소아 수면문제의 행동치료와 약물치료

정석훈(Seockhoon Chung) 대한소아청소년정신의학회 2023 대한소아청소년정신의학회 학술대회논문집 Vol.2023 No.5

남자 고등학생들의 아침-저녁형 수면 양상과 주간 졸음, 피로도와의 관련성

강시현,유한익,정석훈,김창윤,Kang, Shi Hyun,Yoo, Hanik K.,Chung, Seockhoon,Kim, Chang Yoon 대한수면의학회 2012 수면·정신생리 Vol.19 No.2

목 적: 일 고등학교 학생들을 대상으로, 일주기 리듬을 아침-중간-저녁형으로 구분하여, 각 유형 간에 야간 수면 패턴의 차이를 살펴보고, 주간 졸림 및 피로 정도를 비교해 보았다. 방 법: 일 남자 고등학교 2학년 전체 학생 501명을 대상으로 자가설문조사를 하였다. 아침-저녁형 평가를 위한 한국어판 조합척도(Korean translation of composite scale : KtCS), 주중 기상 시 어려움(difficulty awakening), 주중 기상 시 졸린 정도(morning drowsiness), 주간 졸림 척도(Epworth sleepiness scale, ESS), 피로 정도 척도(Fatigue severity scale, FSS)를 이용하였다. 결 과: 저녁형(5시간 36분, SD=63.3분)이 중간형(6시간 11분, SD=61.8분, p<0.001)이나 아침형(6시간 23분, SD=61.8분, p=0.029)에 비해서 주중 평균 수면시간이 유의하게 짧았다. 저녁형은 주중에 매일 낮잠을 자는 비율(16.8%, p<0.001), 카페인 섭취 비율(58.8%, p<0.001), 코골이 비율(18.5%, p=0.037)이 유의하게 높았다. 저녁형은 주간 졸림 정도(8.7, SD=3.2, p<0.001)와 피로도(4.4, SD=1.2, p<0.001)에서 중간형이나 아침형보다 더 높은 점수를 보였다. 결 론: 저녁형 학생들은 주중에 수면패턴이 불규칙하고, 가장 심한 수면 부족을 겪고 있으며, 낮잠 빈도가 높았다. 저녁형은 주간 졸림 정도가 더 심하고, 심한 주관적인 피로감을 보고하였다. 수면 유형 평가 및 동반 수면 질환 여부 검사 등 학생들의 수면 양상에 대한 적절한 관심과 교육, 적극적인 개입이 필요할 것으로 생각된다. Objectives: Individuals differ in their biological rhythms. This study investigated the association between the morningness-eveningness and sleep patterns, daytime sleepiness and fatigue in Korean male adolescents. Methods: Participants were 501 eleventh grade male students ($16.9{\pm}0.2$ years of age) in one male high school in Seoul. Each student completed the Korean translation of composite scale (KtCS), Epworth sleepiness scale (ESS), Fatigue Severity Scale (FSS) and a questionnaire about their sleep schedule. Results: The evening group had shorter weekday sleep time than the intermediate (p<0.001) or morning group (p=0.029). The evening group had more daytime napping (16.8%, p<0.001), high rate of caffeine use (58.8%, p<0.001) and snoring (18.5%, p=0.037). The evening group showed more daytime sleepiness (8.7, SD=3.2, p<0.001) and severe fatigue (4.4, SD=1.2, p<0.001) than the intermediate or morning group. Conclusion: Adolescents with eveningness have higher problems in weekday sleep, daytime sleepiness and fatigue. An intervention program for sleep problem in these adolescents should be considered.

정신분열병 환자의 살인행동과 관련된 기질 및 성격 특성

정재열(Jaeyeul Jung),정석훈(Seockhoon Chung),문필성(Pilsung Moon),김창윤(Chang Yoon Kim),홍진표(Jin Pyo Hong) 대한사회정신의학회 2007 사회정신의학 Vol.12 No.2

연구목적: 기질성격검사를 통하여 살인행동을 보인 정신분열병 환자의 인격적 특성을 알아보고자 한다. 방 법: 살인행동을 보인 정신분열병 환자 84명과 살인행동을 보인 적이 없는 정신분열병 환자 100명, 정상대조군 61명을 대상으로 하여 한국판 기질성격검사를 시행하였다. 일원배치분산분석과 t-검증을 통하여 세 군 간의 기질성격검사의 결과를 비교하였다. 구조화된 면담도구인 SCID(Structured Clinical Interview for DSM-Ⅳ)를 이용하여 진단을 하였고, 양성 및 음성 증상척도 (Positive And Negative Syndrome Scale, PANSS)를 측정하였다. 공격성척도는 LHA(Life History of Aggression)를 사용 하였다. 결 과: 새로움추구요인(Novelty seeking)은 살인행동을 보인 정신분열병 환자들(homicidal schizophrenic patients, HS)이 살인행 동을 보인 적 없는 정신분열병 환자들(non-homicidal schizophrenic patients, NHS)보다 더 낮은 것으로 나타났다(p=0.01). 위험회피요인(Harm avoidance, HA)과 자기초월성(Self-transcendence, ST)은 두 정신분열병 환자군(HS, NHS)에서 일반 대조군에 비해 유의미하게 높게 나왔다(p<0.01). 보상의존요인(Reward dependence, RD)과 자기중심성(Self-directedness, SD), 사회협조성(Cooperativeness, C)은 일반대조군에 비해 낮은 점수를 보였다(p<0.01). 양성 및 음성 증상척도의 총합점수와 인구학적 변인의 차이는 보이지 않았다. 결 론: 높은 새로움추구요인(Novelty seeking)은 살인행동을 보인 정신분열병 환자들의 인격적 특성이 아니며 이번 연구를 통해 기존의 연구결과에서처럼 정신분열병 환자들이 일반대조군에 비해 높은 위험회피요인(HA)과 자기초월성(ST)을 보인다는 것을 확인하였다. Objectives:The aim of this study was to assess dimensions of temperament and character in homicidal schizophrenic patients by using the temperament and character inventory(TCI) which was defined based on Cloninger’s biosocial model. Subjects and Methods:Eighty four homicidal schizophrenic patients and 100 non-homicidal schizophrenic patients and 61 normal controls participated in this study. We used the Korean version of the TCI to compare these 3 groups. Diagnostic evaluation was made with Structured Clinical Interview for DSM-Ⅳ(SCID), and symptom evaluation was made with Positive and Negative Syndrome Scale(PANSS), and violent behavior was assessed with Life History of Aggression(LHA). Results:Novelty seeking(NS) was lower in homicidal schizophrenic patients(HS) than non-homicidal schizophrenic patients(NHS)(p=0.01). Harm avoidance(HA) and Self-transcendence(ST) were higher in two schizophrenic patients groups(HS, NHS) than normal control(p<0.01). In two schizophrenic patients groups(HS, NHS) Reward dependence(RD) and Self-directedness(SD) and Cooperativeness(C) were lower than normal control(p<0.01). Conclusion:The author found that higher NS was not a characteristic of homicidal schizophrenic patients comparing with non-homicidal schizophrenic patients. This study replicates the results of previous studies suggesting that schizophrenic patients have high HA and high ST.

살인 행동을 보인 정신분열병 환자에서 MMPI와 SCL-90-R 검사의 특징

강시현(Shi Hyun Kang),정석훈(Seockhoon Chung),정재열(Jaeyeul Jung),정혜윤(Hye Yoon Chung),성명제(Myung-Jae Sung),김민후(Min Hoo Kim),송해철(Hae-Cheol Song),권수희(Soo Hie Kwon),진영식(Young Sik Jin),백상빈(Sang-Bin Baek) 대한사회정신의학회 2005 사회정신의학 Vol.10 No.2

목 적: 공격성은 정신분열병 환자에게 나타나는 심각한 문제 중 하나이다. 공격성의 가장 극단적 형태인 살인 행동을 보인 정신분열병 환자들이 경험하는 주관적인 정신 증상 및 심리 상태의 특성을 알아보고자 본 연구를 시행하였다. 방 법: 살인 행동이 있었던 정신분열병 입원 환자(n=64)를 연구대상으로 하였고 살인 행동은 없었으며 실험군과 나이, 교육 연한, 항정신병 약물 용량을 짝짓기하여 선정한 정신분열병 입원 환자를 대조군(n=75)으로 선정하여 두 군간의 주관적 정신 증상 및 심리상태를 비교 연구하였다. 주관적 상태는 Minnesota Multiphasic Personality Inventory(MMPI)와 Symptom checklist-90-R(SCL-90-R)로 평가하였다. 살인 행동 환자군은 살인 행동 후 정신감정 시점에 검사된 MMPI와 SCL-90-R결과를 얻었다. 결 과: 살인 행동을 보인 환자군은 대조군에 비하여 MMPI와 SCL-90-R검사 모두에서 전반적으로 더 높은 점수를 받았다. MMPI 검사에서 우울증, 히스테리, 반사회성, 편집증, 내향성 척도가 살인 행동군에서 대조군에 비해 유의하게 높았다. SCL-90-R 검사에 서는 강박증, 대인관계 예민성, 불안, 편집증, 정신증 항목에서 살인 행동군에서 통계적으로 유의하게 높은 점수를 보였다. 결 론: 살인 행동을 보인 정신분열병 환자군은 주관적으로 사회적 상황에서 정서적으로 불안정하여 피해의식을 쉽게 느끼고 분노와 정감 조절이 어려울 때 인지적 왜곡에 부합하여 공격적 행동이 유발될 가능성이 있다. Objectives:Violence is a serious problem in some patients with schizophrenia. Homicide is one of the most extreme aggressive behavior. The purpose of this study was to investigate the characteristics of subjective symptomatology and psychological state of schizophrenia with homicidal behavior. Methods:Subjects were schizophrenia patients hospitalized in a mental hospital due to their homicidal behavior (n=64, group 1). Control subjects were schizophrenia patients without homicide also hospitalized in another mental hospital(n=75, group 2). Subjects were matched by age, years of education and dosage of antipsychotics. Minnesota Multiphasic Personality Inventory(MMPI) and Symptom checklist-90-R(SCL-90-R) were used to evaluate the subjective symptomatology. In group 1, the results of MMPI and SCL-90-R had been acquired following the incident that led to hospitalization. Results:Schizophrenia patients with homicide showed overall elevated MMPI clinical scales and SCL-90-R scales. The group with homicidal behavior had significantly higher scores than patients without homicidal behavior on the subscales of depression, hysteria, psychopathic deviance, paranoid, social introversion as assessed by the MMPI. They also had significantly higher scores on the subscales of obsessive-compulsive, interpersonal sensitivity, anxiety, paranoid ideation, psychoticism as assessed by the SCL-90-R. Conclusion:Schizophrenia patients with homicidal behavior did present different clinical subjective pictures : unstable emotion, more paranoid tendency, difficulty with control of anger, more perceptual disturbance. Under those subjective states they had a risk of violent behavior.

학령전기 아동의 정서인지행동특성과 양육스트레스

박장호(Jangho Park),정석훈(Seockhoon Chung),김효원(Hyo-Won Kim) 대한소아청소년정신의학회 2011 소아청소년정신의학 Vol.22 No.4

Objectives:The objective of this study was to evaluate the relationship of the parenting stress with their children’s characteristics for typically developing preschool children. Methods:Parents of 38 preschool children (mean age : 4.4±0.7 years, 22 boys) completed the Korean Parenting Stress Index, the Korean Child Behavior Checklist, the Conners Parent and Teacher Rating Scale-Abbreviated form (CPRS and CTRS), the Junior Temperament and Character Inventory, the Children’s Sleep Habit Questionnaire and the Social Responsiveness Scale. All 38 children performed the Comprehensive Attention Test (CAT). Results:The children’s inattentive and hyperactive problems, as measured by the CBCL, CPRS and CAT, had positive correlation with parenting stress. Both internalizing and externalizing behavioral problems were associated with parenting stress. Of the child’s temperament dimensions, Novelty Seeking and Harm Avoidance were positively correlated with parenting stress, but Persistence and Cooperativeness were negatively correlated with parenting stress. Sleep anxiety and other sleep characteristics showed a correlation with parenting stress. Social Motivation and Communication were also positively related to parenting stress. Conclusion:Our results suggest that parenting stress could be related to the children’s cognition, emotion, behavioral characteristics, sleep habits and social development. These results could assist in the development of interventions to improve the parental well-being in typically developing preschool children.

Teacher’s perspectives on challenges in educational environment of public schools during the COVID-19 pandemic: A qualitative study in South Korea

이지훈(Lee, Jihoon),이주희(Lee, Joohee),정석훈(Chung, Seockhoon),강솔비(Kang, Solbi),서수연(Suh, Sooyeon),이상하(Lee, Sangha) 한국재활심리학회 2021 재활심리연구 Vol.28 No.4

COVID-19 팬데믹(pandemic)은 등교 중지 및 원격수업 등의 형태로 학교 교육에 큰 영향을 주었고 교사들의 부담을 가중시켰다. 본 연구는 COVID-19로 인해 변화된 학교 현장에서 공립 교사들이 경험하는 심리적 고통과 소진 요인을 탐색하는 것을 목적으로 하였다. 이를 위해 현재 서울 소재 학교에서 근무하고 있는 9명의 교사를 대상으로 표적집단면접(Focus Group Interview, FGI)을 진행하였다. FGI에서 수집된 질적 정보들을 주제별로 나누어 분석하였고, 개방코딩을 통해 중복되는 개념을 제거한 후 초점코딩으로 하위 주제와 최종 주제를 개념화하였다. 그 결과, 국내 공립 학교에서 직면한 COVID-19의 문제는 ‘활력이 없는 학교’, ‘소모적인 온라인 수업’, ‘[힘 없는] 중간자인 교사’의 세 가지로 분류되었다. 본 연구는 COVID-19 기간 동안 학교 현장에서 교사, 학생, 학부모 간의 역학관계와 더불어 교사의 위치와 책임에 관한 인식을 파악했다는 것에 의의가 있다. 연구결과를 바탕으로 추후 교사들을 위한 심리적 지원에 대한 제언과 더불어 연구의 한계점을 논하였다. The COVID-19 pandemic has resulted in an increase in psychological distress, burnout, and workloads among public school teachers. This study aimed to explore the teachers experiences regarding the impact of the pandemic on their mental health and burnout. Nine teachers who were currently working in public schools in Seoul, South korea were invited to participate in focus group interviews (FGI). Data from FGIs were combined and analyzed thematically. The open codes were grouped and categorized by identifying and classifying the overlapping concepts into focused codes, which were then conceptualized into sub-themes and final themes. The analysis revealed three main themes of the COVID-19 pandemic-related challenges across public schools in Seoul. 1) Schools have no vitality; 2) Online classes are energy-consuming; and 3) Teachers are vulnerable middlemen. The results of this study offer insight into teachers perceptions of the unique position in which they are in to support students and their parents during the COVID-19 pandemic. Limitations of the study and implications for future research were also discussed.

정신분열병 환자의 살인행동과 관련된 임상양상

정석훈,이태경,정재열,장정기,장상현,이미경,강시현,정혜윤,유한익,김창윤,홍진표 大韓神經精神醫學會 2006 신경정신의학 Vol.45 No.1

Objectives : Recent studies have shown that schizophrenic patients are at increased risk to commit acts of aggression, and aggressive behaviors have severe critical results for the patients and victims. The purpose of the present study is to assess the homicidal behaviors of schizophrenic patients as a extreme case of aggressiveness. Methods : 93 homicidal schizophrenic patients and 93 non-homicidal schizophrenic patients participated in this study. Diagnostic evaluation was made with SCID (Structured Clinical Interview for DSM-IV), and personality trait was evaluated with SIDP (Structured Interview for DSM-IV Personality Disorders). Symptom evaluation was done with PANSS (Positive And Negative Syndrome Scale), and violent behaviors were assessed with LHA (Life History of Aggression) and OAS (Overt Aggression Scale). Results : There were no significant differences in demographic vahables, schizotypal personality trait and antisocial Personality trait between two groups. Mean age at homicidal commitment was 34±8.9 years and 9.8±7.5 years after the onset of illness. The major criminal victims were the parents of the patients (N=49, 53.7%). The aggressiveness was higher in homicidal schizophrenic patients in LHA and OAS scales. There were statistical significances in separate items of the PANSS scale such as excitement (P4), Poor rapport (N3), lack of judgement and insight (G12), disturbance of volition (G13), Poor impulse control (G14) and active social avoidnance (G16), but not in the positive, negative, general subscales and the total scores of the PANSS scale. Conclusion : Excitement and poor impulse control persisted in homicidal schizophrenics, although overt psychotic Symptoms decline after proper treatment. Homicidal behavior can be preventive if proper treatment for excitement and poor impulse control are given.

최근 발병한 정신분열병 환자의 증상 관해 및 정신사회적 기능 : 1년 전향적 추적 관찰 연구

정석훈,박원명,권준수,박지홍,안준호,고진경,김창윤 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.5

Objectives : The long-term outcome of schizophrenia is still considered vahable and inconclusive. We perfonned a one-year prospective observational study to investigate the longitudinal outcomes in patients with recent-onset schizophrenia. The primary purpose was to determine the descriptive outcomes in tenns of symptom remission and psychosocial function. The secondary purpose was to identify predictor variables associated with the outcomes. Methods : Patients experiencing their first episode ofpsychosis or hospitalization within the past 2 years with a diagnosis of DSM-IV schizophrenia were included. Clinical symptoms were assessed monthly using Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS) and Clinical Global Impression (CGI) scale. Psychosocial function was measured using PSYCH-UP (Psychosocial symptoms you currently have, follow-up version) and Heinrichs' Quality of Life Scale (QLS) at baseline, 6, and 12 months and Global Assessment of Functioning (GAF) monthly. Remission was defined on the basis of overall, and psychotic core symptoms as having 1) BPRS total score ≤ 36, and 2) Each individual item score of core psychotic items (conceptual disorganization, suspiciousness, hal-lucinatory behavior, unusual thought content) ≤3, and 3) CGI severity score ≤3, and 4) Duration of remission at least for 2 consecutive months. To identify the predictive variables for the outcome, relationships between time to remission and various clinical variables were examined using Cox proportional hazards model. Results : A total of 49 patients with schizophrenia were enrolled in this study. The proportions of patients with symptom re-mission were 54.5% (24/44, drop outs=5) at 3 months, 55.3% (21/38, drop outs=11) at 6 months, and 64.3% (18/28, drop outs=21) at 12 months. Mean time to remission was 3.76±2.43 (s.d.) months, and the mean duration of remission was 7.54±2.99 months. Significantly longer time to remission was predicted by higher SANS total score at baseline in various predictor variables (p=0.01). Impairments of psychosocial function measured using PSYCH-UP and QOL were significantly improved at the end of this study, but still remained at mild to moderate level. SANS total score and GAF score significantly correlated with most ofthe items related to psychosocial fimction at 12 months. The proportion of the patients with GAF score ≥60 increased from 6.1% at baseline to 85.8% at 12 months. Of the patients who were in remission at 12 months, 95.5% obtained GAF score ≥60. Conclusion : This study showed 64.3% of symptom remission rate in patients with recent-onset schizophrenia. Symptom re-mission was accompanied by significant improvement ofglobal function. The severity of negative symptom at baseline appeared to be a significant predictor for time to remission. Psychosocial function was improved at the end of this study, but impainnents still remained at mild to moderate level. GAF score and negative symptoms significantly correlated with psychosocial function.

지연성 수면위상증후군 청소년에서 기상 시 어려움과 주간 졸림에 대한 Dawn Simulation 효과 연구

강시현,유한익,정석훈,왕희령,안준호,윤인영,김창윤 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.6

Objectives : Delayed sleep phase syndrome (DSPS) is characterized by difficulties in falling asleep and waking up at a desired time. Dawn simulation is a technique using a light that gradually increases in intensity before awakening in the morning, to imitate a natural sunrise. It has been found to be effective in decreasing both morning drowsiness and difficulty in awakening as well as treating symptoms of seasonal affective disorder. The aim of this study was to determine whether dawn simulation is helpful in decreasing difficulty in morning awakening and daytime sleepiness in adolescents with DSPS. Methods : Twelve adolescents with DSPS participated in a 2-week dawn simulation trial. Each subject self-assessed level of difficulty in awakening, morning drowsiness and daytime sleepiness during a 2-week baseline period and a following 2-week trial period with dawn simulator. Subjects used Stanford Sleepiness Scale (SSS) for measuring morning drowsiness and Epworth Sleepiness Scale (ESS) for measuring daytime sleepiness. Difficulty in awakening was assessed by a single-item questionnaire. Results : Dawn simulation trial decreased morning drowsiness (p=0.016) and daytime sleepiness (p=O.013) significantly compared to baseline. It also seemed to improve difficulty in awakening, but the effect was not statistically significant (p=0.092). Conclusion : Dawn simulation may help waking up in the morning and may improve daytime functioning by deceasing both morning drowsiness and daytime sleepiness in adolescents with DSPS.