두뇌손상환자의 정신장애 평가기준 설정을 위한 연구 : 1. 장애판정의 현상 1. Present Status of Disability Evaluation

변원탄 大韓神經精神醫學會 1987 신경정신의학 Vol.26 No.2

노동력 장애를 판정할 목적으로 법원으로 부터 의뢰된 두뇌 손상 환자 94례를 인구 통계학적 특성, 사고 및 두뇌 손상의 특성, 평가과정 및 판정결과, 정신병리. 판정결과 및 정신병리에 영향을 미치는 요인들에 관하여 분석한 결과를 다음과 같이 요약할 수 있었다. 1) 두뇌손상 환자는 남자에서 많고 사회적 활동기 연령층에 많으며 낮은 사회경제 계층에서 많았다. 2) 법원에서 의뢰되는 두뇌손상 환자는 교통사고 환자가 많았으며 두뇌손상의 증거가 명확하고 고도의 손상을 입은 환자가 많았다. 3) 판정시기는 대개가 손상후 1년이상 경과된 경우가 많았고, 판정기준으로는 McBrede의 기준을 사용하는 경우가 많았으며 판정결과는 매우 광범위했다. 4) 진단의 상세화없이 단순히 기질성 뇌증후군이라는 진단을 내린 경우가 28.7%였으며, 뇌좌상후 증후군의 진단 개념이 사용되는 경우가 의외로 적었고 상세화된 진단명 중에는 외상성 신경증이 가장 많았다. 5) 두뇌손상의 정도가 환자의 정신병리 및 판정결과에 가장 의미있는 영향을 미치고 있었고, 그외의 요소들은 환자의 정신병리에는 부분적인, 영향을 미치고 있으나 판정결과에는 아무런 영향을 미치지 않았다. 6) 주관적인 신체증상의 호소는 신경증으로 진단되는 경향이 있었고 매우 불리한 판정을 받고 있었다. The author surveyed 94 cases of head injury referred from the court with the purpose of evaluation of mental disability. Premorbid characteristics of patients, information about the accidents, information about assessments, psychopathology, factors affecting the psychopathology and result of assessments, the relationship between psychopathology and diagnosis were studied. The results are summarized as follows; 1) The incidence of head injuries was significantly high in male, socially-active age group, & lower socio-economic level. 2) The incidence of automobile accident was significantly higher than industrial accidents and when comparing to another study the patients whose damages were evident and severe were more in number. 3) The time interval to assessing the disability was more than 1 year in almost all cases, and the disability evaluation criteria of McBride was used more commonly. And the results of assessment were of very wide distribution. 4) Organic brain syndrome was used as a diagnostic term without any specification in 28.7% of cases. In contrast, the concept of postconcussional syndrome was used in very few cases, and the diagnosis of posttaumatic neurosis was the most in numbers among the specified one. 5) The severity and evidency of brain damage was the most important factor among others affecting the psychopathology and the result of assessment. 6) The subjective complatints of patients tend to be treated as having a neurosis, and had many disadvantages in disability evaluation.

정신의학에 대한 의과대학생들의 태도

변원탄 부산의대 1983 부산의대잡지 - 부산대학교 의과대학 Vol.23 No.2

醫科大學 精神科 實習 敎育의 質的 向上을 위한 方案 硏究

邊原彈 大韓神經精神醫學會 1985 신경정신의학 Vol.24 No.1

The author asked 85 medical student to rate their perception of usefulness of various psychiatric clerkship curriculm to evaluate attitudinal change after psychiatric clerkship and to know about what they want to learn about psychiatry. The author also discussed several problems appeared during clerkship and suggested that elaborate educational programs and sincerity on the part of teaching members are inevitably important to promote student's motives to learn, cultivation of professional man-power for student education is a task that must be settled urgently, exploitation of new method and material for psychiatric education is necessary and we must be prepared to teach practical knowledges and skills essential for practice as a primary care physicians.

자문조정 정신의학의 현황

변원탄 대한신경정신의학회 1988 신경정신의학 Vol.27 No.1

두뇌손상환자의 정신장애평가 기준설정을 위한 연구 : 2. 정신병리와 진단 2. Psychopathology and Diagnosis

변원탄 大韓神經精神醫學會 1988 신경정신의학 Vol.27 No.4

The psychopathology and subjective physical symptoms were studied in 95 head injury patients. Memory impairment, concentration difficulty, and nervousness and irritability were the most frequent triad of mental symptoms. Among subjective physical symptoms the headache, head-conscious, and fatigability were the most frequent ones. 53.7% of the patients were diagnosed as postconcussional syndrome, 20.0% as organic personality syndrome, 13.7% as dementia, 9.5% as neurosis or posttraumatic stress disorders and 3.2% as organic amnestic syndrome. Cognitive impairments and behavioral disorders were significantly helpful in differentiating post-traumatic conditions, but the affective disorders and somatic symptoms were not. The symptom constellations of postconcussional syndrome seems to be present in all head injuries. The cluster analysis of postconcussional syndrome revealed 4 main divisions, the pure postconcussional syndrome, postconcussional neurotic state, postconcussional syndrome with personality change and postconcussional syndrome with cognitive impairment. Long-term follow up observations and study for the patients whose financial compensation were not an issue are necessary for an objective evaluation of head injuries.

醫科大學 精神科 實習 教育의 質的 向上을 위한 方案 硏究

邊原彈 대한신경정신의학회 1985 신경정신의학 Vol.24 No.1

The author asked 85 medical student to rate, their perception of usefulness of various psychiatric clerkship curriculm to evaluate attitudinal change after psychiatric clerkship and to know about what they want to learn about psychiatry- The author also discussed several problems appeared during clerkship and suggested that elaborate educational programs and sincerity on the part of teaching members are inevitably important to promote student’s motives to learn, cultivation o f professional man-power for student education is a task that must be settled urgently, exploitation of new method and material for psychiatric education is necessary and we must be prepared to teach practical knowledges and skills essential for practice as a primary care physicians.

노인정신 장애자에 대한 임상적 고찰

변원탄 大韓神經精神醫學會 1977 신경정신의학 Vol.16 No.3

저자는 지난 5년간 (1971.1.1∼1975.12.31) 부산 대학 병원 정신과 외래 및 입원 환자중 60세 이상 노인 환자 77명을 대상으로 하여 앞으로 노인 정신 의학적인 여러가지 측면에서 광범한 조사 연구를 하기 위한 기초자료를 얻고자 예비조사를 하고 분석 정리한 결과를 다음과 같이 요약할 수 있었다. 1. 전체 환자중 노인 정신 장애자는 0.6%였다. 2. 60∼70세의 노인 환자가 거의 대부분이었다. 3. 남자 환자가 여자환자보다 많았다. 4. 갱년기 우울증 환자가 24예 (31.2%)였고, 신경증 환자는 22예 (28.6%)였다. 5. 학교 교육을 받은 사람이 24예 (31.2%)였다. 6. 직업을 가진 사람이 22예 (28.6%)로서, 상업과 농업이 대부분이었고, 연령은 60∼65세가 17예 (22.1%), 66∼70세가 5예 (6.5%)였다. 7. 배우자를 가진 사람이 약 반수였다. 8. 종교를 가진 사람이 약 절반이었고 불교가 대부분이었다. 9. 도시 거주자는 농촌 거주자보다 많았다. The author made a study of 77 out-patients and in-patients who were 60 years old and over at the psychiatric department of Busan National University Hospital during the past 5 years from 1971 to 1975. The author performed this clinical study in order to get a preliminary data for further intensive study for psychiatric problems to old age psychiatric patients. These cases were analyzed in terms of annual distribution, years and age, age and sex, annual diagnostic distribution, diagnosis and sex, diagnosis and age, education, occupation, age and occupation, spouse, religion and living place etc. The results of this clinical study were as follows. 1. Old age patient rate was 0.6% of total psychiatric patients during past 5 years. 2. As to the age range, the most stood between 60 and 70 years (87.1%). 3. Male patients were more in number than female patients. 4. In contents of diagnosis the most were involutional melancholia and neurosis was next. 5. It revealed that 24 cases (31.1%) of old age patients were educated. 6. 22 cases (28.6%) had occupation and almost all of them were merchant or farmer. 17 cases (22.1%) were between 60 and 70 years old. 7. Almost half of the patients had their spouse. 8. Nearly half of all cases had religion and almost all of them were Buddhist. 9. Urban area were three times more than rural area.

종합병원 입원환자의 불안과 우울에 관한 연구

이현숙,홍창희,변원탄 大韓神經精神醫學會 1989 신경정신의학 Vol.28 No.2

저자는 1987년 12월부터 88년 5월까지 부산대학교 병원과 부산 메리놀 병원에 입원중인 환자 317명을 대상으로 Zung의 Self-Rating Anxiety Scale(SAS)과 Self-Rating Depression Scale(SDS)을 이용하여 불안과 우울의 정도 및 빈도를 구하고 이를 건강대조군, 정신과 불안장해 환자군 및 우울장애 환자군과 비교하여 불안과 우울의 특성을 구하고 또한 인구통계학적인 변인과 질병에 관계되는 변인에 따른 불안과 우울정도를 조사하여 다음과 같은 결과를 얻었다. 1) 입원환자군의 SAS 및 SDS평균점수는 각각 38.5, 44.6으로서 그 불안과 우울의 정도는 모두 건강대조군보다는 유의하게 높았으나(p<0.05) 정신과 환자군보다는 유의하게 낮았다.(p<0.05) 2) 불안장애와 우울장애를 구분해 주는 SAS 및 SDS상의 기준점은 예민도가 84.4%, 88.0% 특이도가 81.1%, 85.8% 전반적 진단력이 82.1%, 86.5%로 나타나는 42점, 49점으로 잡는 것이 가장 타당할 것으로 판단된다. 이 때 입원환자의 36.0%가 불안장애, 37.2%가 우울장애에 속했다. 3) 입원환자군에서는 불안의 특성은 불안정서나 감각증상의 불안요인은 적고(P<0.05) 과민성과 부분적인 자율신경계 증상의 불안요인은 높은 것이었고(p<0.05) 우울의 특성은 초조감을 동반한 우울이나 관념적 우울요인은 유의하게 적고(p<0.05) 지체성우울과 식물성 증상의 우울요인은 유의하게 높은 것이다(p<0.05). 4) 남자보다 여자환자군에서 불안과 우울의 정도가 모두 유의하게 높았고(p<0.01) 저 소득층에서는 우울의 정도만 유의하게 높았다. (p<0.05). 그리고 회복에 대해 부정적 전망을 가진 환자군이 다른 환자군보다 불안과 우울의 정도가 모두 유의하게 높았다(p<0.001). This study aimed to evaluate the severity and tile frequency of depressive and anxiety disorders observed in 317 inpatients who were admitted to two general hospitals in Pusan, Pusan National University Hospital and Markynoll Hospital from December, 1987 to May, 1988. The evaluation was done by using the method of Zung's Self-Rating Anxiety Scale and Self-Rating Depression Scale. The characteristics of anxiety and deprssion in general hosptial inpatients were compared with those of the healthy subjects and psychiatric patients with anxiety and depressive disorders. The changes of severity in anxiety and depression according to the demographic and other related factors which might influence on the emotional status of these patients were analyzed. The results were as follow ; 1) The mean score of SAS in inpatients was 38.5 which was significantly higher than that of healthy subjects and lower than that of anxiety disorders. The mean score of SDS in inpatients was 44.6 and it was significantly higher than that of healthy subjects and lower than that of depressive disorders. 2) The authors suggests the score of 42 in SAS and 49 in SDS as the cut off score which distinguish clinical anxiety or depressive disorders from normal condition when considering the sensitivity(84.4%, 88.0%) and specificity(81.1%, 85.8%) and overall diagnostic power(82.1%, 86.5%). In that case, the 36.5% and 37.2% of inpatients were included in anxiety and depressive disorders. 3) The characteristic feature of anxiety in inpatients was the more frequent occurrence of vigilance and scanning and of some of the autonomic symptoms and rarer occurrence of anxious mood and sensory symptoms. In the case of depression, the feature of retarded depression and vegetative symptoms were more frequent and the depressed affect with agitation and ideational depression were rarer. 4) The severity of anxiety and depression was significantly higher in the female than male and in the group who have the negative prospect to recovery to their own illness than other groups. The severity of depression was also significantly higher in the lower income group than other groups.

알콜의존 환자에서 음주욕구를 유발하는 조건화자극에 대한 연구

한귀원,김명정,김성곤,변원탄 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.4

DSM-IV에 의하여 알콜 의존으로 진단되어 입원 중인 18세에서 65세 사이의 남자로서 과거 3주이상의 단주 경험이 있는 환자 110명을 대상으로 음주 욕구를 유발하는 조건화 자극의 종류와 빈도를 조사하였다. 먼저 예비조사를 통하여 환자들로부터 수집한 알콜연관자극들 중에서 흔한 내적 및 외적 자극 각각 25가지씩, 모두 50가지를 선정한 후, 대상 환자로 하여금 50가지의 알콜연관자극 중에서 자신에게 해당하는 자극을 모두 선택하게 하였다. 그 후 각 알콜연관자극의 빈도와 유형별 빈도를 조사하고 환자의 인구학적 특성, 음주력, 불안 및 우울 척도 등과 관련하여 검토하였다. 그 결과는 다음과 같다. 1) 조건화 자극을 내적 및 외적 알콜연관자극으로 분류하였을 때, 내적 자극은 신체 상태, 긍정적 기분 상태 그리고 부정적 기분 상태로, 외적 자극은 즐거운 상황, 불쾌한 상황, 알콜과 연관된 상황 및 기타 상황으로 분류되었다. 2) 1인당 선택한 문항의 평균 수는 14.1±8.6개로 내적 자극이 7.5±4.8개, 외적 자극이 6.5±4.4개이었으며 각 자극을 하나라도 선택한 사람은, 내적 자극은 대상군 모두가 선택하였고 외적 자극은 대상군의 99.1%가 선택하였다. 부정적 기분 상태와 불쾌한 상황은 각각 97.3%, 88.2%로서 가장 높은 빈도를 보였고 긍정적 기분 상태와 즐거운 상황도 각각 42.7%, 71.8%로서 높은 빈도를 보였다. 신체 상태에 관한 자극은 대상군의 68.2%가, 알콜과 연관된 상황에 관한 자극은 68.2%가, 그리고 기타 상황에 관한 자극은 49.1%가 선택하였다. 3) 음주 욕구를 증가사켰던 내적 자극 중 높은 빈도로 선택된 문항들은 화가 날 때(71%), 외로울 때(47%),고민이 될 때(45%), 시장기가 돌 때(45%), 잠이 안올 때(45%) 등이었고, 외적 자극 중에서 높은 빈도로 선택된 문항들은 가족이나 친척들과 갈등이 있거나 다투는 경우(53%), 잔치, 초상, 계 등 사회적인 모임이 있을 경우(52%), 하는 일이 잘 되지 않을 때(49%), 직장에서 혹은 친구와 갈등이 있거나 다투는 경우(42%)등이었다. 4) 환자의 나이와 신체 상태의 알콜연관자극 간에는 유의한 정상관관계가 있었고, 문제 음주로 인해 처음 정신과에 입원한 나이와 신체 상태의 알콜연관자극 간에도 유의한 정상관관계가 있었으며, 교육 수준과 신체 상태의 알콜연관자극 사이에는 유의한 역상관관계가 있었다. 그리고 입원횟수와 부정적 기분 상태의 알콜연관자극 사이에는 유의한 정상관관계가 있었다. 그러나 첫 음주 시작 나이, 문제 음주 시작 나이, 문제 음주 지속 기간, 최대 단주 기간, 병원 치료 후 평균 단주 기간, 개인의 특성 불안과 우울 점수 등과 알콜연관 자극의 유형 간에는 유의한 상관관계가 없었다. 또한 직업 유무별, 사회경제 상태별, 음주가족력 유무별, 결혼 상태별, 종교별 및 음주 양상별로 본 알콜연관자극의 유형별 선택 문항 수에 있어서도 통계적으로 의미있는 차이는 없었다. Conditioned stimuli provoking alcohlol craving in the alcoholics were surveyed in 110 hospitalized male patients with the diagnosis of alcohol dependence according to DSM-IV who had had 3 weeks or more of successful periods of alcohol abstinence after the onset of alcohol dependence. A preliminary study of preparing a list of 50 alcohol related cues(ARCs) was performed by collecting ARCs from 50 alcoholic patients, choosing the more frequent stimuli and rearranging those into 25 internal and 25 external ARCs. And then, each of the 110 subjects was asked to choose all the ARCs which provoked alcohol craving in the past to survey the frequency of the ARCs and their relevance with regards to a number of variables such as certain demographic data, alcohol history and anxiety and depression. The results were as follows ; 1) The ARCs were divided into internal and external ARCs ; the internal ARCs were categorized into positive affects, negative affects and somatic conditions and the external ARCs into pleasant situations, unpleasant situations, alcohlol-related situations and other situations. 2) Total mean number of ARCs per person was 14.1±8.6, that of internal ARCs being 7.5±4.8 and that of external ARSc being 6.5±4.4. All the subjects chose at least one of the internal ARCs and 99.1% chose one or more external ARCs. ARCs of negative affects and unpleasant situations were chosen by 97.3% and 88.2% of the subjects respectively, whereas, those of positive affects and pleasant situations were chosen by 42.7% and 71.8% respectively, showing unexpectedly high frequency. ARCs pertaining to somatic conditions were chosen by 68.2% of the subjects, those of alcohol-related situations were chosen by 68.2% and those of other situations by 49.1%. 3) Frequently chosen items of internal ARCs were when I was angry (71%),' when I was lonely'(47%), 'when I was distressed'(45%), 'when I was hungry'(45%) and 'when I had trouble sleeping' (45%). Those of external ARCs were 'when I had an argument or conflict with a relative' (53%), 'when I was at a social meeting such as party or funeral ceremony'(52%), when the things were not going to work out' (49%), 'when I met a friend whom I liked'(49%) and 'when I had an argument with a friend or people at work' (42%). 4) Positive correlations were seen between age and ARCs of somatic conditions and between age at the first psychiatric hospitalization and ARCs of somatic conditions. However, negative correlation was found between educational level and ARCs of somatic conditions. Number of psychiatric hospitalization was positively correlated with ARCs of negative affects. But there were no significant correlations in age at the first drink, age of onset of alcohol related problems, duration of alcohol related problem drinking, maximal length of abstinence, usual duration of abstinence after hospital treatment and score of trait anxiety and BDI. No significant difference was noted in the mean number of ARC subtypes between different groups divided by other demographic or clinical variables such as status of job, social class, family history of alcohol dependence, status of marriage, religion and drinking patterns.

정신분열병 환자에서의 한국어판 사회적응 척도의 개발 : 신뢰도 및 타당도 연구

김철권,서지민,김상수,조진석,하준선,김정옥,변원탄 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.6

연구목적: 정신분열병 환자의 사회적응 정도를 측정하는데 사용되는 사회적응 척도의 한국어판을 개발하기 위함이다. 방 법: 사회적응 척도를 번역한 후 정신분열병 환자 67명과 정상인 78명을 대상으로 신뢰도와 타당도를 검증하였다. 결 과: 자료분석 결과 검사-재검사 신뢰도는 0.85, 검사자간 신뢰도는 0.89, 내적 일치도는 0.87로 높은 수치였다. 변별 타당도를 검증하기 위하여 정신분열병 환자군과 정상 대조군을 비교한 결과 정신분열병 환자군에서 사회적응 정도가 유의하게 낮았다. 구성 타당도를 알아보기 위하여 10개 영역간의 상관관계를 측정한 결과 성적적응 영역을 제외한 모든 영역들에서 유의한 상관관계를 보였다. 본 척도의 전반적 평가 영역 결과와 GAF 결과간의 상관성을 통해 간접적으로 검증한 공존 타당도 역시 유의하였다. 결 론: 한국판 사회적응 척도는 우수한 신뢰도와 타당도가 입증되었고 나아가 정신분열병 환자의 사회적응 정도를 평가하는데 유용하게 사용되어질 수 있을 것이다. Objectives: The purpose of this study was to develop the Korean version of the Social Adjustment Scale Ⅱ-Revised Version(KSAS Ⅱ-RV) in the schizophrenics. Methods: KSAS Ⅱ-RV was administered to 67 schizophrenic patients and 78 matched normal controls for examining the reliability and validity. Results: Data analysis showed statistically significant reliabilities and validities of KSAS Ⅱ-RV. The test-retest reliability, inter-rater reliability, and internal consistency for total scores of KSAS Ⅱ-RV were 0.85, 0.89. and 0.87, respectively. Evidence for discriminant validity of KSAS Ⅱ-RV comes from the results that the mean scores of schizophrenic patients were significantly high than those of normal controls. Construct validity was assessed by calculating the 10 inter-subareas correlations of the KSAS Ⅱ-RV, and all except the sexual adjustment area were statistically significant. Significant correlations between the global area scores of KSAS Ⅱ-RV and those of Global Assessment of Functioning Scale lend support for the concurrent validity of this instrument indirectly. Conclusions: KSAS Ⅱ-RV was found to be a valid and reliable instrument which can be used to evaluate the degree of social adjustment in the schizophrenic patients.