발병연령에 따른 공황장애 임상 양상의 차이

신은숙,하주원,김형태,임세원,신동원,신영철,오강섭,Shin, Eunsook,Ha, Juwon,Kim, Hyung Tae,Lim, Sewon,Shin, Dongwon,Shin, Youngchul,Oh, Kang-Seob 대한불안의학회 2014 대한불안의학회지 Vol.10 No.2

Objective : The correlation between age of onset and symptoms/severity of panic disorder has not yet been determined. The aim of this research is to determine the different clinical features of panic disorder according to the age of onset. Methods : Patients diagnosed with panic disorder were placed into two groups according to onset of age. The subjects were checked for 13 different panic symptoms presented in the DSM-IV. The investigation was also executed by severity, the anxiety sensitivity index, the scale for depression and anxiety. Results : The early onset group had significantly higher frequencies than the late onset group in the areas of "choking feeling" and "derealization or paresthesia". It was found that only "choking feeling" was statically significant as a risk factor of early onset panic disorder. Among the objective anxiety scale, the subscale of psychological anxiety was higher in the early onset group compared to the late onset group. Conclusion : "Choking feeling" was the only panic symptom that showed a significant difference in accordance with onset age. Earlier onset patients tend to experience a more frequent "choking feeling," which is related to respiratory symptoms. This could mean that earlier onset patients are more likely to have higher psychological anxiety.

우울장애가 있는 독거노인에 대한 긍정심리 집단치료의 효과

이승원,하주원,김현수,이지희,이주영,이정애,오강섭,Lee, Seungwon,Ha, Juwon,Kim, Hyun-Soo,Lee, Jee-Hee,Lee, Ju Young,Lee, Jung-Ae,Oh, Kang Seob 대한불안의학회 2015 대한불안의학회지 Vol.11 No.1

Objective : Positive psychotherapy is based on the premise that positive thoughts and satisfaction with life are determinants for improving the symptoms of depressive disorder. This article highlights the effectiveness of group positive psychotherapy on the elderly living alone with depressive disorder in Korea. Methods : A total of 25 Korean elderly living alone with depressive disorder participated in group positive psychotherapy. The participants completed the Hamilton rating scale for depression (HAMD) and the Positive Thinking Questionnaire (PTQ) before and after the group positive psychotherapy. Results : The HAMD and PTQ scores of the participants after the group positive psychotherapy were higher than before the psychotherapy. A correlation between the age of patients and improvement of symptoms after group positive psychotherapy was found : the older the patients were, the better the improvements were. Conclusion : The study shows that group positive psychotherapy in the elderly living alone is effective in improving the symptoms of depressive disorder. The participant's age was found to be a factor that affects the improvement of depressive disorder symptoms.

불안장애의 치료추구시간에 대한 공존 정신질환의 영향 : 사회불안장애와 공황장애 간 비교

김혜민,하주원,임세원,오강섭,Kim, Hye-Min,Ha, Juwon,Lim, Se-Won,Oh, Kang-Seob 대한불안의학회 2012 대한불안의학회지 Vol.8 No.2

Objective : Individuals with anxiety disorders experience a wide range of time to seeking treatment (TST) as well as various comorbid mental disorders. The present study examined the TST in social anxiety disorder (SAD) and panic disorder. This study aimed to find out the influence of comorbid mental disorder on TST of anxiety disorder through the comparison of SAD and panic disorder. Methods : This study included 311 SAD and 378 panic disorder patients at the initial visit of psychiatric clinic. Contribution of clinical (number of comorbidity, comorbid type and onset age) and demographic (current age) factors to TST were investigated by multivariate analysis. Results : The median length of TST was 14.03 years in SAD and 2.26 years in panic disorder. In social anxiety disorder, fewer comorbidity, younger onset age, and older age were factors associated with delayed TST. In panic disorder, only younger onset age was associated with delayed TST. In both disorders, comorbid depressive disorder was associated with shorter TST. Conclusion : Our data provided the differences in illness behavior needing help based on comorbid mental disorders between SAD and panic disorder. In addition to comorbid disorder, factors affecting TST of anxiety disorder requires future investigation.

투석 환자에서 연령에 따른 우울, 불안 및 긍정사고의 차이

노기원,하주원,임세원,이재은,이규백,김향,오강섭,Noh, Ki-Won,Ha, Juwon,Lim, Se-Won,Lee, Jae-Eun,Lee, Kyu-Beck,Kim, Hyang,Oh, Kang-Seob 대한불안의학회 2013 대한불안의학회지 Vol.9 No.1

본 연구는 혈액 투석 중인 성인 환자 집단과 노인 환자 집단 간의 우울, 불안 및 자율신경기능의 차이를 비교해 보고자 하였다. 정신의학적 특징들과 자율신경기능을 비교해보았을 때 만성질환에 견디어 내는 능력에 있어서 노인 환자 집단이 성인 환자 집단에 비해 취약하지 않은 결과를 보였다. 이는 만성질환을 앓고 있는 동일한 상황에서 노인들이 보다 긍정적 사고 경향을 가지고 있는 것과 관련되어 있을 것으로 생각된다. Objective : The end-stage renal disease patients who shared fear of death, functional impairment due to hemodialysis are vulnerable to depression, anxiety and other mental problems. It is possible that their psychiatric characteristics and related autonomic nervous functions have some differences depending on their age. We purpose to find the differences of psychiatric characteristics and related autonomic nervous functions between adult and elderly hemodialysis patients. Methods : Our subjects are end-stage renal disease hemodialysis patients composed of 39 adults (<65 years) and 24 seniors (${\geq}65$ years). Outcome measures included the 17-item Hamilton Rating Scale for Depression, The Hamilton Rating Scale for Anxiety, The Apathy Evaluation Scale and Mini-International Neuropsychiatric Interview by clinician. And subjects fulfilled self-report scale, The Positive thinking scale and The Snaith-Hamilton Pleasure Scale. The autonomic nervous functions are measured by heart rate variability. Results : There are no significant differences in demographic factors between two groups. The 17-item Hamilton Rating Scale for Depression, The Hamilton Rating Scale for Anxiety, The Apathy Evaluation Scale, The Snaith-Hamilton Pleasure Scale and autonomic nervous functions are also not different. But only positive thinking scale is higher in adult hemodialysis group than the elderly (F=5.395, p=0.024). Conclusion : This study compared depression, anxiety and autonomic nervous functions between adult and senior hemodialysis patients. There are no significant differences in psychiatric characteristics and autonomic nervous functions between two groups except positive thinking traits. Senior patients endured their chronic disease similar to adult patients did in spite of their old age. This result suggests that elderly's higher positive thinking traits affect their endurances about the negative situations.

정신건강의학과 자문 의뢰된 암 환자의 항우울제 내약성 비교 연구

고은미,박진성,하주원,임세원,김태석,하지현,백종우,이병철,최병무,이강준,김성완,양종철,고영훈,오강섭,Ko, Eunmi,Park, Jin-Seong,Ha, Juwon,Lim, Sewon,Kim, Tae-Suk,Ha, Jee Hyun,Paik, Jong-Woo,Lee, Boung Chul,Choe, Byeong Moo,Lee, Kang-Joon,Kim, Sun 한국정신신체의학회 2013 정신신체의학 Vol.21 No.1

연구목적 암환자들은 다양한 정신건강의학과적 증상을 겪으며 약물 부작용에 취약하다. 본 연구는 정신건강의학과 자문 의뢰된 암환자에서 항우울제의 내약성을 비교하고자 한다. 방 법 9개 대학병원 및 종합병원 정신건강의학과에 자문 의뢰된 암 환자들을 후향적으로 검토하여 자료를 분석하였다. 가장 빈번하게 처방된 세가지 항우울제(Escitalopram, Mirtazapine, Paroxetine)의 6개월 동안 치료 중단율을 비교하였다. 결 과 처방 빈도는 Escitalopram 150(47.2%), Mirtazapine 92(28.9%), Paroxetine 76(23.9%) 순서로 항우울제 투여 중단 비율은 세군 간 유의한 차이가 없었다. 입원 환자에 비해 외래 환자에서 유의하게 약물 중단 위험도가 높았다(p<0.0001). 결 론 임상 현장에서 암환자의 항우울제 치료 중단율은 약물 종류에 따라 차이가 없었다. 치료 순응도 향상을 위하여 암환자의 특성을 고려한 개별 접근이 필요할 것이다. Objectives : Many patients diagnosed with cancer suffer from various psychiatric symptoms such as depression, anxiety and insomnia as well as cancer itself. Patients with cancer are more vulnerable to possible adverse events of psychotropic medications. Although antidepressants are widely used among cancer patients, there is little information about tolerability of antidepressants. This study was conducted to compare tolerability of antidepressants in cancer patients referred for psychiatric consultation. Methods : The participants were cancer patients who had been referred to psychiatrist for their psychiatric symptoms. We retrospectively analyzed the data of patients diagnosed with cancer from 9 general hospitals in Korea. The discontinuation rate for a 6 months period after treatment initiation for three antidepressants(Escitalopram, Mirtazapine, Paroxetine) were compared. Results : Antidepressants were prescribed for 96.3% of subjects and Escitalopram 150(47.2%), Mirtazapine 92(28.9%) and Paroxetine 76(23.9%) were prescribed frequently in order There were no significant differences in discontinuation rates among the three antidepressants during the 6 month period after initiation of pharmacotherapy. But there was a difference in discontinuation rates between inpatients versus outpatients(p<0.0001). Conclusions : In a naturalistic setting for the antidepressant treatment for cancer patients, it seems that there are no differences in discontinuation rates among these three antidepressants. It is therefore essential that such interactions are carefully considered when treating patients of antidepressants who already have cancer.

정신장애인이 진행하는 인권교육 프로그램의 효과

안지윤(Jiyun Ahn),하주원(Juwon Ha),윤미경(Mi-Kyung Yun),김정진(Jung-Jin Kim),최원화(Won-Hwa Choi),김현수(Hyun-Soo Kim) 대한사회정신의학회 2015 사회정신의학 Vol.20 No.1

연구목적 : 인권교육은 정신장애인들에게 있어 그들 자신을 차별로부터 보호하고, 사회적 낙인을 극복하는 데에 중요한 역할을 한다. 본 연구는 정신질환이 있는 당사자가 정신장애인을 대상으로 하는 인권교육에서 직접 강사로 활동하도록 하는 프로그램을 시행하여 효과를 알아보고자 하였다. 방 법 : 경기도내 정신보건센터에 등록된 조현병 혹은 양극성 장애와 같은 만성 정신 질환자 중에서 자원한 40명을 대상으로 하였다. 지원자들은 인권교육 강사 양성교육을 받은 뒤 다른 기관으로 가서 인권교육을 진행할 수 있었으며, 이와 같은 ‘인권 백도씨’ 프로그램을 10주에 걸쳐 1주간격으로 10회기로 진행 하였다. 인권교육의 전과 후에 장애수용척도(Acceptance of Disability Scale Revise, AD-R), 역량 강화척도(Empowerment scale), 한국어판 정신건강회복 척도(Mental Health recovery Measure, MHRM-K)와 같은 자기보고식 설문을 진행하였다. 결 과 : ‘인권 백도씨’ 프로그램 시행 후 역량 강화 척도는 51.3±11.8에서 52.9±12.5로(Cohen’s d -0.13, effect-size r -0.066) MHRMK는 79.3±12.9에서 81.6±12.5(Cohen’s d -0.18, effect-size r -0.090)로 각각 증가하였다. 결 론 : 정신장애인이 진행하는 인권교육프로그램은 역량 강화와 장애 수용 측면에서 효과적이었다. ‘인권 백도씨’ 강사 양성프로그램은 정신과적 직업재활의 새롭고 효과적인 대안이 될 수 있겠다. Objective : Human rights education is important for the patients with mental disorders to protect themselves against discrimination and to overcome their stigmas. This study investigated the effectiveness of educating people with mental disorders about human rights, when it was given by the ones having mental disorder as well. Methods : Forty volunteers with chronic mental illnesses, schizophrenia or bipolar disorder who were registered in mental health centers in Gyeonggi-do were recruited. They received lecturer training program of human rights by trained instructors who conducted a total of 10 sessions over a period of 10 weeks with 1-week intervals called ‘Human Rights 100℃’. After the training, people with mental illnesses could educate other people about human rights. We administered self-reported questionnaire, which included Acceptance of Disability scale Revise (AD-R), Empowerment scale, and a Korean version of Mental Health Recovery Measure (MHRM-K) before and after the human rights education. Scale change before and after program is analyzed by paired t test. And repeated measured ANOVA was used to analyze the factors affecting the changes after the program. Results : The program ‘Human Rights 100℃’ was effective in improving Empowerment scale (from 51.3±11.8 to 52.9±12.5, Cohen’s d -0.13, effect-size r -0.066) and MHRM-K (from 79.3±12.9 to 81.6±12.5, Cohen’s d -0.18, effect-size r -0.090). Conclusion : It was effective that people with mental illness were trained as lectures for human rights education for empowerment and acceptance of disability. ‘Human Rights 100℃’ training program was newer and effective alternative in vocational rehabilitation in psychiatry.

병적 도박의 치료

신영철(Young-Chul Shin),하주원(Juwon Ha) 한국중독정신의학회 2013 중독정신의학 Vol.17 No.1

This article highlights the recent development of pharmacological and non-pharmacological treatment for pathological gambling. Diagnosis and patients selection is required for further adequate treatment. Although there are, no approved pharmacological treat-ments for pathological gambling, efficacy of opiate antagonist and mood stabilizers have been reported. Among non-pharmacological treatments, cognitive-behavioral therapy is most widely used. Some important issues in cognitive-behavioral therapy for pathological gambling are also introduced.

가출청소년에서 우울증상과 애착 및 중독문제

고미애(Miae Ko),홍민하(Minha Hong),김영은(Young-Eun Kim),하주원(Juwon Ha),이상민(Sang Min Lee),김현수(Hyun-Soo Kim) 대한소아청소년정신의학회 2016 소아청소년정신의학 Vol.27 No.3

Objectives: This study investigated the relationship between depression, attachment and addiction problems in runaway youths. Methods: We sent a questionnaire package to 187 runaway youths in 18 adolescent shelters. The questionnaire package collected their sociodemographic data and included the Patient Health Questionnaire-9, Inventory of Parent Attachment (IPA), Korean Internet Addiction Self-Scale (K-Scale), Korean version of Alcohol Use Disorders Identification Test, and Korean version of the Fagerström Test for Nicotine Dependence. Results: The percentage of youth with depression was 28.8% (N=54). In the depression group, there were significantly more problematic alcohol users (53.06%, p=.0199) and significantly lower IPA scores (p=.0064). There was a significant negative correlation between depression and a IPA, and significant positive correlation between depression and the K-Scale. Conclusion: These results suggest that runaway youths with depression have more problematic alcohol drinking and attachment problems.