애착의 관점에서 본 중독

이계성(Kye-Seong Lee),김대진(Dai-Jin Kim),신정호(Jong-Ho Shin),신상은(Sang-Eun Shin),이명지(Myung-Ji Lee) 한국중독정신의학회 2007 중독정신의학 Vol.11 No.1

Studies of addiction or substance abuse gave us much information about the neurobiology of reward and reward circuit. This review showed the possibility that the mesocorticolimbic pathway was primarily evolved to mediated ethologically relevant cues, such as a social attachment appeared important in maternal behavior in rats and pair bonding in monogamous voles. Specifically in the mesocorticolimbic pathway, activation of D2 receptor seemed to mediate drug addiction and the hedonic properties of social bond formation. A circuit linking the anterior hypothalamus (medial preoptic area) to the ventral tegmental area and the nucleus accumbens shell might be especially im-portant in mediating motivation and the rewarding properties of social interaction. The neuropeptides oxytocin and vasopressin released by social attachment & pair bonding appear to be critical linking social signals to the mesocorticolimbic circuit. In the aspect of attachment, returning the role of reward circuit that have been hijacked by addiction to where it bleongs is important part of being treat patients with drug addition. It could be the one way to help patient to feel happiness and security through reconnecting human relationships, by developing new trustworthy bonding to rely on and by restoring relationship among family to intimacy and closeness.

긴장성두통과 편두통의 바이오피드백 치료

박주언,이계성,신상은,Park, Joo-Eon,Lee, Kye-Seong,Shin, Sang-Eun 한국정신신체의학회 2006 정신신체의학 Vol.14 No.1

연구목적 : 두통은 일생 동안 90% 이상의 사람들이 경험하게 되는 임상 증후군이다. 이 논문은 긴장성두통과 편두통의 현재의 개념과 바이오피드백 치료 및 이완요법에 대해 요약하였다. 방법: Pubmed/Medline 검색에 포함된 용어는 바이오피드백(biofeedback), 이완(relaxation), 생리적(physiological), 행동적 (behavioral), 비약물의 (nonpharmacological), 두통(headache), 긴장성두통(tension-type headache), 그리고 편두통(migraine)이었다. 검색되지 않은 저술 중 적절한 논문과 바이오피드백을 수행하는 전문가의 의견도 포함시켰다. 결과 : 두통은 바이오피드백 및 이완요법을 포함한 행동치료적 개입에 의해 치료될 수 있는 정신생리장애(psycho-physiological disorder)로 볼 수 있다. 두통에서 이러한 치료들을 통해 임상적 호전을 보인다는 보고들이 지속되고 있다. 또한, 환자에게 실제 적용 시 고려할 점도 제시하였다. 결론: 바이오피드백 치료와 이완요법은 단독 또는 약물치료와 함께 두통 환자에게 제공될 수 있는 효과적인 치료법으로 제안된다. Objectives : Headache is a clinical symptom that more than 90% of all individuals experience during their life time. This article provides a current concept of tension-type and migraine headaches and summarizes the effects of biofeedback treatment and/or relaxation techniques. Methods : The following terms were used for Pubmed/Medline search : biofeedback, relaxation, physiological, behavioral, nonpharmacological, headache, tension-type headache, and migraine. A review of references from relevant literature was also conducted to collect reports not identified in the Pubmed/Medline search. Interviews with experts on biofeedback were also included in this review. Results : Headache is a psychophysiological symptom that can be treated by some behavioral interventions including biofeedback and relaxation. Literatures on biofeedback and/or relaxation have consistently reported significant therapeutic effects on headaches. Important factors that we have to consider, when we apply to headache patients with biofeedback and relaxation techniques, were also presented. Conclusion : The available evidence suggests that biofeedback and relaxation techniques are effective treatments for the patients with headaches and can be provided to the patients as monotherapy or combination therapy with medication.

우리나라의 주세체계와 건강증진사업의 연계방안에 대한 연구

천성수 ( Sung Soo Chun ),노성원 ( Sung Won Roh ),이계성 ( Kye Seong Lee ),( Rubelyn E. Inot ) 대한보건협회 2010 대한보건연구 Vol.36 No.2

This study was conducted to analyse the current Liquor tax rate system and to develop the alternatives of tax system and suggest the best practices between the system and national health promotion activities. We reviewed the articles and sources from journals and official dacuments of Korean Government. The current Liquor tax rate system can`t control alcohol consumption, therefore It is necessary to change it to a system that is closer to that of other developed countries. First, it is necessary to change the current Liquor Tax Levy in Korea, which consists of a high tax rate for high priced alcohol and a low tax rate for low priced alcohol. Current Liquor tax was implemented without proper consideration of the percentage of alcoholic content in diferent beverages, and this is a loophole that leaks tax revenue and further contributes to consumption of the high percentage alcohol that increases alcohol harms. Second, alcohol has produced problems for Korean national health and its people, so a “Health Earmarked Tax” is appropriate to be levied for health promotion and harm prevention activities. And Levy Tax is one of alternatives for national health promotion. Third, it is an essential effort to increase the price of the alcoholic beverages for reducing alcohol consumption. It is necessary to do activities on the national health promotion fields such as lifestyle changing projects, alcohol research projects, treatment and rehabilitations projects for community, and so on by the health promotion funds from alcoholic beverages.

농림지역개발을 위한 정보화방안에 관한 연구 - 전북 5개 농촌지역을 중심으로 -

정인성(In Sung Jung),이계성(Kye Sung Lee) 한국지역사회발전학회 1998 地域社會開發硏究 Vol.23 No.1

N/A

알코올 의존 환자의 병식수준과 방어기제의 관계

김기철(Ki-Chul Kim),이계성(Kye-Seong Lee):정 건(Gun Jung),신상은(Sang-Eun Shin) 한국중독정신의학회 2004 중독정신의학 Vol.8 No.2

Objectives:The purpose of this study estimate level of insight and defense mechanisms in alcoholic patients and investigate the relationship between insight level and defense mechanisms in them. Method:The subjects participated in this study were 94 alcoholic patients who were diagnosed as alcohol dependence by DSM-IV and admitted to Incheon Christian Hospital and EunHei Hospital between November, 2003 and February, 2004. The subjects were surveyed by questionnaire about the sociodemographic data, HAIS, Ewha Defense Mechanism Test and Ways of Coping checklist. Results:First, we compared the defense mechanisms between the fair insight group and the poor insight group the fair insight group had significant higher scores than poor insight group in projection, identification, somatization, actingout, regression, controlling, rationalization, dissociation. Second, we evaluated the average scores of each defense mechanisms acting-out had the highest average score among the defense mechanisms. Second was denial, third was show-off. And then, we grouped the defense mechanisms by maturity level, fair insight group had significant higher scores than poor insight group in immature and neurotic level. In the Ways of Coping Checklist, fair insight group had higher scores than poor insight group in emotion-focused coping rather than problem-focused coping. Conclusion:The fair insight group had relatively higher scores using projection, identification, somatization, acting-out, regression, controlling, rationalization, dissociation and emotionfocused coping than poor insight group. These results may reflect the characteristics of fair insight group which they show some reality as they begin to have insight but at the same time, they have difficulty in admitting the reality when they are confronted with it.

알코올 의존 : 화학적 뇌손상

양재효(Jae-Hyo Yang),이계성(Kye-Seong Lee),신상은(Sang-Eun Shin),이명지(Myung-Ji Lee),성경화(Kyung-Hwa Sung) 한국중독정신의학회 2008 중독정신의학 Vol.12 No.1

Objectives:The purpose of this study is, by the evaluation of a neuropsychological test, to identify how severe executive cognitive function impairment in chronic alcoholism compares to that of traumatic brain injury (TBI). Methods:42 alcoholic patients and 41 TBI patients, matched for age, educational level, premorbid IQ, and executive cognitive score, were enrolled in this study. Korean versions of the Wechsler Adult Intelligence Scale (k-WAIS) and EXIT (Executive intelligence test) were ad-ministered for both groups. Results:In between-group com-parison, the decrease of IQ (Mean=-5.45/-11.12, p=.010) and EIQ (Mean=-17.98/-32.46, p=.002) from the estimated pre-morbid level in the TBI subjects were significantly higher than that of alcoholic subjects. The decrease of IQ and EIQ of alcoholic subjects reached 49.01% and 55.39%, respectively, compared with that of TBI subjects. Subtest TBI subjects, with the exception of figural fluency (Mean=21.14/17.68, p=.094), showed statistically significant poor performance on the Stroop test (Sim-ple : Mean=22.16/48.44, p=.000 ; Medial : Mean=33.14/ 56.44, p=.002 ; Interference : Mean=43.52/73.71, p=.001), verbal fluency (Mean=20.07/15.05, p= .025), and the auditory verbal learning test (Recognition:Mean=11.36/8.54, p=.000; Recall:Mean=7.00/4.27, p=.000). In within-group comparison, IQ and EIQ significantly decreased from the estimated premor-bid level in both groups (IQ:p=.000, EIQ:p=.000), but EIQ decreased more than that of IQ in both groups (Alcoholic:p=.000, TBI:p=.000). Conclusion:This study supports the “frontal lobe hypothesis” and shows that chronic alcoholism could lead to more serious executive function impairment than we expected. Given this condition, concern about the need of cognitive rehabilitation should be increased.

한국판 전두엽 기능 평가 검사(Frontal Assessment Battery;K-FAB)의 신뢰도와 타당도 연구

정여진(Yeo-Jin Chung),이계성(Kye-Seong Lee),신상은(Sang-Eun Shin),김현주(Hyun-Ju Kim),성경화(Kyung-Hwa Sung) 한국중독정신의학회 2009 중독정신의학 Vol.13 No.2

The Frontal Assessment Battery (FAB) is a short cognitive and behavioral battery, comprising six subtests, for the bedside screening of global executive dysfunction. This study determined the reliability and validity of the Korean version of the FAB (K-FAB) among psychiatric patients. We enrolled 69 subjects with various psychiatric diagnosies, including alcohol dependence, and concurrently administered. Kim’s Frontal-Executive Function Neuropsychological Test (K-FENT). Forty-four subjects completed both the K-FENT and Wisconsin Card Sorting Test (WCST). Two physicians independently conducted the K-FAB. Eeach rater was blind to score of other rater. We compared the total K-FAB score to the K-FENT and WCST results to determine its concurrent validity. Finally, we obtained receiver operating characteristic (ROC) curves to determine the optimum cut-off score. The internal consistency was sufficient (Cronbach’s alpha=0.797), and the K-FAB scores were highly correlated bet-ween the two raters. The total K-FAB score correlated significantly with EIQ (r=0.665, p<0.01), the summary score of the Executive Intelligence Test (EXIT). It also correlated with total number of correct responses, perseverative errors, and total number of catergories completed in WCST. At the cut-off value 13, the K-FAB showed good sensitivity (80%) and specificity (69%). The K-FAB is a useful and easy bedside test for screen-ing frontal-executive functional impairments in a variety of psychiatric patients.

알코올 의존 환자 가족의 공동의존에 영향을 미치는 요인과 이에 따른 가족의 대처방식

선지영(Jee-Young Sun),이계성(Kye-Seong Lee),신상은(Sang-Eun Shin),박주언(Ju-Eon Park) 한국중독정신의학회 2006 중독정신의학 Vol.10 No.2

Objectives:The purpose of this study is to investigate the level and affecting factors of codependence & relationship with how to cope with patient in the family of alcoholics. Method:The subject were 60 family members of patients with alcohol dependence. All subjects were assessed by questionnaire about the demographic data, Children of Alcoholics Screening Test (CAST), Korean Version of Alcohol Use Disorders Identification Test (AUDIT-K), the Korean Version of Checklist from Codependents Anonymous (CCA-K), Spouse Sobriety Influence Inventory (SSII). Alcohol related characteristics of patients were surveyed through chart review and interview with family members. Results:First, the level of codependence among family with alcohol dependence was 93.3%. Among the characteristics of family, only the number of male brothers had significant positive relation with codependence. The presence of job among family members related with codependence & had significant positive relationship with how to cope with patients. Second, among the characteristics of patients, many factors that reflects severity of alcohol dependence had significant positive relationship with codependence & how to cope with patients. Conclusion:Our result support that codependence was the stress response came from in the relation with alcohol dependent patients because alcohol related characteristics of patients highly related with codependence compared to the characteristics of family members such as family history of alcohol. In the aspect of treatment, codependence should be considered, we have to help the family members to increase capacity how to cope with patients.

일 도시지역 사업장내 인터넷 중독과 직무스트레스에 관한 연구

김남석(Nam-Seok Kim),신상은(Sang-Eun Shin),이계성(Kye-Sung Lee),이명지(Myung-Ji Lee),장은영(Eun-Young Jang) 한국중독정신의학회 2007 중독정신의학 Vol.11 No.2

Objectives:This study examined the prevalence of internet addiction, job stress, and psychopathology among industrial workers in Incheon, Korea. Methods:The subjects were male industrial workers (n=139) in Incheon, Korea. A self-rating questionnaire, asking about demographic data and including Young’s Internet addiction Test (IAT), the short form of the Korean Occupational Stress Scale (KOSS-SF) for job stress, and the Symptom Checklist-90-Revision (SCL-90-R), was administered in August 2006. Results:In this study, 12 subjects (8.6%) were in the internet addiction group and 128 subjects (91.4%) were in the non-addiction group. On the KOSS-SF, the internet addiction group scored higher for job stress than the internet non-addiction group, although the difference was not statistically significant. On the job stress subscales, relation conflict and workplace culture were significantly higher in the internet addiction group. The internet addiction group had higher scores on all symptom scales of the SCL-90-R. Paranoia was the psychopathology mediating the relation conflict between job stress and internet addiction. Conclusion:On the job stress subscales, relation conflict and workplace culture scored significantly higher in the internet addiction group than in the internet non-addiction group. The internet addiction group showed more severe psychopathology. Using the mediational relation model, we confirmed that the psychopathology of the SCL-90-R mediating job stress and internet addiction was paranoia. For more details, a future study is needed.

한글판 ASSIST(Alcohol, Smoking & Substance Involvement Screening Test

신현주(Hyun Joo Shin),조근호(Geunho Cho),박애란(Ae-Ran Park),이상규(Sang-Kyu Lee),이해국(Hae-Kook Lee),김한오(Hano Kim),이계성(Kye-Seong Lee) 한국중독정신의학회 2014 중독정신의학 Vol.18 No.1

Objective : This study was performed to establish the reliability and validity of the Korean version of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Methods : This study included 342 adult male and female patients using alcohol or drug and controls. Through the assessment of the 50 patients who were recruited from alcohol consultation center, the evaluator was blind to the individual’s score each other and these data were used to evaluate interrater reliability. To evaluate the reliability and validity of Korean version ASSIST, we used a Fagerstrom test for nicotine dependence (FTND), a alcohol use disorder identification test (AUDIT), a drug abuse screening test (DAST) and compared the results with the ASSIST. Results : Korean version of ASSIST was calculated as valuable validity and reliability. That it, the construct validity of Korean version of ASSIST SSI score was as follows : smoking (0.81), alcohol (0.84), cannabinoids (0.75), cocaine (0.96), amphetamine (0.95), inhalant (0.96), sedative (0.91), hallucinogen (0.63), opioids (0.60), others (0.39). Reliability and validity were shown in all drugs with statistical significance. The cut-off values for screening substances with ASSIST were as follows : in smoking, the cut-off value to divide low risk and moderate is 22.5 and the value to divide moderate risk to high risk is 25.5. In alcohol, the cut-off value to divide low risk and moderate is 21.5 and the value to divide moderate risk and high risk is 23.5. Other substances also show similar significance. The result of this study was similar to those of previous studies of other countries. Conclusion : The reliability and validity of the Korean ver-sion of ASSIST were shown in all drugs with statistical significance. The Korean version of ASSIST can be a useful tool for investigating problems associated with drug use in primary clinical environment and providing brief intervention.