뚜렛 장애와 주의력결핍 과잉행동장애 아동의 실행기능 비교

성형모,박형배 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.3

연구목적 : 뚜렛장애(이하TS)와 주의력결핍과잉행동장애(이하 ADHD)의 실행기능을 평가하고 서로 비교하여 두 질환에서의 실행기능상의 차이를 이해하는데 도움을 얻고자 본 연구를 시행하였다. 대상 및 방법 : DSM-IV의 진단기준에 의하여 TS만을 진단받은 18명의 아동과 ADHD만을 진단받은 아동 18명을 실험군으로 선정하였으며, 정상군18명을 실험군과 비슷한 연령과 성별, 성적 등을 고려하여 선발하였다. 각 질환을 가진 아동들 중 DSM-IV상의 다른 공존질환이 있는 경우는 실험대상에서 제외하였다. 세집단의 아동들에게는 모두 지적 능력평가를 위해 K-ABC검사를 시행하였으며, 실행기능의 평가를 위하여 위스콘신 카드분류 검사(이하 WCST)와 연속수행검사(CPT)를 실시하였고, 모든 검사는 약물효과를 배제하기 위해서 투약을 시작하기 전에 시행하였다. 결 과 : 세 집단의 CPT결과 오경보오류, 민감도, 반응기준에서 ADHD군이 정상군과 치아(p<0.5)가 있었던 반면, TS군은 정상군과 차이가 없었고, 오경보오류에서는 ADHD군이 TS군과 정상군에 비해 유의한 차이를 보여(p<0.05), ADHD가 TS에 비해 낮은 수행을 보이는 것을 알 수 있었다. WCST 수행결과를 총반응수, 오반응수, 개념수준반응수, 완성된 범주수에서 두 질환군 모두 정상군에 비해 유의하게 저조한 수행을 보였으며 (p<0.05), 보속반응수, 보속오류수에서는 ADHD군만이 정상군에 비해 유의한 차이가 있었다.(p<0.05). 결 론 : TS와 ADHD 두 질환이 모두 실행기능의 이상을 가지지만, TS에 비해 ADHD에서 더욱 현저한 실행기능이 이상이 나타난다고 할 수 있을 것이다. 또한 이러한 실행기능상의 차이는 두 질환사이에 서로 다른 병태생리를 가진다는 가설을 뒷받침해 준다고 할 수 있을 것이다. Objectives : This study was performed to verify and compared deterioration of executive functions in the children with Tourette's disorder(TS) with those with Attention Deficit Hyperactivity Disorder(ADHD) and to understand the differentes. Method : We administered Kaufman Assessment Battery for Children(K-ABC), Continuous Performance Test(CPT), Wisconsin Card Sorting Test(WCST) on three groups of 18 children each : tow groups of outpatients, one pure Ts and one pure ADHD, diagnosed using DSM-IV criteria, and the third, a control group of normal, healthy children who were selected considering age, sex and academic achievement. The children performed all testings without the use of medications Results : In comparisons of CPT perfotmance, the ADHD group showed poor performance with significant difference in commission error, attentiveness and risk taking(p<0.05), and the TS group showed significant difference in attentiveness(p<0.05) when compared with the control group. There was significant difference between the ADHD group and the TS group in commission error(p<0.05). In comparisons of WCST, the ADHD group and the TS group showed significantly poorer performance than the controls in number of trials administered, total number of errors, conceptual level response, number of categories complete, perseverative response and perseverative error(p<0.05), but only the ADHD group showed poor performance in perseverative response and perseverative error(p<0.05). When the results of CPT were analyzed after adjustment for IQ, the ADHD group showed significantly more errors than the TS disorder group in commission error, and only the ADHD group showed significant difference in attentiveness compared with the normal controls(p<0.05). In WCST, while these two group showed significantly poor performance compared with the normal children group in the 5 sub-categories such as total number of errors, perseverative response, perseverative error, conceptual level response and number of categories complete(p<0.05). Conclusion : The abnormalities of executive functions appear in both ADHD and tourette's disorder, but more apparent abnormalities in executive functions were shown in ADHD than in Tourette's disorder. Also the differences of executive functions suggest that these two diseases may have different psychopathophysiology in these dimensions.

한국어판 백 우물 설문지 2판의 신뢰도 및 타당도 연구

성형모(Hyung-Mo Sung),김정범(Jung-Bum Kim),박영남(Young-Nam Park),배대석(Dai-Seok Bai),이선희(Sun-Hee Lee),안현의(Hyun-Nie Ahn) 대한생물치료정신의학회 2008 생물치료정신의학 Vol.14 No.2

Objectives : This study was performed to standardize the Korean version of Beck Depression Inventory Ⅱ(BDI-Ⅱ) , self-rating scale to assess severity of depressive symptoms. Also, this study was performed to determine psychometric properties and clinical usefulness of the BDI-Ⅱ. Methods : 31 patients diagnosed as major depressive disorder or dysthymic disorder by DSM-Ⅳ criteria and 77 normal persons were recruited in this study. All subject completed BDI, BDI-Ⅳ, SCL -90-R and MMPI. Then, Hamilton rating scale for depression (HAMD) were administrated by a psychologist. Results : Internal consistency using Cronbach α was 0.834 in depressive patient group and 0.880 in normal control group. In addition, 8DI-Ⅱ showed a very good criterion validity with very strong correlations with BDI, SCL-90-R, MMPI and HAMD. The area under the ROC curve was 0.992. With cut-off point of 22, the korean version BDI-Ⅱ had a sensitivity .935, specificity .981. And discriminant ability was 95.4% Conclusion : Korean version of the 8DI-Ⅱ is considered as a short and valid tool to identify, also to asses severity of depressive symptoms in patients and normal population.

주의력결핍 과잉행동장애의 치료효과 예측인자

이종범,성형모,정성덕,김진성,서완석,배대석,정은정,박형배 대한정신약물학회 2002 대한정신약물학회지 Vol.13 No.3

Neurofeedback의 이해와 임상적용

박형배,성형모,Park, Hyung-Bae,Sung, Hyung-Mo 한국정신신체의학회 2006 정신신체의학 Vol.14 No.1

뉴로피드백(neurofeedback)은 EEG biofeedback, neurotherapy 등의 이름으로 불리기도 하는 새로운 치료법으로, 뇌파를 이용하고 뇌(brain) 자체와 뇌 기능(brain function)을 대상으로 한다는 점에서는 일반적인 바이오피드백(biofeedback)과는 차이가 있다. 따라서 바이오피드백의 한 형태로 출발을 하였지만, 현재는 독자적이고 전문화된 방식의 새로운 치료법으로 자리 메김을 하고 있다. 뉴로피드백에 대한 이해를 도우기 위해 뉴로피드백의 역사와 이론적 배경을 우선 알아본 후, 실제 임상에서 어떻게 사용되고 있는 지를 알아보고자 한다. 뉴로피드백은 임상분야에서 간질(epilepsy)의 치료에 처음으로 도입된 이후 그 효과가 입증되었으며, 주의력결핍과잉행동장애(attention deficit hyperactivity disorder, ADHD), 불안 및 우울장애, 수면장애, 물질의존 등의 많은 정신과 질환에 효과적으로 사용되고 있다. 정신과 질환이외에도 두통, 만성통증, 만성피로증후군 등 많은 다양한 영역에 걸쳐 적용되고 있다. 최근에는 질환들 뿐 만이 아니라, 스포츠와 예술 활동에서의 수행능력(peak performance)의 향상, 인지기능의 향상 등의 분야로 활용범위가 확대되고 있어 뉴로피드백의 효용성과 그 가능성에 대한 기대가 더욱 높아지고 있다. Neurofeedback, also known as EEG biofeedback or neurotherapy, is a new therapy differentiated from biofeedback in that brain waves are monitored to study brain itself as well as its functions. Needless to say, it has originated from biofeedback, however it has established itself as an independent and specialized therapy in the field of neurotherapy. In order to have a better understanding of neurofeedback we are going to have a look into its historical and theoretical background first and then we will explain how it can be used clinically. Neurofeedback was clinically introduced for epilepsy for the first time and its effect was proved. Since then it has been used successfully for a number of psychiatric disorders, such as attention deficit hyperactivity disorder(ADHD), anxiety, anxiety and mood disorder, sleep disorder, substance dependency, etc. Furthermore, it has been used for non-psychiatric or psychosomatic symptoms, such as headache, chronic pains, chronic fatigue symptoms, etc. Recently, it has been also used for non-medical areas, such as improvement of peak performance for sports and art activities, enhancement of cognitive function, etc, making the neurofeedback a very promising field for its potential and effectiveness.

흰쥐에서 반복적 스트레스가 GABA성 신경전달에 미치는 영향

김창수,이종범,성형모,시현석,김진성,박형배,정성덕,하정희 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.1

연구목적 : 일반적으로 생체는 각종 스트레스에 반응하여 적응(adaptation) 기전이 나타난다. 이러한 적응 기전과 관련하여 포유동물의 중요한 억제성 신경전달계인 GABA성 신경전달계의 스트레스성 자극에 대한 반응양상에 대한 연구가 진행되고 있다. 신경전달의 변화양상은 부하된 스트레스의 종류 및 기간에 따라 다양하게 나타나므로 더욱 상세한 연구를 필요로 한다. 방 법 : 본 연구에서는 하루 2시간의 부동화 스트레스를 반복적으로 2주간 부하한 흰쥐의 뇌조직에서 GABA성 신경전달의 변화 양상을 관찰하고자 하였다. 수용체 결합반응을 통하여 GABA 수용체의 각 component별 배위자들의 각 수용체에 대한 결합 반응의 변화 양상을 정상 대조군와 비교하여 보고, 유의한 변화가 있는 부분의 상세한 검정을 위하여 포화결합반응을 통하여 친화력(Kd) 및 최대결합력(Bmax)에서의 변화양상을 검색하였다. 뿐만 아니라 GABA성 신경전달에 관여하는 중요한 신경전달체인 내인성 GABA의 함량과 대사효소인 GABA transaminase의 활성도의 변화양상도 검색하였다. 결 과 : 연구결과 반복적인 부동화 스트레스는 GABA 수용체 효현제인 [³H]muscimol의 흰쥐 뇌조직 GABA 수용체에 대한 결합도에는 별다른 영향을 미치지 않았다. 대뇌피질조직의 GABA 대사효소인 GABA transaminase 활성도를 감소시켰으나, 피질조직외의 다른 조직의 GABA transaminase 활성도나 내인성 GABA의 농도에는 별다른 영향을 미치지 않았다. 반복적인 부동화 스트레스를 부하한 흰쥐의 대뇌피질, 해마 및 시상하부 조직에서는 [³H]flunitrazepam의 수용체 결합도가 감소하였으며, 포화결합 반응결과 수용체의 수가 감소하였음을 확인하였다. 결 론 : 이상의 결과를 요약하면, 흰쥐에게 부하한 반복적인 부동화 스트레스는 뇌조직의 benzodiazepine 수용체의 수를 감소시킴으로써 GABA성 신경전달을 감소시키며, 이러한 GABA성 신경전달계의 변환은 생체에서 스트레스로 인한 행동장애의 한 기전이 될 수 있을 것으로 생각되었다. Objectives : Changes of GABAergic neurotransmission in response to the application of different types of environmental stress have been the subject of research for over two decades. However, the nature of the changes induced by stress appear to show a dependent phenomena on the type and duration of stressor agent employed. Methods : For this reason, this study was performed to observe the effects of repeated stress on the radioligands binding to GABAA/benzodiazepine receptors of discrete brain regions. The author also examined the activity of GABA transaminase and the concentration of endogenous GABA. Male Sprague-Dawley rats, weighing 150-200g were forced to suffer an immobilization stress for 2 hours during 14 consecutive days. Results : Repeated immobilization stress decreased the binding of [3H]flunitrazepam on the benzodiazepine receptor in the cortex, hippocampus and hypothalamus. Saturation experiments followed by scatchard analyses of the results showed decreased density of benzodiazepine receptor and the affinity remained unchanged. Repeated immobilization stress did not affect the binding of [3H]muscimol on the GABAA receptor, the activity of GABA transaminase, and the concentration of endogenous GABA in the brain regions. Conclusions : From these results, it can be concluded that repeated immobilization stress modulated GABAergic neurotransmission via downregulation of the benzodiazepine receptor in the brain.

주의력 저하 아동에 대한 뉴로피드백 치료의 주의집중력 향상

신기석,이영진,이용호,성형모,서호석,Sin, Ki-Seok,Lee, Young-Jin,Lee, Yong-Ho,Sung, Hyung-Mo,Suh, Ho-Suk 한국정신신체의학회 2009 정신신체의학 Vol.17 No.1

Objectives : This research is to figure out the neurofeedback treatment for the inattentive children is effective in improving attention deficit and furthermore, in relieving hyperactivity and impulsivity. Methods : 20 children subjects participated for this study. C3-A1 protocol neurofeedback was given 15 to 20 times to each child, it is carried out to compare the degree of attention in each case every 5 times of neurofeedback by using ADHD Rating Scale-IV : Parent Version(ARS) and Attention Deficit Disorder Evaluation Scale-Home Version(ADDES-HV). Results : The subscale of mean inattention score of ARS was reduced from 14.2 to 8.8 significantly(p<0.05) after 20 sessions of neurofeedback treatment, also the subscale of mean impulsivity/hyperactivity score of ARS from 13.3 to 7.1. The subscales of mean inattention, impulsivity and hyperactivity score of ADDES-HV was also reduced significantly(p<0.05) after 20 sessions of neurofeedback treatment. The changes of scores appeared significantly(p<0.05) from 10-15 sessions of neurofeedback treatment. Conclusion : The results of this study suggest that neurofeedback can improve children's attention deficit, hyperactivity and impulsivity, there exists the possibility of being a method to treat ADHD. 연구목적 : 본 연구에서는 주의집중력이 저하된 아동에게 뉴로피드백 훈련이 주의집중력의 향상에 효과가 있는가를 알아보고, 더 나아가 과잉행동(hyperactivity)과 충동성(impulsivity)의 호전에 효과가 있는가를 알아보고자 하였다. 방법 : 본 연구에서는 주의집중력이 저하된 아동 20명을 대상으로 각 아동별로 뉴로피드백 C3-A1 프로토콜을 15~20회 시행하였으며, 뉴로피드백 시행 전과 후의 주의집중력 정도를 ADHD Rating Scale-IV : Parent Version(ARS)과 Attention Deficit Disorder Evaluation Scale-Home Version(ADDES-HV)을 이용하여 비교하였다. 결과 : ARS 점수는 뉴로피드백 시행 전 inattention 소척도 평균 점수 14.2점에서 20회 시행 후의 평균 점수 8.8점으로 유의하게(p<0.05) 감소하였으며, impulsivity/hyperactivity 소척도의 평균 점수는 13.3점에서 7.1점으로 유의하게 감소하였다. ADDES-HV의 경우는 뉴로피드백 시행 전 inattention 소척도 평균 점수 34.8점에서 20회 시행 후의 평균 점수 20.7점으로 유의하게 감소하였으며(p<0.05), impulsivity 소척도는 22.5점에서 12.7점, hyperactivity 소척도는 18.8점에서 9.9점으로 유의하게 감소하였다. 이 점수들은 대개 10~15회 시점부터 유의하게 변화하기 시작하였다. 결론 : 뉴로피드백 치료를 통하여 아동의 주의집중력, 과잉행동, 충동성이 호전되었으며, 이는 뉴로피드백이 주의력 향상, ADHD의 치료에 한 방법이 될 수 있는 가능성을 시사하고 있다.

우울증 환자 가족들의 심리적 스트레스에 관한 연구 : 정신분열병 환자 가족과 비교

김진희,이은정,정성원,성형모,사공정규,김정범,Kim, Jin-Hee,Lee, Eun-Jeong,Jung, Sung-Won,Sung, Hyung-Mo,SaKong, Jeong-Kyu,Kim, Jung-Bum 대한불안의학회 2010 대한불안의학회지 Vol.6 No.1

Objective : This study compared the psychological stresses of depressed patients' families with those of schizophrenic patients' families. We investigated the influence of depressive patients' clinical features and their families' demographic characteristics on the families' depressive symptoms and stresses. Methods : Participants were 23 family members of depressed patients and 20 family members of schizophrenic patients. We measured the patients' clinical features (duration of illness, number of previous hospitalizations, and satisfaction with medication), and each family member's socioeconomic status and psychological characteristics (depressive mood, anxiety, family stress, and stress response), analyzing the data via independent t-test, chi-square test, and correlation and hierarchical multiple regression analyses. Results : The depressed patients' average clinical global impression (CGI) was significantly higher than that of the schizophrenic patients. The depressed patients' family members showed stress responses significantly higher than those of schizophrenic patients' family members. Furthermore, in depressed patients, frequency of hospitalization was positively correlated with family members' stat anxiety. For both patient types, family stress was positively correlated with the patient's severity of illness and the family's state anxiety, trait anxiety, and stress response ; socioeconomic status was positively correlated with the family's depressive symptoms ; the family's state anxiety positively correlated with the family's trait anxiety and stress response ; and the family's trait anxiety positively correlated with the family's stress response. Socioeconomic status predicted the family's depressive symptoms, and socioeconomic, illness severity and stress response predicted family stress. Conclusion : These findings suggest that both depressed patients' families and schizophrenic patients' families suffer from psychological stress. The study data also have important clinical implications, in that families of depressed patients need psychiatric intervention, as well as the patients themselves. In particular, family intervention should focus on psycho-education and stress coping strategies.

우울증 환자에서 불안장애의 동반이환 : 우울증 임상연구센터 코호트연구

사공정규,이도윤,서호석,성형모,김정범,정영은,이민수,김재민,조선진 대한우울조울병학회 2011 우울조울병 Vol.9 No.1

Purpose : Anxiety disorder and depressive disorder are often comorbid with each other, and the comorbidity is associated with poorer psychiatric outcome, resistance to treatment, increased risk for suicide, greater chance for recurrence. We aimed to investigate the comorbidity of anxiety disorder in Korea. Method : Subjects were total of 867 depressed patients recruited CRESCEND-K multicenter trial. We used SCID (Structured Clinical Interview for DSM - IV) to find comorbidity of anxiety disorders in depressed patient. Results : Of 867 patients, total 8.2% had anxiety disorder. Proportion of anxiety disorder Not Otherwise Specified was 3.5%, panic disorder was 1.7%, generalized anxiety disorder was 1.1%, post traumatic stress disorder was 0.9%, obsessive compulsive disorder was 0.6%, social phobia was 0.4%. Conclusion : In this study, anxiety disorder in depression were measured at a low comorbidity rate in compare to previous studies. Selection bias, use of antidepressants at registration, severity of depression symptoms, and point of SICD administration seems to have affected these results. It is probable that comorbidity evaluation would be more precise if shorter, structured interviews such as M.I.N.I.-Plus were used during first clinical interview for depression diagnosis. (J of Kor Soc for Dep and Bip Disorders 2011;9:30-36)

주의력결핍 과잉행동장애 아동의 연령에 따른 특성비교

정영철,이종범,박형배,정성덕,성형모,사공정규 대한생물치료정신의학회 2001 생물치료정신의학 Vol.7 No.1

Objectives : This study is to verify the developmental changes of ADHD symptoms and functions with aging from 7 to 12 year-old. Method : The subjects of this study were 120 children(108 boys and 12 girls) who were diagnosed as ADHD by DSM - IV at department of neuropsychiatry of Yeungnam University Medical Center. Multidementional tests(K-ABC, ADDES-HV, CAP, CPT, KPl-C, WCST) were carried out to evaluate the change of ADHD symptoms and functions. Results : In K-ABC, children with ADHD showed statistically significant increased "Reading and Understanding" ability(p<.001) with age. In ADDES-HV, They showed decreased inattention (p<.05) and hyperactivity(p<.05) but, not showed significant change of impulsivity symptom with age. In CAP, They showed decreased hyperactivity(p<.001) and inattention (p<.05) and lower total score(p<.05) with age. their result were similar with ADDES-HV. In CPT, They showed decreased hit reaction time(p<.001) and hit reaction time standard errors(p<.01) and variability of standard errors(p<.05) with age. In KPI-C, They showed decreased anxiety(p<.01), depression(p<.001), somatization(p<.05), delinquency(p<.05) and hyperactivity(p<.01) with age. Social relationship(P<.05) was improved, as well as decreased psychoticism(p<.05) and autism (p<.001). In WCST, They showed increased completed categories(p<.001), total corrects(p<.001) and fewer total errors (p<.001) with age. Conclusion : Above findings indicate that symptoms of inattention and hyperactivity in school-aged ADHD children tend to decline with age, but age was less associated with decline in impulsivity symptom . In additions, Their executive functions were improved notably and they appeared stability of emotion, close social relationship and decreased delinquency.

우울증의 진단 및 평가 지침 개발 : 평가 지침을 중심으로

문은수,사공정규,정성원,성형모,이준엽,구본훈,김양태,신임희,조현주,김대현,김민경,최정식,정인명,김정범 대한신경정신의학회 2014 신경정신의학 Vol.53 No.1

ObjectivesZZThe aim of this study is to develop guideline for evaluation of depression. MethodsZZDevelopment of this guideline was processed according to the ADAPTE manual, which was developed for adaptation of good clinical practice guidelines. Important key questions were determined, and a systematic review of clinical practice guidelines was performed. The contents of guidelines selected by comparison of the methodological quality and currency were evaluated with regard to the applicability and acceptability. Answers to key questions and clinical recommendations were established by peer review. ResultsZZCareful evaluations on the characteristics of depression, including subtype, severity, suicidality, and psychiatric and physical comorbidities were recommended because these factors can have an influence on course and prognosis in treatment of depression. ConclusionZZThe results of this study may contribute to the systematic evaluation of depression, based on clinical importance. However, this guideline did not include systematic reviews regarding useful scales for evaluation of depression. In the future, amendment of this guideline might be needed in order to supplement limitations