대학병원에서 노인정신건강 크리닉의 1년 경험

전진숙(Jin-Sook Cheon),송혜란(Hae-Ran Song),오병훈(Byoung-Hoon Oh) 대한임상노인의학회 2002 대한임상노인의학회지 Vol.3 No.3

연구배경 : 기억장애크리닉은 세계적으로 20여년 전에 시작되었다. 한국에서는 1995년에 개시되어 노인정신의학 분야의 특수크리닉은 시작 단계에 불과하다. 최근에 이에 관한 관심의 증가와 더불어 이론적 기초를 제공하기 위해서 치매크리닉의 구성과 목적, 치매크리닉의 업무(진단과 평가, 치료, 연구, 뇌기증) 등에 대한 문헌을 고찰하고, 실제적인 임상 경험의 검토를 통해서 문제점을 제시하고자 한다. 방법 : 2001년 6월 초부터 2002년 5월 말까지 고신대학교 복음병원 신경정신과에 개설 '치매?노인정신건강크리닉'에서 1년간 진료한 자료를 정리 분석하여 참고가 되도록 하였다. 결과 : 1) 입원, 외래, 응급실 등 치료경로에 따른 노인환자의 내원 빈도는 계절별 분포의 차이가 없었다. 입원이나 응급실에 내원한 60세 이상의 노인환자는 59세 이하의 환자와 성별 분포의 차이가 없었다. 외래에 내원한 59세 이하의 환자는 남성이 유의하게 많은 반면에, 60세 이상의 노인 환자는 통계적으로 유의하게 여성이 더 많았다(p=0.000). 2) '치매ㆍ노인정신건강크리닉'에 내원한 노인환자의 정신과적 진단명에 따른 빈도는 우울장애(31.3%), 알쯔하이머병(26.2%), 신체형장애(19.7%), 혈관성치매(10.6%), 불안장애(3.6%), 수면장애(3.3%), 알코올성장애(2.7%)순이었다. 3) '치매ㆍ노인정신건강크리닉'에 내원한 노인환자의 정신과적 진단에 따른 연령별 분포는 65세 미만에는 우울장애가, 그 이후는 치매가 유의하게 많았다(p=0. 000). 한편, 수면장애는 65∼74세(young-old)에 가장 많은 반면, 알코올성장애, 신체형장애, 불안장애는 60∼64세(초로기)에 가장 많은 경향을 보였다. 4) '치매ㆍ노인정신건강크리닉'에 내원한 노인환자의 정신과적 진단에 따른 계절별 분포는 통계적으로 유의한 차이가 없었다. 그러나 성별 분포는 유의한 차이가 있었다. 즉, 알쯔하이머병과 우울장애는 여성에서, 혈관성 치매는 남성에서 유의하게 많았다(p=0.000). 또한, 알코올성장애와 수면장애는 남성에서, 신체형장애와 불안장애는 여성에서 조금 더 많은 경향을 보였다. 결론 : 노인환자는 성인 환자와 다른 임상적 특징을 지니므로 노인의 특성에 맞는 개별화된 진료체제가 필요하다. Background : The history of memory disorders clinic began about 20 years ago. In Korea, the specialist clinic in psychogeriatric area steps into the beginning stage, though the first geriatric mental health clinic started since 1995. Practical information including settings and purposes, diagnoses and assessments, interventions, research and brain banks by reviewing articles and clinical experiences is provided for those who are interested in the memory clinics. Methods : A clinical data collected from one-year experience(from June 1st, 2001 to May 31st, 2002) in the 'DementiaㆍGeriatric Mental Health Clinic' established to the Department of Neuropsychiatry, Kosin University Gospel Hospital were analyzed. Results : 1) The seasonal distribution was not different according to referral 6route such as admission, outpatient, emergency room. Sex distribution was not different between geriatric patients with age over 60 and patients with age below 59 who were referred from admission or emergency room. While males were more prevalent among outpatients with age below 59, females were more among outpatients with age over 60(p=0.000). 2) The frequency of geriatric patients visited to the 'Dementia?Geriatric Mental Health Clinic' according to psychiatric diagnoses was depression(31.3%), Alzheimer's disease(26.2%), somatoform disorder(l9.7%), vascular dementia(10.6%), anxiety disorder(3.6%), sleep disorder(3.3%) and alcohol-related disorder(2.7%) in order. 3) The age distribution of geriatric patients visited to the 'Dementia?Geriatric Mental Health Clinic' according to psychiatric diagnoses revealed that depression was most prevalent among patients with age under 65, while dementia among patients with age over 65(p=0.000). Otherwise, sleep disorder was prevalent among young-old patients(65~74 yrs old), while alcohol-related disorder, somatoform disorder, anxiety disorder was prevalent among presenile age(60~64 yrs old). 4) There was no significant difference in the seasonal distribution according to psychiatric diagnoses for the aged psychiatric patients who had visited 'Dementia?Geriatric Mental Health Clinic'. However, there was significant difference in sex distribution. That is, Alzheimer' s disease and depression could be found more in females, while vascular dementia in males(p=0.000). Otherwise, alcohol-related disorder and sleep disorder was more prevalent in males, while somatoform disoder and anxiety disorder in females. Conclusion : A specialized clinical system for the aged psychiatric patients might be needed, because of their age-specific unique features somewhat different from other age groups.

경도인지장애에서 구간거리 측정

전진숙(Jin Sook Cheon),조원용(Won Yong Cho),전갑수(Gap Soo Jeon),송혜란(Hae Ran Song),오병훈(Byoung Hoon Oh) 대한노인정신의학회 2004 노인정신의학 Vol.8 No.2

Objectives:The hippocampal atrophy has been known to be an important biological marker for the early diagnosis of mild cognitive impairment (MCI). The aims of this study are to disclose the differerence in the interuncal distance (IUD) between MCI, dementia of the Alzheimer's type (DAT) and healthy aged controls, and to identify the affecting factors. Methods:In transaxial plane, the IUDs at the level of the suprasellar cistern on the T1-weighted images on the brain MRI were measured in patients with MCI (N=30), those with DAT (N=34), and healthy aged controls (N=20). Furthermore, demographic data about age, sex, educational level as well as cerebrovascular factors were obtained by structured interviews and medical records, and the severity of cognitive disorders were assessed using the Mini-Mental Status Examination (MMSE), the Clinical Dementia Rating (CDR) and the Global Deterioration Scale (GDS). Results:1) The mean (±S.D.) IUD of DAT group (26.52±3.37 mm) was significantly different from that of healthy aged controls (24.35±2.91 mm)(p=0.044). However, there were no significant differences between IUD of MCI group (25.60±2.66 mm) and that of DAT group (p=0.483) as well as that of healthy aged controls and that of MCI group (p=0.363). 2) Variables such as age, sex, educational level, cerebrovascular risk factors and severity of cognitive disorder were not related to the IUD. Conclusions:The measurement of IUD on the brain MRI did not seem to be a helpful biological marker for the early detection of MCI in clinical practice.

유전 및 육종 : 자가성감별 계통 조성을 위한 국내 토종 닭의 깃털 조만성 양상과 유전자형 빈도

손시환 ( Sea Hwan Sohn ),박단비 ( Dhan Bee Park ),송혜란 ( Hae Ran Song ),조은정 ( Eun Jung Cho ),강보석 ( Bo-seok Kang ),서옥석 ( Ok Suk Suh ) 한국동물자원과학회(구 한국축산학회) 2012 한국축산학회지 Vol.54 No.4

초생추의 성 감별은 양계산업에서 대단히 중요하다. 현재 대표적인 병아리의 암수 감별 방법은 우모 발생속도에 관여하는 반성유전자를 이용하여 깃털의 형태적 차이로 성을 식별하는 방법이다. 따라서 본 연구에서는 자가성감별 토종 닭 종계 개발을 위하여 국내 보유하고 있는 토종 순계를 대상으로 깃털 조만성의 분포 양상 및 이의 유전자형 빈도를 분석하고 더불어 병아리의 깃털 발생 양상에 따른 조우성과 만우성의 식별 방법을 제시하고자 하였다. 발생 직후 병아리의 주부익우 형태에 따른 조만우성의 식별은 조우성의 경우 주익우가 부익우보다 현저히 길어 형태적 차이가 뚜렷하나, 만우성은 주부익우 간의 차이가 없었다. 또한 꼬리 깃 형태에 따른 조만성의 식별은 5일령 이후 조우성의 경우 꼬리 깃의 성장이 현저하게 나타나는 반면 만우성의 경우 이러한 성장이 보이지 않았다. 두 방법 공히 깃털 형태에 따른 조만우성의 구분이 가능하였고, 주부익우 형태와 꼬리 깃 성장에 의한 식별 간의 판정 일치도는 98% 정도로서 발생 직후 주부익우의 형태적 차이로 거의 모든 개체에서 조만우성의 식별이 가능한 것으로 사료된다. 공시된 품종들의 조만우성 분포 양상 및 유전자형 빈도는 토종 외래계인 흑색 코니시종, 로드아일랜드레드종 및 한국재래닭 적갈색종에서만 조우성과 만우성 개체가 혼재하여 분포하는 것으로 나타났고, 이들 모두 열성 조만성 유전자 빈도가 훨씬 높은 것으로 분석되었다. 반면 국내 토종 순계로서 갈색 코니시종, 오골계, 한국재래닭 황갈색종, 회갈색종, 백색종, 흑색종 및 백색레그혼종들은 모두 조우성만 존재하는 것으로 나타났다. 이러한 결과는 국내 토종 품종을 이용하여 병아리의 깃털 성 감별이 가능함을 시사하는 것으로 만우성 모 계통과 조우성 부 계통을 조성한다면 생산되는 병아리의 깃털 형태로서 쉽게 암수 구분이 가능할 것으로 사료된다. The method of sexing based on differences in the rate of feather growth provides a convenient and inexpensive approach. The locus of feather development gene(K) is located on the Z chromosome and can be utilized to produce phenotypes that distinguish between the sexes of chicks at hatching. To establish the auto-sexing native chicken strains, this study analyzed the genotype frequency of the feathering in domestic chicken breeds. The method of classification of slow- and rapid-feathering chickens was also investigated. In the slow-feathering chicks, the coverts were either the same length or longer than the primary wing feathers at hatching. However, the rapid-feathering chicks had the primary wing feathers that were longer than the coverts. The growth pattern of tail feather also distinctively differed between the rapid- and slow-feathering chicks after 5-days. The accuracy of wing feather sexing was about 98% compared with tail sexing. In domestic chicken breeds, Korean Black Cornish, Korean Rhode Island Red, and Korean Native Chicken-Red had both dominant(K) and recessive(k+) feathering genes. The other breeds of chickens, Korean Brown Cornish, Ogol, White Leghorn, Korean Native Chicken-Yellow, -Gray, -White and -Black had only the recessive feathering gene(k+). Consequently, feather sexing is available using the domestic chicken breeds. Establishing the maternal stock with dominant gene(K-) and paternal stock with recessive gene (k+k+), the slow-feathering characteristic is passed from mothers to their sons, and the rapid-feathering characteristic is inherited by daughters from their fathers.

한국재래닭 깃털 성감별 계통에 있어 조우성과 만우성이 개체의 생산능력에 미치는 영향

손시환(Sea Hwan Sohn),김나영(Na Young Kim),박단비(Dhan Bee Park),송혜란(Hae Ran Song),조은정(Eun Jung Cho),최성복(Seong Bok Choi),허강녕(Kang Nyeong Heo),최희철(Hee Cheol Choi) 한국가금학회 2013 韓國家禽學會誌 Vol.40 No.3

한국 노인의 사기에 영향을 미치는 요인

전진숙(Jin Sook Cheon),변인우(In Woo Byun),송혜란(Hae Ran Song),오병훈(Byoung Hoon Oh) 대한노인정신의학회 2004 노인정신의학 Vol.8 No.1

Objectives:The aims of this study were to assess the morale of Korean elders, to analyze the affecting factors, and to look for the ways to raise their morale. Methods:The structured interviews and measurements of depression (Four-Item Geriatric Depression Scale and Vulnerability Factors), cognitive function (Short Portable Mental Status Questionnaire) and morale(Measurement of Morale in the Elderly Scale, MMES) were taken for the 50 Korean elders (28 females and 22 males) with age over 65 who were visiting Jong Myo during January to February in 2004. Results:1) In Korean elders, the mean scores of total MMES were 100.82±12.36. According to the items, mean scores of Satisfaction were 43.52±5.14, Equanimity 36.80±7.53, Will-to-live 20.00±4.43. 2) The total MMES scores were significantly affected by variables such as income (p<0.05), economy (p<0.005), elder abuse (p<0.01) and depression (p<0.001). While other variables including age, residence, education, number of children, sex, religion, spouse, job, illness and cognitive function were not related. Conclusion:To encourage morale in the Korean elders, economic support by welfarism, socio-legal prevention of elder abuse, and active involvement of geropsychiatrists into the early detection and treatment of depression must be needed.

치매 환자 간병인의 부담

전진숙(Jin Sook Cheon),조성곤(Sung Gohn Jo),송혜란(Hae Ran Song),오병훈(Byoung Hoon Oh) 대한노인정신의학회 2003 노인정신의학 Vol.7 No.2

Objectives : The caregiver burden means emotional, social, financial, psyc-hological physical problems which could be experienced occupational caregivers or families who cared disable patients. The caregiver burden affected by primary stressors (severity of disa-bility in dementia patients) and secondary stressors (withdrawal from society, conflict between job and caregiving, loss of personal identify) may result in physical ill-health, depression, anxiety for the caregiving. The aims of this study were to assess caregiver burden in dementia, and to identify affecting factors. Methods : 30 caregivers for dementia patients who had been treated at the "Dementia-Geriatric Mental Health Clinic" in the Kosin University Gospel Hospital and 44 healthy volunteers were sel-edcted. Using the screen for CaregIver Burden (SCB), the degree of caregiver burden was measu-red. The demographic data was obtained by structured interview. Primary and secondary stressors were also analyzed. The severity of depression and anxiety was assessed by the Hamilton Depre-ssion Scale (HDS) and Hamilton Anxiety Scale (HAS). The severity of cognitive dysfunction (MMSE, CDR, GDS), behavioral symptoms (Revised Memory and Behavior Problems Checklist, PMBPC), daily functional disability (ADL, IADL) for the dementia patients were evaluated. Results : 1) The SCB scores were significantly (p<0.001) higher in dementia caregivers (8.71±4.90) than in controls (0.23±0.48).2) The SCB scores were not correlated with age of care-givers (γ=0.081), education (γ=-0.613), duration of caregiving (γ=0.275). The RMBPC scores had statistically significant positive correlation with SCB scores (γ=0.545, p<0.01), while age if dementia patients (γ=-0.234), onset age of dementia (γ=-0.280), duration of dementia (γ=0.029), CDR (γ=0.080), GDS (γ=-0.125), MMSE (γ=-0.212), ADL (γ=-0.315), IADL (γ=0.155) had not. 3) The SCB scores had statistically significant po-sitive correlation with degree of secondary stress (γ=0.581, p<0.01) and anxiety (γ=0.376, p<0.05). The degree of secondary stress had statistically significant positive correlation with degree of emotional stress (γ=0.757, p<0.01), depression (γ=0.482, p<0.01), anxiety (γ=0.376, p<0.01). Conclusion : The caregiver burden in dementia seemed to be originated from primary stressors related to the behavioral symptoms as well as secondary stressors (degree of emotional stress, depression, anxiety, etc.). Therefore, active intervention by the geriatric specialists might be helpful to reduce their strain.

경도인지장애에서 뇌자기공명영상검사상 백질병소에 관한 연구

전진숙(Jin Sook Cheon),전갑수(Gap Soo Jeon),조원용(Won Yong Cho),송혜란(Hae Ran Song),오병훈(Byoung Hoon Oh) 대한생물치료정신의학회 2006 생물치료정신의학 Vol.12 No.1

Objectives : The aims of this study were to know the frequency of white matter lesions(WMLs) on brain magnetic resonance imaging(MRI) in patients with mild cognitive impairment(MCI), and to identify related factors. Methods : Among WMLs, periventricular hyperintensities(PVHs) and deep white matter hyperintensities(DWMHs) on brain MRI in patients with MCI(N=30), patients with dementia of the Alzheimer's type (DAT)(N=34) and normal aged controls(N=20) were analyzed. Furthermore, related variables including cardiovascular risk factors were discussed. Results : 1) The frequencies of the third degree PVHs in patients with MCI(16.6%) were significantly different from those of normal aged controls(5.0%), and from those of patients with DAT(38.2%)(p<0.05). However, frequencies of the third degree DWMHs in patients with MCI(23.3%) were not different from those of normal aged controls(10.0%), and from those of patients with DAT(35.3%). 2) The frequencies of various cardiovascular risk factors in patients with MCI, patients with DAT and normal aged controls were not significantly different. 3) The severity of PVLs seemed to be related to age(p<0.05), systolic blood pressure(p<0.05) and diastolic blood pressure(p<0.005). The severity of DWMHs were seemed to be related to sex(p<0.05), education(p<0.05), Global Deterioration Scale(p<0.05), systolic blood pressure(p<0.01) and diastolic blood pressure(p<0.05). Conclusion : The PVHs might be useful to discriminate patients with MCI from normal aged person. Active management of hypertension seemed to be crucial to prevent from development of WMLs.