불안신경증과 알코올남용·의존 환자에서 Tofisopam의 항불안 및 항우울 효과 검증

김승태(Seungtai. Peter Kim),홍경수(Kyung-Sue Hong),김도관(Doh Kwan Kim),홍성도(Sungdo David. Hong),유범희(Bum-Hee Yu) 한국중독정신의학회 1997 중독정신의학 Vol.1 No.1

The study aims at evaluating antianxiety and antidepressant effects of tofisopam, a benzodiazepine-related chemical substance with some variations in its nitrogen number and positions. The study subjects were 27 adult outpatients, namely, 11 anxiety neurosis patients(M 6, F 5) and 16 alcohol abuse or alcohol dependence patients(M 13, F 3), diagnosed according to DSM-IV. Tofisopam, doses ranging 100-150mg per day, was administered to each patient in an open clinical trial, over a period of 6-8 week. Each patient was administered with Hamilton Anxiety Scale(HAS) and Hamilton Depression Scale(HDS) twice, before the initiation of tofisopam admininistration and at the completion of 6-8 weeks of the medication administration, to assess the degree and extent of improvements of anxiety and depression symptoms. The following results were obtained from the study: (1) Tofisopam showed noticeably significant antianxiety effects and less significant antidepressant effects. (2) There were no clinically observable or reported untoward CNS effects(e.g. drowsiness, impaired memory, disturbance in attention, etc.) by tofisopam. (3) The more significant improvements among the anxiety symptom clusters were physical(musculomotor and sensory) and autonomic nervous system symptoms. (4) During and immediately after the completion of 6-8 weeks of tofisopam adminstration, alcoholic patients reported of significantly reduced or extinct alcohol cravings. However, it remains to be carefully evaluated whether anticraving effects of tofisopam is transient, long lasting, or psychogenic, etc. The study results warrants further careful revalidations by use of a longitudinal double-blind crossover design and on a large number of patients.

전산화 신경인지기능 검사를 이용한 알코올 중독자의 인지기능 평가

김석중(Suk-Jung Kim),김재진(Jae-Jin Kim),최인석(In-Seok Choi),홍성도(Sungdo David Hong),정인원(In-Won Chung) 한국중독정신의학회 1997 중독정신의학 Vol.1 No.1

Chronic alcoholics show various degrees of dysfunction in abstraction, memory, perception, problem-solving ability, motor performance and so on. The evaluation of neurocognitive status is important to figure out the CNS effect of long-term heavy drinking and the prognosis of alcoholic patients. The present study was designed to assess cognitive deficits of alcoholics with recently developed computerized neurocognitive tests and to inspect the clinical applicability. We administered Standard Progressive Matrices, Cognitrone, Determination Unit, and Motor Performance Test Series in Vienna Test System(Schufried 1994), a computerized test battery, to twenty-two male hospitalized alcoholics who met DSM-III-R criteria for dependence and abuse and were abstinent for at least 6 weeks. Alcoholics tended to show less correct answers on Standard Progressive Matrices than controls, especially in difficult sets to solve, and displayed longer reaction time for correct answer on Cognitrone, less appropriate reactions and more missed reactions on Determination Unit, and poorer performances on Motor Performance Test Series. These results suggest that alcoholics with relatively long abstinence period, though somewhat improved, still manifest deficits of visuo-spatial intelligence, poor motor performance, and psychomotor clumsiness aggravated in stressful situations. Considering many advantages of computerized tests, the computerized neurocognitive tests may be clinically useful for assessing cognitive deficits in alcoholics under certain restriction.

충북대학교병원 응급실에 내원한 전환장애 환자의 인구통계학적 특성에 관한 고찰

신철진,홍성도,김시경 충북대학교 의과대학 충북대학교 의학연구소 1997 忠北醫大學術誌 Vol.7 No.1

충북대학교병원 응급실에 내원한 전환장애 환자의 인구통계학적 특성 및 임상적 특성, 약물 치료를 포함한 응급처치 방법과 그에 대한 환자의 반응, 추적조사의 순응도를 조사하여 충북, 청주 지역 전환장애 환자의 특성과 향후 치료방향을 제시할 수 있는 자료로 활용하고자 본 연구를 시행하였다. 저자들은 1996년 3월부터 1997년 2월까지 충북대학교 병원 응급실에 내원하여 신경정신과적 진단평가를 밭은 73명의 전환장애 환자를 대상으로 인구통계학적 변수와 질병의 유발 요인과 증상, 치료에 대한 반응을 조사하였다. 전환장애 환자의 성별 분포는 남자 23명, 여자 50명으로 여자 환자가 많았으며 20대와 30대가 60.3%를 차지하였다 교육수준은 고졸 이하가 89.0%로 나타났으며 생활수준은 중하류가 87.6%로 많았다 직업의 분포를 살펴보면 주부가 39.7%, 학생이 15.1%으로 다수를 차지하였다. 전체 환자중 83.6%에서 증상의 호전을 보였으며 직업 및 성별에 따른 증상 및 병전성격 치료반응 등의 차이는 보이지 않았다. 그러나 유발인자에서는 주부들이 가족 및 배우자에 의한 요인이 다른 계층보다 유의하게 높았으며 학생들은 장래문제가 많았고, 전문직들은 상대적으로 다양한 유발요인을 가지고 있었다. 본 연구 결과는 여성, 중하류, 교육수준이 낮은 사람에서 많다는 기존의 국내외 연구결과들과 일치하며, 전환장애의 유발요인은 시대와 장소에 따른 문화적 특이성을 반영하지만 전환장애 자체는 시간과 장소에 관계없이 내적 또는 외적 요인에 의하여 언어적 의사소통 및 욕구충족이 억압된 데 대한 일반적인 반응이라는 가설에 부합되는 소견이라 할 수 있다. The demographics, clinical characteristics, treatment methods, and responses in the patients with conversion disorder who visited Chungbuk National University Hospital were investigated to assess the characteristics of conversion disorder in Cheongju and Chungbuk area and to have some implications about the treatment. Seventy-three patients with conversion disorder diagnosed by DSM-IV criteria were recruited from MAR, 1996 to FEB, 1997. The subjects consist of twenty-three males and fifty females. The patients in their third and forth decades was 60.6% of all. On educational levels, the subjects of 89.0% were below collegian. The subjects of 87.6% were in the middle and lou7 economical states. Their occupations were housewife(39.7%), students(15.1%) and etc. The subjects of 83.6% showed improvement of symptoms, and there was no significant differences in types of symptoms, premorbid personality, and treatment responses according to their sex and occupations. However housewives had significantly more spouse and family problems for the precipitating factors. Students had more future problems, and professionals had various kinds of precipitating factors. This study showed the same result as previous studies carried out in domestic or other country in that conversion disorder is prevalent in female, middle and low classes of economical status, and low educational levels. These results are compatible with the notion that the precipitating factors of conversion symptoms are variable along with the specific cultural environment, but conversion disorder itself is the behavioral response to the repression of wishfulfillment or verbal communication by intrinsic or extrinsic factors regardless of time and space.

주의력 결핍 과잉 행동 장애의 유병률과 관련 인자 : 서울시 학교 정신보건 사업

양수진,정성심,홍성도 大韓神經精神醫學會 2006 신경정신의학 Vol.45 No.1

Objectives : To estimate the prevalence and correlates of children who had Attention Deficit Hyperactivity Disorder (ADHD) in Seoul. Methods : A cross-sectional survey of 2,429 children included in four elementary schools at Seoul. Parents and teachers completed the Korean ADHD Rating Scales (K-ARS) and the Korean version of the Strengths and Difficulties Questionnaire (SDQ-Kr). Child psychiatrists interviewed the children who demonstrated clinically significant scores on K-ARS and SDQ-Kr. Further assessments were conducted with other psychological tests if needed. Results : 1) Of 2,429 children, 158 (6.5%) children had ADHD. 2) Compared to controls, ADHD children showed more frequently male preponderance, more single parent family, lower parental education level, more paternal no employment, poorer sibling relationship, fewer number of friends, and lower ability in language and mathematics. 3) In multivariate analysis, ADHD were associated with boys, single parent family, poor sibling relationship, and low language ability. Our stratified analysis by gender, there were association with single parent family and lower language ability in boys, and poor sibling relationship and lower mathematics ability in girls. Conclusion : This study found 6.5% prevalence of ADHD and ADHD were associated with gender, family environment, and academic achievements. Understanding of high-risk children would help in developing an ADHD school mental health program.

"아동 기질에 대한 부모 설문지"의 한글 표준화 연구

최성구,김승태,이소영,정유숙,홍성도,김이영 대한신경정신의학회 1999 신경정신의학 Vol.38 No.1

연구목적 : 저자들은 국내 기질연구에 장애가 되고 잇는 원인중의 하나가 표준화된 기질 평가도구의 미비라고 생각하였다. 따라서 저자들은 기질 연구의 효시가 되었던 Thomas와 chess에 의해 개발되고 표준화되었으며, 3세에서 7세 사이 아동의 기질을 부모설문지를 통하여 평가 할 수 있는 “Parental Temperament Questionnaire”의 한국어판 표준화를 위하여 본 연구를 설계하고 실시하였다. 방 법 : 연구대상은 전국 25곳의 삼성어린이집에 다니고 있는 1,175명의 아동이었다. 저자들에 의해 번역된 “아동 기질에 대한 기질 설문지”, 기존에 표준화되어 신뢰도와 타당도가 입증된 “한국판 걸음마기 기질평가 척도” 및 “예일 소아행동 평가척도”를 연구대상 아동의 부모들에게 배포한 후 채점된 결과를 이용하여 신뢰도 및 타당도를 검증하였다. 결 과 : 검사-재검사 신뢰도, 기질범주별 문항-범주 상관선, 내적 일관성 등의 신뢰도 검사에서 모두 만족할만한 수준의 값들을 보여주었다. 설문지사의 각 기질 범주 점수와 어머니가 느끼는 기질 범주사이의 상관성은 “산만성” 범주를 제외하고는 모든 범주에서 통계적 의의가 있었다. “아동 기질에 대한 기질 설문지”, 각 기질범주 점수와 “한국판 걸음마기 기질평가 척도”의 기질범주 사이의 상관관계에서 모든 기질 범주에서 통계적으로 유사한 상관관계를 보였다. “아동 기질에 대한 기질 설문지”의 9가지 기질 범주와 “예일 소아행동 평가척도”의 11가지 소척도 사이에는 다양한 상관관계를 보였다. 결 론 : 본 연구를 통하여 개발된 “아동 기질에 대한 기질 설문지”는 신뢰도 및 타당도면에서 검증된 표준화된 도구이며 향후 기질연구에 기초도구로 사용되길 기대한다. Objective : One of the factors that obstructs active progress of the temperament study in Korea is lack of the standardized assessment tools. Therefore, this study was designed and conducted for the purposed Korean standardization of “Parental Temperament Questionnaire (PTQ)”, which was developed by Thomas Chess, to assess the temperament of children between the ages of 3 and 7 years through parental questionnaire. Method : The samples consisted of 1,175 children who were attending nurseries nationwide. PTQ was translated into Korean language by the authors and distributed to the parents of these children, along with “Toddler Temperament Scale(TTS)” and “Yale Child Inventory(YCI)” which had been previously standardized by different investigators. The reliability and validity of the Korean version of PTQ were tested. Results : Test-retest reliability, item-category correlations and internal consistency of the Korean version of PTQ were generally satisfactory. Correlations between the perceived temperament and the rated temperament were statistically significant in all temperamental categories except destructibility. The correlation between PTQ and TTS was statistically significant in all categories. The 9 categories of PTQ correlated variously with 11 subscales of preschool behavioral assessment of YCL. Conclusion : The Korean version of PTQ is a standardized tool to assess the temperament of children between ages 3 and 7 years, which will be a useful basic tool for the study of temperament of Korean children.

주의력결핍 과잉행동장애 아동에서 혈중 납농도 수준과 문제행동 및 주의력과의 관계

김의정,김지훈,정유숙,홍성도,연규월 梨花女子大學校 醫科大學 醫科學硏究所 2002 EMJ (Ewha medical journal) Vol.25 No.1

연구목적 : ADHD의 원인은 아직 분명하게 밝혀지지 않았으며 그중 하나의 원인으로 제기되고 있는 것이 납과의 연관성이다. 최근에는 낮은 농도의 납 축적은 신경 행동학적인 손상과 직접적인 연관이 있다고 받아들여지고 있으며 주의력결핍 과잉행동장애의 다양한 치료적 접근은 적절한 평가와 원인에 대한 이해를 바탕으로 할 것이며 따라서 원인론에 대한 이러한 연구를 통하여 다양한 원인적 요소를 밝히고자 하는 노력은 매우 중요하다고 할 수 있다. 이에 본 연구에서는 혈중 납 농도와 주의력결핍 과잉행동장애 사이에 어떤 원인론적 연관성이 있을 것이라는 가설하에 1) 주의력 결핍 과잉 행동 장애 아동에서 혈중 납농도와 여러 영역의 문제행동 사이의 상관성 조사, 2) 혈중 납 농도와 CPT(Continuous Performance Test)간의 상관성 조사를 목적으로 한다. 연구방법 : 삼성서울병원 소아정신과에 내원한 환아로 소아정신과 전문의가 DSM-Ⅳ 진단 기준에 따라 주의력결핍 과잉행동장애로 진단한 62명의 환아를 대상으로 하였으며, 과거력이나 현 병력상 경련 질환이 있거나 대뇌손상의 경력이 있는 환아, 정신지체, 자폐아의 경우는 배제하였다. 대상아동의 평균 연령은 9.37±1.98세였다. 기초설문지를 통해 인구학적 특성을 조사하였고, 한국어판 부모, 교사용 아동문제 행동 평가 척도(Child Behavior Check-List), 단축형 Conners 평가 척도, WWPARS(Werry-Weiss-Peter Activity Rating Scale), HSQ(Home Situation Questionnaire), SSQ(School Situation Questionnaire)를 사용하여 가정과 학교에서의 문제행동의 정도와 상황을 평가하도록 하였다. 62명중 26명에서 주의력과 충동성의 정도를 파악하기 위하여 TOVA(The Test Of Variability of Attention)를 실시하였다. 모든 대상의 아동들의 전혈을 채혈하여 혈중 납농도를 측정하였다. 결과 : 1) 전체 62명 대상군의 평균 혈중 납농도는 3.39±1.32㎍/㎗이었다. 2)부모용 문제 행동 평가 척도중 사회적 위축척도와 혈중 납농도사이에는 0.33의 상관계수를 나타냈다(p<0.01). 3)TOVA의 측정요인중 omission error, commission error, variation과 혈중 납농도 사이에는 각각 0.34(p<0.1), 0.43(p<0.05), 0.34(p<0.1)의 상관계수를 나타냈다. 결론 : 혈중 납농도의 측정치는 부모용 문제행동 평가척도중 사회적 위축 척도와 연관을 보였으며, 주의력 및 충동성을 나타내는 TOVA 검사중의 omission error, commission error, variation 점수와도 연관성을 보였다. 이는 주의력결핍 과잉행동 장애 아동에서 혈중 납농도의 축적과 주의력 문제간에 어떤 연관성을 시사한다. Objective : It is now generally accepted that lead low doses may influence behavioral and attentional problems in children. The selection of a treatment approach depends on a proper assessment of the cause of the problem. This study was carried out to investigate the relationship between exposure to lead and behavioral and attentional problems in attention deficit hyperactivity disorder(ADHD). Methods : The participants were 62 boys, 6 to 12 years of age with ADHD. Children with probable causes of attentional or behavioral problems other than lead contamination were excluded from the study. Various aspects of behavioral problems were measured using questionnaires for parents and teachers. Attentional problems were measured with TOVA(The Test Of Variability of Attention). As an assessment of body lead burden, lead concentration in blood was measured. Results : Mean lead concentration in blood was 3.39 1.32㎍/㎗. Correlations between lead concentration in blood and the possible confounding factors were not significant. The results were same as that of lead concentration in attentional and behavioral problems. Lead concentration was significantly correlated with the scores of TOVA : omission error(r=0.34, p<0.1) ; commission error(r=0.43, p<0.05) ; and variation(r=0.34, p<0.1). Correlations between lead concentration and social withdrawal subscale of CBCL were significant(r=0.33, p<0.01). Conclusions : It appears that some link between low-level exposure to lead and performances exist.