정신분석적 관점에서의 불안

박용천,Park Yong-Chon 대한불안의학회 2005 대한불안의학회지 Vol.1 No.1

By the influence of the descriptive approach of DSM-III, the anxiety became the same thing as the anxiety disorder to the clinicians. This unfortunate result sacrificed psychodynamic model of symptom formations and simplified the anxiety as one of the disease entity not as the overdetermined symptoms. These phenomenon awakened the psychoanalytic interest which was in sleep. Freud was the first major articulator of the basic significance of anxiety in human behavior. He attributed the particular quality of the anxiety experience to the trauma of birth, and subsequently to the fear of castration. Such classification of the anxiety according to the psychosexual development is helpful for the clinicians in understanding the origin of anxiety which the patient shows during the psychotherapy. The other analytical view of interpersonal psychoanalysis came from Sullivan. A large part of his therapy is taken up with recognizing and correcting parataxic distortions that interfere with realistic self-appraisal of events and of oneself in relation to others. Perhaps no explanation is the 'most basic' explanation for human anxiety. Anxiety is a multifaceted entity consisting of aspects of realm of discourse. Existential anxiety is inescapable in Western culture but it can be transcended by the cultivation of mind in Eastern culture. The analysts need to stay attuned to their own propensities for anxiety and must permit their own experiences with anxiety to be the grist for the psychotherapeutic mill.

인격과 우울증 치료결과의 상호작용

박용천,김석현,Park, Yong Chon,Kim, Seok Hyeon 대한생물정신의학회 2001 생물정신의학 Vol.8 No.1

It is known that the personality is the crucial factor in the treatment outcome of depression. The authors tried to identify the results of such studies and various components which determine the treatment outcome of depression. Nearly 60 papers published between the year 1990 and 2000 about the treatment of depression and personality were reviewed. Among them about 30 papers were selected to compare the research methods, results and discussions. The arguments and critics of the papers were discussed. In the many debates, the authors admitted the fact that premorbid personality trait influences the treatment outcome of depression negatively regardless of treatment method. Subtyping of depression is feasible along the presence of good or bad predictors of treatment outcome for depression. Differentiation of depression and personality seems to have no problem, however test of personality state before the development of psychiatric disorder such as depression is not amenable. For example, cluster A personality trait is often misunderstood as depression in clinical setting. In some cases cognitive behavioral therapy is effective in the treatment of depression accompanying personality disorder. The authors insist that the analysis of personality in the dimensional aspect rather than in the categorical aspect gives more information in the research of personality influencing the treatment outcome of depression. In addition, the reason why we understand the relationship between depression and personality were discussed.

간이정신진단검사 (SCL-90-R) : 입영장정을 위한 집단선별검사로서의 가능성에 대한 예비적 연구

박용천 ( Yong-chon Park ) 국군의무사령부 1987 대한군진의학학술지 Vol.18 No.1

한국에서 우울증의 특징과 비약물학적 치료

노성원,박용천,Roh, Sungwon,Park, Yong Chon 대한생물정신의학회 2006 생물정신의학 Vol.13 No.4

Depression is one of the most common mental disorders. Some characteristics of depression in Korea were elucidated. The tendency to express depressive feeling through somatic complaints is more prominent in Korea than in Western countries. Careful studies on depressive symptoms suggest that guilt and suicidal idea are apparent among Korean depressive patients as well as among Western subjects. But most depressive patients in Korea are reluctant to express suicidal idea, which is hidden under the somatic complaints. We should remember the possibility of research artifacts or cultural bias with regard to the evaluation of depressive symptoms of a country in comparison with other countries. Non-pharmacological treatment of depression includes dynamic psychotherapy, cognitive behavioral therapy, interpersonal psychotherapy, self-care treatment, etc. Some kinds of Korean culture relevant psychotherapies are introduced: Tea therapy, Imago therapy, Tao psychotherapy, and combined approach. Interest in the aged people is growing recently, and the research about the factors which affect the depressive disorders in older patients and treatment strategy for them is ongoing.

정신치료와 신경생물학적 연구결과의 관계

오현영,박용천,Oh, Hyun-Young,Park, Yong-Chon 대한생물정신의학회 2012 생물정신의학 Vol.19 No.1

The mechanism of psychotherapy is explained by the recent developments in neuroscience and neuroimaging. The purpose of this study is to understand the nature of psychotherapy and to discuss the future of psychotherapy improvement with the help of advances of the neurobiological findings in psychotherapy. For this study, we investigated a wide range of materials. We searched for various researches on psychotherapy, brain, and neurobiology. In addition to the conventional psychodynamic psychotherapy, we investigated research findings on cognitive behavioral therapy, interpersonal psychotherapy and eye movement desensitization and reprocessing (EMDR). Moreover, based on the actual experiences of treating patients, we speculated the neurobiological mechanisms of the process and results of psychotherapy. With the development of neuroscience, we are now able to understand the personal consciousness, unconsciousness and developmental process. Also subdividing the disease is made possible. Personalized treatment has become available, and we are able to predict the prognosis of patients. Our memories are composed by implicit memory and explicit memory. By psychotherapy, we can consciously remember explicit memory, and it becomes easier to explore implicit memory through free association. Through psychotherapy, we will also be able to learn the effect of acquired environment and experience. Psychotherapy is able to correct human behaviors by modifying the memories. Through the regulation of emotions, it becomes possible to modify the memories and correct the behaviors. In this process, doctor-patient relationship is the main factor which cause positive treatment effects. Furthermore imagination therapy or unconscious, non-verbal stimuli could bring about positive treatment effects. Now psychotherapy could be explained and studied by neuroscientific researches. In this sense, we could provide the direction of future advances in neuroscience by the neurobiological understanding of psychotherapy.

우울증의 자기 관리 방법

이선혜,박용천,Lee, Sun-Hea,Park, Yong Chon 대한생물정신의학회 2007 생물정신의학 Vol.14 No.1

Objectives : Depression disturbs the individual life from the loss of productivity to suicide. Furthermore the whole society is also influenced by depression in social and economic areas. Many scientific treatment methods are known to be effective in depression. But in reality more than half of patients with depression prefer self help treatment rather than medically based treatment. For the patients with mild depression and primary physicians, it is reasonable to provide the evidence based self care including self help or alternative treatment. This study is supported by the Korean Health 21 R&D Project for the Depression Center to establish the Korean treatment guideline for depression. Methods : The members of Depression Center including the authors attended the workshops where the methods of evidence based medicine such as literature search, quality evaluation of the articles, making the level of evidence were educated. The professional librarians helped the authors for get the searched articles. Among the total of 354 abstracts of systemic review and 300 abstracts of random controlled trials, 3 systemic reviews and 2 random controlled trials were the main structure of evaluation. Result : Among the 37 self care methods known to be effective for depression, 11 kinds of methods were worth of evaluation. The first step for the self care of mild depression is to use St. John's wort, exercise, bibliotherapy, and light therapy in depression during winter season. Acupuncture, negative ion therapy, massage, relaxation technique are known to be efective with evidence. Music therapy, hypnotherapy, and aromatherapy are known to be effective but until now the evidences is insufficient and further evaluations are needed. Conclusion : Among 11 listed self-care methods, several methods need more evidence especially in Korean situation. Exercise is the most recommendable evidence based self care method in Korea nowadays. St. John's wort is effective with evidence, but it is not the OTC drug in Korea, so it is not recommendable now. For the bibliotherapy, there is no book such as "Feeling Good" in Korea. Only the introductory book about depression is available. Publishing the self help book based upon cognitive behavioral approach or psychodynamic approach is needed. Light therapy is practiced in a few clinics, but not self-help style. Exposure to the sunlight is recommended in the level of commen sense. These self care methods are for the mild patient. Moderate to severe patients with depression should seek the professional treatment.

한국에서 우울증의 비약물학적 치료의 현황과 요구도

오홍석,이해원,박용천,Oh, Hong Seok,Lee, Hae Won,Park, Yong Chon 대한생물정신의학회 2007 생물정신의학 Vol.14 No.1

Objectives : As a part of plan to develop evidence-based treatment guidelines for depression that is more suitable for Korean situation, we investigate the present status and client's requirements for non-pharmacological treatment of depression in Korean clinical situation. Methods : Subjects were patients with depression in 12 university hospitals which are located in metropolises in Korea. We analyzed the records from questionnaires about current clinical status and requirements for the non-pharmacological treatment of depression in Korea. Results : 50.8% of the subjects have experienced non-pharmacological treatments for their depression. The preference of non-pharmacological treatment method of depression is exercise/interesting activity, counseling by psychiatrists and psychotherapy, and the best effective treatment method is psychotherapy (Es=4.36). Actually, the mean consultation time by psychiatrist is $11.31{\pm}7.16$ min, and the appropriate consultation time for client's situation is $18.39{\pm}8.95$ min. During consultation, patients' satisfaction measurement for psychiatrist's explanation about pharmacological treatment is $64.17{\pm}27.11$, and satisfaction measurement for psychiatrist's counseling for their depression about personal problems, resent stress, interpersonal relationship is $61.66{\pm}26.63$. Conclusion : In Korea, many psychiatrists offered biologically oriented treatment to their patients with depression, and patients' satisfaction measurement about consultation by psychiatrists is low. Many patients wanted to combined pharmacological and non-pharmacological treatment for their depression, and aspired to information about complementary and self-help treatment methods. It is necessary to develop non-pharmacological treatment guideline for depression which reflect the clinical situation in Korea and meet Korean patients' need.

의약분업에 관한 정신과 환자와 가족의 견해

박정수(Jung-Soo Park),최명환(Myoung-Hwan Choi),이충경(Choong-koung Lee),정은기(Eun-Kee Chung),박용천(Yong-Chon Park),김찬형(Chan-Hyung Kim) 대한사회정신의학회 2000 사회정신의학 Vol.5 No.1

2000년 7월 1일부터 실시 예정인 의약분업은 의약품의 오·남용으로부터 국민을 보호하고 의사와 약사 두 전문 인력간의 역할구분을 명확히 하여 국민들로 하여금 정확한 의료에의 접근을 가능케 하여 궁극적으로는 국민의 건강을 보호한다는 목적을 가지고 있는데, 실제 의약분업의 목적하는 바 건강 증진의 대상인 국민조차도 의약분업에 대해서 잘 알지 못하고 있는 실정이다. 본 조사는 의약분업에 대한 정신과 환자, 보호자들의 인식과 이들이 생각하는 문제점들에 관한 것으로 각 시.도별 정신과 전문병원, 대학병원정신과, 개인 정신과 의원에 다니는 환자와 보호자를 대상으로 1999년 9월 20일부터 동년 10월30일까지 설문조사를 하였다. 설문지의 내용은 의약분업에 대한 인식도, 정신과에서의 의약분업 시 발생할 수 있는 문제점 등을 포함해서 8개 항목으로 구성되었다. 전체2,664명의 회신자료중 환자와 보호자를 구별할 수 없는 응답자 39명을 제외한 환자 응답자가 2,330명, 보호자 응답자가 295명이었다. 조사의 결과 의약분업 시행이 얼마 남지 않은 현시점에서 환자나 보호자는 의약분업이 무엇인지 정확히 알고 있는 사람이 드물었다. 또 정신과에서 의약분업 실시 때 발생할 수 있는 문제들에 대해 환자의 60.3%, 보호자의 66.4%에서 번거롭고 경제적으로 부담이 된다.고 했고, 예상 부작용에 대해서도 치료의 일관성 상실과 약물의 오·남용 심화된다.는 응답이 가장 많았다. 또 환자 보호자 대부분에서 정신과 진료에서 의약분업은 제외되어야 한다고 응답했다. 의약분업은 좋은 제도이지만 여기에는 많은 문제점이 있다. 특히 의사와 환자관계가 중요한 정신과에서는 더욱 많은 문제점들을 야기할 수 있겠다. 의약분업은 충분한 사전조사와 가능한 문제점들을 고려하여 시행되어야 할 것이다. The separation of dispensary from medical practice that is supposed be applied from July first, 2000 has two purposes. The first one is protecting people from the abuse of drugs and the second one is apparently distinguishing the roles, which are pharmacist and medical doctor, to accelerate people’s access to correct medical treatment. In this context the ultimate purpose of it could be assumed to protect people’s health. However actually people do not know much about the separation of pharmacy and clinic. This Article is about the problems that mental patients and their families could think of and the perception they might have, when the separation of pharmacy and clinic is in effect nation-wide. The mental patients and their families, who were visited from september 20th, 1999 to October 30th, 1999 in civil, national, and private hospitals, were selected for survey target. The contents of questions consist of eight items including the followings. They were the perception of mental patients and their families for the separation of dispensary from medical practice and the problems that could be expected at the time of its enforcement. The number of returned questionnaire were 2,664 and 39 of them were excluded due to the unclear distinction between patients and families. Finally the patient responders were 2,330 and the family responders were 295. As a result of survey it is very rare that patients or families know clearly what the separation of dispensary from medical practice is, the policy of the separation of pharmacy and clinic is supposed to be enforced in the near future though. For the problems that could be raised after the enforcement of it, 60.3% of patients and 66.4% of families said that they felt complicated and it would be a burden to them economically and for the expected side effect most of patients and their families answered that the loss of consistent treatment and abuse of drug would be more deepened than before. Additionally they also answered that the policy of the separation of dispensary from medical practice should be exempted in the case of psychiatric treatment. Although the separation of dispensary from medical practice is a good system, there are several problems. Actually the fact, that the doctor-patient relationship is important in the psychiatric treatment, could cause more problems. The separation of dispensary from medical practice should be enforced with the consideration of possible problems and sufficient preliminary examination.

학령기 아동 정서ㆍ행동문제에 대한 부모-교사 평가 일치도

박효인(Hyo In Park),김진미(Jin Mi Kim),박용천(Yong Chon Park),김석현(Seok Hyeon Kim),안동현(Dong Hyun Ahn) 대한소아청소년정신의학회 2010 소아청소년정신의학 Vol.21 No.3

Objectives:In assessing behavioral/emotional problems in school-aged children, the importance of multi-informant reporting has been well documented. However, in clinical settings obtaining multiple informants’ opinions has proven difficult. For that reason, we researched the agreement and predictive validity of the Child Problem-Behavior Screening Questionnaire (CPSQ) in order to reveal how accurate parents’ assessments reflected teachersopinions. Methods:We conducted the first screening for second- and third-grade children from 3 elementary schools in Seoul from 2003 to 2007 using the CPSQ. There were 1178 children included in the analysis. We then administered the Korean version of the Child Behavior Checklist (K-CBCL) as a second screening tool and subsequently, the ADHD Diagnostic System (ADS) and the Korean Educational Development Institute version of the Wechsler Intelligence Scale for Children (KEDI-WISC) was administered by a psychiatrist. We examined each item on the CPSQ and the subscale’s agreement between parent and teacher as well as the predictive validity of the CPSQ in children diagnosed with emotional/behavioral problems. Results:The agreement rates between parents and teachers appeared high for questions 18 (0.433), 1 (0.385), and 2 (0.325). Among the subscales, a relatively high correlation was found for externalizing problems, attention deficit hyperactivity disorder, and cognitive problems. For all diagnosed children, their parents revealed a higher sensitivity and lower specificity than teachers. Conclusion:From these results, we confirmed that the CPSQ can be useful for sorting out externalizing and cognitive problems. There is a need for further study, however, with a larger sample size.

자문의뢰된 섬망환자에 대한 진단 일치율과 정신과 의견의 반영도

오응석,남정현,김석현,박용천,김성목,Oh, Eung-Seok,Nam, Jung-Hyun,Kim, Seok-Hyeon,Park, Yong-Chon,Kim, Sung-Mok 한국정신신체의학회 2001 정신신체의학 Vol.9 No.2

연구목적: 신경정신과에 자문 의뢰된 사례 중 섬망상태를 주 증상으로 한 환자들을 대상으로 자문의사와 의뢰의사간의 진단 일치율 및 정신과 권고사항에 대한 반영도를 조사하여 자문시 상호 협조정도를 알아보고 치료 반영도에 영향을 미치는 요인을 밝히려 하였다. 방법: 1995년 7월 1일부터 1997년 12월 31일 사이에 한양대학교 구리병원에 입원하여 신경정신과에 자문 의뢰되었던 583명 중 54명의 섬망환자를 대상으로 하였다. 대상자의 자문요청서와 과거입원기록을 통해서 환자들의 인적사항, 입원진단명, 증상, 의뢰 전 처방, 정신과 처방, 의뢰 후 처방, 섬망에 대해 의뢰의사가 내린 진단과 자문의사의 진단 등에 대한 정보를 얻었다. 권고사항에 대한 반영도는 완전 반영, 부분 반영, 비반영으로 나누어 이중 완전 반영과 부분 반영을 반영한 것으로 평가하였다 의뢰한 과를 각 과별 그리고 내과계와 외과계로 나누어 각각의 반영도를 비교하였다. 결과: 섬망상태의 원인에 대한 진단 일치율은 자문과의 진단 기준으로 보면 원인이 기질성 뇌 증후군 (organic brain syndrome)인 경우가 가장 높았고 (85.7%) 전반적인 의학적 상태(general medical condition)의 경우가 가장 낮았다 (0%). 반영도는 의뢰과별로 유의한 차이가 없었으며, 내과계와 외과계간에도 유의한 차이가 없었다. 반영도에 영향을 미치는 중상을 비교한 결과 충동적 공격적 행동이 동반된 경우에 반영도가 73.5%이고, 행동변화가 동반되지 않은 경우가 40.0%여서 행동상의 문제가 동반되었을 때 정선과 의견에 대한 반영도가 통계적으로 유의하게 높았다. 수면장애가 동반된 경우에도 반영도가 높았는데 행동변화와 수연장애의 두 증상을 하나의 변인으로 비교한 결과, 두 증상이 모두 있는 경우는 반영도가 80.0%, 하나의 증상만 있거나 모두 없는 경우 반영도가 44.8%여서 유의한 차이가 있었다. 의뢰과에서 평가가 용이하지 않은 증상인 의식상태, 지남력상태, 환각의 유무는 반영도와 통계적 유의성이 없었다. 결론: 섬망의 원인에 대한 진단 일치율은 병변의 확인이 용이한 기질성 뇌 증후군의 경우가 가장 높았고 권고사항에 대한 반영도에 영향을 주는 요인은 행동변화와 수면장애의 증상이 나타나는 경우였다. Objectives : The author investigated the rate of diagnostic agreement between consultants and consultees and concordance ratings on the consultees' recommendation to examine the interactive collaborativeness and find the factors that influence the reflectiveness on treatment. Methods : The subjects were 54 patients with delirium selected from 583 cases referred from other departments who were admitted to Hanyang University Kuri Hospital from July 1, 1995 to Dec. 31, 1997. The information on demographic data, diagnostic impression, symptoms, management before consultation, psychiatric recommendation, management after consultation, diagnoses at the referring departments and the psychiatric department on delirium was obtained by medical records and consultation papers retrospectively. The reflectiveness of the psychiatric recommendation was divided into complete concordance, partial concordance, and nonconcordance and among them the complete and partial concordance were considered for concordance. The reflectiveness was compared among all the departments and between medical unit and surgery unit. Results: The rate of diagnostic agreement on the cause of delirium was highest(85.7%) in organic brain syndrome and lowest in general medical condition(0%). There was no statistically significant differences between medical unit and surgery unit. Neither differences were there among all the departments. In comparing symptoms affecting the reflectiveness, it was 73.5% in impulsive and aggressive behavioral changes, whereas 40.0% in behavioral changes. Reflectiveness of psychiatric recommendation showed higher scores in the case of behavioral changes. The cases of sleep problem showed higher scores of reflectiveness. When these two symptoms of behavioral change and sleep problem were compared as one factor, the results suggested that there were significant differences. The cases with both two symptoms showed 80% in reflectiveness, and the cases with only one symptom or no symptoms showed 44.8% in reflectiveness. There were no statistical significances between concordance ratings and symptoms such as disturbance of consciousness, disorientation, and hallucination that cannot be easily evaluated at the referring departments. Conclusions : The rate of diagnostic agreement on the cause of delirium was highest in the case of organic brain syndrome in which lesions can be easily recognized. The factors that influence the reflectiveness of psychiatric recommendation were behavior changes and sleep disorders in the symptoms of evaluated cases.