자연경과 관찰에 의한 주의력결핍 과잉행동장애 아동에서 장기간의 약물치료가 성장에 미치는 영향

염찬우(Chan-Woo Yeom),은태경(Tae-Kyung Eun),박훈섭(Hoon-Sub Park),이규영(Kyu-Young Lee),김의중(Eui-Joong Kim),주은정(Eun-Jeong Joo),구영진(Young-Jin Koo) 대한소아청소년정신의학회 2014 소아청소년정신의학 Vol.25 No.2

Objectives:This study was conducted naturalistically in order to observe the long-term effects of attention-deficit hyperactivity disorder (ADHD) medications on growth rates among Korean school-aged boys with ADHD. Methods:Participants in the study were boys with ADHD aged 6 to 11 years who have taken ADHD medication, methylphenidate (extended release) or atomoxetine. They attended scheduled visits monthly or bimonthly for clinical assessment with measurement of height and weight. In this study, 35 boys with ADHD (mean age at baseline=7.90±1.77 years ; mean age at endpoint=12.54±1.91 years) were included, with a mean follow-up period of 4.64 years (±1.62 years), ranging from 2 to 9.7 years. Height, weight, and body mass index (BMI) measurements were converted to “age-corrected Z-scores” using data from Growth Charts provided by the Korean Center for Disease Control and Prevention from 2007. Results:Age-corrected endpoint growth parameters (height, weight, BMI Z-scores) did not differ significantly from the baseline values (height t=0.027 ; weight t=-0.61 ; BMI t=-1.86, in paired t-test). Especially high correlation was observed between the baseline and endpoint height Z-scores (r=0.876, p<.001), for which the coefficient of determination r² was 0.767, meaning that the amount of variability in endpoint height Z-scores explained by the baseline height Z-scores was 76.7%. Conclusion:Our results suggested that the long-term effects of ADHD medications on growth parameters to be tolerable in Korean school-aged boys with ADHD.

Depression and self-concept in girls with perception of pubertal onset

양지현,한상우,염찬우,박용준,최화수,서지영,구영진 대한소아내분비학회 2013 Annals of Pediatirc Endocrinology & Metabolism Vol.18 No.3

Purpose: Early pubertal timing in girls is associated with psychological and behavioral problems. This study aimed to evaluate the psychological features of girls who perceived breast development beginning by analyzing their depression levels and selfconcept. Methods: From March 2007 to December 2012, 93 girls were enrolled and assigned to a pre-8 (younger than 8 years, n=43) or post-8 (8 years and older, n=50) group according to the age at onset of perceived breast development, and their height, body weight, body mass index, bone age (BA), Tanner stage, and luteinizing hormone and follicle-stimulating hormone levels were examined. We investigated their psychological state with the Korean Children’s Depression Inventory (CDI) and Piers-Harris Children’s Self-Concept Scale (PHCSC) to evaluate depression levels and self-concept, respectively. Results: The pre-8 group had a significantly greater height standard deviation score,(0.5±1.01 vs. 0.11±0.86, P =0.048) and more advanced BA (2.07±1.02 years vs. 1.40±0.98years, P =0.004) compared to the post-8 group. There were no statistically significant intergroup differences for the CDI and PHCSC scores; however, the pre-8 group scored higher than the post-8 group in the physical appearance and attributes domain of the PHCSC (9.93±2.57 vs. 8.52±3.03, P =0.017). Conclusion: The timing of perceived breast development among girls who thought puberty to begin did not affect depression levels and self-concept. There was no correlation between Tanner stage and depression levels and self-concept despite the perception of pubertal onset. The pre-8 group had a more positive view of their physical appearance than the post-8 group.

뇌졸중 환자를 위한 심리사회적 개입의 효과: 체계적 문헌고찰 및 메타분석

하혜주,심은정,서현지,염찬우,함봉진 한국건강심리학회 2020 한국심리학회지 건강 Vol.25 No.5

This study reviewed and analyzed the characteristics and overall effect size (ES) of psychosocial interventions for stroke patients. The systematic review included 61 articles published in domestic and international journals up to October 2019, and the meta-analysis analyzed data from 37 articles. The subgroup analysis was conducted to determine the study characteristics (i.e., intervention type, format, and setting, control group, outcome, study design, and level of risk of bias) influencing the intervention effect. The psychosocial interventions for stroke patients were mainly provided in the form of psychotherapy, psychosocial education, supportive therapy, or combined therapy in inpatient or outpatient settings. The interventions were provided in individual or group format focusing on depression, anxiety, quality of life, and self-efficacy. The result of the meta-analysis observed low ES (g = 0.40; 95% CI, 0.31-0.50), and that ES varied depending on the intervention types and settings. The psychotherapy was more effective than other types, and a larger ES was observed in interventions provided in an inpatient setting than outpatient or home settings. The estimated ESs were corrected using the trim-fill method because of possible publication bias, but it remained significant, suggesting that psychosocial interventions are effective in improving distress in stroke patients. 본 연구는 뇌졸중 환자 대상 심리사회적 개입 연구의 현황 및 특성을 확인하고 개입의 전반적인 효과크기를 확인하였다. 2019년 10월까지 국내외 학술지에 게재된 61편의 연구를 대상으로 체계적 문헌고찰을 진행하였다. 그 중 37편을 대상으로 메타분석을 수행하였고, 개입 효과크기가 개입 유형, 형태 및 환경, 통제 집단 유형, 결과 지표 종류, 연구 설계, 비뚤림 위험에 따라 달라지는지 확인하기 위해 하위집단분석을 수행하였다. 뇌졸중 환자 대상 심리사회적 개입은 주로 심리치료, 심리사회교육, 지지치료, 결합치료였으며, 병원 장면(i.e., 외래, 입원)에서 개인이나 집단 개입 형태로 우울, 불안, 삶의 질, 자기효능감에 초점을 맞추었다. 메타분석 결과, 뇌졸중 환자 대상 심리사회적 개입은 작은 효과크기(g = 0.40; 95% CI, 0.31-0.50)를 보였고, 개입 유형 및 환경에 따른 차이가 관찰되었다. 심리치료가 결합치료, 심리사회교육, 지지치료보다 더 효과적이며, 입원 환경에서 제공되는 개입이 외래나 환자 가정, 지역사회에서 제공하는 것보다 효과적이었다. 분석 대상 연구들의 출판 편향 경향으로 Trim-fill 방법으로 효과크기를 교정하였으나 여전히 유의하였다. 본 연구 결과는 심리사회적 개입이 뇌졸중 환자의 디스트레스 개선에 효과적임을 시사한다.

암 경험자의 직장복귀지원에 대한 요구도 및 관련 요인

이성원,이광민,오규한,염찬우,정상협,함봉진,Lee, Sungwon,Lee, Kwang-Min,Oh, Gyu-Han,Yeom, Chan-Woo,Jung, Sanghyup,Hahm, Bong-Jin 한국정신신체의학회 2020 정신신체의학 Vol.28 No.2

연구목적 암 경험자의 직장복귀는 암 관리의 중요한 영역이 되었지만 암의 예방과 치료 영역에 비해 관련한 지원이 부족한 상태이다. 본 연구에서는 암환자와 암환자 가족을 대상으로 암 경험자 직장복귀지원에 대한 요구도 및 관련 요인을 조사하였다. 방 법 2019년 세 차례 진행된 암 경험자를 위한 음악회에 참석한 암환자 182명을 대상으로, 디스트레스 온도계 및 문제목록과 0~10점 범위의 직장복귀지원 요구도 평가도구를 적용하여 직장복귀지원에 대한 요구도 및 관련 요인을 조사하였다. 또한, 음악회에 참석한 암환자 가족 114명을 대상으로 디스트레스 온도계 및 문제목록과 직장복귀지원 요구도 평가도구를 사용하여, 가족의 시각에서 암환자의 직장복귀지원에 대한 요구도 및 관련 요인을 평가하도록 하였다. 암환자 군 182명과 암환자 가족 군 114명에 대해 두 군간의 직장복귀지원에 대한 요구도를 비교하였고, 각 집단의 요구도 관련 요인을 로지스틱 회귀분석을 통해 조사하였다. 결 과 암 경험자를 위한 직장복귀지원이 "매우 필요"하다고 보고한 비율이 암환자 군과 가족 군에서 각각 34.6%, 28.1%이었다. 암 경험자 직장복귀지원에 대한 요구도는 암환자 군에서 6.60±3.365점, 암환자 가족 군에서 6.17±3.454점으로 유의미한 차이가 없었다(p=0.282). 암환자가 스스로 평가한 직장복귀지원에 대한 요구도는 수술 치료 경험이 있는 경우(OR=2.592, p=0.007), 가임능력 문제를 경험하는 경우(OR=6.137, p=0.025), 외모 문제를 경험하는 경우(OR=2.081, p=0.041), 피로를 경험하는 경우(OR=2.330, p=0.020) 높은 것으로 나타났다. 암환자 가족이 평가한 암환자의 직장복귀지원에 대한 요구도는 암환자가 유방암 경험자인 경우(호흡기 암종 대비 OR=13.038, p=0.022 ; 혈액암 대비 OR=4.517, p=0.025 ; 기타 암종 대비 OR=13.102, p=0.019), 직장/학교 문제를 호소하는 경우(OR= 4.578, p= 0.005), 우울을 호소하는 경우(OR= 3.213, p=0.022) 높은 것으로 나타났다. 결 론 암 경험자 직장복귀지원에 대한 요구도가 암환자 군과 암환자 가족 군 모두에서 높고, 요구도와 관련된 요인은 두 군간에 차이가 있음을 확인하였다. 암 경험자를 위한 직장복귀지원 대책이 필요하며, 대책 수립에는 암환자의 임상적 특성, 디스트레스, 암환자와 가족간의 차이를 고려해야 함을 시사한다. Objectives : The purpose of this study was to investigate the needs for return-to-work support of cancer survivors and related factors in patients with cancer and their caregivers. Methods : 182 patients and 114 caregivers were recruited. Distress Thermometer and Problem List and scale ranging 0~10 measuring the degree of needs for return-to-work support were utilized. The needs for return-to-work support between the patient group and caregiver group (patient's needs evaluated by the caregiver) were compared, and related factors were investigated using logistic regression analysis. Results : 34.6% and 28.1% of patients and caregivers reported return-to-work support of cancer survivors is "very necessary". The degree of needs was 6.60±3.365 points in the patient group and 6.17±3.454 points in the caregiver group, with no significant difference (p=0.282). The needs for return-to-work support evaluated by patients was high when they underwent surgery (OR=2.592, p=0.007), has fertility problems (OR=6.137, p=0.025), has appearance problems (OR=2.081, p=0.041), or has fatigue (OR=2.330, p=0.020). The needs for return-to-work support of patients evaluated by caregivers was high when patients treated with breast cancer (vs respiratory cancer, OR=13.038, p=0.022 ; vs leukemia/lymphoma, OR=4.517, p=0.025 ; vs other cancer, OR=13.102, p=0.019), has work/school problems (OR=4.578, p=0.005), or has depression (OR=3.213, p=0.022). Conclusions : The degree of needs for return-to-work support of cancer survivors was high, and factors related to the needs were different between the two groups. This suggests that return-to-work support of cancer survivors is required, and clinical characteristics, the distress of patients, and differences between patients and their caregivers should be considered in establishing a support plan.

The Effect of Temperament on the Association Between Pre-treatment Anxiety and Chemotherapy-Related Symptoms in Patients With Breast Cancer

Choi Jung-In,Jung Sanghyup,Oh Gyu Han,Son Kyung-Lak,Kwang-Min Lee,Jung Dooyoung,Kim Tae-Yong,Im Seock-Ah,Lee Kyung-Hun,Min-Sup Shin,Hahm Bong-Jin,염찬우 대한신경정신의학회 2022 PSYCHIATRY INVESTIGATION Vol.19 No.11

Objective Pre-treatment anxiety (PA) before chemotherapy increases complaints of chemotherapy-related symptoms (CRS). The results on the association have been inconsistent, and the effect of temperament remains unclear. We aimed to determine whether PA is a risk factor for CRS and the effect of differing temperaments on CRS.Methods This prospective study comprised 176 breast cancer patients awaiting adjuvant chemotherapy post-surgery. We assessed CRS, PA, and temperament using the MD Anderson Symptom Inventory (MDASI), the Hospital Anxiety and Depression Scale, and the short form of the Temperament and Character Inventory-Revised, respectively. The MDASI was re-administered three weeks after the first chemo-cycle.Results PA showed weak positive correlation with several CRS after the first cycle; no CRS was significantly associated with PA when pre-treatment depressive symptoms and baseline CRS were adjusted in multiple regression analysis. Moderation model analysis indicated that the PA effect on several CRS, including pain, insomnia, anorexia, dry mouth, and vomiting, was moderated by harm avoidance (HA) but not by other temperament dimensions. In particular, PA was positively associated with CRS in patients with low HA.Conclusion The results in patients with low HA indicate that more attention to PA in patients with confident and optimistic temperaments is necessary.