한국 노년기 혈관성 우울증의 임상적 특성에 관한 연구

허휴정,한창태,원왕연,홍승철,이창욱,임현국,전태연 대한신경정신의학회 2012 신경정신의학 Vol.51 No.5

Objectives This study was done in Korean elderly people in order to examine the relationship of white matter hyperintensity with clinical neuropsychological function and depression symptom severity. Methods A total of 148 subjects diagnosed first major depressive episode after age of 60 years were included. Brain magnetic resonance imaging scan was rated with the modified Fazekas White Matter Rating Scale by researcher blinded to clinical information. Cognitive function was evaluated with a comprehensive neurological battery and depression severity was assessed by Hamilton Depression Scale. Subjects were divided into vascular depression group and non vascular group according to the degree of white matter hyperintensity. Independent t-test was used to compare clinical difference between two groups and correlation analysis was used to identify whether white matter hyperintensity severity is correlated with neuropsychological function and depressive symptom. Results Vascular depression group was significantly poorer performance in verbal fluency, Boston naming test, Mini-Mental State Examination, trail making test B and stroop test (p<0.05). Furthermore, trail making test B and stroop test performance was correlated with white matter hyperintensity severity. However, Hamilton Depression Scale score was not significantly different between two groups. Conclusion Several findings from our study suggest that white matter hyperintensity is associated with neuropsychological performance, especially executive function. Moreover, executive dysfunction might contribute to poor treatment outcome of vascular depression group. 본 연구는 혈관성 우울증의 가설을 지지하는 여러 연구들을 토대로 하여, 한국 노인 인구에 있어서도 혈관성 우울증의가설을 지지할 만한 여러 가지 임상적인 특징들이 관찰되는지를 규명하려 하였다. 혈관성 우울증 환자의 경우, 비혈관성우울증 환자에 비해 여러 영역의 신경심리학적 기능, 특히 실행기능에 있어서 두드러진 저하를 보였으나 우울증상 자체에있어서는 유의미한 차이가 관찰되지 않았다. 본 연구의 결과를 토대로 볼 때, 혈관성 우울증 환자에 있어서 인지기능의 저하, 특히 실행기능의 저하는 일상생활 수행에 장애를 일으킬것으로 보이며, 우울증 자체의 완전한 관해에 도달하는 데에도 지장을 줄 것으로 추정된다. 따라서 향후에는 혈관성 우울증 환자들의 치료경과 및 예후를 규명하는 장기적인 연구가더 필요할 것으로 보인다.

감정조절 : 초진단적 관점에서 개념과 정신치료에의 적용

허휴정,채정호,서유빈 대한우울조울병학회 2014 우울조울병 Vol.12 No.3

Deficits in emotion regulation are associated with various forms of psychopathology and considered a common etiological factor relevant for the development and maintenance of a wide range of mental disorders. For this reason, it is essential to cultivate emotion regulation skills in psychotherapeutic intervention. In this review, we introduce the conceptual framework of emotional regulation, summarize the relevant findings about emotional regulation and psychopathology, and address emotion regulation skill training that is recently proposed in psychotherapy. Emotion regulation has been defined as the extrinsic and intrinsic processes for monitoring, evaluating, and modifying emotional reactions. Process of emotion regulation is composed of situation selection, situation modification, attentional deployment, cognitive change and response modulation. Various types of psychotherapeutic intervention such as mindfulness based therapy, dialectical behavior therapy, and acceptance and commitment therapy have attempted to improve emotion regulation skills. Although these therapies are developed for the specific disorders, most of the interventions have shown to be effective in a broad range of mental disorders. This may reflect the fact that emotion regulation is a transdiagnostic factor of various psychiatric disorders. Considering this, integrating various emotion regulation therapies for unified transdiagnostic protocol for wide range of disorders would be needed in the future.

정신과 임상에서 명상의 활용 : 마음챙김 명상을 중심으로

허휴정,한상빈,박예나,채정호 대한신경정신의학회 2015 신경정신의학 Vol.54 No.4

There is a considerable body of literature describing the trials of meditation as adjunctive treatment of psychiatry. Although meditation has included various concepts and activity through a long history, meditation used as a therapeutic intervention in psychiatry has usually been accepted as a kind of emotion and attention regulation training. The aim of this article was to review historical origin, clinical effectiveness, and neurobiological mechanism of meditation as treatment for psychiatric disorders. Meditation is originated from various types of religious tradition. In general, meditation is divided by the consciousness meditation and the awareness meditation. Concept of mindfulness-based therapy is mainly based on awareness meditation. In addition to two types of meditation, loving kindness meditation is developed and exercised in compassion-focused therapy. Neurobiological evidence suggests that meditation reduces stress-related autonomic and endocrine change. In addition, research using neuroimaging has provided biological evidence that a specific region of brain activity and connectivity is related to subjective experience of meditation. Clinical trials support the effectiveness of meditation for the treatment of anxiety, depression, and any other stress-related disorders. In the future, profound understanding of the neurobiological mechanism, clinical effectiveness, and side effects of meditation as treatment intervention of for psychiatric disorders would be provided for evidence based meditative practice.

임상용 간편 긍정자원 척도(Clinical Short-Form Positive Resources Test; POREST)의 개발

허휴정(Hyu Jung Huh),김선영(Sun-Young Kim),민정아(Jung-A Min),채정호(Jeong-Ho Chae) 대한스트레스학회 2018 스트레스硏究 Vol.26 No.2

본 연구의 목적은 임상현장에서 사용할 수 있는 간단한 긍정성 자원 척도를 개발하는 것이다. 문헌탐색과 전문가 워크샵을 통하여 기초 예비 문항을 만들어 설문을 실시하고 결과를 분석하여 실제 적용할 문항을 선정하였고, 최종 선정된 총 23문항을 가지고 설문을 실시하여 최종 도구의 개발을 위한 문항분석 및 신뢰도를 평가하였으며, 마지막으로 총 267예에 대한 본 조사를 시행함으로써 새로 개발된 긍정자원척도의 신뢰도 및 타당도를 검증하였다. 연구 결과, POREST는 5개의 요인으로 구성되어 있으며, POREST는 내적합치도가 적절했으며, 문항-총점 간 상관계수 확인 결과 내용적인 일관성과 시간적인 안정성을 지닌 척도임을 확인할 수 있었으며, 감별 타당도 확인 위해 정신건강의학과 외래 환자군과 건강대조군 점수 비교 결과 유의한 차이 보였다. 본 연구는, 기존의 긍정적 변인에 인지적 정서조절, 운동 등의 변인을 추가하여 개인의 긍정 자원을 좀 더 광범위한 시각으로 보려고 시도했다는 점에서 의미가 있다. Background: The present study aimed to develop a brief tool for assessing individual’s positive resource in clinical setting. The Positive Resources Test is a self-report questionnaire that measures 5 multi-dementional positive resources and comprises of 23 items, each rated on a 5-point scale. Methods: Literature searching and delphi survey were performed for making preliminary items, consulting and selecting final items. In order to test validity and reliability of the finally selected 23 items, data were collected from 546 adults. The measures included a variety of positive psychological scales. Results: The result of exploratory factor analysis of Positive Resources Test suggested 5 factor structures. The Positive Resources Test was shown to have acceptable psychometric porperties, including acceptable internal consistency reliabilities, factorial validity, and high convergent correlations. Conclusions: Although there is room for improvement for some facet scales, the Positive Resources Test appears to be useful tool for assessing individual’s positive resources.

일 종합병원 입원 암환자의 불안과 우울증상의 시점 유병률 : 암 환자 디스트레스 중재 전략을 위한 예비 연구

이민아,허휴정,민정아,이창욱,이철,김태석,Lee, Min-A,Huh, Hyu-Jung,Min, Jung-Ah,Lee, Chang-Uk,Lee, Chul,Kim, Tae-Suk 한국정신신체의학회 2013 정신신체의학 Vol.21 No.2

목 적 암환자의 불안 및 우울증상 유병률이 높다는 것은 이미 알려진 사실이나 이에 대한 선별과 개입의 노력은 미미한 실정이다. 본 연구는 암환자의 불안, 우울증상의 선별 및 중재를 위한 기초작업으로 암환자의 불안, 우울증상의 시점 유병률을 조사하고 위험인자를 규명하였다. 방 법 일 종합병원 암센터에 입원한 암환자를 대상으로 병원불안우울척도를 시행했으며, 사회인구학적 및 암 관련 임상 자료를 조사하였다. 결 과 불안, 우울증상의 유병률은 각각 10.5%, 34.2%이었다. 로지스틱 회귀분석에서 전이가 있을 시 불안증상 위험이 더 높았고, 항암치료 경험과 중등도 미만의 사회경제적 수준이 우울증상과 관련된 위험인자로 나타났다. 결 론 본 연구에서 36.8%의 입원 암환자가 불안 혹은 우울증상을 겪고 있었으며 전이, 항암치료 경험, 중등도 미만의 사회경제적 수준이 불안 및 우울증상의 위험인자로 나타났다. 이를 통해 불안, 우울증상을 보이는 암환자를 위한 효과적인 선별검사와 관리 시스템 체계화의 필요성을 확인하였다. Objectives: This study aimed to examine the point prevalence of anxiety, depression and the associated risk factors in hospitalized patients with cancer. Methods: A total of 114 patients with cancer who admitted to the Cancer Center in St. Mary's Hospital were enrolled for a day. The patients were asked to complete Hospital Anxiety and Depression Scale(HADS). Sociodemographic and cancer related clinical variables were also evaluated. Results: The point prevalence of anxiety and depression was 10.5% and 34.2%, respectively, as assessed with HADS. Logistic regression models revealed that distant metastasis was significantly associated with anxiety in patients with cancer and previous chemotherapy and Low socioeconomic status were significantly associated with depression. Conclusions: Our results indicate that more than one third of patients with cancer suffer from either anxiety or depression. In addition, previous chemotherapy as well as low socioeconomic status and distant metastasis were associated risk factors of anxiety and depression, respectively. These findings suggest the need for screening and systematized psychosocial intervention for psychological distress in hospitalized patients with cancer.

우울 정서가 의사결정과정에 끼치는 영향 : 정량적 방법론을 중심으로

김석영,허휴정,채정호 대한신경정신의학회 2015 신경정신의학 Vol.54 No.3

The increasing number of patients with depression is a serious social issue in contemporary Korean society. To fully understand the pathophysiology of depression, this paper reviewed how depression affects the decision making process of humans. Various recent studies in behavioral economics, mathematics, medicine, and neurobiology have shown how humans make decisions and how emotional disturbances, such as depressive disorder, affect this process. There has been great progress in behavioral economics during this decade, and numerous experiments have been designed to evaluate decision making process in humans. In general, economic decision making is evaluated using the Iowa Gambling Task, and social decision making is assessed using the ultimatum game. Numerous research studies have analyzed the performance and reaction of patients with depression in these games. As a result of the advancement of neurophysiology, research has successfully identified the part of the brain that causes the specific results of tests being conducted on patients with depression. Meanwhile, computational neuroscientists have established decision making models based on bayesian framework. These models also match with the neuroanatomy. Although a large part remains unclear, researchers look forward to achieving a better understanding in depression by analyzing the distinct patterns of responses that patients under depression show in the experiment of behavioral economics

행동활성화체계 및 행동억제체계의 민감도가 우울증 환자의 대인관계에 미치는 영향

남미영,허휴정,채정호 대한우울조울병학회 2015 우울조울병 Vol.13 No.3

Objectives : Behavioral inhibition/behavioral activation systems (BIS/BAS) influence on one’s behavioral patterns. This study investigated that depressive patients with high BIS sensitivity tend to have high KIIP-SC score and people with high KIIP-SC score tend to have more interpersonal problems. Methods : A total of 152 patients diagnosed with depressive disorders completed questionnaire measuring BIS/BAS, demographic, clinical characteristics such as depression, anxiety and interpersonal problems(KIIP-SC). We used multiple regression analysis to investigate the relevance of BIS/BAS sensitivity and KIIP-SC and its subscales. Results : High BIS scores were associated with high scores of KIIP-SC and of subscales of the KIIP-SC ; cold, socially avoidant, nonassertive, exploitable, overly nurturant, and intrusive. High BAS scores were associated with high scores of domineering and intrusive area and with low scores of cold, socially avoidant, nonassertive areas. BAS scores were not associated with KIIP-SC scores. There was no significant difference on total KIIP-SC scores according to sex, meanwhile, men had higher domineering and vindictive area scores than women. Conclusions : Depressed patients with behavioral inhibition systems had more interpersonal problems than those with behavioral activation systems. These findings suggest BIS scores are associated with interpersonal problems in patients with depressive disorders.

우울장애 환자의 신체화 증상에 영향을 미치는 임상 요인 : 반추적 반응과 신체화 증상의 연관성

정재훈,허휴정,채정호 대한우울조울병학회 2014 우울조울병 Vol.12 No.2

Objectives : In many studies, somatization symptoms have been proposed to predict treatment outcome of depressive disorders and reported to have a strong relationship with depressive disorders. The aim of the study was to identify demographic and clinical characteristics related to somatization symptoms in patients with depressive disorders. Method : A total of 115 patients who had met the DSM-IV criteria for nonpsychotic depressive disorders were recruited and completed the self-administered scales of depressive, anxiety and somatization symptoms and the degree of rumination. Pearson’s correlation test and t-test were carried out to identify factors that might influence somatization symptoms. Multiple logistic regression analysis was performed to determine factors that have an independent correlation with somatization symptoms. Results : Among demographic and clinical variables, somatization symptoms were related to gender, depression, anxiety, ruminative response and anger rumination. In multiple logistic regression analysis, only gender, depression and ruminative response had a significant influence on somatization symptoms. Conclusion : In this study, these finding focused on ruminative response that might contribute to somatization symptoms in patients with depressive disorders. Ruminative response might be an important factor predicting the treatment outcome of depression.

우울 및 불안장애 환자에서 신체 통증과 관련된 인지정서조절전략

태혜진,허휴정,권예지,황지현,채정호,Tae, Hyejin,Heo, Hyu-Jung,Kwon, Yeji,Hwang, Jihyun,Chae, Jeong-Ho 대한불안의학회 2016 대한불안의학회지 Vol.12 No.1

Objective : Emotional state and emotion regulation strategies are considered to be important factors influencing the pattern and severity of somatic pain. The aim of this study is to investigate the relationship between cognitive emotional regulation strategies and somatic pain in patients with depression and/or anxiety disorders. Methods : A total of 140 outpatients, diagnosed with depression and/or anxiety disorders according to DSM-IV-TR, were evaluated using the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), the Cognitive Emotion Regulation Questionnaire (CERQ), and the Numerical Rating Scale (NRS) for somatic pain. Pearson correlations and independent t-tests were performed to analyze the relationship between somatic pain, the severity of depression and/or anxiety and cognitive emotion regulation strategies. Results : The severity of pain was significantly correlated with depressive symptoms, but not with anxiety. Patients with somatic pain tend to use maladaptive cognitive emotion regulating strategies more frequently, especially rumination and catastrophizing. Conclusion : These findings suggest that somatic pain correlates with maladaptive cognitive emotional regulating strategies. Interventions which modulate these non-productive strategies, especially rumination and catastrophizing, would be a new approach for managing patients with depressive and/or anxiety disorders who are suffering from somatic pain.

우울증 환자에서 외상 사건 경험과 주관적 수면 문제의 특성

김민섭,허휴정,채정호,Kim, Min Seob,Huh, Hyu Jung,Chae, Jeong-Ho 대한불안의학회 2016 대한불안의학회지 Vol.12 No.1

Objective : The aim of this study was to investigate the relationship between subjective sleep problems and various types of traumatic events of patients with depressive disorder. Methods : A total of 411 patients diagnosed with depressive disorders were recruited in this study. The participants filled out Life Time Events Checklist (LEC), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI). We used the independent t-test and analysis of covariance to compare each component of PSQI between depressive patients with and without traumatic experiences. Results : The groups of patients who experienced a serious accident at work, home or during recreational activity, sexual assault, other unwanted or uncomfortable sexual experience, life-threatening illness or injury, and sudden, unexpected death of a near and dear one showed lower scores in a few components of PSQI. Sleep disturbance was a common problem in all five groups. Lower subjective sleep quality and longer sleep latency was observed in three groups. There were no differences in the other components of PSQI among groups. Conclusion : This study showed that various types of traumatic events may have different effects on subjective sleep quality as a consequence of the traumatic event which they had experienced.