한국인 전상자의 외상성 신경증의 임상적 연구

연규월 최신의학사 1984 最新醫學 Vol.27 No.1

가족환경이 정신분열증 환자 재발에 미치는 영향

연규월 梨花女子大學校 韓國生活科學硏究院 1992 韓國生活科學硏究院 論叢 Vol.49 No.-

Objective : The aim of this work was to study the relationship between intrafamilial expressed emotion(EE) and other prognostic indicators on the schizophrenic relapse. Method : Subjects were 43 schizophrenic patients who were admitted to the department of neuropsychiatry at Ewha Womans university hospital. During hospital admission, their key relatives were interviewed with the Camberwell Family Interview(CFI) and levels of emotional expression were assessed. After discharge from hospital with clinical improvement, all patients were followed-up for a period of nine months and their psychiatric state was assessed to provide information about relapse. Results : The majority of patients were female and unmarried and living with parents. The greater proportion of the key relatives was mother. Remitted patients from high-expressed emotion households relapsed at a significantly higher rate than did those from low expressed emotion households. The best clinical outcome was observed in those patients who redided in low-EE home environments and regularly adhered to antipsychotic medication regimens. Conclusions : There was a significant association between high levels of expressed emotion and relapse for remitted schizophrenic patients and the regular use of medication was a protective factor to the schizophrenic relapse particularly for the patients in high-EE environments.

항경련제 복용과 혈액소견 및 간기능에 대한 일반 이학적 검사의 필요성

연규월 梨花女子大學校 醫科大學 醫科學硏究所 1993 EMJ (Ewha medical journal) Vol.16 No.3

In a prospective study of 59 epileptic patients receiving anticonvulsant drugs, the author evaluated routine screening for hematologic and liver toxicity. CBC, differential, platelets and liver function were obtained within 6 months after anticonvulsant medication. During this time, the author evaluated the psychiatric symptoms and adverse effects of drugs. In laboratory monitoring, 5.1% of patients had minor abnormalities of blood studies(minimal below level of Hb, Hct, MCV) and 18.6% of patients had abnormalities of liver function(elevation of ALP. ALT & AST) necessitating rechecks. All were the same finding on repeat, but there were no clinical symptoms of hematological abnormalities and liver toxicity. In clinical monitoring. 62.7 of patients had psychiatric symptoms and the most common symptom wasdepression(15.3%). 71.2% of patients had minor adverse effects of anticonvulsants and the most common symptom was disturbance of school performance(18.6%). Conclusively, severe toxic reaction was not in the patients with abnormal hematologic & liver function, but psychiatric symptoms and adverse effects of drugs were sufficiently evaluated from clinical observation. So, the author believes that clinical monitoring is more important than laboratory monitoring and routine blood & liver function is not necessary.

근친상간으로 인한 가성경련발작 1례

연규월 梨花女子大學校 醫科大學 醫科學硏究所 1995 EMJ (Ewha medical journal) Vol.18 No.4

One case is described in which pseudoseizure developed after father-daughter incest anddisappeared after psychotherapeutic exploration of the incestuous experience. Patient was youngadult female referred for seizures, suicide attempts, self-destructive ideations and acting outs,and dissociative symptoms. It is suggested that, female young adults presented to the clinicianwith symptoms of pseudoseizure, a detailed history should be taken to explore for the possibility of incest.

소아 청소년 정신과 외래환자의 임상양상

연규월 梨花女子大學校 醫科大學 醫科學硏究所 1997 EMJ (Ewha medical journal) Vol.20 No.4

목적: 본 연구의 목적은 소아 청소년 정신장애 외래환자의 일반적 특성. 주요 임상증상. 진단. 그리고 치료에 대해 조사하여 그 결과를 토대로 향후 본교실 소아 청소년분과 발전에 기초 자료로 삼고저 함이다. 방법: 1997년 1월 1일부터 7월31일까지 만 6개월동안 이화여대부속 동대문병원 정신과외래를 처음 방문한 소아 청소년 호나자 111명을 대상으로 병력조사와 문진을 통해 일반 인구학적 특성, 주요임상증상, 진단분포, 치료기간 및 종류에 대해 통계학적 조사를 하였다. 결과: 1)일반 인구학적 특징 대상환자 111명의 남녀 비율은 1.1:1이고, 연령별로는 13~18세 사이의 청소년기가 가장 많았다(52.3%), 형제 순위는 첫째 아이가 가장 많았고(42.3%), 대부분 양부모가 모두 생존하였다(91.9%). 첫 번째 방문시 동반자는 어머니가 가장 많았고(75.7%) 대상자이 대부분이 서울시내에 거주하였다(74.8%). 2) 주요 임상증상 대상자들의 호소증상은 대부분 3개 이상이었고(69.4%), 가장 많은 호소증상은 신체적 증상이고 학업문제, 불안, 두려움, 안절부절함, 주의산만, 행실장애 및 물질남용 등의 순이었다. 3)진단분포 대상자 대부분이 1개 이상의 진단을 공유하고 있었다. 가장 많은 진단은 행실장애이고, 기분장애, 지질성 정신장애, 불안장애, 학습장애의 순이었다. 4) 치료기간 및 종류 대상자 대부분이 5번 이상의 외래치료를 받았다(62.2%). 남녀 모두 약물치료와 정신치료 또는 행동치료의 병합치료가 많았으며 남아는 놀이치료나 정신치료를 받은 경우가 가장 적었고 여아는 관찰만 한 경우가 가장 적었으며 두 집단간 유의한 차이가 있었다. 111명의 외래 환자중 28명(25.2%)이 조사기간동안 1번이상의 입원한 기왕력이 있었다. 결론: 이상의 결과는 점차 증가하고 있는 소아 청소년 정신 장애 환자 치료를 위한 특수치료시설(놀이치료, 행동치료)의 확보와 소아 청소년 정신장애 분과 설립의 필요성을 제시하고 있다. Objectives : This study aims to investigate the domographic characteristics, main clinical problems, diagnoses and treatments of child and adolescent psychiatric outpatients. Methods : The statistical analyses were based on the clinical reports and medical records of 111 child and adolescent psychiatric patients who wisited to the outpatient clinic during current 6 months. Results : 1)The sex ratio(male : female) of these 111 patients was 1.1:1 and the most frequent age group was adolescent period(13-18 years of age). In sibling order, the first born child was more prevalent. Almost all the patients had both parents and was accompanied by a mother on the first visit. The most living place of the patients was in Seoul. 2) The main problems visiting our coinic were in following order : somatic symptoms, learning problems, anxiety, fear & restlessness, attention deficits, conduct problems and substance abuse etc. 3) Diagnostic distribution of the patients was in following order : conduct disorder, mood disorder, organic mental disorder, attention deficit hyperactivity disorder, anxiety disorder etc. 4) The patients who visited to the outpatient coinic above 5 times were more frequent. The more frequently used method for treatments was in the sequence of pharmacotherapy combined with psychotherapy and behavior therapy. Conclusion : These results suggest that the necessity of the space of special therapy(such as play and behavior therapy) for the children and division of child and adolescent psychiatry is very important in current situation.

소아기 신체 및 성학대와 정신증상과의 관계 : A Focus on the Dissociative Symptoms 해리증상을 중심으로

우행원,연규월 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.6

This study examined whether dissociative symptoms were specific to patient with histories of childhood physical and sexual abuse. 69 female psychiatric inpatients were interviewed and completed self-report instruments that focused on childhood history of trauma, dissociative symptoms and general psychiatric symptoms. 50.72% of the subjects reported childhood physical and/or sexual abuse. The most frequent perpetrators of childhood physical abuse were family members and those of childhood sexual abuse were not family members. 85.5% had dissociative symptom scores above the mean score of normal adults and 17.4% had scores at or above the mean score of patients with posttraumatic stress disorder. A higher proportions of subjects with high scores than of subjects with low scores had auditory hallucinations, self-destructive ideation, poor concentration and more previous hospitalizations. The score of interpersonal sensitivity, paranoid ideology, psychoticism, global severity index of general psychiatric symptoms were significantly high in patients with childhood abuse, but the mean scores were within inpatient psychiatric norms. Finally the authors concluded that subjects with a history of childhood abuse reported higher levels of dissociative symptoms than those who did not, and dissociative experiences scale was useful screening method for major dissociative psychopathology.

부부간 성적갈등에 영향을 미치는 요인에 관한 연구

연규월,이근후 梨花女子大學校 醫科大學 醫科學硏究所 1988 EMJ (Ewha medical journal) Vol.11 No.4

Author has been researched the factors which influence the latent sexual conflict of marital relation by way of social field survey through questionnair method from June 20th, 1984 to Aug. 10th, 1984. The results are as followings : In case of latent sexual conflict of marital relation, the most influential factors are age, sivling order, survival of parents, preference of parents, experience of sexual education at the age of puberty, experience of masturbation at the age of puberty, style of marriage, period of acquaintance before marriage premarital sexual experience, and occupation. The most important factors among the said factors are the experience and the attitude before the age of puberty.

혈청 Vitamin B_12 및 Folic Acid 농도와 정신장애와의 관계

연규월,우행원 梨花女子大學校 醫科大學 醫科學硏究所 1993 EMJ (Ewha medical journal) Vol.16 No.1

The serum vitamin B_12(B_12) and folic acid estimations were performed on 206 psychiatricinpatients, consecutive admissions to a Ewha Womans University Hospital. NeuropsychiatricDepartment.The mean serum B_12 value in the subjects(1004.24±479.76pg/ml) was somewhat higher thanthe normal serum B_12 value and none of the subjects has serum B_12 deficiency. The mean serum B_12 value was the lowest in 21∼30 age group and the highest in 31∼40age group(p<0.05). The mean serum folic acid value(8.09±4.15ng/ml) was in the range of normal value. Butthe patients with low serum folic acid value(O~2.5ng/ml) were 6 cases(2.9%), consisting of3 schizophrenia, 1 mood disorder and 1 epilepsy and the ratio of patients with low anti equivocalserum folic acid value(<5.Ong/ml) was 23.8% . The mean serum folic acid value was the lowestin 11~20 age group and the highest in 51~60 age group(p<0.05). Patients with epilepsy, organic mental disorder and schizophrenia(in order) had significantlylower mean serum B_12 & folic acid values and alcoholism had significantly higher mean serumB_12 & folic acid values(p<0.05). It was concluded that serum B_12 deficiency was not related to the psychiatric disorders andthe serum folic acid deficiency, but folic acid deficiency appeared to be in certain psychiatricdisorders and related to the chronicity of mental illness.

간질환자의 항경련제 혈중농도와 정신증상에 관한 연구

연규월 梨花女子大學校 韓國生活科學硏究院 1991 韓國生活科學硏究院 論叢 Vol.48 No.-

Recently with increasing recognition of some of the chronic and neuropathological effects of anticonvulsant therapy and the development of technique for measuring serum anticonvulsant levels, more serious attentin is being derected at the possible role of such therapy in the precipitation of mental symptoms. The author studied 61 epileptic patients attending the neuropsychiatric clinic of Ewha Womans University Hospital to confirm the serum anticonvulsant levels in relation to the clinical symptoms of mental state, seizure control and the sign of toxicity from Jan.1, 1990 to May 31, 1991. For each category of mental state(psychomotor slowing, intellectual deterioration, psychiatric illness or personality change), the subjects with evidence of impairment had higher concentration of both DPH and PB, CBZ, VPA than those without such impairment. Those subjects with well controlled seizures had higher concentrations than those with poorly controlled seizures. The sign of toxicity(ataxia and dysarthria) was in the range of therapeutic blood level and 3 of those subject with the sign of toxicity had history of brain damage and abnormal findings of computerized axial tomography of brain. So, the anticonvulsant medication may have an adverse effect on the mental processes of epileptic patients quite apart from an inderectly beneficial effects from controlling seizures in the range of therapeutic blood level.

불면증환자의 정신장애 공존에 관한 연구

연규월 梨花女子大學校 醫科大學 醫科學硏究所 1996 EMJ (Ewha medical journal) Vol.19 No.3

목적 : DSM-IV 진단기준을 적용하여 정신과로 내원한 외래환자중 불면증을 호소하는 환자만을 대상으로 이들이 공유하고 있는 정신장애의 빈도를 조사하고 각 주요 진단별 다면적인성검사 척도 및 사회적 직업적 기능 수준을 비교 분석하여 불면증 환자의 정신장애 진단 및 치료에 이용하고 자 본 연구를 실시하였다. 방법 : 1995년 7월 1일부터 1996년 6월 30일까지 이화여대 부속 동대문 병원 정신과 외래로 내원한 초진환자중 만 16세 이상 65세 미만의 불면증을 주소로 하는 환자 62명을 대상으로 포괄적인 정신의학적 면담을 실시하여 DSM-IV 진단기준에 따라 임상적 장애(Axis I), 인격장애(Axis II)로 나누어 주요진단 및 부가적 진단의 비율을 조사하고 일반 의학적 상태는 Axis III에 포함시켰다. 부가적으로 정신병리를 찾아내는데 도움이 되는 MMPI와 GAF 척도검사를 실시하였다. 결과 : 1) 일반 인구학적 분포에서는 남자, 연령분포가 21세에서 50세 사이, 결혼한 경우, 직업이 없는 경우의 환자들에서 불면증 호소가 많았다. 2) 대상자의 95.2%가 Axis I 의 주요정신장애 진단을 가졌고 66.1%가 부가적 진단을 가졌으며 가장 많은 정신장애는 기분장애, 불안장애, 신체화장애의 순이었다. 3) 대상자의 51.6%가 Axis II의 주요 인격장애 진단을 가졌고 14.5%가 부가적 진단을 가졌으며 가장 많은 진단은 강박성, 기타(회피성, 의존성 , 수동 공격성)히스테리성 인격장애의 순이었다. 4) 대상자의 72.6% 에서 MMPI척도중 1개 또는 2개 이상의 정신병리적 상승척도(T점수 30점이상)을 나타냈고 평균 숫자는1.66±1.43개이었다. 가장 많은 척도는 우울증이었고 히스테리성, 건강염려증의 순이었다. 6) 대상자들의 평균 GAP 점수는 61.65±5,64로 때때로 사회적 직업적 기능에서 어려움은 있으나 일반적인 기능은 양호한 수준에 속하였고, Axis I 각 주요진단별 CAF 평균점수에서 유의한 차이가 있었고 정신병리가 심할수록 GAP 점수가 낮았다. 결론 : 이상의 결과로 볼때 정신과외래로 내원한 환자의 불면증은정신장애, 저인병리, 사회적 기능상태와 매우 밀접한 연관이 있다고 사료된다. Objective : The aim of this study was to investigate the frequency of psychiatric diagnoses(AxisⅠ,Ⅱ and Ⅲ) using DSM-IV as well as the significances of personality traits and social of occupational functioning in a group of psychiatric outpatient insomnmiacs. Method : 62 subjects who complained of insomnia over a 2-week period were evaluated for psychiatric and personality disorders and medical conditions by a comprehensive psychiatric diagnostic interview. Each patient also completed the MMPI test and was evaluated on GAF score. Results : The higher prevalence of insomnia has been reported in the age group of 21 to 50 years, married and unemployed patients in this study. 95.2% of the subjects had a principal diagnosis on Axis I and the most prevalent diagnoses were mood disorders and accompanying diagnoses were anxiety and somatoform disorders(in frequency order). 51.6% of the subjects had a principal diagnosis on Axis Ⅱ and the most prevalent diagnoses were compulsive personality disorders and accompanying diagnoses were others(avoidant, dependent, and passive-aggresive) and historionic personalty disorders. 50% of the subjects had Axis Ⅲ diagnoses and the most prevalent diagnoses were gastrointestinal disordrs. 72.6% of the subjects had elevated scores on one or more MMPI scales(T score of 70 or greater) and the most frequently elevated scale was the depression and accompanying scales were hysteria and hypochondriasis. The mean GAF score value of the patient was 61.65±5.64 and showed significant difference in each Axis I principal diagnoses. Conclusions : In summary, strong associations between insomnia and psychiatric disorders were confirmed by this investigation.