구조화 전화추적 면담을 이용한 품행장애 입원 치료 환자의 예후

방양원,채정호,문석우,이은회,함웅 대한소아청소년정신의학회 2000 소아청소년정신의학 Vol.11 No.2

연구 목적 : 본 연구의 목적은 입원치료후 퇴원한 품행장애 환자들의 예후와 가족들의 정신과 입원치료의 효능에 대한 인식도를 알아보고 예후에 영향을 미칠 수 있는 요인을 알아보기 위한 것이다. 방법 : 품행장애의 진단 하에 7일 이상 입원치료를 받았으며 퇴원 후 6개월이 경과된 300명 중 전화 추적이 가능하였던 96명에서 퇴원 후 문제행동, 가족관계, 가족들의 인식도를 조사하였으며 이와 관련된 요인을 알아보았다. 결과 : 퇴원 후 문제행동의 양상은 입원전보다 호전된 경우가 90%이었으며 더 심해진 경우는 2%이었으며 8%는 변화가 없었다. 퇴원 후 가족관계는 보다 좋아진 경우가 70%, 나빠진 경우가 2%, 별 차이가 없는 경우가 28%이었다. 병원치료의 효율성에 대한 가족들의 인식도는 도움이 되었다는 경우가 57%, 해가 되었다는 경우가 6%, 그저 그렇다가 37%이었다. 퇴원 후 문제행동, 가족관계, 가족들의 입원치료에 대한 인식도 등 세 가지 항목이 모두 양호하다고 답변한 대상을 양호군으로 설정하고 그 외의 대상을 대조군으로 하여 양군의 특성의 차이를 비교하였을 때 양호군의 연령이 유의하게 낮았으며 가족 형태의 문제가 있었고 MMPI하위척도 중 남성성 -여성성 척도 점수가 유의하게 높았다. 결론 : 비록 본 연구는 여러 제한점이 내포되어 있음에도 불구하고, 정신과 입원치료를 받았던 청소년의 행동이 대부분은 호전된다는 것을 시사하여 품행장애에서의 정신과적 치료에 상당히 고무적인 결과를 나타내었으며 추후 대상자와 치료프로그램의 다양성을 통제한 연구를 지속하는 것이 필요할 것으로 생각되었다. 중심 단어 : 품행장애ㆍ청소년ㆍ예후ㆍ입원치료. Objectives : The major goal of this study was to investigate the treatment outcome of psychiatric treatment in inpatients with conduct disorder and to elucidate factors affecting its prognosis. Methods : We reviewed the medical records of 300 inpatients with conduct disorder who had been treated with a specialized adolescent treatment program. Follow-up structured telephone interview had been performed in 96 patients. Results : 1) At the point of follow-up, 90% of the patients were improved in behavioral patterns, 2% of the patients were worse, and 8% of the patients were unchanged. 2) Intrafamilial relationship was improved in 70% of the patients, worse in 2%, and unchanged in 28%, 3) Fiftyseven percent of families thought to be helped by psychiatric inpatient treatment, 6% replied to be harmed, and 37% thought not to be helpful. 4) Comparing the good prognosis group who were all better in behavioral patterns, intrafamilial relationship, and efficacy of treatment with the rest of subjects, the good prognosis group was significantly younger and had more history of problems in familial structure. Conclusion : Although the present study had some meterological limits, the promising positive results in the outcome of inpatients with conduct disorder encourages further more sophisticated investigations in this problematic psychiatric conditions. KEY WORDS : Conduct disorderㆍAdolescentㆍTreatment outcomeㆍInpatient treatment.

주정중독환자들의 퇴원 후 경과에 관한 연구

성상경,함 웅,방양원 大韓神經精神醫學會 1993 신경정신의학 Vol.32 No.5

Follow-up study of 153 alcoholic inpatients who received over 2 weeks of treatment, and their families was conducted by the telephone interview and structured questionnaire. The results were as follows : 1) Within 6 months after discharge, about 80.3% of the patients had a first-drinking experience while only 12.4% of them remained abstinent after 2 years. 2) After discharge, about 67.2% of the patients improved or were abstinent but only 3.6% of them worsened compared to the pre-admission period. 3) After discharge, 66.4% of the patients discontinued their treatment, whereas only 13.9% of them continued to receive out-patient treatments. 4) The drinking pattern was significantly correlated with behavioral pattern, social and job adaptations, interpersonal relationship and familial relationship(P<.001). 5) As for the attitude of the families towards the effectiveness of the neuropsychiatric in-patient treatment, 73% of them responded that the treatment had been effective. 6) The annual mortality rate in alcoholic patient after discharge(3.5%) was two times more than the control group(1.6%). 7) The most frequency cause of death among discharged alcoholics was circulatory system disease wuch as liver cirrhosis, hepatic cancer and cardiac arrest, whereas that in the control group was of unknown etiology(eg, natural death induced by aging process).

청소년, 성인의 주의력결핍 과다활동장애

이영식,방양원 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.5

주의력결핍 과다활동장애는 지속적인 주의력의 결손, 충동성, 과다활동을 특징으로 하는 일종의 발달성 장애이다. 따라서 이 질환은 소아기에 국한된 장애가 아니고 청소년기, 성인기로 이행되면서 과다활동은 초기 청소년기에 사라지지만 약 반수 이상의 소아환자의 경우 근본적 정신병리는 성인기까지 지속되어 표면적으로는 다른 양상으로 진행한다. 집중력장애, 충동성, 불안정한 정서상태는 종종 사고의 위험, 약물남용, 정동장애, 행실장애, 반사회적 인격장애, 부부관계의 불화, 이혼, 투옥, 직업상실등 개인의 일일생활 수행과 사회적 적응을 어렵게 한다. 미국의 경우도 이렇게 중요한 질환임에도 불구하고 최근에야 비로서 이분야에 대한 관심이 높아져 성인 ADHD 특수크리닉이 활성화되는 데에는 나름대로의 이유가 있는 듯하다. 더군다나 상대적으로 소아정신의학의 역사가 짧은 우리나라의 경우는 이 분야에 대한 관심이 거의 전무한 상태이다. 따라서 본고를 통해 중요한 질환임에도 불구하고 상대적으로 관심이 저조한 이유를 우선 살펴보고, 성인환자의 진단개념 및 진단방법, 역학, 약물치료 및 정신사회적 중재방안에 대해 정리하여봄으로써 소아 ADHD 잔류증상으로 인한 청소년 행실장애, 약물남용, 성인의 폭발성 인격장애, 반사회적 인격장애, 기분의 기복이 심한 정동장애, 알코올리즘 환자의 정신병리 평가나 치료에 도움을 주고자 한다. It seems best to view ADHD as a developmental disability that comprises impairments in persistence of effort(sustained attention), the ability to delay responding and inhibit behavior (impusivity), and the regulation of excessive activity level or responding in situations(hyperactivity). These problems tend to arise early in childhood, often during the preschool years, and persist in over half the cases into adulthood as adult ADHD. ADHD in adolescents and adults responds to treatment with stimulants, tricyclic antidepressants, etc. Nonpharmacologic modalities such as behavior modification, individual and family therapy and cognitive therapy are useful adjuncts to psychopharmacologic management. Without effective treatment, ADHD often results in increased risk of trauma, substance abuse, conduct disorder, marital disharmony, family dysfunction, divorce, and incarceration in adolesence and adulthood. Lifelong treatment with proper medication and counselling are important to ADHD.

소아 기면증의 진단과 치료

방양원(Yang Weon, Bang),채규영(Kyu Young, Chae) 대한소아신경학회 2009 대한소아신경학회지 Vol.17 No.2

Narcolepsy is chronic devastating disease that characterized by excessive daytime sleepiness, cataplexy, which often precipitated by intense emotion or excitement, hypnagogic, or hypnapompic hallucinations, sleep paralysis and nocturnal disrupted sleep. In child onset narcolepsy, the presentations of narcolepsy can be very variable, making misdiagnosis as seizure disorders or delaying diagnosis as much as several years after disease onset. For the diagnosis of narcolepsy, overnight polysomnography(PSG) and multiple sleep latency test(MSLT) should be evaluated. Test for Cerebrospinal fluid hypocretin(orexin) concentration and human leukocyte antigens(HLA) would be great helpful to confirm the narcolepsy with cataplexy even in early stage of disease in children. The mainstays of treatment are that reducing the excessive daytime sleepiness, preventing the intrusion of the REM related phenomena including cataplexy and consolidating the nighttime sleep. Central nervous system stimulators such as methylphenidate or amphetamine decrease excessive daytime sleepiness and tricyclic antidepressant(TCA) or selective serotonin reuptake inhibitors(SSRI) can prevent cataplexy. Recently, new therapeutic agents such as modafinil and sodium oxybate are emerging in clinical practice with much effectiveness. Counseling for poor school performance, social isolation and depression should be provided. Early diagnosis and treatment can greatly improve the quality of life. Awareness of excessive daytime sleepiness in children or adolescent will allow pediatricians to effectively identify hypersomnia such as narcolepsy.

청소년 품행장애의 6개월 단기 예후에 영향을 미치는 변인 Ⅱ : 우울 및 불안척도와 주의력결핍 과잉활동 척도를 중심으로 RELATION TO DEPRESSION/ANXIETY AND ADHD INVENTORY

방양원,진태원,채정호,이정균 대한소아ㆍ청소년정신의학회 1996 소아청소년정신의학 Vol.7 No.2

만남집단과 환자집단의 집단정신치료 비교

방양원,이규황,이후경,함웅,윤성철 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.4

Objects : This study was conducted to understand the essential group phenomena of Encounter group and Patient group through the global comparison of short-term group psychotherapy between two groups. Methods : The Encounter group consisted of 17 normal persons and Patient group consisted of 19 patients with schizophrenia. all the members of the two groups were unmarried females. The mean rank of therapeutic factors of two groups was compared by short-form of Yalom's Q-sort. The differences between each therapeutic factor of two groups was compared by Mann-Whitney test. Also the global differences between two groups were compared by analyzing both the individuals within the groups and the groups as a whole. Results : The results of the comparison of the therapeutic factors of the two groups are as follows : 1) Existential factor was set a high value by all the two groups. 2) Encounter group set a high value an interpersonal learning(Input), but Patient group set a high value on instillation of hope and group cohesiveness. 3) Identification was set a high value by Encounter group, but was set a low value by Patient group. The results of the global analysis of two groups are as follows : 1) It was more difficult for Encounter group to maintain the motivation of attendance and to recognize their own problems than Patient group. 2) All the leaders and the members of Encounter group showed more positive attitude than those of Patient group. On the contrary all the leaders and the members of Patient group showed more negative attitude than those of encounter group. 3) Patient group expressed more intense feelings and expressed the feelings more frankly and more simply than Encounter group. 4) Encounter group dealt with the matters pertaining to "self realization", that is, fundamental question of human beings more than Patient group. Patient group dealt with the matters pertaining to social adaptation, that is , "ego strengthening" more than Encounter group. 5) In Encounter group, the feeling of in feriority was the major cause of the dropout. But in patient group, the discharge from hospital was the major cause of th dropout. Conclusion : We have found out the various differences between encounter group and patient group by the comparison of therapeutic factors and analytic understanding of the two groups. These results are the basic data for understanding of Encounter group and Patient group. And these results can be applied to the development of the skills of group psychotherapy for the treatment of the patients.

한국 소아청소년정신과 의사의 전문적 치료 현황

정경희(Kyung-Hi Jung),안동현(Dong-Hyun Ahn),김정유(Jeong-Yu Kim),김현정(Hyoun-Jeong Kim),방양원(Yang-Won Bang) 대한소아청소년정신의학회 2014 소아청소년정신의학 Vol.25 No.1

Objectives:The aim of this study is to assess the career paths and practice patterns of child and adolescent psychiatrists in South Korea. Methods:A survey on demographic data, work environment, opinion on fellowship training program, and current practice patterns was conducted in 76/223 (34.0%) of all child and adolescent psychiatrists (N=223) were from 1980 to 2008. The survey data from the responders were analyzed. Results:More than half of those surveyed were women. The mean age of survey participants was 40.8 years; most were married, and lived in the Seoul National Capital Area. In general, the responders were very satisfied with their work. They worked in private practice, public sector, group practice, and as consultants. Up to 87% of the patients treated were children and adolescents. The most common treatment modalities were medication and parent psychoeducation. Social skills training and play therapy were applied mainly for children aged 4 to 12 years old. Cognitive behavioral therapy and counseling were preferred in adolescents. Conclusion:The current study used a database approach in order to define current practice patterns. These data may be helpful in consideration of future training programs, workforce issues in child and adolescent psychiatry in South Korea, and also in collaboration with other mental health providers.

훈방대상 비행청소년의 분노, 분노대처 및 스트레스 반응

박상군(Sang-Kun Park),이후경(Hoo-Kyeong Lee),윤성철(Sung-Chul Yoon),안현주(Hyun-Joo Ahn),김선재(Sun-Jae Kim),방양원(Yang-Weon Bang),장혜진(Hye-Jin Jang) 대한소아청소년정신의학회 2005 소아청소년정신의학 Vol.16 No.2