외상 후 강박장애의 연속 증례 : 6개월 추적 조사

배활립,김대호,안정우 大韓神經精神醫學會 2006 신경정신의학 Vol.45 No.5

A number of recent case reports and series indicate that obsessive compulsive disorder (OCD) can develop after traumatic experience as a comorbid conditon to post-traumatic stress disorder (PTSD). These descriptive studies consistently addressed that those patients respond poorly to treatments and had an unfavorable outcome. However, this conclusion was not supported by prospective follow up with objective measurement of symptomatology. This report presents three single trauma-related PTSD patients who developed full-blown OCD concurrently with or after the initiation of PTSD. These patients represent 10% of new PTSD outpatients at a PTSD clinic during one year period and 25% of PTSD patients who had been admitted, In all three cases compulsion seemed to distract or serve as avoidance to intrusive symptoms of PTSD. Despite Eye Movement Desensitization and Reprocessing (EMDR) and/or exposure therapy for PTSD together with at least two antidepressant trials for PTSD and OCD, at six month follow-up PTSD partially improved and OCD remained unchanged. This finding is consistent with previous reports from western literature.

불안장애 외래 환자의 대인관계 외상과 관련된 증상학적 요인

배활립,김대호,김양석,오대영 大韓神經精神醫學會 2008 신경정신의학 Vol.47 No.6

Objectives : Psychiatric patients report higher rates of interpersonal trauma, and they present with more symptoms and behavioral problems. However, less is known about other anxiety disorders, except for posttraumatic stress disorder. In this study, we investigated symptomatic correlates of interpersonal trauma (i.e., physical or sexual assaults) in patients with heterogeneous anxiety disorders. Methods : We surveyed a consecutive sample of 90 outpatients with DSM-IV anxiety disorders (panic disorder, generalized anxiety disorder, obsessive compulsive disorder, social phobia, anxiety disorder not otherwise specified) at the psychiatric department of a university-affiliated hospital. The questionnaire was comprised of the Symptom Checklist-90-Revised (SCL-90-R), Beck Depression Inventory, State and Trait Anxiety Inventory, and Impact of Events Scale-Revised. Results : Patients with interpersonal trauma (n=51) demonstrated a significantly higher level of interpersonal sensitivity, paranoid ideation, and obsessive-compulsive subscale of the SCL-90-R. However, logistic regression analysis suggested that interpersonal sensitivity alone was suggested as the best fitting model. Conclusion : Anxiety disorder patients with interpersonal trauma demonstrated difficulty in domains of interpersonal relationship. Clinicians treating this population should consider this finding for better engagement and management.

정신분열병 환자의 정신병후 외상후 스트레스 장애 : 연속 증례

배활립,오대영,김대호 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.1

Objectives : A growing body of literature supports the view that experiences of psychotic symptoms or involuntary admission may act as traumatic events which cause post-traumatic stress disorder (PTSD). Authors report three cases of postpsychotic (PP) PTSD developed in the course of schizophrenic illness. Methods : Clinician-administered PTSD Scale (CAPS) and Positive and Negative Syndrome Scale for Schizophrenia (PA-NSS) were administered for evaluation of symptomatology. Results : Two cases represented PP/PTSD caused by psychotic symptoms, especially auditory and visual hallucination, and one case by forced involuntary admissions. All three cases met DSM-IV diagnostic criteria of PTSD. The severity was mild in therange of 48 to 51 by CAPS. Conclusion : PP/PTSD developed during or soon after psychotic episodes and persisted for as long as nine years, Clinicians working with individuals with psychotic disorders should keep in mind that some portion of their patients may suffer from lin-gering posttraumatic effect of psychotic episode -related experiences.

소아기 특정 공포증의 EMDR 치료 증례

배활립,김대호,장희순,Bae, Hwal-Lip,Kim, Dae-Ho,Jang, Hee-Soon 대한불안의학회 2009 대한불안의학회지 Vol.5 No.1

Recently, Eye Movement Desensitization and Reprocessing (EMDR) was given the status of an approved form of psychotherapy for the treatment of post-traumatic stress disorder. However, its effectiveness in the treatment of other anxiety disorders such as phobia is yet to be determined given that controlled studies have provided mixed results. This report summarizes the case of a child with a specific phobia (i.e. nighttime fear) which was successfully treated with two sessions of EMDR. This result suggests the further and thorough evaluation of this technique for use in childhood phobic disorders.

Eye Movement Desensitization and Reprocessing for Adolescent Depression

배활립,박용천,김대호 대한신경정신의학회 2008 PSYCHIATRY INVESTIGATION Vol.5 No.1

While cognitive behavior therapy is considered to be the first-line therapy for adolescent depression, there are limited data on whether other psychotherapeutic techniques are also effective in treating adolescents with depression. This report suggests the potential application of eye movement desensitization and reprocessing (EMDR) for treatment of depressive disorder related, not to trauma, but to stressful life events. At present, EMDR has only been empirically validated for only trauma-related disorders such as posttraumatic stress disorder. Two teenagers with major depressive disorder (MDD) underwent three and seven sessions of EMDR aimed at memories of stressful life events. After treatment, their depressive symptoms decreased to the level of full remission, and the therapeutic gains were maintained after two and three months of follow up. The effectiveness of EMDR for depression is explained by the model of adaptive information processing. Given the powerful effects observed within a brief period of time, the authors suggest that further investigation of EMDR for depressive disorders is warranted. While cognitive behavior therapy is considered to be the first-line therapy for adolescent depression, there are limited data on whether other psychotherapeutic techniques are also effective in treating adolescents with depression. This report suggests the potential application of eye movement desensitization and reprocessing (EMDR) for treatment of depressive disorder related, not to trauma, but to stressful life events. At present, EMDR has only been empirically validated for only trauma-related disorders such as posttraumatic stress disorder. Two teenagers with major depressive disorder (MDD) underwent three and seven sessions of EMDR aimed at memories of stressful life events. After treatment, their depressive symptoms decreased to the level of full remission, and the therapeutic gains were maintained after two and three months of follow up. The effectiveness of EMDR for depression is explained by the model of adaptive information processing. Given the powerful effects observed within a brief period of time, the authors suggest that further investigation of EMDR for depressive disorders is warranted.

Add-on Eye Movement Desensitization and Reprocessing (EMDR) Therapy for Adults with Post-traumatic Stress Disorder Who Failed to Respond to Initial Antidepressant Pharmacotherapy

배활립,김대호,조유빈,김동주,김석현 대한의학회 2018 Journal of Korean medical science Vol.33 No.48

This study examined the add-on efficacy of eye movement desensitization and reprocessing (EMDR) therapy among adult civilians with post-traumatic stress disorder (PTSD) who continued to be symptomatic after more than 12 weeks of initial antidepressant treatment. Scores for the Clinician Administered PTSD Scale (CAPS) were rated pre- and post-EMDR and at a 6-month follow-up. After an average of six sessions of EMDR treatment, seven of 14 patients (50%) showed more than a 30% decrease in CAPS score and eight (57%) no longer met the criteria for PTSD. Our results indicate that EMDR could be successfully added after failure of initial pharmacotherapy for PTSD.

불안장애 환자를 대상으로 한 한국판 상태불안척도의 요인분석

이건석,배활립,김대호,Lee, Koun-Seok,Bae, Hwal-Lip,Kim, Dae-Ho 대한불안의학회 2008 대한불안의학회지 Vol.4 No.2

Objective : Brief screening for anxiety symptoms in clinical practice can further facilitate the diagnosis and evaluation of anxiety disorders. This study examined the factorial validity of the Korean version of the State-Trait Inventory (STAI)-Form X, one of the most frequently used self-report questionnaires for anxiety. Methods : Data from the STAI and Beck Depression Inventory were obtained from a consecutive sample of 200 outpatients diagnosed with DSM-IV anxiety disorders at a psychiatric unit of a university hospital. The factor structures of the State and Trait Scales were assessed using exploratory factor analysis. Results : Three-factor components, including 'State anxiety present', 'State anxiety absent' and 'Selfconfidence', were extracted from the State Scale, explaining 59% of the total variance. A four-factor solution involving 'Trait anxiety and depression present', 'Trait anxiety and depression absent', 'Anxiety proneness' and 'Stability' (59% of total variance) was extracted from the Trait Scale. The internal consistency of the STAI and factors were satisfactory. There were significant correlations between depressive symptoms and factors of the STAI. Conclusion : The STAI-form X showed factorial validity for Korean patients with anxiety disorders. However, our finding that this anxiety scale also measures depressive symptoms should be interpreted with caution.

외상후 스트레스 장애 이외의 정신 장애에 대한 EMDR 전후의 치료 반응 및 증상 변화

이해원,김대호,배활립,최준호,오동훈,박용천,Lee, Hae-Won,Kim, Dae-Ho,Bae, Hwal-Lip,Choi, Joon-Ho,Oh, Dong-Hoon,Park, Yong-Chon 대한불안의학회 2008 대한불안의학회지 Vol.4 No.1

Objective : Eye movement desensitization and reprocessing (EMDR) has been established as an effective treatment for patients with posttraumatic stress disorder (PTSD). However, the literature is unclear as to whether EMDR is effective in the treatment of other psychiatric disorders. The purpose of this study was to evaluate the potential use of EMDR in the treatment of psychiatric disorders other than PTSD by using a clinician's impression of patient response and a subjective symptom evaluation. Methods : Seventeen diagnostically heterogenous patients without PTSD underwent an average of 4.3 sessions of EMDR. Symptom severity was assessed by the Clinical Global Impression-Change Scale (CGIC), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Symptom Checklist-90- Revised (SCL-90-R) before and after EMDR. Those whose CGI-C scores were 'very much improved' and 'much improved' after EMDR were classified as 'responders.' The patients' before and after treatment scores of symptom severity and group differences were compared. Results : Twelve of the 17 participants (12/17, 71%) were classified as 'responders.' The patients' scores on all of the scales, with the exception of the trait anxiety scale and obsession-compulsion scale of the SCL- 90-R, significantly decreased after treatment. There was no difference in sociodemographic and clinical variables between the responders and non-responders. Conclusion : The results of our study suggest that EMDR can be a promising candidate for the treatment of patients with psychiatric disorders other than PTSD, and thus further controlled studies are needed to determine whether EMDR can be applied to various psychiatric populations.

학교 밖 청소년의 자살위험에 영향을 미치는 요인

조지현,김장래,배활립,전명욱,이경신,이소희 대한신경정신의학회 2023 신경정신의학 Vol.62 No.4

Objectives This study examined the factors associated with suicide risk among out-of-school youths (OSY) by analyzing their medical records retrospectively. Methods The medical records of 280 OSYs who were admitted to the National Medical Center from January 2015 to December 2018 were examined. The demographic and clinical records, including behavioral problems, post-traumatic symptoms, harmful alcohol consumption, family functioning, and quality of life, were analyzed. Results Among the 280 subjects, 80 (28.6%) were considered a high-risk suicidal group. The number of post-traumatic symptoms was found to be positively correlated, and the family functioning scores were negatively correlated with the increasing risk of suicide in the OSY based on the multiple regression analysis of the medical records. Conclusion The result of this study provides inputs for suicide prevention programs targeted at OSYs by identifying the risk and protective factors associated with suicide among the group.

최근 외상을 경험한 초등학교 아동들에 대한 정동 조절 집단치료의 치료 반응

정정엽,김대호,김석현,배활립,이건석,고복자 대한신경정신의학회 2014 신경정신의학 Vol.53 No.3

ObjectivesZZThe aim of this study was to investigate the treatment effect and predictors of responseof affect regulation group therapy (ARGT) delivered to a group of recently traumatizedchildren. MethodsZZA total of 464 school children, who had witnessed or confronted a tragic accident atschool, were given a single-session of affect regulation group therapy, that which included psychoeducationand affect regulation elements from eye movement desensitization and reprocessing. Of 213 children whose with initial score of Subject Unit of Disturbance Scale (SUDS) scoreover 4, we compared pre- and post-treatment scores and performed conducted the respondervs. non-responder comparison. The pPost-traumatic disorder (PTSD) symptom scores measuredby using Child Reaction to Traumatic Events Scale-Revised (CRTES-R), demographic variables,and clinical variables were considered. ResultsZZAffect regulation group therapy was effective for children who had experienced anacute traumatic event (t=16.3, p<0.001). Baseline SUDS score of for non-responder were wassignificantly higher (t=-2.89, p<0.001) and CRTES-R score approached a level of significancelevel (t=-1.72, p=0.09). However, results of logistic regression analysis identified showed that thepretreatment SUDS score was the only significant predictor of non-response. ConclusionZZAffect regulation group therapy appeared to be effective for children who had undergoneexperienced an acute traumatic event. And in addition, the survivors’ subjective distresswas more important to treatment response than severity of PTSD symptoms severity.