리스페리돈으로 교체 투여한 정신분열병 환자에서 주관적 안녕감

윤보현,시영화,김현일,차현철,윤진상 대한정신약물학회 2004 대한정신약물학회지 Vol.15 No.3

Objectives: The aim of this study was to evaluate the subjective well-being of schizophrenic patients who switched their antipsychotics to risperidone as the maintenance treatment over 24 weeks. Methods: Thirty-one patients were evaluated using Positive and Negative Syndrome Scale (PANSS) for psychopathology and UKU side effects rating scale for drug-induced adverse events. Also the subjects were asked to score the 10 items self-rating scale (KmSWN-10), which derived from the 19-items of Korean modified version of Subjective Well-being under the neuroleptic treatment (KmSWN) scale. The assessments were administered at baseline, 2 weeks, 12 weeks and 24 weeks after switching to risperidone. Analysis were done using repeated measures of ANOVA. Pearson correlation analysis were also done to assess the correlation between KmSWN-10 and psychopathology and drug induced side effects. Results: There were significant improvements on the scores of KmSWN-10 and reductions on the PANSS and UKU side effect rating scores during the treatment of risperidone. KmSWN-10 was negatively correlated with the total, negative and general psychopathology scales of PANSS at baseline, and also negatively corrleated with total, positive, negative, general psychopathology scales and depressive factor of PANSS scores and total UKU side effects rating scores at 24 weeks of treatment. Conclusion: The results suggest that the maintenance treatment with risperidone positively affected on the subjective well-being of schizophrenic patients due to improvement of psychotic symptoms and decrement of side effects. KmSWN-10 may be more related with negative and general psychopathlogy scales of PANSS in this study.

입원중인 정신분열병 환자에서 비전형 및 전형 항정신병약물에 대한 주관적인 반응

윤보현,시영화,배승오,이은숙,이형영 대한생물치료정신의학회 2002 생물치료정신의학 Vol.8 No.2

입원중인 정신분열병 환자를 대상으로 항정신분열약물에 대한 주관적 반응과 약물에 대한 태도가 비전형 및 전형 항정신병약물에 따라 다르게 나타나는지를 알아보고자 하였다. 비전형 항정신병약물을 복용중인 31명과 전형 항정신병약물을 복용중인 42명의 정신분열병 환자를 대상으로 하였으며, 이들은 모두 급성기를 지나 안정기에 있는 환자들이었다. 이들을 대상으로 인구통계학적 자료, 임상력 및 임상상태를 비교하였으며, 항정신병약물에 대한 주관적 반응 및 약물에 대한 태도를 평가하기 위해 10문항의 자가 평가 설문지인 Drug Attitude Inventory(DAI-10)를 시행하여 양군 간에 비교하였다. 전형 항정신병약물군은 비전형 항정신병약물군에 비해 입원 치료 중에 더 많은 항콜린성 약물을 복용하고 있었으며, 추체외로계 증후군과 약물의 진정효과로 인한 불편감을 호소하였다. DAI-10에서 비전형 항정신병약물군은 전형 항정신병약물군에 비해 항정신병약물에 대한 주관적 부정적 느낌이 적었으며, 최종 점수에서 훨씬 긍정적인 약물에 대한 주관적 반응과 태도를 보였다. 본 연구의 결과로서 전형 항정신병약물은 약물로 인한 부작용의 효과로 인해 부정적 반응에 영향을 주었으며, 반면에 비전형 항정신병약물은 긍정적인 약물에 대한 반응과 태도에 영향을 주었음을 확인하였다. Objectives : Drug Attitude Inventory(DAI) was used to compare the subjective response to antipsychotics between schizophrenic inpatients receiving atypical and typical antipsychotic medications. Method : Seventy three patients meeting selection criteria and receiving atypical(N=31) and typical antipsychotics(N=42) were examined. All of them were in the stabilized stage of their illnesses. Subjective response to neurolepics was evaluated using 10-items of Drug Attitude Inventory(DAI-10). Demographic and clinical data were also analyzed between two groups. Results : Patients receiving typical antipsychotics had adjuvant medications such as anticholinergics and more complained of the neuroleptic-induced side effects. They showed more dysphoric responses to the subjective responses to neuroleptics. Patients taking atypical antipsychotics showed significantly non-dysphoric responses on the items asking the negative aspects of medications and more subjective positive responses on the final scores. Conclusion : These results suggest that atypical antipsychotics influenced on the subjective positive responses to neuroleptics and neuroleptic-induced side effect affected the subjective negative feelings and attitude to antipsychotics.

조현병 외래 환자에서 야간식이증후군의 유병률과 관련요인

남석현,윤보현,시영화,송제헌,박수희,박형종,이지선,Nam, Seok-Hyun,Yoon, Bo-Hyun,Sea, Young-Hwa,Song, Je-Heon,Park, Suhee,Park, Hyungjong,Lee, Ji Seon 한국정신신체의학회 2014 정신신체의학 Vol.22 No.2

연구목적 본 연구의 목적은 조현병 외래 환자를 대상으로 야간식이증후군(night eating syndrome : NES)의 유병률과 이와 관련된 임상적 요인들에 대해 살펴보는 것이다. 방 법 정신건강의학과 외래를 방문한 201명의 조현병 환자들을 14 문항의 자기보고 형식인 야간식이증후군 설문지(Night Eating Questionnaire : NEQ)로 평가하였다. 인구학적, 임상적 특징과 체 질량 지수(BMI)을 조사하였고, 주관적인 기분과 수면, 폭식과 체중 관련 삶의 질에 대해서는 각각 Beck's Depression Inventory(BDI), Pittsburgh Sleep Quality Index(PSQI), Binge Eating Scale(BES)와 Korean version of Obesity-Related Quality of Life Scale(KOQoL)를 이용하여 평가하였다. 결 과 조현병 외래 환자에서 야간 식이 증후군의 유병률은 10.4%(201명 중 21명)이었다. NES 군과 non-NES 군간에 나이를 제외하면 인구사회학적 및 임상적 특성, BMI에서는 유의한 차이를 보이지 않았다. NES 군이 Non-NES 군에 비해 보다 우울했고, 수면과 폭식 양상, 체중 관련 삶의 질에 있어서 의미 있는 장애를 나타냈다. '아침 식욕부진'과 '지연된 아침식사'(NEQ에서 NES 핵심 항목 5개 중 2개)는 두 군간에 차이가 없었으나, '야간 섭식', '야간 식욕항진' 그리고 '기분/수면'은 NES 군에서 더 손상되어 있는 것으로 나타났다. 결 론 본 연구는 조현병 외래 환자를 대상으로 NES의 유병률과 관련 요인에 대해 기술한 최초의시도이다. 비록 NES와 비만과의 연관성은 밝히지 못했지만, 본 연구의 결과는 NES가 정신 건강에 부정적 영향을 준다는 사실을 보여주었다. 향후 이러한 결과를 뒷받침할 수 있는 추가 연구가 필요할 것이다. Objectives : The aim of study was to examine the prevalence of night eating syndrome(NES) and its correlates in schizophrenic outpatients. Methods : The 14 items of self-reported night eating questionnaire(NEQ) was administered to 201 schizophrenic patients in psychiatric outpatient clinic. We examined demographic and clinical characteristics, body mass index(BMI), subjective measures of mood, sleep, binge eating, and weight-related quality of life using Beck's Depression Inventory(BDI), Pittsburgh Sleep Quality Index(PSQI), Binge Eating Scale(BES) and Korean version of Obesity-Related Quality of Life Scale(KOQoL), respectively. Results : The prevalence of night eaters in schizophrenic outpatients was 10.4%(21 of 201). Comparisons between NES group and non-NES group revealed no significant differences in sociodemographic characteristics, clinical status and BMI. Compared to non-NES, patients with NES reported significantly greater depressed mood and sleep disturbance, more binge eating pattern, and decreased weight-related quality of life. While 'morning anorexia' and 'delayed morning meal'(2 of 5 NES core components in NEQ) were not differed between groups, 'nocturnal ingestions', 'evening hyperphagia', and 'mood/sleep' were more impaired in NES group. Conclusions : These findings are the first to describe the prevalence and its correlates of night eaters in schizophrenic outpatients. These results suggest that NES has negative mental health implications, although it was not associated with obesity. Further study to generalize these results is required.

Association of Mental Health Status with Suicidal Ideation among the Community-Dwelling Elderly

김경민,윤보현,시영화,박수희,송재헌,윤현주 대한우울조울병학회 2019 우울조울병 Vol.17 No.3

Background: This study examined how mental health status influenced suicidal ideation among community-dwelling elderly at senior citizen centers in Korea. Methods: Data were obtained from a survey on elderly mental health in Jeollanam-do (a southwest province in Korea) conducted by the Jeollanam-do Provincial Mental Health and Welfare Center. In total, 4,113 people were recruited from all 22 cities in Jeollanam-do. We evaluated sociodemographic factors and mental health status using self-reported questionnaires, namely, the Suicidal Ideation Scale, Geriatric Depression Scale-Short Form Korean Version, Multidimensional Scale of Perceived Social Support, Korean version of the General Health Questionale-12, and Satisfaction with Life Scale, to assess psychosocial factors affecting suicidal ideation. Multivariate logistic regression was performed to examine the factors associated with suicidal ideation. Results: Among the 4,113 subjects, 325 (7.9%) reported recent suicidal ideation. Multivariate logistic regression analysis revealed that depression (p<0.001), low-level social support and life satisfaction (p=0.006), poor general mental health (p<0.001), physical disease (p=0.009), and poor self-perceived health status (p=0.039) were significantly associated with suicidal ideation. Conclusion: The presence of physical disease, poor self-perceived health status, depression, and poor general mental health conditions increase the risk of suicide ideation among the elderly. Social support and life satisfaction affected their suicidal ideation independently of depression.

정신질환자의 인권지표 개발 : 국립병원의 조현병과 양극성장애 환자를 중심으로

홍창희,정성미,시영화,윤보현,배안 대한신경정신의학회 2014 신경정신의학 Vol.53 No.1

Objectives The purpose of this study was to develop and validate the indicator of humanrights of people with mental illness (HRPM). Methods The HRPM scale was administered to 382 inpatients at national hospital psychiatric(schizophrenia 77.0%, bipolar disorder 7.6%). Reliability of HRPM was tested by internal consistency,test-retest reliability, and item-total correlation. Domains and contents were examined forassessment of construct validity of HRPM. Results Human rights of people with mental illness was highly reliable in terms of internal consistency(Cronbach alpha=0.87), test-retest reliability (r=0.81), and corrected item-total correlationr range from 0.42 to 0.71. In addition, construct validity of HRPM was established with thedomains and contents in conceptually expected ways. Conclusion These results offer reliability and validity for the indicator of HRPM. The implicationsand limitations of this study were discussed, and future directions of study were suggested. 본 연구는 정신질환을 지닌 사람들의 인권실태를 정확하게 파악하고 측정하기 위한 정신질환자의 인권지표 개발을위해 수행되었다. 인권지표의 타당성 선정기준 확보를 위해MI원칙,9) 정신보건법2) 등의 연구 결과를 근간으로 5점 리커트형 척도로 구성된 37문항의 인권지표를 개발하였다. 개발된 인권지표의 심리측정적 속성을 알아본 결과, 내적 일치도, 검사-재검사 신뢰도 및 문항-총점 간 상관 등 신뢰도와,척도의 영역과 내용으로 알아 본 구성개념 타당도 모두 양호하게 나타났다. 이와 더불어 비교적 쉽고 단순한 문항으로구성되어 있어서 본 연구에서 개발된 인권지표가 정신질환자의 인권에 관한 연구와 실태파악에 신뢰롭고 유용하게 사용될 수 있을 것으로 예상된다.

정신분열병 외래 환자를 대상으로 한 야간 식이 설문지의 심리측정적 특성

이세영,윤보현,시영화,박수희,배안 대한신경정신의학회 2010 신경정신의학 Vol.49 No.6

ObjectivesZZThe purpose of this study was to evaluate the psychometric properties of the Night Eating Questionnaire (NEQ) as a measure of the night eating syndrome (NES) in a sample of outpatients with schizophrenia. MethodsZZThe behavioral and psychological symptoms of NES were assessed with the 14-item self-report questionnaire (NEQ). Body weight and height were measured to calculate the body mass index (BMI). Subjective estimates of depression, binge eating patterns, sleep quality and weight-related quality of life were evaluated using Beck’s Depression Inventory (BDI), the Binge Eating Scale (BES), the Pittsburgh Sleep Quality Index (PSQI) and the Korean version of Obesity-related Quality of Life (KOQoL) Scale. ResultsZZAmong 165 schizophrenic outpatients who completed the NEQ, 15 (9.1%) patients sc-reened as having NES (total NEQ ≥25). The NEQ demonstrated high internal consistency (Cronbach’s alpha=0.72), and the item-total correlations (r=0.29-0.75 ; p<0.001, respectively) were acceptable, except for morning anorexia. A principal components analysis revealed five factors (nocturnal ingestions,evening hyperphagia, mood/sleep, morning anorexia, and delayed morning meal), which ex-plained 65.7% of the total variance. Although the NEQ total score was not correlated with BMI, age at onset, duration of illness, or use of atypical antipsychotics, it was significantly correlated with total scores on the BDI, BES, PSQI and KOQoL. Test-retest reliability was also good (r=0.74, p<0.001). ConclusionZZOur results showed that the NEQ appears to be an efficient, valid measure of NES in outpatients with schizophrenia.

양극성 장애 환자의 병식과 정신병리

윤대일,배안,시영화,김윤기,이경미 대한우울조울병학회 2010 우울조울병 Vol.8 No.1

Objectives:The insight in patients with mental disorder is found to affect the long-term treatment outcome and prognosis significantly. Some studies have been done for patients with schizophrenia, but there have been few studies examining this topic in patients with bipolar disorder in Korea. Accordingly the aim of this study is to examine the correlation between the insight and psychopathology in patients with bipolar disorder. Methods:Fifty-six patients who were diagnosed as bipolar disorder based on DSM-IV were recruited from inpatient or outpatient clinic. We used Young Mania Rating Scale (YMRS), Montgomery-Åsberg Depression Rating Scale (MADRS), and Clinical Global Impression-Severity (CGI-S) to evaluate the psychopathology. Scale to Assess Unawareness of Mental Disorder (SUMD) and six level of insight were chosen to assess the insight. Results:The severity of manic symptom and poor insight were correlated (r=0.543, p<0.001). The insight was also related with the general severity of illness (r=0.465, p<0.001). However, there was no association with depressive symptoms. In addition, SUMD and six level of insight were shown to have a high negative correlation (r=-0.741, p<0.001). Conclusion:The insight of the patients with bipolar disorder is highly associated with the psychopathology, especially manic symptoms. Thus, rapid recovery from illness may help to improve the level of insight.

정신분열병환자의 가족지지 지각일치수준과 정서표현성 및 증상과의 관계

서지윤,홍창희,시영화 대한신경정신의학회 2010 신경정신의학 Vol.49 No.6

ObjectivesZZThe aim of this study was to explore relationships among the level of agreement ab-out perceived family support, emotional expressivity and psychiatric symptoms in patients with schizophrenia and their families. MethodsZZThe Family Support Scale, the Emotional Expressivity Scale and the Symptom Check-list-90-Revision were administered to 73 patients with schizophrenia and their 73 family members. ResultsZZAgreement about perceived family support was divided into four levels. The first level was where there was affirmative agreement between the patient and the family member. The second level was where there was negative agreement between the patient and the family member. At the third level there was a negative perception by the patient and an affirmative perception by the family member, and the final level was where there was an affirmative perception by the patient and a negative perception by the family member. The more positive the patients perceived their family support to be, the more they expressed their emotional expressivity. The patients, who agreed affirmatively with their family member about family support, were more able to express their emotion and had fewer psychiatric symptoms than the patients, who had negative agreement with their family member about family support. ConclusionZZThe level of perceived agreement of the family support affects emotional expressivity and psychiatric symptoms in patients with schizophrenia. The family support perception by the patient and family member can help you understand emotional expressivity and psychiatric symptom in schizophrenics.

양극성 장애 외래환자에서 야간식이증후군의 임상적 특성

정하란,윤보현,시영화,송제헌,박수희,구본기,김경민,남석현,Jung, Haran,Yoon, Bo-Hyun,Sea, Young-Hwa,Song, Je-Heon,Park, Suhee,Koo, Bonki,Kim, Kyung-Min,Nam, Seok-Hyun 한국정신신체의학회 2014 정신신체의학 Vol.22 No.2

연구목적 이 연구의 목적은 양극성 장애로 진단받은 정신과 외래 환자에서 야간 식이습관의 임상적 특성을 조사하는데 있다. 방 법 정신건강의학과 외래를 방문한 84명의 양극성 장애 환자를 대상으로 14개 항목의 야간 식이증후군 설문지(NEQ)를 자가 보고로 실시하였다. 이들의 인구학적, 임상적 특성을 조사하고 신체 질량 지수(BMI), 주관석 기분과 수면, 폭식과 체중에 관련된 삶의 질에 대한 평가를 Beck Depression Inventory(BDI), Binge Eating Scale(BES), Korean version of Obesity-related Quality of Life scale(KOQoL), Pittsburg Sleep Quality Index(PSQI) 등을 포함한 설문을 통해 얻었다. 결 과 양극성 장애 외래 환자 중 야간 식이증후군의 유병률은 14.3%(84명 중 12명)이었다. NES와 Non-NES군 사이에서는 경제적 상태와 동반되는 내과 질환을 제외한 성별, 나이, 교육 년 수, 결혼 및 직업 상태, 흡연, 음주 등의 인구사회학적 특성에서 양군간에 유의한 차이를 보이지는 않았다. 하지만, Non-NES 군에 비해 NES군에서 폭식이 많았고 비만으로 인한 삶의 질 저하가 나타났다. 결 론 이번 연구는 야간식이를 보이는 양극성 장애 외래환자의 임상적 특성을 처음으로 기술하였다. 비록 양극성 장애 외래 환자의NES군에서 뚜렷한 상관 관계를 보이는 특성이 많지는 않았지만, 상대적으로 NES 유병률이 높은 것으로 볼 때 임상에서 양극성 장애 환자 평가 시 비만 여부에 관계 없이 NES를 염두에 두어야 할 것이다. Objectives : The aim of this study is to evaluate the clinical characteristics of night eating syndrome(NES) in bipolar disorder outpatients. Methods : The 14 items of self-reported night eating questionnaire(NEQ) was administered to 84 bipolar patients in psychiatric outpatient clinic. We examined demographic and clinical characteristics, body mass index(BMI), subjective measures of mood, sleep, binge eating & weight-related quality of life using Beck's Depression Inventory (BDI), Pittsburgh Sleep Quality Index(PSQI), Binge Eating Scale(BES) and Korean version of Obesity-Related Quality of Life Scale(KOQoL), respectively. Results : The prevalence of night eating syndrome in bipolar outpatients was 14.3%(12 of 84). Comparisons between NES group and non-NES group revealed no significant differences in demographic characteristics, BMI and clinical status except economic status and comorbid medical illnesses. However, compared to non-NES, patients with NES was more likely to have binge eating pattern and poorer weight-related quality of life. Conclusions : This study is to be the first to describe the clinical correlates of night eaters in bipolar outpatients. Although there were few significant correlates of NES in bipolar outpatients, relatively high prevalence of NES suggest that clinicians should be aware to assess the patients with bipolar disorder on NES, regardless of obesity status of patients.

청소년에서 자살사고가 동반된 자해행동에 대한 예측인자

탁창훈,윤보현,김경민,시영화,정하란,송제헌,박수희,박진형 대한우울조울병학회 2017 우울조울병 Vol.15 No.3

Objective : To examine the relationship between self-injurious behavior and suicidality and to identify predictive factors of self-injurious behavior with suicidal ideation in adolescents. Methods : Among 4,421 middle and high school students, 613 subjects that reported self-injurious behavior were included in this study. They were asked to complete self-reporting questionnaires to evaluate sociodemographic factors and psychosocial status. They were divided into self-injurious behavior with the suicidal ideation group and the non-suicidal self-injurious behavior group according to self-report items. Data were compared between the two groups. Results : Six hundred thirteen adolescents (13.8%) of 4,421 reported history of past self-injurious behavior and 352 (57.4%) of 613 adolescents experienced concurrent suicidal ideation. Multivariate logistic regression analysis revealed that depression (OR=2.989), female (OR=2.447), drinking (OR=1.826) and recent stress (OR=1.017) were significantly associated with self-injurious behavior with suicidal ideation in adolescents. Conclusion : Results revealed multiple factors predicting selfharm behavior accompanying suicidal ideation in adolescents that may be useful for intervention programs for high risk adolescents of suicide.