우리나라 알코올 중독환자 치료현황과 과제

기선완,Gi, Seon-Wan 한국주류산업협회 1997 주류산업 Vol.17 No.4

알코올 의존에 대한 최근 정신사회 치료적 접근

기선완 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.6

Alcohol use disorder is a one of major psychiatric problems in Korea. But after detoxification treatment, relapse is very frequent. Psychosocial therapy is a crucial element in alcoholism treatment and prognosis. There are so many psychosocial treatment modalities, In this article, various psychosocial treatments are explained. The main lists of introduced recent Psychoso-cial treatments on alcoholism are as follows : therapeutic community, cognitive-behavioral therapy, motivation enhancement therapy, twelve step facilitation therapy, network therapy, and other community-based treatment, In Korea, in contrast to the importance of huge alcoholic problems, comprehensive alcoholism treatment system is weak. Therefore well-modified and Korean styled psychosocial treatment programs on alcoholism is requested.

선진 알코올센터의 관리체계 사례를 통한 한국적 적용

기선완 한국알코올과학회 2004 한국알코올과학회 학술대회 Vol.2004 No.1

만성 정신분열증 환자에 있어 Clozapine 투여에 의한 비정형적 Prolactin반응

이홍식,김찬형,기선완 대한신경정신의학회 1994 신경정신의학 Vol.33 No.3

Objects : Typical antipsychotic drugs robustily increase prolactin both in rodents and in man. Unlike in rodents, Meltzer(1989) found that acutely administered clozapine did not increases serum prolactin levels in schizophrenia and his preliminary data suggested that prolactin levels might even be reduced during clozapine treatment. Methods : We investigated the serum prolactin levels in chronic schizophrenics, who were assigned to clozapine(N=28) or haloperidol(N=20) for eight weeks. Blood samples were obtained biweekly during the study period, and serum prolactin concentrations were measured by standard double-antibody radioimmunoassay. Results : The serum prolactin levels were not changed in the schizophrenic patients to whom clozapine had been administrated, otherwise marked increases in serum prolactin level were observed in the haloperidol treatment group. Conclusion : Our results suggest that clozapine differs from typical antipsychotics(e.g., haloperidol) in its failure to produce serum prolactin elevation in schizophrenic patients.

일 지역사회의 자살기도자와 자살사망자에 대한임상적 특성 비교

황지희,기선완,이기환,김지웅,이태용 대한우울조울병학회 2010 우울조울병 Vol.8 No.2

Objectives:Suicide is an important public health problem and one of the leading causes of death worldwide. The purpose of this study was to examine the differences in clinical and sociodemographic characteristics between suicide attempters and completers in Chungcheongnam-Do Community. Methods:This study was a part of the Mental Health Survey of Chungcheongnam-Do. 73 subjects (33 attempters, 40 completers) were investigated with a questionnaire about suicide related factors. Basic sociodemographic and clinical datas were compared between suicide attempters and suicide completers. Results:The suicide completers were characterized by male preponderance,lower rates of previous suicide attempt and psychiatric treatment. In both groups, depression were strongly related to suicide. The most common method of suicide in both groups wasagricultural chemicalsoverdose. In addition, the suicide completers used the lethal methods such as Hanging, drowning, neck fastened and jumping compare to attempters. Howeverthe suicide attempters used the non-severe methods such as psychotropics overdose and cutting. Economic problems were a leading cause of suicide in both groups. Also, impulsivity and despair were most common psychological state at the time of suicide. Conclusion:There were significant differences between suicide attempters and completers in gender, distressful disease, method of suicides, previous suicide attempts. This result emphasis the need for further investigation on high risk group for suicide.

The Activity of the Lateral Orbitofrontal Cortex during the Processing of Neutral Facial Affect in Comparison with Emotionally Salient Facial Affect

Kim, Ji Woong,Kee, Seon Wan,Park, Jin Kyun,Kim, Ji Hyung 건양대학교 의과대학 2003 건양의대학술지 Vol.3 No.2

신체형장애, 우울장애 및 정신신체장애 환자들간의 질병행동의 비교

고경봉,기선완,Koh, Kyung-Bong,Ki, Sun-Wan 한국정신신체의학회 1997 정신신체의학 Vol.5 No.2

A comparison was made regarding illness behavior among patients with somatoform disorders, depressive disorders and psychosomatic disorders. The subjects consisted of out-patients with somatoform disorders(N=52), depressive disorders(N=52) and psychosomatic disorders(N=51). illness behavior was assessed by illness Behavior Assessment Schedule and the questionnaire about help-seeking behavior. The patients with somatoform disorders and psychosomatic disorders more often affirmed the presence of somatic disease, were more likely to have phobia of disease, had more preoccupation with ideas of disease and more frequently shopped around oriental clinics than the patients with depressive disorders. The patients with somatoform disorders more often attributed its cause to physical factors, less often attributed the origin of affective disturbance to psychological causes, showed Less depression and irritability, and were less likely to accept psychiatric treatment recommended by other physicians than depressive patients. The patients with somatoform disorders were more likely to report having been told that they suffered from a mild illness than those with psychosomatic disorders. The patients with somatoform disorders with psychological problems tended to inhibit expression of their emotion. Female patients with somatoform disorders more often affirmed the presence of psychological disorder and attributed its cause to psychological factors than male ones. These results suggest that in illness behavior, patients with somatoform disorders are different from depressive patients, whereas the former patients are similar to psychosomatic patients except the discrepancy between therapists and patients regarding evaluation of their symptoms. Thus, it is emphasized that first, therapists need to approach patients with somatoform disorders somatically with understanding of their underlying need to deny psychological problems, followed by either psychological or biopsychosocial approach. 본 연구는 정신과외래에 내원한 52명의 신체형장애, 52명의 우울장애, 51명의 정신신체장애환자들을 대상으로 질병행동을 비교하기 위해 실시되었다 질병행동을 평가하기 위해서 질병행동평가스케줄(illness behavior assessment schedule) 및 치료추구행태에 관한 설문을 사용하였으며 면담방법은 구조적인 형태로 이루어졌다. 신체형장애환자들과 정신신체장애환자들은 각각 우울장애환자들에 비해 신체적 질병에 대한 확신, 질병에 대한 공포, 질병에 대한 집착이 더 강하고 한의원의 이용빈도가 더 높았다. 신체형장애환자들은 우울장애환자들에 비해 질병의 원인을 신체적인 것으로 더 확신하고 정동장애의 원인을 심리적인 것으로 귀착시키는 경향이 낮으며 우울 및 안절부절못하는 정도 및 정신과에 대한 수용도가 각각 더 낮았다. 한편 신체형장애환자들은 정신신체장애환자들보다 질병의 정도가 더 경한 것으로 설명되었음을 확신하였다. 신체형장애환자들은 정신적 고통이 있는 경우에 감정표현의 억제가 더 현저하였다. 신체형장애환자들 중 여자들이 남자들보다 더 심리적 장애가 있고 병의 원인을 심리적인 인자로 귀착시켜 여자에 대한 정신과적 접근이 더 용이할 수 있음을 시사하였다. 이상의 결과들은 질병 행동에 있어서 신체형장애환자들이 우울장애환자들과는 다른 반면 증상의 평가에 있어서 치료자와 환자간의 차이를 제외하고는 정신신체장애환자들과 비슷한 양상임을 시사한다. 따라서 신체형장애환자들에 대한 접근은 이런 환자들의 심리적인 것을 부정하려는 욕구를 이해하면서 처음에는 신체적인 접근으로 시작하여 점진적으로 심리적 및 생물정신사회적인 접근으로 전환해야 할 필요성이 강조된다.조절되어진다는 사실을 제시한다. 하지만 태생어류에서 이 호르몬의 실질적 작용 메카니즘 및 명확한 작용시기에 대해서는 보다 많은 연구가 요구되어 진다.을 설계하는 것이 가능하였다.적(最適) 온도(溫度)는 $30^{\circ}C$, avicelase와 ${\beta}-glucosidase$의 최적(最適) pH는 5.0, CMCase는 pH 5.5 이었으며, 균사(菌絲) 생육(生育)은 pH 5.0에서 양호(良好)하였다. 배양(培養) 기간(期間)은 avicelase가 8일(日), CMCase가 10일(日), ${\beta}-glucosidase$는 16 일간(日間) 배양(培養)하였을 때 최대치(最大値)를 보였고, 균사(菌絲) 생육(生育)은 12일(日) 배양(培養)했을 때 가장 양호(良好)하였다.가한 반면, 중국인들은 고소한 향의 강도, 고소한 향의 기호도, 전체적인 맛에서 뚜렷하게 일본참기름을 우수하게 평가하였다.s의 항체(抗體)로 반응(反應)시킨 후 protein-A gold(15 nm)로 표식(標識)시킨 바 제일 바깥 상층(上層)의 keratinocyte에 있어서 세포막표면(細胞膜表面)을 따라 표식(標識)되어 세포막항원(細胞膜抗元)을 나타내었으며, 이와 같은 소견(所見)으로 미루어 정상피부(正常皮膚) 중층편평상피세포(重層扁平上皮細胞)에서도 동일(同一)한 소견(所見)을 관찰(觀察)할 수 있다고 본다.al remnants, Resorption of fetus로 관찰된 것이다. Fetal death는 수정후 $14{\sim}18$일까지의 사망으로써 Maceration of fetus로

한국인 알코올사용장애의 의료기관과 지역사회기관 간 전향적 임상경과 비교

장재훈,기선완,서정석,정원미,이수비,박일호 한국중독정신의학회 2023 중독정신의학 Vol.27 No.1

Objectives: Although alcohol use disorder (AUD) is a burdening public health problem, medical and community-based services are under-utilized in South Korea. To understand factors affecting the course of AUD, a nation-wide longitudinal follow-up study was conducted. Methods: A 3-year biannual follow-up evaluation of patients with AUD from six areas in South Korea was conducted in 2016–2019. Baseline demographic and clinical data, alcohol-related problems, affective symptoms, insight level, and motivation measures were compared between patients who failed and succeeded in cessation from heavy drinking (CHD) and between patients from medical (hospital) and community-based services. Results: The 6-month CHD rate was 18.3%–48.5%. After six months, follow-up loss and CHD were drastically decreased over time. AUD, alcohol craving, depression, and anxiety scale scores were higher in patients who failed CHD. Hospital patients showed higher AUD severity scores, whereas community patients showed higher depression scores. Failed CHD patients had greater AUD severity in medical setting and greater depression and anxiety severity in community setting. Conclusion: This study performed the first nation-wide prospective survey on the course of patients with AUD in South Korea. Difference in CHD rate and associated factors between medical and community settings in AUD treatment suggest a need for implementing treatment setting-specific programs.

한국어판 대인 관계 반응성 척도의 신뢰도 및 타당도 연구

강일,기선완,김성은,황지희,송지은,장범석,김지웅 대한신경정신의학회 2009 신경정신의학 Vol.48 No.5

본 연구에서 한국어판 IRI는 만족할 만한 수준의 신뢰도와 타당도를 보여 주었다. 공감이 모든 일상 생활에 있어서 중요한 사회적 상호작용의 필수적인 요소임을 고려할 때, 정신과 의사뿐만 아니라, 사회적 상호작용 및 대인 관계 나아가 사회적 행동 등을 연구하는 심리학자나 사회 과학자 또는 교육분야의 종사자들이 공감과 관련된 수많은 연구들을 수행하는 데 있어 한국어판 IRI를 유용한 도구로 이용할 수 있을 것이라 생각된다. 향후 과제로는 한국어판 IRI와 국내외의 다른 공감과 관련된 척도들과 비교 연구 및 좀 더 다양한 대상군들에게 이 척도를 시행하여 실제로 적용가능한지 등에 대해 탐색해 보는 것 등을 고려해 볼 수 있겠다. 그리고 이러한 시도를 바탕으로 공감의 생물학적 원인을 찾고, 정신병리와의 관련성 등에 대해 현재보다 폭넓은 연구를 진행할 수 있을 것이다. Objectives: The aim of this study was to test the reliability and validity of the Korean version of Interpersonal Reactivity Index (K-IRI). Methods: A total of 484 participants were included in this study. Internal consistency and test/retest reliability (n=35) were examined. Criterion validity of the K-IRI was assessed against Affective Dimension of the 3D-Wisdom Scale. Factor analyses were also performed using principal component analysis with varimax rotation. Results: The internal consistency of the K-IRI was 0.80, and test-retest reliability was 0.76. Criterion validity was evaluated by correlating the K-IRI with the Affective Dimension of 3D-Wisdom Scale (r=0.31). Factor analyses revealed factor structures similar to the original IRI. Conclusion: The K-IRI appeared to be a reliable and valid instrument for assessing empathy in the Korean population. This suggests that this scale may be applicable in clinical trials, research, and clinical practice.

알코올 금단 증상의 치료에서 Topiramate의 효과 및 안정성

최은애,기선완,김성은,김지웅,박진균 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.3

Objectives : Benzodiazepines are most often used for the treatment of alcohol withdrawal, but they also may result in several adverse consequencies such as sedation, respiratory depression, cognitive impairment, disinhibition, and abuse. New anticonvulsants, topiramate may have a potential to treat alcohol withdrawal effectively. This study compared the therapeutic responses of a benzodiazepine, lorazepam, and an anticonvulsant, topiramate, for the treatment of alcohol withdrawal. Methods : Fifty-two hospitalized patients with the diagnosis of DSM-IV Alcohol dependence, after obtaining written informed consent, were randomely divided into the either lorazepam (N=27) or the topiramate (N=25) groups. Subjects were assessed with CIWA-Ar scores at the time of baseline, 1, 3, 5 day after the last alcohol drinking. Lorazepam was given 4 mg divided by 4 on day 1, tapering to 2 mg divided by 2, and topiramate was given fixed single dose of 50 mg a day. Results : There were no significant differences between two groups in demographic or clinical characteristics except marital status and s-ALT level. Two groups had similar ADS scores and baseline withdrawal severity. There were no significant differences by treatment group in CIWA-Ar scores over time (F=0.883, P>0.05). Conclusion : Efficacy and safety were not different between the two groups. Therefore our results suggest that topiramate is a Promising alternative agent to benzodiazepine for treating alcohol withdrawal.