양극성 장애 외래환자에서 야간식이증후군의 임상적 특성

정하란,윤보현,시영화,송제헌,박수희,구본기,김경민,남석현,Jung, Haran,Yoon, Bo-Hyun,Sea, Young-Hwa,Song, Je-Heon,Park, Suhee,Koo, Bonki,Kim, Kyung-Min,Nam, Seok-Hyun 한국정신신체의학회 2014 정신신체의학 Vol.22 No.2

연구목적 이 연구의 목적은 양극성 장애로 진단받은 정신과 외래 환자에서 야간 식이습관의 임상적 특성을 조사하는데 있다. 방 법 정신건강의학과 외래를 방문한 84명의 양극성 장애 환자를 대상으로 14개 항목의 야간 식이증후군 설문지(NEQ)를 자가 보고로 실시하였다. 이들의 인구학적, 임상적 특성을 조사하고 신체 질량 지수(BMI), 주관석 기분과 수면, 폭식과 체중에 관련된 삶의 질에 대한 평가를 Beck Depression Inventory(BDI), Binge Eating Scale(BES), Korean version of Obesity-related Quality of Life scale(KOQoL), Pittsburg Sleep Quality Index(PSQI) 등을 포함한 설문을 통해 얻었다. 결 과 양극성 장애 외래 환자 중 야간 식이증후군의 유병률은 14.3%(84명 중 12명)이었다. NES와 Non-NES군 사이에서는 경제적 상태와 동반되는 내과 질환을 제외한 성별, 나이, 교육 년 수, 결혼 및 직업 상태, 흡연, 음주 등의 인구사회학적 특성에서 양군간에 유의한 차이를 보이지는 않았다. 하지만, Non-NES 군에 비해 NES군에서 폭식이 많았고 비만으로 인한 삶의 질 저하가 나타났다. 결 론 이번 연구는 야간식이를 보이는 양극성 장애 외래환자의 임상적 특성을 처음으로 기술하였다. 비록 양극성 장애 외래 환자의NES군에서 뚜렷한 상관 관계를 보이는 특성이 많지는 않았지만, 상대적으로 NES 유병률이 높은 것으로 볼 때 임상에서 양극성 장애 환자 평가 시 비만 여부에 관계 없이 NES를 염두에 두어야 할 것이다. Objectives : The aim of this study is to evaluate the clinical characteristics of night eating syndrome(NES) in bipolar disorder outpatients. Methods : The 14 items of self-reported night eating questionnaire(NEQ) was administered to 84 bipolar patients in psychiatric outpatient clinic. We examined demographic and clinical characteristics, body mass index(BMI), subjective measures of mood, sleep, binge eating & weight-related quality of life using Beck's Depression Inventory (BDI), Pittsburgh Sleep Quality Index(PSQI), Binge Eating Scale(BES) and Korean version of Obesity-Related Quality of Life Scale(KOQoL), respectively. Results : The prevalence of night eating syndrome in bipolar outpatients was 14.3%(12 of 84). Comparisons between NES group and non-NES group revealed no significant differences in demographic characteristics, BMI and clinical status except economic status and comorbid medical illnesses. However, compared to non-NES, patients with NES was more likely to have binge eating pattern and poorer weight-related quality of life. Conclusions : This study is to be the first to describe the clinical correlates of night eaters in bipolar outpatients. Although there were few significant correlates of NES in bipolar outpatients, relatively high prevalence of NES suggest that clinicians should be aware to assess the patients with bipolar disorder on NES, regardless of obesity status of patients.

Screening for Attention Deficit Hyperactivity Disorder among Korean College Students: Prevalence, Correlates and Comorbidities

강한고은비,윤보현,정하란,김경민,윤현주,송재헌,박수희,시영화 대한우울조울병학회 2019 우울조울병 Vol.17 No.3

Background: The aim of this study was to screen Korean college students for correlates, and comorbidities associated with attention-deficit hyperactivity disorder (ADHD). Methods: A total of 2,593 college students participated in the study. Socio-demographic and clinical data were collected and self-report scales, such as the Adult ADHD Self-Report Scale-Version 1.1, the Center for Epidemiologic Studies Depression Scale, the Korean version of the Mood Disorder, a modified Korean version of the 16-item Prodromal Questionnaire, and the Alcohol Use Disorders Identification Test were included. Students with and without ADHD were compared using univariable analyses, and the association of ADHD with other psychiatric comorbidities was predicted using multivariable analyses. Results: Of the total participants, 4.7% were diagnosed with ADHD. Multivariable analysis revealed that ADHD in college students was significantly associated with depression, psychotic-like experience, alcohol abuse, and female sex after adjustment. We found that ADHD in young college students was associated with several psychiatric comorbidities. Conclusion: These results suggest the need for early detection of ADHD in young adults and highlight the importance of implementing early psychiatric intervention for problems such as depression, psychotic-like experience, and alcohol abuse in adults with ADHD.

소비자 만족 증진을 위한 간호서비스 리포지셔닝 방안

박영희,나후자,정하란,이신숙,박묘윤,이남형,윤미옥,민효숙,신동순,문원희,황관옥,심희숙,오경옥 충남대학교 간호과학연구소 2003 충남대 간호학술지 Vol.6 No.1

The purpose of this study was to evaluate the change of the satisfaction degrees before and after repositioning strategies between the consumers and nurses about nursing services. The subjects of this study were composed of 666 consumers and 215 nurses. Data were collected from December 2002 to August 2003. The tool used for this study was modified SERVQUAL model and the data were analyzed using SPSS/PC ver. 10.0. The result of the study were as follows: 1. The satisfaction degrees of consumers about nursing services were showed statistically significant difference in all items (before repositioning: 73.67±12.27, after 1st repositioning: 74.5±10.62, after 2nd repositioning: 79.76±11.65) The influencing factor of nursing service was marital status according to the result of multiple regression analysis. 2. There was statistically significant difference in all 5 factors which were tangibility, reliability, responsiveness, assurance, empathy (P<0.001), in the satisfaction degrees of consumers about nursing service. 3. There was statistically significant difference in 3 factors which were tangibles, assurance, empathy (P<0.000) in the nurses' satisfaction degrees about nursing service. 4. There was statistically significant difference in all 5 factors in satisfaction degrees about nursing service between the consumers and nurses (P<0.001). In conclusion, We know that this study contribute to consumers' satisfaction improvements, it was shown positive change between the consumers' and nurses' satisfaction degrees about nursing service through the performance of repositioning strategies. If continuous investigation and feed back were accomplished for the consumers' satisfaction improvements, we thought they brought us the goal of improved hospital image as well as rehospitalization, for increasing income.

수술 전 환자 및 수술부위 확인 강화활동을 통한 환자안전 증진

신용섭,박순선,정하란,이신숙,이미향,이선희,박향숙,이영옥,지현순,윤현숙,황인옥,송윤희,신수희,봉희정,전미영,서경희,김보영,주은영,이용옥 한국의료QA학회 2009 가을학술대회 Vol.2009 No.3

수혈적응증 입력 프로그램 개발 및 혈액제제 신청 사유 분석

신우용,이정재,정하란,신정원 대한수혈학회 2019 大韓輸血學會誌 Vol.30 No.2

Background: Transfusion guidelines are not only essential for the optimal use of blood products, but also help reduce transfusion-related adverse reactions and improve patients’ outcomes. In this hospital, a transfusion-indication data-entry program based on the national transfusion guidelines was developed and applied to the electronic medical record system in 2016. All transfusion orders, except for emergencies, have been performed using this program since then. This study analyzed the reasons for the transfusion to monitor the blood product usage and provide feedback to clinicians. Methods: The transfusion-indications were classified by the blood product and a pop-up window listing these indications was produced. The indications were as follows: red blood cells (RBCs) - acute blood loss, chronic anemia, surgery/procedure, transplantation and ‘other’; platelets (PLTs) - active bleeding, bleeding prophylaxis, surgery/procedure, massive transfusion, and ‘other’; fresh frozen plasma (FFP) - bleeding in coagulopathy, bleeding prophylaxis in coagulopathy, massive transfusion, plasma exchange, and ‘other’. The indications entered into the data-entry program from Sep 2016 to Feb 2018 were analyzed. Results: The most common indications for transfusion were chronic anemia for RBCs (7977/16138, 49.4%), bleeding prophylaxis for PLTs (5726/11158, 51.3%), and ‘other’ for FFP (2180/6024, 36.2%). Many clinicians entered the transfusion indication as ‘other’, but the free-text supplied by the clinician when ‘other’ was selected, often corresponded to an indication already categorized in the transfusion-indication data-entry program. Conclusion: Feedback and training on the data of transfusion indications are needed for clinicians to properly use blood products by operating the transfusion-indication data-entry program more efficiently. (Korean J Blood Transfus 2019;30:138-147)

청소년에서 자살사고가 동반된 자해행동에 대한 예측인자

탁창훈,윤보현,김경민,시영화,정하란,송제헌,박수희,박진형 대한우울조울병학회 2017 우울조울병 Vol.15 No.3

Objective : To examine the relationship between self-injurious behavior and suicidality and to identify predictive factors of self-injurious behavior with suicidal ideation in adolescents. Methods : Among 4,421 middle and high school students, 613 subjects that reported self-injurious behavior were included in this study. They were asked to complete self-reporting questionnaires to evaluate sociodemographic factors and psychosocial status. They were divided into self-injurious behavior with the suicidal ideation group and the non-suicidal self-injurious behavior group according to self-report items. Data were compared between the two groups. Results : Six hundred thirteen adolescents (13.8%) of 4,421 reported history of past self-injurious behavior and 352 (57.4%) of 613 adolescents experienced concurrent suicidal ideation. Multivariate logistic regression analysis revealed that depression (OR=2.989), female (OR=2.447), drinking (OR=1.826) and recent stress (OR=1.017) were significantly associated with self-injurious behavior with suicidal ideation in adolescents. Conclusion : Results revealed multiple factors predicting selfharm behavior accompanying suicidal ideation in adolescents that may be useful for intervention programs for high risk adolescents of suicide.

조현병 환자에서 가족관계와 삶의 질의 관계

강한고은비(Hangoeunbi Kang),정하란(Ha-Ran Jung),이주연(Ju-Yeon Lee),김선영(Seon-Young Kim),김재민(Jae-Min Kim),윤진상(Jin-Sang Yoon),김성완(Sung-Wan Kim) 대한생물치료정신의학회 2018 생물치료정신의학 Vol.24 No.3

Objectives:The aim of this study was to examine associations between quality of life in patients with schizophrenia and their family relationships. Methods:A total of 68 patients with schizophrenia participated in the study. Socio-demographic and clinical data were collected, as well as results from the Subjective Well-being under Neuroleptic Treatment Scale-Short Form(SWNK), Family Emotional Involvement and Criticism Scale(FEICS), a visual analogue scale for evaluating the degree of perceived criticism(VAS), the Family Adaptability and Cohesion Evaluation Scale(FACES), Beck Cognitive Insight Scale(BCIS), and Rosenberg Self Esteem Scale(R-SES). Psychiatrists administered the Positive and Negative Syndrome Scale and the Calgary Depression Scale for Schizophrenia(CDSS), and collected a history of previous suicide attempts. Results:The SWN-K total scores showed significant negative correlations with scores on the FEICS perceived criticism, CDSS, and VAS measures and significant positive correlations with scores on the R-SES, FACES, and BCIS. Multiple regression analysis revealed that FEICS perceived criticism, FACES, and BCIS scores were significantly associated with SWN-K scores. The FACES total score was significantly lower in patients with a history of previous suicide attempt. Conclusion:The quality of life of patients with schizophrenia was negatively associated with greater perceived familial criticism and positively associated with better family cohesion and higher patient insight. In patients with a history of suicide attempts, family adaptability and cohesion were significantly low.

정형외과 수술의 무수혈적 환자혈액관리 프로토콜

서유성,이정재,노재휘,정하란,이원석,장병웅,김용범,천동일,최성우,이재철,최형석 대한수혈학회 2019 大韓輸血學會誌 Vol.30 No.1

We developed a new blood management protocol that allows patients to not undergo transfusion during major orthopaedic surgery. Here, we report the safety of or our protocol. The preoperative pharmacological protocol consisted of the administration of 40 g of recombinant erythropoietin subcutaneously and 100 mg of iron supplements intravenously. During the operation, reinfusion of drainage blood using a cell saver and plasma expander was used. The cell saver device passed the collected blood through a filter, which washed the blood, removing the hemolyzed cells and other impurities. Intravenous tranexamic acid 1 g is given just before the operation, except high-risk patients for venous thromboembolism. Postoperatively, recombinant erythropoietin and iron supplements were administered in the same manner with the preoperative protocol and continued until a hemoglobin level reached 10 g/dL.

수술설 감염 위험요인 감소활동

신용섭,김연숙,박순선,이신숙,정하란,송명수,이미향,신수희,이희진,이효진,인민정,김태희,민현정,김선혜,박수연,김미자,외 한국의료QA학회 2008 가을학술대회 Vol.2008 No.3

5년 동안 추적한 만성 조현병 환자에서 대사증후군의 예측인자

조재길,윤보현,전봉희,박수희,송제헌,정하란,홍계현,Joe, Jae-Gil,Yoon, Bo-Hyun,Jeon, Bong-Hee,Park, Su-Hee,Song, Je-Heon,Jeong, Ha-Ran,Hong, Kye Hyun 한국정신신체의학회 2016 정신신체의학 Vol.24 No.2

연구목적 본 연구는 대사증후군의 예방과 회복을 위해 5년 동안 추적이 가능한 만성 조현병 환자에서 대사증후군의 변화와 예측인자를 조사하였다. 방 법 2011년부터 2016년까지 추적이 가능하며 동의서에 동의한 107명의 환자가 본 연구에 포함되었다. Revised National Cholesterol Education Program-Adult Treatment Panel III(NCEP-ATP III)를 이용하여 대사증후군을 정의하였다. 결 과 추적 관찰 기간 동안 22명(20.5%)의 환자가 새롭게 대사증후군에 진단되었고 14명(13.1%)는 대사증후군에서 회복되었다. 77명(66.4%)은 변화가 없었다(대사증후군이 있는 환자:34명[31.8%], 대사증후군이 없는 환자 : 37명[34.6%]). 복부둘레와 중성 지방이 대사증후군의 유무가 변화된 환자들에서 중요한 인자였다. 다른 변수를 통제한 다변량 회귀분석에서 여성(OR=2.846, 95% C.I. 1.020-7.942), 1달에 1회 이상 외래 방문(OR=3.155, 95% C.I. 1.188-8.379), 항우울제 병합치료(OR=3.991, 95% C.I. 1.048-15.205)가 대사증후군의 유병률에 유의한 영향을 주었다. 반면에 항정신병 약물의 종류나 용량은 대사증후군의 유병률에 영향을 주지 못했다. 결 론 만성 조현병 환자에서 약제의 변경 및 용량조절보다 증상에서의 회복과 건강한 생활 습관이 대사증후군에 중요하다. Objectives : To investigate changes in, and predictors of, metabolic syndrome(MetS) status over a 5-year period in chronic schizophrenic patients and to identify factors associated with the prevention of or recovery from MetS. Methods : In total, 107 patients, all of whom provided written informed consent, were followed from 2011 to 2016 at Naju National Hospital for this study. MetS was defined according to the revised National Cholesterol Education Program-Adult Treatment Panel III guidelines. Results : During follow-up period, 22(20.5%) patients were newly diagnosed to MetS, 14(13.1%) were disappeared, 77(66.4%) were not changed[MetS : 34(31.8%), No MetS 37(34.6%)]. Common significant factors in the two changed groups were triglyceride and waist circumference, not dose and type of antipsychotic medication. Multiple logistic regression analysis revealed that female gender(odds ratio[OR]=2.846, 95% confidence interval[CI] : 1.020-7.942), attending two or more outpatient visits per month(OR=3.155, 95% CI : 1.188-8.379) and taking antidepressant medication(OR=3.991, 95% CI : 1.048-15.205) were significantly associated with MetS after controlling for other confounding variables. Type and dose of antipsychotic medication were not significantly associated with MetS. Conclusions : Triglyceride and waist circumference were important manageable indicator of MetS. Adoption of a healthy lifestyle is more important than adjusting the dose or type of antipsychotic medication in the treatment of chronic schizophrenia patients with MetS.