노인성 기억장애의 인지 개선제

서국희(Guk-Hee Suh) 대한노인정신의학회 2001 노인정신의학 Vol.5 No.1

치매의 역학적 변천-알쯔하이머병과 혈관성 치매 관련 지표의 횡국가적 비교

서국희(Guk-Hee Suh) 대한노인정신의학회 2000 노인정신의학 Vol.4 No.2

Objective:Aims to observe temporal change in dementia prevalence, identify factors related to regional diversity of dementia subtype and propose explanatory hypothesis. Method:Studies qualifying selection criteria were chosen after PubMedline search, to identify prevalence of all dementia, Alzheimer's disease(AD) and vascular dementia(VaD) and to compare those analytically with related data. Result:1) There has been temporal change of dementia prevalence in Far-eastern countries; more prevalent VaD(before year 1989), mutually contradictory reports(1990–1994)-more prevalent VaD in Japan, more prevalent AD in Korea and China-, more prevalent AD(after 1995). 2) Dementia prevalence in Africa seems relatively low and AD is more prevalent than VaD. 3) Reports from India are mutually contradictory;more prevalent VaD, more prevalent AD. 4) Reports from America and Europe have been consistent that AD is more prevalent as previously reported. Conclusion:Author' hypothesis is as follows. It may be hard to find dementia case in a society until average life expectancy reaches to the threshold age of dementia. Once it is over the threshold age, incidence of dementia may upsurge in a short period. High incidence-high mortality society may last for a while. With the efforts to control risk factors of dementia and improve medical services, incidence and mortality of dementia may gradually decline to reach low incidence-low mortality society at the end. The transition from high incidence-high mor-tality society to low incidence-low mortality society may develop in various ways according to social health policies and efforts to control risk factors of dementia and improve medical services. The reason why dementia case was not found in Nigeria is because average life expectancy in Nigeria was not reached to the threshold age of dementia. The reasons why VaD is less prevalent than AD in Far-eastern countries are mainly due to low incidence of VaD in Japan, but mainly due to high mortality of VaD in Korea and China. Namely, Japan is closer to the low incidencelow mortality society than Korea and China.

기독교 교역자, 정신장애인 가족 및 지역사회지도자의 정신장애에 대한 태도

서국희(Guk-Hee Suh),신형주(Hyongju Shin) 대한사회정신의학회 2000 사회정신의학 Vol.5 No.1

연구목적: 남양주시 지역사회정신보건사업에 결정적인 영향을 미치는 핵심적 집단의 정신장애에 대한 태도와 이를 결정하는 요인을 밝히고, 이들의 태도변화를 정신보건사업 시행전과 일정기간후에 평가하기 위한 기초자료를 마련하기 위함이다. 방 법: 본 조사는 1997년 4월부터 12월까지 남양주시 정신보건사업의 일환으로 정신장애에 대한 태도를 OMI(Opinion about Mental Illness) 척도를 사용하여 측정하였다. 우편설문을 실시한 지역사회지도자의 경우 697명중 120명이 회신하여 18%의 조사응답율을 보였고, 정신보건 세미나에 참석한 기독교 교역자 75명중 57명이 조사완료하여 76%의 응답율을 보였고, 정신보건센터에 등록한 정신장애인 가족은 50명중 47명이 완성하여 94%의 응답율을 보였다. 결 과: 1) 전체군의 정신장애인에 대한 태도는‘자비심’ 척도가 가장 높아 인도주의에 입각한 온정적이고 관대한 태도를 엿볼 수 있지만 ‘정신건강개념’ 척도와 ‘사회생활 제한성’ 척도가 서로 그리 큰 차이를 보이지 않아 정신장애인에 대한 태도가 혼란스럽고 애매한 상태에 있음을 추정할 수 있었다. 2) 정신장애인 가족의 태도를 보면 ‘권위의식’ 척도와 ‘대인관계 원인’ 척도가 세 군중에서 가장 높았다. 이는 환자에 대한 죄책감과 분노가 뒤섞인 양가적인 감정으로 해석될 수 있다. 3) 지역사회지도자의 견해에서 NIMBY 현상을 관찰할 수 있었다. 4) 기독교 교역자들은 ‘사회생활 제한성’ 척도가 가장 높으면서 ‘자비심’ 척도는 세 군중에서 가장 낮고 ‘정신건강 개념’ 척도는 딴군들과 비슷하였다. 정신장애의 원인을‘귀신들림’으로 해석하고 신앙치료에 의존하며 환자를 사회와 격리시키려는 경향이 있음을 알 수 있었다. 결 론: 지역사회지도자나 기독교 교역자를 대상으로 정신병의 원인에 대한 새로운 지식을 습득할 수 있도록 교육하고 과학적이고 인도적인 태도를 모범적으로 보여주는 사례들을 모아서 홍보하고, 가족들과 지역사회지도자에게는‘정신건강 개념’을 향상시키기 위하여 정신장애의 증상과 대처방법, 응급상황에 대한 조치와 긴급후송체계에 대한 홍보를 하는 것이 바람직하겠다. Objectives:To identify the attitudes toward the mental illness and factors critical to them among the key-persons in the community, who may have great influence on the progression of Namyangju City community mental health service and to obtain the initial data for the further evaluation to assess the interval changes in attitudes of them before and after the service. Method:This study was conducted between April, 1997 and December, 1997 as a part of the Namyangju City community mental health service, using the OMI scale to measure the attitudes toward the mental illness. 120 questionnaires out of 697 were collected(response rate:18%), that were posted to the community opinion leaders. 57 out of 75 were collected(response rate:76%), that were passed out to the Christian priest at the mental health seminar. 47 out of 50 were collected(response rate:94%), that were filled up at the time of patient registration by the family members of them. Result:1) Highest ‘Benevolence’ score in whole subjects may be a evidence of cordial and generous attitudes toward the mentally ill from the standpoint of humanity, but small gap between ‘mental hygiene ideology’ score and ‘social restrictiveness’ score suggested the confused and vague attitudes toward the mentally ill. 2) ‘Authoritatianism’ score and ‘interpersonal etiology’ score were statistically significantly higher in family group than in other two, that suggested the ambivalent emotion intermingled with guilt and anger. 3) NIMBY phenomenon was observed in the attitude toward the mentally ill in community opinion leader group. 4) ‘Benevolence’ score was statistically significantly highest and ‘social restrictiveness’ was lowest in Christian priest group. However, ‘mental hygiene ideology’ score is not statistically different among three groups. It suggested that more Christian priests had higher tendency to comprehend the mental illness as ‘Satan possession’, to treat it by faith healing, and to put the patients with mental illness away from the society. Conclusion:It is expected that the Christian priests and community opinion leaders need to have new knowledge about the etiologies of mental illness, and see the typical cases with scientific and humanistic attitudes. For the family members and community opinion leaders to improve ‘mental hygiene ideology’, public information about symptoms and management of mental illness and emergency, and how to transfer them to the hospital have to be given.

혈관성 치매의 임상양상 및 진단

서국희(Guk-Hee Suh) 대한노인정신의학회 1999 노인정신의학 Vol.3 No.2

Hachinski coined the term 'multi-infarct dementia', which now changed to'vascular demntia', and used the Hachiski Ischemia Score (HIS) to differentiate multi-infarct dementia from Alzheimer's disease since 1974. The past two decades has seen a renewed interest in vascular dementia. New classification systems like DSM-IV, ICD-10, NINDS-AIREN and ADDTC have been developed to improve the reliability of the diagnosis, and there have been advances in diagnostic methodology, such as neuroimaging and neuropsychological assessment. Diagnostic criteria for vascular dementia remain to be validated by carefully designed, systematic, clinicopathologic study. Once such criteria are validated, meaningful study of subgroups of vascular dementia can be explored. Until the relationship between vascular dementia and Alzheimer's disease is better defined, the nosology for vascular dementia may be defined best as dementia associated with stroke. Various aspects of clinical manefestation of vascular dementia were discussed and presented as tables.

인지평가 참고진단 시스템(CARDS)의 진단능력

서국희(Guk-Hee Suh) 대한노인정신의학회 2002 노인정신의학 Vol.6 No.2

Background: Recent therapeutic advances to delay the progression of dementia have renewed calls to improve early detection and management of individuals with dementia. A new computerized neuropsychological interview and clinical examination, the Cognitive Assessment and Reference Diagnosis System (CARDS) was developed to incorporate in a single instrument all the information required to make an accurate clinical diagnosis of dementia, its subtype, depression and delirium, to present reference diagnoses just after completion of tests, and to detect early dementia. This study aims to verify the diagnostic capability of the CARDS. Methods:The CARDS was administered to 56 dementia patients (38 Alzheimer's disease, 18 vascular dementia) as well as 40 nondemented subjects. To evaluate the sensitivity and specificity of the CARDS, we compared the CARDS diagnosis with the clinician’s diagnosis on dementia, Alzheimer's disease, vascular dementia and depression. To test diagnostic capability of the CARDS in the diagnosis of early dementia, we compared mean scores of total and subscales in the CARDS of GDS stage 3 group with those of GDS stage 4 group. Results:The CARDS demonstrated high levels of sensitivity and specificity in the diagnosis of dementia, AD, VaD and depression. Mean CARDS scores for total and 3 subscales (amnesia, aphasia, agnosia) in GDS stage 3 group were significantly different from those of GDS stage 4 group (p<0.001). Conclusion:We demonstrated that CARDS is valid instrument not only for dementia diagnosis but also for detection of early dementia.

화상 중환자에서의 섬망과 사망

서국희(Guk-Hee Suh),신형직(Hyong Jik Shin),함봉진(Bong Jin Hahm),조성진(Seong-Jin Cho),이동우(Dong-Woo Lee),최인근(Ihn-Geun Choi),손현균(Hyeon Gyun Son),연병길(Byeong Kil Yeon) 대한노인정신의학회 1999 노인정신의학 Vol.3 No.2

Objective : This study was to estimate the prevalence of and identify the predisposing risk factors of delirium and to determine the effect of delirium on the prognosis, especially death in burn patients. Method : The study was completed by thorough examination of medical records, with additional confirmation, of the 245 patients who were admitted to the Burn ICU in Burn treatment center of Hangang Sacred Heart Hospital during last one year (Jan. 1. 1998-Dec. 31. 1998). Delirium was retrospectively diagnosed according to DSM-IV. Only when disturbance of consciousness and attention, cognitive dysfunction –especially disorientation–, or perceptual disturbance were observed, diagnosis of delirium were given. Final outcome such as death was discriminated through examination of medical records or question to those who knew the patient. Result : One year prevalence of delirium in burn patients is 34.4%. Statistically significant predisposing risk factors of delirium were five;Age 65 and over (OR=45.51, 95% CI : 6.07-341.11), burn size over 60% of total body surface (OR=6.48, 95% CI : 3.16-13.28), current psychiatric disorder (OR=6.81, 95% CI : 1.42-32.57), current medical disease (OR=3.00, 95% CI : 1.40-6.45), alcohol abuse (OR=3.17, 95% CI : 1.07-9.43) Statistically significant deathrelated risk factors were three;burn size over 60% of total body surface (OR=4.58, 95% CI : 2.00-10.46), delirium (OR=2.94, 95% CI : 1.25-6.94), current psychiatric disorder (OR=4.09,95% CI : 1.05-15.87). Aging is not the death-related factor in this study. Conclusion : Three factors, such as delirium, organic brain damage, and burn size over 60% of total body surface may predict higher risk of death in burn patients.

C . G . Jung 단어연상검사의 연상규준 비교연구 - 한국과 스위스 피검자군을 중심으로 -

서국희(Guk Hee Suh),이죽내(Zuk Nae Lee) 한국분석심리학회 1997 心性硏究 Vol.12 No.2

N/A N/A

알쯔하이머병의 행동적 정신병리 평가척도 한국어판 (BEHAVE-AD-K)의 신뢰도 및 증상군별 점수 분석

서국희(Guk-Hee Suh),손현균(Hyun Gyun Son),신형주(Hyongju Shin),김인명(In-Myoung Kim),홍상의(Sangeui Hong),박종한(Jonghan Park),최인근(Ihn-Geun Choi),김상국(Sang Kook Kim),연병길(Byeong Kil Yeon) 대한노인정신의학회 2001 노인정신의학 Vol.5 No.1

Objective:The aims of this study were to (1) validate the inter-rater reliability of the BEHAVE-AD, Korean version, to (2) analyze the quantitative relationship between severity of Alzheimer's disease (AD) and mean scores on each of the BEHAVE-AD categories and mean total BEHAVE-AD score. Design:Cross-sectional study of geriatric patients with AD evaluated at a mental hospital for the elderly. Sample:Fifty-two consecutive patients diagnosed with probable Alzheimer's disease (AD) according to NINCDS-ADRDA diagnostic criteria. Results:In reliability study, significant correlations were obtained for all BEHAVE-AD symptoms category scores and for mean total BEHAVE-AD scores. Analysis of BEHAVE-AD scores as a function of disease severity demonstrated a non-linear relationship between severity of behavioral symptoms and the global and cognitive advance of AD. Score analysis of the BEHAVE-AD indicates that these behavioral disturbances become most severe in the moderate and moderately severe stages of AD. Conclusion:All the results proved the cross-cultural validity and reliability of the BEHAVEAD, Korean version. Furthermore, these results have implications for the methodology of pharmacological trials of putative cognitive enhancer compounds in AD.

지역사회 정신보건과 민간 정신의료기관

서국희(Guk-Hee Suh) 대한사회정신의학회 2000 사회정신의학 Vol.5 No.2

만성 정신질환자의 장기 수용 정신보건 정책이 유지되고 적극적인 탈원화를 시도하지 않기 때문에 우리 나라의 지역사회 정신보건사업은 답보 상태에 있고 약간은 원칙에서 벗어난 정신보건사업이 이루어지고 있다. 정신보건사업의 우선적인 대상을 정신분열병 등의 만성 중증 정신질환자로 정해야 한다. 또한 정신보건사업의 성과는 지역사회 장기체류 환자의 숫자로 평가해야 한다. 탈원화를 이루기 위해서는 정신의료 분야의 90% 이상을 차지하는 민간 정신의료기관의 적극적인 참여가 필수적이다. 지역사회 내의 정신과 의사가 적극적으로 참여할 수 있는 방안을 마련하고 crisis intervention을 통한 입원 억제와 정기적인 정신과 외래 치료를 강조함으로써 입원 중심의 정신의료 체계에서 지역사회 중심의 체계로 전환하게 된다면, 비용 절감 효과도 클 것이다. Because of mental health policy to support long-stay admission of the chronic mentally ill and not to try to promote active dehospitalization, the community mental health project in Korea may be left stagnant and a little out of rule. Primary subject of community mental health project has to be decided the chronic mentally ill, especially like patients with schizophrenia. And outcome of community mental health project has to be assessed by the number of long-term patients in community. It is essential to persuade the private mental health sector to actively join in the project to reach the goal of deinstitutionalization. Proportion of them in mental health sector may be over 90%. If it is possible for us to change from admission-centered system to community care-centered system by finding ways for the psychiatrists in field to actively join in and to reduce admission by crisis intervention and regular visit to outpatient clinic, it will influence on a great cost-saving effect.

Wish to Die and Associated Factors in the Rural Elderly

Guk-Hee Suh(서국희),Jang Kyu Kim(김장규),Hee Yeon Jung(정희연),Moo Jin Kim(김무진),Maeng-Je Cho(조맹제) 대한노인정신의학회 1999 노인정신의학 Vol.3 No.1

연구목적 : 본 연구의 목적은 노인의 자살 사고 유병률과 관련요인을 파악하고자 하는 것이다. 특히 우울증 이외의 어떤 인자들이 자살 사고와 관련되는지를 알아보고자 한다. 연구방법 : 경기도 연천군 지역에서 1996년 12월부터 1997년 8월사이 만 65세 이상의 노인 1,037명을 대상으로 역학조사를 행하여 자료를 얻었다. 조사참여자들에게 지난 2주동안 죽고싶다는 생각이 든 적이 있는지를 묻고, 있다고 답하면 지난 2주동안 여러 번 죽고 싶었는지를 물어 자살사고를 파악하였다. 가능한 관련 인자들을 다음의 다섯 군으로 분류하였다. 사회인구학적 인자(성별, 연령, 결혼상태, 아들과 딸의 숫자, 교육, 종교), 경제적 인자(재정 상태, 현재 및 과거 직업, 의료보험 또는 의료보호), 사회적 지지 인자(APGAR, 사회적 활동, 거주형태), 신체적 건강 인자(질병유무, 복약여부, 과거 입원력, 흡연년수, 음주년수, ADL과 IADL에 의한 기능장해여부) 그리고 정신적 건강 인자(DSM-III-R 치매, 우울장애, 망상증상, 감각기능 장해). 자료의 통계분석에서는 유병률을 계산하고 관련요인들을 로짓회귀분석을 사용하여 분석하였다. 연구결과 : 1013명의 조사노인중 148명(14.6%)이 지난 이주일동안 반복적으로 죽고싶다는 생각을 했다고 보고하였다. 이들 148명중 56명(37.8%)은 치매, 우울장애, 망상장애 혹은 감각기능 장해의 진단을 받지 않았고, 148명중 42명이 주요우울증을 앓고 있었고 70명(47.3%)이 우울장애의 진단을 받았다. 148명중 20명(13.5%)은 치매의 진단을 받았다. 죽고 싶다는 욕구가 우울증과 관련되지만, 우울증과 독립적으로 관련이 되는 몇몇 다른 요인들이 발견되었다. 85세 이상의 고령과 낮은 경제상태가 통계적으로 유의한 수준의 관련인자이다. 일상생활 수행능력 장해, 자신이 평가한 건강 불량, 낮은 사회적 지지와 배우자없이 생활함 등은 95% 신뢰구간의 하한이 0.9를 넘는 거의 유의한 수준에 있다. 죽고 싶다는 욕구만을 표현한 소수의 기분상태는 정상이었다. 결론 : 노인이 죽고 싶다는 표현을 하면, 면밀한 정신과적인 평가를 해야 할 필요가 있다. 죽고 싶다는 욕구는 우울증 이외의 다른 요인들과도 관련되며 거의 우울증상이 없는 사람에게도 있을 수 있다. 이런 자살 사고와 관련된 요인들을 교정하면, 삶의 의욕을 회복할 수 있을 것인가에 대해서 연구할 필요가 있다.것으로 나타났다.