Texas 대학 연수보고

채영래 서울大學校 醫科大學 精神科學敎室 1993 精神 醫學 Vol.18 No.3

정신분열장애와 HLA

채영래,정염성 최신의학사 1987 最新醫學 Vol.30 No.1

신경성 식욕부진 치료경험

채영래 한국의학사 1987 診斷과治療 Vol.7 No.2

한국판 성격장애 검사(Personality Disorder Questionnaire-Revised: PDQ-R) : Evaluation of the Test Reliability and Validity 신뢰도 및 타당도 검증

채영래 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.1

objects : The clinical importance of personality disorder(PD) is becoming increasingly apparent because axis Ⅱ pathology has been shown to adversely affect treatment response. Therefore, recognition of PD in clinical as well as research settings should receive greater emphasis. Among the numbers of new instruments designed to assess PD, the Personality Disorder Questionnaire-Revised(PDQ-R), self-report questionnaire, contains criteria precisely matching DSM-Ⅲ-R criteria and is very easy to administer and to score. We tested here the reliability and validity of the Korean version of PDQ-R. Methods : The subjects were consisted of 217 control drawn from various groups of general population by cluster sampling methods and 32 PD patients. We administered the 125-item Korean version of PDQ-R items in all and tested internal consistency, test-reliability and discriminant validity. Results : In 217 general population, internal consistency was above .400(range : .254 to .596) in most PD categories. After deleting 30 items which had weak correlation coefficient, Crohnbach alpha of PDQ-R items in all PD exceeded .400(range : .419 to .632). Test-retest reliability done 1-week interval was above .500 except borderline and sadistic PD. To evaluate the discriminant validity, we administered PDQ-R to 143 normal controls and 32 PD patients. There were significant differences in total PDQ-R score between groups when controlled the effects of age, sex, educational level. Conclusion : Our results indicated that the Korean version of PDQ-R had reasonable reliability and validity and might be useful in screening for overall personality disturbances.

정신감정이 의뢰된 군 범법자들에 대한 정신의학적 검토

채영래 大韓神經精神醫學會 1986 신경정신의학 Vol.25 No.1

1964년부터 1985년까지 국군 수도 병원에 정신감정이 의뢰되었던 85명의 범법자에 대하여 개인적 배경, 범죄양상, 범행동기, 진단, 감정결과 및 반복 범행별로 고찰한결과 다음과 같은 결론을 얻었다. 1)연령별로 20-25세가 대부분(91.8%)을 차지하였고, 계급별로는 이등병이 제일 많았고(42.4%), 학력은 고졸이상이 65.8%이었으며, 양쪽 혹은 한쪽 부모를 상실한 경우가 34.1%에 달하였다. 2)범죄양상은 군무 이탈이 제일 많았다(64.7%). 3)범죄의 동기는 충동적인 경우(38.8%)와 정신증상에 의한 경우(22.3%)가 대부분을 차지하였다. 4)진단은 인격장애가 가장 많았고(37.6%), 특별한 질병이 없는 경우가 23.5%, 정신분열 장애가 20.0%를 차지하였다. 5)감정결과 형사책임이 없는 경우가 25.9%이었고, 68.2%에서는 형사 책임능력이 있는 것으로 나타났다. 6)전체 범법자의 12.9%에서 반복 범죄 행위를 나타냈다. This review was designed to investigate 85 criminals of Korean military serviceman who had been referred by court to Capital Armed Forces General Hospital for psychiatric evaluation during the period of 1964-1985. Major characteristics may be summerized as follow; 1)About 92% of them were between 20-25 years in their age, and privates were more common than any other ranks. # Educationally, about 65% of them belonged to the level above the high school course. Thirty four percent of the cases lost their parents or seperated or seperated from them one another. 2)Escape from the military service revealed higher incidence(64.7%) than any other crimes. 3)As regarding their motivational factors for criminal acts, it was due to impulsiveness(38.8%) and psychotic symptoms(22.3%). 4)Diagnostic distributions were as follow; personality disorder(37.6%), no mental disorder(23.5%) schizophrenic disorder(20.0%). 5)Repeated criminals occupied 12.9% of all cases and they committed the same crime repeatedly. 6)Analysis done on the basis of criminal responsibility showed that those who were determined not to have responsibility for their criminal behavior were 25.9% and that those to have 68.2%.

Dothiepin의 항우울 효과에 대한 임상연구

이규환,백인호,이철,채영래 大韓神經精神醫學會 1990 신경정신의학 Vol.29 No.5

This study was designed to investigate the therapeutic efficacy and adverse reactions of dothiepin. The subjects consisted of 40 patients diagnosed as major depression with DSM-III-R, who had been admitted to the Department of Neuropsychiatry, Kangnam St. Mary's Hospital, Catholic University Medical College from October 1, 1989 to Mary 31, 1990. Under double-blind conditions they were treated with either dothiepin or mianserin for a period of 4 weeks. Patients were assessed by Hamilton Depression Scale before treatment and after 1, 2 and 4 weeks of treatment. The results were as follows: 1) A statistically significant improvement on the Hamilton Depression Scale was seen with both drugs after only one week's treatment(P<0.001). 2) A comparison of the antidepressant effects of both drugs failed to show a statistical difference. 3) As for the side effects associated with dothiepin, constipation was the commonest, followed by dry mouth, urinary retention, and drowsiness. However, the anticholinergic effects of dothiepin were mild, and by indirect comparison, dothiepin seemed to have fewer side effects than amitriptyline. In view of our results, dothiepin was found to be an effective antidepressant agent.

흰쥐의 절망행동 모형에서 항우울제의 효과에 미치는 Triiodothyronine(T3)의 영향

김보연,백인호,채영래 大韓神經精神醫學會 1990 신경정신의학 Vol.29 No.3

In an attempt to identify some of the biochemical processes underlying immobility in rats, the authors investigated the effects of a variety of pharmacological agents known to modify neurotransmission in central noradrenaline, dopamine and serotonin systems. The results suggest that immobility is sensitive to agents which modify the activity of central catecholamines but is insensitive to agents which act primarily on serotonin. And, several investigations have suggested a special relationship exists between thyroid function and affective disorders. Give the activity of T3 on psychopharmacological models of depression in rodents, we also investigated the effects of T3 on behavioral tests in rats. The present study shows that the reversal by amitriptyline of depressive-like behavior in rats was markedly potentiated to T3 administration. This supports notion of intricate thy-roid and CNS interaction in the mechanism of action of antidepressant, especially by sero-tonergic system.

Neuroleptic Malignant Syndrome에 합병되어 나타난 급성 신부전증 1예

채영래,백인호,송정중 大韓神經精神醫學會 1990 신경정신의학 Vol.29 No.4

Neuroleptic malignant syndrome(NMS) is an uncommon but fatal idiosyncratic reaction to neuroleptics. It comprises fever, muscular rigidity, altered consciousness and autonomic dysfunction. The most common serious complications of NMS is rhabdomyolysis, which produces acute myoglobinuric renal failure. The authors experienced a schizophrenic male patient with acute renal failure as a sequela of NMS. The patient was 27-year-old man who had received haloperidol for 9 years. Emergency hemodialysis, hydration and diuretics promoted recovery of impaired renal function. The patient survived the acute episode of NMS without any sequela and resumed his treatment with neuroleptics.

정신과 자문에 대한 타과 의사들의 인식과 태도

채영래,백인호,노왕구,유태열,김광수,한진희 大韓神經精神醫學會 1990 신경정신의학 Vol.29 No.5

The preceptions and attitudes of nonpsychiatric physicians toward psychiatric consultation was surveyed with a questionnaire in 128 physicians(63 staffs and 65 residents) at two general hospitals in Seoul. Physicians estimated 13.6% of their inpatients had significant psychiatric problems, however they considered that only 8.3% of the patient would need psychiatric consultation. Most frequently mentioned reason for psychiatric consultation was 'overt psychiatric symptoms(e.g. severe depression anxiety, sleep disturbance, etc.)' followed by problems suggesting psychiatric conditions such as suicidal behaviors. On the contrary, they showed little concern on the holistic care needed in such case of terminal patient. 89% of physicians showed the psychiatric recommendations, such as psychiatric diagnosis, diagnostic procedures, psychiatric drugs and psychosocial treatment. Although surgeons and staffs seemed to have more positive attitude to the psychiatric consultation than in internists and residents, they showed the lack of understanding of psychological problems. In contrast, internists and residents appeared to be able to understand the problems better than other respondents, however, they tended not to seek actively the professional mangement from psychiatrist. These findings suggest the significance of psychiatric problems in the current medical setting seems to be neglected and psychiatric consultation is likely to be utilized in limited cases.

우울증 환자에서 Cortisol 일일변화 검사의 의의

채영래,한상익,백인호 大韓神經精神醫學會 1988 신경정신의학 Vol.27 No.4

This study was designed to investigate whether depressed patient showed increased plasma contisol level compared with nondepressed patients and to examine whether diurnal variation is preserved or flattened in depressed patients and whether diurnal variation itself could be a useful diagnostic procedure in depression. We studied also the possible relationship between the diurnal variation of cortisol secretion and the degree of symptomatic improvement with antidepressant administration in major depression patients. The results were as follows : 1) The value of serum cortisol levels checked before antidepressant administration were 8.44±4.89㎍/dl, 5.74±3.19㎍/dl, 3.18±3.54㎍/dl, 10.75±5.23㎍/dl at 12AM, 4PM, 11PM and 8AM respectively in endogenous depression group, and 6.39±3.29㎍/dl, 6.25±3.75㎍/dl, 2.74±1.85㎍/dl, 10.79±4.77㎍/dl respectively in control group. There were no significant differences in serum cortisol levels between both groups(Table 2). 2) In 31 endogenous depressives, 18(58.1%) maintained diurnal variation of cortisol level and 13(41.9%) showed flattened variation. However, of 16 control group(schizophrenics and dysthymic disorder patients), 11(68.8%) maintained diurnal variation of cortisol secretion and5(31.2%) showed flattened variation. As a result, the sensitivity, specificity and predictive value of diurnal cortisol test for endogenous depression were 42%, 67%, and 72% respectively 3) In 26 major depression patients, 11 patients who showed flattened diurnal variation of cortisol secretion had significantly high "agitative depression" factors of Hamiltion Rating Scale for Depression compared with 15 patients who maintained diurnal variation. 4) Among 15 major depression patients whose diurnal variation was preserved, 12(80.0%) showed marked improvement of depressive symptoms with antidepressant administration and 3(20.0%) did not. Among 11 major depression patients whose diurnal variation was disturbed, 6(54.5%) improved and 5(45.5%) did not. There were no significant differences in symptomatic improvement between two groups.