동독과 서독의 중심 거리에서 나타나는 환경 색채 특성에 관한 연구

이원혜(Lee, Won Hye),박영순(Park, young soon),이현수(Lee, Hyun Soo),송정화(Song, Jung Hwa) 한국색채학회 2004 한국색채학회 학술대회 Vol.2004 No.6

인지행동재활치료가 정신분열병 환자들의 인지 기능에 미치는 영향

이원혜(Won-Hye Lee),황태연(Tae-Yeon Hwang),이우경(Woo-Kyung Lee) 대한사회정신의학회 2001 사회정신의학 Vol.6 No.2

목 적: 본 연구는 만성 정신분열병 환자들을 대상으로 실시한 인지행동재활치료(CBRT)의 효과를 검증하고자 하였다. 연구방법: 만성 정신분열병으로 진단 받아 입원 중인 환자 12명을 대상으로 매주 1회(매회 50분간)씩 18주 동안 지남력, 주의집중력 훈련, 기억력 훈련, 변별력 및 조직화 훈련 등 4단계로 구성된 인지행동재활치료(CBRT)를 실시하였다. 대조군으로는 동일한 기간동안 일반적인 정신사회재활치료를 실시한 집단(n=9명)과, 일반적인 입원 치료만을 받은 집단(n=9명)을 두었다. 세 집단 모두 치료 전과 치료 후 신경심리 검사를 실시하여 그 변화를 비교하였다. 치료 전과 치료 후 인지 기능의 변화를 알아보기 위해 세 집단 모두, KWIS(Korean Wechsler Adult Intelligence Scale)의 WARD7 단축형, DS-CPT(Degraded Stimulus Continuous Performance Test), SPAN(SPAN of Apprehension Program), Word Fluency Test, Word Memory Test를 실시하였다. 결 과: 세 집단의 치료 전, 후 인지 기능 변화의 주효과 및 상호작용 효과를 살펴보기 위한 MANOVA 분석 결과, KWIS의 숫자, 상식, 토막짜기, 빠진곳 찾기에서 집단간 주효과(p<.05)가 발견되었는데, CBRT 집단이 다른 두 집단에 비해 토막짜기, 빠진곳 찾기의 수행이 유의하게 상승하였다. 또한, 산수와 SPAN에서는 치료 전, 후의 상호작용 효과도 관찰되었는데(p<.05), CBRT 집단은 치료 후 SPAN의 12matix에서 유의한 상승을 보인 반면, 일반적인 입원 치료만 받은 집단은 수행 수준이 오히려 감소하였다. 집단 내 변화를 알아보기 위해 세 집단 각각에 대해 paired-t test를 시행한 결과, CBRT 집단은 KWIS의 전체 지능, 동작성지능, 토막짜기, 빠진곳 찾기와 SPAN의 12matrix, 언어적 유창성에서 치료 후 수행이 유의하게 증가하였으나(p<.05). 정신사회재활치료 집단은 KWIS의 동작성 지능에서만 유의한 변화가 있었으며(p<.05), 일반적인 입원 치료만 받은 집단은 신경심리 검사의 어떤 변인에 대해서도 유의한 변화가 나타나지 않았다. 결 론: 만성 정신분열병 환자들을 대상으로 한 CBRT는 전반적인 인지 기능 향상에 효과적이었으며, 특히 시각적 기민성과 변별 능력, 지각적 분석 및 통합 능력, 적극적이고 융통성 있는 사고 활동에 긍정적인 영향을 미치면서 행동적 수준의 변화로 이어지고 있음을 시사한다. 이러한 신경심리 검사에서의 수행 향상이 치료 후에도 지속될 수 있는지에 대한 추후 연구(follow-up)가 필요할 것이다. 또한, 기초인지 기능의 향상이 일상생활의 적응이나 대인 관계 기술, 직업 수행 등 전반적인 기능의 호전으로 일반화 될 수 있을 지에 대해서도 후속 연구가 필요할 것이다. Objectives:This study was designed to investigate the outcomes of the Cognitive Behavioral Rehabilitation Therapy (CBRT) for chronic schizophrenic patients. Methods:The subjects were 30 chronic chronic schizophrenic inpatients. CBRT group(N=12) was given orientation training, visual discrimination and organization training, attention and concetration training, and memory function training. Compared groups were given psychosocial rehabilitation(N=9) and general inpatient care(N=9). Korean Wechsler Intelligence Scale(KWIS), Continuous Performance Test(CPT), Span of Apprehension(SPAN), Verbal memory test and Verbal fluency test were performed before and after the interventions. Results:CBRT group were significantly improved in full IQ, performance IQ, picture complete, block design, Span 12matrix, verbal fluency. But psychosocial rehabilitation group was only improved in performance IQ and general inpatient group showed no significant effects in all outcomes variables. Conclusion:Our findings suggest that CBRT for chronic schizophrenic patient was effective on improving general cognitive function. Especially, it increased psychomotor activity and entailed improvement of visual alertness, vigilance, perceptual organization and mental flexibility. In the future studies, follow-up study of effectiveness must be performed and generalization of cognitive functional improvement from CBRT into other psychosocial functions should be reviewed.

시설 거주 노인 우울증의 인지기능저하

이정식(Jung Sik Lee),이원혜(Won Hye Lee),이우경(Woo Kyeong Lee),오홍석(Hong Seok Oh) 대한노인정신의학회 2006 노인정신의학 Vol.10 No.1

Objectives : There is a wide spectrum of cognitive dysfunction in geriatric depression due to heterogeneity. The Authors tried to investigate cognitive dysfunction in the elderly with depression and the association between geriatric depression and demographic variables such as sex, age, and education. Methods : Total 101 non-demented participants living in the asylum for the aged had completed frontal lobe function test (executive function and conceptualization) and CERAD-K (the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease) to evaluate neuropsychological function. Symptoms of depression were evaluated by SGDS-K (Short Geriatric Depression Scale of Korean version). We divided the elderly into two groups (depressed, non-depressed group) to evaluate the differences in cognitive function. Results : 30 (29.7%) of the subjects suffered depression and 50 (49.5%) had cognitive decline. Geriatric depression is not associated with age, sex, and education. Depressed older adults had lower executive function score in total group and cognitive decline group than non-depressed. Within cognitive decline group, subject with geriatric depression had lower scores in word fluency and word delayed recall than non-depressed. There was significant correlation between SGDS-K score and executive function. Conclusion : Subjects with geriatric depression had significant executive dysfunction. Executive dysfunction in depressed older adults may provide the basis for further investigation of mechanisms of geriatric depression. Timely identification of executive dysfunction fundamental to daily activities of depressed older adults may lead to coping strategies that will improve the prognosis of geriatric depression.

비자의 입원에 관련된 주요 요인에 대한 입원적합성심사 위원들의 의견 분석

이원선(Won Sun Lee),심아림(Ah Rim Sim),이원혜(Wonhye Lee),전진용(Jin Yong Jun),박동연(Dong Yeon Park),황태연(Tae-Yeon Hwang) 대한사회정신의학회 2023 사회정신의학 Vol.28 No.2

목적 : 2016년 개정된 정신건강복지법에 따라, 정신과적 비자의 입원 적합성 심사를 위해 입원적합성심사 위원회(이하 입적심)가 2018년 6월부터 운영되었다. 입적심 제도의 검토와 보완을 위해 비자의 입원 심사 현황을 파악하고자 입적심 위원들의 심사기준, 주요 쟁점 사안 및 입적심 운영에 대한 의견을 조사하였다. 방법 : 2020년 6월부터 7월까지 국립정신건강센터 입적심 위원들을 대상으로 설문지를 배포하였고 총 74명의 설문지가 수거되었다. 설문지에는 비자의 입원의 적합성에 대한 주요 심사사항, 심사기준 및 위원회 운영에 관련된 내용들이 포함되었고, 세부질문으로 구성된 4개 영역의 선택형 문항과 서술형 문항으로 구성되었다. 조사 내용에 대한 기술적 분석에 추가하여 설문 문항에 대한 연령, 나이, 직역, 소위별 응답의 차이를 카이제곱 검정으로 분석하였다. 결과 :입원 적합성 심사 시 고려 사항의 우선순위는 ‘자·타해 위험성’(81.1%), ‘입원 필요성’(56.8%), ‘이송 강압성’(54.1%) 순이었으며, 이송 시 강압성에 대해서는 ‘신체 강박’(83.8%), ‘이송침대에 강박’(68.9%), ‘강압적 분위기’(32.4%)를 우선적으로 고려하는 것으로 나타났다. 설문 항목에 대한 참여자의 사회 인구학적 인자를 분석한 결과, 전반적인 심사 견해에 있어서는 사회 인구학적인자와 유의미한 연관성은 두드러지지 않았으나, 알코올, 청소년 문제와 같은 특수 상황에 대한 심사에는 직군별 차이를 보였다. 아울러 위원들은 자·타해 위험성에 대한 세부 기준 및 위원별 심사 기준의 통일성을 높이기 위한 방안 마련을 제안하는 것으로 나타났다. 결론 : 본 연구를 통하여 입적심 위원들의 심사 견해에 대한 국내 수도권 지역 자료를 확보하고 분석할 수 있었다. 이를 바탕으로 입적심 운영 및 제도를 보완하고 개선한다면 공정하고 일관된 비자의 입원 심사가 이루어질 것으로 기대한다. Objectives: In accordance with the revised Mental Health and Welfare Act of June 2016, the Involuntary Admission Review Committee (hereinafter referred to as “the committee”) has been established since June 2018 to assess the suitability of involuntary admission of psychiatric patients. To examine and improve the committee system, this study surveyed the assessment criteria, major issues, and opinions on the operation of the committee, with a focus on the assessment of involuntary hospitalization. Methods: From June to July 2020, a survey was distributed to 74 members of the National Center for Mental Health's committee for the assessment of involuntary hospitalization. The survey consisted of multiple-choice and open-ended questions regarding the major assessment criteria, standards, and operation of the committee in relation to the suitability of involuntary admission. The survey data were analyzed using chi-square tests to examine differences in responses based on age, job position, and other demographic variables. Results: The prioritized considerations in assessing the suitability of involuntary admission were ‘risk for suicidality/homicidality’ (81.1%), ‘necessity of hospitalization’ (56.8%), and ‘coercive transport’ (54.1%). Regarding the use of coercion during transport, ‘physically coercion’ (83.8%), ‘restraint on a stretcher car’ (68.9%), and ‘coercive atmosphere’ (32.4%) were the most commonly considered factors. While there was no significant association between demographic variables and overall assessment opinions, differences were observed in the assessment of special situations such as alcohol use and adolescent issues based on job position. The committee members suggested measures to increase uniformity in assessment standards for the risk of harm to oneself or others and individual assessment standards. Conclusion: This study provides the domestic data on the assessment opinions of committee members for involuntary hospitalization. Based on these findings, we expect that fair and consistent assessment of involuntary admission of psychiatric patients can be achieved through improvements and revisions in the committee system and operation.

시설 거주 노인 우울증의 인지기능변화

이정식(Jung Sik Lee),박은미(Eun Mi Park),장순우(Soon Woo Chang),이주호(Joo Ho Lee),이원혜(Won Hye Lee) 대한노인정신의학회 2007 노인정신의학 Vol.11 No.2

Objectives : Cognitive impairment often occurs with geriatric depression, and may persist despite remission of depression. The authors investigated change of cognitive functions in geriatric depression according to time interval to identify whether cognitive impairment may persist or not. Methods : At baseline and 1 year follow-up, total 88 non-demented participants living in the asylum for the aged had a clinical examination that included depression assessment (SGDS-K : Short Geriatric Depression Scale of Korean version) and neuropsychological test (frontal lobe function test and CERAD-K : the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease). We divided the elderly into two groups (depressed : 27, non-depressed : 61) and evaluated the differences in change of cognitive functions. Results : Depressed group had lower scores on the word delayed recall test and construction recall test than non-depressed group at one-year follow-up. Except executive function, there was no significant difference in cognitive change between two groups according to time interval. Conclusion : These results support previous observations that cognitive impairment in geriatric depression may persist, especially in the executive function. Timely identification of executive function of depressed older adults may lead to coping strategies that will improve the prognosis of geriatric depression.

시설거주 노인들에서 주관적 기억장애 호소와 객관적 인지기능

이정식 ( Jung Sik Lee ),이우경 ( Woo Kyeong Lee ),박은미 ( Eun Mi Park ),이원혜 ( Won Hye Lee ),오홍석 ( Hong Seok Oh ),안은숙 ( Eun Soog An ),고영 ( Young Ko ) 한국정신병리진단분류학회 2006 精神病理學 Vol.15 No.1

Objectives: There are inconsistent results about relationships among the subjective memory complaints(SMC), objective memory functions, and depression. The Authors tried to examine the association of subjective memory complaints in the elderly with objective cognitive functions, depression and other demographic variables such as sex, age, and education. Methods: Total 175 participants living in the asylum for the aged had completed CERAD-K(the Korean version of the Consortium to Establish a Registry for Alzheimer`s Disease) to evaluate neuropsychological function. All of them were evaluated by four specific questions about everyday memory function. Symptoms of depression were evaluated by SGDS-K(Short Geriatric Depression Scale of Korean version). We divided the elderly into two groups(SMC+ group, SMC- group) to evaluate the differences in cognitive function and depression. Results: 109(62.3%) of the subject acknowledged having trouble with their memory. Memory decline and cognitive decline were associated with SMC. SMC+ group scored significantly lower on word delayed recall test than SMC- group, especially. Age, sex and education were significantly associated with SMC in total subject but not education in non-demented subject. Total score of SMC was explained partly by word delayed recall and depression variables in non-demented subject. Conclusion: This study suggested that association between SMC and objective memory function had clinical implication that SMC was a significant part of MCI criteria associated with early stage of Alzheimer`s Disease.

지역사회 정신보건센터의 정신사회재활 성과에 대한 3년간의 추적조사

황태연(Tae-Yeon Hwang),박찬일(Chan-Il Park),이종국(Jong-Gook Lee),고영(Young Ko),이명수(Myung-Soo Lee),이우경(Woo-Kyung Lee),이원혜(Won-Hye Lee) 대한사회정신의학회 2001 사회정신의학 Vol.6 No.2

서울, 경기 지역에서 1995년도부터 시행된 지역사회 정신보건사업은 정신보건센터를 중심으로 정신장애인들과 그 가족에게 포괄적인 정신사회재활 프로그램을 제공하여 왔고, 많은 정신장애인의 사회복귀와 삶의 질 향상에 기여해 왔으나, 프로그램의 효과와 만족도를 평가하려는 노력은 부족했다. 본 연구는 정신보건센터에서 서비스를 제공받고 있는 회원들을 대상으로 한 3년간의 추적 조사를 통하여 정신사회재활 프로그램의 성과를 검토해 보고자 하였다. 1998년 10월부터 1999년 3월까지 서울 및 경기지역의 6개 정신보건센터와 재활센터에 등록되어 있는 169명의 환자를 대상으로‘한국판 정신사회재활성과 측정도구’와‘한국판 정신사회적 기능-증상 척도’를 적용하였고, 2001년 5월부터 7월까지 대상환자를 추적하여 재평가를 실시하였다. 전체 169명의 대상자 중 128명이 추적 조사되었다. 이중 남자 78명, 여자 50명이었고 대부분의 회원은 정신분열병과 정동장애 환자였다. 평균 나이는 38.4세, 첫 발병은 24세, 첫 입원연령은 26세였다. 추적조사 기간 중 평균 입원은 0.35회, 입원일은 1.9개월, 총 지역사회 경과일은 27.8개월이었다. 조사기간 중 주거형태가 다양해지고 독립주거가 증가했고, 다양한 형태의 직업을 가지면서 독립적, 경쟁적 고용 등 경제 활동과 만족도가 증가하였다. 한달 평균 임금을 비롯하여 전체 수입 및 생활비가 증가했고, 문화비 지출은 감소하였다. 센터 프로그램에 대한 회원 설문조사 결과 전반적인 만족도와 자긍심이 증가하였고 정신사회적 증상과 기능 평가에서는 이전에 비해 더 많은 우울 및 정신병적 증상을 호소하였으나 일상생활 기능은 호전되었음을 알 수 있었다. 이러한 정신사회재활적 성과를 고려할 때 정신보건센터 프로그램이 만성정신장애인의 삶의 질과 기능, 자율성을 증가시켰음을 알 수 있었기에, 향후 지역사회 정신보건센터를 확충시키는 정신보건정책이 필요하다고 생각된다. 또한 만성 정신질환자들의 프로그램 만족도를 포함하는 정신사회재활 성과의 지속적인 추적조사를 통하여 프로그램의 평가와 발전이 이루어져야 될 것이다. Community mental health centers(CMHCs) have provided patients with mental illness and their families with comprehensive psychosocial rehabilitation programs and contributed to community integration and improvement of quality of life of the patients. However, there have been few studies on the effectiveness of and patients’ satisfaction to the programs. This study was performed to measure the outcomes of psychosocial rehabilitation programs of CMHCs through 3 year’s follow-up. At the baseline, The Korean version of Toolkit for measuring psychosocial rehabilitation outcomes and The Korean Version of Behavior and Symptom Identification Scale(BASIS-32) were administered to 169 subjects who were members of 6 CMHCs and 1 psychiatric rehabilitation center in Seoul City and Kyonggi province. 128 subjects were followed out of 169 subjects. Authors re-evaluated the same subjects 29 months after the baseline study using same measures. Male members were 78(60.9%) and females were 50(39.1%). Most of them are under diagnosis of schizophrenia( 82.8%) or schizoaffective disorder(7.9%). The mean age was 38.4yr., mean age of onset was 24yr., mean age of first hospitalization was 26yr. Number of hospitalization was 0.35, length of stay at the inpatient unit was 1.9 months, and community tenure was 27.8 months during the 29 months’ period of study. Residences were diversified and independent living was increased. Jobs were also diversified and independent competitive employment wes increased. Total monthly income including labor income and total monthly expenditure were increased. Member survey showed improvement of program satisfaction and improved self-esteem. BASIS-32 showed that the members had more difficulties in the areas of symptoms but reported improvement of daily functioning compared with the baseline. These outcomes tells psychosocial rehabilitation programs of the CMHCs increased the quality of life, functioning, and autonomy of the chronic mentally ill patients in the community that the national mental health policy should be directed to establishment of more CMHCs. In the future, there must be periodic monitoring of the psychosocial rehabilitation program through comprehensive outcome measures.

국내 우울증 평가도구 타당화 연구의 체계적 고찰-진단적 타당성을 중점으로 : 한국형 우울 선별 도구 개발을 위한 예비 연구

정수연,김신향,박기호,제갈은주,이원혜,최윤영,이승환,최기홍,Jung, Sooyun,Kim, Shin-Hyang,Park, Kiho,Jaekal, Eunju,Lee, Won-Hye,Choi, Younyoung,Lee, Seung-Hwan,Choi, Kee-Hong 대한불안의학회 2017 대한불안의학회지 Vol.13 No.2

Reliable and valid diagnostic screening tools in the primary care setting enable accurate estimation of depression in individuals at risk or in need of treatment, and provide patients with an opportunity to receive optimal treatments. Although there have been extensive studies on screening tools for depression used in domestic mental health settings, there is little consideration and lack of a thorough review of the diagnostic validity of screening tools. In the current review, we selected 13 representative screening tools for depression which were evaluated in a total of 19 validation studies conducted in Korea. We summarized DSM-5 target domains, diagnostic indices, sensitivity, specificity, cut-off scores, and diagnostic validity information for each tool. Finally, the depression measurement expert group was constituted to evaluate the current status of screening tools for depression, and their recommendations for a new screening tool were summarized. This study was conducted as part of the Mental Health Technology Development project to develop the Korean screening tool for depression (K-DEP).

한국판 치매 행동평가 척도(BRSD-K)와 한국판 Neuropsychiartic Inventory(NPI-K)의 도구적 특성 비교

윤종철 ( Jong Chul Youn ),이원혜 ( Won Hea Lee ),최종배 ( Jong Bae Choi ) 한국정신병리진단분류학회 2008 精神病理學 Vol.17 No.1

Aim: This study was purposed to compare the psychometric properties between the Korean version of Behavior Rating Scale for Dementia(BRSD-K) and Neuropsychiatric Inventory(NPI-K). Methods: The formal caregivers of 99 dementia patients who were diagnosed by DSM-IV criteria and admitted to geriatric hospital or nursing home were interviewed by both BRSD-K and NPI-K for measuring behavioral and psychological symptoms in dementia (BPSD). Overall prevalence of BPSD, mean scores of BRSD-K and NPI-K according to the severity of dementia, correlations between BRSDK total and subscale scores and the corresponding scores of NPI-K were analyzed. Results: Above 95% of the subjects showed one or more BPSD during the last month. Severity of BPSD measured by BRSD-K and NPI-K were not statistically significant among the severity of dementia. Correlations between BRSD-K subscale score and the corresponding scores of NPI-K were statistically significant except that of psychotic subscale score of BRSD-K and delusion score of NPI-K(p<0.01). Conclusion: Results of this study showed that BRSD-K and NPI-K were not identical although both were useful to evaluate BPSD. It was also suggested that BPSD of inpatient were different from those of outpatient since it was relatively severe in mild stage.

양극성 장애 환자에서 불안이 질병 경과에 미치는 영향 : 전향적 추적관찰에 대한 중간분석

김수정,김소정,송혜현,이원혜,전명욱,남윤영,박동연,Kim, Soojeong,Kim, So Jeong,Song, Hye Hyun,Lee, Wonhye,Chon, Myong-Wuk,Nam, Yoon Young,Park, Dong Yeon 대한생물정신의학회 2021 생물정신의학 Vol.28 No.1

Objectives Despite growing attention to anxiety in bipolar disorder (BD), little research has assessed anxiety symptoms in the course of BD. The current prospective follow-up study examines the influence of subjectively and objectively measured anxiety symptoms on the course of BD. Methods A total of 49 patients with BD were followed-up prospectively for average of one year at an average of four months interval. The Korean version of the Beck Anxiety Inventory (K-BAI), the Hamilton Anxiety Rating Scale, heart rate variability (HRV) were used to measure anxiety subjectively, objectively and physiologically. Participants were divided into high and low anxiety groups based on their K-BAI scores. Kaplan-Meier survival analysis was performed to compare the recurrence of mood episode, suicide attempt, emergency room visit, and psychiatric hospitalization between two groups. Mediators were investigated with Cox proportional hazards models. Results Compared to the low anxiety group, the high anxiety group reported significantly higher impulsiveness (p = 0.016) and lower high frequency component on HRV (p = 0.007) after controlling for severity of BD. Regarding survival analysis, the high anxiety group showed hastened depressive episode recurrence (p = 0.048) and suicidal ideation was the mediator of the hazard ratio (HR) 1.089 (p = 0.029) in the Cox model. Moreover, the high anxiety group showed a tendency of accelerated suicide attempt (p = 0.12) and impulsivity was the risk factor of suicide attempt (HR = 1.089, p = 0.036). Conclusions This interim analysis of prospective study suggests that high anxiety level in BD may anticipate unfavorable course. Further studies are needed to understand the multifactorial mechanism of anxious bipolar patients.