외상성 뇌손상 환자에서 Amantadine의 치료적 효과 : 2증례 및 고찰

정한용,이소영,김양래,Jung, Han Yong,Lee, Soyoung Irene,Kim, Yang Rae 대한생물정신의학회 2001 생물정신의학 Vol.8 No.1

We reported two cases of amantadine treatment in traumatic brain injury patients and reviewed the literature of amantadine treatment of those patients. Problems with short-term memory, attention, planning, problem solving, impulsivity, disinhibition, poor motivation, and other behavioral and cognitive deficit could occur following traumatic brain injury or other types of acquired brain injury. This report described results of amantadine using in two patients with this type of symptom profile. Patients received neuropsychiatric examination as well as BPRS and Barthel index. These patients were improved, respectively from 57 point to 82 point(case 1), from 85 to 94(case 2) in Barthel index, and from 66 point to 35 point(case 1), from 55 to 32 point(case 2) in BPRS. These two patients did not reveal any other adverse effect. The rationale for using amantadine were discussed. 두부 외상을 받은 환자는 여러 가지 다양한 병태생리학적인 과정을 통해 뇌손상을 받으며 이로 인해 다양한 신경정신과적인 장애를 나타낸다. 두부외상을 받은 두 명의 환자에서 이에 대한 약물학적인 접근으로 amantadine을 사용하였고 증세의 호전을 경험하였다. 이에 대한 이론적인 근거로는 amantadine은 전연접(presynaptic)과 후연접(postsynaptic)에서 도파민 신경전달(dopamine neurotransmission)을 증진시켜 인지기능과 전두엽 기능장애에서 발생되는 특징적인 정신 행동학적인 증상을 호전시키고, NMDA 수용체 길항제(NMDA receptor antagonist)로 작용하여 흥분성 독성물질(excitotoxic substrate)에 의한 이차적인 신경손상을 차단하는 신경보호제(neuroprotective agent)로 작용한다. 이와 같이 amantadine은 급성과 만성 외상성 뇌손상 환자 모두에서 나타나는 인지, 기분과 행동장애의 치료에 효과적이고 안전하며 비싸지 않은 가격으로 사용될 수 있을 것으로 사료된다. 또한 이 영역에서 더욱 많은 대조군 연구가 필요하고, 나아가서 외상성 뇌손상 환자의 인지기능 호전을 위한 약물학적인 개입에 관한 연구가 필요할 것으로 사료된다.

외상성 뇌 손상 환자의 신경정신과 영역 치료

정한용,Jung, Han Yong 대한생물정신의학회 1998 생물정신의학 Vol.5 No.1

The neuropsychiatric sequelae of traumatic brain injury are effects on complex aspect of cognition, emotion and behavior. They include problems with attention and arousal, concentration, executive function, intellectual changes, memory inpairments, personality changes, affective disorders, anxiety disorders, psychosis, apathy, aggression, and irritability. There are many useful therapeutic approaches available for people who have been brain injuries. Although a multifactioral, multidisciplinary, collaborative approach to treatment is proposed, for purposes of exposition the author have divided treatment into psychopharmacological, cognitive, behavioral, psychological, and social interventions.

외상성 뇌손상환자에서 Amantadine의 사용

정한용,김양래,Jung, Han Yong,Kim, Yang Rae 대한생물정신의학회 2000 생물정신의학 Vol.7 No.1

Avariety of symptoms can occur following traumatic brain injury(TBI) or other types of acquired brain injury. These symptoms can include problems with short-term memory, attention, planning, problem solving, impulsivity, disinhibition, poor motivation, and other behavioral and cognitive deficit. These symptoms may respond to certain drugs, such as dopaminergic agents. Amantadine may protect patients from secondary neuronal damage after brain injury as a effect of NMDA receptor antagonists and may improve functioning of brain-injured patients as a dopaminergic agonist. Clinically, based on current evidence, amantadine may provide a potentially effective, safe, and inexpensive option for treating the cognitive, mood, and behavioral disorders of individuals with brain injury. The rationales for using amantadine are discussed, and pertinent literatures are reviewed.

불안장애

정한용,Jung, Han-Yong 한국생명보험의학회 2010 保險醫學會誌 Vol.29 No.1

Anxiety disorders Anxiety disorders are among the most prevalent mental disorders in the general population. Anxiety disorders can be viewed as a family of related but distinct mental disorders, which include following as classified in the text revision of fourth edition of Diagnostic and Statistical Manual Disorders(DSM-IV-TR): (1) panic disorder with or without agoraphobia; (2) agoraphobia with or without panic disorder; (3) specific phobia; (4) social phobia; (5) obsessive-compulsive disorder; (6) posttraumatic stress disorder; (7) acute stress disorder; (8) generalized anxiety disorder. An acute intense attack of anxiety accompanied by feeling of impending doom is known as panic disorder. The term phobia refer to an excessive fear of a specific object, circumstance, or situation. Obsessivecompulsive disorder is represented by a diverse group of symptoms that include intrusive thoughts, rituals, preoccupations, and compulsions. Posttraumatic stress disorder is a condition marked by development of symptoms after exposure to traumatic life events. Generalized anxiety disorder is defined as excessive anxiety and worry about several events or activities for most days during at least a 6-month period.

외상성 뇌손상 환자에서 주의력이 실행기능에 미치는 영향 : 단계 모형의 검증

정한용,박준호,이소영,김양래,Jung, Han-Yong,Park, Joon-Ho,Lee, SoYoung Irene,Kim, Yang-Rae 대한생물정신의학회 2007 생물정신의학 Vol.14 No.1

Objectives : The purpose of this study was to test stage model in Traumatic Brain Injury(TBI) patients. According to the stage model, attention deficits which is basic stage in information processing lead to memory disturbance and subsequently affect higher-order cognitive function such as memory, decision-making, abstract thinking, and judgement related to executive function. Therefore, it was hypothesized that attention affect recall(retrieval efficacy) related to executive function mostly relative to other cognitive function, in TBI patients with low executive function. Methods : Participants were referred to a TBI clinic and then was rated on K-WAIS and Executive Intelligence Test(EXIT). Participants were divided into two groups according to Executive IQ(EIQ) score, which of high function group(N=67) was more than 80(above low average) and of low function group(N=52) was under 80 (under borderline). To test the stage model, using hierarchical regression analysis, recall(retrieval efficacy) was regressed on 3 subscales(attention, verbal, visuospatial scale) after controlling for IQ according to each group. Furthermore, the mediation effect of attention between retrieval efficacy and verbal, visuospatial score was analyzed. Results : In the low function group, only attention area predicted significantly recall(retrieval efficacy), indicating that lower attention were related to lower EIQ after controlling for IQ. In the high function group, no area predicted significantly retrieval efficacy. In the low function group, verbal and visuospatial scale did not predicted significantly retrieval efficacy, indicating that there was no evidences supporting the mediation model. Conclusion : Only attention affect retrieval efficacy in TBI patients with low executive function. But, the mediation effect of attention between retrieval efficacy and verbal and visuospatial scale was not tested in the low function group. These results implied that stage model was tested partially. In treating cognitive deficit in TBI patients, it is necessary to develop cognitive rehabilitation program based on stage model. Furthermore, it is necessary to necessary to test mediation model in the future study.

외상성 뇌 손상이후의 우울증

정한용,한선호,Jung, Han Yong,Han, Sun Ho 대한생물정신의학회 1999 생물정신의학 Vol.6 No.1

외상성 뇌 손상은 다양한 신경행동학적 후유증을 나타낸다. 불안정한 기분, 무감동증, 공격성, 충동성, 과민성 등을 나타내고 기억력 상실, 집중력 장해, 정보처리 지연, 지남력 감소, 자기인식 결여, 및 문제 해결 능력의 결여 등 인지 기능의 손상을 나타낸다. 이러한 신경행동학적 증상은 직업과 가정을 포함하는 개인의 역할 수행에 다양한 충격을 주고 이는 또한 다양한 정도의 감정적 어려움을 더하게 되어, 이러한 생물학적, 심리적, 사회적 요인들이 우울증을 일으킨다. 외상성 뇌 손상이후의 우울증의 발병률은 주요 우울증이 25~50%, 기분저하 장애가 15~30%로 보고되고 있다. 외상성 뇌 손상이후의 우울증의 양상은 근본적으로는 일반적인 우울증의 양상과 별다른 차이가 없는 것으로 보고된 바 있다. 뇌 손상이후의 시간에 따라 우울증 양상에서의 차이를 보여 첫 6개월에 나타나는 경우에는 불안, 초기 불면증, 기분의 조석 변동, 및 식욕 장애 등이, 그리고 12개월의 경우에는 말기 불면증, 성욕 상실, 집중력 저하 등이 각각 두드러진 것으로 보고된 바 있다. 또한 외상성 뇌 손상이후의 급성 기에 발생하는 우울증은 보다 더 생물학적 원인이 관여하는 것으로, 지연성 우울증의 경우에는 심리적인 요인들이 더 많이 관여하는 것으로 보고되고 있다. 좌측전반부 병소와 주요 우울증의 연관성이 여러 연구에서 보고되고 있으며, 특히 불안을 호소하는 우울증은 우반구 병소와 그리고 불안의 호소가 적은 우울증은 좌측 전반부와 연관된다고 보고되었다. 외상성 뇌 손상이후에 우울증을 나타내는 경우의 병리생리학적 변화는 우울증의 원인론과 연관되어 많은 관심을 받고있으나 아직 어떠한 결론을 도출해내기에는 이르다. 치료에는 fluoxetine, desipramine 등 부작용이 적은 항우울제가 선택된다. Traumatic Brain Injury(TBI) of any severity can result in broad and persisting biopsychosocial sequelae. Depression after TBI occur at a greater frequency than in the general population, with estimates approaching 25% to 50% for major depression, and 155 to 30% for dysthmia. Acute onset depressions are related to lesion location and may have their etiology in biological response of the injured brain, whereas delayed onset depressions may be mediated by psychosocial factors, suggesting psychological reactions as a possible mechanism. Anxious depressions are associated with right hemisphere lesions, whereas major depressions alone are associated with left dorsolateral frontal and left basal ganglia lesions. However, there is insufficient information to postulate a specific neuroanatomic model for TBI-related depression.

노인에서의 외상성 뇌손상

정한용(Han-Yong Jung),이헌정(Heon-Jeong Lee) 대한노인정신의학회 2001 노인정신의학 Vol.5 No.2

Traumatic Brain Injury (TBI) is as common in elderly people as it is in young adults. Compared to TBI among young adults, TBI mong the elderly differs in mechanism of injury, clinical presentation, comorbidities, and prognosis. This article begins with an overview of the literature on epidemiology, unique characteristics and pathophysiology of geriatric head injuries. Neurological sequelae and indices of general outcome following TBI will be discussed. We will discuss the proposed relationship between TBI and Alzheimer's disease, which lead to a greater understanding of the pathogenesis of both TBI and Alzheimer's disease. The literature about the assessment and management of TBI will be reviewed.

국내학술지 문헌고찰을 통해 나타난 치매의 진단 및 평가방법의 변화

정한용(Han Yong Jung),김신겸(Shin Gyeom Kim),전용호(Yong Ho Jun) 대한노인정신의학회 2005 노인정신의학 Vol.9 No.2

Objectives : The purpose of the present study was to investigate what aspects of evaluation was ordered for diagnosis of dementia up to the present in Korea. Methods : Article review was performed via web searching. We searched the Korean Medical Database (KMbase) for title words containing 'dementia'. Only original articles were used for the analysis. According to the published year, all articles were divided into three stage (1990-1994, 1995-1999, 2000-2003). The data was collected for what instruments were used and what clinical diagnostic criteria for the diagnosis of dementia. Results : 97 studies were identified through a KM base search of all Korean-language publications between 1 January 1990 and 31 December 2003. Mini-Mental State Examination was not only most commonly applied screening test for dementia in all three stage, also mainly employed as a standard test for validating other screening test. The trends that the DSM clinical diagnotic criteria was soley used were changed in later stage, and then much more studies used NINCDS-ADRDA and NINDS-AIREN criteria in conjunction with DSM diagnostic criteria. Variable instruments to assess functional impairment and behavioral problem were more widely used in three stage than before. In addition, usage of the neuroimage was significantly increased in the 3rd stage. Conclusion : This results show increasing trend in study on dementia in Korea with the aid of systematic diagnosis of dementia including specific clinical diagnosis, screening test, cognitive function test, functional and behavioral assessment.

전공계열의 분류에 따른 전공의들의 자아방어기제

정한용(Han Yong Jung),김동욱(Dong Wook Kim) 한국의학교육학회 2000 Korean journal of medical education Vol.12 No.1

전공의 과정을 위한 전공과의 선택에 있어 작용되는 많은 요인들 중 성격특성이 중요한 요소가 될 것이다. 이에 본 연구는 객관적 질문지 형태의 이화방어기제검사를 사용하여, 현재 병원에서 근무하고 있는 전공의들의 전문과목 선택에 있어 크게 내. 외과 계열로 나눈 후 각 과에서 근무하는 사람들 사이의 자아방어기제상의 차이가 있는 지를 살펴봄으로써, 특정 과를 전공하는 전공의들의 공통적인 성격 특성이나 적응방식이 계열별로 차이가 있는가를 살펴보았다. 이상의 방어기제검사를 통해서 첫째, 내, 외과 계열을 선택한 전공의들 사이의 자아 방어기제의 평균점수에서 외과계열을 선택한 전공의들은 미숙한 방어기제 중 동일시 (identification)가, 신경증적 방어기제에서는 허세 (show-off)가 각각 유의미하게 높았다. 둘째, 내과와 외과계열 두 집단의 방어기제의 성숙도 수준을 알아보기 위해 성숙도에 따라 4단계로 분류된 각각의 방어기제의 표준점수를 평균한 후에 이를 비교한 결과, 외과계열이 내과계열에 비해 신경증적 방어기제를 유의하게 많이 사용하는 것으로 나타났다. 셋째, 내과와 외과계열 두 집단사이의 주 방어기제의 빈도를 비교하여, 대부분의 방어기제의 빈도에서는 두 집단간에 유의한 차이는 없었으나, 미숙한 방어기전에서 동일시(identification)와 신경증적 방어기전에서 허세 (show-off), 또한 성숙한 방어기전에서는 승화 (sublimation)를 주된 방어기전으로 사용하는 것에서 외과군이 내과군에 비해 그 빈도가 유의하게 높은 결과를 볼 수 있었다. 이러한 결과를 토대로 볼 때, 두 집단간의 방어기제 평균점수를 비교해보면, 외과계열에서 내과계열에 비해 동일시 (identification)와 허세 (show-off)를 유의하게 높게 사용된 것은 외과계의 특성 상 내과계보다는 더욱 도제의 양식으로 함께 일하면서 수술에 동참하고 하나 하나의 기술을 터득해야만 하는 외과 수련의 특성과 함께 내과적 치료에 비하면 더 화려하고 극적인 치료의 성격을 갖는 외과계열의 특성을 반영하고 있는 것으로 볼 수 있었다. 또한 주된 방어기제의 빈도 측면에서 보면, 내과계열이 외과계열에 비해 주요 방어기제를 적게 나타냄으로 해서 심리적 특성이 적었다는 것을 볼 수 있었다. 본 연구는 현재 전공을 선택해 그 과에서 수련을 받고 있는 전공과의 특성에 적합한 성격을 밝혀내는데 유용한 자료가 될 수 있을 것이고, 이를 토대로 향후 전공과목을 선택하여 적응하는 문제에 있어 자신의 성격특성과 맞는 과를 알아보는데 도움이 될 수 있을 것이다. 또한 전공하고 있는 전공의들에게 있어서는 자신들의 성격 특성을 알아 선택한 과에 보다 만족하고, 자신의 능력을 훌륭히 발휘하는데 도움이 될 수 있겠다. The purpose of this study was to explore the differentiation of common personality profiles and defense mechanisms between medicine and surgery resident groups. The authors evaluated the defense mechanisms of the residents by using Ewha Defense Mechanisms Test. The authors compared the defense mechanisms between two groups (medicine and surgery resident groups) who were training at SoonChunHyang University hospital in 1999. First, There were significant differences in mean scores of the defense mechanisms ratings. For the surgery group, identification and show-off were significantly higher than in the medicine group. Secondly, the differences of defense mechanism ratings, which were divided by maturity level between the two groups, were significantly higher using neurotic defense of the surgery group. Thirdly, the authors compared the frequency of major defense mechanisms of the two groups. The surgery group used identification, show-off and sublimation as major defense mechanisms in higher frequency than the medicine group. This result reflects on the fact that the surgery group has exact an apprentice discipline and dramatical therapeutic approach. The results seem to be useful in understanding the resident s optimal character for specific specialties that were selected by evaluating the differences of the common characteristics and coping mechanisms of each specialty group.

내․외과계열에서 나타나는 자아방어기제의 특성에 대한 연구: 전문의를 대상으로

정한용(Han Yong Jung),김양래(Yang Rae Kim) 한국의학교육학회 2001 Korean journal of medical education Vol.13 No.2

The purpose of this study was to explore the differentiation of common personality profiles and defense mechanisms between medicine and surgery specialist groups. The authors evaluated the defense mechanisms of the specialist by using Ewha Defense Mechanisms Test. The authors compared the defense mechanisms between two groups (medicine and surgery specialist groups) who are employed Soonchunhyang university hospital at 2000. First, There were significant differences in mean scores of the defense mechanisms ratings. For the surgery groups, projection and show-off were significantly higher than in the medicine group, and for the medicine groups, altruism was significantly higher than surgery groups. Second, Compared of maturity level between two groups, the medicine group used mature defense significantly. Third, We compared of major defense mechanisms between two groups. Surgery groups used show-off as a major defense mechanisms in significantly higher frequency than the medicine groups. This results were reflect that surgery group have property of apprentice system and dramatical therapeutic approach. The results seem to be useful in understanding specialist s optimal character for specific specialities that were selected by evaluating the differences of the common characteristics and coping mechanisms of each specialty group.