우울증의 인지치료

이재우 釜山大學校 醫科大學 精神科學敎室 1997 釜山精神醫學 Vol.6 No.-

인지치료는 왜곡된 정보화 과정과 정신병리와의 관계에 대한 많은 부분 연구 증명하는 잘 구조화된 이론적 모델이다. 치료시 치료자와 환자는 공동으로 역기능적 인지, 감정적인 고통, 문제행동 양상 사이와의 관계를 밝히는 작업을 한다. 중재는 정신병리의 표면(행동장애와 부정적인 자동적 사고의 인지)으로 부터 깊은 (core belief, schema)곳으로 점차적으로 이동한다. 행동기술들의 선택은 증상에 따라 그리고 치료의 인지적인 면을 촉진하기 위해 선택되어 진다. session의 구성과 완급(pacing)을 위해서 잘 정의된 목표를 확인하고 안건을 체계적으로 사용하고 되먹임(feedback) 및 숙제를 규칙적으로 사용한다. 약물치료와 인지치료를 연합하여 사용하는 것이 바람직하고 부가적인 효과가 있다고 판단되어지면 약물 치료를 같이 사용하기도 한다. Cognitive therapy is a clearly formulated theoretical model that research, document an extensive amount of the relationship between disordered information processing and psychopathology. In treatment sessions, the therapist and patient work collaboratively to elucidate relationships among dysfunctional cognitions, emotional distress, and problematic patterns of behavior. Interventions move progressively from surface(behavioral disturbances and recognition of automatic negative thoughts) to deeper levels(core beliefs, schemas) of psychopathology. Selected behavioral techniques are used to address specific symptoms and facilitate the cognitive aspects of therapy. For structuring and pacing sessions, identify well-defined goals, systematically use an agenda, regularly use feedback and homework assignments. The cognitive approach can be used in concert with pharmacotherapy when a combined treatment plan is indicated, and available evidence suggests that this strategy may have addictive effects

의약분업과 인권

박정수 釜山大學校 醫科大學 精神科學敎室 1998 釜山精神醫學 Vol.7 No.-

공황 장애의 인지치료

제영묘 釜山大學校 醫科大學 精神科學敎室 1997 釜山精神醫學 Vol.6 No.-

In recent years, it is received that cognitive therapy have considerable effects in the treatment of anxiety disorders. In the case of panic disorder, the cognitive treatment strategy is well developed, the resulting treatment has been extensively evaluated, and is highly effective. Comparisons with other psychological interventions and waiting-list control groups indicate that cognitive therapy is an effective and specific treatment for panic disorder. A key prediction of the cognitive model of panic is that individuals with panic disorder will be more likely to interpret bodily sensations in a catastrophic fashion than individuals who do not experience panic attacks. Cognitive therapy for panic disorder is intended to help patients identify and modify the negative thoughts that accompany panic attacks and the beliefs on which these thoughts are based. Also, cognitive therapy includes detailed exploration of patients' idiosyncratic evidence for their negative beliefs and the modification of safety behaviors. I provided here an overview of the cognitive approach to the conceptualization and treatment of panic disorder and review controlled trials evaluating the effectiveness of cognitive therapy.

한국어판 PADUA 강박척도 : 신뢰도와 타당도 Reliability and Validity

박제민,김명정,김성곤,박재흥,강철중,김병철,전명호,김재형,양구범 釜山大學校 醫科大學 精神科學敎室 1998 釜山精神醫學 Vol.7 No.-

This study reports the psychometric peroperties and factorial structure of a Korean version of the Padua Inventory (PI) in clinical (35 patients withobsessive-compulsive disorder and 66 with other psychiatric disorders) and non-clinical (458 including 120 undergraduate medical students) samples. The PI total and subscales showed good internal consistency, convergent and known-group validity. Test-retest reliability with interval of one year was superior to that of obsessive-compulsive subscale of SCL-90R. PI scores of non-clinical sample were lower than those reported in western countries, apart from Dutch sample. Principal component analysis on data from whole sample suggested four-factor solutions, which was comparable to that found in other versions of the PI developed in the western cultures. Items asking urges or worries of breaking or stealing things were separated from the factor 'urges and worries of losing control over motor behavior'. Factor analysis on data from non-clinical sample revealed five-factor solution: being contaminated, checking behaviors, doubting, worries of disasters, and ruminations. The first two factors were very same as the western reports, the other three were comparable to 'impaired control over mental activities', but 'urges and worries of losing control over motor behavior' was not extracted as a separate factor in this study. Needs for cross-cultural study including other Asian countries arise to confirm lower PI scores and different factor structures in this sample reflects Korean-specific or Asian-specific culture.

물질 남용의 인지행동 치료

이덕기 釜山大學校 醫科大學 精神科學敎室 1997 釜山精神醫學 Vol.6 No.-

Over the past decade, numerous cognitive-behavioral therapies of substance abuse have been developed. These structured, focused, collaborative approaches have been based on the assumption that substance abuse is mediated by complex cognitive-behavioral processes. In this article, an overview of cognitive-behavioral substance abuse theories and techniques has been presented. According to Rotgers, these approachs "have been among the most productive of the last quarter century with respect to the advancement of empirically validated knowledge of the origins and treatment of psychoactive substance use disorders". Recently Liese and Franz have described 10 lessons learned from applying cognitive therapy to substance abuse. Specifically, cognitive-behavioral therapists should (1) be knowledgeable about a wide variety of psychoactive drugs, addictive behaviors, and traditional treatment modalities; (2) communicate and collaborate with other addiction treatment personnel; (3) understand and address the role of drugs in mood regulation; (4) conceptualize and treat coexisting psychopathology; (5) explore the development of all patients' drug use problems; (6) address therapeutic relationship issues; (7) confront patients appropriately and effectively; (8) stay focused in sessions; (9) use techniques appropriately and sparingly; and (10) never give up on addicted patients. It is assumed that many more lessons will be learned as cognitive-behavioral therapies continue to be applied to substance abuse.

강박장애의 행동치료 : 노출과 반응차단 Exposure and Response Prevention

박제민 釜山大學校 醫科大學 精神科學敎室 1997 釜山精神醫學 Vol.6 No.-

This paper is written to remind the Korean psychiatric society of behaviour therapy(BT), mainly exposure and response prevention(ERP), as one of the therapeutic options with better longterm prognosis for obsessive-compulsive disorder (OCD). Initial and regular assessments do critical role in BT. During 2 or 3 initial assessment sessions, the-rapist evaluates symptom areas and severity, suitability for BT, and other factors influencing therapeutic out-come, such as presence of co-morbid psychiatric disorders and personality traits. Therapeutic goals and target symptoms should be specific, measurable and reasonable. The patient(and co-therapist) should be informed about how ERPworks, what they are expected to do during treatment, how they estimate their symptoms and keep diary. Basic principles and types of ERP is reviewed with emphasis on the importance of self-exposure, mental ritual prevention, and generalization. Issues regarding management of pure obsessions and co-morbid mental disorders and discussed briefly.

미국의 지역사회 정신보건센터

김철권 釜山大學校 醫科大學 精神科學敎室 1998 釜山精神醫學 Vol.7 No.-

Community Mental Health Center(CMHC) is the visible product of the federal community mental health movement in the United States during the 1960s and 1970s. Deinstitutionalization and CMHC served as a momentum to replace the customary state hospital-based system by community-based mental health services system. The mission of CMHC is to provide a clinical service to the need of Department of Mental Health (DMH) priority patients, the training and supervision to the multidisciplinary team, and the research into the treatment of serious mental illness. The criteria for treatment eligibility, the component of services, and the catchment area of CMHC is mandated and specified by DMH. Initially, CMHC were expected to be core mental health service agency that provide more comprehensive, capable and humanized treatment than had the state hospitals. But those expectations were so unrealistic. CMHC failed to provide comprehensive services needed by the severely psychiatrically disabled because of many reasons such as gatekeeping, simple planned services, several problems in regard of catchment areas, ineffective interagency communication and linkages, staffs' lack of special skills and experiences for effective work with chronic mental patients, bureaucratism, and diminishing psychiatrists. In Korea, CMHC has been built in many areas and the establishment is processing actively. However, the consensus of opinion about the need and role of CMHC under the condition of institutional care is predominent should be need in order to develop the CMHC-based mental health services system. To take root CMHC in the Korean mental helath field, we need the essential change of the attitude of psychiatric department of universities and the Korean Neuropsychiatric Association, the clarification of CMHCs' role, the definition of the roles of professionals on the mental health team, and the development of integrated mental health delivery system.

Pick 병이 의심되는 조기 발병 치매 : 증례 보고 A Case Report

박재흥,김명정,김성곤 釜山大學校 醫科大學 精神科學敎室 1997 釜山精神醫學 Vol.6 No.-

A 32-year-old male patient was diagnosed as an early onset dementia suspected Pick's disease clinically. He presented personality change, behavioral change including regressed behavior and socially inappropriate behavior, frequent alcohol drinking with black-out, and decreased occupational performance, and his family regarded personality change and behavioral change as his chief problems. Because the authors experienced the unique case of early onset dementia suspected Pick's disease, they reported it and reviewed related articles.

중독증에 대한 치교 결과의 평가

이덕기 釜山大學校 醫科大學 精神科學敎室 1998 釜山精神醫學 Vol.7 No.-

An ideal program should be comprehensive. It should provide a range of levels and intensities of treatment targeted to severity of illness as well as a range of specific services targeted to individual patients' needs. Assessment should be standardized(e.g., by the Addiction Severity Index) and should be ongoing so that patients are moved from one level of treatment to another based on an assessment of their current condition. Level of treatment should be determined according to generally accepted criteria(e.g., ASAM Patient Placement Criteria). Specific services, e.g., psychiatric services and marital counseling, should be provided in accordance with the specific problems generated in the assessment Treatment modalities should be selected on the basis of proven effectiveness. Consideration should always be given to combining pharmacological with psychological treatments. Treatment show to be ineffective in repeated trials should be discarded. When possible, staff should be retrained to use a more effective modality. Staff and patient need clarity regarding treatment goals as well as the criteria to be met for particular levels and intensities of treatment; program length in general will not be fixed, even though a given number of sessions may be required to complete the basics, e.g., relapse prevention or coping skills training. Attention should be paid to the general ambience of the program, the ease of transition from one level to another, and its user friendliness. Empathy should be encouraged and confrontational approaches discouraged. However, program regulations and expectations should be clear, consistent and reinforced. Finally, the program should have ongoing methods for evaluating itself on a number of dimensions, including patient retention and outcomes.

장기적 트립토판 결여식이 생쥐의 강제수영 중 부동자세시간에 미치는 영향

박제민,김명정,양구범,전명호,서영대,김성곤 釜山大學校 醫科大學 精神科學敎室 1998 釜山精神醫學 Vol.7 No.-

To investigate possible relationship between depression and chronic decrease of serotonin, immobility time during forced swimming test(IT) and motor activity(ACT) in open field test weremeasured in mice raised with 4 weeks of tryptophan-free or control diet. The results were 1) IT was not affected by tryptophan depletion neither gender, 2) forced swim-induced behavioral inhibition was not observed in tryptophan depleted male mice, 3) muricidal behavior was increased in tryptophan depleted male mice. It was suggested that chronic decrease in serotonin level affected stress-related animal behavior gender dependently, and it might be related with a certain type of depression, agitated depression in males, for an example.