공황장애 환자에서 인지행동치료의 약물 감량 효과

최영희,김경미,박기환,윤혜영 대한정신약물학회 2003 대한정신약물학회지 Vol.14 No.4

Objective : The purpose of this study is to determine whether CBT is effective in tapering or discontinuing medication regardless of the type of medication and its maintenance effects after long-term follow up. Method : 224 patients meet DSM-IV criteria for panic disorder with or without agoraphobia completed 12 weekly sessions of Panic Control Therapy (PCT; Barlow et al.). 80 patients who were using benzodiazepines alone and 144 patients who were using benzodiazepines and Antidepressants were measured with several screening scales at the pre- and post-treatment. The scales were Beck Depression Inventory (BDI), Spielberg State Anxiety Inventory (STAI-State), Spielberg Trait Anxiety Inventory (STAI-Trait), Body Sensation Questionnaire (BSQ), Agoraphobic Cognition Questionnaire (ACQ), Anxiety Sensitivity Index (ASI), Panic Belief Questionnaire (PBQ). These patients were assessed at 3 months, 6 months, 12 months of follow up and they were also assessed for their medications, panic frequency, and End-State Functioning. Results : After the completion of PCP, both benzodiazepines alone group and benzodiazepines and antidepressants combination group showed significant improvement (P<0.001) in all the results of 7-self reported questionnaires. 54% of patients discontinued their medication and 90.9% of patients were in HES at post-treatment. 70 % of patients were in HES at 3 month, 6 month, and 12 month follow up. The patients who could not discontinue medication also tapered their medication afterwards. The rate of discontinuing medication was significantly higher for the patients using benzodiazepines alone (86.3%) than patients using combination of benzodiazepines and antidepressants (56.3%). Conclusion : These findings support cognitive behavioral therapy can replace medication and these effects seem to last long. 목 적:공황장애 환자들에 대한 인지행동치료가 치료 약물의 종류와 무관하게 약물을 중단하는데 도움을 주며, 장기간에 걸쳐 호전 상태를 유지할 수 있는지 여부를 검증하기 위해 이 연구를 시행하였다. 방 법:DSM-Ⅳ 진단에 따라 공황장애로 진단 받고 약물치료중인 24명의 환자를 대상으로 12회기 집단 인지행동치료를 실시하였다. 인지행동치료 전 복용 약물을 벤조다이아제핀계 약물 복용 군 80명과 벤조다이아최영희 등 375 제핀과 항우울제 병합요법군 144명의 환자군으로 나누어, 치료 전과 후에 시행한 Beck Depression Inven -tory(BDI), Spielberg State Anxiety Inventory(STAI -State), Spielberg Trait Anxiety Inventory(STAI-Trait), Body Sensation Questionnaire(BSQ), Agora-phobic Cognition Questionnaire(ACQ), Anxiety Sen -sitivity Index(ASI), Panic Belief Questionaire(PBQ)의 결과를 분석하였다. 또한, 3개월, 6개월 12개월 추적조사를 통해 각 약물군별 약물복용 여부와 최종상태기능(End-State Fungtioning)을 평가하여 분석하였고, 12개월 추적조사기간동안 약물 복용양 변화와 약물군별 차이, 최종상태기능 사이의 관계를 분석하였다. 결 과:인지행동치료 전 사용 약물의 종류와 상관없이, 인지행동치료 이후 모든 임상 변인이 통계적으로 유의미하게 향상되었다. 인지행동치료 직후, 대상군의 54%의 환자들이 약물을 끊었고 이들 중 90.9%가 상위 최종 상태를 유지되고 있었으며, 3개월, 6개월, 12개월 추적조사에서 이들의 약 70%는 여전히 상위최종상태를 유지하고 있었다. 또한 약물 복용을 중단하지 못한 환자들도 지속적으로 약물 복용을 감량하여 3개월 뒤에는 약 6%, 6개월 및 12개월 추적조사 시에는 약 68%의 환자가 약물 복용을 중단하였고 이들 역시 약 70%에서 상위최종상태를 유지하고 있었다. 벤조다이아제핀 단독 투여군의 경우 86.3%의 환자가 인지행동치료 이후 약물복용을 중단하여 이후 추가적인 약물복용이 필요하지 않았으며 이들의 약 70%는 약물 복용 없이 상위최종상태를 유지하고 있었고, 2.7%만이 약물 감량 이후 재복용 하였다. 반면 벤조다이아제핀계 약물과 항우울제 병합요법군은 57.0%의 환자가 인지행동치료 이후 약물복용을 중단하여 지속적으로 약물복용을 하지 않았다.

전산화단층촬영을 이용한 신경교종의 악성도진단에 관한 고찰

최영희 대한영상의학회 1983 대한영상의학회지 Vol.19 No.4

It is well known that the cell type ad histopathological grading of gliomas correlate well clinical course and prognosis. Therefore, it is tempting to set certain criteria that predict the histopathologic characteristics of the gliomas before the surgical intervention. With a total of 56 cases of gliomas which were verified histopathologically in Seoul National University Hospital between July 1978 and May 1983, a statistical analysis of the computed tomographic findings was done with the partcular emphasis on the correlation iwth histopathological features. The results are as follows : 1. The calcification is observed in 27 cases (48.2%) in total : in 20 cases (62.5%) among low grade group, in 6 cases (46.1%) among high grade group and in 1 case (9.1%) among glioblastoma multiforme group respectively. 2. The mass effect, especially surrounding low density correlates well with the grade of malignancy. 3. The contrast enhancement is observed in 43 cases (76.8%). The pattern of enhancement provides clues for the assessment of cell type and grade with fair degree of reliability. Among low grade group, 10 cases (31.3%) show no enhancement and 10 cases show solid enhancement. Among high grade group, 6 cases (46.8%) show solid enhancement and nodular or ring enhancement are not observed. Among glioblastoma multiforme group, 8 cases (72.7%) show characteristic thick irregular ring enhancement. 4. Plain CT densities are not useful in differentiating each group in statistically significant level. 5. Neither the margin of the mass nor th edegree of contrast enchancement contributes for the differentiation of each group. 6. Summarizing the above mentioned findings it is concluded that computed tomography is very helpful in differentiating the gliomas with regard to histopathological cell type and the grade of malignancy as well.

고해상 CT상 모자이크 양상의 폐음영 : 31예의 방사선학적 고찰

최영희 대한영상의학회 1998 대한영상의학회지 Vol.39 No.1

Purpose : To correlate radiologic findings with clinical findings in patients with a mosaic patten of lung attenuation, as seen on thin-section CT. Materials and Methods : Thirty-one cases in which a mosaic pattern of lung attenuation was detected on combined expiratory and inspiratory scans of thin-section CT were retrospectively analyzed. Cases involving infiltrative lung disease were excluded. Both thin-section CT and clinical findings were analyzed and the relationship between the extent of the area of hyperlucency -as seen on expiratory scan- and physiologic parameters was evaluated. The subjects were 10 men and 21 women ranged in age from 25 to 76 (mean 50)years. Results : Twenty-nine patients with small airway disease, [chronic bronchitis and/or bronchiolitis(n=11), bronchiectasis(n=8), bronchial asthma(n=8), mycoplasmic pneumonitis(n=1) and hypersensitive pneumonitis(n=1),] and two patients with pulmonary vascular disease, [chronic pulmonary thromboembolism(n=1) and stenosis of the left upper pulmonary artery(n=1)] were included in our study. Commonly associated thin-section CT findings in the cases involving small airway disease(n=29) were bronchial wall thickening(n=25), nodular opacity(n=25), bronchial and bronchiolar dilatation(n=20) and small branching opacity(n=16). These findings were not observed in two patients with pulmonary vascular disease, though bronchial wall thickening was seen in the patient with chronic pulmonary thromboembolism. At expiratory scan level, there was statistical correlation between FEV1/FVC and the number of pulmonary segments(r= 0.982, p<0.05), but no correlation between FEV1/FVC and the percentage area of hyperlucency(r=0.803, p>0.05). Conclusion: The mosaic pattern of lung attenuation seen on thin-section CT is indicative of various diseases, involving small airways such as bronchiolitis, bronchitis, bronchiectasis and bronchial asthma, and vascular lung disease. Bronchial wall thickening and nodular opacity can be associated with small airway diseases.

봄철에 맞는 건강음식

최영희,Choe, Yeong-Hui 한국윤활유공업협회 2006 윤활유협회보 Vol.118 No.-

권두언

최영희 한국고전문화연구원 1993 古文硏究 Vol.5 No.1

N/A

개인용 컴퓨터를 이용한 교육 프로그램의 개발 선천성 심혈관 질환의 자기공명 영상 진단

최영희 대한영상의학회 1996 대한영상의학회지 Vol.34 No.2

관동맥 조영술에 의한 한국인 관동맥의 정상변이

최영희 대한영상의학회 1994 대한영상의학회지 Vol.31 No.2

비소세포성 폐암의 병기판정에 있어서 CT와 MRI의 정확도 평가

최영희 대한영상의학회 1995 대한영상의학회지 Vol.32 No.4

Purpose : To evaluate accuracy of magnetic resonance(MR) imaging for staging of lung cancer and to compare theaccuracies of CT and MRI. Materials and Methods : We retrospectively analyzed 25 cases of lung cancer, which wereconfirmed surgically and pathologically. Five experienced radiologists participated in the receiver operatingcharacteristic(ROC) analysis to evaluate and compare the accuracies of the CT and MR imaging in preoperativestaging of non small cell lung cancer by assessing tumor invasion of bronchus, mediastinum, chest wall, and hilaror mediastinal lymph node metastasis. Imaging results were evaluated against "truth" data based on both surgeryand pathologic examination. Results : sensitivity of CT in distinguishing T3-T4 tumors was 60%; specificity was76%. These values for MR imaging were not significantly different( 53% and 72%). With ROC analysis, no differenceexisted between accuracies of CT and MR imaging in diagnosis of bronchial involvement, but MR imaging wassignificantly more accurate than CT(p<0.05) in diagnosis of mediastinal invasion. There was no significantdifference between accuracies of CT and MR imaging in detecting mediastinal node metastasis(N2 or N3);sensitivities were 64% and 78%, respectively, and specificites were 64% and 66%. Conclusion : There was nosignificant difference in accuracies of CT and MR imaging in preoperative tumor classification and assessment ofmediastinal node metastasis, but MR imaging was more accurate than CT in assessment of mediastinal invasion. invasion.

정신역동과 인지행동치료

최영희 대한신경정신의학회 2010 신경정신의학 Vol.49 No.1

Cognitive Behavior Treatment (CBT) is always evolving. Based on the cognitive model, it analyzes the mind and promotes a client to identify his or her problems, thus finding ways to change long term maladaptive behavior patterns into new adaptive behavior pattern in an effort to develop self. This evolution in CBT along with schema therapy has exhibited effectiveness in borderline personality disorder where patients are stereotypically shown to be resistant to treatment. The author presented a comparison of CBT and Schema Therapy approach with the psychodynamic approach in order to conceptualize the method in a distinct manner. Many therapists are so keen on defining one particular condition using various jargon that they sometimes make the mistake of overlooking the fact that our clients are sufferingand are in dire need. What is important is that the therapist remembers to help and guide the patients to gain the ability to live an active and meaningful life regardless of the jargon involved. An effort to define and unify the core conceptual logic and the language through collaboration of various schools of methodology is essential.

壬辰倭亂에 대한 몇 가지 意見

崔永禧 慶尙大學校 南冥學硏究所 1997 남명학연구 Vol.7 No.-