[사목 자료] 손진욱 교수의 정신의학 이야기

손진욱 미래사목연구소 2011 사목정보 Vol.4 No.5

[사목 자료] 손진욱 교수의 정신의학 이야기

손진욱 미래사목연구소 2011 사목정보 Vol.4 No.4

[사목 자료] 손진욱 교수의 정신의학 이야기

손진욱 미래사목연구소 2011 사목정보 Vol.4 No.3

일개(一個) 대학병원(大學病院) 초입원환자(初入院患者)의 불면증(不眠症) 유병률(有病率), 원인(原因) 및 약물처방(藥物處方)에 관한 연구(硏究)

손진욱,이태우,Sohn, Jin-Wook,Lee, Tae-Woo 대한수면의학회 1997 수면·정신생리 Vol.4 No.1

The purpose of this study was to investigate the prevalence, primary causes, and management of insomnia newly admitted patients in a university hospital. Subjects consisted of 168 adult patients (95 men and 73 women, 88 medical and 94 surgical patients) newly admitted to Gyeongsang National University Hospital from September 7 through September 27, 1996. Sleep patterns of all subjects in the usual nights before admission(UN), the previous night to admission(PN), the night on admission(ON), and the 5th night after admission(5N) were investigated using the Korean version of the St. Mary's Hospital Sleep Questionaire. In addition, all insomnia patients and their doctors and nurses in charge were interviewed by psychiatric residents. Additionally, their medical records were reviewed. Prevalence of insomnia were 22.6% in the UN, 42.9% in PN, 51.8% in ON, and 43.5% in 5N. The prevalence of insomnia was significantly increased immediately before and after admission. There were no significant differences in the prevalence of insomnia by age and sex. The most ammon primary causes of insomnia were somatic symptoms and psychological factors in PN, somatic symptoms and noise in ON and 5n. Only 17 (10.1%) of insomnia patients took medicstions for insomnia control(analgesics in 15, hypnotics in 2). These results shorred that the prevalence of insomnia was significantly increased on hospitalization due to somatic symptoms, environmental factors, and psychological factors, but nearly none were adequately managed.

경남 일부지역 농민들의 수면습관

정근화,손진욱 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.6

In order to investigate the sleep habits of farmers in a rural area, we studied 270 subjects(farmers) in a rural area from August 14, 1995 to August 19, 1995. Sleep habits were analyzed according to age groups(3 groups of 18-30, 31-50, over 51 years) and sex. The results were as follows : 1) The mean sleep length was 6.7±1.5 hours, and was longer in female than in male. In the above 51-year-old age group, sleep length was significantly shorter than those in the other two age groups. 2) The mean sleep latency was 21.6±21.5 minutes, and was longer in female than in male. There were no significant differences in sleep latency among age groups. 3) The sleep onset time was later in the 18-30-year-old age group than in the other two age groups. The awakening time was earlier in the over 51-year-old age group than in the other two age groups. 4) One hundred and four subjects(38.5%) complained difficulty falling asleep, 196 subjects(72.6%) complained fragmented sleep, and 86 subjects(31.9%) complained early morning awakening during the past two weeks. Difficulty falling asleep and fragmented sleep were more common in females than in male. 5) One hundred and seventeen subjects(43.3%) had napped during the past two weeks and there were no significant differences among age groups. 6) One hundred and sixty five subjects(61.1%) experienced daytime drowsiness during the past two weeks and there were no significant differences among age groups. 7) Ninety-one subjects(33.7%) reported nightmares, 32 subjects(11.9%) reported sleeptalking 3 subjects(1.1%) reported sleepwalking, and 15 subjects(5.6%) reported bruxism during past two weeks.

대형정신병원 입원환자의 수면제 처방에 관련된 인자

김현숙,서혜수,송인제,손진욱 대한생물치료정신의학회 1997 생물치료정신의학 Vol.3 No.1

만성화된 환자들이 주로 입원하여 있는 대형정신병원에서 수면제의 처방에 영향을 미치는 요소들을 조사해 보고자 하였다. 1996년 10월 2일 국립부곡정신병원에 입원해 있는 환자 402명을 대상으로 병록지조사를 통해 입원시부터 조사당일까지의 수면제 사용을 조사였다. 담당의사의 routine order에 의한 수면제 처방의 여부, 담당의사의 p.r.n. order에 의한 처방 여부, 당직의사에 의한 수면제 처방 여부를 조사하여 환자의 나이, 성별, 진단, 입원횟수, 유병기간, 담당의사의 정신과 근무 연수 등의 변수에 따라 비교해 다음과 같은 결과를 얻었다. 1) 207명(51.5%)이 재원기간동안 최소한 일회 이상 수면제를 복용하였고, 195명(48.5%)은 수면제를 복용한 적이 없었다. 2) 담당의사의 routine order에 의한 수면제 처방의 빈도는 남자에 비해 여자에서 높았다. 3) 담당의사의 routine order에 의한 수면제 처방의 빈도는 전문의가 담당의사인 환자군에서 높았다. 4) 담당의사의 p.r.n. order에 의한 수면제 처방의 빈도는 전공의 1년차가 담당하는 환자나 전문의가 담당하는 환자에서 높았다. 5) 연령, 진단, 유병기간, 입원횟수 등은 수면제 처방의 빈도와 유의한 관계가 없었다. 이상의 결과를 통해 국립부곡정신병원의 입원환자에서 수면제의 처방이 환자의 성별과 담당의사의 정신과 근무 연수와 관계됨을 알 수 있었다. The purpose of this study was to investigate the factors that were associated with the prescription of hypnotics in inpatients of a large mental hospital. The medical records were reviewed in 402 inpatients who were admitting in Bugok National Mental Hospital at October 2, 1996. The results were as follows: 1) Fifty-one percent of the whole group received a hypnotics at least once during hospitalization. 2) The prescription of hypnotics by routine order of doctor in charge was more frequent in female patients than male patients. 3) The prescription of hypnotics by routine order of doctor in change was more frequent in patients whose doctor in charge was a psychiatric specialist than patients whose doctor in charge was a psychiatric resident. 4) The prescription of hypnotics by p.r.n. order of doctor in charge was more frequent in patients whose doctor in charge was a first-year psychiatric resident or a psychiatric specialist than a second, a third, or a forth-year psychiatric resident. 5) Age, duration of illness, frequency of admission, and diagnosis were not significantly associated with frequency of hypnotics prescription. These findings suggest that the prescription of hypnotics in inpatients of Bugok National Mental Hospital was positively associated with patient's sex and duration of service of doctor in charge.

전기경련충격이 흰쥐 뇌의 Glutamine Synthetase의 활성도에 미치는 영향에 관한 연구

손진욱 大韓神經精神醫學會 1990 신경정신의학 Vol.29 No.3

In order to elucidate the machanism of action of electroconvulsive shock (ECS) in psy-chiatric illness, the author investigated the effect of electroshock on glutamine synthetase (GS) in rat brain. GS activities in hippocampus, corpus striatum and cerebral cortex were measured after single, multiple and regressive electroshocks (subconvulsive and convulsive doses) to nor-mal rats, and GS activities were also measured after ECS in methionine sulfoximine trea-ted rats. Major findings were that ten daily ECS (multiple ECS) decreased GS activities in the hippocampus and four ECS in 30 min interval (regressive ECS) reinforced the GS inhibi-tion of methionine sulfoximine. These findings suggest that GS may play a signifncant role in the mechanism of action of ECS and need further studies.

만성정신분열병환자의 혈장 및 뇌척수액내 β-Endorphin 양물질의 함량에 관한 예비적 연구

김용식,김이영,박상철,손진욱 大韓神經精神醫學會 1983 신경정신의학 Vol.22 No.2

만성정신분열병 환자 40명 (남 20, 여 20)을 대상군으로 하고 정상인 및 신경과 환자 12명을 대조군으로하여 혈장 및 뇌척수액에서의 β-endorphin 함량을 방사선 면역측정법으로 연구했다. 여기서 얻은 중요한 결과로는 항정신병 약물을 17일간 투약 중단했을 때 β-endorphin의 함량은 혈장에서 대조군은 63.2±11.9pg/ml인데 비하여 대상군은 116.7±15.9pg/ml였고, 뇌척수액에서는 대조군이 64.6±12.0pg/ml인데 비하여 대상군은 94.1±9.0pg/ml로 양군 간에 유의한 차이는 없었다. 대상군을 haloperidol군과 bromocriptine군으로 양분하여 각각 21일간 투약한 후에 혈장 및 뇌척수액에서의 β-endorphin 함량을 측정했을 때 haloperidol군에서는 투약전의 혈장에서 120.4±42.1pg/ml이었으나 투약 후는 48.8±16.3pg/ml로 유의한 차이가 있었고 1일 0.6mg의 haloperidol 투여군에서는 투약전의 혈장에서 122.7±26.1pg/ml인 것이 46.6±10.5pg/ml로 뇌척수액에서는 99.8±16.3pg/ml인 것이 29.3±6.2pg/ml로 각각 유의한 차이가 있었다. 한편 β-endorphin의 혈장 및 뇌척수액에서의 함량과 BPRS 총득점으로 본 정신중상과 AIMS로 본 지연성 운동장애와는 관련성이 없었으며 1일 0.6mg의 bromocriptined의 정신분열병 및 지연성 운동장애에 대한 치료 효과는 찾아볼 수 없었다. (본 연구에 많은 도움을 주신 서울의대 예방의학교실의 안윤록 조교수님, 생화학교실원, 박행욱 전 용인 정신병원장님을 비롯한 용인정신병원 직원 여러분에게 감사드립니다.) In order to evaluate the relationship between endorphin system and dopamine system in chronic schizophrenia, we have examined β-endorphin like substance level in the plasma and CSF of 40 chronic schizophrenia(male 20 and female 20, mean age 30.1±14.6) with β-endorphin radioimmunoassay kit supplied by New England Nuclear. There were no significant differences in plasma and in CSF between mean β-endorphin levels of the schizophrenia after 17days antipsychotic drugs withdrawal period (plasma 116.7±15.0pg/ml and 94.1±9.0pg/ml) and controls (plasma 63.2±11.9pg/ml and 64.4±12.0pg/ml). After 17 days antipsychotic drugs withdrawal period, the schizophrenic patients were randomly subdivided into haloperidol group (male 10 and female 10) and low dose (0.6mg/day) bromocriptine group (male 10 and female 10). The mean levels of β-endorphin were significantly reduced after 21 days haloperidol treatment compared with after 17 days antipsychotic drugs withdrawal period in plasma (before treatment, 120±42.1pg/ml and after treatment, 48.8±16.3pg/ml, p<0.005) but not in CSF (before treatment, 74.8±15.8pg/ml and after treatment 30.2±5.1pg/ml). However after 21 days low dose (0.6mg/day) bromocriptine treatment, there were significant reduction of mean levels of β-endorphin both in plasma (before treatment, 122.7±26.1pg/ml and after treatment, 46.6±10.5pg/ml, p<0.001) and CSF (before treatment, 99.8±16.3pg/ml and after treatment, 29.3±6.1pg/ml, p<0.01). No relationships between plasma and CSF β-endorphin levels and BPRS total scores of AIMS highest scores were found in the haloperidol group and the low dose (0.6mg/day) bromocriptine group.

뇌의 REM 수면 발생기전

손진욱,Sohn, Jin-Wook 대한수면의학회 1995 수면·정신생리 Vol.2 No.2

The author reviews current knowledge about what REM sleep is and where and how it is generated. REM sleep is the state in which our most vivid dreams occur. REM sleep is identified by the simultaneous presence of a desynchronized cortical EEG, an absence of activity in the antigravity muscles(atonia), and periodic bursts of rapid eye movements. Another characteristic phenomena of REM sleep are the highly synchronized hippocampal EEG of theta frequency and the ponto-geniculo-occipital(PGO) spike. All these phenomena can be explained in terms of changes in neuronal activity. Transection studies have determined that the pons is sufficient for generating REM sleep. Lesion studies have identified a small region in the lateral pontine tegmentum corresponding to lateral portions of the nucleus reticularis pontis oralis(RPO) and the region immediately ventral to the locus coeruleus, which is required for REM sleep. Unit recording studies have found a population of cells within this region that is selectively active in REM sleep. Cholinergic neurons of the giant cell field of pontine tegmentum(ETG), which is 'REM a sleep-on cells', has shown to be critically involved in the generation of REM sleep. Noradrenergic neurons of the locus coeruleus and serotonergic neurons of the dorsal raphe, which are called 'REM sleep-off cells', appear to act in a reciprocal manner to the cholinergic neurons. It is proposed that the periodic cessations of discharge of 'REM sleep-off cells' during REM sleep might be significant for the prevention of the desensitization of receptors of these neurons.

우울증의 정신력동에 관한 임상적 연구-대상상실과 자기애적 손상-

손진욱 서울대학교 의과대학 정신과학교실 1988 서울醫大 精神醫學 Vol.13 No.2