치매 선별을 위한 한국어판 기억손상선별척도 검사의 신뢰도 및 타당도

장성만(Sung Man Chang),최정석(Jung-Seok Choi),이준영(Jun-Young Lee) 대한사회정신의학회 2008 사회정신의학 Vol.13 No.1

연구목적 본 연구는 간편하면서도 유용하게 사용될 수 있는 치매 선별용 인지기능 검사 도구인 Memory Impairment Screen(MIS)를 한국어판(MIS-K)으로 구성하여 그 신뢰도와 타당도를 검증하고자 한다. 방 법 최종적으로 정신과 전문의의 진단을 거친 총 124명(치매 34명, 정상 90명)의 참여자들을 대상으로 MIS-K의 신뢰도와 공존타당도를 검증하였고, MIS-K의 총점에 따른 최적 절단점의 민감도 및 특이도를 산출하였다. 결 과 MIS-K는 높은 내적 일치도와 함께 우수한 평가자간 및 검사-재검사 신뢰도를 보였다. MIS-K는 B-ADL(Korean version of Bathel ADL Index), L-IADL(Korean version of Bathel ADL Index), MMSE-KC, BDS-K(Korean Behavioral dyscontrol scale) 및 GDS(geriatric depression scale)와 유의한 상관관계를 보였으며, ROC 곡선분석을 통해 추정된 최적 절단점(5/6) 에서의 민감도와 특이도가 각각 0.94, 0.93으로 높게 나타났다. ROC곡선의 Area Under Curve(AUC) 분석결과 MIS-K는 MMSE-KC와 치매선별도구로서 상대적으로 우수한 진단적 효율성을 보였다. 결 론 한국어판 MIS(MIS-K)는 높은 신뢰도와 타당도를 가지고 있으며, 치매선별을 위해 간편하면서도 유용한 인지기능 평가 도구이다. The aims of this study are to develop the Korean Version of Memory Impairment Screen(MIS-K) by analyzing reliability and validity, and to show its usefulness as a dementia screening instrument. A total of 124 participants(34 dementia vs. 90 normal control) were confirmed the final diagnosis by psychiatrist. All of them were administered MIS-K, B-ADL(Korean version of Bathel ADL Index), L-IADL(Korean version of Bathel ADL Index), MMSE-KC, BDS-K(Korean Behavioral dyscontrol scale) and GDS(geriatric depression scale). Inter-rater reliability, test-retest reliability and internal consistency of MIS-K were analyzed. To verify the concurrent validity of MIS-K, correlations with other tests(MMSE-KC, B-ADL, L-IADL, MMSE-KC) were analyzed. The sensitivity and specificity for each cut-off point of MIS-K were estimated and the Receiver Operator Characteristic (ROC) curve method was performed to get its optimal cut-off point. MIS-K was found to have significantly high internal consistency, inter-rater reliability, and test-retest reliability. The significant correlations of MIS-K with other tests were also shown. Its optimal cut-off point was estimated as 5/6, and the sensitivity and specificity were 0.94 and 0.93, respectively. The ROC curve analysis indicated that the diagnostic efficiency of MIS-K was comparable with MMSE-KC. We conclude that MIS-K has not only high reliability and validity, but also usefulness as a screening instrument for dementia.

일측 한국인에서 우울장애의 증상 양상

장성만(Sung Man Chang),조맹제(Maeng Je Cho) 대한사회정신의학회 2007 사회정신의학 Vol.12 No.1

목 적: 본 연구는 전국 규모의 역학연구를 통하여, 주요우울장애에 이환된 경험이 있는 지역사회 거주자들을 대상으로, 한국인에서 흔히 경험하는 우울증의 증상 양상을 파악하고자 시행되었다. 방 법: 2001년 KECA(Korean Epidemiologic Catchment Area) 연구에 응답한 만 18세 이상 65세 미만의 성인 6,275명을 대상으로 하였다. 한국어판 CIDI(Composite International Diagnostic Interview)를 통해 주요우울장애의 이환을 진단하였다. 전체 대상자 중 269명(4.3%)이 주요우울장애 이환의 경험이 있었다. 본 연구에서는 DSM-Ⅳ와 ICD-10에서 정의하는 주요우울장애의 진단기준인 26개 증상들에 대하여 성별, 연령별 교정 후 분석을 시행하였다. 결 과: 주요우울장애에 이환자들에서 흔히 경험되는 증상들은 피로감(90.3%), 집중력곤란(86.9%), 우울감(84.0%), 불면(83.7%), 의욕상실(77.0%), 식욕저하(77.3%) 등의 순으로 나타났다. 우울증 이환자들에서 의욕상실, 피로감, 과다수면, 정신운동지체, 죄책 감, 우유부단, 자살시도, 성욕감퇴, 흥미상실의 증상들이 남녀간의 차이를 보였다(p<0.05). 우울감, 의욕상실, 피로감, 불면, 2시간 이상 일찍 깸, 과다수면, 정신운동초조, 죄책감의 증상들은 연령에 따른 차이를 보였다(p<0.05). 결 론: 본 연구는 한국인의 주요우울장애 이환자들에서 흔히 호소하는 우울증의 증상들을 확인할 수 있었다. 또한 우울증의 증상들은 성과 연령에 따라 호소하는 증상의 빈도 차이가 있음을 확인할 수 있었다. Objective:The aims of this study was to investigate the frequency and kinds of symptoms and the profile of depressive symptoms in the Korean adults with major depressive disorder. Methods:Six thousands and two hundred seventy-five community dwelling subjects, aged 18 years or older, were interviewed by using Korean version of Composite International Diagnostic Interview(K-CIDI). A total of 6,275 participants completed the CIDI interview. In this study, depression symptoms consisted of 26 items presented by DSM-IV and ICD-10. Results:Common depression symptoms were the following order:fatigue(90.3%), Concentration difficulty(86.9%), depressed mood(84.0%), insomnia(83.7%), Loss of interest(77.0%), Decreased appetite(77.3%) and etc. Comparing depressive symptoms in terms of gender, the following symptoms were more frequent in female:Loss of interest, Fatigue, Hypersomnia, Psychomotor retardation, Feeling guilty, Suicide attempt, and Loss of pleasure. In male, Indecisiveness, and Decreased libido. Concerning age, the following symptoms are more prevalent in elderly:Depressed mood, Insomnia, Psychomotor agitated, and Feeling guilty. However, the following symptoms more prevalent in young adults: Loss of interest, Fatigue, and Hypersomnia. Conclusion:The most frequent depression symptoms were detected among community resident Korean adults. Some kinds of symptoms of Korean adults with major depressive disorder were different according to gender and age.

노인과 운전

장성만(Sung Man Chang) 대한노인정신의학회 2010 노인정신의학 Vol.14 No.1

There are some differences between elderly drivers and younger drivers in that the elderly are more likely to have cognitive, motor and sensoriperceptual deficits affecting their driving performance. The elderly driver is more likely to have a chronic illness and to be on medication, that might adversely affect driving. The elderly driver requires more study and help either by retraining or provision of adaptations to vehicles. Competence to drive is of clinical importance to doctors and recent studies would suggest that doctors need to be more aware of the current guidelines on driving and be prepared to offer advice.

위 평활근에서 비교감성 비콜린성 이완반응과 susbstance P에 의한 조절

장성종 ( Sung Jong Chang ),허광식 ( Gwang Sik Heo ),박찬국 ( Chan Guk Park ),김만우 ( Man Woo Kim ),전제열 ( Jae Yeoul Jun ) 대한소화기학회 2002 대한소화기학회 추계학술대회 Vol.2002 No.-

수술전 환자들의 정신과적 문제

장성만,이상원,Chang, Sung-Man,Lee, Sang-Won 한국정신신체의학회 2009 정신신체의학 Vol.17 No.1

수술을 앞 둔 환자들에서 이미 정신질환으로 치료 중이거나 수술이라는 상황으로 인한 다양한 정신과 질환들을 흔히 볼 수 있다. 일반적으로 외과계 의사들은 내과계 의사들에 비해 환자의 정신병리를 과소평가하거나 정신과 자문을 꺼리는 경향이 있다. 따라서 수술을 받는 환자의 정신과적 문제들 중 많은 부분이 진단되지 못하거나 잘 못 진단되어 적절하게 치료받지 못 한다. 본 저자는 수술과 관련하여 흔히 발생하는 정신과적 문제 및 상황들에 대해 살펴보려 한다. Psychiatric disorders are quite common in surgical patients. However, surgeons are less likely to refer patients to psychiatrists than other physicians, who also have a tendency to under-recognize psychiatric disorders among their patients. Therefore, a large proportion of psychopathology in surgical patients is either undiagnosed or misdiagnosed and not optimally treated, if treated at all. This column focuses on common psychiatric issues that generally arise in surgical patients and reviews psychiatric issues specific to specialized surgical settings and patients (eg, burn units, obesity surgery).

하지불안증후군과 정신과 약물

우정민,장성만,Woo, Jung-Min,Chang, Sung-Man 대한수면의학회 2010 수면·정신생리 Vol.17 No.1

Restless legs syndrome (RLS) is a common sensorimotor disorder that is characterized by an urge to move the legs and peculiar, unpleasant sensations deep in the legs and its prevalence in the general population is between 3.2% and 15%. RLS significantly impairs patients' lives, often by severely disrupting sleep. However, both clinicians and patients under-recognize the RLS. RLS phenotypes include an idiopathic form and secondary form that is usually resulted from various causative conditions. The pathophysiology of RLS may be related with the dopaminergic system, which is closely linked to a number of psychotropic medications, including antidepressant and antipsychotics. Several antidepressants and antipsychotics have been shown to induce or exacerbate RLS. We need pay attention to the fact that commonly prescribed medications can be the cause of RLS.

졸피뎀 유발 복합 수면 행동

이지민(Jimin Lee),장성만(Sung Man Chang) 대한생물치료정신의학회 2021 생물치료정신의학 Vol.27 No.2

Zolpidem is a non-benzodiazepine hypnotic agent as an agonist of the GABAA benzodiazepine receptor. Zolpidem is considered to have lower abuse and dependence potential than benzodiazepines, and is widely used for the short-term treatment of insomnia. However, the complex sleep-related behaviors caused by zolpidem have recently emerged as a major challenge. The purpose of this study was to review zolpidem-induced complex sleep-related behaviors and one of the most commonly reported behaviors, sleep-related eating disorder. The risk factors for these complex sleep-related behaviors are female sex, advanced age, daily doses of 10 mg or more, alcohol consumption, and comorbid medical illnesses. Strategies for managing zolpidem-induced complex sleep-related behaviors; discontinuing the use of zolpidem, switching to different sedative-hypnotic drugs, treating patients with other classes of medications, and using non-pharmacological treatment strategies for patients with sleep disorder. These strategies should also include examining drug regimens for potential drug interactions that may predispose patients to experiencing complex behaviors, administering zolpidem appropriately, and selecting patients more carefully for treatment in terms of their likelihood of experiencing medication-related adverse reactions. In conclusion, complex sleep-related behaviors related to zolpidem should be considered adverse drug reactions prior to drug prescription, and a patient’s potential risk factors should be evaluated. Physicians should pay attention to the occurrence of abnormal behavioral adverse effects related to zolpidem.

치매 환자에서의 자율신경기능 이상

이지민(Jimin Lee),장성만(Sung Man Chang) 대한노인정신의학회 2021 노인정신의학 Vol.25 No.2

Autonomic dysfunction commonly occurs in patients with dementia and is typically reported in patients with Alzheimer’s disease and Lewy body dementia. The clinical presentation of autonomic dysfunction includes symptoms related to orthostatic hypotension (manifested as dizziness, falls, and syncope, etc.), constipation, and urinary tract symptoms. Non-pharmacological management of orthostatic hypotension should include bolus water drinking. Pharmacological management includes the administration of midodrine (selective α1-adrenoceptor agonist), droxidopa (norepinephrine prodrug), or atomoxetine (selective noradrenaline reuptake inhibitor). Management of constipation includes the administration of probiotics, osmotic laxatives (e.g. macrogol), and type-2 chloride channel activators (e.g. lubiprostone), and management of urinary tract symptoms includes the administration of mirabegron (selective β3-adrenergic receptor). Autonomic dysfunction interferes with daily activities and negatively affects patients’ and caregivers’ quality of life. Therefore, early diagnosis of autonomic dysfunction and prompt initiation of optimal treatment are important to improve patients’ quality of life and prognosis

성별에 따른 우울증 양상과 신경전달물질의 차이

윤서영(Seoyoung Yoon),장성만(Sung Man Chang) 대한생물치료정신의학회 2019 생물치료정신의학 Vol.25 No.1

Depression is almost twice as prevalent in women than men. Atypical symptoms, somatic complaints, and comorbid anxiety disorders are more common in women, whereas suicide and comorbid substance use disorders are more common in men. Previous studies have also reported gender differences in the efficacy of and tolerability to specific classes of antidepressants. Various psychosocial and biological factors have been proposed to explain the gender differences in clinical characteristics of depression. The predominant theory of depression pathogenesis is the monoamine hypothesis, and consequently, monoamine neurotransmitters have been the primary target of antidepressants. In the first section of this review, study findings of clinical differences in depression by gender are summarized. Then, we provide an overview of the findings from human and rodent studies of gender differences in serotonin, norepinephrine, dopamine, and glutamate neurotransmitter systems. Total level, rate of synthesis, and receptor profiles of neurotransmitters seem to differ by gender in the euthymic state, depressed state, and in responses to stress or antidepressants. Furthermore, these neurotransmitters interact with gonadal hormones and the hypothalamic-pituitaryadrenal axis, systems that innately exhibit gender differences. Although most of the studies conducted so far are limited to animal models and results of the studies are heterogeneous, growing evidence suggests that gender differences exist in neurotransmitter systems, which possibly leads to gender differences in depression. More intensive studies in this field are needed to build gender-specific treatment strategies.

치매와 우울증의 감별을 위한 한국어판 간이정신상태검사의 차별문항 추출

한송이(Song Yi Han),장성만(Sung Man Chang) 대한생물치료정신의학회 2012 생물치료정신의학 Vol.18 No.2

Objectives:The Mini-Mental State Examination is arguably the most widely used screening measure for cognitive impairment. The aims of this study are to evaluate the psychometric properties of the Mini-Mental State Examination- Korean Version(MMSE-KC) as a quantitative measure of cognitive ability. Methods:Data were analyzed from a total of 312 participants age 65 or older from cross-sectional community-based study, which were collected about demographic information and individual item responses to MMSE-KC. Item response theory was used to analyze individual items. Results:Comparison of the data with a unidimensional 2-parameter model indicated that the total score obtained by summing across all items yields a reliable(0.78) quantitative estimate of global cognitive ability. All items fit the model and together spanned a range of difficulty(threshold parameter) from -3.86(easier) to 1.15(more difficult) logits, and discrimination(slope parameter) from 0.55 to 8.6 logits. The items about ‘recall of three words’ and ‘attention’ were the most difficult items and have most powerful discrimination parameter. Copying pentagons and time(year) orientation were more difficult than the other items. The patients with dementia showed differential item functioning such items as orientation to place, the last two items of ‘recall of three words’, the last two items of ‘attention’, and ‘three stage command’. Conclusion:The MMSE-KC can provide a reliable and valid quantitative estimate of cognitive ability. More attention should be paid to the difficult items like ‘recall of three words’ and ‘attention’ for the discrimination of dementia from non-dementia people.