노인 조현병 환자에서 삶의 질과 호모시스테인 농도의 관계

박신형 ( Sin Hyung Park ),전진숙 ( Jin Sook Cheon ) 한국정신병리진단분류학회 2015 精神病理學 Vol.23 No.1

연구목적 : 본 연구의 목적은 노인 조현병 환자에서 삶의 질과 호모시스테인 (Hcy) 농도와의 연관성을 알아보기 위함이다. 연구방법 : 조현병으로 입원한 65세 이상의 노인환자 128명(남자 57명, 여자 71명)을 대상으로 반구조적 면담과 삶의 질(SQLS), 일상생활 활동능력(K-ADL), 인지기능(MMSE-K), 정신증의 심한 정도(K-PANSS) 및 우울증의 심한 정도(K-GDS)를 평가하였다. 연구결과 : 1) Hcy 증가군에서는 남성이 여성보다 유의하게 더 많았고(p<0.05), Hcy 정상군 보다 Hcy 농도, K-ADL, K-PANSS 및 K-GDS 점수가 유의하게 더 높았으며, MMSE-K 점수는 유의하게 더 낮았다(각각 p<0.001). 2) 삶의 질(K-SQLS)은 Hcy 증가군에서 Hcy 정상군보다 유의하게 낮았다(p<0.001). 3) K-SQLS는 Hcy 농도, K-ADL 및 K-GDS와 유의한 순 상관관계가 있었고, MMSE-K 및 K-PANSS와 유의한 역상관관계가 있었다. 4) 회귀분석 결과, K-SQLS에 유의한 영향을 미치는 변인은 Hcy 농도 및 K-GDS 이었다. 결론 : 노인 조현병 환자에서 Hcy을 감소시키는 책략과 우울증을 경감시킴으로써 삶의 질을 증진시킬 수 있을 것으로 기대된다. Objectives : The aim of this study was to identify variables including homocysteine levels associated with the quality of life in old age schizophrenics. Methods : The data were obtained from admitted schizophrenics with age over 65 (N=128, male 57, female 71) by semistructured interviews and measurements of quality of life (K-SQLS), functional activities of daily living(K-ADL), cognitive function (MMSE-K), severity of psychosis (K-PANSS) and depression (K-GDS). Results : 1) The old age schizophrenics with increased homocysteine levels had significantly more males (p<0.05), higher Hcy levels and higher scores in the K-ADL, K-PANSS and K-GDS, and lower total scores of the MMSE-K (p<0.001, respectively). 2) The total scores of the K-SQLS were significantly higher in old schizophrenics with increased homocysteine levels. That is, the quality of life was significantly lower in old schizophrenics with increased Hcy. 3) The K-SQLS in old age schizophrenics had positive correlation with Hcy, K-ADL and K-GDS. and had negative correlation with MMSE-K and K-PANSS with statistical significance. 4) Variables influencing on the K-SQLS were Hcy and K-GDS according to regression analysis. Conclusions : Applying strategies to reduce homocysteine levels and depression could be expected to improve the quality of life in old age schizophrenics.

일주일 간격의 단계적 인공 슬관절 전치환술의 합병증 발생률 및 임상 결과

박신형(Sin Hyung Park),임수재(Soo Jae Yim) 대한정형외과학회 2015 대한정형외과학회지 Vol.50 No.1

목적: 양측 인공 슬관절 전치환술을 일주일 간격으로 단계적으로 시행한 환자군, 한번의 마취하에 동시에 시행한 환자군, 입원 기간을 달리하여 단계적으로 시행한 환자군의 임상 결과 및 합병증의 발생률을 비교하고자 하였다. 대상 및 방법: 2004년 5월부터 2012년 3월까지 양측 슬관절 퇴행성 관절염으로 순천향대학교 부천병원에서 양측 슬관절 전치환술을 시행한 환자 273명 546예를 세 군으로 나누어 hospital for special surgery (HSS) score 및 합병증의 발생률을 후향적으로 비교 분석하였다. 결과: 평균 HSS 점수는 세 군 모두에서 통계적으로 유의할 만한 호전을 보였으며 수술 후 HSS 점수는 통계적으로 유의한 차이를 보이지 않았다(p=0.325). 일주일 간격의 단계적 인공 슬관절 전치환술을 시행한 군은 한 번의 마취하에 양측 인공 슬관절 전치환술을 동시에 시행한 군과 비교하여 통계적으로 유의하게 낮은 합병증의 발생률을 보였으며(p=0.049), 다른 입원 기간으로 양측을 단계적으로 시행한 군과 비교하여서는 통계적으로 유의한 차이를 보이지 않았다(p=0.786). 결론: 일주일 간격의 단계적 인공 슬관절 전치환술은 다른 군과 비교하여 임상 결과 및 합병증의 발생률에서 좋은 결과를 보였으며 수술이 필요한 양측 슬관절 퇴행성 관절염 환자에서 좋은 선택이 될 수 있다. Purpose: The purpose of this study is to compare the clinical results and the rates of complication among three groups that received the simultaneous total knee replacement (TKR), one-week interval staged bilateral TKR, or several-months interval staged TKR. Materials and Methods: We conducted a retrospective study of patients who had been diagnosed with bilateral degenerative osteoarthritis undergoing bilateral TKR from 2004 May to 2012 March. We divided patients into three groups which received simultaneous TKR (Group A, n=84), one-week interval staged bilateral TKR (Group B, n=124), or several-months interval staged TKR (Group C, n=65). Hospital for special surgery (HSS) score and the rate of complication were evaluated and compared. Results: Mean postoperative HSS score showed significant improvement in the three groups. No difference in postoperative HSS was observed among the three groups (p=0.325). The complication rate in Group A was lower than that in Group B (p=0.049) and that in Group A was similar to that in Group C (p=0.786). Conclusion: Group A had a better result than Group B and was similar to Group C in complication rate. One-week interval staged TKR can be good choice in patients with bilateral degenerative osteoarthritis.

경도인지장애에서 몬트리올 인지평가 척도의 유용성

박신형(Sin Hyung Park),전진숙(Jin Sook Cheon),박지용(Ji Yong Park),고영주(Young Ju Ko),오병훈(Byoung Hoon Oh) 대한생물치료정신의학회 2010 생물치료정신의학 Vol.16 No.1

Objectives:This study was tried to know usefulness of the Montreal Cognitive Assessment(MoCA) to detect mild cognitive impairment(MCI), to identify any differences according to items, and to disclose variables associated with MoCA. Methods:The MoCA-K(Korean Version of the Montreal Cognitive Assessment) and the MMSE-K(Korean Version of the Mini-Mental State Examination) were performed to normal controls(N=25), patients with MCI(N=27), and patients with dementia of the Alzheimer’s type(N=26). Results:1) At cut-off of 23/24, sensitivity of the MoCA-K to detect MCI was 70% and specificity was 92%. While sensitivity of the MMSE-K was 11%, and specificity was 96%. In general, the MoCA-K had higher sensitivity than the MMSE-K, while specificity was similar. 2) There were more differences in items of the MoCA than those of the MMSE, especially in attention and abstraction(p<0.001, respectively). 3) Total scores of the MoCA-K had positive correlation with total scores of the MMSE-K(γ=0.879, p<0.01) and education(γ=0.489, p<0.01), and negative correlation with age(γ=-0.550, p<0.01). Conclusion:The MoCA test seemed to be more useful than the MMSE to detect mild cognitive impairment. However, bias from age and educational level might affect the test results like MMSE.

2005년 대한민국 질소 유입 및 유출 수지

윤동민(Dong Min Yun),박신형(Sin Hyung Park),박재우(Jae Woo Park) 大韓環境工學會 2008 대한환경공학회지 Vol.30 No.1

본 연구에서는 기존의 질소 수지에 관한 연구를 바탕으로, 우리나라의 2005년 질소의 총 유입과 유출을 수지분석 방법을 이용하여 추정하였다. 전체의 양을 정확히 추정하는 것은 불가능하지만 사용할 수 있는 데이터 수치를 활용하여 대략적인 질소의 유·출입의 양을 산출하였다. 주요 질소 흐름을 도시계, 농·축산지역, 임야의 세 부분으로 나누어 그 양을 각각 산정하였으며, 질소의 주요 유입으로는 화학적, 생물학적 질소 고정, 건식 및 습식 침착량, 해외로부터 수입된 양 등이 있으며, 유출된 양은 작물흡수, 휘발, 탈질, 침식, 표면유출, 산림소비, 질소산화물(NOx) 소비량 등으로 결정하고 그 양을 추정하였다. 그 외 추정 불 가능한 비점오염원에 의한 오염량을 물질 수지 분석방법으로 양을 추정하였다. 연간 질소의 총 유입량은 1,442,254 ton·yr-1이며, 총유출량은 814,415 ton·yr-1 이었다. 질소 수지 분석하여 연간 발생한 비점오염원의 양을 추정해본 결과 유입질소의 19.4%정도의 질소가 강 또는 바다에 흘러들었다. 유사한 시도로서는 가장 최근에 이루어진 2002년도에 연구되었던 질소 유입량에 비해서 21% 많은 양으로 조사되었으며, 특히 정부 정책의 변화가 질소 수지에 영향을 미쳐 유출분야에서는 매립에 의한 질소량이 전체 유출 질소량의 20%에서 1% 미만으로 줄어들었다. Nitrogen budgets in Korea in 2005 were estimated using a mass balance approach. Major nitrogen fluxes were divided into three sections: cities, agricultural area, and forest. Nitrogen inputs were chemical and biological fixation, dry and wet deposition, imported food and feed, while crop uptake, volatilization, denitrification, leaching, runoff, and forest consumption were nitrogen outputs. Non-point source(NPS) pollution budgets were also estimated by mass balance approach. Annual total nitrogen inputs budgets were 1,442,254 ton·yr-1, and outputs were 814,415 ton·yr-1. Approximately 19.4% of nitrogen input leaked to river and seawater as NPS pollution. It contains nitrogen input 21 percent more than the previous research in 2002. Especially the change of government plans affect nitrogen budget. As a result, in the output field, the whole nitrogen amount due to landfill reduce from 20 percent to less than 1 percent.

한국 남성 노인의 도박에 영향미치는 요인

박지용(Ji Yong Park),전진숙(Jin Sook Cheon),권명환(Myong Hwan Kwon),박신형(Sin Hyung Park),오병훈(Byoung Hoon Oh) 대한생물치료정신의학회 2008 생물치료정신의학 Vol.14 No.1

Objectives : Although pathological gambling pertains to the impulse control disorder according to the DSM-Ⅳ, it can be comorbid with various psychiatric disorders including personality disorders(antisocial, narcissistic, borderline). Alcohol and other substance related disorders, suicide, obsessive compulsive disorder, anxiety disorder, attention deficit hyperactivity disorder, mood disorder were reported to be related. Therefore, the aim of this study was to identify influencing or risk factors on the gambling behavior among Korean elderly males. Methods : Structured interviews and assessments using various rating instruments to measure cognitive dis-order (the SPMSQ-K), depression(the K-BDI and the HRSD), alcoholism(the Brief MAST-K), pathological gambling (the Korean Version of the South Oaks Gambling Screen, the SOGS-K) were performed for the elderly males with age over 60 who were living in Busan (N=105). Results: 1) There were significant difference between normal and pathological gambling subgroups of elderly in alcoholism(p<0.05), severity of gambling(p<0.05), living alone(p<0.05), housing(p<0.005), monthly income(p<0.05), smoking(p<0.05) and motivation of gambling(p<0.05). 2) The gambling behavior in the elderly had statistically significant positive correlation with age, alcoholism, depression, cognitive function, education and physical illness (p<0.01, respectively), while had statistically significant negative correlation with monthly income(p<0.01). 3) Especially, the more aged group had about 4 times higher risk and more depressed group had about 19 times higher risk for the pathological gambling. Conclusion: The gambling behavior of Korean elderly seems to be intimately related to the psychosocial factors as well as mental health problems. Most of all, early detection and active treatment of geriatric depression seems to be important.

한국에서 지역사회 거주 남성 노인과 성인의 도박성향 비교

전진숙(Jin Sook Cheon),권명환(Myong Hwan Kwon),박지용(Ji Yong Park),박소민(So Min Park),박신형(Sin Hyung Park),오병훈(Byoung Hoon Oh) 대한생물치료정신의학회 2007 생물치료정신의학 Vol.13 No.2

Objectives:The rate of participating to gambling even in old age is rapidly increasing. However, there are few studies on the gambling effect to health. The pathological gambling can be related to job loss, bankrupcy, arrest, divorce, mental health problem, general health abnormality. Therefore, the aims of this study were to compare gambling behaviors among Korean elderly and adults, to know the rate of pathological gambling and to determine cutoff point, and to provide data to develop a brief pathological gambling screening test specific to the Korean elderly by comparing items of the rating instrument of pathological gambling. Methods:The subjects who were volunteers without history of neuropsychiatric illnesses living in Busan were randomly selected among elderly males within age 60 to 85(N=105) and adult males within age 30 to 49(N=100). The structured interviews and assessments using various rating instruments which required about 40 minutes were performed by three psychiatric residents with the aid of 3-4th grade medical students who were totally blind about subjects. The demographic data(age, sex, education, occupation, religion, marriage, living style, income, etc), physical illness(stroke, metabolic disorder, degenerative arthritis, cancer, etc), pathological gambling(the Korean Version of the South Oaks Gambling Screen, the SOGS-K), gambling history(initiating age, duration, stakes, frequency, companion, etc) were included. Results:1) On comparing of gambling behavior in the Korean elderly males to those in adult males, there were statistically significant difference in the duration, stakes, motivation and types of gambling(p<0.001, respectively). Otherwise, there were no statistically significant difference in frequency, companion, parental gambling problem and initiating age of gambling. 2) Using cutoff score 5 as in USA, the rate of pathological gambling in elderly(41.0%) was significantly higher than those in adults(24.0%)(p<0.05). However, applying cutoff score tentatively determined by the mean±S.D., there were no statistically significant difference between elderly(cutoff score 7, 12.4%) and adults(cutoff score 6, 21.0%). 3) There were significant difference between normal and pathological gambling subgroups of elderly in severity of gambling(p<0.05), living alone(p<0.05), housing(p<0.005), monthly income(p<0.05), smoking(p<0.05) and motivation of gambling(p<0.05). There were significant difference between normal and pathological gambling subgroups of adults in education(p<0.001), religion(p<0.05), physical illness (p<0.005), initiation age of gambling (p<0.05), frequency of gambling(p<0.005), stakes(p<0.05) and total money spending in gambling per month(p<0.005). 4) In five items including item number 7(p<0.005), 9(p<0.005), 10(p<0.05), 11(p<0.001) and 14(p<0.05) among the countable items of the SOGS-K(item number 4-11, 13-15, and 16a-16i), there were significant difference between adults and elderly, which might be used to make the brief form of the SOGS-K. Conclusions:The gambling behavior of Korean elderly seems to be intimately related to the lack of recreational resources and mental health problems. Therefore, we expect our results can be reflected to the welfare policy for the Korean elderly to provide social and medical services, developing brief pathological gambling screening test to detect gambling problems earlier among Korean elderly.