폐경기 여성에서 에스트로젠 치료가 우울증상과 주의집중력에 미치는 영향

기백석,김성엽,이상훈,남범우,민경준,Kee, Baik Seok,Kim, Sung Yeop,Lee, Sang Hoon,Nam, Bum Woo,Min, Kyung Joon 대한생물정신의학회 1999 생물정신의학 Vol.6 No.2

본 연구는 폐경기 여성에서의 에스트로젠 치료에 따른 우울정도와 주의집중력의 차이를 평가하기 위해 폐경이 된 지 1년이 지난 폐경기 여성을 대상으로 사용군과 비 사용군으로 나누어 각각 30명을 대상으로 했다. 검사 도구는 한흥무 등(1986)이 표준화 한 Beck의 Beck depression inventory(BDI)를 사용하여 사용군과 비사용군으로 나누어 평가하였다. 그리고 주의 집중력의 평가는 K-WAIS(염태호 등 1992)의 소검사 항목인 숫자외우기와 바꿔쓰기을 사용하였다. 에스트로젠 사용군과 비사용군에서 각각의 검사 항목에 대해 t-test로서 유의한 차이가 있는지 비교하였다. 더불어 사용군과 비사용군에서 혈중 에스트라디올 농도를 측정하여 각 검사항목과 상관관계가 있는지 Pearson's correlation(r)를 통해 확인하였다. 결과는 BDI와 숫자외우기 중 바로 따라 외우기에서만 유의한 차이가 있었으며 다른 항목에서는 차이가 없었다. 그리고 혈중 에스트라디올 농도와 검사 항목간의 유의한 상관관계는 없었다. 본 실험을 통해 에스트로젠이 폐경기 여성에서 우울증상의 경감에 효과적이나 기억력 및 주의집중력에는 효과가 없음을 확인할 수 있었다. Objectives : The purpose of this study was to evaluate the difference of depressive symptoms and attention between estrogen user and non-user in postmenopausal women. Methods : 30 Estrogen users and 30 non-users were participated in this study. They were all menopausal for at least 1 year and have 12 or more education years. We used BDI(Beck depression inventory), digit span and digit symbol to evaluate depressive symptoms and attention in both groups. We also measured the plasma estradiol level and identified the correlation between estradiol level and BDI, digit span and digit symbol. Results : The demographic data was not different between both groups. Estrogen users scored higher than non-users in digit span(forward) and lower than non-users in BDI. The correlation between estradiol level and BDI, digit span and digit symbol was not significant. Conclusion : Estrogen replacement therapy was effective in alleviating depressive symptoms but ineffective in improving attention in postmenopausal women.

혈관성 치매와 알쯔하이머형 치매의 위험 요인에 대한 예비 연구

기백석(Baik Seok Kee),윤정현(Jung Hyun Yoon),김상국(Sang Kook Kim) 대한노인정신의학회 1997 노인정신의학 Vol.1 No.1

본 연구는 중앙의대 부속병원과 인천 은혜병원에 입원 중인 노인들중 치매로 진단된 환자들을 대상으로 하여 먼저 기록을 조사하고 DSM-Ⅳ와 NINCDS-ADRDA 진단 기준에 의해 임상 치매 진단을 확정하였다. 각 진단에 의한 위험 요인은 여러 참고 문헌과 환자의 기록을 참고하여 그중 의미있는 요인들을 선정하여 기록 조사 및 설문지 조사를 하였다. 조사 대상 및 연구 결과는 다음과 같다. 1) Alzheimer형 치매는 48명(남성 16명, 여성 32명), 평균 연령은 76.65(±7.47)세, 교육 연한은 3.58(±4.79)년이었고, 혈관성 치매는 26명(남성 7명, 여성19명), 평균 연령과 교육 기간은 각각 73.92(±6.69)세 5.04(±5.27)년이었다. 2) 3가지 위험 요인들 즉 고혈압, 전신 마취 병력, 고혈압 약물치료가 알쯔하이머형 치매에 비해서 혈관성 치매와 유의하게 관련있다고 나왔다. 3) 정신병 약물 치료, 폐쇄성 폐질환, 당뇨병, 음주, 치매 가족력, 두부 외상, 흡연 등은 양 군간에 차이가 없었다. The authers investigated risk factors between vascular dementia and Alzheimer's dementia patients admitted in Chung-Ang University Hospital and Inchen Eun Hea Hospital from October 1996 to Feburary 1997. Chart review was done and complete those were selected and final disgnoses of dementia for subjects (74) were made by DSM-Ⅳ and NINCDS-ADRDA criteria. Risk facters were studied between vascular dementia and Alzheimer's dementia. The results were as follows. 1) Alzheimer's dementia patients were 48 (male 16, female 32), mean age of those was 76.65 (±7.47) years and duration of education of those was 3.58 (±4.79) years. Vascular dementia patients were 26 (male 7, female 19), mean age and duration of education of those were 73.92 (±6.69) years and 5.04 (±5.27) years respectively. 2) With respect to risk factors , vascular dementia patients were more likely have a history of hypertension and general anesthesia. 3) We found no difference in history of COPD, diabetes mellitus, alcohol abuse, family history of dementia, closed head trauma and cigarette smoking.

노인성 기억장애(Age-Associated Memory Impairment) 개념적 및 임상적 고찰

기백석(Baik Seok Kee) 대한노인정신의학회 2001 노인정신의학 Vol.5 No.1

It is sufficient to justify distinguishing age-appropriate and age-inappropriate forms of age-related memory decline. The former, of which AAMI is an example, represents a normal age-related phenomenon, whereas the latter, the true descendent of benign senescent forgetfulness, is by definition abnormal and possibly, pathological. Whether age-inappropriate forgetfulness is progressive, whether it can be distinguished from other concepts of mild cognitive decline by virtue of being specific to memory, and whether it is qualitatively different from normal memory or merely worse is not yet certain. The prevalence of age-inappropriate forgetfulness is undetermined, but it is certainly less common than AAMI. The construct of AAMI was introduced by an NIMH work group. It was the group's declared intention to facilitate communication and stimulate research into late-life memory loss, particularly its treatment. Completely satisfactory diagnostic criteria do not yet exist for AAMI. Improved criteria would take an individual's overall level of intellectual functioning or educational background into account when setting the standard against which to rate memory, distinguish age-appropriate from age-inappropriate decline. AAMI differs from BSF in several points. First, the AAMI criteria define impairment with respect to healthy young adult levels, not to those of the older individual's age peers as was implied in the description of BSF. Second, the term AAMI is non-specific with regard to etiology and does not necessarily imply that the disorder is non-progressive. Thus, patients whose memory impairment is subsequently shown to be the earliest stage of a dementing illness are not necessarily excluded from the category of AAMI, and it is sensible to ask how often AAMI is, in fact, a dementia prodrome.

노인성 치매의 진단과 감별진단

기백석(Baik Seok Kee) 대한노인정신의학회 1999 노인정신의학 Vol.3 No.1

The auther tried to describe the diagnosis and differential diagnosis of senile dementia, especially Alzheimer's dementia (AD). AD is a clinicopathological manifestation, which patients are estimated as about 150 hundred thousands globally in 1997. The etiology of the AD is not cleared but the risk factors of the AD are known as old age, Down's syndrome and genetic factors. The diagnosis of the AD is based on exclusion criteria some years ago. But it is known that there are some distinghed clinical features through the clinical course of AD and physically peculiar features are found using neuroimaging technique. There are some distinguished changes found in the postmortem brain study of AD patients. The auther discussed the AD diagnosis process through AD differential diagnosis, mental status examination, functional global evauation, neuroimaging, electrophysiology, neuropathology and peripheral marker.

노인 환자의 정신상태 검사에서 기분 평가

기백석(Baik Seok Kee) 대한노인정신의학회 1998 노인정신의학 Vol.2 No.2

Among the elderly, affective disorders constitute the most commenly encountered psychiatric illness. Evaluation of Mood in the elderly patients is important because of uniqueness of senile depression. Depression in the elderly may present with various clinical symptoms such as chronic pain, multiple somatic complaints, or even dementia (pseudodementia). Also the seriousness of depression in the elderly is shown by the increase in and success of suicidal attempts among this group. About 15% of the total deaths of patients with affective disorder are due to suicide. Although some elderly depressed individuals presently atypically, most can be diagnosed according to the Washington University research criteria, which form the basis for the DSM-Ⅳ. In view of the effective therapies available for depression, it is especially crucial to make the diagnosis and proceed with treatment. The auther also reviewed rating scales of depression.

은퇴후 처음 발생된 노인 조증 삽화 치험 1례

기백석(Baik Seok Kee),이응준(Eung Jun Lee) 대한노인정신의학회 1997 노인정신의학 Vol.1 No.1

저자들의 증례는 63세의 남자로, 이전에 정신과 병력이나, 정신과 가족력이 없었고, 수면조절을 목적으로 소량의 항우울제를 사용하였으며, 조증 삽화 발병 이전에 정신적 스트레스를 받았었다. 검사상 기질적인 문제는 발견되지 않았으며, DSM-Ⅳ에 의해서 양극성 장애로 진단되었던 경우이다. 본 증례의 경우는 lithium을 사용하여 특별한 부작용없이 성공적으로 치료가 되었으며, 현재는 외래에서 lithium 600 mg으로 유지치료를 하고 있다. 노인 연령에 처음으로 조증 삽화가 발생하는 경우의 양극성 장애는 젊은 연령에서 발생하는 양극성 장애와는 다른 면이 많으며, 원인적인 측면에서도 이질적으로, 유전적인 면이 덜한 것으로 보인다. 이러한 점들은 연령이 증가함에 따라 나이와 연관된 뇌변화에 기인한 질병에 대한 취약성을 생각해 볼 수 있겠다. The authers reported one case of manic episode that occured after retirement in a 63 year old male patient. There was no psychiatric past history and family history. Also there was no abnormal finding on laboratory examination. This patient had received small doses of antidepressants anxiolytic and hypnotic (amitriptyline 10 mg, lorazepam 0.5 mg, triazolam 0.25 mg) to control insomnia since 3 months ago before admission. This patient showed manic symptoms such as grandious idea, expansive and irritable mood, increased psychomotor activity and insomnia after retirement. Pharmacotherapy (lithium and chloropromazine) supportive psychotherapy and family therapy were administered. Excessive motivation for work after retirement and small dose of antidepressant were suspected to trigger a manic episode in this elderly patient. We also reviewed literatures about pathophysiology of elderly manic disorder.

폐경기 여성에서 호르몬 상태와 우울 및 불안 성향간의 상관관계 연구

서정석,기백석,이상훈,이재광,Seo, Jeong-Seok,Kee, Baik-Seok,Lee, Sang-Hoon,Lee, Jae-Kwang 대한생물정신의학회 1996 생물정신의학 Vol.3 No.1

저자들은 1994년 3월부터 1995년 10월까지 중앙대학교 부속병원 폐경기 클리닉에 내원했었던 환자중 폐경군 83명과 대조군 73명을 BDI, STAI로써 우울과 불안정도를 측정하였고, 혈중 E2, LH, FSH 수치를 측정하여 결과는 다음과 같았다. 폐경 여성의 평균 연령은 45.3세였으며 BDI와 STAI 점수 비교에서 폐경군이 대조군에 비해 유의(p<0.01)하게 높아 폐경군이 더 높은 우울 및 불안 성향을 보였으나 폐경 여성이 불안 및 우울감을 더 유발한다는 가설을 뒷받침 하지는 못하였다. 혈중 호르몬의 비교에서 대조군과 폐경군간에 E2치와 FSH치에서 양군간에 유의한 차이(p<0.01)가 있었다. 그리고 대조군에서 STAI, BDI 접수와 호르몬간의 상관관계에서 유의한 상관관계는 없었으며 폐경군에서도 STAI, BDI 접수와 호르몬간의 상관관계에서 유의한 상관관계는 없었다. 즉 폐경기 호르몬의 상태와 우울 및 불안과의 상관관계는 없었다. 폐경기의 심리적 장애의 원인을 생물학적, 사회문화적, 또는 심리적 요인 중 단일 요인으로 성명하기보다 상호 복합적으로 규명해야 하겠다. Objects : There has been the controversy that menopause may or may not influence the psychological distresses. The purpose of this study was to investigate the correlation between the hormonal status and traits of depression & anxiety in menopausal women. Method : Among the women attending menopausal clinic. menopausal women, defined as who having a amenorrhea for more than 12 months, were selected as a study group(n=83). The control group(n=73), who visited to screen the cervix cancer with regular menstruation, hod no history of hormone replacement therapy. Individual data were collected by self-reporting questionnaires. Depression state was evaluated by Beck Depression Inventory(BDI) and anxiety state by Stale Trail Anxiety Inventory(STAI), and the female hormones such as E2, FSH, and LH were obtained by blood sampling at visting clinic. Statistically the data were processed by t-test and pearson correlation analysis(p<0.05). Results : 1) The mean age of menopausal was 45.3 years. 2) In menopausal women the scores of BDI & STAI were significantly higher than in control group(p<0.05). 3) There were significant differences between menopausal and control group by E2 & FSH. 4) There was no correlation between female hormonal status and the STAI & BDI scores in both groups. Conclusion : Although menopausal women had more traits of depression & anxiety than control group, it was difficult to insist that the lack of estrogen was the only etiological factor for the traits of depression & anxiety in menopausal period. In further studies, we must consider another factors, including biological, sociocultural, psychological factor, as the cause of psychological symptoms during menopausal period.

아토피 피부염 환자의 생활사건 스트레스와 대처방식

한덕현,최한규,기백석,남범우,서성준,Han, Duck-Hyun,Choi, Han-Gyu,Kee, Baik-Seok,Nam, Bum-Woo,Seo, Seong-Jun 한국정신신체의학회 1999 정신신체의학 Vol.7 No.2

Background : Various type of psychological and stressful events in life have been reported to have much effect in the onset, progress and exacerbation of psychosomatic disorders such as hypertension, bronchial asthma, peptic ulcer, tension headache, alopecia areata, and atopic dermatitis. However, the nature of the association between stress and psychosomatic disorders remains unclear. Objective : The purpose of this study is to determine the relation of stress and the progress of dermatologic disorder. Method : We examined 30 patients with atopic dermatitis and 30 control subjects with tinea pedis and onychomycosis who visited to Dept. of Dermatology, Chung-Ang University Hospital. To evaluate the stress, we used 'Scale of Life Events' and 'Multidemensional Coping Scale'. Result : 1) The score of life events stress in atopic dermatitis group was significantly higher than that of control group. 2) In the result of coping strategies, the atopic dermatitis group was significantly higher than control group at the active forgetting, positive comparison, and emotional pacification, while in control group religious seeking and accomodation tended to be higher with no statistical significance. Conclusion : These findings suggest that psychosocial stress may play a role in life pattern of atopic dermatitis. But further studies are needed to clarity the exact relationship between stress and psychosomatic disorder. 연구목적 : 본 연구에서는 사회적, 심리적 관점에서 아토피 피부염에서 보이는 스트레스의 양을 측정 하고 스트레스에 대한 대처 방식의 특정을 알아보고자 하였다. 방법 : 1997년 9월부터 1998년 5월까지 중앙대학교 의과대학 부속병원 피부과에 내원한 20세 이상의 아토피 피부염 환자를 분석 대상으로 생활사건 척도(Scale of Life Event)와 다차원적척도(Multimensional Coping Scale)를 이용하여 스트레스 정도와 대처방식의 차이를 알아보고자 하였다. 결과 : 생활 사건에 대한 스트레스의 양은 아토피 피부염 환자군이 $386.52{\pm}257.93$이었고, 대조군은 $255.98{\pm}161.93$으로 통계적으로 유의한 차이를 보였고 대처 방식에 있어서는 아토피 피부염 환자군에서 적극적 망각 척도, 정서적 진정 척도, 긍정적 비교 척도에서 각각 $7.30{\pm}3.56$(t=2.55. df=53, p=0.013), $8.0{\pm}2.05$(t=2.42. df=58, p=0.019), $6.00{\pm}4.97$(t=2.48, df=58, p=0.16)으로 대조군에 비해 통계적으로 유의하게 높았다. 결론 : 스트레스는 아토피 피부염의 발생 및 악화에 영향을 미칠 것으로 추정되며, 적극적 망각과 같은 정서중심적, 비효과적 대처방식을 문제 중심적 대처로 변환시키고 자신보다 못한 상태에 있는 타인을 비교함 자신의 상태를 유지하려하는 인지적 측면과 스트레스 상황에서 발생한 정서적 혼란을 가라앉히려는 정서적 측면에 대해 지지적 치료가 이루어지면 아토피 피부염을 비롯한 정신 신체 질환의 치료에 도움이 될 것으로 생각된다.

두부외상 환자에서 전두엽 손상과 신경인지기능 변화에 따른 주관적인 증상 연구

김준원,한덕현,기백석,박두병,Kim, Jun-Won,Han, Doug-Hyun,Kee, Baik-Seok,Park, Doo-Byung 대한불안의학회 2012 대한불안의학회지 Vol.8 No.1

Objective : The purpose of this study was to analyze the correlation between symptom severity and neurocognitive factors in traumatic head injury patients. In addition, the effect of frontal lobe damage on these parameters was examined. Methods : We selected 18 patients who had brain damage for the moderate to severe traumatic brain injury (MSTBI) group, and 17 patients who met the diagnostic criteria for post-traumatic stress disorder (PTSD) without the finding of brain damage for the comparison group. For the evaluation of neurocognitive function, K-WAIS, Rey-Kim Memory Test, K-FENT, WCST, and MMPI-2 were used. Results : The results of the comparison (using the malingering scale) revealed that the values of PDS and PK, which express the severity of symptoms, and the values of the validity scale F, F (B), and F (P) were significantly higher in the overly-expressed group. F (B) in overly-expressed group and PK, Pt, and Sc in the properly-expressed group had significant correlation with the severity of symptoms. F (B), S, and Stroop error inhibition in PTSD, and PK, Pt, Sc, and MQ in MSTBI had significant correlation with the severity of symptoms. The results of the comparison based on the finding of frontal lobe damage revealed that PDS, EIQ, and MQ ware significantly higher in the group without brain damage. Conclusions : It was revealed that each neurocognitive factor was correlated with the severity of symptoms. There was a decrease in complaints or symptoms reported by the frontal lobe injury group, and this is believed to be due to degenerative change in the personality and emotional functioning of these patients following frontal lobe damage.

정신분열병 환자의 혈청에서 Brain-Derived Neurotrophic Factor 증가

김소연,민경준,기백석,박두병,김주희,Kim, So Youn,Min, Kyung Joon,Kee, Baik Seok,Park, Doo Byung,Kim, Joo Hee 대한생물정신의학회 2004 생물정신의학 Vol.11 No.2

Objectives:Abnormalities in neurotrophic factors that regulate neuronal development and synaptic plasticity are often implicated as some causes of schizophrenia. In previous studies, researchers reported that brain and serum BDNF levels underwent similar changes during maturation and aging processes in rats. They also found a positive correlation between serum and cortical BDNF levels. In this study, we investigated whether the serum levels of BDNF in Korean schizophrenic patients would be different from those of healthy controls. Methods:Using an ELISA kit, serum BDNF levels were assessed in schizophrenic group(N=49) and control group(N=50). Results:Serum BDNF levels in the schizophrenic group($36.29{\pm}19.78$ng/ml) were significantly higher than those in control group($22.4{\pm}14.4$ng/ml). The BDNF levels did not correlate with duration of treatment, age or daily dose of antipsychotics in patients with schizophrenia. Conclusions:This result suggests that schizophrenia is characterized by high serum BDNF levels and supports the hypothesis of neurotrophic factor involvement in psychotic disorder. Serum BDNF level is likely to be one of the possible biological markers for schizophrenia.