만성적인 신체질환이 있는 노인 환자의 우울증 조기발견을 위한 병원기반 모델

박선철,이화영,이동우,한상우,박상호,김여주,최재성,정성원,이소영,나경세,권영준,Park, Seon-Cheol,Lee, Hwa-Young,Lee, Dong-Woo,Han, Sang-Woo,Park, Sang-Ho,Kim, Yeo-Joo,Choi, Jae Sung,Jung, Sung Won,Lee, Soyoung Irene,Na, Kyoung-Sae,Kwon, 대한생물정신의학회 2013 생물정신의학 Vol.20 No.2

The geriatric patients with chronic physical diseases are frequently associated with the continuous clusters of depression including nonpathological sadness, subsyndromal depression, minor depressive disorder, and major depressive disorder. Because of the complex and reciprocal relationships among depression, elderly, and chronic physical diseases, screening approaches with specific nosological methods should be needed in the realm of early detection of depression. Cognitive decline is frequently manifested in geriatric depression with medical or neurological diseases. Also, somatic symptoms of depression or emotional symptoms of physical diseases can play a role as a hampering factor in the early detection of depression. Furthermore, after-care has been regarded as an essential factor of depression screening in the geriatric patients with chronic physical diseases. We reviewed the most popular examples of integrated medicine for depression in primary care. Thus, we propose a general hospital-based model for early detection of depression which includes favorable response loop between screening and therapeutic intervention. Our model can be a basis for evidence-based detection and after-care for depression in the geriatric patients with chronic medical diseases.

복합외상과 극단적 스트레스 장애

박선철,김석현,Park, Seon-Cheol,Kim, Seok-Hyeon 대한불안의학회 2009 대한불안의학회지 Vol.5 No.2

Disorder of Extreme Stress, Not Otherwise Specified (DESNOS) is the proposed diagnosis that meets the severe, complex, and prolonged psychological sequela of victims with chronic traumatization (e.g., family violence, incest, and childhood sexual or physical abuse). The hallmarks of DESNOS are a multiplicity of symptoms (e.g., somatization, dissociation, and depression), pathological changes in relationships, identity disturbances, and a propensity to experience repeated harm and injury at the hands of oneself and others. DESNOS can be directly assessed by Structured Interview of Disorder of Extreme Stress (SIDES) and Self- Report Inventory of Disorder of Extreme Stress (SIDES-SR). The treatment of DESNOS should be phaseoriented and involve movement back and forth among three basic stages : 1) stabilization ; 2) trauma processing ; 3) reintegration.

정신증상과 기술 정신병리학

박선철 ( Seon-cheol Park ),양병환 ( Byung-hwan Yang ) 한국정신병리진단분류학회 2015 精神病理學 Vol.23 No.1

Mental symptoms have a central position in the conceptual network connecting the in descriptive psychopathology. Due to its possessing features of both objectivity and subjectivity, mental symptoms can be considered as being composed of the concepts of form and content. The symptoms cannot be analyzed only reductively, but should also be understood in the relation of parts to the whole. Psychiatric diagnoses, which have been defined by operational concepts, can be said to correspond to a “language game.” Hence, symptoms which are pathognomic or indexical to the diagnosis may not be identified. Since psychopathology is not just symptomatology, symptoms should rather be viewed with a phenomenological approach.Furtherresearchontheidentificationofpathologicalprocessesisneeded.

폐종괴로 나타난 폐의 림프관평활근종증 1례

박선철 ( Seon Cheol Park ),박병훈 ( Byung Hoon Park ),신상윤 ( Sang Yun Shin ),전한호 ( Han Ho Jeon ),정경수 ( Kyung Soo Chung ),박준철 ( Jun Chul Park ),정재헌 ( Jae Heon Jeong ),권지은 ( Ji Eun Kwon ),박무석 ( Moo Suk Park ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.3

Lymphangioleiomyomatosis (LAM) is a rare disease that affects females of reproductive age. It is characterized by the abnormal proliferation of smooth muscle cells in the lung and along the axial lymphatics. We report a case of lymphangioleiomyomatosis presenting as a lung mass. The patient visited the emergency room because of dyspnea upon exertion. The chest X-ray showed a lung mass in the right lower lung field and a pneumothorax in the left lung. Chest computed tomography revealed a 5 x 3 cm sized mass in the right lower lobe and multiple thin-walled small cysts scattered in both lungs. Transbronchial biopsy of the lung mass was performed. The biopsy specimen showed atypical smooth muscle cell proliferation and cystic dilatation of the terminal bronchioles, which confirmed the diagnosis of lymphangioleiomyomatosis. To the best of our knowledge, this is the first case of lymphangioleiomyomatosis presenting as a lung mass. (Tuberc Respir Dis 2007; 63: 289-293)

운동의 항우울효과

박선철(Seon-Cheol Park) 대한신경정신의학회 2018 신경정신의학 Vol.57 No.2

Exercise is considered as one of the therapeutic options. in many major treatment guidelines for depression In terms of the underlying neurobiological mechanisms, it has been suggested that the antidepressive effects of exercise can be explained by the increased hippocampal volume associated with an increased level of brain-derived neurotrophic factor (BDNF). However, there have been no significant effects of exercise on cognitive functions in depression. Exercise has been used based on substantial evidence in the context of its therapeutic efficacy in depression. In personalized medicine, various potential mediators for the relationship between exercise and depressive symptoms should be controlled. Since it has been consistently reported that exercise has no significant therapeutic effects on cognitive domains in depression, it is necessary that the efficacy of exercise on cognitive domains should be evaluated with rigorous methodology. Furthermore, it has been suggested that exercise has potentially positive effects in the prevention of depression. Despite the controversies regarding supporting evidence, it is concluded that exercise may be regarded as a “safe and broad-spectrum antidepressant” and used in the context of prevention and treatment of depression.”

지연성 이상운동이 있는 조현병 환자의 우울증

차성재,오근,김미숙,박선철,김영훈,Cha, Seongjae,Oh, Keun,Kim, Misuk,Park, Seon-Cheol,Kim, Young Hoon 대한생물정신의학회 2018 생물정신의학 Vol.25 No.4

Objectives This study aimed to investigate the relationship between depressive and anxiety symptoms and tardive dyskinesia (TD) and reveal the association of cognitive function and TD in patients with schizophrenia. Methods We recruited 30 schizophrenia patients with TD and 31 without TD from a national mental hospital in South Korea. To assess depressive and anxiety symptoms, the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI) were conducted. Using the five-factor structure of the BDI-II and BAI, somatic anxiety, cognitive depression, somatic depression, subjective anxiety, and autonomic anxiety were assessed. Computerized neurocognitive function test (CNT) was performed to assess levels of cognitive functions. We compared the clinical characteristics, levels of cognitive functions, and depressive and anxiety symptoms between schizophrenia patients with TD and without TD. Chi-square test, Fisher's exact test, independent t-test and Mann Whitney U test were conducted to compare two groups. Pearson correlation analysis was conducted to evaluate relationships among the abnormal involuntary movement scale (AIMS), BDI-II, BAI, somatic anxiety, cognitive depression, somatic depression, subjective anxiety, and autonomic anxiety. Results The subjects with TD had significantly lower score on the cognitive depression than those without TD (t = -2.087, p = 0.041). There were significant correlations between the AIMS score and the BDI-II score (r = -0.386, p = 0.035) and between the AIMS score and cognitive depression score (r = - 0.385, p = 0.035). Conclusions Our findings suggest the inverse relationship between severities in TD and depression and support the assumption that there is an inverse relationship between the pathophysiology of TD and depression.

조현병에서 형식적 사고장애의 임상적 특성

양채영,김한성,김은경,김일빈,박선철,최준호,Yang, Chaeyoung,Kim, Han-sung,Kim, Eunkyung,Kim, Il Bin,Park, Seon-Cheol,Choi, Joonho 대한생물정신의학회 2021 생물정신의학 Vol.28 No.2

Objectives Our study aimed to present the distinctive correlates of formal thought disorder in patients with schizophrenia, using the Clinical Language Disorder Rating Scale (CLANG). Methods We compared clinical characteristics between schizophrenia patients with (n = 84) and without (n = 82) formal thought disorder. Psychometric scales including the CLANG, the Brief Psychiatric Rating Scale (BPRS), the Young Mania Rating Scale (YMRS), the Calgery Depression Scale for Schizophrenia (CDSS) and the Word Fluency Test (WFT) were used. Results After adjusting the effects of age, sex and total scores on the BPRS, YMRS and WFT, the subjects with disorganized speech presented significantly higher score on the abnormal syntax (p = 0.009), lack of semantic association (p = 0.005), discourse failure (p < 0.0001), pragmatics disorder (p = 0.001), dysarthria (p < 0.0001), and paraphasic error (p = 0.005) items than those without formal thought disorder. With defining the mentioned item scores as covariates, binary logistic regression model predicted that discourse failure (adjusted odds ratio [aOR] = 5.88, p < 0.0001) and pragmatics disorder (aOR = 2.17, p = 0.04) were distinctive correlates of formal thought disorder in patients with schizophrenia. Conclusions This study conducted Clinician Rated Dimensions of Psychosis Symptom Severity (CRDPSS) and CLANG scales on 166 hospitalized schizophrenia patients to explore the sub-items of the CLANG scale independently related to formal thought disorders in schizophrenia patients. Discourse failure and pragmatics disorder might be used as the distinctive indexes for formal thought disorder in patients with schizophrenia.

한국 성인을 대상으로 한 미국 및 유럽 폐활량 검사 재현성 기준의 유용성

박병훈 ( Byung Hoon Park ),박무석 ( Moo Suk Park ),정우영 ( Woo Young Jung ),변민광 ( Min Kwang Byun ),박선철 ( Seon Cheol Park ),신상윤 ( Sang Yun Shin ),전한호 ( Han Ho Jeon ),정경수 ( Kyung Soo Jung ),문지애 ( Ji Ae Moon ),김 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.5

연구배경: 본 연구를 통해 2005년도 ATS/ERS 폐활량검사 지침에서 제시한 재현성 기준을 한국 성인들에게 적용할 수 있는 지와, 한국 성인들의 폐활량 검사 시 재현성에 영향을 미치는 요인들을 알아보고자 하였다. 방 법: 국민건강영양조사, COPD 코호트, 지역사회 코호트로부터 얻은 성인 4,663명의 폐활량검사 결과를 이용하여 dFVC 및 dFEV1를 계산하여 분포를 알아보고, 1994년도 ATS 지침 및 2005년도 ATS/ERS 지침을 만족하는 검사의 비율을 비교하였다. 다중회귀분석을 통해 개인적 특성 및 재현성 기준의 변화가 재현성에 영향을 미치는가를 알아보았다. 결 과: 폐활량검사를 시행한 사람들 중 95% 이상이 150ml 이내의 재현성 기준을 만족시켰다. 1994년도 ATS 지침에 따라 검사를 시행한 경우 재현성을 만족하지 않는 경우가 증가하였다. 다중회귀분석 결과 재현성에 영향을 주는 요인들은 신장, 연령, 체중, 폐쇄성폐질환 여부, 재현성 기준의 변화 등이었으나 재현성에 영향을 미치는 정도는 매우 작았다(0.5∼3.0%). 결 론: 한국인에게도 2005년도 ATS/ERS에서 제시한 재현성 기준을 적용할 수 있을 것으로 생각하며, 이를 위해서는 변경된 재현성 기준에 대한 지속적인 홍보와 검사자 들에 대한 교육 및 정도 관리가 필요하다. Background: The objective of this study was to evaluate the clinical applicability of the repeatability criteria recommended by the American Thoracic Society/European Respiratory Society (ATS/ERS) spirometry guidelines and to determine which factors affect the repeatability of spirometry in Korean adults. Methods: We reviewed the spirometry data of 4,663 Korean adults from the Korean National Health and Nutritional Examination Survey (KNHANES) Chronic Obstructive Pulmonary Disease Cohort (COPD cohort) and the Community-based Cohort Study VI-Fishing village/Islands (community cohort). We measured the anthropometric factors and differences between the highest and second-highest FVC (dFVC) and FEV1 (dFEV1) from prebronchodilator spirometry. Analyses included the distribution of dFVC and dFEV1, comparison of the values meeting the 1994 ATS repeatability criteria with the values meeting the 2005 ATS/ERS repeatability criteria, and the performance of linear regression for evaluating the influence of subject characteristics and the change of criteria on the spiro-metric variability. Results: About 95% of subjects were able to reproduce FVC and FEV1 within 150 ml. The KNHANES based on the 1994 ATS guidelines showed poorer repeatability than the COPD cohort and community cohort based on the 2005 ATS/ERS guidelines. Demographic and anthropometric factors had little effect on repeatability, explaining only 0.5 to 3%. Conclusion: We conclude that the new spirometry repeatability criteria recommended by the 2005 ATS/ERS guidelines is also applicable to Korean adults. The repeatability of spirometry depends little on individual characteristics when an experienced technician performs testing. Therefore, we suggest that sustained efforts for public awareness of new repeatability criteria, quality control of spirograms, and education of personnel are needed for reliable spirometric results. (Tuberc Respir Dis 2007;63:405-411)

공격성의 신경생물학

김기원,안은숙,이유상,박선철,Kim, Ki Won,An, Eun-Soog,Lee, Yu-Sang,Park, Seon-Cheol 대한생물정신의학회 2013 생물정신의학 Vol.20 No.4

Aggression can be defined as 'behavior intended to harm another' which can be seen both from humans and animals. However, trying to understand aggression in a simplistic view may make it difficult to develop an integrated approach. So, we tried to explain aggression in a multidisciplinary approach, affected by various factors such as neuroanatomical structures, neurotransmitter, genes, and sex hormone. Parallel with animal models, human aggression can be understood with two phenomena, offensive aggression and defensive aggression. Neurobiological model of aggression give a chance to explain aggression with an imbalance between prefrontal regulatory influences and hyper-reactivity of the subcortical areas involved in affective evaluation, finally in an aspect of brain organization. Serotonin and GABA usually inhibit aggression and norepinephrine while glutamate and dopamine precipitate aggressive behavior. As there is no one gene which has been identified as a cause of aggression, functions between gene to gene interaction and gene to environment interaction are being magnified. Contributions of sex hormone to aggression, especially molecular biologic interaction of testosterone and regulation of estrogen receptor have been emphasized during the research on aggression. This multidisciplinary approach on aggression with types, neurochemical bases, and animal models can bring integrated interpretation on aggression.

조현병(調鉉病) : 뇌 연결성의 장애

김기원,박경민,장혜련,이유상,박선철,Kim, Ki Won,Park, Kyung-Min,Jang, Hye-Ryeon,Lee, Yu Sang,Park, Seon-Cheol 대한생물정신의학회 2013 생물정신의학 Vol.20 No.4

Objectives We reviewed cellular and synaptic dysconnectivity, disturbances in micro- and macro- circuitries, and neurodevelopmentally-derived disruptions of neural connectivity in the pathogenesis of schizophrenia. Method We reviewed the selected articles about disturbances in neural circuits which had been proposed as a pathogenetic mechanism of schizophrenia. Results The literature review reveals that schizophrenia may be a disease related to disturbance in neurodevelopmental mechanism, shown as 'a misconnection syndrome of neural circuit or neural network'. In descriptive psychopathological view, definition of a disorder of brain connectivity has limitation to explain other aspects of schizophrenia including deterministic strictness in thought process. Conclusion Schizophrenia is considered as a disorder of brain connectivity as well as a neurodevelopmental disorder related with genetic and environmental factors. We could make a suggestion that "JoHyeonByung (attunement disorder)" denotes the disturbances of psychic fine-tuning which correspond to the neural correlates of brain dysconnectivity metaphorically.