소아청소년에서 명상의 임상적 적용

곽영숙(Young Sook Kwack),문덕수(Duk-Soo Moon) 대한신경정신의학회 2020 신경정신의학 Vol.59 No.1

Meditation is one of the psychological therapeutic techniques that can be applied to many conditions, including stress reduction. Meditation can be an alternative to overcoming the limitations of existing therapies, including medication. In particular, this can be helpful for children who have limitations in using medication due to brain development and limitations of psychotherapy, which is done mainly by language. Previous studies have shown that mindfulness meditation helped enhance attention, increase the coping ability, reduce stress, and reduce depression and anxiety in children and adolescents, but there is insufficient evidence to use it as a primary treatment. A larger number of well-controlled studies will be needed to obtain an evidence base for expanding clinical application.

가출청소년에서 학대력과 정신병리와의 관계

곽영숙(Young-Sook Kwack),이혜숙(Hae-Sook Lee) 대한소아청소년정신의학회 2006 소아청소년정신의학 Vol.17 No.2

소아 청소년에서의 신경이완제 악성증후군에 대한 종설

곽영숙(Young-Sook Kwack),류재성(Jae-Sung Ryu) 대한소아청소년정신의학회 2013 소아청소년정신의학 Vol.24 No.1

Neuroleptic malignant syndrome (NMS) is a severe iatrogenic complication of treatment with antipsychotic medication. The aim of this review is to provide the clinical characteristics and treatments of children and adolescents with NMS. Searches were conducted in Medline, Korean studies Information Service System (KISS), and Research Information Service System (RISS). Sixteen case reports and two review articles were selected in Medline, and two Korean cases reported in department of emergency medicine and pediatrics were selected from RISS. Heterogeneous and atypical presentations of NMS were observed in children and adolescents. Some noticeable differences were observed between adult patients and child patients with NMS. In addition, symptom presentations related to atypical antipsychotic agents differed from those of typical ones. In treatment, bromocriptine and benzodiazepine were recommended for management of symptoms. In particular, electroconvulsive therapy (ECT) was a useful treatment option. For prevention and early detection of NMS in children and adolescents, evaluation of risk factors and understanding of diagnostic features of NMS are very important.

고등학생 자살 경향성에 영향을 미치는 요소

곽영숙(Young Sook Kwack),신지현(Ji-hyun Shin) 대한소아청소년정신의학회 2011 소아청소년정신의학 Vol.22 No.4

Objectives:This study investigated factors related to suicide in high school students and focused on perceived academic performance. Methods:We surveyed 293 grade 10 high-school students in Jeju and Gyeonggi provinces and gave them self-assessment questionnaires. To evaluate the suicide risk, the questionnaire included questions about suicidal thoughts, plans, threats, deliberate self-injury, and suicide attempts from the Scale for Suicide Ideation (SSI). Also, it included the Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), Locus of Control Scale (LOC), Rosenberg’s Self Esteem Scale (RSE) and Perceived Academic Performance (PAP) to identify factors related to suicide in high school students. Results:Depression, hopelessness, and low self-esteem were related with suicidal thoughts, plans, attempts, and severe suicidal ideation (SSI score≥16). In the multivariate analysis, a low level of PAP (OR=3.796, 95%CI 1.280-11.257) was significantly associated with severe suicidal ideation (SSI score≥16). Deliberate self-injury was most prevalent in failing the PAP group and also having a high level of PAP (OR=6.161, 95%CI 1.474-25.760). Conclusion:The authors found that the suicide risk of high school students is related to depression, hopelessness, low selfesteem and a low level of PAP. These results provide significant indicators in planning an adolescent suicide prevention program.

대한소아청소년정신의학회 의료윤리규정 : 왜 필요한가?

구영진(Young-Jin Koo),황준원(Jun-Won Hwang),이문수(Moon-Soo Lee),양영희(Young-Hui Yang),방수영(Soo-Young Bang),강제욱(Je-Wook Kang),이대환(Dae-Hwan Lee),이주현(Ju-Hyun Lee),곽영숙(Young-Sook Kwack),김승태(Seungtai Peter Kim),노경선(K 대한소아청소년정신의학회 2016 소아청소년정신의학 Vol.27 No.1

This article provides an overview of the developmental history and rationale of medical ethics to establish the code of ethics and professional conduct of the Korean Academy of Child and Adolescent Psychiatry (KACAP). Most medical professional organizations have their own codes of ethics and conduct because they have continuous responsibility to regulate professional activities and conducts for their members. The Ethics and Award Committee of the KACAP appointed a Task-Force to establish the code of ethics and conduct in 2012. Because bioethics has become global, the Ethics Task Force examined global standards. Global standards in medical ethics and professional conduct adopted by the World Medical Association and the World Psychiatric Association have provided the basic framework for our KACAP’s code of ethics and professional conduct. The Code of Ethics of the Americal Academy of Child and Adolescent Psychiatry has provided us additional specific clarifications required for child and adolescent patients. The code of ethics and professional conduct of the KACAP will be helpful to us in ethical clinical practice and will ensure our competence in recognizing ethical violations.

BDNF가 ADHD의 병인과 치료에 미치는 영향

강나리,송재민,곽영숙,Kang, Na Ri,Song, Jae Min,Kwack, Young-Sook 대한생물정신의학회 2018 생물정신의학 Vol.25 No.2

Attention deficit hyperactivity disorder (ADHD) is a common childhood psychiatric disorder. Recently, it has been suggested that brain-derived neurotropic factor (BDNF) may play a role in the pathogenesis of ADHD. Our aim of this review is to understand the physiological functions of BDNF and its potential relationship with ADHD and therapeutic approaches of ADHD. Searches were conducted in Pubmed and Research Information Service System (RISS). In this review, we summarized important literatures for the physiological functions of BDNF in neurodevelopment, change of serum BDNF level in ADHD, association of BDNF polymorphism and ADHD and potential association of treatment of ADHD with serum BDNF level. Further studies are required to more clearly understand the source and the role of BDNF in ADHD and to develop BDNF based-ADHD treatement.

주의력결핍 과잉행동장애 아동과 아스퍼거장애 아동에서 사회기술훈련의 효과 비교

황지희(Ji-Hee Hwang),곽영숙(Young-Sook Kwack) 대한소아청소년정신의학회 2013 소아청소년정신의학 Vol.24 No.4

Objectives:Attention-deficit hyperactivity disorder (ADHD) and Asperger’s disorder (AD) in children are associated with attentional problems, impulsivity, hyperactivity, and difficulties with social interactions. Pharmacological treatment may alleviate symptoms of ADHD, but seldom solves difficulties with social interactions. Social skills training (SST) may assist in improving their social interactions. We examined the effects of SST on children’s social competences, general behavior, and ADHD symptoms. Methods:Thirty four children, aged 7 to 12 years, participated in the cognitive behavioral SST program once a week at the outpatient division of child-adolescent psychiatry. SST was composed of 24 sessions (ninety minutes) for 6 months. Twenty-five children were diagnosed with ADHD, and 9 children were diagnosed with AD. Parents of the children rated Korea-Child Behavior Checklist (K-CBCL), Conner’s rating scales, Korean-ADHD Rating Scale (K-ARS), Social Skill Rating System (SSRS), and Matson’s Social Skill Rating Scale as an evaluation of the treatment effect, before the first session and after the final session of the training. Results:The ADHD group showed significantly increased scores of social and social competence of CBCL and SSRS. Further, scores of externalizing problems of CBCL, CRS, and ARS were significantly decreased. The Asperger’s group showed significantly increased scores of social competence of CBCL, SSRS, and MESS. There was a significant difference of the improvement in CBCL’s school and total behavior problem score, CRS between drug change group and no drug change group. Conclusion:The result of this study suggests that SST is effective in improving social skills for children with ADHD and AD. In addition, SST has shown its effectiveness in treating attentional problems for children with ADHD. To prove objective usefulness of SST, further studies with a more structured design and long-term duration along with a sufficient number of AD participants will be necessary.

소아청소년 양극성 장애의 임상 경과

강나리(Na-Ri Kang),곽영숙(Young-Sook Kwack) 대한소아청소년정신의학회 2012 소아청소년정신의학 Vol.23 No.1

Objectives:The early onset of mood symptoms in bipolar disorder has been associated with poor outcomes in many studies. However, aspects of the clinical course of bipolar disorder in children and adolescents are controversial. The goal of this article is to review the clinical characteristics and longitudinal course of children and adolescents with bipolar disorders. Methods:Searches were conducted in MedLine, PsycINFO, KISS, and RISS using the terms phenomenology, clinical course, outcome, BPD, pediatric, children and adolescents. Twenty-one reports were selected : either original articles reporting symptoms and clinical characteristics of subjects (ages 5-18 years), or published articles in reviewed journals about bipolar disorder in children and adolescents. Results:Approximately 70% of subjects with bipolar disorder recovered from their index episode, and 50% had at least 1 syndromal recurrence, particularly depressive episodes. For 60% of the follow-up time, subjects had syndromal or subsyndromal symptoms with numerous changes in symptoms and shifts of polarity. Approximately 20% of BP-II subjects converted BP-I. Conclusion:Bipolar disorders in children and adolescents are characterized by episodic illness with subsyndromal and syndromal episodes with mainly depressive and mixed symptoms and rapid mood changes. Extensive follow-up time is needed to evaluate the continuity of bipolar disorder symptoms from childhood to adulthood.

뉴로피드백 훈련이 Attention-Deficit Hyperactivity Disorder 아동의 실행기능에 미치는 영향

윤석민(Seok Min Yun),곽영숙(Young Sook Kwack) 대한소아청소년정신의학회 2015 소아청소년정신의학 Vol.26 No.1

Objectives:Children with attention-deficit hyperactivity disorder (ADHD) have been shown to display more inhibitory deficits and executive function deficits. This study investigated the treatment effects of neurofeedback (NF) training on executive function by comparing the results of neuropsychological tests of the trained children at pre- and post-training. Methods:Fifteen children with ADHD, aged 6 to 14 years, participated in the study. The NF treatment consisted of slow cortical potential (SCP) training and these sessions took place once a week. The ADHD children performed 20 sessions of NF training within 6 months. Pre-training and post-training assessments encompassed Continuous Performance Test (CPT), Stroop Test, Children’s Color Trails Test I&II (CCTT) and Wisconsin Card Sorting Test (WCST). Results:Patients receiving NF training showed significant improvement in visual commission error and standard deviation of auditory response time on CPT ; and total errors on WCST. But there was no significant improvement in the Stroop test and CCTT. Conclusion:SCP training using NF improves the self-regulatory capacities and impulsivity in ADHD patient, especially impulsivity in visual stimulation tasks. This study showed evidence of clinical efficacy of NF on executive function in ADHD.

학교폭력 피해학생과 부모의 정신의학적 문제

장혁진(Hyuk Jin Jang),곽영숙(Young Sook Kwack) 대한소아청소년정신의학회 2014 소아청소년정신의학 Vol.25 No.4

Objectives:This study was conducted in order to investigate the influences of school violence on the mental health of student victims and their parents. Methods:A total of 56 (aged 7?18) student victims and their parents were selected to participate in a survey. The students had experienced school violence from June 2012 to October 2013. They completed a set of self-report questionnaires, including socio-demographic characteristics, family relationship, Impact of Event Scale-Revised, Child Depression Inventory (CDI), Beck Depression Inventory, Revised Children’s Manifest Anxiety Scale, and Parental Bonding Instrument to evaluate psychiatric complications and to understand the emotional bonding between them. Results:The student’s level of impact of event was significantly related to the parent’s level of impact of event (p<.001). The student’s high CDI score showed positive correlation with high level of impact of event (p<.001). In addition, higher level of the student’s perceived emotional support and understandability of family showed association with lower level of impact of event (p<.01, p<.05). Conclusion:The results of this study suggest that the psychiatric sequelae of school violence is seriously affected by family support and parent’s level of impact of event. Therefore, more active intervention is needed for both students and their parents.