BDNF가 ADHD의 병인과 치료에 미치는 영향

강나리,송재민,곽영숙,Kang, Na Ri,Song, Jae Min,Kwack, Young-Sook 대한생물정신의학회 2018 생물정신의학 Vol.25 No.2

Attention deficit hyperactivity disorder (ADHD) is a common childhood psychiatric disorder. Recently, it has been suggested that brain-derived neurotropic factor (BDNF) may play a role in the pathogenesis of ADHD. Our aim of this review is to understand the physiological functions of BDNF and its potential relationship with ADHD and therapeutic approaches of ADHD. Searches were conducted in Pubmed and Research Information Service System (RISS). In this review, we summarized important literatures for the physiological functions of BDNF in neurodevelopment, change of serum BDNF level in ADHD, association of BDNF polymorphism and ADHD and potential association of treatment of ADHD with serum BDNF level. Further studies are required to more clearly understand the source and the role of BDNF in ADHD and to develop BDNF based-ADHD treatement.

新羅 法興王代 의사결정방식의 변화와 大王興輪寺

강나리(Kang, Na-ri) 신라사학회 2013 新羅史學報 Vol.0 No.28

The Councils for official recognition of Buddhism during the reign of King Beopheung are shown in various historical materials about the martyrdom of LeeChadon. Above all, Haedonggoseungjeon is based on the most correct facts. At that time the decision-making method was made by joint debate of king and government officials with the title, Kan(干). However, when the first Council rejected the plan of construction on Heungryunsa, King Beopheung began anyway by an order which was decided on his own. The government officials thereupon remonstrated about the decision. The King Beopheung held the second Councilwhich was based on a traditional decision-making method and punished LeeChadon with the death penalty. At the second Council, opinions were divided, and the King Beopheung closed the Council saying “I can’t follow either of the two”. Thus the construction was halted. However, consequently, this process served to change Heungryunsa’s function to that of a temple. Heungryunsa was founded in a construction halted state in the 14th year of King Beopheung’s reign and construction was restarted with the official recognition of Buddhism in the 22nd year. It was completed in the 5th year of King Jinheung’s reign. King Beopheung obeyed the rule of order by joint debate, but finally achieved his aim. As a result, the rule of order by joint debate which had been assured by cattle sacrifice on the inscription of Bongpyeng in the 11th year of King Beopheung’s reign became unavailable at those Councils. Besides, government officials just had to follow King Beopheung’s own aim in spite of the joint debate form and it brought about the installation of Sangdaedeung. The decision-making by king alone is shown on the inscription of Jeockseong during the reign of King Jinheung. The Councils for official recognition of Buddhism were catalysts for the change of the decision-making method, official recognition of Buddhism and the strengthening of royal authority. 신라 법흥왕대 불교공인회의는 이차돈 순교와 관련하여 다양한 사료에서 확인되는데, 그 중에서도 <신라본기>의 내용을 중심으로 다른 사료를 통해 보충한 <법공전>이 그 전말을 가장 잘 반영하고 있는 것으로 판단된다. 당시 국정은 국왕을 비롯한 干群소지자의 共論을 통한 下敎가 원칙이었는데, 법흥왕은 1차 불교공인회의에서 共論을 통한 창사가 불가능해지자 왕 단독으로 흥륜사 창건 공사를 진행하였다. 이에 군신들이 간하자 법흥왕은 여전히 공론의 형식을 따르는 2차 불교공인회의와 이차돈의 희생으로 자신의 결백을 입증하였다. 그리고 2차 회의에서도 의견이 수렴되지 않자, 법흥왕은 ‘양 쪽을 모두 따를 수가 없다’고 하며 회의를 마무리 지었다.이에 따라 흥륜사 공사는 더 이상의 진행이나 철거 없이 그대로 중단되었다. 그런데 이는 결과적으로 흥륜사가 사찰로서 기능할 수 있는 계기가 되었다. 흥륜사는 법흥왕 14년 공사가 중단된 상태에서 그대로 창사되었고, 22년에 불교의 공인과 함께 공사가 再開되어 진흥왕 5년에 落成하였다. 법흥왕은 共論을 통한 下敎라는 원칙을 지켰지만,이후 몇 년에 걸쳐 결국 자신의 뜻을 관철시켜 나갔다.결과적으로 <봉평비>에서 살우의식으로나마 담보되었던 6부 합의의 共論이 불교공인회의에서는 그 힘을 잃고, 공론의 형식 속에서 실질적으로는 국왕이 의도한 결과에 따르게 된 것이다. 共論의 무력화는 상대등 설치로 연결되었고, 국왕의 의사결정권 독점은 진흥왕대의 <적성비>에서 그 실현을 확인할 수 있다. 이러한 과정을 거치면서 법흥왕은 재위 초의 牟卽智寐錦王에서 聖法興大王??卽知太王으로 거듭날 수 있었다. 불교공인회의는 신앙 혹은 사상의 문제에 국한되지 않고, 신라 정치의 중요한 화두로 작용하여 의사결정방식 변화와 불교 공인, 그리고 왕권의 위상 강화를 가져왔다.이는 결국 6부 세력 중심의 정치가 이루어지던 上古期에서 국왕의 국정운영권이 강화되어 국왕 중심으로 국가운영체제가 재편된 中古期로의 이행과 맞닿아 있었던 것이다.

비만에 이환된 아동청소년에서 보이는 정신건강문제

강나리(Na Ri Kang),이지선(Ji Sun Lee),강기수(Ki Soo Kang),곽영숙(Young Sook Kwack) 대한소아청소년정신의학회 2016 소아청소년정신의학 Vol.27 No.2

Objectives: The purpose of this study was to investigate mental health problems in obese child and adolescent patients. We assess the frequency of mental health problems and their differences according to sex, school grade and severity of obesity. Methods: The sample consisted of 106 children and adolescents aged 8-16 years (61 boys with mean age 10.98±2.26, 45 girls with mean age 9.74±1.96, p=.004) who were diagnosed with obesity and recruited at the Department of Pediatrics of Jeju National University Hospital. The participants completed the Korean-Child Behavior Checklist (K-CBCL), Children’s Depression Inventory (CDI), Korean version of the Eating Attitude Test-26 (KEAT-26), and somatotype drawings. Results: The percentage of participants having a T-score in clinical range on one or more CBCL subscale was 37.7%. The percentage of participants in the high risk group for depression (CDI score above 17) was 20.8% and that in the high risk group for eating disorder (EAT-26 score above 20) was 6%. The girls showed significantly lower CBCL T-scores in social competence (48.39±15.66 vs. 38.91±22.04, p=.011), adjustment function (49.51±17.35 vs. 40.38±22.58, p=.020) and school competence (53.34±10.47 vs. 48.22±15.11, p=.042) than the boys, but the percentages of boys and girls in clinical range were not significantly different. The middle school students showed (significantly) higher CBCL T-scores in somatic symptoms (60.86±9.44 vs. 55.74±6.76, p=.005), aggressive behavior (58.81±6.74 vs. 54.68±6.22, p=.009), total problems (59.86±9.91 vs. 54.88±9.76, p=.039) and externalizing problems (57.90±10.57 vs. 52.44±9.38, p=.022) than the elementary school students. The severe obesity group showed significantly higher CBCL T-scores in attention problems (59.18±9.45 vs. 54.15±5.34, p=.001), social problems (59.25±8.59 vs. 55.96±6.50, p=.038), delinquent behavior (58.07±6.97 vs. 54.73±6.00, p=.017) and total problems (59.21±11.65 vs. 54.67±9.03, p=.037) than the mild to moderate obesity group. Conclusion: Significant proportions of obese children and adolescents suffer from mental health problems. Clinicians need to pay attention to the mental health risk, especially in obese adolescents and severely obese children and adolescents.

소아청소년 양극성 장애의 임상 경과

강나리(Na-Ri Kang),곽영숙(Young-Sook Kwack) 대한소아청소년정신의학회 2012 소아청소년정신의학 Vol.23 No.1

Objectives:The early onset of mood symptoms in bipolar disorder has been associated with poor outcomes in many studies. However, aspects of the clinical course of bipolar disorder in children and adolescents are controversial. The goal of this article is to review the clinical characteristics and longitudinal course of children and adolescents with bipolar disorders. Methods:Searches were conducted in MedLine, PsycINFO, KISS, and RISS using the terms phenomenology, clinical course, outcome, BPD, pediatric, children and adolescents. Twenty-one reports were selected : either original articles reporting symptoms and clinical characteristics of subjects (ages 5-18 years), or published articles in reviewed journals about bipolar disorder in children and adolescents. Results:Approximately 70% of subjects with bipolar disorder recovered from their index episode, and 50% had at least 1 syndromal recurrence, particularly depressive episodes. For 60% of the follow-up time, subjects had syndromal or subsyndromal symptoms with numerous changes in symptoms and shifts of polarity. Approximately 20% of BP-II subjects converted BP-I. Conclusion:Bipolar disorders in children and adolescents are characterized by episodic illness with subsyndromal and syndromal episodes with mainly depressive and mixed symptoms and rapid mood changes. Extensive follow-up time is needed to evaluate the continuity of bipolar disorder symptoms from childhood to adulthood.

함안 성산산성 출토 ‘壬子年’ 목간과 신라의 부세 감면제

강나리 ( Kang Na-ri ) 한국고대학회 2020 先史와 古代 Vol.- No.63

이 논문은 함안 성산산성 목간 작성연대에 관한 기존 연구성과 검토를 바탕으로 작성연대를 추정하고, 성산산성 목간 가운데 가야5599에만 연간지 ‘임자년’이 묵서된 것에 주목하여 이를 새로 판독하고 당시 신라 부세제도의 일면을 살펴본 것이다. 안라국의 신라 편입 시점 혹은 하한은 561년 무렵이고, 성산산성 동성벽 부엽층은 6세기 중엽에서 7세기 전반 사이에 조성된 것으로 파악된다. 성산산성 목간에 보이는 외위명이 공통적으로 사용된 시기는 창녕비 단계부터 남산신성비 단계 무렵으로 볼 수 있으며, 경위 역시 창녕비 단계를 상한으로 한다. 가야5599의 ‘壬子年’은 592년으로 파악된다. 따라서 성산산성 목간의 작성연대는 561년부터 592년 무렵으로, 늦춰 보더라도 7세기 전반을 벗어나지는 않을 것으로 추정된다. 가야5599에서 임자년 다음의 두 글자는 ‘荒(敗)’로 추독할 수 있는데, 흉년과 관련한 의미로 해석된다. 따라서 가야5599는 임자년의 흉년으로 인하여 大村에 사는 □刀只가 원래 정해진 세액보다 적은 쌀 한 섬을 납부한 사실을 기록한 것으로 볼 수 있다. 이를 북주 및 백제, 당, 일본, 고려의 부세제도와 비교하면 6세기 후반 신라에서는 흉년일 때 피해규모에 따라 차등적으로 부세가 감면되었는데, 피해 정도가 50% 이상이어야 감면받을 수 있었으며, 피해 정도에 따라 부세의 항목이 아닌 전체 세액이 감면되는 방식으로, 이러한 혜택은 이월될 수 있었음을 알 수 있다. This paper is based on existing studies and observations on the era of creation from discovered wooden tablets (Mokkan, 木简) at Seongsan Fortress, Haman, South Gyeongsang Province, where it estimates the exact creation date of the tablets themselves while focusing on the fact that only "Gaya5599" from all the tablets discovered from the fortress has "Imja Year (壬子年)" calligraphy imprinted on them, which is one of the sexagenary cycle, therefore conducting a completely new deciphering work as well as to take a glimpse of Silla Dynasty’s taxation scheme. The estimation is that Seongsan’s wooden tablets were created between A.D. 561-592 or no later than the early 7th century. This calculation is backed by careful deliberation on the time Ara Gaya was merged into Silla, the excavated site’s sub-layer formation period, and "Imja Year" on the "Gaya5599" tablet. Two characters imprinted after "Imja Year" from "Gaya5599" are assumed to be "□(敗)," which can be understood as a reference to a bad harvest year. Information written on "Gaya 5599" indicates that it is a record of a civilian named □doji (□刀只) residing in Daechon village (大村) paid a bag of rice, which is less than the normal taxation rate due to the year's poor harvest. Such taxation scheme compared to that of neighboring countries, Silla Dynasty in the late 6th century practiced a systemic tax reduction scheme during a year of poor harvest, where the reduction scheme would only be initiated if the scale of damage was more than 50% of the harvested crops under normal circumstances. It is also apparent that tax reduction was applied in the whole amount payable rather than selectively, as well as such benefits could be carried over to the next taxation cycle.

신라 중고기의 ‘代法’과 역역동원체계

강나리(Kang, Na-Ri) 한국고대사학회 2019 韓國古代史硏究 Vol.0 No.93

함안 성산산성에서 출토된 문서목간인 218호 목간은 진내멸촌의 촌주가 ‘代法’과 관련하여 口城의 미즉이지 대사에게 올린 보고서로, 伊毛羅 及伐尺이 60일로 규정된 일에 대해 30일만 채우고 가버렸음을 보고하는 내용을 담고 있다. ‘代法’은 기존의 문헌사료나 금석문에서 보이지 않지만, 『唐律疏議』 擅興 遣番代違限條와 漢代 목간, 고려시대에 ‘代’가 ‘교대’의 의미로 쓰인 사례가 확인되고, 「명활산성작성비」와 「남산신성비」에서 교대 사실이 추정된다. 성산산성 출토 목간과 관련된 역역에 대해서는 60일이 대법으로 적용되었지만, 대법의 일수가 항상 60일로 고정되지는 않았던 것으로 보인다. ‘代法’은 역역동원의 교대 기간에 대한 규정의 총칭으로, 代法에는 역역의 내용이나 대상, 주체에 따른 세부규정을 포함하고 있었으며, 〈숫자+(日)+(一)代〉의 형식으로 교대 기간을 표시하였던 것으로 이해할 수 있다. 한편, 551년의 「명활산성작성비」에서는 행정촌을 단위로 역역동원이 이루어졌으며, 군의 역할은 미미했다. 그러나 40년 후 「남산신성비」 단계가 되면 군과 행정촌의 이중 역역동원체계가 갖추어져 있었다. 218호 목간의 작성 시기는 「명활산성작성비」와 「남산신성비」 사이로 파악되는데, 이 단계에서 이미 「남산신성비」와 같은 군을 단위로 한 역역동원체계가 작동하고 있었음을 확인할 수 있다. The No.218 wooden tablet excavated from the Seongsan Fortress, Haman, contains a report from the leader of Chinnaemyŏl village to the Mijŭkiji Daesa(弥卽尒智 大舍) of the fortress in connection with Dae-beop(代法), reporting that Yimola Geupbeolcheok(伊毛羅 及伐尺) has completed only 30 days of work prescribed for 60 days. Dae-beop(代法) is not seen in existing literature or epigraph. However, it has been confirmed that ‘Dae(代)’ was used in the Goryeo Dynasty, ‘Dangryulsoui(唐律疏議), and in the wooden tablets of Han Dynasty as the meaning of Rotation(交代) and is believed to have mentioned in the 6th century Silla epigraph. Dae-beop is the general name of the regulations for the period of shift of labor mobilization, and it can be understood that detailed regulations depending on the subject and subject of station. It also indicated the period of shift in the form of 〈number+(日)+(一)代〉. Meanwhile, according to the <Myeonghwal fortress Jaksungbi> in the year 551, labor mobilization was operated in the units of the Haengjŏngch’on(administrative villages, 行政村), and the role of the Kun(county, 郡) was minimal. However, <NamsanShinsungbi>, after 40 years of that, show that the dual labor mobilization system, for which the Kun and Haengjŏngch’on were the units. This study speculates the No.218 wooden tablet of Seongsan was written between these two periods, and that the dual labor mobilization system, whose units was Kun, was already established in that time.

친구의 자살이 청소년의 정신 건강에 미치는 영향

강나리(Na Ri Kang),정운선(Un Sun Chung),곽영숙(Young Sook Kwack) 대한소아청소년정신의학회 2015 소아청소년정신의학 Vol.26 No.4

Objectives:This study examined the impact of peer’s suicide on mental health of middle-school students. The aim of this study was to describe the course of posttraumatic stress and grief reaction, suicide ideation, and depression score among adolescents after exposure to peer’s suicide and to examine the relationship between posttraumatic stress and other mental health scores in these subjects. Methods:Thirty seven middle school students who were exposed to the suicidal death of a peer completed self-report measures to assess levels of depression, grief reaction, post-traumatic stress, and suicide ideation at 1 month and 8 months after the peer’s suicide. Results:There was no significant change in mental health scores between 1 month and 8 months. Level of posttraumatic stress after 8 months was related to acute grief response. Subjects who experienced a clinically significant level of suicidal ideation and posttraumatic stress showed more mental health problems. Conclusion:The results suggested that peer’s suicide strongly impacted mental health issues of adolescents at a critical time of adolescent development. Clinicians should perform a thorough evaluation of mental health problems for youth who experienced peer’s suicide and help them in management of their grief reaction.

주의력결핍과잉행동장애 아동과 자폐스펙트럼장애 아동에서 얼굴 표정 정서 인식과 구별의 차이

이지선(Ji-Seon Lee),강나리(Na-Ri Kang),김희정(Hui-Jeong Kim),곽영숙(Young-Sook Kwak) 대한소아청소년정신의학회 2016 소아청소년정신의학 Vol.27 No.3

Objectives: This study aimed to investigate the differences in the facial emotion recognition and discrimination ability between children with attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Methods: Fifty-three children aged 7 to 11 years participated in this study. Among them, 43 were diagnosed with ADHD and 10 with ASD. The parents of the participants completed the Korean version of the Child Behavior Checklist, ADHD Rating Scale and Conner’s scale. The participants completed the Korean Wechsler Intelligence Scale for Children-fourth edition and Advanced Test of Attention (ATA), Penn Emotion Recognition Task and Penn Emotion Discrimination Task. The group differences in the facial emotion recognition and discrimination ability were analyzed by using analysis of covariance for the purpose of controlling the visual omission error index of ATA. Results: The children with ADHD showed better recognition of happy and sad faces and less false positive neutral responses than those with ASD. Also, the children with ADHD recognized emotions better than those with ASD on female faces and in extreme facial expressions, but not on male faces or in mild facial expressions. We found no differences in the facial emotion discrimination between the children with ADHD and ASD. Conclusion: Our results suggest that children with ADHD recognize facial emotions better than children with ASD, but they still have deficits. Interventions which consider their different emotion recognition and discrimination abilities are needed.