孫昌涉 初期作品의 精神分析的 考察 : [死緣記], [비오는 날], [生滑的]을 對象으로 하여 Sa-yun-kee(a Death Record), Bi-o-neun-nal(a Rainy Day), and Saeng-hwal-chuk(Being Realistic)

趙斗英 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.2

The author has previously explored the psychodynamics of a Korean writer, Chang-Sup Sohn, based on his autobiographic novel, and the creative process of his maiden work in psychoanalytic point of view. In this article, the focus is placed on the psychodynamics of the creative processes on first three short-stories after the maiden work, namely "a Death Record", "a Rainy Day" and "Being 'Realistic". "A Death Record" is a story about a young man, whose personality is described as similar to that of the writer, supporting his friend and the family. This friend had married to the hero's fiancee while the hero was imprisoned as a political prisoner in North Korea. The friend is in terminal state of pulmonary tuberculosis, and becomes paranoid. After witnessing a physical violence of the friend against the friend's wife, the hero had a dream in that he fought against and wrestled with his friend to protect the woman. Using other materials in the story the author interpreted this dream as the fulfillment of the unconscious erotic wishes of the hero directed to the wife of his friend. Expanding this interpretation further to the creative process of the writer the author concluded that the fulfillment of the unconscious incestuous wishes toward his widowed mother who had seduced and deserted him during his latency period was the nuclear creative motivation of this fiction. "A Rainy Day" is a story about a young unmarried crippled woman, who was deserted without any mean in an half-ruined cottage totally exposed to the heavy rains in summer monsoon season during the Korean War by her elder brother. It was found that the creative motivation originated from the writer's suffering from persistent enuresis in childhood ; the cottage represented the enuretic body, and the young woman the writer as a child. "Being Realistic" is a story in that a passive poor young man loses his lover to an aggressive, able and greedy middle-aged man, and an orphan girl in anaclitic depression whose widowed mother stays in North Korea across th front dies of pulmonary tuberculosis. The author concluded that the writer's previous affective state and longing for the mother in childhood after his widowed-mother deserted him by elopement seemed to be the base of the creative impulse of this story.

흰쥐 視床下部 神經細胞의 [met]^(G4635)-enkephalin과 Oxytocin 同所存在性에 關한 免疫組織化學的 硏究

李永植,李永基,張家鏞,趙斗英 서울醫大 1990 精神醫學 Vol.15 No.2

그레이브스병에서 치료에 따른 폐동맥압의 변화

남택만,조한수,이진서,송영림,김두만,두영철,박철영,정인경,홍은경,이성진,오기원,김현규,유재명,최문기,유형준,박성우 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.5

연구배경: 갑상선기능항진증에 의한 갑상선중독증 환자들은 호흡곤란을 호소하며, 그 원인으로 호흡근의 근력 약화, 좌심실부전으로 인한 폐모세혈관의 울혈, 기도저항의 증가, 갑상선종으로 인한 기관의 압박, 호흡기능 이상 등이 거론되고 있다. 폐동맥고혈압이 동반된 그레이브스병 환자가 여러 증례가 보고되었으며, 폐동맥고혈압 환자에게서 갑상선 자가항체와 갑상선기능저하증의 빈도가 높음이 알려지면서 갑상선중독증이 동반된 그레이브스병 환자에게서 관찰되는 호흡곤란의 한 원인으로 폐동맥압 증가가 작용할 가능성이 제시되고 있다. 이에 저자 등은 그레이브스병 환자를 대상으로 폐동맥압을 측정하고 치료 전후의 폐동맥압의 변화를 전향적으로 연구하였다. 방법: 갑상선중독증이 동반된 그레이브스병 환자와 정상 갑상선기능을 나타낸 대조군을 대상으로 갑상선기능검사 및 갑상선 자가항체를 측정하고, 심초음파를 이용하여 치료 전후로 폐동맥압을 측정하여 폐동맥압과 갑상선기능 및 갑상선 자가항체와의 관계, 폐동맥압의 변화 등을 관찰하였다. 결과: 1. 연구대상은 대조군 10명 (남녀비 1:9, 관해 상태의 그레이브스병 3명, 갑상선종 3명, 정상인 4명), 그레이브스병 환자 26명 (남녀비 7:19)이었다. 2. 대조군과 치료 전 그레이브스병 환자의 폐동맥압은 각각 23.5±2.32 mmHg, 29.6±10.3 mmHg이었고, 치료 전의 폐동맥압과 혈청 갑상선자극호르몬 결합억제 면역글로불린 (TBII) 농도는 유의한 양의 상관관계를 보였다. 3. 26명의 그레이브스병 환자 중에서 10명 (38.5%)이 폐동맥고혈압 (기준: 폐동맥압 > 30 mmHg)으로 진단되었다. 4. 치료 전후로 폐동맥압을 측정한 13명은 폐동맥압이 치료 전 29.6±10.3 mmHg에서 치료 후 폐동맥압 22.2±6.48 mmHg로 의미있게 감소하였다. 결론: 갑상선중독증을 보이는 그레이브스병 환자의 약 40% 정도에서 폐동맥고혈압이 발견되어 폐동맥고 혈압은 그레이브스병에 흔하게 동반하는 질환으로 생각된다. 향후 그레이브스병 환자에서 관찰되는 폐동맥압의 증가와 관련한 병인, 발생기전 및 임상적 의의 등에 대한 연구가 필요할 것으로 생각된다. Background: Exertional symptoms, dyspnea and impaired effort tolerance are common in patients with Graves' disease. Proposed explanations include: high-output left heart failure, ineffective oxygen utilization and respiratory muscle weakness. In addition, pulmonary hypertension has also been reported in patients with Graves' disease. A high prevalence of hypothyroidism and positive thyroid autoantibody were also observed in patients with pulmonary arterial hypertension. Therefore, the pulmonary artery pressure in patients with Graves' disease was evaluated. Methods: Two-dimensional and Doppler echocardiographic examinations (Hewlett Packard Sonos 2500) were performed to determine the pulmonary artery (PA) pressure in 26 Graves' disease patients, both before and after treatment (23 patients with propylthiouracil and 3 with RAI), and in 10 euthyroid controls. The changes in the PA pressure after treatment were evaluated in 13 patients with Graves' disease, who became euthyroid after treatment. Results: The pulmonary artery pressure was increased in the untreated Graves' disease patients compared to the normal controls (23.5±2.32 vs. 29.6±10.3 mmHg). 38.5% of the Graves' disease patients (10/26) showed pulmonary arterial hypertension (PA>30 mmHg) and the serum TBII level was higher in the Graves' disease patients with pulmonary arterial hypertension than in those with normal PA pressure (P<0.05). In the Graves' patients who became euthyroid after treatment, the PA pressure was significantly decreased. Conclusion: 38.5% of the untreated Graves' disease patients showed pulmonary arterial hypertension, and the pulmonary artery pressure was significantly decreased in those who became euthyroid after treatment. The pathogenesis and clinical importance of pulmonary arterial hypertension in Graves' disease requires further studies (J Kor Soc Endocrinol 18:465∼472, 2003).

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

아마데우스'의 精神分析的 理解

趙斗英 한국정신분석학회 1997 精神分析 (Psychoanalysis) Vol.8 No.2

韓國古典小說 '沈淸傳'의 精神力動的 硏究

趙斗英,柳仁均 大韓神經精神醫學會 1992 신경정신의학 Vol.31 No.2

We have examined the classic novel, Sim Chong Chon whose main theme is filial piety, upon the assumption that the collective unconscious finds its way into the folktale and thus we can gain some insight into the collective unconscious of Korean people through studies of folktales such as Sim Chong Chon. While much research hitherto has explained the extremity of her filial piety as a product of her natural goodness, this study focused on the family dynamic to determine what make her filial piety so extreme. Sim Chong's father has implicitly demonstrated hostility toward Sim Chong since his wife's death soon after Sim Chong's birth. Some part of her motive for filial piety stems from her guilty feelings towards her father because of her reactive hostility to his treatment of her. The fact that Sim Hak-Gyu, the object of filial piety, is described as selfish and exploitative may reflect the unconscious repulsion of Koreans against the Korean culture in which filial piety receives too much emphasis. Also, Sim Chong's Oedipus Complex is one of the two motives of her filial piety. By making Sim Chong recognize her dead. but potent mother as a model to follow and the rival to compete with, her Oedipus Complex becomes an important motive for masochistic filial piety with her counter aggression against her father's anger and hostility toward her.

FREUD의 '少年 Hans' 症例硏究(Ⅰ) : 恐怖症의 古典的 解釋

趙斗英 한국의학사 1986 診斷과治療 Vol.6 No.5

大學院課程學生(또는 專攻醫)選拔方案 : 精神醫學分野를 中心으로

趙斗英,李定均,禹鐘仁,李符永,洪剛義,金重述 大韓神經精神醫學會 1982 신경정신의학 Vol.21 No.1

본 연구는 우리나라 대학원을 육성코져 하는 의도에서 발달한 1980년도 文敎部 硏究費의 보조를 받아 우리나라에서의 정신의학분야 대학원생을 어떻게 선발하는 것이 최선이냐는 데에 대한 方案을 제시하는 데 그 목적을 둔 것으로, 저자들은 이에 수반하여 이분야 專攻醫의 선발방안도 아울러 연구코져 하였다. 먼저 저자들은 우리나라 현행 대학원생 선발의 예로 서울대학교를 들어 이를 검토한 결과 그 특징으로, 첫째 선발의 주도권이 해당 科(敎室)가 아닌 醫大에 있다는 것과, 두째 서류전형이 없고 면접고사는 형식적인 것에 불과한 반면 영어와 임상의학에 치중된 필기고사가 그 당락을 좌우한다는 사실을 발견·지적하였다. 다음 저자들은 우리나라 현행 전공의선발의 예로 서울대학교병원을 들어 이를 검토한 결과 그 특징으로 첫째 선발의 주도권은 형식상 병원측에 있으나 실제에서는 신경정신과측과 병원측에 양분되어 있었고 그 비중은 科側이 病院側 보다 높다는 인상을 받았다는 것이고, 두째는 이 역시 대학원생 선발과 마찬가지로 서류전형은 없고 영어와 전공과목인 2과목의 필기고사 성적에 그 당락이 좌우됨을 발견하였다. 이같은 우리나라 경우에 비해 Cornell 대학병원 정신과를 예로 든 미국의 전공의 선발과정의 특징은 첫째 서류전형에서 부터 출신의대와 의대성적을 중점 참고하여 탈락이 속출하고, 두째 필기고사는 없으되 다수의 면접위원에 의한 철저하고 엄격한 면접고사에서 최종 당락이 결정된다는 것, 세째 선발의 모든 권한과 책임이 전적으로 해당과에 부여된다는 점이었다. 위와 같은 자료를 준비한 뒤 저자들은 1981년 8∼9월 大韓神經精神醫學會會員으로 있는 專門醫(교수 포함)92명, 專攻醫 94명(대학원생 포함), 도합186명에게「전공의 및 대학원생 선발방안에 대한 질문서」를 발송하여 그 61%인 전문의 59명(전임교수 43명 포함)과 전공의55명(대학원생 49명 포함)도합 114명에게서 회신 받은 것을 종합·평가·분석하여 본선발방안을 작성하였던 바, 현재로서 이 방안은 본연구의 부수목적이었던 신경정신과 전공의선발에는 약간의 무리를 무릅쓰면 즉시 사용할 수 있는 것 임에 비하여 본 목적이었던 대학원생선발에는 그 대학원제도 자체가 지닌 산적한 制度上·運用上의 근본문제로 인하여 즉시 사용은 불가능한 상태임을 알아내었고, 따라서 저자들은 이들 妨害要素 4가지를 제시하면서 대학원 정책입안자들의 高次元的 決斷을 촉구하였다. 이러한 制約이 있음을 前提로 하여 著者들은 다음과 같은 精神醫學分野 大學院課程學生 選拔方案을 제사하는 바이다.―① 학생(전공의) 선발의 모든 권한과 책임은 醫大와 病院이 아닌 科와 敎室이 갖도록 한다. ② 응모에 마감은 해마다 정하되 각 대학원 또는 병원은 각기 독자적으로 다르게 일자를 정하는 것이 좋다. ③ 경쟁율이 높은 대학원 또는 병원은 書類銓衡을 일차적으로 하는 것으로 하되 주로 의대성적·인턴근무·성적·추천서·인턴병원에 관한 사항을 참작토록 한다. ④ 筆記考査는 폐지하던가 시행한다해도 전공과목·임상의학·영어의 3과목으로 제한하며 그 합격율을 최종선발인원의 倍數 이상으로 하도록 한다. ⑤ 面接考査를 철저하고 엄격히 장시간에 걸쳐 多數委員에게서 同一지망자에게 실시토록 하되 지식위주가 아닌 인간성과 자질평가에 주안점을 둔다. ⑥ 선발과정에 있었던 모든 토의·결정사항에 관계되었던 것을 文書化· 機密化하여 半永久 保存함으로써 公正度 유지에 전력을 다한다. No study has been known yet in Korea on evaluation of the students selection system in graduate course while there have been some outspoken critics to the present system in the past several years. Comparison between on-going Korean and American systems was made, and opinions of a group of 59 board-certified leading psychiatrists(including 43 full-time faculty staffs) and 53 psychiatric residents (including 49 graduate course students) on the ideal and best suitable selection system obtained via questionaire method were assessed. On the basis of this assessment, following recommendations were finally made for the future occasions of the selection: 1) Initiatives and whole responsibilities of the selection is preferred be lied in the hands of department of psychiatry instead of medical school authorities. 2) Different application time-limits set for each graduate school are desirable for the conveniences of applicants who want to apply for several places. 3) Preliminary selection on the basis of academic grades in medical school, hospital of the present internship, and recommendation lecters from deans and directors of internship is desirable. 4) Written test for evaluation of medico-psychiatric knowledges seems less important as it does not correctly reveal whole abilities of each applicant. 5) Interview by more than two faculty members for each applicant, not as oral-test style for medico-psychiatric knowledges only, but as evaluation of whole person, is strongly recommended. 6) Those above-mentioned ideas seem highly-reasonable and immediately applicable to the present psychiatric residents selection system without much difficulties, while those could cause severe turmoil in the present graduate school system unless there were some basic and radical changes in medical education system in Korea as to parallel to he international standard.

李箱 初期 詩作品의 精神分析

趙斗英 大韓神經精神醫學會 1978 신경정신의학 Vol.17 No.1

(1) This study was intend to examplify the way of Freudian psychoanalytic approach to poetry, by analyzing unconscious materials and motivations of three poems written by Yi-Sang who has kept a notoriety as the most difficult poet to understand in the recent history of Korean literature, and it could be also, the second part of "psychoanalytic studies on Yi-Sang", related with the author's previous article," analysis of Yi-Sang's early works (focused on the Maiden Novel, December 12th)". (2) In the first part of the article, the author has made a review of psychological interpretations of creative process in poetry done by poets themselves (from Wordsworth to Spender), and reorganized their notions in terms of psychoanalytic approach applying the theories of freud, Kris, and others on creative process. (3) Then the author has reconstructed Yi-Sang's personal history from the birth up to the point of writing those 3 poems. (4) The author could uncover from the poem , "the first memorandum on the line", his conflict, between unconscious wish to flee from the adopted parents into the arms of the natural mother and the counterforce to rationalize his being as that his natural mother might have had neglected him during the pre-adoption period , from the poem, "a strange reversible reaction", his ambivalence to his adopted father and the natural parents, and his volcanic rage toward the adopted mother, and from the third poem, "physical exercise", his feelings of jealousy and sibling rivalry toward the younger brother who stayed with the natural parents.

映畵와 精神分析

趙斗英 한국정신분석학회 1997 精神分析 (Psychoanalysis) Vol.8 No.1