외상성 뇌손상 환자의 공격성에 대한 약물치료

노승호 圓光大學校 醫科大學 神經精神科學敎室 1997 圓光精神醫學 Vol.13 No.2

외상성 뇌 손상 환자의 삶의 목적 수준에 관한 연구

노승호,김성우,Rho, Seung-Ho,Kim, Sung-Woo 한국정신신체의학회 1999 정신신체의학 Vol.7 No.2

Objectives : As traumatic brain injury(TBI) leaves chronic sequelae in mind and body, the injured patients should rectify the meaning and object that they have pursued in their lives and set up a new purpose in life that they may make the rest of their lives meaningful. This study was designed to investigate the purpose and quality of life levels and the influence of demographic and clinical variables on the levels in the patients with TBI, and to be of some help to their rehabilitation. Methods : In order to assess the purpose in life(PIL) and the quality of life(QOL) levels, Purpose-in-Life Test, Sickness Impact Profile, Quality of Life Index, Head Injury Symptom Ckecklist, and Neurobehavioral Rating Scale were administered to the subjects. The subjects were thirty-two patients with TBI and the same numbered normal controls. The TBI group was composed of 16 to 65 year-aged patients who had received mild or severe TBI at least 12 months before, and the controls were siblings or friends of the patients whose age, sex, and educational level were similar to them. Results : 1) The PIL and QOL levels of the patients with TBI remained significantly lower than that of control group after their symptoms of injury were stabilized(p<.01, p<.01). 2) The mean PIL score of TBI group was $58.8{\pm}23.2$, which was to be regarded as the level of existential vacuum. 3) The PIL level of TBI group was significantly correlated with the QOL level(p <.01). 4) The subgroup with lower PIL level in patients with TBI has significantly higher rate of female than that with higher PIL(p<.05), the PIL level of female patients was significantly lower than that of male patients(p <.05). 5) The significant differences in PIL levels were not found, in which comparison was performed between each pair of subgroups of patients with TBI divided by severity of injury(mild vs severe), marital status(married vs unmarried), and occupational status prior to injury(employed vs unemployed). Conclusion : The PIL of patients with TBI still remained the level of existential vacuum after symptoms of sequelae had been stabilized, The QOL level was also extremely low, and as the PIL level was low the QOL was also low. The demographic and clinical variables except sex did not have influence on the PIL level in brain-injured patients. It is suggested that every patient should admit their mental and physical limitations caused by brain injury and revise their purpose in life for successful rehabilitation.

뇌 손상 환자의 기억장애

노승호 圓光大學校 醫科大學 神經精神科學敎室 2000 圓光精神醫學 Vol.16 No.1

기억장애는 뇌 손상 환자의 가장 흔한 후유증 중의 하나이다. 이러한 후유증은 뇌 손상의 부위와 범위 및 심도,그리고 환자의 연령에 따라 달리 나타난다. 뇌의 급격한 가속-감속 운동은 뇌간,피질하백질,전두엽과 측두엽 등에 미세한 병변을 유발한다. 뇌 손상의 특성과 위치에 따라 물리적 힘을 직접 받는 두개 부위에 인접한 뇌가 상처를 받는 충격 손상 (coup injury)과 그 반대 편이 힘의 반동으로 해를 입는 반충 손상 (contrecoup injury)이 발생할 수 있다. 중등도 이상의 뇌 손상에서는 경막하 및 뇌내 혈종,정상압 뇌수두증,무산소증 등 합병증으로 인하여 뇌는 광범위한 손상을 입기 때문에 후유증도 다양하게 나타날 수 있다. 따라서 뇌 손상 환자의 기억력 평가에서 특징적 단일 소견을 제시하기는 어려운 일이다. 여기에서는 뇌 손상 환자에서 흔히 나타나는 기억장애와 손상의 호발 부위에 따른 기억장애의 특성을 살펴보고자 한다.

외상후 경련

노승호 圓光大學校 醫科大學 神經精神科學敎室 1996 圓光精神醫學 Vol.12 No.2

경련 (seizure)이란 대뇌 피질의 신경원들로부터 과도한 전기 자극이 일시에 방출됨으로써 뇌의 일시적인 생리적 기능장애가 초래되는 현상을 말하며, 이러한 경련 삽화가 외상성 뇌 손상 (posttraumatic brain injury : TBI)을 받은 환자들에서 다른 명백한 원인이 없이 일회성 또는 재발성으로 나타나는 경우를 외상후 경련 (posttraumatic seizure : PTS)이라 한다. PTS는 TBI의 주요 합병증의 하나로서 환자의 회복에 중대한 걸림돌이 될 수 있다. TBI는 그 자체가 인지기능 장애와 행동 변화를 유발하고, 경련도 마찬가지로 환자의 인지기능과 사회적 기능 수행에 지대한 영향을 줄 뿐만 아니라 이를 치료하는데 사용되는 항경련제 역시 인지기능에 좋지 않은 영향을 준다. 그런데 PTS의 경우에는 TBI와 경련에서 본질적으로 수반되는 문제가 한 환자에서 함께 나타날 수 있고, 또한 경련이 하나의 심리적인 충격으로 작용하여 환자가 사회생활을 영위하는데 있어 자신감에 심각한 타격을 줄 수 있기 때문에 TBI자체, 경련, 약물의 영향, 심리적인 영향들은 뇌 손상 환자의 재활에 중요한 변수로 작용하게 되는 것이다.

精神遲滯의 診斷

魯承昊 圓光大學校 醫科大學 神經精神科學敎室 1988 圓光精神醫學 Vol.4 No.2

癎疾患者의 悲觀에 關한 硏究

魯承昊 大韓神經精神醫學會 1982 신경정신의학 Vol.21 No.3

In order to study pessimism in the epileptics, Beck's hopelessness scale was used for measuring hopelessness. One-hundred normal subjects, 150 epileptic patients and 100 dermatoses patients were selected randomly. The results were as follows; 1. The hopelessness score was highest in the epileptic group, followed by the dermatoses and the normal control group. 2. No difference was observed between both sexes in each group. 3. In epileptic group, the hopelessness score of those without a religion was higher than that of those with a religion. 4. The scores of all 3 factors the "loss of motivation", the "Feeling about the future" and the "future expectation" were significantly higher in the epileptic group than the others.

외상성 뇌손상 환자의 삶의 질에 대한 임상적 고찰

노승호,천영훈 圓光大學校 醫科大學 神經精神科學敎室 1998 圓光精神醫學 Vol.14 No.1

목적 : TBI 후유증의 증상이 안정된 이후 환자들의 삶의 질은 어느 정도의 수준인지, 그리고 삶의 질 수준이 높은 집단과 낮은 집단은 인구 통계적 변인, 정신사회적 기능 및 신경행동 증상들의 측면에서 어떤 차이가 있는지를 알아보고자 하였다. 방법 : TBI 환자 46명 중 삶의 목적 수준이 높은 집단과 낮은 집단을 각각 15명씩 선정하여 대상군으로 하였고, TBI 환자의 친지들 중 연령과 성 및 교육수준이 비슷한 사람들을 선정하여 대조군으로 하였다. QOLI, SIP, PIL, HISC, NRS를 사용하여 삶의 질, 정신사회적 기능, 삶의 목적, 자각적 및 타각적 신경행동 증상을 평가하여 서로 비교하였다. 결과 : 1)TBI군의 삶의 질은 정상 대조군의 1/3 수준(66.1±23.4 : 6.5±2.5)이었으며, 정신 사회적 기능 및 삶의 목적 수준은 대조군보다 유의하게 낮았고, 자각적 및 타각적 신경행동 증상은 유의하게 심했다(P<.01). 2)TBI군 중 삶의 질 수준이 높은 집단은 낮은 집단에 비해 외상 전과 외상 후 지능이 유의하게 높았다(각각 p<.05, p<.01). 그러나 연령, 성비, 교육수준, 결혼 및 직업상태, 외상의 원인 및 심각도, 외상후 기간에서는 두 군 간에 차이가 없었다. 3)TBI군 중 삶의 질 수준이 높은 집단은 낮은 집단에 비해 정신사회적 기능과 삶의 목적 수준이 유의하게 높았으며, 자각적 및 타각적 증상은 더 적었다(각각p<.01, p<.05, p<.01, P<.05). 4)STBI는 MTBI보다 정신사회적 장해와 자각적 증상이 유의하게 심했다(p<.05, p<.05).그러나 삶의 질 및 목적 수준과 타각적 증상은 두 군간에 차이가 없었다. 결론 : TBI 환자의 삶의 질은 증상이 고정된 이후에도 비장애인보다 현저히 낮은 수준에 머물고 있었으며, 삶의 질 수준이 상대적으로 높은 집단은 낮은 집단에 비해 수상 전, 후의 지능이 높았고, 외상의 심각도가 낮았으며, 정신사회적 기능과 삶의 목적 수준은 더 높았고, 자각적 및 타각적 증상은 더 적었다. This study was designed to investigate the quality of life(QOL) level of the patients with TBI after the symptoms of sequelae was stabilized, and the differences between the patients with higher QOL and those with lower QOL and those with lower QOL in demographic variables, psychosocial functioning, and neurobehavioral symptoms. The subjects were composed of patients with higher QOL(N=15, Group 1) and those with lower QOL(N=15, Group 2), who were assigned according to the level of QOL among 46 patients with TBI, and 30 normal control group. The levels of QOL, psychosocial functioning, purpose in life, and subjective and objective neurobehavioral symptoms were rated by QOLI, SIP, PIL, HISC, and NRS. The results was as follows. 1)In comparing to the normal control group, QOL level of TBI group remained about 1/3 of that of control(66.1±23.4 : 6.5±2.5, respectively). The brain injured patients had significantly lower levels of psychosocial functioning and purpose in life(p<.01), and more severe subjective and objective neurobehavioral symptoms(p<.01). 2)In comparing demographic and clinical variables between Group 1 and 2, pre- and post- injury IQ of Group 1 were significantly higher than those of Group 2(p<.05, p<.01, respectively). But significant differences were not found in other variables(e.g., age, sex, education, marital status, cause and severity of injury, and duration after injury). 3)Group 1 had significantly higher psychosocial function and purpose in life levels, and less subjective and objective symptoms than Group 2(p<.01, p<.05, p<.01, p<.05, respectively). 4)STBI experienced more severe psychosocial impairment and subjective symptoms than MTBI(p<.05, p<.05). However, in QOL and purpose in life level and objective symptoms there were no difference between STBI and MTBI.

만성 통증장애의 정신과적 치료

노승호,Rho, Seung-Ho 한국정신신체의학회 1999 정신신체의학 Vol.7 No.2

Because chronic pain disorder may has multiple causes or contributing factors, including physical, psychological, and socio-environmental variables, the treatment of patients with the disorder requires biopsychosocial approaches in a multidisciplinary setting. In treating chronic pain, it is important to address functioning as well as pain, and treatment should be to increase functional capacity and manage the pain as opposed to curing it. Therefore treatment goal should be adaptation to pain or minimizing pain with corresponding greater functioning. Treatment begins with the initial assessment, which includes evaluation of psychophysiologic mechanisms, operant mechanisms, and overt psychiatric comorbidity. Psychiatric treatment of the patients requires adherence to sound pharmacologic and behavioral principles. There are four categories of drugs useful to psychiatrist in the management of chronic pain patients : 1) narcotic analgesics, 2) nonsteroidal antiinflammatory drugs, 3) psychotropic medications, and 4) anticonvulsants, but antidepressants are the most valuable drugs in pharmnacotherpy for them. Psychological treatments tend to emphasize behavioral and cognitive-behavioral modalities, which are divided into self-management techniques and operant techniques. Psychodynamic and insight-oriented therapies are indicated to some patients with long-standing interpersonal dysfunction or a history of childhood abuse.

외상성 뇌손상의 증상이 SCL-90-R profile에 미치는 영향

노승호 圓光大學校 醫科大學 神經精神科學敎室 1998 圓光精神醫學 Vol.14 No.2

목적 : SCL-90-R을 사용하여 외상성 뇌손상 (TBI) 환자들의 정신병리를 평가할 때 TBI환자 profile의 특징과 TBI 증상이 SCL-90-R의 profile에 어떤 영향을 주는지 알아보고자 하였다. 방법 : TBI 환자 45명의 SCL-90-R profile을 정상 대조군의 자료와 비교하였다. TBI 환자군의 SCL-90-R에서 각 문항별 원점수 평균을 구하고 이를 기준으로 증상의 심도 순으로 배열하여 상위 25%와 하위 25%에 속하는 증상들을 선정한 후 이들이 TBI 증상에 해당하는지 여부를 조사하였다. SCL-90-R 중의 TBI관련문항은 후유장해를 평가한 경험이 있는 의사들에 의해서 선정되었다. TBI 관련 문항을 제외한 교정 profile을 원래의 profile과 비교하였다. 결과 : 1) TBI 환자군의 SCL-90-R profile은 PHO에서 가장 높았고 그 다음은 SOM과 ANX의 순이었으며, 정상 대조군과 비교할 때 SCL-90-R의 모든 하위척도에서 대조군보다 유의하게 높았다(p<.01). 2) SCL-90-R의 90개 문항중 TBI증상에 해당하는 문항은 36개 문항이었고, 하위척도별 비율은 HOS (100.0%), DEP (61.5%), SOM (50%). I-S (44.4%), O-C(30.0%), ANX (30.0%), PHO (14.3%), PSY (10.0%), PAR (0.0%)이었고, 부가적 문항에서는 51.1%였다. 3)TBI환자가 SCL-90-R에서 나타낸 주요 증상 25개 문항 중 20개의 문항 (80.0%)이 TBI와 관련된 것으로 드러났다. TBI 관련 증상 중 환자군이 낮은 심도로 평정한 문항은 3개 문항으로 이들은 모두 HOS 척도에 해당하는 증상이었다. 4) TBI 관련 증상을 제외한 54개 문항으로 수정한 SCL-90-R profile은 SOM에서 유의하게 낮았고(p<.05), 부가적 문항에서도 유의한 차이가 나타났다(p<.05). 결론 : SCL-90-R에서 TBI의 만성 후유증으로 입원한 환자들은 공포와 불안, 우울, 신체화를 특징으로 하는 신경증적 장애를 갖는 것으로 나타났으며, SCL-90-R의 90개 문항 중 TBI에 관련된 증상이 1/3 이상을 차지하고 있기 때문에 TBI 증상들은 SCL-90-R profile, 특히 신체화 척도에 상당한 영향을 미치는 것으로 조사되었다. This study was designed to investigate the characteristics of SCL-90-R profile of patients with TBI and the effect of symptoms associated with traumatic brain injury (TBI) on SCL-90-R profile when evaluating the psychopathology of TBI patients with SCL-90-R. SCL-90-R profile of 45 patients with TBI was compared to that of normal control group. TBI related items on the SCL-90-R were selected by seven psychiatrists based on the independent judgements. Major symptoms of patients presented on the SCL-90-R were compared with the TBI-related items. The results were as follows. 1) SCL-90-R profile was 7-1-5 type, in which the T-scores of PHO scale was highest, and the next were the SOM and the ANX scales, in this order, and the T-scores of SCL-90-R scales of TBI patients were significantly higher than those of normal control group(p<.01). 2) The TBI-related items on SCL-90-R were 36 items, which were composed of HOS (100.0%), DEP (61.5%), SOM (50%). I-S (44.4%), O-C(30.0%), ANX (30.0%), PHO (14.3%), PSY (10.0%), PAR scales (0.0%), and additional items (57.1%). 3) The twenty items (80%) of the major symptoms of TBI patients were TBI-related, and of the TBI-related items three items were rated lower severity by the TBI group, which were corresponded to HOS sacle. 4) In comparing the adjusted profile with exclusion of TBI-related items to the original profile the raw scores of SOM scale and additional items were significaltly lower in the TBI group(p<.05).

외상성 뇌 손상 후 우울증

노승호 圓光大學校 醫科大學 神經精神科學敎室 1996 圓光精神醫學 Vol.12 No.1

The author has reviewed the literatures about depression following traumatic brain injury(TBI). A large number of patients with TBI can suffer from chronic neuropsychiatric sequelae of traumatic injury. Many patients complain of feeling depressed after TBI, but the reported frequency of post-TBI depression has varied from 6% to 77%. Post-TBI depression may be transient syndromes lasting for a few weeks or persistent disorders lasting for many months. The former may be associated with neuropsychological disturbances whereas the latter may be reactive psychological responses to physical or cognitive impairment. Neuroanatomical and neurochemical changes that occur after TBI may predispose patients to the development of the depression, and the degree of physical and cognitive impairment do not appear to play a prominent role in the development of the depression. Several issues for diagnosis and differential diagnosis of depressed mood after TBI are discussed. Also discussed are specific therapeutic interventions. including the appropriate use of medication and psychological treatment.