정신과 입원환자의 공격행동 특성

전태연,권용실,도규영,장계호 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.3

저자들은 1994년 1월 1일부터 1995년 6월 31일까지 가톨릭대학교 의과대학 의정부성모병원 정신과에 입원했던 환자들 중세서 공격행동을 보인 환자(공격군) 72명과 공격행동이 없었던 환자(비공격군) 215명의 임상적 특성에 관한 조사를 하여 다음과 같은 결과를 얻었다. 1) 공격행동을 보인 환자는 72명으로 전체 조사 환자의 25.1%이었다. 2) 성별, 연령, 종교, 결혼 상태와 정신과 질환의 가족력 등에 따른 공격행동의 발생비율의 차이는 유의하지 않았다. 3) 교육 정도와 직업에 따른 공격군의 비육에 유의한 차이가 있었다(p<.05). 4) 진단별로는 공격군에서 조증, 기질성 정신장애, 정신분열증의 빈도가 높았으나 진단에 따른 의미 있는 차이는 없었다. 5) 공격행동의 기왕력은 공격군에서 더 많았고 비공격군과 비교시 의미 있는 차이를 보였으며(p<.001), 입원 형태는 공격군에서 타의 입원의 빈도가 유의하게 높았다(p<.005). 7) 입원시 정신병리는 초조-흥분과 적대감-의심에서 공격군의 빈도가 높았으며 정신병리에 따른 의미 있는 차이를 보였다(p<.001). 8) 총 재원 일수는 공격군에서 평균 59.3일이었고 비공격군이 평균 38.4일로 유의한 차이를 보였다(p<.001). 9) 공격행동의 유형은 말로한 경우가 가장 많았고 물건을 대상으로한 행동, 타인을 대상으로 하는 행동의 순으로 나타났다. 10) 공격행동 직전 행동 특징은 활동증가, 시끄러움, 욕설, 분노, 적대적이었던 경우가 가장 많았다. 11) 공격행동은 정오에서 오후 6시 사이, 휴식시간에 가장 많이 나타났다. 12) 입원 후 1주일 이내에 공격행동의 62.3%가 나타났다. 13) 총공격 점수에 의미 있게 영향을 주었던 변인들로는 종교(p<.05), 교육 정도(p<.05), 직업(p<.05), 입원형태(p<.005), 진단(p<.001), 입원시 정신 병리(p<.001), 공격행동의 기왕력(p<.001) 등으로 나타났다. To evaluate the characteristics of violent behavior of psychiatric inpatients the authors reviewed clinical records of psychiatric patients who had admitted at UiJong Bu St. Mary's Hospital from January 1994 to June 1995. We divided the 287 subjects into violent and nonviolent group according to the presence of violent behaviors in psychiatric ward. We assessed demographic variables, clinical characteristics and violent behaviors using Overt Aggression Scale and compared these variables of violent group with nonviolent group. The results were as follows : 1) The number of violent patients was 72(25.1% of the total). 2) In terms of demographic variables, the differences between two groups in education and occupation were significant(p<.05). 3) In psychiatric diagnoses, violent group were more likely to have mania, schizophrenia and organic mental disorder in sequence but there were no differences between violent and nonviolent group. 4) The history of violent behavior was greater in violent group(p<.001) and the mode of admission was significantly different between two groups(p<.005). 5) In cluster of psychopathology on admission, more frequently found clusters of psychopathology in violent group were agitation-excitement and hostile- suspiciousness and there were significant differences between two groups(p<.001). 6) The length of stay in violent group(59.3 days)was significantly longer than nonviolent group(38.4 days)(p<.001). 7) The types of violent behavior were verbal aggression, physical aggression against objects and physical aggression against other people in frequency sequence. 8) The most frequent type of behavioral clue before violent behavior was hyperactive, loud, verbally abusive, angry, hostile(68.1%). 9) Most of violent behaviors were presented between midday and 6 pm. in resting time. 10) 62.3% of total violent behaviors were occurred within first week following admission. 11) The variables which showed significant effects on total aggression score were religion, educational status, occupation, mode of admission, psychiatric diagnosis, psychopathology on admission and history of violent behavior before admission. In summary, these results showed similar trends compared to previous studies on characteristics of psychiatric inpatients. And we found that more important predictors of violent behavior in practice were likely to be history of violent behavior, psychopathology on admission and behavioral cue before violent behavior.

공터키안(Empty sella)을 동반한 급성췌장염으로 발현된 부갑상선 선종 1예

전언주,오지혜,배경륜,장샛별,전승운,정의달,손호상,원규장 영남대학교 의과대학 2009 Yeungnam University Journal of Medicine Vol.26 No.1

The incidence of coexisting hyperparathyroidism and empty sella syndrome is rare and the etiology and incidence of their coexistence is not known. The association of hyperparathyroidism and the empty sella syndrome may be related to multiple endocrine neoplasia (MEN) syndrome due to a genetic disorder. We experienced a rare case of hyperparathyroidism presenting as acute pancreatitis combined with empty sella. We report here a 37-year old female who manifested epigastric pain because of acute pancreatitis. She had hypercalcemia due to parathyroid adenoma. A pituitary gland was not visible in the sella turcica on MRI scans. On genetic analysis, she did not show a mutation of the MENIN gene. Empty sella is thought to be a coincidental finding with hyperparathyroidism.

인슐린 비의존성 당뇨병에 동반된 심상성 천포창 1 례

이상준,박진용,임태형,윤영호,권순대,남창욱,허규찬,박근용,구본식,김상표,장종억 啓明大學校 醫科大學 1997 계명의대학술지 Vol.16 No.3

저자들은 인슐린 비의존형 당뇨병 환자에서 통증성 구강내 미란 및 전신성 수포성 미란을 동반한 심상성 천포창 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Various skin conditions such as diabetic dermopathy, necrobiosis lipoidica diabeticorum, bullosis diabeticorum, granuloma annulare occur frequently in diabetes, although common lesions may be associated by chance. Pemphigus vulgaris(PV) is a blistering skin disease seen predominantly in elderly patients. This disorder is characterized by the loss of cohesion between epidermal cells with the resultant formation of intraepidermal blisters. These blisters rupture easily, leaving denuded areases that may crust and enlarge peripherally. In half or more of patients, lesions begin in the mouth: approximately 90% of patients have oromucosal involvement at some time during the course of their disease. But the relationship of this disorder with diabetes is not clear. We experienced a case of pemphigus vulgaris associated with NIDDM in 67 years old woman who was admitted due to painful oral ulcer and control of blood glucose, so we present this case with a review of literatures.

보존적 치료 및 수술적 치료에 의한 상위 경추 골절 및 탈구의 안정성

이준규,안재성,양준영,이장익 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

In general, hangman's fracture, odontoid Type III fractures, and most miscellaneous axis fractures are effectively managed with nonoperative methods (typically, the halo vest with its rigid external immobilization). Halo apparatus is a reliable instrument for the management of cervical spine injury, including that of odontoid fractures and other C1-2 injuries. Surgical fusion is the usual alternative to the halo device. Posterior wiring with or without fusion using autogenous iliac bone graft is probably the most common surgical treatment of cervical spine fracture and dislocation. The purpose of this study was to compare with stability of each others and to estimate the atlanto-dental interval and space for available in patients who were received conservative treatment and operative treatment due to upper cervical spine fracture and/or dislocation. 25 patients who were recieved conservative and operative management due to fracture and/or dislocation of the upper cervical spine (Cl and C2) during 1990. Jan. to 1997. May. were defined as a patient group. 12 patients were received conservative treatment. 13 patients were received operative treatment. In patient group who were received conservative treatment, the average of ADI and SAC was within normal range. In patient group who were received operative treatment, the average of ADI and SAC was within normal range. The patient group with the ADI and SAC of normal range were stable with good bone union at the last follow-up examination. Also the patient group was received fusion as their initial treatment for injuries incurred 1 month to 8 month prior to hospitalization were stable with good bone union.

여드름양 발진에서의 말라쎄지아 포자 검출 빈도에 관한 연구

박장규,이웅재,김연수,서영준,김경호,이증훈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2

Steroid acne and pityrosporum folliculitis have similar clinical manifestations. So it was not casy to do differential diagnosis of these two diseases. We have tried to find out the different points between these diseases in clinical characteristics, positive rate of the malassezia spores, and their response to antifungal agents. We studied 21 patients with acneiform eruptions which were distinct from acne vulgaris. Patients were divided into two groups by steroid treatment history. Among 21 patients, 6 were administered steroid just before eruption and 15 were free from steroid within 6 months. We have examined malassezia spores with 10% KOH/Parker blue black ink mount from papules, pustules and comedones according to the patients skin lesions. The malassezia spores detected in 5 paticnts(83.3%) in the former and 9 patients(60%) in the latter. In malassezia folliculitis, the frequency of which showed above the (3+) score of malassezia spore under microscopy was higher than in steroid acne. Mean duration of the disease was 70.4 weeks in latter group, which was longer than 5.2 weeks of the former group. And there were some differences between two groups in the distribution of the lesions. Mean treatment duration was same in two groups (4 wks, 3.5 wks). Steroid acne patients would be treated better with antifungal agents than with acne regimens.

일부 도시지역 노인들의 우울과 일상생활능력에 관련된 요인

박원규,이태용,정용준,오장균,이동배,조영채 충남대학교 의과대학 의학연구소 2002 충남의대잡지 Vol.29 No.1

This study was performed to provide the basic data and related factors available for the assessment of the degree of ADL and depression among older persons, manifesting their physical and psychological status. The subjects included the old people aged more than 65 years old who reside in urban areas. The interviews were delivered to 693 individuals in Taejon metropolitan city during the two-month period from June to July, 2000, and Zung Self-Rating Depression Scale and IADL developed by Older American Resources and Services of Duke medical college, were employed for the assessment of depression and IADL, respectively. The collected data were statistically processed by SPSSWIN(ver 10.0) and led to the following results. The degree of depression among 635 subjects showed that 26.6% had mild depression, 8.2% moderate and 0.6% severe while 64.6% were normal. In terms of IADL, 6.9% had impossible IADL when not aided by others, 37.0% needed some help, 56.0% possible IADL, and the higher depression scores, the significantly higher IADL scores. Based on general characteristics, depression scores were significantly higher in the female group, the older, the lower educated, the ones without cohabitants, without a spouse, without making expenses of living on their own, and IADL scores were lower, meaning the lower capability for performing daily activities, in the male group, the older, the higher educated, the group without a spouse, without making expenses of living on their own. Based on daily activities and psychological characteristics, depression scores were higher in the group who don't go out, who don't have recreational or friendly gatherings, who aren't satisfied with the lives of the past or present, who have a sense of isolation, and who don't have the will to live, and IADL scores were lower in the group who don't go out, who don't have recreational or friendly gatherings, who aren't satisfied with the lives of the past or present, who have a sense of isolation. and who don't have the will to live. Multiple regression analysis revealed that the explanatory variable having effects on depression symptoms included, with the explanatory power of 57.5%, the confidence in life, the degree of education, the subjective index of health, the sense of isolation, the exercise, the degree of IADL, the gender, the level of satisfaction with life, whether they eat breakfast or not, the concern about life, the smoking, the going out, the presence of spouse or not. The explanatory variables having effects, with the explanatory power of 28.9%, on IADL scores included the degree of depression symptoms, the age, the presence of friends or not, the frequency of outgoing, the level of education, the degree of obesity, the confidence in life, the level of satisfaction with life, the drinking or not. The study results showed that the higher depression scores had a tendency to be associated with the decreased capabilities of performing daily activities, and that the factors related to depression and/or IADL, included the confidence in life, the level of education, and the level of satisfaction with life. However, the more detailed and decisive results on the factors related to depression and IADL of the older persons are considered to require continuing efforts and comparisons among a variety of the older population.

알레르기성 비염 환자에서 절지동물성 특이항원의 양성율 및 항원간 일치율

황규윤,남해선,박준수,권준택,백병준,김장묵,오천환,조성란 순천향의학연구소 2000 Journal of Soonchunhyang Medical Science Vol.6 No.2

The current study was designed to evaluate the positive rates of arthropod allergens by Korean inhalant panel of MAST-CLA in patients with allergic rhinitis. One hundred sixty patients, diagnosed to allergic rhinitis in an Out Patient Center of Soonchunhyang University Chunan Hopsital during Aug 1998 to July 2000, were studied. 1. The overall positive rate among 35 specific allergens was 59.4% (95 patients). 2. The arthropod related allergen accounted for 82.1% (78 patients) of the positive rate. 3. Each positive rate of Dermatophagoides farinae (Df), Dermatophagoides pteronyssinus (Dp), house dust (Hd), and cockroach mix (Cm) was 45.0% (72 patients), 43.1% (69 patients), 28.1% (45 patients), and 8.8% (14 patients), respectively. 4.Significant agreement between arthropod allergens was observer (P < 0.05). 5. The obseved agreement between Df and Dp was 95.6%, showing most significant Kappa index (Kappa = 0.911, P < 0.001). There results suggested that although MAST-CLA is a useful measure of identifying specific allergens, the specificity of two mite allergen relatively low, implying because of common allergen between mites in Korean panel of MAST-CLA. Our data also supported that arthropod is the major cause of allergen in patients with allergic rhinitis, however, the MAST-CLA should be modified in order to exclude common allergen of mite and to include more specific mite allergen.

중성자에 조사된 원자로 압력용기 재료(SA508)의 Magneto-acoustic emission 효과

홍준화,박덕근,옥치일,김장환,이종규 韓國非破壞檢査學會 1999 한국비파괴검사학회지 Vol.19 No.6

원자로 압력용기 재료인 SA508 steel을 온도 70 ℃와 대기압하에서 최고 10 n/㎠까지 중성자를 조사시켜 조사량에 따른 미세경도 변화와 magneto-acoustic emission(MAE) 에너지를 측정하였다. 중성자 조사에 따른 경도의 변화는 조사량이 10 /㎠까지는 거의 일정하였으나, 조사량이 10 /㎠이상에서 급격히 증가하였다. MAE 에너지의 변화는 중성자 조사량에 따라 경도의 변화와 같은 형태로 변하였으나 그 변화량은 감소하여 그변화의 추이는 경도의 변화와는 역의 형태였고, 또한 MAE에너지의 상대적 변화와 경도 변화사이에는 아주 좋은 선형성을 보였다. 이러한 결과에서 SA508 강재는 10 /㎠이상의 중성자에 조사될 경우에 재료에 중성자 조사에 의한 미세 결함이 급격히 증가하여 전위(dislocation)이동에 대한 저항성을 나타내는 마찰경화의 증가가 경도의 증가를 유발하고, 또한 이러한 미세 결함은 자기장과의 반응에서는 90°자벽의 운동중에 자기탄성 변화를 유도하여 MAE 에너지의 감소를 유발함을 알 수 있었다. 그리고 경도의 변화량보다 MAE 에너지의 변화량이 더 크게 나타나, 중성자 조사에 의한 미세결함은 기계적 성질보다 자기적 성질에 더 민감하게 반응한다는 것을 알 수 있었다.따라서 MAE가 중성자 조사에 의한 재료의 미세 구조 결함을 비파괴적인 방법으로 평가하는 강력한 도구의 가능성이 있음을 알 수 있었다. Magneto-acoustic emission (MAE) energy and hardness were measured in the reactor pressure vessel steel (SA508 Steel) for the various neutron fluence, irradiated dose up to 10 n/㎠. The hardness was nearly a constant up to 10 n/㎠, but it was rapidly increased with an increase of the neutron irradiation above 10 n/㎠. It may be considered that the increase of hardness is due to the hindrance of dislocation motion induced defect clusters by irradiation. On the other hand, the MAE energy was slowly decreased as the neutron irradiation increased up to 10 n/㎠ and it was rapidly decreased with an increase of the neutron irradiation increased up to 10 n/㎠ and it was rapidly decreased with an increase of the neutron irradiation above 10 n/㎠. The decrease of the MAE energy may be considered as an increase of the defect clusters which is very sensitive to the 90°domain wall motion. Furthermore, the change of MAe energy and hardness had nearly a linear relationship, but the change of MAE energy was more significant than the change of the hardness. Therefore, MAe may be considered as a very useful technique for the nondestructive evaluation of irradiation damage.

위 MALT 림프종에서 다발성 림프절 전이로 오인된 동시성 림프절 결핵 1예

김성은,김규종,김도현,송준영,문대성,장리라,유찬희,문원,박무인,박선자,김영옥 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2

28세 남자가 내시경적 점막절제술을 통해 저등급 위MALT 림프종으로 진단되었다. 병기설정을 위해 18F-FDG PET 검사를 시행하였고 우측 쇄골상부, 우측상/하부 기관주위, AP window 부위에 강한 섭취가 관찰되어 전이성 림프절로 판단하였다. 그러나, 우측 쇄골상부 림프절에서 시행한 절제생검에서 만성육아종성염증소견이 관찰되었고 조직의 결핵 중합효소연쇄반응에서도 양성 반응을 보였다. 2개월간 항결핵제의 사용 후 시행한 추적 컴퓨터단층촬영 검사에서 림프절 크기의 감소를 보여 최종적으로 위 MALT 림프종에서 광범위 림프절 전이로 오인된 동시성 림프절 결핵으로 진단되었다. A 28-year-old man was diagnosed as gastric MALT lymphoma in diagnostic EMR (endoscopic mucosal resection). He subsequently underwent an 18F-FDG PET. 18F-FDG PET showed intense multifocal uptake in right supraclavicular, right upper and lower paratracheal, and AP window areas that was considered radiologically to represent widespread metastatic lymphadenopathy. Excisional biopsy of a supraclavicular lymph node, however, revealed chronic granulomatous lymphadenitis with a positive reaction of Tb-nested PCR. After antituberculosis treatment for 2 months, a follow-up CT scan showed complete resolution of the lesions. Intense 18F-FDG uptake could be due to an infectious process such as synchronous tuberculous lymphadenitis. Therefore, this could mimic a malignant condition such as lymphoma with extensive lymph node metastasis due to a false-positive finding, which may lead to a misdiagnosis.

한국어 판 구조화 임상면담도구 개발 : 신뢰도 연구

한오수,안준호,송선희,조맹제,김장규,배재남,조성진,정범수,서동우,함봉진,이동우,박종익,홍진표 대한신경정신의학회 2000 신경정신의학 Vol.39 No.2

연구목적: 정신장애의 정확한 진단과 평가는 임상에서뿐만 아니라 신뢰성 있는 연구를 위해서도 매우 중요하다. Structured Clinical Interview for DSM-IV(SCID)는 임상전문가들이 사용하는 진단도구로서, 비교적 짧은 시간에 정확한 진단을 내릴 수 있다. 본 연구는 한국어판SCID를 개발하고 그 신뢰도를 평가하기 위해 수행되었다. 방법: 국문학자가 포함된 번역위원회를 통하여 연구용판 SCID를 번역한 후, 정신과 의사 2인과 임상심리학자 1인에게 한국어판SCID 실시방법을 교육시킨 뒤 한국어판SCID를 이용한 면담의 평가자간 신뢰도 (interrater reliability)를 검증하였다. 면담 대상은 1999년 2월에서 3월까지 2개 병원 정신과에 치료중인 환자 90명(남:41명, 여:29명)이었다. 결과: 현재 장애(current disorder) 평가에서 주요 우울장애, 기분부전장애, 정신분열병, 알코올 남용 및 의존, 기타 물질 남용 또는 의존, 여러 불안장애들 및 섭식장애 등과 같은 대부분 장애의 kappa값은 .70이상으로 매우 높았다. 그 이외의 양극성 장애, 망상장애, 광장공포증, 감별 불능 신체화 장애 및 건강염려증의 kappa값도 .69에서 .40사이로 수용할 수 있는 정도였다. 평생 장애(lifetime disorder)에서는 양극성 장애(k=.69)와 감별 불능 신체화장애(k=.59)를 제외한 다른 모든 장애의 kappa값이 .70이상이었다. K-SCID 면담시 Ⅰ축 질환에 대하여 흔하게 다중 진단이 내려졌으며, 평균 진단 수는 1.5∼1.7개로 나타났다. 결론: 한국어판 SCID는 신뢰도가 높은 진단도구로 생각되며, 향후 정신질환의 정확한 진단과 임상연구에 유용하게 사용될 수 있다. Objectives: Accurate diagnosis and assessment for psychiatric disorders is crucial for research, as well as for clinical practice. Structured Clinical Interview for DSM-Ⅳ(SCID-RV) is a less time-consumimg and more accurate structured diagnostic interview form. It can be used by clinical professions and is known for a reliable diagnostic tool. Present study was conducted to develop Korean version of SCID-RV and to test the inter-rater reliability. Methods: The authors have translated original SCID-RV into Korean, and revised in parallel with sociocultural background of Korea. Ninety patients from two psychiatric hospitals, both outpatient and inpatient, were interviewed and rated independently by three raters. Results: The kappa coefficients for most of illnesses, such as major depressive disorder, dysthymia, schizophrenia, alcohol abuse and dependency, anxiety disorder and eating disorder were excellent(>0.70) in the evaluation of current disorders. And the kappa coefficients for bipolar disorder, delusional disorder, agoraphobia, undifferentiated somatoform disorder, and hypochondriasis were acceptable(>0.40) in the evaluation of current disorders. In the evalua-tion of lifetime disorders, the concordant rates of all the diagnoses except bipolar disorder and undifferentiated somatoform disorder were excellent. Lack of hierarchy in DSM-Ⅳ allows for multiple Axis I diagnoses. Mean numbers of Axis I diagnoses per subject assigned by the three raters were 1.5-1.7. Conclusions: Our findings confirm that SCID-RV yields highly reliable diagnoses. SCID-RV is recommended for accurate diagnosis in clinical practice and research on psychiatric disorders.