등교 거부 행동문제인가 정신병리인가?

강원섭 ( Won Sub Kang ),반건호 ( Geon Ho Bahn ) 경희대학교 경희의료원 2005 慶熙醫學 Vol.21 No.1

한국판 의사 공감척도의 신뢰도와 타당도 검사

강원섭 ( Won Sub Kang ),김용희 ( Yong Hee Kim ),장환일 ( Hwan Il Chang ) 한국정신병리진단분류학회 2006 精神病理學 Vol.15 No.1

Objectives: This study was conducted to evaluate the reliability and validity of the Korean Version of the Jefferson Scale of Empathy-HP-version(K-JSE-HP). Method: The subjects were 86 residents who are working at Kyunghee University Hospital. The reliability and validity of K-JSE-HP and the differences on mean empathy scores by physicians` gender, specialty, career, and personality traits were examined. Results: The 20 items(except 2 items) of the K-JSE-HP(emotional empathy, cognitive empathy) was associated with excellent internal consistency(cronbach`s α=0.88) in reliabilities. The correlation coefficient between sum and the general items of the K-JSE-HP showed appropriate scores. Individual items showed good concurrent validity. Empathy scores were inversely correlated with impulsivity. But it were not associated with gender, specialty and career. Conclusion: K-JSE-HP was confirmed in its reliability and validity. It can be a useful scale for evaluating empathy in physician with various specialty.

우울증으로 오진되었던 이차성 부신기능저하 : 증례 보고

문덕수,강원섭,백종우,송지영,김종우,Moon, Duk-Soo,Kang, Won-Sub,Paik, Jong-Woo,Song, Ji-Young,Kim, Jong-Woo 한국정신신체의학회 2011 정신신체의학 Vol.19 No.2

연구목적: 시상하부-뇌하수체-부신 축의 이상은 다양한 정신과적 증상과 연관이 있으며, 우울 증상도 나타날 수 있다. 저자들은 뇌하수체 기능저하 및 이차성 부신기능저하와 연관된 두통, 무의욕, 무기력, 정신운동 저하, 식욕 저하, 불면 및 걱정 등의 우울 증상을 주소로 정신과에 입원한 71세 남자 환자에 대해 증례 보고하고자 한다. 환자는 정신과 입원 후 두통, 불면, 불안 및 소화기 증상은 호전되었으나, 무기력감은 지속되었다. 퇴원 후 고열 및 의식 혼탁으로 감염내과에 재입원을 하였으며, 부신기능 저하소견을 동반한 범뇌하수체기능저하증이 진단되었고, 코티졸 투여로 전반적인 증상이 호전되었다. 뇌하수체 기능저하에 따른 갑상선 기능저하, 부신기능저하, 성장호르몬 저하 등은 무기력, 피곤, 불면, 체중 감소, 식욕 저하 등의 여러 가지 비특이적 증상들을 나타내고, 임상에서 이러한 비특이적 우울 증상을 가진 환자의 경우, 내분비 질환에 대한 감별이 필요하다. The abnormalities in Hypothalamic-pituitary-adrenal(HPA) axis are associated with many psychiatric symptoms including depression. We present a report of a 71 year old man who was admitted to the psychiatric department presenting symptoms of headache, avolition, loss of energy, psychomotor retardation, poor appetite, insomnia, anxiety resulting from adrenal insufficiency and hypopituitarism. Hypothyroidism and electrolyte disturbance were managed and headache, insomnia, anxiety, GI symptoms were improved. But he remained in anergic state. After discharge, he was readmitted to infection department with high fever and drowsy mentality. Adrenal insufficiency was recognized and he was treated with corticosteroid replacement therapy. Finally his diagnosis was made as panhypopituitarism and overall symptoms were resolved. In this case, we showed how the atypical symptoms resulting from hypopituitarism develop and progress. Hypothyroidism, adrenal insufficiency, and growth hormone deficiency resulting secondarily from panhypopituitarism were associated with various nonspecific symptoms such as loss of energy, fatigue, insomnia, weight loss, decreased appetite etc. In clinical situation, differential diagnosis with depression is needed when clinicians were met a patient with these nonspecific symptoms. It is important that laboratory tests and differential diagnosis with endocrine diseases should be conducted, especially in geriatric patients with nonspecific symptoms like anergia, fatigue, poor appetite and so on.

일 종합병원 정신건강의학과 외래환자에서 벤조디아제핀 사용

이재영,강원섭,김종우,김영종,Lee, Jai Young,Kang, Won Sub,Kim, Jong Woo,Kim, Young Jong 대한불안의학회 2015 대한불안의학회지 Vol.11 No.2

Objective : This study examined benzodiazepine prescription patterns of outpatients visiting the psychiatry department in a single general hospital in Korea. Methods : A retrospective descriptive analysis of benzodiazepine prescriptions was performed on a database from 2014 in a general hospital in Korea. We analyzed the following factors of adult outpatients: demographic factors such as sex and age, amount of benzodiazepine prescribed, treatment duration, and diagnosis based on the ICD-10. Results : In 2014, benzodiazepines were prescribed to 46.4% of the outpatients. Percentage of benzodiazepine prescription increased with age and was highest in the age group 40-59 years. Prescription was more prevalent in women and the prescription percentage increased by treatment duration. Patients with the F4 diagnosis (neurotic, stress-related and somatoform disorders) were the most highly prescribed group. For all diagnosis groups, prescription was more prevalent in females or similar for both sexes except for patients with F5 diagnosis (behavioral syndromes associated with physiological disturbances and physical factors), with males being more predominant. Conclusion : Despite the concern regarding the rate of benzodiazepine prescription and administration to geriatric patients, long-term prescription and usage among older patients is still prevalent.

일 대학병원에서 5개년간 섬망의 발생 및 치료 경향의 변화

배재호,강원섭,백종우,김종우,Bae, Jae Ho,Kang, Won Sub,Paik, Jong Woo,Kim, Jong Woo 한국정신신체의학회 2012 정신신체의학 Vol.20 No.2

연구목적 : 섬망은 의식 수준과 인지기능 변화로 인해 사고, 언어, 행동, 수면 양상 등에 갑작스러운 지장을 초래하는 장애로 정의된다. 본 연구의 목적은 최근 5개년간 일 대학병원의 정신과로 자문 의뢰된 섬망 환자들의 특성과 치료 방법을 분석하여 향후 섬망 연구에 있어 기초 자료를 제공하고 섬망의 발생과 치료에 변화가 있었는지 알아보고자 하는 것이다. 방 법 : 2007년 1월부터 2011년 12월까지 서울 회기동 소재의 경희대학교 병원에서 정신과로 자문 의뢰된 환자를 대상으로 섬망으로 진단된 475명의 환자의 의무기록을 후향적으로 검토하여 환자의 성별, 연령, 의뢰과, 의뢰 이유, 섬망의 원인, 섬망의 분류, 의뢰의의 오진율, 치료 방법, 처방 약물 종류 등을 조사 및 분석하였다. 결 과 : 5년간 섬망으로 진단된 475명의 환자 중 남성이 61.7%로 여성보다 더 많았다. 섬망 환자를 정신과로 의뢰하게 된 이유는 수면 장애가 80.8%로 가장 많았고 섬망이 발생한 원인으로는 수술 후 섬망이 30.9%로 가장 많았다. 전체 치료 건수 중 약물 처방이 76.6%이었으며 연도에 따라 유의하게 증가하는 양상을 보였다. 약물 처방 건수 중 항정신병 약물의 사용 빈도는 76.4%였으며 항정신병 약물중 Quetiapine의 사용 비율이 46.8%으로 가장 높았다. 그리고 타과 의뢰의가 섬망의 진단을 놓치게 된 이유는 환자가 이전에 치매를 진단받았을 경우가 6.8%로 가장 많았다. 결 론 : 근 5개년간 일 종합병원에서 정신과로 의뢰되는 섬망은 수술 후 발생하는 경우가 가장 많았고 약물 처방율이 높아지는 추세였다. 환자에게 이전 치매 병력이 있을 경우 섬망이 아닌 다른 질환으로 오진되기 쉬웠다. 본 연구를 통해 섬망의 임상 증상 및 원인, 의뢰 이유, 치료 경향에 대해 평가하고, 수면 주기의 변화에 대한 주의를 기울이며, 수술 후 섬망에 대한 예방전략 수립 및 약물 치료에 따른 치료 근거를 확립하는데 의의를 둘 수 있을 것이다. Objectives : Delirium is a disorder defined as a sudden disturbance in thinking, speaking, acting and sleep pattern due to altered level of consciousness and cognitive function. The objective of this study is to analyze characteristics and therapeutic methods of the delirious patients during the recent 5 years, and provide basic data for further studies and investigation regarding delirium in the occurrence and treatment. Methods : We retrospectively reviewed medical records of 475 patients who were consulted for delirium in Kyunghee University Medical Center from January 2007 to December 2011. Results : During the 5 years, among the 475 patients who were diagnosed as delirium, men were more common(61.7%). The most commonly consulted reason and cause were sleep disturbance(80.8%) and post-operational delirium(30.9%), respectively. The medication prescription percentage was 76.6% and was significantly increased year after year. Ratio of using antipsychotics were 76.4% among prescribed medication and the most frequently prescribed antipsychotic drug was quetiapine(46.8%). Other specialists commonly misdiagnosed delirium when the patient was previously diagnosed as dementia(6.8%). Conclusions : In our study, post-operational delirium was the most commonly referred reason and the percentage of medication prescription tended to increase. Patients with history of dementia were more easily misdiagnosed as diseases other than delirium. Our study suggests that we should evaluate symptoms, causes, reasons of consultation, management tendency of delirium. We should also closely observe changes in sleep patterns and establish the prevention strategies for post-operational delirium and therapeutic bases for pharmacotherapy.

조현병 환자의 치료 반응에 따른 Mismatch Negativity 변화

이소연,이의혁,김종우,강원섭,Lee, Soyoen,Rhie, Eui Hyeok,Kim, Jong Woo,Kang, Won Sub 대한생물정신의학회 2017 생물정신의학 Vol.24 No.4

Objectives Schizophrenia is characterized by disturbances in perception and cognition. Attenuated mismatch negativity (MMN) reflects central auditory dysfunction in schizophrenia. The aim of this study is to compare MMN changes before and after treatment in schizophrenia patients and to assess their association with treatment response. Methods Twenty-three schizophrenia patients underwent an oddball paradigm. MMN was calculated by the difference waveforms of the event-related potentials (ERPs) elicited by subtracting standard from deviant stimulus. The clinical symptoms were measured by the Positive and Negative Syndrome Scale (PANSS), the Psychotic Symptom Rating Scale (PSYRATS). Follow-up evaluation was conducted when the PANSS total score decreased by 30% or more (treatment response group) or before discharge (non-response group). Results The treatment response group showed significantly larger MMN amplitude improvement and latency reduction than the non-response group after treatment (Fz ; mean amplitude p = 0.035, FCz ; p = 0.041). The auditory hallucination group showed shorter latency than that of the group without hallucinations. Additionally, auditory hallucination was associated with prolonged MMN latency and shortened after treatment in the auditory hallucination response group (Fz ; p = 0.048). Conclusions These results suggest that the attenuated MMN amplitude reflects the progression of the disease. The increment of MMN amplitude and shortening of latency after treatment may reflect cognitive functional recovery of central auditory sensory processing.

구조화된 음악 치료 프로그램이 치매 노인의 정서 기능에 미치는 영향에 대한 후향적 분석

전소정(So Jeong Jeon),강원섭(Won Sub Kang),이성애(Seong Ae Lee),이미애(Mee Ae Lee),박동화(Dong Hwa Park),김종우(Jong Woo Kim) 대한노인정신의학회 2021 노인정신의학 Vol.25 No.1

Objective: The effectiveness of music therapy programs for the elderly with dementia has been verified through several studies, but there is a limitation in that most of them are compared with a single group, no treatment group or waiting group. In this study, to overcome this problem, the two groups that performed similar interventions were selected and compared retrospectively. Methods: For 37 people who participated in the treatment programs for the elderly with dementia at Dongdaemun Center for Dementia and its branch center, we retrospectively analyzed the changes in Korean version of Geriatric Depression Scale and Geriatric Quality of Life Scale-Dementia scores measured before and after treatment. Results: Prior to treatment, there is no significant difference between the groups in the demographic variables and the depression and quality of life scores. The difference between pre- and post-scores was not significant in the group at the branch center without a music therapy, but depression was significantly reduced and quality of life had improved in the group at Dongdaemun center with the music therapy program. Conclusion: It was confirmed that participation in the structured music therapy program had a positive effect on the improvement of depression and quality of life in the elderly with dementia compared to other similar interventions.

주의력결핍-과잉운동장애의 비중추신경흥분제 치료의 최신지견

반건호,손소정,이서경,강원섭,조아랑,박진경 경희대학교 2006 慶熙醫學 Vol.22 No.1

Methylphenidate (MPH), amphetamine, and pemoline are cerebrostimulants that have been commonly prescribed for more than half century in the treatment of attention-deficit/hyperactivity disorder (ADHD). The use of such drugs, however, is often followed by untoward effects such as loss of appetite, insomnia, nausea, abdominal pain, vomiting, irritability, and etc. There are also debates about decrements in height and weight percentiles and drug dependency. Thus, in this study, we discussed new therapeutic drugs, non cerebro-stimulants, with possibly less adverse effects and more efficacies. Atomoxetine, highly selective inhibitor of the presynaptic noradrenaline transporter with little or no affinity for other neurotransmitter transporters and receptors, is a non-excitatory drug with a strong possibility to replace CNS excitatory drugs. It is also safer in relation to drug dependency since it does not affect nucleus accumbens or the striatum. Atomoxetine, therefore, can be used in patients who do not respond to the CNS excitatory drugs. Tricyclic antidepressants, imipramine and desipramine are also most extensively studied drugs as ADHD treatment modalities. They also exert inhibitory effect on the reuptake of norepinephrine. The use of these drugs in children, however, is limited because of cardiovascular effects. Bupropion is one of promising drugs in treating prepubertal children with ADHD. It is also useful for comorbid depression and conduct problems. Increasing attention is being given to a narcolepsy drug, modafinil. Modafinil acts on histamine pathway resulting in wakefulness. This effect is similar to that of neuropeptide orexin. Since the effect of modafinil is independent of catecholamine, drug dependency adverse effect is not expected. Recently, some new drugs, such as reboxetine, are reported as safe and efficacious for children with ADHD, but they need long-term safety and controlled studies.