게 높은 경계선(境界線) 인격장애(人格障碍), Cluster B 인격장애(人格障碍) 및 전체 인격장애(人格障碍)의 빈도(頻度)를 보였다(Fisher's exact test, p=0.044, p=0.020, p=0.024, respectively, by the Revised Diagnostic Interview for Personality Disorders;p=0.034, p=0.015, p=0.007, respectively, by the Personality Disorder Questionnaire-Revised). 결 론 : 본(本) 연구(硏究)는 한국인(韓國人) 여대생(女大生)집단에서의 신경성(神經性) 거식증군(拒食症群)은 정상대조군(正常對照群)과 비교(比較)하여 통계적(統計的)으로 유의하게 높은 인격장애(人格障碍)를, 특히 경계선(境界線) 인격장애(人格障碍)를 가지고 있음을 보고(報告)하고, 이 결과(結果)의 이론적(理論的), 임상적(臨床的) 의의(意義)에 관하여 논의(論議)한다. Objectives: To evaluate the prevalence of the DSM-III-R personality disorders in Korean college women with bulimia nervosa. Methods: Sixty-two subjects with bulimia nervosa, as identified by the Structured Clinical Interview for DSM-III-R, were compared to the age- and gender-matched healthy comparison subjects(n=62) on the prevalence of Axis II disorders, as determined by both the Revised Diagnostic Interview for Personality Disorders(DIPD-R) and by the Personality Disorder Questionnaire-Revised(PDQ-R). Results: Subjects with bulimia nervosa had significantly greater prevalences of borderline personality disorder, Cluster B personality disorders, and any personality disorders compared to healthy comparison subjects(Fisher's exact test, p=0.044, p=0.020, p=0.024, respectively, by the DIPD-R ; p=0.034, p=0.015, p=0.007, respectively, by the PDQ-R). Conclusions: This study reports greater prevalences of specific personality disorders, especially, borderline and Cluster B personality disorders in Korean college females with bulimia nervosa compared to comparison subjects.

정신자극제 사용자에서의 최신 뇌영상 연구

류인균(In-Kyoon Lyoo),심민영(Min-Young Sim),이지영(Jee-Young Rhee) 한국중독정신의학회 2005 중독정신의학 Vol.9 No.2

Methamphetamine (MA) and cocaine are representative psychostimulants which have a common characteristic of direct amplification of dopamine concentration at the mesolimbic dopaminergic receptor. Since mesolimbic pathway, including the amygdale and the nucleus a ccumbens, is known to be related to reward and craving, deficits of the mesolimbic pathway have been implicated in drug addiction. Recently, functional brain imaging studies using PET, SPECT, and MRS and structural brain imaging studies including VBM/optimized VBM and DTI has been conducted in MA and cocaine abusers. It has been consistently suggested that there were functional and structural deficits of the mesocortical pathway including orbitofrontal cortex and anterior cingulate cortex in MA and cocaine abusers. These deficits may be partially recovered through long term abstinence. Consequently, functional and structural abnormalities in the mesocortical pathway as well as the mesolimbic pathway may be the underlying mechanism of psychostimulant addiction. Since the mesocortical pathway is implicated in craving, compulsive drug administration, and inhibition dyscontrol, we should be aware that these behavioral and neuropsychological characteristics could be based on organic brain deficits. We could also make full use of this understanding for treatment and rehabilitation to prevent frequent relapse of drug administration.

한국 대학생의 수면 양상 특징

김석주,류인균,원창연,정도언,Kim, Seog-Ju,Lyoo, In-Kyoon,Won, Chang-Yeon,Jeong, Do-Un 대한수면의학회 2006 수면·정신생리 Vol.13 No.1

배 경:이 연구에서는 한국 대학생들의 취침시각, 기상시각, 취침시간을 평일과 휴일로 나누어 조사하였다. 또한, 성별, 연령, 학년이 한국 대학생들의 취침시각, 기상시각, 취침시간, 평일-휴일 간 수면 차이 등에 미치는 영향을 살펴보았다. 방법:한국내 4년제 대학 12개의 대학생들을 대상으로 평일과 휴일의 수면양상을 설문 조사하였다. 총 1,825명(여자 1,416명, 남자 409명, $18{\sim}30$세, 평균 연령 $21.1{\pm}2.2$세)의 결과를 분석하였다. 결과:한국 대학생들은 평일보다 휴일에 50분 늦게 취침하고(평일 00시 49분;휴일 01시 40분;t=39.67, p<0.001), 1시간 58분 늦게 일어나며(평일 07시 52분;휴일 09시 50분;t=39.46, p<0.001), 1시간 8분 더 오래 취침하였다(t=13.33, p<0.001). 남학생들에 비해 여학생들이 평일과 휴일 모두에서 일찍 자고(t=7.10, p<0.01;t=6.04, p<0.01), 일찍 일어나며(t=8.96, p<0.01;t=3.89, p<0.01), 평일 취침시간이 적었다(t=1.99, p<0.01). 또한, 여학생들에서 남학생들에 비해 휴일의 기상시각이 더 연장되고(t=3.41, p<0.01) 취침시간이 더 증가하였다(t=3.68, p<0.01). 학년이 증가할수록 평일 취침시각, 평일 기상시각, 휴일 취침시각이 느려졌고(${\beta}=0.1009$, p<0.01;${\beta}=0.1022$, p<0.01;${\beta}=0.1096$, p<0.01), 휴일 취침시간이 줄어들었으며(${\beta}=-0.0990$, p<0.01), 휴일과 평일의 기상시각 차이나 취침시간 차이가 줄어들었다(${\beta}=-0.0906$, p<0.01;${\beta}=-0.1115$, p=0.02). 결론:한국 대학생들은 평일에 비하여 휴일에 취침시각과 기상시각이 늦고 취침시간이 길었다. 이 결과는 한국 대학생들의 평소 일정이 생물학적인 수면각성 주기에 비해 앞으로 당겨져 있어 평일에 수면이 부족함을 의미한다. 또한, 평일과 휴일의 기상시각과 취침시간의 차이는 여학생과 저학년에서 더욱 두드러져, 수면각성주기 이탈과 수면부족이 여학생과 저학년에서 더욱 심하다는 것을 시사하였다. Introduction: The objective of the present study was to investigate bedtime, rise time and time-in-bed of Korean college students, separately on weekday and on weekend and to compare them. In addition, this study also aimed to evaluate the influence of gender, age and grade on the above sleep parmeters in Korean college students. Methods: Information regarding bedtime and rise time, separately on weekday and on weekend, of Korean college students were obtained by self-administered questionnaire. Questionnaires of 1,825 students (1,416 females and 409 males, age 18-30;mean age $21.1{\pm}2.2$) were used for statistical analyses. Results: Korean college students retired to bed 50 minutes later (00:49 on weekday;01:40 on weekend;t=39.67, p<0.001), rose 1 hour 58 minutes later (07:52 on weekday;09:50 on weekend;t=39.46, p<0.001), and slept 1 hour 8 minutes longer (t=13.33, p<0.001) on weekend. Compared to male students, female students had earlier rise time (t=8.96, p<0.01;t=3.89, p<0.01) and earlier bedtime both on weekday and weekend (t=7.10, p<0.01;t=6.04, p<0.01), and shorter time-in-bed on weekday (t=1.99, p<0.01). In addition, rise time delay and time-in-bed increase on weekend were more prominent in female students than in male students (t=3.41, p<0.01; t=3.68, p<0.01). Grade was correlated with bedtime and rise time on weekday (${\beta}=0.1022$, p<0.01;${\beta}=0.1009$, p<0.01), bedtime and time-in-bed on weekend (${\beta}=0.1096$, p<0.01;${\beta}=-0.0990$, p<0.01), and differences between week-day and weekend of the rise time and the time-in-bed (${\beta}=-0.0906$, p<0.01;${\beta}=-0.1115$, p=0.02). Conclusions: In this study, Korean college students had earlier bedtime/rise time and shorter time-in-bed on weekday than on weekend. These findings suggest that weekday sleep-wake schedule of Korean college students may be advanced relative to their biological sleep-wake cycle and that this discrepancy may be associated with weekday sleep deprivation. In addition, differences of sleep patterns between weekday and weekend were more prominent in female students and students with lower grade. Therefore, discrepancy between weekday sleep-wake schedule and biological sleep-wake cycle, as well as weekday sleep deprivation, might be more serious in female or lower-grade students.

기면병 환자의 주의집중 저하와 주간졸음증 간의 상관관계 부재

김석주,류인균,이유진,이주영,정도언,Kim, Seog-Ju,Lyoo, In-Kyoon,Lee, Yu-Jin,Lee, Ju-Young,Jeong, Do-Un 대한수면의학회 2005 수면·정신생리 Vol.12 No.2

배 경:본 연구에서는 청년기 기면병 환자의 인지기능 변화를 평가하고자 하였다. 청년기 기면병 환자의 인지기능과 수면 증상과의 관계도 관찰하였다. 방 법:17세 이상 35세 이하의 기면병 환자 18명과 정상대조군 18명을 모집하여 연구를 시행하였다. 탈력발작이 있고, HLA $DQB_1$ *0602 양성인 경우만을 기면병 대상군으로 하였다. 기면병 대상군과 정상대조군에게 13종의 신경심리검사(Wisconsin 카드분류, Trail making, Stroop, Ruff, 청각순차합산, 바꿔쓰기, 숫자 외우기, 공간 외우기, Rey 기억력, California 언어학습, 통제단어연상, Boston 이름대기, 굽은 막대 검사)를 시행하여 양군을 비교하였다. 그리고, 기면병 대상군의 신경심리검사 결과와 Epworth 졸음증 척도, Ullanlinna 기면병 척도, 야간수면다원검사 및 입면 잠복시간 반복검사 결과 사이의 상관관계를 분석하였다. 결 과:기면병 대상군은 정상 대조군에 비해 2.0초 간격과 2.4초 간격의 청각순차합산, 바꿔쓰기, 공간 외우기 정방향 검사에서 수행능력이 저조하였다(t=3.86, p<0.001;t=-2.47, p=0.02;t=-3.95, p<0.001;t=-2.22, p=0.03). 다른 신경심리검사에서는 양 군간에 유의한 차이가 없었다. 기면병 대상군에서 저하된 신경심리검사 결과는 Epworth 졸음증 척도나 Ullanlinna 기면병 척도와 유의한 상관관계가 없었으며, 야간수면다원검사나 입면잠복시간 반복검사와도 유의한 상관관계가 없었다. 결 론:본 연구에서 기면병 환자군의 주의력이 저하되어 있음을 관찰하였다. 그러나 주의력 저하는 주간 졸음증과 유의한 상관을 보이지 않았다. 따라서 기면병 환자의 주의력 저하는 주간 졸음증의 개선만으로 호전시킬 수 없다는 점을 시사한다. Objectives: The objective of this study is to assess cognitive functions and their relationship with sleep symptoms in young narcoleptic patients. Methods: Eighteen young narcolepsy patients and 18 normal controls (age: 17-35 years old) were recruited. All narcolepsy patients had HLA $DQB_1$ *0602 allele and cataplexy. Several important areas of cognition were assessed by a battery of neuropsychological tests consisting of 13 tests: executive functions (e.g. cognitive set shifting, inhibition, and selective attention) through Wisconsin card sorting test, Trail Making A/B, Stroop test, Ruff test, Digit Symbol, Controlled Oral Word Association and Boston Naming Test; alertness and sustained attention through paced auditory serial addition test; verbal/nonverbal short-term memory and working memory through Digit Span and Spatial Span; visuospatial memory through Rey-Osterrieth complex figure test; verbal learning and memory through California verbal learning test; and fine motor activity through grooved pegboard test. Sleep symptoms in narcolepsy patients were assessed with Epworth sleepiness scale, Ullanlinna narcolepsy scale, multiple sleep latency test, and nocturnal polysomnography. Relationship between cognitive functions and sleep symptoms in narcolepsy patients was also explored. Results: Compared with normal controls, narcolepsy patients showed poor performance in paced auditory serial addition (2.0 s and 2.4 s), digit symbol tests, and spatial span (forward)(t=3.86, p<0.01; t=-2.47, p=0.02; t=-3.95, p<0.01; t=-2.22, p=0.03, respectively). There were no significant between-group differences in other neuropsychological tests. In addition, results of neuropsychological test in narcolepsy patients were not correlated with Epworth sleepiness scale score, Ullanlinna narcolepsy scale score and sleep variables in multiple sleep latency test or nocturnal polysomnography. Conclusion: The current findings suggest that young narcolepsy patients have impaired attention. In addition, impairment of attention in narcolepsy might not be solely due to sleep symptoms such as excessive daytime sleepiness.

외상 후 스트레스 장애의 이해에 있어서 유전학 및 뇌영상 연구의 기여

김지은,류인균,전찬수,이유상,Kim, Ji-Eun E.,Lyoo, In-Kyoon,Jun, Chan-Soo,Lee, Yu-Sang 대한생물정신의학회 2010 생물정신의학 Vol.17 No.4

Significant advances have been made in understanding the biological underpinnings of post-traumatic stress disorder(PTSD), particularly in the field of genetics and neuroimaging. Association studies in candidate genes related with hypothalamic-pituitary-adrenal axis, monoamines including serotonin, dopamine and noradrenaline, and proteins including FK506-binding protein 5 and brain-derived neurotrophic factor have provided important insights with regard to the vulnerability factors in PTSD. Genome-wide association studies and epigenetic studies may provide further information for the role of genes in the pathophysiology of PTSD. Hippocampus, medial prefrontal cortex, anterior cingulated cortex and amygdala have been considered as key structures that underlie PTSD pathophysiology. Future research that combines genetic and neuroimaging information may provide an opportunity for a more comprehensive understanding of PTSD.

뇌과학 분야 기능적 연결체학의 발전 : 외상후스트레스장애를 중심으로

박신원,정현석,류인균,Park, Shinwon,Jeong, Hyeonseok S.,Lyoo, In Kyoon 대한생물정신의학회 2015 생물정신의학 Vol.22 No.3

Recent breakthroughs in functional neuroimaging techniques have launched the quest of mapping the connections of the human brain, otherwise known as the human connectome. Imaging connectomics is an umbrella term that refers to the neuroimaging techniques used to generate these maps, which recently has enabled comprehensive brain mapping of network connectivity combined with graph theoretic methods. In this review, we present an overview of the key concepts in functional connectomics. Furthermore, we discuss articles that applied task-based and/or resting-state functional magnetic resonance imaging to examine network deficits in post-traumatic stress disorder (PTSD). These studies have provided important insights regarding the etiology of PTSD, as well as the overall organization of the brain network. Advances in functional connectomics are expected to provide insight into the pathophysiology and the development of biomarkers for diagnosis and treatment of PTSD.

난치성 간질환자에서 간질관련요인이 발작간 정신증상에 미치는 영향

김종훈,한우상,이상건,류인균,하규섭,Kim, Jong-Hoon,Han, Wou-Sang,Lee, Sang-Kun,Lyoo, In-Kyoon,Ha, Kyoo-Seob 한국정신신체의학회 1997 정신신체의학 Vol.5 No.2

The aim of this study is to find the relationship between interictal psychiatric symptoms and seizure-related variables such as structural changes, regional interictal perfusion changes, the number of interictal epileptic discharges and the presence of accompanying generalized tonic clonic seizure(GTC). The subjects were 75 patients (47 males : mean age $28.3{\pm}7.7$) with intractable epilepsy, Interictal psychiatric symptoms were rated by Symptom Checklist-90-R(SCL-90-R). Each of 4 seizure variables was measured by MRI, $^{99m}TC-HMPAO$ SPECT and the prolonged EEG monitoring. The mean SCL-90-R subscale T-scores and the ratio of the patients with definite psychiatric symptoms(T-score > 65 at any one subscale of SCL-90-R) were compared among the groups with different seizure variables. Demographic variables and clinical variables were not statistically different among the groups with different seizure variables. The patients with right mesial temporal sclerosis had higher mean SCL-90-R scores for obsessive compulsive symptom, interpersonal sensitivity, depression, hostility and psychotic symptoms than the patients with left mesial temporal sclerosis, and they also showed higher ratio of definite psychiatric symptoms. The presence of interictal epileptic discharges was related with higher T-scores of paranoid subscale. The areas of hypoperfusion, the presence of the GTC, and other clinical seizure variables showed no significant influences on the mean SCL-90-R subscale T-scores. from these results, the authors speculated that interictal subictal epileptic dischrages may be related with psychiatric symptoms of the intractable epileptic patients, especially with right mesial temporal sclerosis.

서울대학교 의과대학의 의료윤리 교육 경험

김옥주(KIM Ock-Joo),류인균(LYOO In Kyoon),장기현(CHANG Kee-Hyun) 한국생명윤리학회 2004 생명윤리 Vol.5 No.2

Since 1950s Seoul National University College of Medicine (SNUMC) has conducted medical humanities education to medical students including medical history and behavioral sciences. Recently, SNUMC has developed an integrated course, "Patient/Doctor/Society," which covers comprehensive topics interrelated among society, medicine, and doctoring. As a part of Patient/Doctor/Society I, the Medical Ethics I course aims at educating first-year medical students with case-based learning and small group discussion. Three experienced professors in different clinical specialties developed cases derived from their clinical experiences for Medical Ethics I course. Divided into small groups consisting of 7-8 students, all students were required to participate in on- and off-line discussions on the cases, and to make presentations on assigned cases. Feedback survey on the course showed that students appraised this course helpful to prepare medical students to recognize moral dimension of clinical medicine. Some of the students, however, were not completely satisfied with the methods; they could hardly find sufficient time for small group discussion in the midst of the compact curriculum. On reflection of the first running year experience of the course Medical Ethics I, the authors think that more educational resources need to be allocated to the course such as class hours, teaching staff and credits. As the SNUMC runs the course Medical Ethics Ⅰ, Ⅱ, Ⅲ every year, teaching staff need to utilize diverse and rich cases and methods as reflected on the feedback of the students.

인터넷 중독의 정신병리

우종인(Jong Inn Woo),류인균(In Kyoon Lyoo),양은주(Eun Joo Yang),하지현(Jee Hyun Ha),김영미(Young Me Kim),장창곡(Chang Gok Chang) 한국정신병리진단분류학회 2000 精神病理學 Vol.9 No.1

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