외상 환자에서 의식소실 유무와 외상후 스트레스 장애의 유병율, 증상 양상, 우울 및 불안에 관한 연구

이유진,연규월,우행원,김영철,임원정 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.4

연구목적 : 본 연구에서는 의식 소실 유무에 따른 외상후 스트레스 장애 유병율 및 증상, 우울, 불안 증상을 알아보기 위해 외상을 당한 환자를 의식 소실이 있었던 환자군과 의식 소실이 없었던 환자군으로 구분하여 두 집단의 외상후 스트레스 장애의 유병율, 증상 및 불안 정도를 비교해보고자 하였다. 방 법 : 사고를 당하고 1달 이상 경과한 환자 120명(남자 69명, 여자 51명)을 대상으로 하였다. 대상군을 의식 소실 유무에 따라 소실군과 비소실군으로 구분하고 사회인구학적 변수, 사고 당시 의식 소실의 유무, 의식 소실 시간, 사고의 종류, 사고에 대한 기억, 사고의 심각도, 손상 심각도 점수(Injury Severity Score)를 조사하여비교하였다. 또한 외상후 스트레스 장애 척도(Clinician Adminstered PTSD Scale), Beck의 우울증 척도(Beck Depression Inventory), 상태 특성 불안처도- Ⅰ, Ⅱ(State Trait Anxiety Inventory- Ⅰ, Ⅱ)를 이용하여 조사하여 두 군 사이의 외상후 스트레스 장애유병율 및 증상, 우울, 불안 정도를 비교하였다. 결 과 : 통 연구 대상자 120명중 의식 소실이 있었던 환자군(소실군)은 56명(46.7%)이었고 의식 소실이 없었던 환자군(비소실군)은 64명(53.3%)이었다. 총 대상자 120명중 30명(25%)이 외상후 스트레스 장애로 진단되었으며 소실군 56명중 17명(30.4%)이 비소실군 64명중 13명(20.3%0이 각각 외상후 스트레스 장애로 진단되었으나 두 군간의 차이는 통계적으로 유의하지 않았다(x^2=1.607, P>0.05). 외상후 스트레스 장애 증상 척도에서는 소실군에서 사고에 대한 기억 상실, 흥미 상실, 이탈, 감정 둔마, 수면자애, 예민함, 집중력 감소 증상의 빈도가 유의하게 높았다(P<0.05). 비소실군에서느 반복적인 회상과 놀람 반응 빈도가 유의하게 높았다(p<0.05). Beck의 우울증 척도 점수는 소실군에서 38.8±8.8, 비소실군에서 31.0±7.9로 의식 소실을 보고한 환자군의 점수가 유의하게 높았으며(t=-3.16, 0<0.05) 상태 특성 불안 척도-I, II는 소실군에서 각각 44.5±3.3, 44.6±3.9, 비소실군에서 각각 42.9±3.0, 42.3±3.4로 소실군의 점수가 유의하게 높았다(t=-2.75, p<0.05, t=-3.38, p<0.05). 결 론 : 사고 당시 의식 소실이 없었던 환자군과 비교하여 외상후 스트레스장애가 비슷한 빈도로 진단되며 의식 소실이 외상후 스트레스 장애의 발생에 유의한 영향을 미침은 물론 불안 및 우울에도 유의한 영향을 미친다고 할 수 있다. Objectives :This study investigated PTSD prevalence, symptoms, depressed mood and anxiety, comparing two groups of the patients in trauma ; one who had experienced the loss of consciousness(group "A" here after) and the other group of patients who had not(group "B" here after). Method : subjects were 120 patients(age18-66) who had received trauma(traffic accident, fall down) more than 1 month. Before they consisted of 56 patients who had experienced the loss of the consciousness(46.7%) and 64 who had not(53.3%). Men were 69 and women were 51. Clinician administered PTSD Scale, Beck Depression Inventory, State Trait Anxiety Inventory-I, II were administered. The factors such as sociodemographic variables, unconsciousness at the time of trauma, memory about tranmatic accidents were considered. Result : Out of 120 subjects, 30 patients(25%) were diagnosed as PTSD : 17 from 56(30.4%) and 13 from 64(20.3%) were found in the group "A" and "B" respectively. Prevalence of PTSD was higher in the group "A" showed significant difference between two groups(x^2=1.607,p>0.05). The CAPS of group "A" showed significantly high frequency in the loss of interest, detachment, restricted affect, sleep difficulty, irritability/anger. concentration difficulty(p<0.05), while the group "B" scored high in intrusive recall and increased startle. The scores of BDI, STAI-I, II were significantly higher in the group "A"(t=-3.16, p<0.05)(t=-2.75, p<0.05, t=-3.38, p<0.05). Conclusion : PTSD was mre frequent and depressed mood and anxiety appeared more often in the group qho experienced the loss of consciousness. Thus the loss of the consciousness at the time of trauma prones of the aevelopment PTSD and symptom of aepression and anxiety.

정신분열병 환자의 유ㆍ소아기 발달 및 소아 청소년기의 병전 사회 적응에 대한 연구

문지현,우행원,김영철,연규월,김종원,임원정 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.6

연구목적: 주요 정신 질환 가운데 하나인 정신분열병은 병의 증상이 나타나기 훨씬 이전인 유아기 및 소아기 때부터 앉기, 서기, 걷기, 말하기, 대소변 가리기 등의 발달 양상과 언어 기능, 운동 기능 등의 양상에서 차이가 나며, 소아 청소년기의 적응 정도도 좋지 않다고 알려져 왔다. 본 연구에서는 대조군과 정신분열병환자군의 발병 전 과거 발달 과정과 병전 적응 정도를 비교하여 그 차이를 알아보고자 하였다. 방 법: 연구 대상은 이대부속 동대문병원 정신과에 입원하였던 환자들 중 정신과 진단 편람 제4판 진단 기준에 의거하여 정신분열병으로 진단 받은 환자군 56명(남자 26명, 여자 30명)과 대조군 51명(남자 25명, 여자 26명)이었다. 연구 방법은 환자와 환자 가족과의 직접 면담 및 병록지 검토를 통해 유아기 발달 과정의 주요 이정표 획득 시기, 소아기의 언어 기능과 운동 기능을 평가하였고, Lewis의 산과적 합병증 척도를 이용하여 출산 합병증을 평가하였으며, 병전 사회 적응 척도를 이용하여 소아 청소년기의 병전 적응 정도를 평가하였다. 사춘기 이차 성징 획득에 관한 정보는 Tanner stage에 기초하여 수집하였다. 결 과: 1) 출산시의 산과적 합병증은 환자군과 대조군에서 유의한 차이가 없었다. 유아기 발달 과정 상 환자군에서 처음 앉은 시기, 걸음마를 시작한 시기, 처음 문장을 말한 시기가 대조군에 비해 유의하게 지연되었다(p<0.05). 2) 소아기 발달 과정을 보면 언어 발달상의 문제는 환자군에서 유의하게 많았으나(p<0.05). 운동 기능 장애의 빈도는 두 군 사이에 차이가 없었다. 읽고 쓰기 시작한 연령은 환자군에서 지연되었다(p<0.05). 환자군에서 언어 기능 장애 및 운동 기능 장애의 빈도는 성별간의 차이를 보이지 않았다. 3) 소아기의 병전 적응 정도는 환자군에서 대조군에 비해 좋지 않은 편이었으나 유의하지 않았다(p=0.06). 반면 청소년기의 적응 정도는 환자군이 유의하게 좋지 않았다(p<0.05). 소아기와 청소년기 동안의 병전 적응 정도를 사회성 영역과 학업 영역으로 나누어 보았을 때 두 영역 모두 환자군에서 유의하게 좋지 않은 것으로 나타났다(p<0.05). 환자군에서 발병 연령이 빠를수록 병전 적응 정도가 좋지 않은 경향이 있었으나 통계적 유의성에는 이르지 못했다(Spearman`s coeff=-0.27, p=0.07). 4) 성별에 따라 살펴보았을 때 남자 환자가 여자 환자보다 학업 영역에서 좋지 않은 적응 정도를 보였다(p<0.05). Tanner Stage에 기초한 이차 성징의 발현은 두 군 사이에 차이가 없었다. 결 론: 이상의 결과를 종합하면, 환자군에서 유아기 발달 과정상 처음 앉는 시기와 걸음마를 시작한 시기 등의 운동 발달 영역과 처음 문장을 말한 시기 등 인지 발달 영역이 대조군에 비해 지연되며, 소아기의 언어 발달 과정에 문제가 있는 경우가 많았고, 읽고 쓰기 시작한 연령이 늦어지며, 발병 전 청소년기의 적응 정도가 대조군에 비하여 좋지 않았다. Objectives: Schizophrenia, one of the major mental illnesses, shows abnormal developmental patterns such as delayed developmental milestones, impaired language and motor function, and poor premorbid social adjustment long before the onset of clinical symptoms of illness. In this study, we tried to find out developmental patterns and premorbid adjustment during childhood and adolescence in schizophrenic patients. Methods: The subjects were 56 inpatients(26 male patients and 30 female patients) who met the diagnostic criteria for schizophrenia by DSM-Ⅳ and 52 healthy control subjects(25 male patients and 26 female patients). Interview with subjects and their families and the review of medical records were done to assess sociodemographic factors, timing of developmental milestones, language and motor function of childhood, and timing of sexual maturational events. Obstetrical Complication Scale of Lewis was used to get information on the subjects prenatal and perinatal history, and Premorbid Social Adjustment Scale(PSAS) to assess premorbid adjustment. Results: 1) There were no significant differences in the rates of obstetrical complications. The developmental milestones during infancy such as sitting, walking, age of first sentence were significantly delayed in the schizophrenics than in the controls(p<0.05). 2) Disturbances of speech and language development were significantly more common in the schizophrenics than in the controls(p<0.05), but there were no significant differences in the rates of disturbance in motor development. Mean ages of reading and writing were significantly delayed in schizophrenics than in the controls(p<0.05). No significant differences were found between males and females for either language disturbance or motor disturbance in the schizophrenics. 3) During adolescence, premorbid adjustment was poorer in schizophrenic patients(p<0.05). The schizophrenic patients scored significantly worse than the controls on both sociability and schooling domains(p<0.05). There was a trend for correlation between poor premorbid functioning and early age of onset, but it failed to achieve statistical significance(Spearman`s coeff=-0.27, p=0.07). 4) Male schizophrenic subjects showed poorer premorbid functioning on schooling domain than female schizophrenic subjects(p<0.05). No significant difference was recognized in timing of sexual maturational events between schizophrenics and controls. Conclusion: In summary, the schizophrenics were significantly delayed in infantile developmental milestones, impaired in development of language, delayed mean age of reading and writing, and showed poorer premorbid social adjustment than the controls.

강박장애 환자에서 Sertraline 치료반응의 예측인자에 관한 연구

유은정,우행원,김영철,연규월,김종원,임원정 대한신경정신의학회 2000 신경정신의학 Vol.39 No.2

연구목적: 1980년 중반부터 강박장애의 치료로 SSRIs가 널리 쓰이고 있으나 치료반응의 예측인자에 대한 연구는 미비한 실정이다. 본 연구에서는 sertraline 투여후 호전군과 비호전군의 인구학적 특성, 발병연령, 이환기간, 과거의 강방장애에 대한 투약경력, 정신과 질환의 가족력, 증상의 심각도, 임상양상 등의 변수들을 관찰하여 sertraline 치료반응과의 상관관계를 살펴보았으며 치료방응을 예측 할 수 있는 인자를 알아보았다. 방법: 연구 대상은 이대부속 동대문병원 정신과에 입원 또는 외래치료를 받은 환자들 중 정신과 진단 편람제 4판 진단 기준에 의거하여 강박장애로 진단 받은 31명(남자 10명, 여자 21명)이었다. 연구 방법은 sertraline을 하루 50mg씩 투약하면서 Y-BOCS, NIMHOCS, CGI로 강박증상의 변화를 평가하였고, HAM-A로 불안정도의 변화를 측정하여 투약 전 점수와 비교하였다. 결과: 1) Y-BOCS 점수 40%이상 감소와 함께 CGI 점수 2점 이상 감소를 보인 호전군은 대상환자 31명중 17명(54.8%)이었고, 비호전군은 14명이었다. 호전군이 비호전군에 비해 늦은 나이에 발병하는 경향을보였고(p<0.1), 이환기간이 짧았으며(p<0.05), 과거의 강박장애에 대한 투약경력은 적었다(p<0.05), 정신과 질환의 가족력은 두 집단간에 차이가 없었다. 2) 호전군에서 투약 전 Y-BOCS의 강박행동 점수가 유의하게 낮았으며(p<0.05), 기타 다른 평가척도에서는 두 집단간에 유의한 차이가 없었다. 3) 평균 Y-BOCS 점수는 투약 전에 비해 sertraline 투약 12주째 43.5%가 감소하였다. 투약 전과 비교하여 투약 2주째부터 불안을 평가하는 HAM-A 점수가 유의하게 감소하였고, 투약 4주째부터 Y-BOCS, NIMHOCS, CGI 점수가 유의하게 감소되기 시작하여 12주까지 지속되었다.(p<0.01). 4) 호전군에서 오염에 대한 강박사고와 씻음의 강박행동의 유의하게 많았으며(p<0.05), 셈의 강박행동은 없었다(p<0.05), 병적 의심은 비호전군에서 많은 경향을 보였다(p<0.1). 결론: 이상의 결과를 종합하면, 질병의 이환기간이 짧으며 과거의 강박장애에 대한 투약경력이 적고 투약 전강박행동이 심하지 않으며, 주된 임상양상이 오염에 대한 강박사고와 씻음의 강박행동인 경우 sertra-line에 좋은 치료반응을 보이지만, 셈의 강박행동이 있는 경우에는 치료반응이 좋지 않다고 예측할 수 있다. Objectives: The pharmacologic treatment of obsessive-compulsive disorder(OCD) with serotonergic antidepressant agents is well established in clinical psychiatry on the basis of serotonin hypothesis. Studies on predictive factors of treatment reponse to OCD are relatively scarce. The author compared the demographic factors, age of onset, length of illness, family history of mental illness, previous drug history for OCD, severity and type of symptoms between the drug reponders and non-responders to find out the predicitive factors that may be related to treatment response. Methods: The subjects were 31, both inpatients and outpatients who met the diagnostic criteria for OCD by DSM-IV and scored 20 or higher on the Yale-Brown Obsessive-Com-pulsive Scale(Y-BOCS) completed 12-week trial of sertraline. Y-BOCS, National Institute of Mental Health Obsessive-Compulsive Scale(NIMHOCS), Clinical Global Impression Scale(CGI) were scored to measure the changes of obsessive-compulsive symptoms, and Hamilto Anxiety Scale(HAM-A) was measured at each visit. Results: 1) The responders, defined as achieving at least a 40% decrease in the Y-BOCS total score and more than a 2 point decrease in CGI score, were 17(54.8%), and non-responders were 14(45.2%). Responders tended to show later onset(p<0.1), and shorter duration of illness(p<0.05), and less previous drug therapy for OCD(p<0.05) than non-responders. There were no significant differences in family history of mental illness between the two groups. 2) The basline Y-BOCS compulsive score was significantly lower in responders(p<0.05), although there was no significant difference in the basline severity of other measures. 3) The obsession of contamination and washing behaviors were more frequent, but compulsive counting was not shown, in responders(p<0.05). The pathological doubt tended to be more common in nonresponders(p<0.1). Conclusions: In summary, the patients with shorter duration of illness, less prior drug ther-apy for OCD, and less severe compulsive behaviors, and the obsession of contamination and washing behaviors are expected to be better outcome with sertraline, whereas compulsive counting are the predictor of poor response.

열수, UV 조사, 초음파처리가 배 유과 총 페놀화합물 함량 증진에 미치는 효과

한승규(Seung-Kyu Han),조정안(Jeong An Jo),김월수(Wol Soo Kim) 한국원예학회 2011 한국원예학회 학술발표요지 Vol.2011 No.10

치료자의 임신에 대한 정신과 환자들의 반응

임원정,연규월,우행원 大韓神經精神醫學會 1994 신경정신의학 Vol.33 No.6

The psychological and physiological effects of pregnancy are various, and the pregnancy brings differences in woman's physical appearance and identity, therefore it affects the pregnant women as well as the family. This study was set up to find the patients' diverse emotional reactions when the psychiatric therapist becomes pregnant and to apply that findings in the treatment. The suvjects were 30 psychiatric inpatients(14 men and 16 women) admitted at Ewha Womans University Hospital Psychiatric Ward Whose mean age was 30.8 ±10.3 years old. Their diagnoses were schizophrenia(17), Schizoaffective disoerder(4), mood disorder(3), presonality disorder(13), conduct disorder(1), and eating disorder(1). The mean age of control group(8 men and 22 women) was 29.0 ±7.3years old. They were examined by the questionnaire which was designed for this study. The reliability of the questionnaire was measured by Cronbach's alpha coefficient and the internal consistency was 0.83 which proved to be high. Among 8 items in the questionnaire, there was no significant difference between the patients and the control in sexuality, fear of abandonment but there was significant difference between the patients and the control in sibling rivalry, competition, denial, identification, hostile fantasies, reaction formation and revival of mother-child relationship. There was no difference due to different sex in both the patients and control. Regardless of different sex, the therapists pregnancy gives many stimulations to patients and it stirs up various-transference emotions which reflects object relations in the childhood. If the therapist understands these transference emotions and verbalize it in the begining, the therapist's pregnancy will provide a productive and effective situation.

당뇨병 환자의 우울증상과 스트레스 대처방식 : 류마티스 관절염 환자 및 건강 대조군과 비교

심민영,연규월,김하경,김영철,홍영선,이지수,이정희,류정화,하창윤,김지민,성유미,김수인,임원정 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.5

Objectives : This study investigated how diabetes mellitus (DM) and depressive symptoms are related, and differed in terms of coping strategies. In addition, we compared those findings with rheumatoid arthritis (RA) patients. Methods : 80 DM patients, 45 RA patients and 77 healthy subjects completed the Beck depression inventory (BDI) and the Korean version of the ways of coping checklist. Results : BDI scores of depressed DM patients were significantly higher than healthy subjects (p<0.01) but not Significantly with depressed RA patients. Both scores of active (p<0.01) and passive coping (p<0.05) in DM patients were significantly lower than healthy subjects (p<0.01), and the scores of wishful thinking of DM patients were significantly lower than RA patients (p<0.01). BDI scores of DM patients were significantly correlated with the number of complications and the scores of problem-focused coping (p<0.05). In the hierarchical regression analysis, even after controlling for clinical Characteristics, coping strategies altogether could account for 31.0% of the variance of the depressive symptoms in DM patients significantly (p<0.01). Conclusion : DM patients showed significantly higher depression rate than healthy subjects but not than RA patients. In DM patients, insufficient coping strategies could explain substantial portions of depressive symptoms. Therefore, enhancing healthier coping strategies in addition to prevent medical complications might lessen depressive symptoms experienced by DM patients.

Hydroxycinnamoylmalic Acids and Their Methyl Esters from Pear (<i>Pyrus pyrifolia</i> Nakai) Fruit Peel

Lee, Ki Hoon,Cho, Jeong-Yong,Lee, Hyoung Jae,Ma, Young-Kyu,Kwon, Joseph,Park, Seong Hwa,Lee, Sang-Hyun,Cho, Jeong An,Kim, Wol-Soo,Park, Keun-Hyung,Moon, Jae-Hak American Chemical Society 2011 Journal of agricultural and food chemistry Vol.59 No.18

<P>Two novel caffeoylmalic acid methyl esters, 2-<I>O</I>-(<I>trans</I>-caffeoyl)malic acid 1-methyl ester (<B>6</B>) and 2-<I>O</I>-(<I>trans</I>-caffeoyl)malic acid 4-methyl ester (<B>7</B>), were isolated from pear (<I>Pyrus pyrifolia</I> Nakai cv. Chuhwangbae) fruit peels. In addition, 5 known hydroxycinnamoylmalic acids and their methyl esters were identified: 2-<I>O</I>-(<I>trans</I>-coumaroyl)malic acid (<B>1</B>), 2-<I>O</I>-(<I>cis</I>-coumaroyl)malic acid (<B>2</B>), 2-<I>O</I>-(<I>cis</I>-coumaroyl)malic acid 1-methyl ester (<B>3</B>), 2-<I>O</I>-(<I>trans</I>-coumaroyl)malic acid 1-methyl ester (<B>4</B>), and 2-<I>O</I>-(<I>trans</I>-caffeoyl)malic acid (phaselic acid, <B>5</B>). The chemical structures of these compounds were determined by spectroscopic data from ESI MS and NMR. Of all the isolated compounds, five hydroxycinnamoylmalic acids and their methyl esters (<B>2</B>–<B>4</B>, <B>6</B>, <B>7</B>) were identified in the pear for the first time.</P>

외상성 뇌손상 환자에서 뇌자기공명영상 소견에 따른 정신증상, 신경인지기능 및 삶의 질

김지민,성유미,연규월,김영철,임원정,김수인 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.3

Objectives : This study was intended to compare psychiatric symptoms, neurocognitive function and quality of life between normal finding group and abnormal finding group on Brain-MRI. We investigated which variables were related to quality of life (QOL) in traumatic brain injury (TBI) patients. Methods : Among thirty nine patients who had mild to moderate TBI, twenty two patients (57%) showed abnormal brain MRI findings correlated with their injury and 17 patients (43%) showed normal or nonspecific brain MRI findings. All patientscompleted Symptom check list-90-revised (SCL-90-R), Beck depression inventory (BDI), State-trait anxiety inventory (STAI), Korean version of the Smith Kline Beecham Quality ofLife scale (KvSBQOL) and Marlowe-Crown Social Desirability Scale (MCSDS). Two psychiatrists assessed the patients using Hamilton rating scale for depression (HAMD), Hamilton anxiety scale (HAMA) and functional assessment scale (FAS). In addition, K-orean Wechsler Adult intelligence Scale (K-WAIS), Rey-Kim Memory Test (R-KMT) and Kims frontal-executive neuropsychological test (KF-ENT) were assessed. Results : On FAS, the mean score was significantly lower in the abnormal finding on B-MRI group than the normal finding group (p=0.014). In the patients with abnormal MRI findings, the QOL scores significantly correlated with several subscales of SCL-90-R (obsessive-compulsive, depression, anxiety, global severity index and positive symptom total), FAS and memory quotient after controlling for MCSDS. However, in the patients with normal MRI findings, QOL scores significantly correlated with BDI and all subscales of SCL-90-R. When all pertinent variables were entered in stepwise regression analysis, depression (p<0.05) and interpersonal sensitivity (p<0.05) subscales of SCL-90-R explained 38.5% and 17.7% of the variance of the QOL score in patients with abnormal MRI findings. As for the patients with normal MRI findings, depression (p<0.05) subscale of SCL-90-R accounted for 54.2% of the variance of the QOL score. Conclusion : TBI patients who have persisting abnormal brain findings suffered from impaired daily functioning. Depression and interpersonal sensitivity explained 55% of the variance of the QOL together, In the patients with normal brain MRI findings, objective depression or anxiety did not correlate with QOL whereas subjective depressive symptom accounted for 54.2% of the variance of the QOL. This study suggests that subjective psychiatric symptoms including depression significantly correlated with the subjective QOL of TBI patients regardless of their brain MRI finding.

배 품종에 따른 배 와인 숙성과정 중 품질특성 비교

임은석(Eun-Seok Lim),조정안(Jeong An Jo),김월수(Wol Soo Kim),이상현(Sang Hyeon Lee),정지훈(Ji Hoon Chung),한승규(Seung Kyu Han),서민수(Min Soo Seo) 한국원예학회 2012 한국원예학회 학술발표요지 Vol.2012 No.10

배 품종별 식초 발효과정 중 품질 특성

임은석(Eun-Seok Lim),조정안(Jeong An Jo),김월수(Wol Soo Kim),이상현(Sang Hyeon Lee),정지훈(Ji-Hoon Chung),한승규(Seung Kyu Han),서민수(Min Soo Seo) 한국원예학회 2012 한국원예학회 학술발표요지 Vol.2012 No.10