알코올 의존과 세로토닌 수송체 유전자 다형성의 연관

손현균,최인근,채영규,최미란,김재환,양병환,김석현,성승모,Son, Hyun-Gyun,Choi, Ihn-Geun,Chai, Young-Gyu,Choi, Mi Ran,Kim, Jae Hwan,Yang, Byung-Hwan,Kim, Seok Hyeon,Sung, Seung Mo 대한생물정신의학회 2003 생물정신의학 Vol.10 No.2

Objective:Under the hypothesis that 5-HTTLPR polymorphism plays some role in the susceptibility or vulnerability of some subgroup of alcohol dependence, associations of 5-HTTLPR polymorphism with alcohol dependence were examined. Method:This association analysis included 109 Korean alcohol dependent and 113 Korean control subjects. DNA of all subjects were genotyped for the biallelic functional polymorphism in the 5-HTTLPR. Considering the likelihood of heterogeneity in the alcohol dependence phenotype, alcohol dependent subjects were subgrouped by onset age, family history of alcohol dependence and severity of withdrawal symptoms. Results:There were no significant differences in the frequencies of either the 5-HTTLPR genotype or the short vs. long allele in alcohol dependent and control subjects. The frequency of the S allele and S-carrier (LS or SS genotype) was significantly increased in the early onset alcohol dependent subjects and the familial alcohol dependent subjects compared with that in the control subjects. Conclusion:The results suggest that the 5-HTT 'S' promoter polymorphism is associated with an increased susceptibility or vulnerability to develop early onset alcohol dependence and familial alcohol dependence, which characterize Cloninger's type 2 alcohol dependence.

외상 후 스트레스장애로 진단된 화상 환자의 기질 및 성격차원 특성

윤석찬,함병주,변정현,은헌정,손현균,서국희,최인근,Yoon, Suk-Chan,Ham, Byung-Joo,Byun, Jeong-Hyun,Eun, Heon-Jeong,Son, Hyeon-Gyun,Suh, Kuk-Hee,Choi, Ihn-Geun 대한생물정신의학회 2005 생물정신의학 Vol.12 No.2

Objective:The aim of this study was to evaluate the temperament and character profiles of the patients with posttraumatic stress disorder(PTSD) after burn injury. Methods:The study subjects consisted of 23 PTSD patients after burn injury, 24 patients not being diagnosed as PTSD after burn injury(non-PTSD) and 53 healthy controls. The assessment of PTSD was performed using clinician administered PTSD scale. All participants were instructed to complete the Temperament and Character Inventory(TCI), the Beck Depression Inventory and the State and Trait Anxiety Inventory of Spielberger. Results:The PTSD group after burn injury, compared with the non-PTSD group and the normal controls, had the higher novelty seeking and harm avoidance scores. But there were no differences in other dimensions in the TCI among the three groups. Conclusion:The results of this study suggest that the PTSD group after burn injury showed the specific properties of temperament and character compared with the non-PTSD group and the normal group.

화상 중환자에서의 섬망과 사망

서국희(Guk-Hee Suh),신형직(Hyong Jik Shin),함봉진(Bong Jin Hahm),조성진(Seong-Jin Cho),이동우(Dong-Woo Lee),최인근(Ihn-Geun Choi),손현균(Hyeon Gyun Son),연병길(Byeong Kil Yeon) 대한노인정신의학회 1999 노인정신의학 Vol.3 No.2

Objective : This study was to estimate the prevalence of and identify the predisposing risk factors of delirium and to determine the effect of delirium on the prognosis, especially death in burn patients. Method : The study was completed by thorough examination of medical records, with additional confirmation, of the 245 patients who were admitted to the Burn ICU in Burn treatment center of Hangang Sacred Heart Hospital during last one year (Jan. 1. 1998-Dec. 31. 1998). Delirium was retrospectively diagnosed according to DSM-IV. Only when disturbance of consciousness and attention, cognitive dysfunction –especially disorientation–, or perceptual disturbance were observed, diagnosis of delirium were given. Final outcome such as death was discriminated through examination of medical records or question to those who knew the patient. Result : One year prevalence of delirium in burn patients is 34.4%. Statistically significant predisposing risk factors of delirium were five;Age 65 and over (OR=45.51, 95% CI : 6.07-341.11), burn size over 60% of total body surface (OR=6.48, 95% CI : 3.16-13.28), current psychiatric disorder (OR=6.81, 95% CI : 1.42-32.57), current medical disease (OR=3.00, 95% CI : 1.40-6.45), alcohol abuse (OR=3.17, 95% CI : 1.07-9.43) Statistically significant deathrelated risk factors were three;burn size over 60% of total body surface (OR=4.58, 95% CI : 2.00-10.46), delirium (OR=2.94, 95% CI : 1.25-6.94), current psychiatric disorder (OR=4.09,95% CI : 1.05-15.87). Aging is not the death-related factor in this study. Conclusion : Three factors, such as delirium, organic brain damage, and burn size over 60% of total body surface may predict higher risk of death in burn patients.

뇌사에 대한 의사와 일반인의 태도 조사

손현균,김광일,김이영 大韓神經精神醫學會 1994 신경정신의학 Vol.33 No.1

In this attitude survey using Q-methodology, the authors attemped to identify the physician`s & public attitudes toward brain death. Thirty three statements related to attitude toward brain death were Q-sorted by 71 physicians & 71 laymen. The data were statistically analysed by Q-factor analysis. Five factors in physician group and six factors in layman group could be extracted. Characteristic features of five factors in the physicians were as follows: Factor A: Physicians of this factor positively approve of brain death by pragmatic reason. They agree to organ transplantation, but they resist donation of their own organs in organ transplantation. They are selfish and treasure their body. These people could be named as 「The egoistic brain death advocators」. Factor B: Physicians of this factor approve of brain death for organ transplantation. Most of them are religious. These people could be named as「The humanitarian brain death advocators」. Factor C: Attitude toward brain death in this group is vague. They agree to organ transplantation and also have intention of donation of their own organs and receipt of others. These people could be named as 「The transplantation devotees」. Factor D: These physicians are indifferent in attitude brain death and organ transplantation basically. These people could be named as「The bystanders」. Factor E: These physicians have no trust in phsysicians, religion and modern medicine. They agree to organ transplantation but strongly oppose to brain death. These people could be named as「The doctor mistrustees」. Characteristic features of factors in the laymen were as follows: Factor A: Subjects of this factor positively approve of brain death. They also agree to organ transplantation. They want to receive organs from others but do not intend to donate their own organs because they selfish and treasure their body. These people could be named as「The egoistic brain death advocators」. Factor B: People of this factor approve of brain death and organ transplantation. They are will to donate their own organs. They are mostly post graduated, single females. These people could be named as「The active brain transplantation advocators」. Factor C: People of this factor have somewhat negative attitude toward brain death but approve of organ transplantation. They have no intention of donation of their own organs in viewing traditional concept and attitude. They are mostly religious. These people could be named as 「The traditionals」. Factor D: These persons have no trust in physicians and religion. They have somewhat negative attitude toward brain death. They have no conspicuous opinion toward brain death and organ transplantation. These people could be named as「The doctor mistrustees」. Factor E: This factor was polarized. 「The extreme opposites to brain death」versue「The extreme brain death advocators」were named.「The extreme opposites to brain death」strongly oppsed to brain death and organ transplantation. Attitude of「The extreme opposites to brain death」are mirror image of「The extreme brain death advocators」. Discussion was carried out on the various attitude toward brain death in physicians and laymen.

한국어판 DIS-IV의 개발과 표준화

서국희,손현균,최상섭,이미경,이중서,최인근,방현숙,연병길 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.5

연구목적 : DSM-Ⅲ-R의 개정판이라기 보다는 새로운 진단 기준으로 간주될 정도였던 DSM-Ⅳ의 출현은 정신장애의 진단분류체계에 매우 큰 영향을 미쳤다. DSM-Ⅳ의 변화를 반영하여 정신과적 진단을 내릴 수 있도록 DIS-Ⅲ를 개정하여 DIS-Ⅳ가 개발되었다. 본 연구는 국내에서의 정신의학적 연구를 더욱 활성화하고 활발하게 국제 공동연구가 이루어질 수 있도록 DIS-Ⅳ 한국어판을 개발하고 이를 표준화하는 데 그 목적이 있다. 방 법 : 번역 위원회에서 번역, 역번역, 어의적 정확성 확인, 한국어 용법에 맞도록 수정한 후 예비 연구를 거쳐 한국어판 DIS-Ⅳ가 완성되었다. 의과대학생 4명에게 Washington University DIS-Ⅳ training course와 동일한 내용과 방법으로 교육을 실시하였다. 두 명의 조사요원들이 한 환자를 DIS-Ⅳ를 사용하여 동시에 검사한 후의 진단을 비교하여 검사자간 신뢰도를 측정하고, 정신과 의사가 독립적으로 DIS-Ⅳ를 사용하여 검사한 후의 진단과 비교하여 절차 타당도를 평가하였다. 조사 대상은 2000년 1월부터 8월까지 2개 대학 병원 정신과 및 국립감호정신병원에서 치료중이던 환자 124명이었다. 결 과 : 평가자간 신뢰도의 kappa값 평균은 0.74였다. 양극성 Ⅰ장애, 범불안장애, 우울장애, 강박장애, 반항장애, 동통장애, 병적 도박, 외상후 스트레스 장애, 특정공포증 및 대부분의 물질 사용 혹은 관련 장애의 kappa값이 0.7 이상이었다. 정신과 의사의 진단과 조사요원의 진단의 일치도를 비교한 절차 타당도를 살펴보면 다음과 같다. 전체적인 sensitivity는 67.6%, specificity는 98.3%, kappa 값은 0.69이었다. 물질 사용 장애 및 물질 관련 장애의 SE는 79%, SP는 98.6%, kappa 값은 0.77이었다. 이를 제외한 나머지 정신 장애의 SE는 60.5%, SP는 98%, kappa 값은 0.64이었다. 본연구의 결과는 Robins 등에 의해 최초로 보고된 DIS의 신뢰도 및 타당도와 거의 비슷한 수준이었다. 결 론: 한국어판 DIS-Ⅳ가 높은 신뢰도와 타당도를 지닌 것으로 생각된다. 이 도구를 통해 물질 사용 및 관련 장애를 타당도와 신뢰도 높게 진단할 수 있다는 점이 매우 중요하다. 향후 정신장애의 진단 능력을 향상시키고 임상연구를 활성화하고 국제적인 학술적 교류를 늘리는데 일조할 수 있을 것이다. Objective : Appearance of DSM-Ⅳ has influenced greatly on the nosological classification of mental disorder, not considered as revised one of DSM-Ⅲ-R but a new criteria. DIS-Ⅳ has been developed after revision of DIS-Ⅲ in consideration of various changes in DSM-Ⅳ. This study is to develop and validate the DIS-Ⅳ, Korean version to activate Korean psychiatric research much more and to modivate more frequent international collaborative study. Method : Translation committee produced DIS-Ⅳ, Korean version through all the procedures of translation, back-translation, confirmation of retained original meaning of the English version, adaptation to Korean linguistic usage and preliminary study. Four medical students were trained during DIS-Ⅳ training course that retained the same contents and methods as of Washington University. Inter-rater reliability was measured by comparison between two diagnoses made from two interviewer who rated one patient at the same time. Procedural validity was measured by comparison between lay-interviewer's diagnosis and psychiatrist's diagnosis which were made after independent DIS-Ⅳ using interview. Subjects were 124 patients who were being treated at two University Hospital and National Forensic Psychiatric Hospital between January, 2000 and August, 2000. Results : Average kappa value of inter-rater reliability was 0.74. Diagnoses showing over 0.7 in kappa value were bipolar I disorder, generalized anxiety disorder, depressive disorder, obsessive-compulsive disorder, oppositional defiant disorder, pain disorder, pathological gambling, post-traumatic stress disorder, specific phobia and almost all substance use disorder or substance-related disorder. Procedural validity, that compared lay-interviewer's diagnosis and psychiatrist's diagnosis, were as follows: For all diagnoses, sensitivity, specificity and kappa were 67.6%, 98.3% and 0.69. For diagnoses of substance use disorder or substance- related disorder, sensitivity, specificity and kappa were 79%, 98% and 0.77. For other diagnoses except substance use disorder or substance- related disorder, sensitivity, specificity and kappa were 60.5%, 98% and 0.64. This results are almost at the same level as that of Robins and her colleagues who tirst reported reliability and validity of DIS. Conclusion : We think that DIS-Ⅳ, Korean version has higher reliability and validity. It is very important that diagnoses of substance use disorder and substance-related disorder can be made reliably and validly by this instrument. We expect that it can help to improve diagnosability of mental disorder, activate clinical research and increase international scientific communication.