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      • KCI등재후보

        초발 정신분열병 환자의 정신병 비치료기간과 관련된 정신사회적 요인

        박선철,김대호,남정현,이해원 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.4

        '스콜라' 이용 시 소속기관이 구독 중이 아닌 경우, 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

        Objectives : This study investigated the psychosocial factors and clinical symptoms related to the duration of untreated Psychosis (DUP) in 35 consecutive first-episode inpatients with schizophrenia. Mcthods : Data from 35 schizophrenic patients were obtained from two general psychiatric inpatient units at a university medical center. These data included scores from Index of Social Position (ISP), Positive and Negative Syndrome Scale (PANSS) and Symptom Checklist-90-Revised (SCL-90-R) as well as socio-demographic informations. Rcsults : Among socio-demographic variables, lower social position (r=.610, P<.001), male sex (r=.407, P=.015), and grew up in rural area (r=.335, p=.045) were significantly correlated with DUP. The interpersonal sensitivity of SCL-90-R was the only symptomatic variable significantly correlated with DUP (r=.379, P=.027). However, after controlling interactive effects of the variables, only lower social position and interpersonal sensitivity remained significant. Lower social position was more influential on DUP than interpersonal sensitivity in the multiple regression model. Conclusion : Both social and symptomatic factors independently influenced DUP in schizophrenic patients. Lower social position defined by education and occupation of patients or caretakers may reflect barriers to psychiatric services or poor identification of mental illness. This together with patients' subjective distress in interpersonal interactions may delay the intervention of psychiatric services.

      • Prevalence, incidence, and mortality of nontuberculous mycobacterial infection in Korea : a nationwide population-based study

        박선철,강민진,강영애 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

        Background: The epidemiologic characteristics of nontuberculous mycobacterial (NTM) disease remain largely unknown. This study evaluated the incidence, prevalence, and mortality of NTM infection in a large nationwide population-based cohort in Korea. Methods: We used data of the National Health Insurance Service database, which is an extensive health-related database including most Korean residents. Adults with a primary diagnosis of NTM, as determined by International Classification of Disease-Tenth Revision coding (A31), were identified between 2003 and 2016. The incidence, prevalence, and mortality of NTM infection were analyzed by sex and age. Results: A total of 46,194 individuals had a primary diagnosis of NTM infection. Their mean age was 55.8 years, and 61.1% were women. The overall age-adjusted incidence and prevalence of NTM infection were 6.2 (male 4.5, female 7.6) and 12.0 (male 8.8, female 14.8) per 100,000 population respectively; both tended to increase rapidly between 2003 and 2016. The incidence increased from 1.0 per 100,000 population in 2003 to 17.9 in 2016; the prevalence from 1.2 to 33.3. The incidence and prevalence also increased with age. The 1-year and 5-year mortality rate in population with NTM infection were 4.7% and 17.8% respectively. Conclusion: In Korea, the annual incidence and prevalence of NTM infection increased rapidly over the 14 years of the study period, and were higher in women and elderly. The 5-year mortality rate in population with NTM infection was 17.8%.

      • Long-term mortality of patients with tuberculosis in Korea : a nationwide population-based study

        박선철,강민진,강영애 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

        Background: Tuberculosis (TB) is a major health problem worldwide, especially in Korea. However, there are no large population- based studies on long-term mortality of TB patients in Korea. Methods: We used data of the National Health Insurance Service database, which is an extensive health-related database including most Korean residents. TB patients were identified by International Classification of Disease-Tenth Revision coding (A15-19, U88-88.1) and anti-TB drugs during 2003-2016. We analyzed the long-term mortality of TB patients by different variables. Results: A total of 357,211 individuals were diagnosed with TB during 2003-2016, and there were a total of 103,682 deaths in TB patients during the study period. The mortality rate was high at the early phase after diagnosis. The 3-month, 6-month, 1-year, and 5-year mortality rate were 7.2%, 9.3%, 12.2%, and 24.7% respectively. The 5-year mortality rate in males was 27.0% and in females 21.2%. The mortality rate increased rapidly with age and Charlson comorbidity index. Miliary TB had higher mortality than other types. Conclusion: The mortality rate of TB patients was high at the early phase after diagnosis. Higher mortality was observed in males, elderly, and patients with more comorbidities or miliary TB.

      • KCI등재

        Psychometric Properties of the Korean Version of the Clinical Language Disorder Rating Scale (CLANG)

        박선철,장은영,이강욱,이정구,이화영,최준호 대한정신약물학회 2016 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.14 No.1

        Objective: Our study aimed to measure inter-rater and test-retest reliability, concurrent and convergent validity, and factor solutions of the Korean version of the Clinical Language Disorder Rating Scale (CLANG). Methods: The Korean version of the CLANG for assessing thought, language, and communication, the Brief Psychiatric Rating Scale, Young Mania Rating Scale, and Calgary Depression Scale for Schizophrenia were used to evaluate language disorder, formal thought disorder, positive and negative symptoms, manic symptoms, and depressive symptoms, respectively, in 167 hospitalized patients with schizophrenia. The factor solution was obtained by the direct oblimin method. A receiver operating characteristic curve was used to find the optimal cut-off score for discriminating schizophrenia patients with and without disorganized speech. Results: Inter-rater reliability was considered moderate (intraclass coefficient=0.67, F=3.30, p=0.04), and test-retest reliability was considered high (r=0.94, p<0.001). Five factors, namely, pragmatics, disclosure, production, prosody, and association, were identified. An optimal cut-off score of 7 points with 84.5% sensitivity and 81.7% specificity was proposed for distinguishing schizophrenia patients with and without disorganized speech. Conclusion: Our findings suggest that the Korean version of the CLANG is a promising tool for evaluating language disorder in patients with schizophrenia.

      • KCI등재

        Patterns of Antipsychotic Prescription to Patients with Schizophrenia in Korea: Results from the Health Insurance Review & Assessment Service-National Patient Sample

        박선철,이명수,강승걸,이승환 대한의학회 2014 Journal of Korean medical science Vol.29 No.5

        This study aimed to analyze the patterns of antipsychotic prescription to patients withschizophrenia in Korea. Using the Health Insurance Review & Assessment Service-NationalPatients Sample (HIRA-NPS), which was a stratified sampling from the entire populationunder the Korean national health security system (2009), descriptive statistics for thepatterns of the monopharmacy and polypharmacy, neuropsychiatric co-medications, andprescribed individual antipsychotic for patients with schizophrenia were performed. Comparisons of socioeconomic and clinical factors were performed among patientsprescribed only with first- and second-generation antipsychotics. Of 126,961 patients withschizophrenia (age 18–80 yr), 13,369 were prescribed with antipsychotic monopharmacyand the rest 113,592 with polypharmacy. Two or more antipsychotics were prescribed to31.34% of the patients. Antiparkinson medications (66.60%), anxiolytics (65.42%), moodstabilizers (36.74%), and antidepressants (25.90%) were co-medicated. Patients who wereprescribed only with first-generation antipsychotics (n = 26,254) were characterized bysignificantly older age, greater proportion of male, higher proportion of medicaid, highertotal medical cost, lower self-payment cost, and higher co-medication rates ofantiparkinson agents and anxiolytics than those who were prescribed only with secondgenerationantipsychotics (n = 67,361). In this study, it has been reported substantialprescription rates of first-generation antipsychotics and antipsychotic polypharmacy andrelatively small prescription rate of clozapine to patients with schizophrenia. Since thisstudy has firstly presented the patterns of antipsychotic prescription to schizophrenicpatients in Korean national population, the findings of this study can be compared withthose of later investigations about this theme.

      • KCI등재

        Knowledge and Attitude of 851 Nursing Personnel toward Depression in General Hospitals of Korea

        박선철,이화영,이동우,한상우,박상호,김여주,최재성,이호성,이소영,나경세,정성원,심세훈,최준호,백종우,권영준 대한의학회 2015 Journal of Korean medical science Vol.30 No.7

        Our study aimed to examine the knowledge and attitude of nursing personnel toward depression in general hospitals of Korea. A total of 851 nursing personnel enrolled at four university-affiliated general hospitals completed self-report questionnaires. Chi-square tests were used to compare the knowledge and attitude of registered or assistant nurses toward depression. In addition, binary logistic regression analysis was used to adjust for the following confounders: age-group and workplace. Registered and assistant nurses differed in their knowledge and attitude toward depression. The proportion of rational and/or correct responses were higher in registered nurses than assistant nurses for the following: constellation of depressive symptoms defined by DSM-IV (adjusted odds ratio [aOR], 3.876; P < 0.001); suicide risk in depression recovery (aOR, 3.223; P = 0.001) and psychological stress as a cause of depression (aOR, 4.370; P < 0.001); the relationship between chronic physical disease and depression (aOR, 8.984; P < 0.001); and other items. Our results suggest that in terms of the biological model of depression, the understanding of registered nurses is greater than that of assistant nurses. Moreover, specific psychiatric education programs for nursing personnel need to be developed in Korea. Our findings can contribute to the development of a general hospital-based model for early detection of depression in patients with chronic medical diseases

      • KCI등재

        Mortality of patients with chronic obstructive pulmonary disease: a nationwide populationbased cohort study

        박선철,김동욱,박은철,신증수,이진국,강영애,김영삼 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.6

        Background/Aims: Chronic obstructive pulmonary disease (COPD) is a major cause of mortality in the world. There are no population-based studies on longterm mortality in COPD patients in Korea. Methods: Using the large, population-based, National Health Insurance Service- National Sample Cohort (NHIS-NSC), we identified COPD patients using the International Classification of Disease-Tenth Revision (ICD-10) and prescription details in the NHIS-NSC during 2003 to 2013. We analyzed the survival curves of COPD patients by sex, age, and cause of death. Results: A total of 14,127 individuals older than 40 years were diagnosed with COPD. There were a total of 3,695 deaths (26.2%) in COPD patients during the study period. The 5-year mortality of COPD patients was 25.4% (29.9% in males and 19.1% in females). The mortality rate increased rapidly with age. The most common cause of death in COPD was chronic lower respiratory disease. Conclusions: This study described long-term mortality in COPD patients in Korea. Higher mortality was observed in males, and it was closely related to age.

      • KCI등재

        근거중심 한국형 우울증 약물학적 치료지침, 개정판 (I) : 항우울제 치료의 초기선택

        박선철,성승환,한규만,원은수,이화영,백종우,전홍진,이문수,심세훈,고영훈,이강준,한창수,함병주,최준호,이희영,황태연,오강섭,박용천,이민수,한상우 대한신경정신의학회 2013 신경정신의학 Vol.52 No.4

        '스콜라' 이용 시 소속기관이 구독 중이 아닌 경우, 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

        Objectives The aim of this study is to establish Korean pharmacological treatment guidelines for the initial choice of antidepressant for treatment of moderate or severe depression. Methods The process for establishment of guidelines involved determination of important key questions, selection of 12 international and domestic clinical practice guidelines for depression,drawing of recommendation drafts, and peer review. Results Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), norepinephrine-dopamine reuptake inhibitors (NDRI), and noradrenergic and specific serotonergic antidepressants (NaSSA) were strongly recommended as the first−line antidepressants for treatment of moderate or severe depression. SSRIs were weakly recommended for patients who had problems with tolerability. Consideration of not only efficacy but also provisional adverse effects, drug-drug interactions, history of treatment response, preference, acceptability, cost, comorbid illnesses, and other factors in the choice of first-line antidepressants was strongly recommended. The treatment recommendations for specific clinical features of depression were as follows. SSRIs were weakly recommended for atypical depression. Augmented use of antipsychotics to antidepressants was strongly recommended for psychotic depression. Bupropion and SSRIs were weakly recommended for seasonal depression. Conclusion The results of this study may contribute toward improving the quality of depression treatment by providing clear and definite recommendations for the initial choice of antidepressant for treatment of moderate or severe depression.

      • KCI등재

        Network Analysis of Language Disorganization in Patients with Schizophrenia

        박선철,김기원,장옥진,윤형준,장승호,김성완,이봉주,박재홍,이강욱,최준호 연세대학교의과대학 2020 Yonsei medical journal Vol.61 No.8

        Language disorganization, an objective component of formal thought process abnormality, has been regarded as a core symptomof schizophrenia from an evolutionary psychopathology perspective. However, to the best of our knowledge, the network structureof language disorganization has rarely been examined in patients with schizophrenia. Thus, our preliminary study aimed to evaluatethe network structure using the Clinical Language Disorder Rating Scale (CLANG) in 167 inpatients with schizophrenia. All 17of the CLANG items were considered to be ordered categorical variables ranging from 0 to 3. Our results indicated that disclosurefailure, excess syntactic constraints, abnormal prosody, and aprosodic speech rank among the top five central domains within thenetwork structure. We deemed that disclosure failure and prosody problems are the most important symptoms of language disorderin schizophrenia. Thus, reduced top-down processing of linguistic information may be a core neurobiological underpinning oflanguage disorganization in schizophrenia. Further studies controlling for the potential effects of confounding factors (i.e., durationof illness) on network analyses of language disorder and formal thought disorder are warranted in patients with schizophrenia.

      • KCI등재

        Clinical Significance of the Number of Depressive Symptoms in Major Depressive Disorder: Results from the CRESCEND Study

        박선철,사공정규,구본훈,김재민,전태연,이민수,김정범,임현우,박용천 대한의학회 2016 Journal of Korean medical science Vol.31 No.4

        Our study aimed to establish the relationship between the number of depressive symptoms and the clinical characteristics of major depressive disorder (MDD). This would enable us to predict the clinical significance of the number of depressive symptoms in MDD patients. Using data from the Clinical Research Center for Depression (CRESCEND) study in Korea, 853 patients with DSM-IV MDD were recruited. The baseline and clinical characteristics of groups with different numbers of depressive symptoms were compared using the χ2 test for discrete variables and covariance (ANCOVA) for continuous variables. In addition, the scores of these groups on the measurement tools were compared by ANCOVA after adjusting the potential effects of confounding variables. After adjusting the effects of monthly income and history of depression, a larger number of depressive symptoms indicated higher overall severity of depression (F [4, 756] = 21.458, P < 0.001) and higher levels of depressive symptoms (F [4, 767] = 19.145, P < 0.001), anxiety symptoms (F [4, 765] = 12.890, P < 0.001), and suicidal ideation (F [4, 653] = 6.970, P < 0.001). It also indicated lower levels of social function (F [4, 760] = 13.343, P < 0.001), and quality of life (F [4, 656] = 11.975, P < 0.001). However, there were no significant differences in alcohol consumption (F [4, 656] = 11.975, P < 0.001). The number of depressive symptoms can be used as an index of greater illness burden in clinical psychiatry.

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