DSM-III-R 주요우울증에 대한 한국어판 Geriatric Depression Scale(GDS)의 진단적 타당성 연구

조맹제,배재남,서국희,함봉진,김장규,이동우,강민희 대한신경정신의학회 1999 신경정신의학 Vol.38 No.1

연구목적: 본 연구는 노인성 우울증의 선별 검사도구로 전세계적으로 널리 사용되고 있는 Geriatric Deression Scale(GDS) 및 축약형 GDS(SGDS)가 우리나라에서도 타당성 있게 사용될 수 있는지 평가하기 위한 것 이다. 방 법: 3차례의 예비연구 과정을 거쳐서 우울증 선별 검사도구인 한국판 GDS을 제작한 후에, 88명의 임상환자군 을 대상으로 한국판 GDS의 신뢰도와 타당도 검증, 주요우울증의 선별을 위한 최적절단점 추정, ROC커브 를 이용한 진단적 타당성 분석을 하였으며, 15문항의 한국판 SGDS에 대한 표준화 연구도 아울러 진행하 였다. 결 과: 1) 한국판 GDS는 높은 내적 일치도를 보였고 우리나라에서 이미 표준화되어 사용되어 온 HRS-D, CES-D 와 높은 상관관계를 보임으로서 공시타당도가 증명되었다. 또한 주요우울증군과 비주요우울증군의 2군으로 임상환자군을 나누었을 때, 한국판 GDS 각 문항의 평균점수 및 총점이 두 군에서 의미 있는 차이를 보이므로서 내용타당도 및 감별타당도가 입증이 되어졌다. 2) DSM-III-R의 주요우울증 진단에 대한 예민도, 특이도, Kappa치를 이용하여 주요우울증 선별을 위한 한국판 GDS의 최적 절단점으로 17점을 선정하였으며 이는 ROC커브에서 제시하는 점수 19점과 차이가 있으 나 주요우울증 진단의 1차 선별을 위한 목적에 따라 예민도를 90%이상 유지하는 17점을 최적 절단점으로 선정하였다. 그리고 ROC커브분석법에서 각 선별도구의 AUC을 비교함으로서 진단도구의 수행능력을 평가하였 는데 한국판 GDS가 기존의 우울증 선별도구의 진단 수행능력에 비해 손색이 없는 유용한 진단 능력을 보여 주었다. 3) 한국판 SGDS는 한국판 GDS와 높은 상관관계를 보여 주었고 내적일치도, 공시타당도, 내용타당도, 감별 타당도가 훌륭하였으며 AUC가 한국판 GDS와 유의하게 차이가 나지 않음으로서 한국판 GDS의 대용으로 한국 판 SGDS의 사용이 가능함을 보여주였다. 한국판 SGDS의 주요우울증 선별을 위한 최적 절단점은 8점으로 선 정하였다. 결 론: 본 연구에서 임상환자군을 대상으로한 한국판 GDS와 SGDS의 타당도, 진단수행능력을 평가함으로서, 임상환자군에 대한 주요우울증의 1차 선별 진단도구로서의 기능을 수행할 수 있음을 보여 주었고, 향후 에 지역사회 일반노인군을 대상으로 하는 우울증상의 1차 선별을 위한 후속연구가 진행이 된다면 임상환 자군과 지역사회 일반노인군 모두를 대상으로 적절한 우울증 선별도구로서의 역할이 가능할 것으로 기대 된다. Objectives:The authors attempted to evaluate the diagnostic validity of the Korean version, Geriatric Depression Scale(GDS) for screening geriatric DSM-III-R major depression among clinical populations. Methods:Through of preliminary trials 3 times, the authors translated GDS including Short form Geriatric Depression Scale(SGDS) into Korean. GDS, SGDS, HRS-D, CES-D was adminis-tered to 88 elderly psychiatric patients(35 major depressives, 51 were non-major depression) and also Diagnostic Interview Schedule(DIS-III-R) was administered independently to diagnoses DSM-III-R major depression. Reliability and validity test 5, optimal cut-off point estimation, and ROC curve analysis were done to investigate the diagnostic validity of GDS and SGDS. Results:Internal consistency-reliability and concurrent validity of GDS, SGDS associated with other depression scales(HRS-D, CES-D) were excellent. Content validity and discriminant validity which differentiate DSM-III-R major depression from non-major depression was also good. The authors suggest the score ‘17’ as the optimal cut-off point of GDS for screening DSM-III-R major depression among clinical populations and the score ‘8’ as optimal cut-off score of SGDS. ROC curve analysis revealed wide AUC of both GDS and SGDS, which indicates its high diagnostic validity in assessing DSM-III-R major depression. The GDS and SGDS were found to be highly correlated(r=0.9594) and any difference of AUC between both scales in ROC curve analysis were not found. This finding suggests that SGDS can be an adequate substitute for GDS. Conclusion:The GDS and SGDS are valid and reliable case finding tools for screening DSM-IIIR major depression among clinical populations in Korea but relatively high cut-off point demands the further evaluation in the viewpoint of culturally determined style of response for the depression questionnaire in Korea.

피치료감호 및 정신감정례의 범죄행위에 관한 고찰 -용인정신병원에 입원의뢰된 환자를 중심으로

조맹제 서울대학교 의과대학 정신과학교실 1986 서울醫大 精神醫學 Vol.11 No.2

한국 주요정신장애의 유병률 및 관련요인 : 2006 전국정신질환역학조사

조맹제,장성만,함봉진,정인원,배안,이영문,안준호,원승희,손정우,홍진표,배재남,이동우,조성진,박종익,이준영,김진영,전홍진,이해우 大韓神經精神醫學會 2009 신경정신의학 Vol.48 No.3

Objectives The aims of this study are to estimate the prevalence of the DSM-IV psychiatric disorders in the Korean population using the Korean version of Composite International Diagnostic Interview (K-CIDI), and to compare those with previous studies. Methods The Korean Epidemiologic Catchment Area study Replication (KECA-R) was Conducted between August 2006 and April 2007. The sampling of the subjects was carried out across 12 catchment areas. A multistage, cluster sampling design was adopted. The target Population included all eligible residents aged 181o 64 years. Face-to-face interviews were conducted with the Korean version of Composite International Diagnostic Interview (K-CIDI) based on the DSM-IV (N=6,510, response rate=81.7%). Results A total of 6,510 participants completed the interview. The lifetime and 12-month prevalence rates for all types of DSM-IV disorders were 30.0% and 17.3%, respectively. Those of Specific disorders were as follows : 1) alcohol use disorder, 16.2% and 5.6% ; 2) nicotine use disorder, 9.0% and 6.0% ; 3) specific phobia, 3.8% and 3.4% ; 4) major depressive disorder, 5.6% and 2.5% ; and 5) generalized anxiety disorder, 1.6% and 0.8%. Data relating to nicotine and alcohol use disorder revealed a very high male/female ratio. Mood disorder and anxiety disorder were more prevalent among females than males. Conclusion The prevalence of psychiatric disorders was high. In comparison with other studies, remarkable differences in the distribution of psychiatric disorders across the country and times were observed.

입원중 정신과에 자문 의뢰된 노인 환자에 대한 고찰

조경형,조맹제 大韓神經精神醫學會 1990 신경정신의학 Vol.29 No.5

Through the review of charts and consultation papers of patients who were referred for psychiatric consultation between July 1, 1988 to June 30, 1989 at the Seoul National University Hospital, we tried to find out the overall clinical characteristics of the elderly group(Age 60 and over) in comparison with those of the young group(Age 15-19) and the results were as follows: 1) The overall psychiatric consultation rate was 0.98%. The rate of psychiatric consultation in the elderly group(1.21%) was significantly higher(p=0.0071) than in the young group(0.98%). This was the opposite of the reports from foreign countries. 2) Among the total consultation cases, the proportion of the elderly group was 22.9%, which was significantly higher than those in other papers in Korea. We think this reflects the increasing proportion of elderly patients amon the total number of patients in general hospital. 3) As a whole the elderly group were accompanied by a greater number of physical disease than the young group(0=0.001). Though the difference between the two groups was not significant in diseases of metabolic and endocrine system, diseases in cardiovascular system and skeletomuscular system were somewhat higher in the elderly group. The two groups showed no difference in both total number of days hospitalized and the number of days in hospital at the time of consultation. The rate of psychotropic drug use at the time of consultation was significantly higher in the Department of Neurology than in the other departments(p=0.00106). 4) The overall difference in referral sources was not significant statistically between two group. The Department of Internal medicine was the most frequent source-about half-which was a little less than the previously reported rate in Korea. We think this result was due to the increase in utilization of psychiatric consultation by the other departments. 5) Organic mental disorder was exceedingly more common in the elderly group(p=0.001) and the psychotic disorder, anxiety disorder, somatization disorder, personality disorder and psychosomatic disorder were more common in the young group, although not significant statistically. 6) The overall distribution of reasons for referral was not different in two groups. The most frequent reason was somatic symptoms without organic evidence, followed by previous psychiatric history and depression. 7) Psychotropic medication was most frequent as a recommandation in both groups. Though not statistically significant, recommendations of psychotropic medication and transfer to psychiatric unit were more frequent in the elderly group. There was no significant difference in diagnostic actions recommended between the two groups except that there was no recommendation for psychological test in the elderly group.

主要憂戀症환자 예비평가에서 the Center for Epidemiologic Studies Depression Scale(CES-D) 의 진단적 타당성 연구

조맹제,김계회 대한신경정신의학회 1993 신경정신의학 Vol.32 No.3

Through four times of preliminary trials, the authors translated the Center for Epidemiologic Studies Depression Scale (CES-D), a self-reporting depression scale, into Korean, paying particular attention to the culturally different mode of expression of depressive feelings and thoughts. The final version of the CES-D was administered to 164 psychiatric patients (30 schizophrenic, 31 alcohol dependence, 30 anxiety disorder, 46 major depression, 27 remitted depression), and 540 non-random selected general population. Reliability and validity test optimal cut-off point estimation, and R O C curve analyis were done to investigate the diagnostic validity of this depression screening instrument in assessing clinical depression (DSM-III-R major depression). Internal consistency-reliability and concurrent validity associated with other depression measure scales (H RD S, DSI, B D I) were excellent Content validity and discriminant validity which differentiate DSM-III-R major depression patients from other psychiatric patients were also good. The authors suggested the score ‘25’ as the optimal cut-off point in clinical setting, and the score ‘21’ in the community setting for its use as a primary screening test for further test to idenify DSM-III-R major depression. This relatively high cut-off point was reviewed in the viewpoint of culturally determined style of response for the depression questionnaire in Korea. R O C curve analysis revealed wide AUC o f this instrument which indicates its high diagnostic validity in assessing DSM-III-R major depression. Observer rating scales such as H R S D and D S I were a bit superior to self reporting scales, and the CES-D and B D I showed almost equal diagnostic validity in assessing DSM-III-R major depression

일 도시 지역사회 노인들의 인지기능장애와 우울증상의 유병율

배재남,권준수,주진형,함봉진,조맹제 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.2

목 적: 본 연구는 도시지역 거주 노인들에서 인지기능장애와 우울증상의 유병율을 조사하기 위한 것이다. 방 법: 훈련된 면담요원들이 상계 10동에 거주하는 447명의 노인들을 가가호호 방문하여 한국판 Mini-Mental State Examination(MMSE-K) , 축약판 Geriatric Depression Scale(SGDS), 그리고 the Center far Epidemiologic Studios Depression(CES-D)을 적용하였다. 그 다음 한 명의 정신과 전문의와 두 명의 정신과 전공의가 MMSE-K점수가 23점 이하인 노인들을 직접 면담하고 DSM-Ⅲ-R의 기준에 따라 치매의 진단을 하였다. 결 과. 인지기능장애의 유병율이 MMSE-K≤23의 기준으로 37.1%(남자 18.8%. 여자 47.0%)였다. 연령군별 유병율(MMSE-K≤23)은 65∼69세 70∼74세. 75∼79세. 80∼84세, 그리고 85세 이상에서 각각 19.2%, 38.5%, 57.8%. 60.0%, 그리고 72.2%였다 MMSE-K<19에 의한 비교적 분명한 인지기능장애의 유병율은 15.4%였다. 인지기능장애의 사례성(MMSE-K<23)은 연령 및 교육과 관련이 있었다. 우울증상의 유병율은 CES-D>25의 기준으로 18.1%(남자 17.3%. 여자 17.9%)였고 SGDS≥10의 기준으로는 15.8%였다. 연령군별 유병율(CES-D≥25)은 65∼69세, 70∼74세, 75∼79세. 80∼84세. 그리고 85세 이상에서 각각 15.7%, 18.1%. 23.4%. 13.3%. 그리고 23.5%였다. 우울증상의 사례성 (CES-D≥25)은 성별, 연령, 교육년수 , 결혼상태, 신체적질환, 직업, 거주형태, 그리고 부양형태와 관련이 없었다. 인지기능장애(MMSB-K<23)를 가진 166명 중 126명이 진단적 검사를 받았다. 126명 중 38명이 치매로 진단을 받았고 성별과 연령군으로 보정한 치매의 유병율은 10.6%(남자 5.5%. 여자 13.5%)로 평가되었다. 결 론: 이전 연구들에 비해 일지기능장애의 사례성 유병율은 약간 높고 우울증상의 사례성 유병율은 낮게 평가되었다. 이러한 결과는 평가도구에 대한 사회문화적 영향과 대상인구의 특성과 같은 방법상의 차이에 의할 가능성이 시사되며 이와같은 소견을 확인하기 위한 추후 연구를 요한다. Objectives : This study was to investigate the prevalence of cognitive impairment and depressive symptoms among the elderly in an urban community. Methods : Korean version of Mini-Mental State Examination(MMSE-K), Short version of Geriatric Depression Scale(SGDS), and the Center for Epidemiologic Studies Depression(CES-D) were administered to 447 elderly persons(37.7% of all residents aged 65 and older) who resided in "Sanggye 10 Dong" by lay interviewers. Then a psychiatrist and two Psychiatric residents interviewed the elderly scoring 23 or less on MMSE-K and diagnosed with dementia according to the criteria of DSM-Ⅲ-R Results : The prevalence of cognitive impairment was estimated as 37.1%(male 18.8%, female 47.0%) by MMSE-K≤23. Prevalences(MMSE-K≤23) for the age groups 65 to 69,70 to 74, 75 to 79, 80 to 84, and over 85 were, respectively 19.2%, 38.5%, 57.8%, 60.0%, and 72.2%. The prevalence of relatively definite cognitive impairment defined by MMSE-K≤ 19 was 15.4%. Caseness of cognitive impairment(MMSE-K≤23) was related to age and education. The prevalence of depressive symptoms was estimated as 18.1%(male 17.3%, female 17.9%) by CES- D≥25 and 15.8% by SGDS≥ 10. Prevalences(CES-D≥25) for the age goups 65 to 69,70 to 74,75 to 79,80 to 84, and over 85 were, respectively 15.7%,18.1%,23.4%,13.3%, and 23.5%. Caseness of depressive symptoms(CES-D ≥25) was not related to sex, age, years of education, marital ststus, physical illness, occupation, living condition, and financial status. Of 166 persons who had cognitive impairment(MMSE-K<23), 126 persons underwent diagnostic interview. Thirty-eight of 126 persons were diagnosed as dementia and the prevalence of dementia adjusted by sex and age group was estimated as 10.6%(male 5.5%, female 13.5%). Conclusion : Caseness of cognitive impairment was more prevalent and caseness of depressive symptoms was less prevalent than that of previous studies. These results mar be attributable to methodological differences among studies such as sociocultural influences on accessment instruments and characteristics of sample and require farther studies to confirm these findings.

한국의 사회 변화와 노인 정신 건강

조맹제,배재남 漢陽大學校 精神健康硏究 1994 精神健康硏究 Vol.13 No.-

환상지통의 정신의학적 측면에 관한 연구

조맹제 최신의학사 1985 最新醫學 Vol.28 No.4

치매의 감별진단

조맹제 藥業新聞社 1993 醫藥情報 Vol.1993 No.9

중증 만성정신질환자 수의 추산 : Through Two Community Surveys 두 지역사회 조사를 중심으로

홍진표,김윤,배재남,정유진,강영호,양병국,김용익,김병후,이철,조맹제 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.2

국내 중증 만성정신질환자 수를 추정하기 위하여 일 농촌 및 대도시 지역의 지역의료보험 및 의료보호 대상자 중 1993년 1년간 의료기관에서 정신증 상병(ICD-9 code 상 290-299) 및 알콜 남용/중독, 성격장애 및 정신박약 진단하에 치료를 받은 적이 있는 사람에 대해 설문조사를 실시하였다. 연구자들이 개발한 진단도구를 이용하여 진단을 평가하고, Strauss-Carpenter scale 등을 이용하여 기능 장애를 평가하고 유병기간 등을 조사하였다. 결과를 요약하면 다음과 같다. 1) 진단평가상 정신분열병군(61.1%)이 가장 많았으며, 정동장애군(23.7%), 알콜장애군(11.2%), 기질성 정신장애군(4.0%)의 순서이었다. 2) 직업활동정도는 진단군별로 차이가 많았다. 지난 1년간 직업활동이 6개월 미만이거나 전혀 없는 환자 비율이 정신분열병군은 67.2%, 알콜장애군 52.0%, 정동장애20.8%의 순으로 정신분열병군이 가장 불량하였다. 3) 사회활동도 진단군별로 차이가 많아서 지난 1년간 의도적, 사회활동이 없는 비율이 정신분열병군이 가장 높았고(72.3%), 알콜장애군(32.0%), 정동장애군(20.7%)의 순이었다. 4) 국내 의료보험 및 사회복지시설 이용 자료 등을 토대로 본 조사 결과를 적용한 결과 국내중증 만성 정신질환자의 수는 약 8만 7천명으로 추산되었다. Objectives: The purpose of this study was to estimate the number of serious and persistent mentally ill patients in Korea. Methods : Study populations were recruited from medical insurance data of two district areas ; one rural and the other urban areas. Subject were all mentally ill who had ever visited any hospital in 1993 and were diagnosed as having psychosis, personality disorder and drug abuse. We conducted a home visiting survey applying semi-structured diagnostic interview, assessing the level of social adjustment with Strauss-Carpenter Scale, and past psychiatric history by the trained researchers, in October and November,1994. Results : According to diagnostic assessment schizophrenic patients constituted the major portion(61.1%) of study subjects. The distribution of occupational functions and social contacts was variable according to diagnosis. Most schizophrenic patients were unemployed or worked less than 6 months in the previous year(67.2%), and showed poor social contact(72.3%). But affective disorder patients were relatively independent in job maintenance and social relationship. Alcoholic patients lay between those of schizophrenic and affective disorder groups. It was estimated that about 87,000 adult Koreans were suffering from chronic mental disorders which seriously interfere with their daily life. Conclusions : Serious and persistent mentally ill patients were common in Korea. Community support program should be provided for them.