소아청소년 수면의 정상 발달

방영롱 대한소아청소년정신의학회 2023 대한소아청소년정신의학회 학술대회논문집 Vol.2023 No.5

Modest Effects of Low-frequency Electrical Stimulation on Patients with Chronic Insomnia in an Open Trial

방영롱,윤인영,전홍준 대한수면학회 2019 sleep medicine research Vol.10 No.1

Background and ObjectiveaaThe purpose of this study, was to investigate the effects of low-fre- quency transcutaneous electric nerve stimulation (TENS) on chronic insomnia. Treatment options in patients with chronic insomnia are limited to medications, and cognitive behavioral therapy. MethodsaaFifty-four chronic insomniacs received TENS with low-frequency, applied on trapezi- ums muscles for at least 30 minutes to 1 hour before sleeping, more than 5 days weekly, for 4 weeks. The Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, Hospital Anxiety and Depression Scale, and quantitative electroencephalography at waking state, were ob- tained pre and post treatment. ResultsaaPoor sleep quality and insomnia severity decreased significantly, and relative delta pow- er in the occipital region, also decreased after TENS. Overall treatment response rate was 57.5%, and predictive factors of treatment response were daytime sleepiness, as well as depressive and anxious mood. Relative delta power in occipital region of responders significantly decreased over time, while that of non-responders did not change This seemed to be associated with insomnia symptom improvement, and resulting daytime alertness. ConclusionsaaLow-frequency electrical stimulation, was modestly effective in chronic insomnia patients. Our results provide an alternative option of insomnia treatment, for future study.

Cut-Off Scores of the Children’s Depression Inventory for Screening and Rating Severity in Korean Adolescents

방영롱,박재홍,김성환 대한신경정신의학회 2015 PSYCHIATRY INVESTIGATION Vol.12 No.1

ObjectiveaaThe aim was to establish an optimal cut-off score of the Children’s Depression Inventory (CDI) for detecting depression and rating severity in Korean adolescents. MethodsaaA total of 468 students aged 12–16 years from 8 middle schools in Busan, Korea participated in this study. The Korean version of the CDI and Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version were used to evaluate depressive symptoms. Receiver-operating characteristics (ROC) analyses were conducted to evaluate case-finding performance and set the cut-off scores. ResultsaaROC analyses demonstrated that the overall discrimination power of the CDI is good enough to evaluate adolescent depression. The CDI sum score of 20 was identified as the optimal screening cut-off score, where sensitivity was 0.83 and specificity was 0.89. This cut-off score could apply regardless of subjects’ gender. The cut-off scores were examined in order of the depression severity: 15 for mild, 20 for moderate, and 25 for severe depression with high sensitivity and specificity. ConclusionaaThe CDI cut-off scores of our study can be recommended for screening depressed youth and rating the severity of depressive symptoms. The high negative predictive value suggested that the cut-off score of 20 would result in a small number of missed cases. Further studies are needed to ascertain these CDI cut-off scores for different age groups.

두부 외상 후 발생한 기질성 정신장애 환자의 가족 부담에 미치는 요인

방영롱(Young-Rong Bang),김철권(Chul-Kwon Kim) 대한사회정신의학회 2013 사회정신의학 Vol.18 No.1

연구목적 : 두부 외상 후 기질성 정신장애를 앓는 환자를 돌보는 주 보호자들을 대상으로 그들이 경험하는 부담을 평가하고, 그 부담에 영향을 미치는 요인이 무엇인지를 규명하기 위함이다. 방 법 : 교통사고나 산업재해에 의한 두부 외상으로 ICD-10 진단기준상 기질성 정신장애로 진단되어, 동아대학교병원 정신건강의학과에서 외래 또는 입원 치료를 받고 있는 환자들의 주 보호자 50명을 대상으로 하였다. 대상 환자와 주 보호자들로부터 면담 혹은 자가 보고 방식으로 사회 인구학적 특성, 가족부담(정신질환자의 가족부담 척도), 우울(Beck 우울척도), 불안(Beck 불안 척도), 사회적지지(다면적 사회지지척도), 환자의 문제행동(BASIS-32) 등을 평가하였다. 자료 분석은 평가한 모든 요인들을 부담에 대한 설명변수로 고려하여 중회귀분석을 실시하였다. 결 과 : 두부 외상 후 기질성 정신장애를 앓고 있는 환자의 주 보호자가 느끼는 부담척도 점수는 평균 58.7점(표준편차 28.2)이었다. 주 보호자의 우울 점수는 평균 26.4점(표준편차 11.8)이었고 불안 점수는 평균 24.7점(표준편차 14.1)이었다. 22점을 절단점으로 하였을 때전체 보호자의 52%와 48%가 각각 우울과 불안을 경험하고 있었다. 가족부담을 설명하는 여러 요인들 중에서 환자 나이, 환자 성별, 흡연 여부, 음주 여부, 보호자가 지각하는 사회적 지지, 환자의 행동증상 등 6개 요인이 전체 가족부담의 80%를 설명하였다. 그 중 환자의 행동증상이 49%로 설명력이 가장 높았다. 행동증상척도(BASIS-32)의 5개 소영역, 즉 대인관계, 우울과 불안, 충동적 또는 중독 행동, 일상생활기능, 정신병적 증상 모두 주 보호자가 경험하는 부담과 유의한 상관을 보였다. 결 론 : 두부 외상 후 기질성 정신장애를 앓고 있는 환자의 주 보호자들은 환자를 돌보는데 있어 상당히 심한 부담과 우울, 그리고 불안을 경험하고 있었다. 이러한 가족부담에 영향을 미치는 요인은 환자의 행동증상, 음주, 흡연, 환자 나이, 보호자가 지각하는 사회적 지지, 환자 성별 등이었다. 이러한 가족부담 요인들 중에서 변화 가능한 요인들을 찾아내어 개선시킨다면, 주 보호자가 느끼는 부담을 효과적으로 줄일 수 있을 것으로 생각된다. Objectives : The purpose of this study is to evaluate the family burden in the primary caregivers of organic mental disorder patients after head trauma, and to investigate the factors influencing family burden. Methods : A total 50 primary caregivers of organic mental disorder patients after head trauma due to traffic or industrial accidents were participated in this study. All patients have attended the psychiatric outpatient clinic or inpatient ward of Dong-A university hospital. We collected data from the caregivers about socio-demographic characteristics, family burden (Family Burden Scale), family depression (BAI) and anxiety (BDI), family perceived social support (MSPSS), patients’ behavior and symptoms (BASIS-32) under several measures. For data analysis, all collected data were considered explanatory variables for burden, then multicollinearity was examined. Results : Total mean score of the family burden in the primary caregivers was 58.7 (SD 28.2). Each score of family depression and anxiety was 26.4 (SD 11.8) and 24.7 (SD 141), and measured up to 52% and 48% of total caregivers. Among several variables influencing the family burden, 6 variables (patients’ age, patients’ sex, patients’ smoking, patients’ alcohol drinking, family perceived social support and patients’ behavior and symptoms) accounted for 80% of the family burden. In particular, patients’ behavior and symptoms turned out to be the highest explanatory ability (49%). When dividing the patients’ behavior and symptoms into five subareas: Personal relationship, Depression and Anxiety, Impulsivity or Addiction behaviors, Daily-life function and Psychotic symptoms, we could see all the subareas were connected with the family burden in a statistically meaningful way. Conclusions : Primary caregivers of organic mental disorder patients after head trauma bore the considerable burden of caring for the patients and felt depressed and anxious. Factors influencing the family burden were patients’ behavior and symptoms, patients’ alcohol drinking, patients’ smoking, patients’ age, family perceived social support and patients’ sex. If we try to figure out the variable factors and improve them, we can decrease family burden effectively.

Modest Improvement of Untreated Severe Sleep-Disordered Breathing in the Middle-Aged and Elderly

전홍준,방영롱,전소연,이태영,박혜연,윤인영 대한신경정신의학회 2017 PSYCHIATRY INVESTIGATION Vol.14 No.5

Objective: It has been reported that untreated sleep-disordered breathing (SDB) deteriorates over time, however this remains contentious. The aim of the present study is to evaluate the clinical course of SDB in middle-aged and older SDB patients, and to identify how relevant factors contribute to the change in SDB severity. Methods: Baseline and follow-up polysomnographic data of 56 untreated SDB patients (mean age, 61.2±5.71) were obtained retrospectively and the mean interval was 62.4±22.0 months. Subgroup analysis was performed based on the baseline severity, and the factors associated with the course of SDB were analyzed. Results: At the baseline, 13 subjects were simple snorers, 15 had mild to moderate SDB, and 28 were severe SDB patients. While there was no significant change in apnea-hypopnea index (AHI) as a whole, subgroup analysis showed decrease of AHI in severe SDB patients (43.9±10.6 to 35.6±20.0, p=0.009). The change in supine time percent and baseline AHI were associated with the change in AHI (β=0.387, p=0.003; β=-0.272, p=0.037). Conclusion: Untreated SDB did not deteriorate over time with modest improvement in severe SDB. A proportion of severe SDB patients might expect decrease in SDB severity irrespective of changes in sleep position or body weight.

독거노인의 좌절된 대인관계 욕구와 삶의 만족도

박지윤,김성환,김준희,방영롱,이수영,이재민,김주연,이미경,박재홍 대한노인정신의학회 2019 노인정신의학 Vol.23 No.1

Objective:This study aims to investigate differences between the elderly living alone and those living with others in frustrated interpersonal needs and life satisfaction. Also, we explore the effects of frustrated interpersonal needs on life satisfaction in the elderly living alone. Methods:The participants include 572 elderly people aged over 60 in Busan, Korea. Life satisfaction were evaluated by the Life Satisfaction Self-Rating Scale (LSRS) and frustrated interpersonal needs were measured by the Interpersonal Needs Questionnaire- Revised (INQ-R). Results:The overall LSRS scores were significantly lower in the elderly living alone (106.2±20.1) than living with others (115.3±13.9, p<0.001). The total INQ-R score was significantly lower in the elderly living alone (73.8±12.1) than those living with others (76.9±12.0, p<0.05). As a result of multiple regression analysis, we came to know that frustrated interpersonal needs were factors affecting life satisfaction in living alone group. Conclusion:The results of present study suggest that the elderly living alone are more likely to have poor life satisfaction and frustrated interpersonal needs. Also, frustrated interpersonal needs are related to life satisfaction. Thus, it is necessary to establish the social support system such as social isolation prevention and interpersonal relationship development.

제 1형 당뇨병 소아 청소년의 하지불안증후군

양우석,유재호,천상명,김성환,최병무,김우진,방영롱,박재홍,Yang, Woo Seok,Yoo, Jae Ho,Cheon, Sang-Myung,Kim, Seong Hwan,Choe, Byeong Moo,Kim, Woo Jin,Bang, Young Rong,Park, Jae Hong 대한수면의학회 2015 수면·정신생리 Vol.22 No.1

Objectives: Restless legs syndrome (RLS) is a common sleep disorder in adults with diabetes. This study investigated the frequency of RLS and clinical correlations in children and adolescents with type 1 diabetes. Methods: This study included 55 consecutive patients (21 males, age $12.6{\pm}3.4years$) with type I diabetes that were regularly treated at the Department of Pediatric Endocrinology. RLS was diagnosed by intensive interviews which also included the Epworth Sleepiness Scale (ESS) and International RLS Rating Scale (IRLSRS). Patients also received neurological examinations and laboratory tests for diabetes, iron metabolism and renal function. Results: Thirteen patients (23.6%, 6 males) were compatible for the diagnostic criteria of RLS. None of the RLS patients showed abnormal findings in neurological evaluations and 7 patients had familial history of RLS. Demographic and laboratory findings were not different between the patients with or without RLS. The RLS group showed significantly increased ESS and IRLSRS scores. Conclusion: RLS was prevalent in children and adolescents with type 1 diabetes. The association between RLS and diabetes-related laboratory findings requires further investigation. 목 적 : 제 1형 당뇨병을 진단 받은 소아 청소년 환자들을 대상으로 RLS를 평가하고 RLS를 동반하는 환자군과 RLS를 동반하지 않은 환자군 간의 임상적 변인과 수면의 특성을 비교하고자 하였다. 방 법 : 소아 청소년과에서 제 1형 당뇨병으로 진단 받은 7세 이상 18세 이하의 소아 청소년 55명을 대상으로 면담, 설문조사, 임상학적 검사를 시행하였다. RLS 진단은 IRLSSG 진단기준을 따랐으며 설문은 Epworth sleepiness scale (ESS), International restless legs syndrome rating scale (IRLSRS)를 이용하였다. 결 과 : 55명의 대상자 중 RLS 빈도는 13명으로 23.6%였다. RLS 관련 변인으로 BMI, Hb, Iron, ferritin, TIBC, creatinine, GFR에서 두 군간에 유의한 차이는 없었다. RLS 환자 13명 중 RLS 가족력을 가진 환자는 7명으로, RLS가 없는 환자의 경우와 현저한 차이를 보였다. 수면의 특성을 조사한 결과 RLS를 동반한 환자군이 RLS를 동반하지 않은 군에 비해 ESS, IRLSRS 결과가 유의하게 높았다. 결 론 : 제 1형 당뇨병을 진단 받은 소아 청소년은 RLS가 흔히 동반되었다. 임상적으로 당뇨 소아 청소년의 RLS 동반여부와 수면의 질을 평가하여 치료하는 것이 필요하겠으며 향후 보다 많은 환자를 대상으로 보다 객관적인 방법을 이용한 연구가 진행되어야 할 것이다.

폐쇄성수면무호흡증에서 우울 증상이 양압기 치료의 효과와 순응도에 미치는 영향

이수영(Su Young Lee),김성환(Seong Hwan Kim),방영롱(Young Rong Bang),장세헌(Sae-Heon Jang),배우용(Woo Yong Bae),김상준(Sang jun Kim) 대한생물치료정신의학회 2021 생물치료정신의학 Vol.27 No.3

Objectives:The aim of this study was to determine how the efficacy and compliance of positive airway pressure (PAP) varies depending on the depressive symptom with obstructive sleep apnea (OSA). Methods:We collected data about baseline Apnea-Hyponea Index (AHI), sleep and mood state and demographic information from 125 obstructive sleep apnea patients prior to the start of positive airway pressure treatment. The Apnea-Hyponea Index and daytime sleepiness were examined as indicators of efficacy of positive airway pressure and daily average usage time and the utilization rate (%) for more than 4 hours were calculated as indicators of compliance of positive airway pressure at the time of 1, 3 or 9 months after the start of positive airway pressure. Repeated-measures ANOVA and linear mixed model (LMM) with adjusting age, body mass index and baseline Insomnia severity index were used for revealing any significant differences between groups over time passed. Results:This difference was confirmed at 9 months after starting positive airway pressure, between the two groups and the usage rate for more than 4 hours in depressive group was lower than that in non-depression group (56.2% vs. 67.5%). Conclusions:We demonstrated that there would be a difference in the compliance of positive airway pressure among patients with obstructive sleep apnea according to depressive state. Therefore, we suggest evaluating depressive symptoms in patients with obstructive sleep apnea before starting positive airway pressure, to increase the compliance of the positive airway pressure, which is essential to maintain the efficacy of the positive airway pressure.

자살사망자의 연령과 성별에 따른 자살 방법과 원인

김동민(Dong Min Kim),김준희(Joon Hee Kim),방영롱(Young Rong Bang),김현수(Hyun Soo Kim),김성환(Seong Hwan Kim),박재홍(Jae Hong Park) 대한생물치료정신의학회 2022 생물치료정신의학 Vol.28 No.3

Objectives:South Korea has one of the highest suicide rates in the world, with the highest rate reported in Busan metropolitan city in the past decade. Based on the data collected regarding the characteristics of suicide completers, we investigated gender- and age-related differences in the causes and methods of completed suicides. Methods:Information from 675 persons who committed suicide was included in the statistical analysis, and descriptive statistics were used to present the demographic variables. To ascertain the differences by gender and age, logistic regression analyses were also conducted. Age groups were stratified according to the stage in life: young, middle, and late adulthood. Additionally the odds ratios and 95% confidence intervals were estimated using gender and age as independent variables, and methods and causes as dependent variables. Results:The most frequent suicide method and cause were hanging and physical illness, respectively, with women were more likely to choose jumping as a suicide method than men. In terms of suicide causes, economic difficulties were more often related to men than women. While the young adulthood group was more likely to choose jumping and gassing than the late adulthood group, the latter was more likely to choose chemical poisoning as a suicide method. Furthermore, in terms of suicide causes, economic difficulty and psychiatric disorder were more often related to the young adulthood group than the late adulthood group. In addition, the middle adulthood group was more often associated with economic difficulty than the late adulthood group, while the latter was more often related with physical illness than the young adulthood group. Conclusions:The causes and methods of suicide in suicide completers differ according to age and gender. The results of our study underline the need to reflect age- and gender-related characteristics in establishing suicide prevention policies.

노인 자살시도자의 자살태도

김주연(Ju Yeon Kim),김준희(Joon Hee Kim),박정숙(Jung-Suk Park),이미경(Mi Kyung Lee),방영롱(Young Rong Bang),김성환(Seong Hwan Kim),박재홍(Jae-Hong Park) 대한노인정신의학회 2020 노인정신의학 Vol.24 No.1

Objectives: This study aims to compare attitude toward suicide among the elderly with suicide attempt, suicide ideation, and without suicide ideation and attempt. Methods: We recruited study groups according to suicide risk. Suicide attempt/ideation group were recruited from Busan Regional Suicide Prevention Center. Control group was recruited from general population. Suicide attempt group was those who attempted suicide within 6 months prior to study participation. Suicide ideation group was those who had suicide ideation within 6 months prior to study participation but did not have lifetime history of suicide attempt. Control group was those who did not have either lifetime history of suicide ideation and attempt. Attitude toward suicide was evaluated by Korean version of Attitude Toward Suicide-20 (ATTS-20) Questionnaire. Results: Total of 141 elderly people aged over 60 were recruited. Four subscale scores of ATTS-20 permissiveness and nonintervention; preventability and incomprehensibility; universality; unpredictability) were significantly lower in the suicide attempt group than suicide ideation and control group. Conclusion: The results of present study suggest that the elderly who had history of suicide attempt are more permissive toward and have lack of comprehension of suicide. These results can be useful to develop effective suicide intervention and prevention strategy for the elderly.