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초로기와 노년기 입원환자에 대한 정신건강의학과 자문의 특성
이지웅,전진숙,김강률,김현석,오병훈,Lee, Ji Woong,Cheon, Jin Sook,Kim, Kang Ryul,Kim, Hyun Seuk,Oh, Byoung Hoon 한국정신신체의학회 2013 정신신체의학 Vol.21 No.2
연구목적 타과 입원 중 정신건강의학과에 자문 의뢰된 초로기와 노년기 환자의 특징에는 어떠한 차이가 있는지 알아보기 위하여 연구를 실시하였다. 방 법 일 대학병원 정신건강의학과에 자문 의뢰된 타과 입원환자 중 50세부터 64세 범위의 초로기 환자(N=162)와 65세 이상의 노년기 환자(N=171)의 자문기록지를 비교분석하였다. 결 과 1) 정신건강의학과 자문의 주소는 초로기에 신체증상, 불안, 수면장애 순, 노년기에 인지저하, 의식혼탁, 우울한 기분 순으로 많았다. 2) 자문 결과에 의한 정신의학적 진단명은 초로기에 섬망, 기분장애, 물질사용장애순, 노년기에 섬망, 기분장애, 주요 신경인지장애 순으로 많았다. 3) 신체질환 치료제의 수는 초로기보다 노년기에 더 많았다. 결 론 정신건강의학과 자문의 특성은 초로기와 노년기 환자에서 차이가 있었으므로, 노인정신의학 자문 활동에 있어서 더욱 세분화된 노인 연령층별 접근이 필요하다고 제시된다. Objectives: The aim of this study was to know differences of characteristics between presenile and senile patients who were consulted to the department of psychiatry during medical-surgical admission. Methods: The demographic and clinical data obtained from the medical records of psychiatric consultation in the presenile inpatients with age 50 to 64 years(N=162) and those of the senile inpatients with age over 65 years(N=171) were reviewed and compared. Results: 1) The most common chief complaints for psychiatric consultation in presenile patients were somatic symptoms, anxiety and sleep disturbance in order, while cognitive decline, clouded consciousness and depressed mood were most common in senile patients with statistical significance. 2) The most frequent psychiatric diagnoses after consultation in presenile patients were delirium, mood disorder and substance use disorder in order, while delirium, mood disorder and major neurocognitive disorder were most frequent in senile patients with statistical significance. 3) There were no significant difference in numbers of physical illnesses, while numbers of therapeutic drugs for them were more in senile patients. Conclusions : Our study found significant differences between presenile and senile patients on psychiatric symptoms and diagnoses in geropsychiatric consultation. Therefore, more subdivided age-specific approach seems to be needed for the geropsychiatric consultation activities.
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고영주(Young Ju Ko),전진숙(Jin Sook Cheon),변현우(Hyun Woo Byun),이지상(Ji Sang Lee),김강률(Kang Ryul Kim),오병훈(Byoung Hoon Oh) 대한생물치료정신의학회 2010 생물치료정신의학 Vol.16 No.2
Objectives : The numbers of geriatric patients visiting emergency department have been increasing with the increase of geriatric population, especially among those with psychiatric problems. The aims of this study are to know the frequency and trend of visiting emergency department among elderly psychiatric patients, to analyse their demographic and clinical characteristics, and to identify related factors. Methods : Among elderly psychiatric patients with age over 60(N=276) who had visited Emergency Medical Center, Kosin University Gospel Hospital from 2000 thru 2009, medical records or electronic medical records of 187 cases were analysed by three psychiatrist who were blind to those patients. Results : 1) The numbers of elderly psychiatric patients were gradually increasing for 10 years versus total numbers of patients(0.18% in 2000, 0.25% in 2009) and versus total numbers of geriatric patients(0.81% in 2000, 0.87% in 2009). However, The increase of elderly psychiatric patients versus total numbers of psychiatric patients became so rapid as 2.5-3 times in 2006(7.58% in 2000, 27.54% in 2009). 2) Most frequent demographic and clinical characteristics of the elderly psychiatric patients visiting emergency department for 10 years were sixties(66.9%), urban dwellers(92.5%), visting during weekdays(67.9%) and stay for 6-24 hours(43.3%)(p<0.05, respectively). The managements were resulted in discharge against medical advice(30.5%), admission to other department(26.7%), discharge after management(19.8%), admission to psychiatric ward(16.6%), transfer to other hospital(3.7%) and being expired(2.7%). 3) The most frequent reasons for visiting emergency department of elderly psychiatric patients were suicidal attempt(13.4%), pain(10.7%), consciousness change(10.7%), continuos alcohol drinking(10.2%) in order. The most frequent psychiatric diagnoses were alcohol dependence(20.9%), depression(19.3%), adjustment disorder(11.2%), delirium(10.7%), anxiety disorder(9.6%) and dementia(8.6%). The most frequent comorbities were cardiovascular diseases(27.3%), hepatic and gastrointestinal diseases(13.9%), neurological diseases(12.3%), endocrinological diseases(10.7%), respiratory diseases(8.6%), renal and urinary diseases(7.5%) and cancer(7.0%) in order. 4) There was significant correlation between psychiatric diagnosis and gender of elderly psychiatric patients visiting emergency department. The causes were significantly correlated with route, arrival time and stay hours. The route of visiting emergency department was significantly correlated with arrival time and stay hours. There was significant correlation between stay hours and management in the emergency department. Conclusion : Elderly psychiatric patients required much time and resources in the emergency department. To solve the rapidly growing problems related to the emergency care for the elderly psychiatric patients, analysing data of visiting emergency department at first and then active preparation of medical personnel shoud be preceded.
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갑상선장애 환자에서 나타나는 인지기능 장애의 특징 및 관련요인
이지상,전진숙,변현우,김강률,이지웅,최영식,오병훈 대한생물치료정신의학회 2011 생물치료정신의학 Vol.17 No.2
Objectives:The aims of this study were to examine changes of cognitive function and its characteristics, and to identify influencing factors on cognitive fuction in patients with thyroid disorders. Methods:Data of 98 patients with thyroid disorders(16 males and 82 females) recruited from thyroid clinic in the Endocine Center of Kosin University Gospel Hospital were obtained by semi-structred interviews and MoCA-K(Korean Version of the Montreal Cognitive Assessment) and Korean version of the HDRS-17(Hamilton Depression Rating Scale-17). Results:1) The cognitive dysfunction was seen in 24 patients with thyroid disorders(24.49%). The total scores of the MoCA-K tests in thyroid patients with cognitive dysfunction(18.42±3.75) were significantly(p<0.001) lower than those of controls(26.43±2.01). Their subtest scores of the MoCA-K such as visuospatial/executive, naming, attention, language, abstraction, delayed recall were also lower than those of controls. 2) The thyroid patients with MoCA-K ≤22 showed higher age and onset age of thyroid disorders, and had lower education and HDL-cholesterol(p<0.001 respectively). 3) Total scores of the MoCA-K tests in patients with thyroid disorders had positive correlation with education(ρ=0.583, p<0.01), and had negative correlation with age(ρ=-0.462, p<0.01) and onset age of thyroid disorders(ρ=-0.494, p<0.01). Otherwise, triiodothyronine and HDL-cholesterol had positive correlation, and sex and triglyceride had negative correlation with some subtest scores of the MoCA-K. Conclusions:The cognitive dysfunction accompanied in about 1/4 of patients with thyroid disorders. The finding that the cognitive function in thyroid disorders seemed to be mainly associated with age and onset age of thyroid disorders, suggested a possibility of an important role of aging mechanism.
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