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최영희,김경미,박기환,윤혜영 대한정신약물학회 2003 대한정신약물학회지 Vol.14 No.4
Objective : The purpose of this study is to determine whether CBT is effective in tapering or discontinuing medication regardless of the type of medication and its maintenance effects after long-term follow up. Method : 224 patients meet DSM-IV criteria for panic disorder with or without agoraphobia completed 12 weekly sessions of Panic Control Therapy (PCT; Barlow et al.). 80 patients who were using benzodiazepines alone and 144 patients who were using benzodiazepines and Antidepressants were measured with several screening scales at the pre- and post-treatment. The scales were Beck Depression Inventory (BDI), Spielberg State Anxiety Inventory (STAI-State), Spielberg Trait Anxiety Inventory (STAI-Trait), Body Sensation Questionnaire (BSQ), Agoraphobic Cognition Questionnaire (ACQ), Anxiety Sensitivity Index (ASI), Panic Belief Questionnaire (PBQ). These patients were assessed at 3 months, 6 months, 12 months of follow up and they were also assessed for their medications, panic frequency, and End-State Functioning. Results : After the completion of PCP, both benzodiazepines alone group and benzodiazepines and antidepressants combination group showed significant improvement (P<0.001) in all the results of 7-self reported questionnaires. 54% of patients discontinued their medication and 90.9% of patients were in HES at post-treatment. 70 % of patients were in HES at 3 month, 6 month, and 12 month follow up. The patients who could not discontinue medication also tapered their medication afterwards. The rate of discontinuing medication was significantly higher for the patients using benzodiazepines alone (86.3%) than patients using combination of benzodiazepines and antidepressants (56.3%). Conclusion : These findings support cognitive behavioral therapy can replace medication and these effects seem to last long. 목 적:공황장애 환자들에 대한 인지행동치료가 치료 약물의 종류와 무관하게 약물을 중단하는데 도움을 주며, 장기간에 걸쳐 호전 상태를 유지할 수 있는지 여부를 검증하기 위해 이 연구를 시행하였다. 방 법:DSM-Ⅳ 진단에 따라 공황장애로 진단 받고 약물치료중인 24명의 환자를 대상으로 12회기 집단 인지행동치료를 실시하였다. 인지행동치료 전 복용 약물을 벤조다이아제핀계 약물 복용 군 80명과 벤조다이아최영희 등 375 제핀과 항우울제 병합요법군 144명의 환자군으로 나누어, 치료 전과 후에 시행한 Beck Depression Inven -tory(BDI), Spielberg State Anxiety Inventory(STAI -State), Spielberg Trait Anxiety Inventory(STAI-Trait), Body Sensation Questionnaire(BSQ), Agora-phobic Cognition Questionnaire(ACQ), Anxiety Sen -sitivity Index(ASI), Panic Belief Questionaire(PBQ)의 결과를 분석하였다. 또한, 3개월, 6개월 12개월 추적조사를 통해 각 약물군별 약물복용 여부와 최종상태기능(End-State Fungtioning)을 평가하여 분석하였고, 12개월 추적조사기간동안 약물 복용양 변화와 약물군별 차이, 최종상태기능 사이의 관계를 분석하였다. 결 과:인지행동치료 전 사용 약물의 종류와 상관없이, 인지행동치료 이후 모든 임상 변인이 통계적으로 유의미하게 향상되었다. 인지행동치료 직후, 대상군의 54%의 환자들이 약물을 끊었고 이들 중 90.9%가 상위 최종 상태를 유지되고 있었으며, 3개월, 6개월, 12개월 추적조사에서 이들의 약 70%는 여전히 상위최종상태를 유지하고 있었다. 또한 약물 복용을 중단하지 못한 환자들도 지속적으로 약물 복용을 감량하여 3개월 뒤에는 약 6%, 6개월 및 12개월 추적조사 시에는 약 68%의 환자가 약물 복용을 중단하였고 이들 역시 약 70%에서 상위최종상태를 유지하고 있었다. 벤조다이아제핀 단독 투여군의 경우 86.3%의 환자가 인지행동치료 이후 약물복용을 중단하여 이후 추가적인 약물복용이 필요하지 않았으며 이들의 약 70%는 약물 복용 없이 상위최종상태를 유지하고 있었고, 2.7%만이 약물 감량 이후 재복용 하였다. 반면 벤조다이아제핀계 약물과 항우울제 병합요법군은 57.0%의 환자가 인지행동치료 이후 약물복용을 중단하여 지속적으로 약물복용을 하지 않았다.
남성 공황장애 환자에서의 monoamine oxidase A 프로모터 유전자 다형성의 연합 연구
최영희,우종민,박헌구,조우연,윤혜영,윤경식,조대연,홍경수 白中央醫療院 2004 仁濟醫學 Vol.25 No.1
Objectives: Genetic variation of the monoamine oxidase (MAO) A promoter gene polymorphism has been associated with its functional capacity. The authors tried to find the association between MAO A promoter polymorphism and panic disorder. Methods: 317 patients with panic disorder and 92 normal controls were enrolled in this study. 308 patients and 84 normal controls were completed study. Results: There was significant difference in allele frequencies of MAO A promoter polymorphism between male panic patients and normal controls (s allele: 60.7% vs. 44.3%, 1 allele: 39.3% vs 55.7%, x^(2)=10.008, df=1, p=0.002). The frequencies of MAO A promoter alleles between panic disorder and normal controls were 2 repeat (1.1% vs. 1.2%), 3 repeat (58.3% vs. 45.8%), 4 repeat (40.6% vs. 53.0%)(x2=8.368, df=2, p=0.015). Conclusion: Our results suggest that MAO A promoter gene may be related to panic disorder.
최영희,남병극,김효경,박지강,홍은석,김양호,Choi, Young-Hee,Nam, Byung-Kuk,Kim, Hyo-Kyung,Park, Ji-Kang,Hong, Eun-Seog,Kim, Yang-Ho 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.1
Three workers, field operators in lubricating oil processing of petroleum refinery industry were found unconscious by other worker. One of them who were exposed to an high concentration of H2S was presented with Glasgow Coma Score of 5, severe hypoxemia on arterial blood gas analysis, normal chest radiography, and normal blood pressure. On hospital day 7, his mental state became clear, and neurologic examination showed quadriparesis, profound spasticity, increased tendon reflexes, abnormal Babinski response, and bradykinesia. He was also found to have decreased memory, attention deficits and blunted affect which suggest general cognitive dysfunction, which improved soon. MRI scan showed abnormal signals in both basal ganglia and motor cortex, compatible with clinical findings of motor dysfunction. Neuropsychologic testing showed deficits of cognitive functions. SPECT showed markedly decreased cortical perfusion in frontotemporoparietal area with deep white matter. Another case was recovered completely, but the other expired the next day.