MMPI에 의한 알코올 의존의 통계적 아형분류

남궁기,조현상,김병천,현명호,안혜리,이희상,유계준 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.5

목적 및 방법 : 본 연구에서는 알코올 의존으로 진단된 남자 환자 75명을 대상으로 MMPI 점수를 이용하여 군집 분석으로 아형 분류를 시도한 후, 사회인구학적 특성과 음주와 관련된 변인으로 그 분류가 판별 타당성이 있는지를 알아보았다. 결 과 : 군집 분석 결과 전체 대상은 6(Pa)-7(Pt)-8(Sc) 프로파일의 정신병적 아형(21.4%), 2(D)-3(Hy)-1(Hs) 프로파일의 신경증적 아형(49.3%), 그리고 정상 프로파일 아형(29.3%)의 세 아형으로 분류되었다. 이 세 아형간의 연령, 학력, 결혼 상태, 음주로 인한 입원 경력, 주당 평균 음주 일수, 음주시 평균 음주량, 음주 시작 연령, 직계가족상의 알코올리즘의 가족력 유무의 차이를 비교한 결과 통계적으로 유의한 차이는 없었다. 결 론 : 본 연구의 결과는 통계학적으로 유의한 세 아형으로 분류되었으나 이 아형 분류가 판별 타당성을 갖추지 못했음을 시사한다. Obects & Methods : The authors tried to classify 75 male patients with alcohol dependence by using cluster analysis of their MMPI data, to identify the characteristics of each subtype classified through that process and to evaluate the discriminant validity of the classification. Results : The subjects were divided into 3 subtypes by K-means cluster analysis of MMPI scores : a psychotic subtype of 6(Pa)-7(Pt)-8(Sc) profile(21.4%), a neurotic subtype of 2(D)-3(Hy)-1(Hs) profile(49.3%), a normal subtype(29.3%). But, there were no statistically significant differences of age, educational level, marital status, admission history due to alcoholic problems, number of drinking day per week, average amount of ethanol consumed per drinking occasion, age at onset of drinking and family history of alcoholism among these three subtypes. Conclusion : It seems that the subjects with alcohol dependence could be classified into three subtypes with statistical significance, but this statistical classification does not constitute any evidence of discriminant validity.

心因性 無反應症

兪桂濬 연세대학교 의과대학 1984 연세의대논문집 Vol.17 No.1

性機能障碍에 對한 最近槪念 : DSM-Ⅲ-R을 中心으로 Centered on DSM-Ⅲ-R criteria

兪桂濬 大韓神經精新醫學會 1988 신경정신의학 Vol.27 No.5

The author presented introductory remarks including the brief historical review of the changes in sexual concepts from Freud's thinking to the recoent trends of human sexuality, and also described the differential comments on classification and definition of sexual dysfunctions according to DSM-Ⅱ, ICD-9, DSM-Ⅲ and DSM-Ⅲ-R, and finally centered to emphasize them adopted by DSM-Ⅲ-R. In DSM-Ⅲ, sexual dysfunctions constitute a separate category of Axis I disorders and eight distinct syndromes(table 1), and the sexual response cycle is divided into four phases : appetitive, excitement, orgasm and resolution. Before DSM-Ⅲ, sexual dysfunction was based on a biphasic model of the human sexual response and of sexual disorders, dividing them into two classes ; those characterized by disturbances of the exicitement phase, namely impotence and inhibited female excitement, and the orgasm phase dysfunctions ; premature ejaculation and retarded ejaculation in male and inhibited female orgasm. DSM-Ⅲ-R, the various observations led to the conceptualization of the triphasic concept of the human sexual responses, and to the development of specific more effective treatment approaches for the desire phase disorders. Thus, it became apparent that the sexual response cyele is comprised of three phase: desire, excitement and orgasm. DSM-Ⅲ emphasized a lack of sexual desire which previously had not been recognized as a distinct clinical entity. The notion that inhibited sexual desire constitutes a distinct clinical entity was rapidly accepted to the extent that the triphasic concept provided the theoretical basis for the new classification for sexual dysfunction adopted by DSM-Ⅲ. More recently, disorders of sexual desire have been further subdivied into two separate clinical entities in DSM-Ⅲ-R : Hypoactive sexual desire and sexual aversion disorder. The author described briefly classification and definition of six major categories of sexual disorders listed in DSM-Ⅲ-R(Table 2).

횡성군에서의 자살에 관한 연구

박기창,한정옥,유계준 大韓神經精神醫學會 1985 신경정신의학 Vol.24 No.2

An epidemiologic and psychiatric studies about suicides in Whoeng-Sung county for the past 7 years from January 1, 1977 to December 31, 1983 were conducted in order to identify overall pictures of suicides committed in this area. All the suicidal cases were obtained from the records of Whoeng-Sung police station. The authors visited homes of suicide victims and interviewed the family members, the relatives and the neighbors. The total number of suicides committed in this area during the study period was 123, and the suicidal rate was 23.4 per 100,000 population. The number, excluding the inhabitants outside this area, was 109, and the rate was 20.7 per 100,000 population. The male to female ratio was 2 to 1 and the highest rates were shown in the age group of 50-59 for male and 20-29 for female. Also, higher rates were shown in lesser educated, lower economic class, and people of Buddism and Confucianism. The main method for suicides, accounting for 76.2% of the total, was by ingestion of herbicides and insecticides for farming purposes. The place selected for the suicide was usually at victim's own house (67.9%). 82.4% of the victims have previously suggested their intention to commit suicide and of the victim have left a will. Also the suicidal rate was highest in the summer, higher in the afternoon, and higher in the beginning of the week for the male. Single men showed the highest suicidal rate. The common precipitating factors of committing suicide were family trouble, chronic illness or disability and financial difficulty. The most apparant dynamic motives of the suidides was easy self-abandonment of one's own life. Most of the suicidal victims had some psychopathologic condition (91.6%).

인지기능과 사건관계 전위

이성훈,이종섭,한은선,유계준 大韓神經精神醫學會 1990 신경정신의학 Vol.29 No.4

Event related potential(ERP) were measured in thirty one normal controls(32.9±6.3 in average age), while two kinds of stimuli, frequent and infrequent stimuli were given with an instruction(for counting infrequent stimuli), without an instruction. The amplitudes on N1, P2, P3 were significantly higher with infrequent stimuli than with frequent stimuli in ignoring condition. In instructed condition, the significantly higher amplitudes in P1, N1, P3 components were noted with infrequent stimuli than with frequent stimuli. The amplitude of P3 increased most prominently in an attending condition comparing to an ignoring condition. Good performers of this task showed significantly higher amplitudes in N1 and P3 than bad performers.

흡연 학생을 위한 지역사회 청소년 약물남용 프로그램의 효과

김도훈,낭궁기,오병훈,유계준 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.1

본 연구는 우리나라 청소년들의 약물남용중에서 가장 광범위하면서 이에대한 대책이 부족한 청소년 흡연학생을 위한, 지역사회 청소년 약물학교 프로그램의 효과를 검증해 봄으로서, 지역사회 병원과 학교간의 협조 체계를 구축, 운용하는 지역사회 청소년 약물남용 예방, 치료, 재활프로그램의 모델을 제시하고자 고안 시행되었다. 청소년 흡연학생을 위한 지역사회 약물학교 프로그램의 효과를 보기위한 기초자료를 얻기위해 연구대상 학교 경기도 성남시 소재 P 인문계 남자고등학교를 선정하고, 이 학교 학생중 무작위로 146명의 학생을 선정하여 연구대상학교의 약물남용실태를 조사하였다. 지역사회 약물학교 프로그램을 이수한 33명의 학생들을 실험군으로 하고, 연구대상학교 실태조사에 참여한 60명의 흡연집단 학생중에서 무작위로 선정한 24명의 학생을 비교군으로 하였다. 실험군과 비교군 모두 실태조사 및 프로그램 실시 8개월 후에 다시 실태조사를 실시하여 그동안의 변화를 χ²-test와 t-test로 비교하고 분석하여 다음과 같은 결과 및 결론을 얻을 수 있었다. 1) 첫 흡연시기는 대부분 중학교 3학년에서 고등학교 1학년이었으며 대부분 학생이 고등학교 1학년때 이미 습관적으로 흡연을 하고 있었다. 따라서 청소년 학생들의 흡연의 시작을 예방하거나 늦추기 위해서는, 학교에 근간한 흡연을 위한 약물남용 예방 프로그램은 국민학교때부터 시작하는 것이 필요하며, 늦어도 흡연 시작이 가장 많은 시기인 중학교 3학년에서 고등학교 1학년 학생이나 또는 흡연을 시작하기 바로 전 시기인 중학교1∼2학년 학생에 촛점을 두어 시작해야 효과가 클 것으로 생각된다. 아울러 흡연학생의 80%가 1회이상의 금연시도를 하였으며 6회 이상 시도도 약 20%를 차지하고 있었는바, 흡연 학생을 위한 금연 프로그램이 절실히 필요한 것으로 생각된다. 2) 흡연 청소년 학생을 위한 지역사회 약물학교 프로그램의 효과는 매우 긍정적이었다. 지역사회 약물학교 프로그램에 참가한 흡연학생들은 8개월 후의 추적조사에서 최근 1개월간의 흡연율이 19.2% 감소하였고 니코틴 중독점수가 변화가 없었으며 최근 1개월 동안의 음주율의 변화가 거의 없었다. 이에 비해서 약물학교 프로그램에 참석하지 않은 흡연학생은 실태조사 8개월 후에 추적조사에서 최근 1개월간의 흡연율이 22.6%가 증가하였고 니코틴 중독점수가 1.80에서 3.43으로 의미있게 증가하였고 최근 1개월 동안의 음주율이 18.1% 증가하였다. 3) 흡연 청소년 학생을 위한 지역사회 약물학교 프로그램에 참가한 흡연학생들은 교육 8개월후 추적조사에서 교육전보다 학교문제가 적었으며, 약물학교 비참여군과는 달리 가족기능이 높아지고 친구문제가 적어지는 경향이 있었으나, 흡연에 대한 지식은 낮아졌으며 흡연에 대한 태도가 오히려 호의적인 경향을 보였다. 이는 약물학교에 참여한 학생들이 학교 문제, 친구문제의 감소, 가족기능의 향상 등으로 스트레스가 감소하여 흡연에 대한 욕구가 낮아져서 흡연율이 감소된 것으로 생각된다. 이같은 결과로 미루어 볼때, 청소년을 대상으로 하는 약물남용 예방 및 치료 프로그램을 운영할 때는 약물의 유해성에 관한 직접적인 교육 뿐 아니라 청소년이 가지고 있는 심리, 정서상의 문제를 다루어 주고 해소시킬 수 있는 프로그램을 아울러 병행하는 것이 중요할 것으로 생각된다. This study was designed to suggest community-based adolescent drug abuse program model to prevent, treat and rehabilitate the adolescent drug abusers, which works by cooperation between community hospitals and schools, by proving the effectiveness of community-based adolescent drug abuse problem for adolescent smoking students since smoking is one of the most common adolescent abuse problems in the community. To gain the basic data for proving the effect of community drug abuse program for adolescent smoking students, one male high school was selected as the studying school located in Seong Nam city. Among this high school students 146 students were selected randomly to investigate drug abuse status of this school. The experimental group was 33 students who participate in community-based drug abuse problem and the control group was 24 students who were selected randomly among the 60 smoking students who participated in investigating the drug abuse status in the studying school. The both experimental group and control group were reinvestigated of the drug abuse status eight months after completion of community-based drug abuse program, and change during this period was analysed with x²-test and t-test. The results and conclusions were as follows. 1) The smoking onset time was ranged mostly from senior in middle school to freshmen in high school and the most students smoked already habitually when they were freshmen in high school. 80% of smoking students had tried to quit smoking more than one time and 20% had tried to quit smoking more than six times and failed. This data suggest that the smoking prevention program must be started as soon as possible for effectiveness of adolescent drug abuse program just before many students start smoking and the smoking cessation program for smoking students is needed desperately. 2) The community-based drug abuse program for smoking students was effective. The smoking students who participate in drug abuse program(experimental group) showed 19.2% decline of recent one month smoking rates eight months after completion of the program, but the smoking students who did not participate in drug abuse program(control group) showed 22.6% incline of recent one month smoking rates. In the experimental group, the Fagerstrom's nicotine dependance score and recent one month drinking rates showed no differance between initial and 8 month follow-up investigatement, but in the control group, the Fagerstrom's nicotine dependence scores were increased significantly from 1.80 to 3.43 and recent one month drinking rates showed 18.1% incline after 8 month follow-up periods. 3) The smoking students who participate in drug abuse program has less school problems and increased family functioning and decreasing tendency of friends problems but less knowledge about cigarettes and more permissive in attitude to smoking after eight months follow-up period. These results suggest that students who participated in community-based drug abuse program experienced reduction of stress, which results in decline of smoking rates. Therefore, I think that the drug abuse program which deals with the psychological and emotional problems of adolescents is needed as much as direct education about the harmful effect of cigarettes in adolescent drug abuse program for smoking students.

간질에 관한 사회정신의학적 연구

오석환,유계준 大韓神經精神醫學會 1971 신경정신의학 Vol.10 No.1

Feeling the keen necessity while the authors were studying on the family attitude toward epilepsy the study of the social attitude toward epilepsy was conducted. A total sample of 1,400 adults were drawn from the available population who reside in the five major areas and its outskirts. The sample contained proper proportion by sex, by age, by occupation and by educational level. A series of questions framed to detect a concept of the present day social attitude toward and knowledge of epilepsy were asked by the method of questionnaire. From the obtained results the authors have observed that knowledge of epilepsy was widespread and negative, guarding and rejecting feelings were fairly pronounced. 1) Knowledge of epilepsy was found in 94.28% of the samplings, through either having seen a seizure(53.57%) or having heard about it(40.71%). 2) When they were asked about their feeling toward epilepsy, bad feeling was expressed by 75%, unpleasant feeling by 69.21%, having epileptics around their house and 62.21% wanted to have epileptics isolated. 3) When asked if they would let their children play with epileptics, 58.57% answered No and only 17.14% said Yes. 4) Employment was objected to by 28.50% and advocated with qualification by 48.93%. 5) Marriage was approved only by 11.79% and objected to by 56.14%. But when asked if it were their own children case, 74.14% objected and only 3.29% approved. 6) Sympathetic feeling toward the family of epileptics was expressed by 72.29% and benevolent feeling by 15.64%. 7) Among those diseases including epilepsy which are generally feared by public, such as cancer, schizophrenia, poliomyelitis, syphilis, encephalitis and tuberculosis, epilepsy was feared in order next to cancer and schizophrenia. It is the author's feeling gained from the results that the public enlightenment and better understanding of epilepsy are urgently required in this society.

한국인과 중국 길림성 조선족의 우울증에 대한 횡문화적 비교 연구 : 우울 척도(CES-D)의 요인 구조에 관하여 On Factor Structures of CES-D

이동근,김만권,이호영,신승철,유계준 大韓神經精神醫學會 1991 신경정신의학 Vol.30 No.5

The center for Epidemiological Studies Depression Scale(CES-D) was developed to be appropriate for use in studies of the epidemiology of depressive symptomatology in the general population. This study was attempted to compare the factor structures of the CES-D between Koreans in Republic of Korea and in Gilin Province of People`s Republic of China. The average scores of CES-D in both groups were very similar, and the response tendency of each item of CES-D seemed to be similar in both groups. The findings reflect the influence by the same language which Koreans of both groups use. However, there was the difference between, two groups in analysis of factor structures. We also found similarities in the factor structures between Korean-Chinese women and Korean Rural samples. Therefore, their conceptualization of depressive affect as reflected in the factor analyses was considered to be quite close. This finding emphasized that Korean-Chinese women`s cultural patterns of emotion are almost identical to those of Korean Rural habitants less modernized.

정신분열병 치료효과에 대한 신경인지기능의 예측력에 관한 연구

오병훈,이희상,최의헌,현명호,조현상,유계준 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.6

연구목적 : 신경인지기능검사가·정신분열 병 환자의 혜후 및 치료에 대한 반응을 예측할 수 있는 인자로 작용할 수 있다는 연구결과들이 있었다. 이들 연구에서는 인지기능을 측정하는 검사도구 중 일부를 이용하여 치료 결과를 예측해 본 것이므로 저자들은 보다 광범위한 신경인지기능검사를 이용하여 이들 중 어떤 검사결과가 정신분열 병 환자들에 대한 치료결과를 얼마나 예측해 줄 수 있는지를 알아보기 위해 본 연구를 수행하였다. 방법: 연구대상은 BSM-IV 진단기준에 의거 정 신분열병으로 진단된 입원 환자 33명을 대상으로 최소 1주일 이상의 약물세척 후 약물투여 직전에 K-WAIS. WMS-R Vienna Test System 중 Signal Detection,Decision-Reaction Timer. Motor Performance Series 등의 신경인지기능검사를 시행하였다. 치료에 대한 반응의 평가는 Brief Psychatric Rating Scale(BPRS)와 Clinical Global Impression(CGI)을 사용하여 약물투여 전과 약물투여 후 8주에 시행하였다. 연구대상을 약물투여후 8주째의 BPRS점수가 약물투여 전의 BPRS 점수에 비해 20% 이상 호전이 있으면서 CGl 점수가 3이하인 경우를 기준으로 호전군과 비호전군으로 나눈 다음 두 군 사이의 신경인지기능검사 결과를 비교해보았다. 결 과: 신경인지기능정사에서 K-WAIS 중 언어성지능, 전체지능 Vienna Teat System 중 신호탐지력검사의 정확한 반응수, 반응 결정시간검사의 정확한 반응수 등에서 호전군과 비호전군 사이에 통계적으로 유의한 차이가 있었다. 이들 변인을 가지고 호전군과 비호전군을 구분하는 판별분석을 시행한 결과 66.7%의 환자를 정확하게 핀별하여 주었으나 통계적으로 유의하지는 않은 것으로 나타났다. 결론 : 판별 분석에 의하여 신경인지기능검사로써 환자군을 호전군과 비호전군으로 구분한 결과는 통계적으로 유의한 수준은 아니었으나, 신경인지기능검사가 정신분열병의 치료결과를 예측할수 있는 인자로 활용 될 가능성이 있음을 시사 한다. Objectives : This study was to investigate a wider range of neurocognitive function tests to find out how accurately each subtest could predict the outcomes of treatment in schizophrenics. Methods : The subjects were 33 inpatients diagnosed as schizophrenia according to DSM-IV. Each subject had a drug wash-out period of at least 1 week and had been given K-WAIS, WMS-R, and Signal Detection, Derision Reaction Timer, and Motor Performance Series in Vienna Test System just before drug administration. Treatment response was evaluated with BPRS and CGI scales before and 8 weeks artier drug treatment. We divided the subjects into responders and non-responders according to the outcomes of the above clinical scales in week 8. The responder group was defined with having 20% increase in BPRS score and a CGI score of less than 3.Then we compared the neuropsychological test results between the two groups. Results : Significantly different results between responders and non-responders were Verbal IQ and Full Scale IQ in K-WAIS, the number of correct responses in Signal Detection and Decision Reaction Timer in Vienna Test System. In discrimination analysis of the two groups using these subtests as variables, we could predict the responders with 66.7% accuracy, even though statistically non-significant. Conclusion : Although discriminating between responders and non-responders using negro-cognitive function tests were proven to be statistically non-significant, the possibility that neurocognitive function tests can be utilized to predict the treatment outcome in schizophrenia cannot be completely ruled out.

Clozapine에 의한 무과립구증

이홍식,김지현,이희상,도정호,김찬형,유계준 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.1

The authors reported one case of agranulocytosis that occurred in the clozapine treatment in a 34-year-old male patient with chronic schizophrenia. Agranulocytosis, a WBC count of 2700 with 4% neutrophils, developed on Day 25 of clozapine treatment, when clozapine was stopped. On day 26, he became febrile with temperature of 38℃ and he was treated with antibiotics, Claforan for 4 days, and received carefully daily blood monitering and observation. Six days after stopping the administration of clozapine, his WBC exhibited the normal range with increasing numbers of neutrophils(WBC, 6000/mm³; neutrophils, 43%) and he began to improve clinically. Also, we described the recent review of incidence, the natural history and implicated possible mechanisms for clozapine-induced agranulocytosis.