정신질환에 영향을 미치는 사회적 요인들

이정태(Chung Tai Lee) 대한사회정신의학회 2000 사회정신의학 Vol.5 No.1

사회정신의학(social psychiatry)은 정신질환과 인간의 환경간의 관계를 다루는 정신의학의 한 분야로서 사회적 결속(social cohesion), 공유되는 가치들(shared values), 경제적 상태, 적에 의한 위협, 생존에 대한 기대 등 여러 가지 요인들의 효과들에 관한 개념들을 포함한다. 또한 개개인과 이들을 둘러싸고 있는 것들 사이의 접촉 영역에 작용하여 결국 정신질환의 발생에 기여하거나 경과에 영향을 끼치는 힘들에 대하여 연구하는 학문으로 정의된다. 사회정신의학의 영역에는 정신의학적 역학, 지역사회정신의학, 사법정신의학, 문화정신의학, 횡문화 정신의학 등이 포함된다. 본 고에서는 정신질환에 영향을 미치는 사회적 요인들을 역학적 연구조사의 결과들을 함께 고찰하였다. 연령, 성별, 혼인상태 등이 질병의 분포에 미치는 영향, 사회계층에 따른 질병 분포, 도시화, 지역에 따른 영향, 세대의 변화에 따른 영향, 거시사회적 요인들, 그리고 전쟁이나 급속한 현대화 등의 영향을 고찰하였고, 이어서 부정적 생활사건들이나 가혹한 경험들, 실직 등이 정신질환에 미치는 영향을 살펴보았으며, 사회적 지지의 많고 적음에 따른 차이를 추정해 보았다. 동시에 최근 우리 사회에서 발생하였던 대형 사고나 재해 등이 어떠한 영향을 미치고 있는지에 대해서도 연구결과들을 중심으로 고찰을 시도하였다. 대부분의 문헌이 우리 나라의 처지를 반영한 것은 아니어서 괴리감이 없지 않으나, 우리가 아직 깊이 연구해 보지 못했던 분야에 대하여 하나의 자극제가 되었으면 하는 바람이다. Social psychiatry is a component of psychiatry, and is concerned with the relationship between mental disorders and the human environment. It includes the concepts about the effects of various factors such as social cohesion, shared values, economic stutus, threat from the enemies, and expect for survivor. Also it is defined as the science studying the forces which affect the interface between individuals and those around them, and which may act on the onset, or influence the course of mental illnesses. There are psychiatric epidemiology, community psychiatry, forensic psychiatry, cultural psychiatry, and cross-cultural psychiatry, in the realm of social psychiatry. Author reviewed various social factors affecting mental disorders, with presentation of the results of epidemiological studies, Those reviewed were the effects of age, sex, marital status, and social class in the distribution of mental illnesses, the influence of urbanization, regional variation, and secular change, and the macrosocial factors including war and rapid modernization, which succeeded to the review of adverse life events, extreme experiences, and unemployment affecting mental illnesses, as well as social support as a protective elements of the human environment. At the same time, author also reviewed the results of researches approaching psychological effects of one of the human disasters, named “Sampoong Accident”, and economic crisis, so called “IMF crisis”, both which recently impacted upon our society and resulted in adverse consequences.

의과대학생의 성격유형과 자연최면경험

이정태(Chung Tai Lee),한상익(Sang Ick Han),김광수(Kwang Soo Kim),박원명(Won Myong Bahk),유태열(Tae Yul Lew),정진복(Jin Bok Jung),전양환(Yang Whan Jeon) 한국정신병리진단분류학회 1995 精神病理學 Vol.4 No.1

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알코올중독증 환자의 대뇌 국소혈류량 변화

이정태(Chung Tai Lee),손형선(Hyung-Sun Sohn),성양숙(Yang-Sook Sung),양문정(Mun-Jung Yang),채정호(Jeong-Ho Chae),박원명(Won-Myong Bahk),김광수(Kwang-Soo Kim),유태열(Tae-Yul Lew) 한국중독정신의학회 1998 중독정신의학 Vol.2 No.1

The purpose of this study was to investigate the effect of chronic alcohol intake to regional cerebral blood flow in the patients with alcohol dependence by single photon emission computerized tomography (SPECT). The subjects were detoxified alcoholic inpatients (n=10) diagnosed as alcohol dependence by DSM-IV criteria and control group (n=8). The regions of interest (ROIs) were drawn in frontal lobe (3 ROIs), temporal lobe (3 ROIs), parietal lobe (3 ROIs), occipital lobe (1 ROI), and thalamus (1 ROI). We compared data from chronic alcoholic patients to those from controls about cerebral asymmetry indices and regional cerebral blood flow (rCBF) indices measured from each ROI. The results were as follows:1) There were significant differences in asymmetry indices of thalamus with alcoholic patients and control group (p<0.05). 2) rCBF indices of alcoholic patients were significantly higher than those of control group in left posterior temporal cortex, right posterior parietal cortex and right thalamus (p<0.05), and tended strongly to be higher than those of control group in right posterior temporal cortex, left posterior parietal cortex and left superior lateral frontal cortex. The result of increased rCBF in cerebral cortex and thalamus of detoxified inpatients with alcohol dependence suggested that there may exist a significant association between alcohol dependence and frontothalamic circuitry as brain reward system. In comparison of rCBF in both hemispheres, rCBF in right thalamus was observed to increase, which is possibly associated with impulsivity and change of affective status. Further research on the change of rCBF according to the duration after alcohol withdrawal is warranted.

알코올중독에 대한 포괄적 치료 체계의 개발

이해국(Hae Kook Lee),이명수(Myung-Soo Lee),기선완(Seon Wan Ki),최삼욱(Sam-Wook Choi),조근호(Keun Ho Joe),박애란(Aeran Park),정인원(In-Won Chung),김석범(Seok Beom Kim),이정태(Chung Tai Lee),권용실(Yong Sil Kweon) 대한사회정신의학회 2007 사회정신의학 Vol.12 No.2

Alcoholism is complex primary physiological disease with unique therapeutic interventions, and neither a primary behavior disorder nor ay symptomatic manifestation of any other disease process. And, it is highly prevalent disease with important impact on public health perspective. Therapeutic approach for alcoholism need to be organized by integrative and comprehensive systems, because that development and course of alcoholism are influenced by complex interaction between biological and environmental factors. We tried to developing effective intervening systems for alcoholism in seoul by evaluating the current state of service for alcoholism and referring to advanced treatment system in other countries. The problems of current state are lack of public awareness for seriousness of alcoholism, difficult access to treatment system and weak capacities to managing alcoholic patients in the community. Integrative and comprehensive intervening system for alcoholism are accomplished by developing system of matching services to alcoholic subjects in the community level based on seriousness and needs of alcoholic subjects. Referring to current state of alcoholism service in Seoul, treatment system should be developed based on continuum of care system in which the different intensity of service is placed and organized in the community level. First, the rehabilitation centers for chronic alcoholics and intensive outpatients centers should be newly established. Second, it is needed to strengthen the function of alcohol counseling centers and community mental health centers as coordination centers for alcoholics. Third, legal and political support should be established to induce improvement of inpatient and outpatient treatment service quality. Finally, setting up a committee to support and organize these integrative treatment systems is needed.

주요 우울증에서 Interleukin-10 유전자의 제한효소 절편길이 다형성

전태연,배치운,이정태,박원명,김광수,Jun, Taeyoun,Pae, Chi-Un,Lee, Chung Tai,Bahk, Won-Myong,Kim, Kwang-Soo 대한생물정신의학회 2000 생물정신의학 Vol.7 No.2

Objective : Major depression is known to have immunologic dysfunctions, the recent studies revealed that cytokines including IL-6 and IL-$1{\beta}$ were increased in patients with major depression. Since molecular genetic methods have been progressed, this study was to investigate the relationship between major depression and immunologic aspects by analyzing polymorphism of IL-10 gene. Method : 92 patients with major depression were included and data of 146 normal controls obtained from the Catholic Hemopoietic Stem Cell Information Bank of Korea were used in this study. DNA was extracted from whole blood, thereafter amplified by polymerase chain reaction, and digested by Mae III After that procedure, we obtained and assessed RFLP of two alleles, IL-10T and IL-10C. All data were analyzed by ${\chi}^2$ test. Results : 1) There were no significant difference in genotype frequencies of $IL-10^*T/T$, $IL-10^*T/C$, and $IL-10^*C/C$ between major depression patients group and control group. 2) There were no significant difference in allelic frequencies of $IL-10^*T$ and $IL-10^*C$ between major depression patients group and control group. Conclusion : We did not verified the differences in frequencies of $IL-10^*T/^*IL-10^*C$ gene between the major depression patients group and control group, respectively. But the results of this study do not declare that the IL-10 gene has no association with major depression. We do suggest that further systematic studies including various clinical variables should be conducted.

일 도시지역 위험음주의 유병률과 관련요인에 관한 연구

조중범(Joong-Bum Jo),이정태(Chung-Tai Lee),권용실(Yong-Sil Kweon),이경욱(Kyoung-Uk Lee),이해국(Hae-Kook Lee),조선진(Sun-Jin Jo),김한오(Hano Kim) 한국중독정신의학회 2011 중독정신의학 Vol.15 No.2

Objective : The aim of this study was to estimate the prevalence of hazardous drinking in a representative community sample of Seoul, Korea and to assess the sociodemographic and psycho-logical factors associated with hazardous drinking. Methods : Sociodemographic data, scores for AUDIT-K and other psycho-logical screening instruments were collected from a sample of 798 individuals from one of the municipal areas of Seoul. Recruitment was done based on a stratified-multistage-cluster sampling. Results : The 12-month prevalence of hazardous drinking was 36.6% (60.5% of males and 18.5% of females). Considering the sample as a whole, multiple logistic regression analysis showed that the risk factors of hazardous drinking were male (adjusted OR=7.96, 95% CI 5.36-11.83), young age (18-29 years old, adjusted OR=3.84, 95% CI 1.81-8.17) and high stress level (adjusted OR=1.72, 95% CI 1.19-2.49). Among males, the widowed/separated/divorced (adjusted OR=5.76, 95% CI 1.17-28.27) and high stress level (adjusted OR=1.68, 95% CI 1.03-2.75) were significant risk factors for hazardous drinking. In the case of females, young age (adjusted OR=6.22, 95% CI 2.04-18.94), high stress level (adjusted OR=2.01, 95% CI 1.12-3.61) and low resilience (adjusted OR=2.15, 95% CI 1.19-3.89) were risk factors for hazardous drinking. Conclusion : The prevalence of hazardous drinking in Seoul in this study was demonstrated to be one of the highest in the world. Our results also suggested that hazardous drinking was further associated with sociodemographic factors than with psychological factors. Preventive measures and intervention pro-grams should be tailored to males, young females and people with stressful life events to reduce the hazardous drinking in the community.

리아프노프 지수를 이용한 알쯔하이머형 치매 환자 뇌파의 비선형 역동 분석을 위한 예비연구

채정호,김대진,최성빈,박원명,이정태,김광수,정재승,김수용,Chae, Jeong-Ho,Kim, Dai-Jin,Choi, Sung-Bin,Bahk, Won-Myong,Lee, Chung Tai,Kim, Kwang-Soo,Jeong, Jaeseung,Kim, Soo-Yong 대한생물정신의학회 1998 생물정신의학 Vol.5 No.1

치매에서의 뇌파 연구는 주로 주파수 분석과 지형화 분석을 이용하여 정량화하는 것을 위주로 진행되어 왔으나, 이러한 선형적 분석은 뇌파와 같이 복잡한 신호를 분석하는 것에는 한계가 있었다. 최근 새로운 패러다임인 카오스 이론에 근거를 두고 뇌파를 비선형적으로 측정하는 방법이 소개되고 있다. 본 연구는 알쯔하이머형 치매 환자의 뇌파 신호를 최대 양수 리아프노프 지수를 이용하여 비선형적으로 분석하는 것이 가능한 가를 알아보고 그 결과를 대조군과 비교해보기 위하여 시도되었다. 3명의 알쯔하이머형 치매 환자와 3명의 대조군에서 뇌파 신호를 받아 디지털화한 후에 비선형 분석법 중 하나인 최대 양수 리아프노프 지수를 산출하였다. 알쯔하이머형 치매군은 전체 15개의 전극 부위 중 8곳의 전극 부위에서 대조군에 비하여 유의하게 낮은 최대 양수 리아프노프 지수를 나타내었다. 각 두뇌 영역별 및 반구별 분석에서도 알쯔하이머형 치매군이 대조군에 비하여 전 두뇌 영역에서 최대 양수 리아프노프 지수가 유의하게 낮았다. 이에 따라 알쯔하이머형 치매 환자의 뇌파를 비선형적 분석하여 조사한 이들 두뇌의 카오스적 성상이 감소되어 있다는 것을 확인할 수 있었다. 이 결과는 향후 뇌파의 비선형적 분석인 리아프노프 지수 산출이 두뇌 기능을 조사하는 데에 유용한 새로운 방법이 될 가능성이 있다는 것을 시사한다. The changes of electroencephalogram(EEG) in patients with dementia of Alzheimer's type are most commonly studied by analyzing power or magnitude in traditionally defined frequency bands. However because of the absence of an identified metric which quantifies the complex amount of information, there are many limitations in using such a linear method. According to the chaos theory, irregular signals of EEG can be also resulted from low dimensional deterministic chaos. Chaotic nonlinear dynamics in the EEG can be studied by calculating the largest Lyapunov exponent($L_1$). The authors have analyzed EEG epochs from three patients with dementia of Alzheimer's type and three matched control subjects. The largest $L_1$ is calculated from EEG epochs consisting of 16,384 data points per channel in 15 channels. The results showed that patients with dementia of Alzheimer's type had significantly lower $L_1$ than non-demented controls on 8 channels. Topographic analysis showed that the $L_1$ were significantly lower in patients with Alzheimer's disease on all the frontal, temporal, central, and occipital head regions. These results show that brains of patients with dementia of Alzheimer's type have a decreased chaotic quality of electrophysiological behavior. We conclude that the nonlinear analysis such as calculating the $L_1$ can be a promising tool for detecting relative changes in the complexity of brain dynamics.

효율적인 적정음주기준의 개발

이해국(Hae-Kook Lee),이정태(Chung-Tai Lee),권용실(Yong-Sil Kweon) 한국중독정신의학회 2006 중독정신의학 Vol.10 No.2

Alcohol consumption has been associated with favorable as well as adverse health effects. Alcohol is an addictive substance, therefore some individuals who drink alcoholic beverages develope alcoholism and others experience various alcohol problems. We have a permissive cultural background to alcohol drinking, so the prevalence of alcoholism and alcohol problems are generally high. Therefore, it is needed to develope effective guideline for moderate drinking to prevent drinking related harm. Many countries have moderate drinking guidelines to prevent heavy drinking and drinking related harm. Generally, guidelines recommend 35-50 gram of alcohol as a tolerable level of daily consumption. But, developing and application of guidelines are very carefully considered because even small amount of alcohol can cause various risk by individual’s vulnerabilities and different sociocultural background. And, it is not recommended that the abstinences start drinking to obtain health effect of moderate drinking. We reviewed some drinking guidelines of other countries, and suggested several principles of conducting moderate drinking guidelines. First, considering our permissive legal and cultural environment, we need a more strict guidelines. Second, to developing effective drinking guidelines, the efforts to increase public awareness of drinking related harm need to be conducted. Third, the intensive researches which is related to pharmcokinetics and toxic effects of alcohol in Korean should be followed.

중독관리통합지원센터에서 조사한 지역사회알코올 사용문제 실태

김성환(Sunghwan Kim),이해국(Hae Kook Lee),이정태(Chung-Tai Lee),전광용(Kwang Yong Jeon),윤창교(Chang-gyo Yoon),원은옥(Eun Ok Won),박승일(Seung-il Park),이승엽(Seung-Yup Lee) 한국중독정신의학회 2018 중독정신의학 Vol.22 No.2

Objectives : We aimed to investigate the prevalence of problematic alcohol use screened with Alcohol Use Disorders Identification Test (AUDIT) by a community addiction management center and provide data on descriptive comparison with the overall prevalence investigated by the community health survey 2012-2016. Since the community health survey does not utilize a standardized test, there is a need to examine whether it accurately captures the problematic alcohol use in the community. Methods : We analyzed the 2013-2017 data of 6888 people screened by the Uijeongbu Community Addiction Management Center with AUDIT. The prevalence was compared with the overall prevalence investigated by the community health survey 2012-2016. Results : Hazardous drinking behavior (male 53.8%, female 35.4%) and suspected alcohol use disorder (male 19.6%, female 6.7%) were significantly higher in males than females and the odds ratios of males were 2.13 and 3.40, respectively. The age groups from the twenties to the fifties reported high problematic alcohol use. The results revealed that hazardous drinking and suspected alcohol use disorder rate were higher at the center screening as compared to the general population based on the community health survey conducted during the similar period. Conclusion : Young and middle-aged adult males were the identified risk group for problematic alcohol use that re-quires more public health resources for the prevention. It is hypothesized that utilization of established screening tools in the community health survey may improve the accuracy of problematic alcohol use detection in the community.

알코올 금단 환자에서 금단 섬망 발생의 위험요인

권용실(Yong-Sil Kweon),이해국(Hae-Kook Lee),이정태(Chung Tai Lee),이지현(Ji-Hyun Yi) 한국중독정신의학회 2003 중독정신의학 Vol.7 No.2

Alcohol withdrawal syndrome occurs in alcohol dependent patients who discontinue or decrease their alcohol consumption. Delirium tremens, is not a frequent, but serious complication of alcohol withdrawal in patients with alcohol dependence. To identify clinical characteristics associated with development of delirium tremens, we performed retrospective case-control study among discharged with diagnosis of alcohol dependence. Seventy six patients discharged between June 2002 and June 2003 were enrolled to this study. Among 76 subjects, 29 patients developed delirium tremens during hospitalization. Bivariate analysis indicated that age, duration of current episode, days since last drinks, comorbid medical illness and presence of brain vulnerability were associated with development of delirium tremens. In a stepwise multiple regression model, four risk factor were significantly correlated with the development of delirium tremens:days since last drinks, brain vulnerability, age, pulse rate (Percentage correct=82.9%). Prediction of alcohol withdrawal delirium by evaluation of several readily available clinical variables can be useful in effective management of alcohol withdrawal patients.