TAS-20의 한국판 3종간의 신뢰도 및 타당도 비교

정운선,임효덕,이양현,김상헌,Chung, Un-Sun,Rim, Hyo-Deog,Lee, Yang-Hyun,Kim, Sang-Heon 한국정신신체의학회 2003 정신신체의학 Vol.11 No.1

연구목적: 1985년 Taylor 등이 발표한 TAS는 감정표현불능증을 측정하는 도구로서 1992년 TAS-20으로 개정되어 여러 나라에서 신뢰도와 타당도가 검증되었다. 본 연구는 혼재되어 쓰이고 있는 세 가지 TAS 한국판 감정표현불능증 척도를 비교하여 가장 신뢰도와 타당도가 높은 척도를 통일하여 사용하고자 시도되었다. 첫 번째 척도는 1996년 이양현 등이 개발한 것{이후 TAS-20K(1996)}이다. 두 번째 척도는 위 연구에서 "어떤 문제를 묘사하기보다는 분석하는 편이다"라고 직역한 5번 항목의 결과가 예측치와 상반되어 '분석하다'라는 단어에 대한 우리나라와 서양의 문화적 견해 차이를 고려하여 5번 문항을 수정 제안한 것{이후 TAS-20K(2003)}으로서, 타당도와 신뢰도의 호전을 검증하지 않은 것이다. 세 번째 척도는 1997년 신현균과 원호택이 TAS-20을 번역한 것(이후 S-TAS)으로 20항목의 원래 항목 수를 23개로 수정 번역한 특성을 지니고 있다. 방 법: 의학과 학생 408명을 대상으로 세 가지 척도의 서로 다른 항목, 즉 TAS-20K(1996)의 20항목, TAS-20K(2003)의 수정 제안된 1항목, S-TAS의 23항목을 무작위로 배열하여 구성된 하나의 척도를 사용하여 검사를 시행하였다. 세 가지 척도의 신뢰도를 비교하기 위해 내적 일치도(Cronbach $\alpha$ coefficients)를 구하였고 타당도를 비교하기 위해 확증적 요인 분석(confirmatory factor analysis)을 실시하였다. 결 과: TAS-20K(2003)은 TAS-20K(1996)보다 내적 일치도가 호전되었다. TAS-20K(2003)과 S-TAS는 모두 원척도의 세 요인 구조를 재현하였고, 우수한 내적 일치도와 받아들일 만한 타당도를 보여 주었다. 그러나 S-TAS는 19번 항목이 요인 2와 상관성이 낮게 나타났고, 이전 연구에서와 같이 2번 항목과 요인 1간의 상관성이 재현되지 않아 본래 요인 2에 속한 19번 항목을 요인 1에도 포함시키는 것이 타당하지 않았다. 결 론: TAS-20K(2003)과 S-TAS는 모두 원본 TAS-20의 번역판으로서 우수한 타당도와 받아들일만한 신뢰도를 보였다. 그러나 TAS-20K(2003)은 원본과 동일한 항목 수와 구조, 동일한 점수 체계를 유지하고 있으며 TAS-20은 이미 15개 이상의 언어로 번역되어 있는 도구이나, S-TAS는 항목 수 및 점수 체계, 요인 구조를 원본 TAS-20과 다르게 변형시켜 국제적인 비교 연구를 위해서는 제한점이 있다고 하겠다. 따라서 향후 감정표현불능증의 국내 연구에서 TAS-20K(2003), 즉 TAS-20K를 사용하는 것이 더 적절할 것으로 제안한다. Objectives: The purpose of this study was to compare reliability and validity of three Korean versions of the 20-item Toronto Alexithymia scale and to confirm the most reliable and validated Korean translation of the 20-item Toronto Alexithymia Scale for both clinical and research purpose in Korea. The first one was a Korean version of the 20-Item Toronto Alexithymia Scale developed by Lee YH et al in 1996 which was designated as TAS-20K(1996) in this study. This scale had a problem with one item due to the cultural difference regarding the word 'analyzing' between western culture and Korean culture. The second one was the revised version of TAS-20K(1996) on that point by Lee YH et al in 1996 without validation which was designated as TAS-20K(2003) in this study. The third one was a 23-item Korean version developed by Sin HG and Won HT in 1997, which was somewhat different from the 20-item Toronto Alexithymia Scale(TAS-20) in the number of total item, the content of some items and the scoring method. This scale was designated as S-TAS here. Methods: 408 medical students were tested with one scale composed of all the different items randomly arranged from the three versions. We evaluated goodness-of-fit and Cronbach $\alpha$ coefficients of three scales for reliability. We used confirmatory factor analysis to compare validity. Results: TAS-20K(2003) showed that it had better internal consistency than TAS-20K(1996), which implied that the cultural difference should be considered in the Korean translation. Both TAS-20K(2003) and S-TAS replicated three-factor structures and had adequacy of fit, good internal consistency and acceptable validity. However, S-TAS had one item with poor item-factor correlation and didn't show high correlation between item 2 and factor 1 as before in 1997. Conclusion: Although S-TAS had added 3 items and changed the content of two items, it didn't show better reliability and validity than TAS-20K(2003). Therefore it is proposed to use TAS-20K (2003) as the Korean version of the 20-item Toronto Alexithymia Scale(TAS-20K) for international communication of results of Alexithymia research. It has good internal consistency and validity and maintains original items, the same construct and scoring method as the 20-item Toronto Alexithymia Scale.

폐경기 증후군의 생물학적 접근

강병조,이죽내,임효덕,강석헌,Kang, Byung-Jo,Lee, Zuk-Nae,Rim, Hyo-Deog,Kang, Suk-Hun 한국정신신체의학회 1996 정신신체의학 Vol.4 No.1

최근 호르몬 대치요법으로 갱년기 증상들만 없어질 뿐 아니라 심장질환, 골다공증 등의 예방은 물론이고 젊음의 유지 및 삶의 질이 높아지자 산부인과 의사는 물론이고 정신과 의사들도 갱년기 증상에 대해서 다시 더 많은 관심을 갖게 되었다. 그리하여 저자는 일반 정신과 의사들이 갱년기 증상을 이해하는데 도움을 주기 위하여 갱년기 증상중 정신과와 관련이 있는 열성홍조와 갱년기 우울증을 중심으로 다음과 같은 몇 가지 점을 문헌고찰을 통하여 재검토하였다. 갱년기 및 폐경기의 정의. 갱년기의 생리(난소의 노화, 주간 율동의 변화, 초일주기 율동의 변화, 시신경교차 상부핵의 일주기 율동의 변화), 혈관운동성 홍조(정의와 병태생리, 원인, 진단, 치료), 갱년기 우울증(정의, 원인, 치료) 등을 재고찰하여 보았다. Hormone replacement therapy in menopausal women has recently been a hot issue in medical fields. The author reviewed the physiology of menopause and discussed the physiological mechanism and biological management of vascular flushing and menopausal depression. The above symptoms are hard to distinguish from those of psychiatric disorders.

망상을 가지고 있는 정신분열병 환자들에서 나타나는 비약적 결론내리기의 실험적 고찰

이문기(Moon-Ki Lee),임효덕(Hyo-Deog Rim),원승희(Seung-Hee Won),김양태(Yang-Tae Kim) 대한생물치료정신의학회 2011 생물치료정신의학 Vol.17 No.1

Objectives : Delusion is the key symptom that is observed among the patients with schizophrenia. The patients with schizophrenia with delusion symptom tend to have an early conclusion based on the unsatisfying data under the cognitively uncertain circumstances. Such reasoning bias is called as the “Jumping-to-conclusion”. Few studies have been made on the effect of “Jumping-to-conclusion” bias onto delusion in our nation. The present study aimed to review the presence of the reasoning bias of “Jumping-to-conclusion” in the patients with schizophrenia and to investigate the meaningful relationship of such “Jumping-to-conclusion” with patient symptoms and working memories of the patients with schizophrenia.. Methods : The patient group of the present study included 26 patients with schizophrenia who were hospitalized or treated as outpatients in the national bugok hospital. The diagnosis for the schizophrenia was made by 2 medical specialists in the psychiatric department based on the DSM-Ⅳ diagnosis criteria. As the normal control group, 25 normal healthy subjects who could be comparable to the patient group in terms of gender, age, and education year were included. To all participants of the study, bead test and emotional card test were performed, and the computerized Wisconsin card sorting test that can measure the working memories of test subjects was also performed. Results : Compared to the normal group, the schizophrenia patient group made an early conclusion in both of bead test and emotional card test. But the results did not show statistically significant relationship with the PANSS score and with the Wisconsin card sorting test. Conclusion : The present study confirmed the presence of “Jumping-to-conclusion” bias in the patients with schizophrenia and proved that this bias is not related to psychiatric symptoms and to injuries of working memories.

정신약물에 의한 피부 부작용

우정민(Jungmin Woo),임효덕(Hyo-Deog Rim),원승희(Seunghee Won),이승재(Seung Jae Lee),김병수(Byung-Soo Kim),장성만(Sung Man Chang) 대한생물치료정신의학회 2017 생물치료정신의학 Vol.23 No.3

Psychotropic drugs are one of the most widely prescribed drugs. Adverse skin reactions are associated with psychotic drugs. These drug side effects occur in about 2% to 5% of patients. Mostly, the prognosis is good. However, some may be life-threatening. Life-threatening side effects are mainly related to mood stabilizers, antidepressants, and antipsychotic drugs. Once these side effects occur, the drug should be discontinued and treated for cutaneous and related symptoms. However, it would be better if prevention could be done before these side effects develop. Interestingly, mild adverse events occur within a few days, and severe adverse events develop after 1-3 weeks. Regardless of its severity, skin adverse effects can cause secondary issues that increase the cost of treatment and lower the patient`s adherence to medications, so clinician should be able to recognize and respond quickly to this problem.

HIV 감염의 정신의학적 이해와 치료적 고려점

장서영(Seoyoung Jang),임효덕(Hyo-Deog Rim),김경민(Kyungmin Kim),김병수(Byung-Soo Kim),우정민(Jungmin Woo) 대한생물치료정신의학회 2020 생물치료정신의학 Vol.26 No.3

Following the development of human immunodeficiency virus (HIV) treatments, the mean lifespan of patients with an HIV infection has increased to a level comparable to the general population. Patients receiving HIV treatment can achieve viral suppression and perform routine activities without the risk of infection transmission. Recently, the quality of life (QoL) and mental health of patients are becoming the primary outcomes in HIV treatment. The objective of this review was to investigate psychiatric disorders in patients with an HIV infection and available treatment programs. A search for clinical studies and scientific publications was performed. Patients with an HIV infection had a higher prevalence of psychiatric disorders than the general population. The psychopathological factors in HIV infection included neurobiological changes of infection, side-effects of medications, negative social perception, and unresolved intrapsychic conflicts. Severe and unmanaged psychiatric disorders with HIV infection negatively impacted HIV infection transmission and treatment adherence. However, psychiatric treatment programs and referrals to a psychiatric professional were found to be insufficient in most countries. This review revealed a need for psychiatric interventions in clinical practice to improve patients’ mental health and HIV treatment adherence. Psychiatric interventions integrated with conventional HIV treatment can be efficacious to achieve this goal. In addition, clinicians need to investigate and recognize HIV-related stigma as the relationship between patients and clinicians has a significant role in the patient’s treatment adherence.

지역사회 정신보건서비스에 대한 요구도 조사

배종덕(Jong Duk Bae),임효덕(Hyo Deog Rim),정희정(Hee Jeoung Jeoung),이호진(Ho Jin Lee),박병선(Byung Sun Park),장성만(Sung Man Chang) 대한사회정신의학회 2009 사회정신의학 Vol.14 No.2

본 연구는 정신보건센터에 대한 지역주민들의 요구도를 파악하고, 향후 지역사회 정신보건사업에서 제공하여야 할 서비스에 대하여 알아보고자 하였다. 조사 결과 대부분의 지역사회 주민들이 정신보건센터의 필요성에 대하여 공감하고 있었다. 하지만, 서비스 제공 내용에 관해서는 일반 지역주민과 정신장애인 및 그 가족에서 차이를 보였다. 지역사회 정신보건사업은 그 직접적인 소비의 대상이 되는 정신장애인 및 그 가족들이 요구하는 지역사회 재활과 환자 관리를 더욱 강화해야 필요가 있을 것으로 보인다. Objectives:The aims of the study is to assess the needs of general population and family of the mentally ill living in community and to provide basic data for developing practical services in community mental health. Methods:Face to face interviews were done for the subjects (n=182), randomly selected from the community, with questionnaire about community needs of mental health. We compared the needs between general population and the mentally ill and their family. Results:Among the respondents, 96.2% of them recognized the need of community mental health service. Similarly, both of the groups recognized needs of the community mental health services about dementia, adolescent problem, alcohol use, and mental disorder entities. The need of psychosocial rehabilitation was preferentially demanded among the mentally ill and their family. Conclusions:This study suggests that community mental health service should be provided considering the priority based on the community needs.

지연된 유방암 진단을 예측하는 정신사회적 요인 : 부부관계기능의 역할

김지영,우정민,이상신,김혜원,강동우,임효덕,Kim, Ji Young,Woo, Jungmin,Lee, Sang Shin,Kim, Hea Won,Khang, Dongwoo,Rim, Hyo-Deog 한국정신신체의학회 2014 정신신체의학 Vol.22 No.1

연구목적 2001년 이후로 유방암은 한국에서 가장 흔한 여성 암이 되었다. 진행 유방암으로 진단받을 고위험군을 확인하는 것은 유방암 사망률을 줄이기 위한 효과적인 방법 중 하나라고 할 수 있다. 본 연구의 목적은 유방암을 진단 받은 시점에서 진행 유방암과 연관된 사회인구학적, 건강행위 건강특성, 임상적 그리고 정신사회적 요인을 조사하며, 진행 유방암을 예측할 수 있는 요인을 밝히는 데 있다. 방법 경북대학교 병원에서 처음으로 유방암을 진단받고, 수술을 시행한 후 '유방암 환자들을 위한 스트레스 클리닉'에 자문 의뢰되어 정신의학적 면담이 시행된 219명의 환자를 대상으로 하였다. 기본 사회인구학적 자료를 비롯하여, 자가진단 및 유방촬영술의 규칙적 시행여부, 진단 당시의 병기, 유방암 발견 경위 등을 조사하였다. 정신사회적 요인으로는 경제적 및 가족적 부담, 부부관계기능, 가족관계기능 정도 등을 반구조화된 면담을 통해 파악하였다. 교차분석과 로지스틱 회귀분석으로 조기 유방암 환자군과 진행 유방암 환자군 간에 변수를 비교하고 진행 유방암 환자군을 예측할 수 있는 요인을 확인하였다. 결과 유방암을 진단받은 시점에서 120명(54.8%)이 진행 유방암으로 확인이 되었다. 단변량분석을 통하여 조기 유방암을 진단받은 환자군과 진행 유방암을 진단받은 환자군 사이에 통계적으로 유의한 차이가 난 변수는 다음과 같았다. 건강행위 및 특성 변수로는 자가 검진행위(p<0.000), 매년 유방촬영술 시행여부(p<0.000)이었다. 암 관련 임상적 특징으로는 종양 발견경위(p<0.000), 첫 증상의 양상(p<0.000), 첫 증상 발견부터 치료까지 소요된 기간(p<0.000)이었다. 정신사회적 요인으로는 부부관계기능(p<0.000)과 가족관계기능(p=0.000), 과도한 경제적 가족적 부담(p=0.018)이었다. 로지스틱회귀분석을 통하여 매년 비진행 유방암에 영향을 미치는 독립인자로는 매년 유방암 선별을 위해서 실시하는 유방촬영술을 비정기적으로 시행하거나(OR=7.431 ; 95% CI 2.407-22.944), 전혀 시행하지 않는 경우(OR=25.299 ; 95% CI 7.855-81.482)였으며 정신사회적 요인으로는 기능 부전적 부부관계(OR=4.772 ; 95% CI 2.244-10.145)가 유일했다. 결론 본 연구를 통하여 진행 유방암 진단의 위험인자로 널리 알려진 비정기적 검진을 재확인하였으며, 이외에도 정신사회적 요인으로서 '비기능적 부부관계기능'을 밝혀냈다. 이러한 결과는 유방암을 조기에 진단하는데 전통적으로 인정되어 왔던 사회인구학적, 임상적 요인 이외에도 정신사회적 요인이 중요한 영역임을 시사한다. Objectives : Breast cancer has been the most prevalent female cancer in South Korea since 2001. Early detection of this disease is the most effective strategy for reducing mortality. The objective of this study was to identify factors which could predict advanced stage at diagnosis of breast cancer. Methods : Participants who were initially diagnosed with breast cancer and referred to the Stress Clinic of the Breast Cancer Center at Kyungpook National University Hospital were included. Through a semi-structured interview, the authors investigated psychosocial variables such as the extent of marital and family functioning and emotional-economic family burden as well as sociodemographic and health behavior-, health characteristic- and cancer-related variables. Results : Data were collected from 219 participants. One hundred and twenty(54.8%) subjects were diagnosed with advanced-stage breast cancer. Variables that were significantly different between the advanced-stage and early-stage groups included : monthly breast self examination(p<0.000), annual mammographic screening(p<0.000), mode of tumor detection(p<0.000), nature of the first symptoms(p<0.000), time to treatment after diagnosis(p<0.000), overloaded economic and family burden(p=0.018), marital functioning(p<0.000) and family functioning(p<0.00). Logistic regression analysis indicated that irregular annual mammography screening(OR=7.431 ; 95% CI 2.407-22.944) or a lack of screening(OR=25.299 ; 95% CI 7.855-81.482) and a dysfunctional marital relationship(OR=4.772 ; 95% CI 2.244-10.145) were significantly associated with advanced stage at diagnosis of breast cancer. Conclusions : We reconfirmed screening behavior to be a risk factor for delayed diagnosis of breast cancer. Our findings also emphasized the importance of psychosocial factors such as marital functioning in early detection of breast cancer. Psychiatric consultation in the area of martial functioning could be beneficial for increasing early detection in breast cancer.

유방암 환자에서 생활사건 스트레스가 치료지연에 미치는 영향

우정민(Jungmin Woo),정재훈(Jaehoon Jeong),임효덕(Hyo-Deog Rim) 대한생물치료정신의학회 2015 생물치료정신의학 Vol.21 No.1

메스암페타민 의존으로 입원한 환자의 인구학적 및 임상적 특성

김병규(Byung-Gyu Kim),박희권(Hee-Kwon Park),임효덕(Hyo-Deog Rim),조성남(Sung-Nam Cho),김지영(Ji-Yeong Kim),권성민(Sung-Min Kwon),권도훈(Do-Hoon Kwon) 한국중독정신의학회 2005 중독정신의학 Vol.9 No.1

The purpose of this study was to obtain the demographic and clinical characteristics of hospitalized methamphetamine abuse or dependent patients at National Bugok Hospital. The study subjects were 52 hospitalized male patients who met the DSMIV criteria for methamphetamine abuse or dependence. Two psychiatrists of National Bugok Hospital obtained basic data of the patients. The survey questionnaires had components that could inform clinical data of the patterns and typical problems associated with methamphetamine use. The average age of the study subjects was 37.6 years. The majority of patients were in their 30s (67.3%) and 40s (26.9%). High school graduation was the most common education achievement level. Individuals who had higher education levels tended to start taking methamphetamine earlier and admit themselves to hospitals voluntarily. It took 6.8 years from the start of methamphetamine use for users to be arrested and 10.4 years for them to admit themselves for treatment. After injecting methamphetamine, most of the study subjects indulged in risky behavior such as reckless sexual contact and driving. Because of methamphetamine users’ conviction about having control over the drug and denial of drug-related problems, they are unable or unwilling to recognize the problematic nature of the drug. The government must provide education programs on the related problems of methamphetamine use and provide treatment facilities for users.

부부관계기능이 한국 여성 유방암 환자의 증상 인식 후 치료 지연에 미치는 영향

김경덕(Kyungdeok Kim),이상원(Sangwon Lee),우정민(Jungmin Woo),이상신(Sang Shin Lee),임효덕(Hyo-Deog Rim) 대한생물치료정신의학회 2016 생물치료정신의학 Vol.22 No.3

Objectives:Early detection and treatment of breast cancer has a high correlation with survival. Nevertheless, onethird of the patients who are newly diagnosed with breast cancer do not visit hospital within three months of recognizing their symptoms. This study was performed to determine the influence of marital relationship functioning on the time it takes patients with symptomatic breast cancer to present to hospital. Methods:Two hundred and sixteen post-operative breast cancer patients who were referred to the Stress Clinic at the Breast Cancer Center at Kyungpook National University Hospital were included. We divided the patients into two groups: early presentation(within three months), and delayed presentation(after three months) once a diagnosis of breast cancer is determined. Marital relationship functioning was evaluated with the Global Assessment of Relational Functioning(GARF) tool. Results:Fifty seven patients fell into the delayed presentation group(i.e. they presented to the Stress Clinic after three months). It was determined that advanced stage cancer was more prevalent in the delayed presentation group (p=0.035). Patient delay was associated with a higher level of dysfunctional marital relationship functioning(OR=3.861, 95% CI=1.003-12.553). Conclusion:Dysfunctional marital relationship functioning was found to be an important factor associated with delayed presentation for the treatment of breast cancer.