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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.
자폐장애 아동의 약물효과 평정을 위한 이상행동 체크리스트 예비연구
문덕수(Duk-Soo Moon),정운선(Un-Sun Chung),정성훈(Sung Hoon Jung),조아랑(Ah Rang Cho),반건호(Geon Ho Bahn) 대한소아청소년정신의학회 2013 소아청소년정신의학 Vol.24 No.3
Objectives:We assessed the availability of Aberrant Behavior Checklist (ABC) for the evaluation of the pharmacological effect in autistic disorder. Methods:A retrospective review of the medical records of 27 children with autistic disorder, who visited the department of child and adolescent psychiatry of Kyungpook National University Hospital, from October 2011 to February 2013, was conducted. After treatment with risperidone, changes in the severity and improvement of symptoms were measured using ABC at the baseline, 2nd visit and 3rd visit, respectively. Results:The mean daily dose of risperidone increased from 0.66±0.27mg (baseline, initial dose) to 1.02±0.50mg, 2nd visit, and 1.19±0.50mg, 3rd visit. According to ABC, irritability, lethargy, hyperactivity, and inappropriate speech subscale scores decreased significantly from the baseline to 2nd visit. Irritability and Hyperactivity subscale scores decreased significantly from the 2nd to 3rd visit. All subscales and total scores of ABC decreased significantly from the baseline to 3rd visit. Conclusion:The results of this study suggest that ABC can be used as an efficient tool to measure the symptoms of autistic disorder and to evaluate the medication effect on continuous treatment.
곽영숙(Young Sook Kwack),문덕수(Duk-Soo Moon) 대한신경정신의학회 2020 신경정신의학 Vol.59 No.1
Meditation is one of the psychological therapeutic techniques that can be applied to many conditions, including stress reduction. Meditation can be an alternative to overcoming the limitations of existing therapies, including medication. In particular, this can be helpful for children who have limitations in using medication due to brain development and limitations of psychotherapy, which is done mainly by language. Previous studies have shown that mindfulness meditation helped enhance attention, increase the coping ability, reduce stress, and reduce depression and anxiety in children and adolescents, but there is insufficient evidence to use it as a primary treatment. A larger number of well-controlled studies will be needed to obtain an evidence base for expanding clinical application.
김봉석(Bongseog Kim),문덕수(Duk-Soo Moon),곽영숙(Young-Sook Kwack),홍민하(Minha Hong),반건호(Geon Ho Bahn) 대한소아청소년정신의학회 2014 소아청소년정신의학 Vol.25 No.3
This is an analysis report of the “Korean Academy of Child and Adolescent Psychiatry (KACAP), Vision 2033 Survey”. The survey questionnaires were developed by the planning department of KACAP and sent to KACAP members from 2012 to 2013. This survey consisted of six categories : membership, academic activity, journal publication, administrative system, fellowship training program, and future planning. The response rate was 40.5%. In addition to multiple choice questions, responders also described their own ideas and suggestions regarding KACAP. The results of this study can be used as evidence for planning the vision 2033 of KACAP.
국내 자폐스펙트럼장애 아동의 병원 기반 조기 집중 중재 실태 조사
이주영(Ju Young Lee),문덕수(Duk-Soo Moon),신석호(Suk-Ho Shin),유희정(Hee-Jung Yoo),변희정(Hee-Jung Byun),서동수(Dong-Soo Suh) 대한소아청소년정신의학회 2017 소아청소년정신의학 Vol.28 No.4
Objectives: Early intensive interventions are very important for children with autism spectrum disorder. We examined the actual conditions of hospital-based early intensive interventions for autism spectrum disorder in Seoul, in order to help develop and implement an evidence-based early intensive intervention model for use in Korea. Methods: Nine hospital-based institutes running an early intensive intervention program for children with autism spectrum disorder responded to a questionnaire in September 2014. They provided a brief introduction to their program, explained its theoretical bases, and reported the number of children, their age, intervention time, duration and so on. Results: In the majority of the institutions, the intervention was provided for over 20 hours every week, and the theoretical bases included various applied behavioral analysis (ABA) methods and other therapies (language and occupational therapy). The therapist-child ratio ranged from 1:1 to 5:3. Various types of therapists were involved, including behavioral analysts, special education teachers and (or) language pathologists. There was only one clinic where the behavioral analyst was the main therapist. Usually, the intervention was terminated just before the child entered elementary school. The main merit of the hospital-based intervention in our survey was the effectiveness of the multi-disciplinary intervention plan and its other merits were the accuracy of the diagnosis, its ability to be combined with medicine, and so on. Conclusion: The current hospital-based early intensive intervention programs provide interventions for over 20 hours per week and employ multidisciplinary approaches. However, there are very few institutes for children with autism and very few intervention specialists and specialist education courses in the country. We need more educational programs for intervention therapists and have to try to develop policies which encourage the implementation of an evidence-based early intensive intervention program nationwide.
정창수,홍기훈,김석현,박준건,김영일,문덕수,장경일,남수용,박용철,Chung, Chang-Soo,Hong, Gi-Hoon,Kim, Suk-Hyun,Park, Jun-Kun,Kim, Yong-Il,Moon, Duk-Soo,Chang, Kyung-Il,Nam, Su-Yong,Park, Yong-Chul 한국해양학회 2000 바다 Vol.5 No.3
한국 남해대륙붕에서의 물질순환을 이해하기 위해 남해연안의 보길도와 제주도를 잇는 제주해협에서 1997년부터 1999년까지 3년간 화학물질 플럭스에 대한 조사를 실시하였다. 제주해협의 입자성부유물질, 용존무기영양염류, 입자성유기탄소 및 질소는 전계절에 걸쳐 90% 이상이 동향류에 의해 황해 및 동중국해로부터 제주해협을 통해 남해로 유입된다. 제주해협을 통해 남해로 유입되는 화학물질들의 연간 플럭스는 부유물질이 22.9${\times}$10$^6$ ton yr$^{-1}$, 암모니움 이온은 0.52${\times}$10$^{10}$ mol yr$^{-1}$, 질산이온은 6.05${\times}$10$^{10}$ mol yr$^{-1}$, 인산이온은 0.36${\times}$10$^{10}$ mol yr$^{-1}$, 규산은 10.27${\times}$10$^{10}$ mol yr$^{-1}$이다. 해수수송량(Sv)당 입자성부유물질 연간 플럭스는 제주해협(44.48${\times}$10$^6$ ton yr$^{-1}$ Sv$^{-1}$)이 대한해협 (26.08${\times}$10$^6$ ton yr$^{-1}$ Sv$^{-1}$)보다 약 1.7배 크다. 또한 제주해협 통과 질산이온 연간 플럭스(11.60${\times}$10$^{10}$ mol yr$^{-1}$ Sv$^{-1}$)는 대한해협 (9.72${\times}$10$^{10}$ mol yr$^{-1}$ Sv$^{-1}$)보다 약 1.2배, 동중국해에서 쿠로시오에 의한 수송량(18.55${\times}$10$^{10}$ ton yr$^{-1}$ Sv$^{-1}$)에 비해서는 2/3 수준으로 높다. 결론적으로 풍부한 화학물질들을 함유한 제주해류는 남해 및 동해의 생지화학적 과정들에 있어 상당히 중요함을 시사한다. The estimated total material transports through the Cheju Strait using all data which investigated in 1997 and 1999 are as follows; A large amount of suspended sediments and dissovted inorganic nutrients are carried tothe South Sea through the Cheju Strait by a persistent eastward flow (Cheju Current) from the Y311ow Sea andthe East China Sea. The annual material Oanspous by the Cheju Current are as follows; 22.9${\times}$10$^6$ ton yr$^{-1}$(SS), 0.52${\times}$10$^{10}$ mol yr$^{-1}$ (NH$_4\;^+$), 6.05${\times}$10$^{10}$ mol yr$^{-1}$ (NO$_3\;^-$), 0.36${\times}$10$^{10}$ mol yr$^{-1}$ (PO$_4\;^{3-}$), 10.27${\times}$10$^{10}$ mol yr$^{-1}$ (Si(OH)$_4$). The annual suspended sediment flux per water transport in the Cheju Strait (44.48${\times}$10$^6$ ton yr$^{-1}$ Sv$^{-1}$) is about 1.7 larger than that in the Korean Strait (26.08${\times}$10$^6$ ton yr$^{-1}$ Sv$^{-1}$). The annual nitrate flux per water transport (11.60${\times}$10$^{10}$ mol yr$^{-1}$ Sv$^{-1}$) is about 1.2 larger than that in the Korean Strait (9.72${\times}$10$^{10}$ mol yr$^{-1}$ Sv$^{-1}$) and 2/3 of that by Kuroshio in the East China Sea (18.55${\times}$10$^{10}$ ton yr$^{-1}$ Sv$^{-1}$). It suggests that chemical rich Cheju Current will play a significant role in the biogeochemical processes in the South Sea where the huge land-based waste are introduced.
김선주(Sun Ju Kim),이연정(Yeon Jung Lee),홍민하(Minha Hong),문덕수(Duk Soo Moon),반건호(Geon Ho Bahn) 대한소아청소년정신의학회 2013 소아청소년정신의학 Vol.24 No.4
Objectives:‘Taegyo,’ prenatal education, is steeped into Korean culture. Although there has been a traditional focus on providing education and care for the fetus in Korea, there is a lack of medical evidence for its effectiveness. Methods:The authors assessed the scientific basis for ‘Taegyo’ by reviewing the evidences. Results:‘Taegyo’ in Korea began with the spread of Buddhist culture from China, and transmitted by word-of-mouth. The first ‘Taegyo’ book, the Tae-gyo-shin-gi, was published on 1803. Modern prenatal education is very diverse. However, only a few studies on its effect have been conducted. Development of medicine, especially obstetrics, fetology, pediatrics, psychiatry, and etc., has learned that many factors, including bad environmental conditions and maternal stress, influenced against the fetus and mother. As for the paternal side, occupation, smoking, and stress were also revealed to have consequences for the development of the fetus. On the contrary, adequate maternal nutrition, exercise, and music stimulation positively impact the fetal development and healthy birth. Conclusion:Traditional contents of ‘Taegyo’ were proved to have effectiveness from evidence-based medicine and animal experiments. We need further studies to explore the impact of prenatal education for the fetal development and maternal health.