한국인 양극성장애 환자에서 endothelial nitric oxide synthase 유전자 다형성

정상근 ( Sang Keun Chung ),최명수 ( Myong Su Choi ),양종철 ( Jong Chel Yang ),박태원 ( Tae Won Park ),정영철 ( Yong Chul Chung ),정애자 ( Ae Ja Jung ),황익근 ( Ik Keun Hwang ) 전북대학교 의과학연구소 2009 全北醫大論文集 Vol.33 No.1

Objectives: Although endothelial nitric oxide synthase(eNOS) gene has been investigated in many neuropsychiatric disorders, results were controversial and even contradictory. We performed this study to examine the genotypes and the allele frequency distribution of eNOS gene in Korean bipolar disorder patients, and the differences between them and healthy controls. Methods: eNOS genotypes in 51 bipolar disorder patients and 121 healthy controls were analyzed by polymerase chain reaction and amplified refractory mutation system. Results: When genotypes of eNOS were classified as a/a, a/b, b/b, there were no statistical differences in genotypes between two groups. There were also no statistical differences in allele frequency between two groups. Conclusions: These results suggest that eNOS gene may not be causally related to the development of bipolar disorder in Korean population.

꿈의 신경생물학적, 정신생리적적 기초

정상근,Chung, Sang-Keun 대한수면의학회 2001 수면·정신생리 Vol.8 No.2

In all ages and countries, dreaming has always been a topic that has interested people. Throughout history, theories about dreaming have been heavily dependent on concurrent theories in related domains. Many researchers have claimed that dreaming occurs during REM and NREM sleep and have rejected the strict association between REM sleep mechanisms and dreams. Although dreams may occur in both REM and NREM periods, they are likely to be produced by different mechanisms during REM and NREM sleep. All physicians managing dreaming-related problems in clinical practice need to understand the multidimensional aspects of dreaming. Therefore, I have reviewed the literature on mechanisms generating and the meaning of dreaming in the neurobiological and psychophysiological perspectives.

소위 '홧병'에서 분노유발사건의 상상과 이야기작업에 의한 정신생리반응:심혈관계 반응

정상근,신준호,황익근,Chung, Sang-Keun,Shin, Jun-Ho,Hwang, Ik-Keun 대한수면의학회 2000 수면·정신생리 Vol.7 No.2

목 적 : 저자들은 홧병 환자에서 분노유발사건의 상상 및 이야기와 관련된 자율신경계 특히 심혈관계의 특징적인 정신생리반응양상을 파악하였다. 방 법 : 전북대학교병원 정신과 외래 및 입원 환자 중 소위 '홧병'으로 진단된 43명을 대상으로 하였다. 분노(Spiel-berger의 분노평가척도), 불안(상태특성불안척도, Hamilton 불안척도), 우울(Beck 우울 척도, Hamilton 우울 척도) 수준을 생리적 측정 전 평가하고, 홧병의 원인이 되는 분노유발사건을 조사하였다. 분노유발사건의 상상 및 이야기작업동안의 주관적 스트레스정도(SUDS)와 사건의 생생한 정도(VIVID)도 평가하였다. 스트레스 작업으로서 분노사건의 상상과 이야기 작업을 이용하였다. 스트레스 작업 전의 기저기, 작업기간, 작업 후 휴식기동안 혈압과 맥박이 측정되었다. 심리적, 생리적 평가항목들에 대한 분노사건의 상상과 이야기 작업사이의 차이를 분석하였다. 결 과 : 분노유발사건 상상보다 이야기작업에서, 이완기 및 수축기 혈압의 놀람(모두 p=.000) 및 회복반응(각각 p=.000, p=.017), 맥박(p=.000)의 놀람반응이 유의하게 더컸고, 분노유발사건의 생생한 정도(p=.000) 및 분노유발사건의 주관적 스트레스정도(p=.000)가 더 높았다. 즉, 홧병 환자는 분노유발사건을 상상하는 경우보다 이야기하는 경우에 자율신경계 기능이 유의하게 더 항진되고, 사건에 대한 생생한 정도 및 주관적 스트레스를 더 강하게 느꼈다. 결 론 : 상기 연구결과, 저자들은 홧병 환자들이 분노유발 사건에 대해 과도하게 반복적으로 회상하고 분노표출을 하지 않도록 하는 것이 자율신경계, 특히 심혈관계 반응의 안정에 도움이 될 것이라고 제안한다. Objectives: This study was performed to examine the characteristic cardiovascular response patterns associated with the imagination and discussion of anger-provoked events in patients with hwa-byung. Methods: Forty-three female patients with hwa-byung were evaluated with the Korean version of the State-Trait Anger Expression Inventory, the State-Trait Anxiety Inventory, Hamilton Rating Scale for Anxiety, Beck Depression Inventory, and Hamilton Rating Scale for Depression just before the task. Subjective Units of Distress (SUDS) and Vividness of the event (VIVID) during the imagination and discussion of the event were evaluated immediately after tasks. Blood pressure (BP) and heart rate (HR) during baseline, rest, and tasks were also evaluated. Results: Both startle and recovery responses of BP, startle response of HR, SUDS, and VIVID in discussion task were significantly larger than in the imagination task. Conclusion: Results suggest that it is undesirable for the patients to excessively and repeatedly recall and talk about the anger events.

스트레스의 사회 심리적 이해

정상근,Chung, Sang-Keun 한국정신신체의학회 2001 정신신체의학 Vol.9 No.1

인생을 살아가는 동안 누구든지 스트레스를 경험한다. 심리사회적 스트레스 요인은 매우 다양하다. 또한 그에 대한 개인의 스트레스평가, 대응, 반응들도 매우 다양하다. 여기에는 개인차가 많이 있는데, 개인적 자원이나 취약성 인자와 같은 개인적 소인의 영향을 받기 때문이다. 이러한 스트레스과정의 결과로서, 개인은 정신적 성장의 기회가 되거나, 정신적, 신체적 적응(안녕)에 변화가 없을 수도 있으며, 또는 부적응(질병) 상태를 초래할 수 있다. 따라서 개인에게 맞는 스트레스 예방관리나 치료법이 필요하다. 진료의사가 임상현장에서 스트레스 관련 환자들을 진료할 때 스트레스의 전반적인(특히 심리사회적) 이해가 필수적이다. 저자는 그러한 이해를 돕기 위해서 심리사회적 측면의 스트레스와 관련된 문헌들을 포괄적으로 고찰하였다. Most people experience stress during his or her life. The types of psychosocial stressors are variable. Also, the stress appraisal, coping, and responses in stress process are variable. These varieties reflect individual differences due to ongoing social situation, personal dispositions such as personal resources and vulnerability factors, etc. The stress process results in psychosocial growth or no substantial change in functioning or health, or adverse change in functioning(illness) or health to person. Therefore, the preventive management and treatment of stress need to be tailored to individual characteristics. All physicians managing the stress-related patients have to understand the multidimensional aspects of stress. To understand stress better in psychosocial aspect, I comprehensively reviewed the literature on stress.

공황장애 환자의 스트레스 대처방식과 신체 증상 지각에 대한 인지적 특성

정해원,이무석,박우영,양종철,임은성,박태원,정영철,정상근,황익근,Jung, Hae-Won,Lee, Moo-Suk,Park, Woo-Young,Yang, Jong-Chul,Lim, Eun-Sung,Park, Tae-Won,Chung, Yong-Chul,Chung, Sang-Keun,Hwang, Ik-Keun 대한불안의학회 2007 대한불안의학회지 Vol.3 No.2

Objective : The purpose of this study was to investigate the strategies used to cope with stress and the cognitive characteristics of somatic symptom perception in patients with panic disorder. Methods : A total of 101 patients who met the DSM-IV criteria for panic disorder and 60 normal controls were recruited for participation in this study. We evaluated the subjects using The Way of Stress Coping Questionnaire (SCQ), Somato-Sensory Amplification Scale (SSAS), Symptom Interpretation Questionnaire (SIQ), and the Panic Disorder Severity Scale (PDSS). We analyzed the data using an independent t-test and Pearson correlation analysis (p<0.05). Results : The patients who used emotionally focused coping strategies scored significantly lower on the SCQ. The patients with panic disorder showed greater amplification of body sensations in the SSAS, a significantly higher score on the physical interpretation subset of the SIQ, and a lower score on the environmental interpretation subset of the SIQ than the normal controls. The PDSS scores were positively correlated with the SSAS score and physical interpretation score on the SIQ. Conclusion : These results show that patients with panic disorder have poor emotionally focused strategies for coping with stress, greater amplification of body sensations, and a tendency towards a physical interpretation of somatic symptoms.

화농성 합병증을 일으킨 선천적 기관지성 낭종

정회교 ( Hoe Kyo Chung ),임상근 ( Sang Keun Rhim ),권세훈 ( Sae Hoon Kwon ),이승도 ( Sung Do Rhee ),권성진 ( Sung Jin Kwon ),전종수 ( Jong Soo John ) 국군의무사령부 1965 대한군진의학학술지 Vol.4 No.1

항우울제와 몽유병:Mirtazapine에 의한 증례 1례

정상근,오근영,조광현,황익근,Chung, Sang-Keun,Oh, Keun-Young,Cho, Kwang-Hyun,Hwang, Ik-Keun 대한수면의학회 2003 수면·정신생리 Vol.10 No.2

몽유병은 수면수반증으로 분류되는데, 항우울제와 기타 향정신약물에 의해 이차적으로 유발될 수 있다는 보고들이 있었다. 그러나, NaSSA(noradrenergic and specific serotonergic antidepressant)계열인 mirtazapine에 의해 유발된 몽유병에 대한 보고가 없었다. 저자들은 우울증 환자에서 mirtazapine 사용에 의한 몽유병 1예를 경험하였기에 관련 문헌들을 고찰하고 보고하는 바이다. Somnambulism is classified as a parasomnia and has been reported with the use of antidepressants and other psychotropics. However, to our knowledge, there have been no reports of somnambulism associated with the use of mirtazapine (a noradrenergic and specific serotonergic antidepressant;NaSSA). We experienced a case of the mirtazapine (30 mg/day)- induced somnambulism in a 65 year-old woman with major depressive disorder who has never been diagnosed as panic disorder, somnambulism, other parasomnias, neurological disorders (including epilepsy), and other medical diseases. The sleepwalking symptoms disappeared after the antidepressant was replaced with paroxetine (20 mg/day).

공황장애환자의 정신생리적 반응

정상근,조광현,정애자,박태원,황익근,Chung, Sang-Keun,Cho, Kwang-Hyun,Jung, Ae-Ja,Park, Tae-Won,Hwang, Ik-Keun 대한수면의학회 2001 수면·정신생리 Vol.8 No.1

목 적 : 정상 대조군보다 공황장애환자의 생리적 각성수준이 더 높고 생리적 유연성이 더 적을 것이다. 이러한 가정을 확인하기 위해 공황장애환자와 정상대조군사이의 정신생리반응의 차이를 알아보았다. 방 법 : 환자군은 DSM-Ⅳ의 공황장애 진단기준에 맞는 외래 및 입원 환자 10명(남성 9명, 여성 1명;연령 $47.5{\pm}14.3$세), 정상 대조군(남성 9명, 여성 1명 ; 연령 $47.3{\pm}10.1$세)은 전북의대 학생 및 전북대학교병원직원 10명으로 선정하였다. 심리적 평가항목으로서, 불안, 우울 수준은 상태특성불안척도, Beck 우울 척도, Hamilton 불안 및 우울 척도로 평가하였다. 생리적 평가항목으로서 자율신경계의 정신생리반응을 측정하였는데, 맥박, 호흡속도, 피부전도반응, 근전도 등은 J & J I-330모델을 이용하였다. 스트레스작업은 4가지로서 암산, 비디오게임, 과호흡, 스트레스사건 이야기작업을 이용하였다. 정신생리반응의 측정순서는 생리반응 측정전 약 15분간의 휴식후 각각 3분씩의 '기저기간-암산작업 기간-휴식기간(3분)-비디오게임 기간-휴식기간-과호흡 기간-휴식기간-트레스사건 이야기작업 기간'으로 하였다. 두 군사이의 스트레스작업에 따른 심리적, 생리적 평가 항목들의 차이를 통계 분석하였다. 결 과 : 대조군보다 공황장애군에서 우울, 불안수준이 유의하게 더 높았다. 생리반응 중 피부전도반응(p=.017), 근전도(p=.047), 맥박(p=.049)의 기저치가 대조군보다 공황장애군에서 유의하게 더 높았다. 또한, 피부전도반응의 경우, 과호흡시 놀람반응이 대조군보다 공황장애군에서 유의하게 더 컸다(p=.001). 맥박의 경우, 암산작업시 놀람 및 회복반응이 대조군보다 환자군에서 유의하게 더 적었다(각각 p=.007, p=.002). 환자군내에서 피부전도반응의 경우, 암산(p=.0001) 및 비디오게임(p=.021) 작업시 놀람반응이 회복반응보다 유의하게 더 컸다. 또한 호흡반응의 경우, 환자군내에서 과호흡시(p=.035) 놀람반응보다 회복반응이 유의하게 더 컸다. 결 론 : 상기 결과로 미루어보아, 공황장애환자는 정상 대조군보다 기저기에서 대부분 자율신경계의 생리적 각성수준이 더 높았으나, 측정항목에 따라 생리적 유연성의 기복이 있었다. 따라서, 공황장애환자의 치료시 자율신경계의 각성수준을 감소시키고, 일부 스트레스에 대한 생리적 유연성 회복이 필요하다고 생각한다. Objectives: An Increased level of psychophysiologic arousal and diminished physiologic flexibility would be observed in patients with panic disorder compared with a normal control group. We investigated the differences of psychophysiologic response between patients with panic disorder and normal control to examine this hypothesis. Methods: Ten Korean patients with panic disorder who met the diagnostic criteria of DSM-IV were compared with 10 normal healthy subjects. In psychological assessment, levels of anxiety and depression were evaluated by State-Trait Anxiety Inventory, Beck's Depression Inventory and Hamilton Rating Scale For Anxiety and Depression. Heart rate, respiration rate, electrodermal response, and electromyographic activity were measured by biofeedback system (J & J I-330 model) to determine psychophysiologic responses on autonomic nervous system. Stressful tasks included mental arithmetic, video game, hyperventilation, and talking about a stressful event. Psychophysiologic responses were measured according to the following procedures : baseline(3 min)-mental arithmetic (3 min)-rest (3 min)-video game (3 min)-rest (3 min)-hyperventilation (3 min)-rest (3 min)-talking about a stressful event (3 min). Results: The baseline level of anxiety and depression, electrodermal response (p=.017), electromyographic activity (p=.047) and heart rate (p=.049) of patients with panic disorder were significantly higher than those of the normal subject group. In electrodermal response, patient group had significantly higher startle response than the control group during hyperventilation (p=.001). Startle and recovery responses of heart rate in the patient group were significantly lower than responses in the control group during mental arithmetic (p=.007, p=.002). In electrodermal response of the patient group, startle response was significantly higher than recovery response during mental arithmetic (p=.000) and video game task (p=.021). Recovery response was significantly higher than startle response in respiratory response during hyperventilation. Conclusion: The results showed that patients with panic disorder had higher autonomic arousal than the control group, but the physiologic flexibility was variable. We suggest that it is helpful for treatment of panic disorder to decrease the level of autonomic arousal and to recover the physiologic flexibility in certain stressful event.

흡연의 정신의학적 고찰

정상근(Sang-Keun Chung),황익근(Ik-Keun Hwang) 한국중독정신의학회 1997 중독정신의학 Vol.1 No.1

Cigarette is not any more favorite food, and nicotine is one of addicting drugs. Despite of adverse health effects due to cigarette smoking, there are several factors(i.e. social, psychological, genetic, biological) that make smoking behavior initiate, maintain, relapse. Cigarette smoking is diagnosed and classified as ‘mental and behavioral disordrs due to use of tobacco’ and as ‘nicotine-related disorders’ in ICD-10, and as ‘nicotinerelated disorders’ in DSM-Ⅳ. The prevalence of smoking is higher in psychiatric patients than the general population, and nicotine dependence can be considered as a kind of chronic relapsing illness. Because nicotine dependence is as complex in its components and determinants as other addictions, more comprehensive multicomponent treatments may be required for the achievement of successful abstinence. Because of above background, we reviewed psychiatric aspects of references about cigarette smoking to established guidelines of smoking cessation program.

2006 한국인의 불안 : 불안 리서치 결과 보고

정상근,권준수,2006 한국인의 불안 리서치 그룹,Chung, Sang-Keun,Kwon, Jun-Soo 대한불안의학회 2006 대한불안의학회지 Vol.2 No.2

Objectives : We performed this '2006 Korean Anxiety Research' to understand the actual state about Korean anxiety and get the basic data for mental health promotion. Methods : Semistructured questionnaire and Beck Anxiety Inventory -Korean version (BAI) were administered to total 1,000 adults (20-69 years old 501 male & 499 female adults living in Seoul and 5 metropolitan cities in Korea) on March 20th~31st, 2006. Results : Anxious subjects by the total score of BAI was 3.3%. But the responders the item 'I am in the anxious state' was 25% among total subjects. 6% (n=59) among total subjects were the responders experienced the anxiety requiring usually the counselling or treatment. The frequency of their anxiety was most commonly 1 to 2 times/month. The main causes of their anxiety were 'their health problems or illness', 'economic difficulty', 'interpersonal conflicts'. But 'help by health professional' among their usual anxiety reduction methods' was only 15% among them. Only 19% among them were under the treatment of anxiety. Only 27% among 48 subjects not under the treatment of anxiety had a desire for the anxiety treatment in the near future. Conclusion : Some people in the anxious state impairing their daily lives were not yet under the treatment. And most of them had no desire for the anxiety treatment. Therefore we will systematically plan the further health education on the anxiety-related problems for the Korean mental health promotion and the quality of life.