직장인의 약물 및 알코올 사용에 대한 인구역학적 연구

김기준(Ki-Jun Kim),오동열(Dong-Yul Oh),신지용(Jee-Yong Shin),이충경(Choong-Koung Lee) 한국중독정신의학회 1999 중독정신의학 Vol.3 No.1

The primary purpose of this research is the first epidemiologic study of drug and alcohol use on workplaces in Korea. In particular, this study presents epidemiological survey results administered to 518 employees for studying the use of drug and alcohol at four different worksites. In this reaearch, we examine the prevalence of drug and alcohol use and the epidemiologic risk factor of employee who has an alcoholic problem by statistical comparison with employee who has not. The drug and alcohol-related problems, experienced by employee, such as physical illness, psychiatric symptom, economic damage, car accident, and violent hehavior are also informed, using self-reported data from employees. In the following section, we describe our research limits and discuss the future workplace policy of drug and alcohol use. The results offer a significant percentage of problematic drug and alcohol users in our workplace and the worksite employees are potentially experienced in physical, psychiatrical problems by drug and alcohol use. The risk epidemiologic factors of alcohol abuse and dependence groups in employee show that the male white collar employee who is older than 30 years old with lower monthly income has higher percentage than others. In conclusion, serious consideration should be given in worksite drug and alcohol use problems and prevention, education, prospective study should be also developed continuously.

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.

의약분업 시행상 나타난 정신과 치료상의 문제점들에 대한 정신과 의사, 환자 및 보호자들의 견해

박정수(Jung-Soo Park),정재열(Jae-Yeul Jung),홍진표(Jin-Pyo Hong),송인권(In-Kwon Song),이혁(Hyuk Lee),서동우(Tong-Woo Suh),박강규(Kang-Kyu Park),이충경(Choong-Koung Lee) 대한사회정신의학회 2001 사회정신의학 Vol.6 No.1

목 적: 이 연구는 의약분업 시행 후 드러난 정신과 진료에서의 문제점들을 조사하고 이에 대한 정신과의사, 환자 및 보호자들의 견해를 통합하여 제도적 개선과 합리적 대안을 마련하기 위한 것이다. 방 법: 모든 정신과 의료기관에 설문지 취지에 대한 설명과 함께 설문지를 우편으로 발송하여 환자, 보호자, 정신과 의사에게 설문지를 작성하도록 한 후 우편으로 회신 받았다. 결 과: 정신과 환자 및 가족의 29.3%가 약국에서 대체조제를 경험하였으며 82.5%가 의약분업 시행후 이전 보다 더 불편해졌다고 응답하였으며 25.9%에서 약국에서 조제시 환자 및 보호자가 정신과 약물을 구입하는 것을 다른 사람이 알게된다고 응답하였다. 정신과 의사의 16.4%가 원외처방전을 전혀 발행하지 않고 있었으며 55.9%는 10%미만의 원외처방전을 발행하고 있었다. 많은 정신과 의사들은 현재의 의약분업에서 정신과 진료는 제외되어야 한다고 생각하고 있었다. 결 론: 현재의 의약분업 제도는 정신과 진료의 많은 영역에서 중요한 문제점들이 발견되고 있고 약사법의 의약분업 예외조항과 관련해서 재검토가 필요하다. Objectives:This study is designed to investigate the issues and problems of psychiatric practice after introduction of the‘separation of dispensary from medical practice’, and opinions of psychiatrists, psychiatric patients and their families, and to improve this medical system by suggesting reasonable alternatives. Methods:The psychiatrists, the psychiatric patients and their families who visited civil, national, and private hospitals, were selected for survey from september, 2000 to February, 2001. Results:The main results were as followings: Among psychiatric patients and their families, 1) 29.3% of responders experienced prescribed drugs substituted by others and 82.5% of responders were in discomfort after introduction of‘the separation of dispensary from medical practice’. 2) 25.9% of responder experienced invasion of privacy at a pharmacy. Among psychiatrists, 1) 16.4% of responders didn’t make out prescriptions to pharmacy at all and 55.9% of responders made out prescriptions to pharmacy less than 10% of all prescriptions. 2) Many psychiatrists wanted that psychiatric practice should be excluded from‘the separation of dispensary from medical practice’. Conclusion:The results of the study revealed that the current‘separation of dispensary from medical practice’ in Korea had many serious problems in many areas of psychiatric practice, and the present Pharmaceutical Law should be urged to reconsider.

殺人 15例를 포함한 精神鑑定 50例에 대한 精神醫學的 考察

吳世元,李忠敬 大韓神經精神醫學會 1983 신경정신의학 Vol.22 No.4

Between Jan. 1975 and Dec.1978, the Chon Nam Provincial Mental Hospital have received 50 cases for psychiatric evaluetion from the public offices. According to our study of personal background and psychiatric examination record, about 40 cases of mental disorder were found among them. Therefore the results below are from studies done on three areas: diagnostic distribution, criminal phase, and murder characteristics. 1. The sex (N=50) was mostly male (92%). 78% of the cases were 20 to 39-year-old age group. Married patients were 40 percent and unmarried, divorced and separated patients were 60 percent. Half of them received education for one to six years only. 70 percents of them reside in the farming and fishing village by a habitation group. Furthermore about half of the cases were out of work. 2. Of the referrals, 64 percent came from the police station, and 22 percent came from the public procurator's office. 3. 72.5 percent of the diagnostic distribution (N=40) were schizophrenia. 4. In this study, 37.5 percent of the charges were murder, and followed by assault, destruction, the anti-communism law, and the disturbing pubic-peace law, etc. 5. On the targets of crime the family was 45 percent and the public office was 25 percent. 6. Act of crime were almost all due to psychotic conditions: for example delusion, hallucination, confusion and violence etc. 7. Of 15 cases of homicide, 73.3 percent had schizophrenia. 80 percent of the case were committed in summer or spring. 46.6 percent of the homicide occurred during the daytime. 8. 80 percent of the weapons used in committing the homicide were tools and blunt weapons. The places where the homicide were committed was usually one's house or next door. 9 The victims for murder were mostly consisted of the biological family: parents, life-partners, children, and sister-in-law, ect. After committing the murder, the patients didn't hide their crime, but commonly they recognized, deviated or denied their crime in part.

알콜 관련성 간질에 관한 임상적 고찰 : 유병율과 위험인자를 중심으로 for the Aspects of Prevalence Rate & Risk Factors

오동열,박병희,이충경 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.5

본 연구에서는 국립서울정신병원 알콜병동 입원환자를 대상으로 알콜 관련성 간질의 유병율을 조사하고 그 위험인자를 알아보았다. 1년간 알콜전문병동에 입원한 434명의 알콜장애 환자 중 8.5%인 37명에서 알콜 관련성 간질(ARS)의 경험을 확인하였다. 선행연구에 의거한 위험인자의 조사결과 이들은 알콜 섭취량, 알콜 섭취기간, 진전성 섬망 경험 여부, 두부외상력 등에서 모두 간질 비경험군에 비해 유의하게 높은 수치를 나타냈다(p<0.05). 알콜 관련성 간질의 임상적 특징 중 중첩 간질 발작은 12명(32.4%)에서 나타났다. 뇌파검사에서 이상소견은 2명에서만 나타났다.이러한 결과는 여러 선행 연구에서 보고와 거의 일치하는 결과이고 단 중첩 간질 발작의 빈도가 외국의 경우에 비해 적은 양상을 나타냈다. 이는 급성 해독기관에서 주로 조사된 외국의선행 연구들과는 달리 입원상황과 과거 간질력을 모두 조사 대상에 포함시켰고 금단 증상에 대한 예방 조치가 이루어진 상황 후라는 점에서 직접적인 비교는 어려울 것으로 생각된다. 알콜 관련성 간질의 원인으로 Victor는 금단현상과 이후의 잦은 해독작용 등을 주장하고 Ng는 알콜자체의 독성을 주장하는데 본 연구에서는 두 연구 모두에서 제시하는 소견이 포함되어 있어 하나의 원인 보다는 알콜 자체의 독성과 함께 금단 후의 과정도 관련된 복합적인 요인들의 결과라고 추론된다. 임상적특징을 보건데 알콜 관련성 간질임이 확인되면 좋은 예후를 예측할 수 있으므로 중독 초기의 적극적인 평가와 급성 알콜중독 환자에 대한 철저한 치료과정이 필요하다고 하겠다. Objects : Increasing numbers of alcoholics takes burdens of physical problems and one of the most serious complication is alcohol related seizure. This study was conducted to assess the prevalence of alcohol related seizures(ARS) in alcoholic patients and also the risk factors associated with ARS. Method :434 male alcoholic patients who were admitted to the alcohol inpatient unit on Seoul National Mental Hospital were studied. Patient interview and chart review was performed to take alcohol and seizure histories at the time of admission and also at the point of seizure attack during admission. Neurological examination and brain study was performed to each one of the patient group. Results : Prevalence of alcohol withdrawal seizure was 8.5%. Variables associated with alcohol related seizure were duration of drinking, amount of drinking, comorbid delirium tremens, histories of minor head trauma. Most of subjects were neurologically free. Among the total 37 subjects, grand mal seizures were developed in 36 subjects and in 25 subjects seizure were developed within 48 hours. All of them experienced delirium tremens and 12 of them were attacked by recurrent seizures within 6 hours. Conclusion : Alcohol related seizure(ARS) was related to severity of alcoholic symptoms. Further studies are needed to find out the pathophysiology, the ways of management and prevention of alcohol withdrawal seizure for increasing risk of alcohol problems today.

한국 정신장애의 역학 조사 연구[I] : 각 정신장애의 유병률

조맹제,함봉진,김장규,박강규,정은기,서동우,김선욱,조성진,이준영,홍진표,최용성,박종익,이동우,이기철,배재남,신정호,정인원,박종한,배안,이충경 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.4

Objectives : This study aims to estimate the prevalence of the DSM-IV psychiatric disorders in Korean population using the Korean version of Composite International Diagnostic Interview (K-CIDI). Methods : Subjects were selected by taking multi-stage, cluster samples of 7,867 adult household residents, 18 to 64 years of age, in ten catchment areas. Total 78 trained interviewers administered the K-CIDI to the selected respondents, from June 1 to November30,2001. Results : Total 6,275 respondents completed the interview. Some 33.5% of respondents reported at least one lifetime disorder, 20.6% reported at least one-year disorder, and 16.7% reported at least one-month disorder. The most common lifetime disorders were alcohol abuse/dependence (17.24%), nicotine dependence/withdrawal (11.19%), specific phobia (5.16%), and major de-pressive disorder (4.25%). The lifetime prevalence of substance abuse/dependence (0.25%) and schizophrenia (0.16%) was very low. Nicotine and alcohol use disorder showed very high male/female ratio. Mood disorder and anxiety disorder were more prevalent among female than male. Conclusion : The prevalence of psychiatric disorders was high. In comparison with other studies, remarkable differences in distributions of psychiatric disorders across the areas and times were observed.

全羅南道內 不具廢疾者 收容所에 收容된 精神障碍者에 對한 實態報告

尹昌範,李忠敬,鄭光現,丁相鍵,姜珍祥 全南大醫大 1975 전남의대학술지 Vol.12 No.3

노인정신장애환자의 추적치료 실태에 대한 고찰

신명기,이충경,정은기 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.3

The authors performed this statistical study in order to get a preliminary data for further intensive study and the possible ways to improve psychiatric care for elderly patients. The authors reviewed the clinical records of 128 elderly patients who had admitted at Seoul National Mental Hospital from Jan. 1991 to Oct 1992. And the authors interviewed with telephone 74 persons who had not taken follow-up treatment. The results of the study were as follows: 1) Those who had taken follow-up treatment wer 108 patients(84.4%). 2) Those who had combined with other physical disease were 68 patients(53.1%). The Car-diovascular disease was most frequent(20.8%). 3) There were no meaningful differences between the group who had and had not taken follow-up treatment on several variables. 4) The causes of no follow-up treatment were as follows: ①Patient's death:27 cases(36.5%). ②Symptom improved:17 cases(22.9%). ③To another Hospital:16 cases(21.6%). ④Marginal adaptation:7 cases(9.5%). ⑤Others:7 cases(9.5%). readmission to Seoul National Mental Hospital:3 cases. admitted to sanitarium: 2 cases. abandoned by dependents: 1 case. discontented with Doctor: 1 case. In conclusion, there were no meaningful differences between the group that receiue cl and not receired follow-up treatment on several variables. And the most common cause of no follow-up treatment was the patients' death.

국립서울정신병원의 성과측정방법 개발에 대한 연구

장안기,박강규,이충경 국립서울정신병원 2000 臨床硏究論文集 Vol.2000 No.-