월경전 불쾌기분장애 환자의 광치료 임상 시도

조숙행,김진세,김승현,김린,Joe, Sook-Haeng,Kim, Jin-Se,Kim, Seung-Hyun,Kim, Leen 대한수면의학회 1999 수면·정신생리 Vol.6 No.1

목 적 : 광치료는 계절성 기분장애, 약간의 비계절성 주요 우울장애 및 월경전우울증 등의 치료에 이용되고 있다. 저자들은 일중주기리듬의 장애가 병인론으로 제시되고 있는 월경전 불쾌기분 장애에 대한 광치료 효과를 평가하기 위하여 광치료의 임상시도를 하였다. 방 법 : DSM-IV의 월경전 불쾌기분장애 진단기준에 충족되는 4명의 환자에서 광박스(light box,Apolo bright lite III)를 이용한 저녁 광치료(6:30-8:00pm) 시도하였다. 결 과 : 연구대상은 광치료 후, 그 정도에는 차이가 있으나, 월경전기 증상과 더불어 우울기분과 불안이 감소하는 변화를 보였다. 본 연구는 임상시도로 연구대상이 적고, 위약 효과의 통제가 없으며, 증상 평가 방법에 있어 어려움 등 한계가 있으나, 이러한 변화는 특히 비정형 우울증상이 있는 환자에서 두드러졌으며, 신체증상보다는 심리증상에 보다 효과적인 결과를 보였다. 결 론 : 광치료는 월경전불쾌기분 장애 환자의 약물학적 치료에 대안적 방법으로 볼 수 있겠다. 향후 보다 많은 수의 환자를 대상으로, 위약대조 교차연구(아침, 저녁 광치료)가 필요할 것으로 사료된다. Objectives: Patients with premenstrual dysphoric disorder(or PMDD) have impairments of the social, occupational or academic function due to psychological or somatic symptoms, which have the characteristic pattern of symptom exacerbation in the week before menses begin and remission shortly after the onset of menses. In the chronobiological view, many researchers have assumed that the etiology of PMDD is the advanced circadian rhythm. It has been suggested that light has a therapeutic effect on PMDD, because evening light results in phase delay of circadian rhythm through the biochemical changes including melatonin. Methods: The authors investigated the therapeutic effect of light therapy on four patients with prospectively diagnosed PMDD by DSM-IV criteria using clinical psychiatric interview, Premenstrual Assessment Form(PAF) and Daily Rating Form(or DRF). In the evening(6:30pm-8:00pm), the 2,500 lux light administered for seven consecutive days during the symptomatic late luteal phase of menstrual cycle. Beck Depression Inventory(or BDI), Hamilton Rating Scale for Depression(or HAM-D), Spielberg State Anxiety Inventory(or SA), and DRF were evaluated before and after seven days of light therapy. Results: Premenstrual symptoms of PMDD could be effectively treated with the evening bright light therapy, especially in PMDD patients with atypical symptoms. In addition, the light therapy seemed to more effective on the psychologic symptoms than the somatic symptoms of PMDD. There was no significant side-effect of light therapy, except the transient and mild eye-strain in one case. Conclusions: In spite of the results of limited data from our clinical trial, the authors suggest that the potential use of light therapy as an alternative to the pharmacological management of patients with PMDD.

후기황체기 불쾌기분장애(LLPDD) 환자의 광선치료 1례

조숙행,Joe, Sook-Haeng 대한수면의학회 1994 수면·정신생리 Vol.1 No.2

The author reports a 32 years old female patient with late luteal phase dysphoric disorder who received evening bright light treatment for 7 consecutive days during the late luteal phase of menstrual cycle. After the treatment, beneficial clinical effects were observed. This result suggests that bright light can be an alternative treatment for LLPDD. However, the placebo effects should be ruled out completely. Further controlled studies with more patients will be needed.

한국어판 일상 생활 스트레스 척도(K-DSI)의 표준화 연구

조숙행,이현수,송현철,김승현,서광윤,신동균,고승덕,Joe, Sook-Haeng,Lee, Hyeon-Soo,Song, Hyun-Cheol,Kim, Seung-Hyun,Sub, Kwang-Yun,Sin, Dong-Kyun,Ko, Seung-Duk 한국정신신체의학회 2000 정신신체의학 Vol.8 No.1

연구목적 : 본 연구에서는 일상 생활에서 흔히 경험하는 사소한 스트레스 요인들을 측정하는데 민감한 척도인 일상생활 스트레스 명가 척도의 한국어판(K-DSI)올 표준화함으로써 정상인에서의 규준표를 제시하고자 하였다. 방법 : 19세 이상의 정상인 524명을 대상으로 한국어판 일상생활 스트레스 평가 척도의 58개 문항을 일주일 동안 연속적으로 매일 작성하도록 하였다. 마지막날에 상태-특성 불안 척도(STAI)와 Beck 우울척도(BDI), 사회 재적용 평가 척도(SRRS)를 작성하도록 하였다. 인구학적 변인에 따라 K-DSI의 사건, 영향, 영향/사건 비율 점수를 비교 분석하였으며(ANOVA or t-test). 변량 분석의 사후 검증 방법으로 Scheffe's test를 사용하였다. 내적 일치도를 통해 신뢰도를 검증하고. BDI, STAI, SRRS 점수와의 상관 분석을 통해 수렴 타당도를 검증하였다. K-DSI 점수들의 백분율 분포에 근거하여 규준표를 작성하였다. 결과 : K-DSI 점수는 남성에 비해 여성에서, 나이가 젊을수록 학력이 높을수록 높았으며, 5개의 하부 요인 범주 중 인지적 스트레스 요인들이 가장 많은 것으로 나타났다. K-DSI의 내적 일치도는 Chrombach $\alpha$값이 .99로 높게 나타났으며, BDI, STAI, SRRS 점수와 K-DSI의 일일 및 주간 사건, 영향 접수는 유의한 상관관계를 보여주었다. 백분율 분포에서 75%에 해당되는 사건 접수는 17점, 영향 접수는 57점, 영향/사건 비율은 3.48~3.49점이었으며, 1주일 사건 접수는 118~124점이고, 1주일 영향 점수는 368~389점, 영향/사건 비율은 3.47~3.48점이었다. 또한 95%에 해당하는 사건 점수는 57점, 영향 점수는 151~161점, 영향/사건 비율은 4.72~4.86점이었으며, 1주일 사건 점수는 405점이고, 1주일 영향 접수는 1038~1122점, 영향/사건 비율은 4.46~4.56점이었다. 결론 : DSI의 신뢰도와 타당도가 만족스러운 수준을 보였고 인구학적 특성에 따라 흥미로운 결과가 나타남으로써 임상적 유용성이 검증되었다. 무엇보다도 규준을 스트레스 경험의 평가에 대한 객관적인 비교기준이 될 수 있는 규준자료를 제시하였다는데 큰 의의가 있다고 할 수 있다. Objectives : This study was to provide normative data of Korean version of DSI(K-DSI), a sensitive measure of relatively minor stressors that could be administered daily. Methods : K-DSI was administered in 524 adults, age of 19 or over, daily for 1 week. On the seventh day, Becks Depression Inventory(BDI), State-Trait Anxiety Inventory(STAI), and Social Readjustment Rating Scale(SRRS) were also given to test the convergent validity. Analyses(ANOVA or t-test) were conducted to examine the potential effects of demographic variables on K-DSI score. Internal consistency for reliability and Pearson's corelation coefficient with BDI, STAI, SRRS for convergent validity were computed. Percentile scores were calculated for daily and weekly K-DSI Event, Impact and I/E Ratio scores. Results : K-DSI scores in women were higher than those in men. According to age and educational level, the younger and the higher educational level the normative groups were, the higher were K-DSI scores. Among the 5 categories of the inventory, the category of cognitive stressors was highest. Internal consistency of K-DSI(Cronbach's $\alpha$) was .99. Daily and Weekly events and impacts scores were significantly correlated with the scores of State-Trait Anxiety Inventory, Social Readjustment Rating Scale, and Beck Depression Inventory. 75 percentile scores of the daily/weekly Events, Impacts, and I/E ratio were 17/118 - 124, 57/368 - 389 and 3.48 - 3.49/3.47 - 3.48 respectively. And 95 percentile scores of daily/weekly Events, Impacts, and I/E ratio were 57/151- 161, 405/1038 - 1122, and 4.72 - 4.86/4.46 - 4.56 respectively. Conclusion : Reliability and validity of K-DSI were tested satisfactorily. Authors presented the normative data of K-DSI for Koreans. K-DSI could be a useful measure in clinical settings or researches to assess the minor stressors frequently experienced in everyday life.

한국어판 매일 스트레스 평가서 개발을 위한 예비연구

조숙행,이현수,곽동일,남민,Joe, Sook-Haeng,Lee, Hyeon-Soo,Kwak, Dong-Il,Nam, Min 한국정신신체의학회 1997 정신신체의학 Vol.5 No.1

As a preliminary step to develop the Daily stress Inventory(DSI) for assessing minor stressors frequently experienced in everyday lift. We examined the reliability and validity of the DSI. The Daily Stress Inventory(DSI), the Beck Depression Inventory(BDI), the State-Trait Anxiety Inventory(STAI), the Social Readjustment Rating Scale(SRRS) and the Minnesota Multiphasic Personality Inventory(MMPI) were administered to 111 college students. Compared with the weekly DSI Event, Impact and I/E ratio scores of the American college students, the weekly event and I/E ratio scores of the Korean college students were significantly higher but weekly Impact score was lower. The internal consistency reliability of the DSI as computed by Cronbach alpha was .98. The DSI I/E ratio scores were significantly correlated with the scores of State Anxiety$({\gamma}=.27)$ and Trait Anxiety${\gamma}=.24)$, but not with BDI scores. And the SSRS scores were not significantly correlated to the DSI Event or Impact and In ratio scores. Significant correlations were revealed between the DSI Impact scores and the Sc and Ma scales of the MMPI. And the correlation between the DSI I/E ratio scores and the L, D, Hy, Pd and Pa scales of the MMPI was also significant. But no significant correlation was found between the DSI Event scores and all the scales of the MMPI. This study suggests that the DSI can be a reliable and valid tool to assess the minor stress frequently experienced in everyday life future study should be directed to obtain normative data based on more varied and larger population. Especially gathering additional evidences for the validity of the DSI using other minor stressor scale will be required.

광치료의 기본원리와 임상 실제

조숙행,Joe, Sook-Haeng 대한수면의학회 1998 수면·정신생리 Vol.5 No.2

Nowadays light therapy is accepted practice in the treatment for Seasonal Affective Disorder. The author reviewed the practical aspects of light therapy, latest treatment research on optimal parameters of light therapy and the mechanisms of action of light therapy. Therapeutic efficacy of light therapy using light visors & dawn simulators has been suggested but further studies are needed to clarify the efficacy. The treatment most strongly supported by research studies is light therapy using a light box to administer bright white light (2500 lux for 2 hours or 10000 lux for 30 minutes). Although some patients may be selective responders to morning light exposure, the optimal timing of light exposure still remains controversial. In practice, generally the duration of exposure can be increased or decreased as necessary and also the timing of exposure can be splitted (e.g. AM/PM usage) if optimal response is obtained. For most, a positive response of light therapy is usually noted within $4{\sim}5\;days$ and optimal response is obtained within 2 weeks. Generally the relapse of symptom occurs within days of discontinuation of light therapy, so to prevent relapse, light therapy should be continued throughout the winter season for typical seasonal affective disorder. Side effects of light therapy appear to be mild and well tolerated. Several theories for the mechanisms of action of light therapy at the basis of seasonal affective disorder had been suggested but remain still controversial. Further studies on the optimal parameters and the mechanisms of light therapy help us to better understand and treat not only seasonal affective disorders but also chronobiological disorders and nonseasonal affective disorders.

과수면을 수반한 계절성 정동장애 1례 -광치료 전후의 수면다원검사 소견을 중심으로-

조숙행,김인,서광윤,Joe, Sook-Haeng,Kim, Leen,Suh, Kwang-Yoon 대한수면의학회 1998 수면·정신생리 Vol.5 No.2

Authors report the findings of nocturnal polysomnography and multiple sleep latency test(MSLT) before and after morning light treatment in a winter depressive patient with hypersomnia. On polysomnographic recordings, the sleep pattern of this case before light treatment was similar to that of narcolepsy exhibited, sleep onset REM period(SOREMP). After treatment, the shortened REM latency changed to normal condition, but, deep sleep percentage did not changed, and stage 4 sleep percentage was decreased. Depressive symptoms were improved on clinical interview with Hamilton Depressive Rating Scale. Sleep log showed shortened sleep latency and reduced sleep duration. These findings suggest that although light treatment could alter the sleep structure in seasonal affective disorder with hypersomnia, it does not necessarily imply that antidepressant response of light treatment is result of change of sleep structure.

내분비질환에 영향을 미치는 심리적 요인

조숙행,Joe, Sook-Haeng 한국정신신체의학회 1998 정신신체의학 Vol.6 No.2

Although there has been a considerable research in psychoneuroendocrinology, particularly in relation to the biology of mood disorders, there has been a paucity of research regarding the effects of psychological factors on endocrine diseases. Of the existing literature, the most research is focused on diabetes mellitus, graves' disease. Especially diabetes appears to be the only endocrine disease that has been the focus of recent research studies. Most of the studies had retrospective designs or several methodological flaw. There has been no consistent results demonstrating that psychological factors affect the onset of diabetes mellitus. Several studies have suggested that psychological factors affect the course of diabetes. A small number of studies showed some evidence that psychological stress was associated with changes in glucose regulation in a subset of diabetic patients. There was also evidence to suggest that some temperament and coping skill influence glycemic control in child, adolescent diabetics. Studies of behavioral or psychosocial intervention on diabetic control have been small and have produced mixed results. There was a few controlled study suggested that stressful life events might be a causal role in Cushing's disease and Graves'disease, but there is no presently sufficient evidence to suggest that psychological factors affect the onset and the course of Cushing's disease and Graves' disease. In future, there is need for a well-designed biopsychosocial research with prospective designs, well defined patient population and control groups to study the relationship between psychological factors and endocrine diseases.

청소년의 월경전기 변화

조숙행,Joe, Sook-Haeng 한국정신신체의학회 1996 정신신체의학 Vol.4 No.2

To assess premenstrual changes in adolescents, a self rating retrospective premenstrual assessment from(PAF) and a prospective daily rating form(DRF) were administered to 230 high school students who reported premenstrual changes. The results were as follows 1) According to typological categories of retrospective premenstrual assessment form, the most commonly reported changes in mood and behavior were major depressive syndrome(40.0%), impulsive syndrome(20.9%). Especially among the subtype of depressive syndrome, hostility feature and withdrawal feature were most frequent. The most commonly reported changes in physical condition were general discomfort(73.5%), fatigue(33.9%). 50.9% of all subjects reported impaired social function. 2) 41.2% of the subjects who met the criteria for typological categories of retrospective premenstrual assessment form were confirmed by prospective daily rating form. 3) According to different criteria of percent change method of assessing symptom change, 38.7% of all subjects had at least one mild premenstrual change and 23.5% had at least one moderate premenstrual change. 4) Using prospective daily rating form, overall psychological changes were confirmed more frequently than physical changes. Of the mild premenstrual changes, 'low energy, tired & weak', 'less or impaired work' were most common changes. Of the moderate premenstrual changes, the most common change was 'low energy, tired & weak'. 5) As attitude toward menstruation, 44.9% of the subjects with confirmed premenstrual changes had more negative attitude(disgusted) toward menstruation. 6) The subjects with confirmed mild or moderate premenstrual changes had only dysphoric mood changes or both physical and dysphoric mood changes, but did not have only physical changes. These results suggest that retrospective reports of premenstrual changes were partially confirmed by daily prospective ratings. A substantial number of adolescents appeared to experience premenstrual changes, and the most common confimed premenstrual change of mild or moderate severity was 'low energy, tired and weak'.

정상인에서의 멜라토닌 투여에 따른 행동 및 생리적 효과

조숙행,남민,Joe, Sook-Haeng,Nam, Min 한국정신신체의학회 1997 정신신체의학 Vol.5 No.2

Objectives : The behavioral and physiological effects following low doses and high doses of melatonin have not been fully explored. In this study the authors investigated the nature and extent of the hypnotic effects, oral temperature, blood pressure effects, performance effects and subjective feelings following the acute administration of low pharmacological oral doses of melatonin at mid-day. Methods : Thirty-five healthy young medical students were randomly assigned to receive 6mg of oral melatonin(N=11), 12mg of oral melatonin(N=12) or a placebo(N=12) in a double-blind, placebo controlled trial. Measures of the behavioral and physiological effects used in the study were Stanford Sleepiness Scale, Digit Symbol Substitution Test, Trail test and visual analogue scale for subjective feelings. Oral temperature and blood pressure were measured. The subjects were studied between 10:00 and 16:00 hours. Data were analyzed by using repeated-measures analyses of variance(ANOVA). Results: Melatonin produced statistically significant effects on oral temperature, but there were no significant effects on time and the $dose{\times}time$ interaction. There was a significant difference on oral temperature between the 12mg oral melatonin group and the placebo group at 12:00 and 16:00 hours, but no significant difference between the 12mg and the 6mg oral melatonin groups. Melatonin produced a dose-related increase in subjective sleepiness and had significant effects on time, the $dose{\times}time$ interaction. There was a significant difference on subjective sleepiness among the placebo, 6mg, 12mg oral melatonin groups at 13:00-16:00 hours. Melatonin did not produce statistically significant dose-related effects on subjective fatigue but produced significant effects on time and the $dose{\times}time$ interaction. There was a significant difference on subjective fatigue between the 12mg, the 6mg oral melatonin groups and the placebo group at 13:00 hour. Conclusions : These data indicated that acute administration of melatonin at mid-day increased subjective sleepiness and fatigue but decreased oral temperatures. These effects were shown especially in 12mg oral melatonin group.

월경 전기 평가서 (Premenstrual Assessment Form : PAF)의 신뢰도, 타당도 연구 - 청소년을 대상으로 -

조숙행,이현수,곽동일,고승덕,Joe, Sook-Haeng,Lee, Hyeon-Soo,Kwak, Dong-Il,Ko, Seung-Duk 한국정신신체의학회 1996 정신신체의학 Vol.4 No.1

본 연구는 월경전기 평가서(PAF)의 신뢰도와 타당도를 검증하고자 하였다. 서울시내 모 여고생 300명을 대상으로 PAF를 실시하여 검사 실시 상의 신뢰성이 의심되는 것을 제외한 250명 중에서 월경전기에 불편감을 느끼는가라는 질문에 예라고 응답한 230명의 자료에 대해 통계분석을 하였다. 피험자의 평균 연령은 $16.8{\pm}30.71$세, 초경연령은 $13.1{\pm}61.12$세였다. PAF 95문항의 평균과 반응빈도를 살펴본 결과 모든 문항에 골고루 응답되어 PMS의 다양성을 확인할 수 있었고 그 중에서도 한국 청소년의 주된 월경전기증상을 반영하는 것으로 보이는 21개 문항을 확인할 수 있었다. 검사의 내적 일치도는 ${\alpha}=.95$로 상당히 높아 문항의 동질성이 있음이 밝혀졌으며 검사-재검사 신뢰도는 r=.80으로 시간경과에 따른 검사의 안정성을 확인할 수 있었다. 요인분석 결과 충동성 및 불안정성 요인, 우울 요인, 철수 및 사회적 기능 손상 요인, 불안 및 인지기능 손상 요인, 신체생리적 변화 요인, 전반적 불편감 요인, 안녕감 증가 요인, 기타요인의 8개 요인구조가 확인되었다. 결론적으로 타당도 연구에서는 추출된 하위 요인구조 들이 월경전기 증상을 잘 반영하고 있으며 신뢰도 연구 결과도 만족스러운 수준을 보여 PAP가 월경전기 변화를 선별평가 하는데 유용하게 쓰일 수 있을 것으로 기대된다. 논의에서는 요인분석에 의한 분류체계를 Halbreich등(1982)의 주관적 평가기준에 의해 만들어진 형태학적 분류와 비교하여 보았고 마지막으로 본 연구의 제한점에 대해 논의해보았다. This study was attempted to investigate reliability and validity of premenstrual assessment form(PAF). PAF was administered to 230 high school students who had reported premenstrual changes. PAF revealed considerable diversity in premenstrual symtom changes of the subjects. The items with most frequent reported premenstrual changes were 21 items out of 95. Cronbach's internal consistency was .95, and test-retest reliability was .80. Validity test was performed by constructional validation analysis. 8 factors(impulsive & unstable factor, depressive factor, withdrawal & social functioning impairment factor, anxiety & cognitive dysfunction factor, physiological factor, general discomfort factor, increased well-being factor, other factor) emerged at factor analysis. Each of them accounted for 33.97, 5.10, 3.70, 2.93, 2.64, 2.46, 2.12, 2.03 of total variance respectively. High school students experienced impulsive & unstable features of premenstrual symptoms more frequently. This study suggests PAF can be a reliable and valid tool as a initial screening and evaluation of premenstrual changes. finally, factor analysis result was compared with PAF typological categories.