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송지영,염태호,오동재,조성욱,Song, Ji-Young,Yum, Tae-Ho,Oh, Dong-Jae,Cho, Seong-Wook 한국정신신체의학회 1997 정신신체의학 Vol.5 No.2
목적: 한국인의 질병행동 특성에는 전통적인 질병개념, 신체화경향 및 각종 사회문화적 요소와 복합적으로 관련되어 있다. 이에 신체화 기전을 근본으로 한 신체형환자의 질병행동의 특성을 파악하여 여기에서 얻은 결과를 향후 치료에 활용해 보고자 하였다. 방법: 환자군은 DSM-IV에 의거하여 신체형장애로 진단된 환자 29명이었고, 대조군은 질병대조군으로서 골절 및 급성질환에 의해서 수술받은 환자 57명으로 하였다. 양군에서 임상증상의 특성과 통증의 유무 및 통증정도측정(Visual Analogue Scale) 상태불안(Spielberger의 Anxiety State Inventory), 우울정도 측정(Beck's Depression Inventory), 스트레스정도(Psychosocial Stress Scale)를 재고, 그리고 질병행동의 특성은 질병행동 평가 설문인 illness Behavior questionnaire(IBQ)를 한국어로 번역하여 신뢰도를 검증한 후에 검사도구로 이용하였다. 결과: 신체형장애 환자는 대조군에 비해 증상기간이 길고 (71.8+64.3개월), 나이가 많았으며(39.0+10.2세), 측정당시의 통증정도($1.0{\pm}2.0$, p<0.05)는 낮았다. 과거력상 신체질병이 상대적으로 많았고, 불안$(50.9{\pm}10.7)$과 우울정도(20.3+9.5)가 높았다. 그러나 스트레스의 정도는 비슷하였다. IBQ의 척도중에 건강염려증$(5.2{\pm}2.6)$, 질병확신(3.1+2.0) 그리고 정서장애 척도$(3.0{\pm}1.6)$는 환자군에서 의미있게 높았으나(p<0.05), 심리적인 관심 대 신체적인 관심, 감정억제, 부정 및 짜증 척도에서는 양군에서 비슷하였다. 결론: 신체형장애 환자는 병에 대한 두려움과 질병확신에 의해서 신체증상에 더욱 집중하며, 이는 과거의 신체질환 병력, 잦은 신체검사와 병원방문과 같은 행동특성과 관련된다. 이들이 급성 신체질환자보다 스트레스정도가 높지도 않으면서 불안과 우울의 정도가 크다는 것은, 신체형장애환자의 신체화기전에 정서장애가 중요한 요소임을 보여 주는 것이라고 생각한다. 행동증후군으로서의 신체형장애를 파악하는 데에 있어서 질병행동의 평가는 중요하며, 앞으로 한국어로 번역되고 신뢰도가 확립된 IBQ는 질병행동의 특성을 아는데 뿐만 아니라 신체형장애와 기타의 질환과 구별하는 도구로 유용하게 쓰일 수 있다고 사료된다. Abnormal illness behavior in patients with somatoform disorders were known formed by their traditional disease concepts and somatization-prone socio-cultural factors. The authors evaluated the characteristics of abnormal illness behavior in patients with somatoform disorders(who had somatization) by using abnormal illness behavior questionnaire. Methods : 29 somatoform disorders(SD) and 57 disease controls were compared by clinical characteristics, severity of pain, state anxiety(by Spielberger's State & Trait Anxiety Inventory), depression(by Beck's Depression Inventory) and level of psychosocial stess(by DSM-III-R). The illness behavior was measured by illness Behavior Questionnaire(IBQ). Results SD group had longer period of somatic symptoms with less severity in pain. The degree of anxiety and depression were higher in SB compared with controls. However, the degree of psychosocial stress was almost same between both groups. In IBQ, SD showed higher scores in general hypochondriasis, disease conviction, and affective disturbance subscales compared to control group. Conclusion: High disease conviction and hypochondriacal nature revealed by IBQ seemed to be a role in making somatization by way of somatic focusing and hypervigilance. And those tended to lead patients visit hospital frequently and report various somatic complaints. Evaluating abnormal illness behavior in somatoform disorders would be not only helpful in understanding the natures of somatoform disorders but also useful differentiating SD with other psychiatric conditions.
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동통을 가진 신체형장애 환자에서 감정표현능력과 압통역치
송지영,김태수,오동재,윤도준,염태호,Song, Ji-Young,Kim, Tae-Soo,Oh, Dong-Jae,Yoon, Doh-Joon,Yum, Tae-Ho 한국정신신체의학회 1994 정신신체의학 Vol.2 No.1
저자들은 동통을 가진 신체형장애 환자들에서 물리적인 외부자극에 대한 지각과 외부자극에 따른 언어행동의 관계성을 파악하기 위해서 본 연구를 시행하였다. 환자 34명 (남 10, 여 24)과 건강대조군 37명 (남 19, 여 18)을 대상으로, 물리 적 자극에 대한 지각도의 측정은 압통역치 측정기(algometer)를 이용하였으며, 감정표현능력의 측정은 Toronto Alexithymia Scale을 이용하였다. 한편 신체증상의 정도와 부모-자녀 결합형태검사를 시행하였다. 전체환자의 81.4%는 6개월이상 증상을 지속적으로 많이 호소하는 만성화 특성을 보였다. 그리고 alexithymia의 정도, 신체증상 호소정도, 압통역치가 모두 환자군에서 유의하게 높았다. 그리고 환자군의 44.1%는 alexithymia라고 할 수 있었다. 한편 압통역치와 alexithymia간에 유의한 상관성은 없었다. 결론적으로, 동통을 가진 신체형장애환자들이 정상인에 비해 외부 동통자극에 덜 민감하며, 이는 병의 만성화와 관련되는 것 같다. 이들은 또 외부자극에 따른 적절한 감정표현능력도 떨어져 있는 경우가 많은데, 이것은 신체화의 한 조건이 되며, 한편으로는 정신치료적 접근을 방해하는 한 요소가 될 수 있음을 시사한다. The authors investigated the relationship between the response to the external stimulation and ability of verbal behavior in the patients with somatoform disorder who have pain. The subjects consisted of 34 patients(male 10, female 24) and 37 normal controls(male 19, female 18). Pressure pain thesholds were measured by algometer and alexithymia was assessed by Toronto Alexithymia Scale(TAS). Somatization Scale of SCL-90R and Parental Bonding Instrument were also used. It was shown that 82.4% of the patients had chronic somatic complaints. The mean values of TAS, degree of somatic symptoms and pressure pain thresholds were significantly higher in the patient group than in the normal controls. 44.1% of the patients was considered alexithymia group and there was no correlation between scores of alexithymia and value of pressure pain thresholds. In conclusion, the patients with somatoform disorder who had pain were dull in pain perception to external physical stimulation. This result suggested that their low perception of pain could be closely related with chronicity of illness. And the Poverty of verbal expression of inner emotion was suggested to be one of the factors affecting somatization and difficulty in psychotherapy.
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국내 정신의학 연구에 사용된 심리검사도구에 대한 검토(Ⅰ)
장환일,반건호,김교헌,염태호 大韓神經精神醫學會 1989 신경정신의학 Vol.28 No.4
The purpose of this article is to delineate the trends of the use of the psychological test instruments in psychiatric research. The subjects for the study were 125 scientific articles published in "Neuropsychiatry"(Journal of the Korean Neuropsychiatric Association) from 1985 through 1987. The results were as follows; 1) Psychological test instruments were used in 125 articles among 205 articles which were published in the journal "Neuropsychiatry" for 3 years. The number of psychological test instruments used in 125 articles was 214 ; only one instrument was used in 75 articles and more than 2 instruments in 50 articles. 2) All psychological tests instruments were classified into projective technique, self-report inventory, observation method, intelligence test and unknown. The most commonly used type was the self-report inventory(57.0%). 3) 27.1% of the psychological test instruments were made by the authors themselves;48.1%, already-existing ; 24.8% unclassified. 4) The most common purpose of using thd psychological test, was for the psychodiagnostic tool. Through this study the following problems or questions were raised. 1) Defects in methodology of assessment in psychiatric research(especially when using psychological test instruments) 2) Absent or insufficient explanation about the reason why the psychological test instruments were selected and used in the article 3) Uncertainty in validity and reliability, especially in cases of the psychological test instruments of the author's self-made 4) Insufficient coping method to overcome the weakpoint of the self-report type 5) Various problems resulted from the absence of the clinical psychological in the process of psychiatric research using the psychological test 6) Does the content of the article not depend upon the peculiar psychological test so much? 7) It might be necessary to establish the criteria for classification of psychological test instruments 8) Further study would be necessary to assess the appropriateness and quality of the psychological test instruments used in psychiatric research.
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精神分裂症患者의 家族 및 自我槪念에 關한 心理學的 硏究
廉泰鎬,金相泰,鄭東哲 大韓神經精神醫學會 1972 신경정신의학 Vol.11 No.2
Ten semantic differential scales, four of evaluative, each three of potency and activity, were administered to 90 schizophrenics. The results were compared with those of 50 psychoneurotics and normal controls. The concepts rated on the scales were father, mother, brother, self, love and guilt. Following was the findings: 1) Schizophrenic group showed some differences with the normal and psychoneurotic groups in their ratings on the concepts of family members. 2) Schizophrenic group reflected the defect of self-concept in a high degree than the other two groups. 3) Schizophrenic group seem to be highly reflected the tendency of the defective concept-formation, love and guilt, than the other two groups. 4) The possibilities of the semantic differential technique as a useful tool of the schizophrenic group in the rating of concepts was discussed.
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