애착의 신경생물학

신의진(Yee-Jin Shin),홍현주(Hyun Ju Hong),오태성(Tae Sung Oh) 대한소아청소년정신의학회 2004 소아청소년정신의학 Vol.15 No.2

영유아기 정신적 문제의 진단적 평가

신의진 ( Yee-jin Shin ),오경민 ( Kyung-min Oh ) 한국영유아아동정신건강학회 2008 영유아아동정신건강연구 Vol.1 No.1

최근 여성들의 사회참여에 따른 육아문제의 사회화, 영유아기 조기교육 열풍, 자녀들의 정신적 문제에 대한 부모들의 인식증가 등의 사회적 변화와 관련하여 임상 현장에서도 발달 문제를 호소하는 만 4세미하의 어린 아동들의 수가 증가하고 있으며, 유아교육 및 보육 기관에서도 행동발달 상의 문제를 가지는 아동이 증가한다고 보고된다. 이처럼 임상 영역에서 발달상의 위험을 가진 영유아기 아동이 증가함에도 불구하고 아직 이들을 적절히 평가하고 진단하는 임상적 체계가 충분하지 않은 실정이다. 또한 이들에게 적절한 조기 개입 프로그램도 부족하고 그 효과를 뒷받침하는 연구 결과도 거의 없는 상태이다. 영유아기 아동의 정신병리는 첫째, 빠른 발달선상에 있어 발달병리 자체도 빠르게 변하므로 객관적으로 측정하는 것이 쉽지 않고, 둘째, 주양육자와의 관계를 포함한 주변상황에 따라 병리가 다르게 나타날수도 있고, 셋째, 현재 보이는 문제가 단순히 발달상의 위험요소인지 아니면 병리로 까지 발전된 상황인지 구별하는 것이 어렵고도 중요하다는 특징을 가진다. 더구나 현재 널리 쓰이고 있는 정신과 질환의 진단분류체계인 DSM, ICD에서는 영유아기 아동의 정신병리를 제대로 반영하지 못하고 있어 미국에서는 DC 0-3라는 새로운 영유아기 전용 진단분류체계를 만들고 있다. 본고에서는 영유아기의 정신병리에 대한 분류 및 진단적 평가과정에 대해 소개하고자 한다. Recently, due to dramatic social changes such as more women working outside home, a great increase in mothers' passion for educating their children from early age, and heightened awareness of early childhood mental problems, we are finding that an increasing number of children under the age of 4 have developmental problems, and nursery schools and organizations are reporting that children having behavioral developmental problems are increasing. Although the number of infants and children, who are at risk of developmental problems, rises, no enough clinical framework, which can be used to evaluate and diagnose them properly, has been established yet. Also, early intervention programs and research results supporting effectiveness of the programs are not sufficient. Early childhood's psychopathology has the following characteristics. First, since children's developmental pathologies are rapidly changing in line with children's rapid development, it is very difficult to measure them objectively. Second, pathologies are highly affected by circumstantial factors, including children's relationship with main caregivers. Third, it is difficult to determine whether what is seen now is simply a developmental problem or pathological problem. In fact, well-known psychiatry diagnostic classification systems such as the DSM and ICD fail to reflect and explain young children's psychopathologies. Therefore, a new diagnostic classification system for infants and young children, called DC O-3, has been developed in the U.S. This paper introduces some classification and diagnostic evaluation steps of early childhood psychopatholgies.

ADHD 환자에 대한 OROS-Methylphenidate 약물치료의 부작용과 관련요인들에 대한 연구

김진선(Jin-Sun Kim),김붕년(Bung-Nyun Kim),조수철(Soo-Churl Cho),신민섭(Min-Sup Shin),유희정(Hee-Jeong Yoo),김재원(Jae-Won Kim),송동호(Dong-Ho Song),신동원(Dong-Won Shin),정유숙(Yoo-Sook Joung),천근아(Keun-Ah Cheon),신의진(Yee-Jin Shi 대한소아청소년정신의학회 2010 소아청소년정신의학 Vol.21 No.2

Objectives:The aim of this study was to investigate the effect of the clinical and demographic variables such as body weight, dosage, family history of attention-deficit hyperactivity disorder (ADHD), and psychiatric co-morbidity on the side-effects of OROS-Methylphenidate (OROS-MPH), and to evaluate the relationship between drug response and side effect severity. Methods:A total of 144 children (ages 6-18) with diagnosed ADHD were treated with OROS-MPH. Children were examined at baseline and after 1, 3, 6, 9, and 12 weeks of each treatment condition. The stimulant drug side effect rating scale (SERS), pulse rate, systolic blood pressure, diastolic blood pressure, and electrocardiogram (ECG) were evaluated to assess side effect profiles. Changes in these parameters from baseline were examined and analyzed. Results:Anorexia (30.95%) and insomnia (13.10%) were the most commonly reported side effects during this study. Insomnia and loss of appetite score increased at one week follow-up, but was sustained or decreased as treatment progressed. Small but significant increases in pulse rate and diastolic blood pressure were observed during treatment;however, no clinically meaningful changes in ECG parameters were noted during the study. Low body weight, high dosage of OROS-MPH, and family history of ADHD were associated with cardiovascular side effect. In contrast, there was no significant relationship between OROS-MPH treatment response and the severity of side effect and no difference resulted between the responder and non-responder groups with respect to OROS-MPH dosage in the 12 weeks of follow-up. Conclusion:To the best of our knowledge, this study is the first Korean study to investigate comprehensive side effect profiles and their correlates in OROS-MPH treatment for ADHD children. OROS-MPH was well tolerated with no clinically significant side effects during the treatment period. In conclusion, low body weight, high dosage of OROSMPH, and family history of ADHD could be used as predictive factors in increasing pulse rate and blood pressure.

소아기 만성 난치성 질환 환아 보호자의 치료과정에서의 어려움과 정신건강 서비스에 대한 인식

류혜진 ( Hye Jin Ryu ),엄소용 ( Soyong Eom ),이영목 ( Young Mock Lee ),신의진 ( Yee Jin Shin ) 한국영유아아동정신건강학회 2020 영유아아동정신건강연구 Vol.13 No.1

본 논문은 소아 만성 난치성 질환을 겪고 있는 자녀를 둔 보호자들이 치료과정에서 경험하는 어려움의 내용들을 탐색해보고, 환아를 포함하여 보호자들의 정신건강 서비스와 관련한 실제적인 접근 실태 및 요구 수준을 확인하고자 하였다. 이를 위해 만성 난치성 질환으로 확진 받은 소아 환아의 보호자 70명을 대상으로 자체 개발된 설문 평가지를 통해 수집한 자료를 분석하였다. 연구결과, 보호자들이 경험하고 있는 어려움으로 환아 진료와 부양으로 인한 나머지 가족들의 심리적 및 정신적 어려움이 일관적으로 높게 나타났으며, 난치성 질환의 특성으로 인한 자녀 질병과 관련한 이해와 정확한 정보 획득의 제한도 보고되었다. 보호자의 정신건강 서비스 경험 유무에 대하여는 74%가 경험 없음을 보고하였고, 심리상담을 받을 수 있는 시간 및 경제적 여건이 되지 않았던 점을 가장 빈번하게 지적하였다. 자녀가 받고 있는 치료적 개입과 관련해서도 자녀의 정신건강 서비스 경험은 미비하였으나, 필요성에 대하여는 79%가 긍정적인 답변을 나타내어 이에 대한 보호자들의 욕구를 확인할 수 있었다. 본 연구 결과를 통해 만성 난치성 질환의 효율적인 관리에 있어 환아 뿐 아니라 가족 구성원들이 경험하는 심리, 정서적 문제에 대한 국가적 차원의 전문적인 정신건강 지원 서비스의 제공이 필수적임을 확인하여 보다 현실적이고 실질적인 심리 지원 시스템의 정립에 도움이 되는 기초자료를 제공하고자 하였다. The aim of this study is to identify the actual access status and level of demand for caregivers’ mental health services, including services for children, by exploring the difficulties experienced by caregivers of children with chronic intractable diseases in medical care. The findings show that the psychological and mental difficulties of the family of such patients due to patient care are consistently high, with limited access to accurate information and treatments appropriate for incurable diseases also reported. 74% of the respondents in this study reported they had no experience with mental health services available to them, indicating most frequently that they did not have time or the economic ability to undertake psychological counseling. With regard to children, therapeutic interventions have sought mainly to improve the performance outcomes of basic daily functions, though the service experience associated with mental health for children was insufficient. Nevertheless, 79% of respondents responded positively when asked about the need for intervention in mental health services for their children, thus confirming these needs. The results of this study demonstrate that the provision of professional mental health support services at the national level for psychological and emotional problems is essential for the efficient management of chronic incurable disease, while also providing basic data to help establish a more realistic and practical psychological support system.

유아의 가정에서의 코티솔 패턴과 내면화 행동성향 간의 관계

이영 ( Young Lee ),신의진 ( Yee Jin Shin ),정지나 ( Jee Nha Chung ),민성혜 ( Sung Hye Min ),민현숙 ( Hyun Suk Min ),이경숙 ( Kyung Sook Lee ) 대한가정학회 2007 Human Ecology Research(HER) Vol.45 No.9

아스퍼거장애 아동의 이야기 분석

이경숙(Lee, Kyung-Sook),신의진(Shin, Yee-Jin),조숙환(Cho, Sook Whan),주금정(Joo, Kum-Jeong) 담화·인지언어학회 2011 담화와 인지 Vol.18 No.3

Studies of English-speaking children with autistic spectrum disorder (ASD) have reported that narrative assessment is sensitive to the communication impairments. Narrative development of Korean children with ASD has rarely been examined, and it is unclear how qualitatively different their deficits may be from typically developing Korean children’s narrative ability. The purpose of this study was to provide an analysis of narratives in 10 children with Asperger’s Syndrome (AS) and 10 typically developing children matched on age, gender, language abilities, and cognitive abilities. Participants completed stories based on the MacArthur Story Stem Battery. Each of their stories was assessed in terms of story organization components developed in Strong Narrative Assessment Procedure(Strong, 1998). It was found that children with AS produced narratives that were significantly less coherent than the narratives of controls. It seemed less likely for children with AS to organize their utterances coherently in relation to the gist of the story stems provided at each setting. It is speculated that lack of narrative ability is associated with deficiencies in cognitive skills in theory of mind and perspective-switch.

심한 정신적 외상 경험을 한 학령 전기 아동의 정신적 표상에 대한 예비연구

엄소용(So-Yong Eom),신의진(Yee-Jin Shin),송원영(Won-Young Song),오경자(Kyung-Ja Oh),최의겸(Eui-Gyum Choi),심은지(Eun-Ji Shim) 대한소아청소년정신의학회 2004 소아청소년정신의학 Vol.15 No.1

저출산에 대한 심리적 이해: 남녀대학생과 중년기 기혼여성을 중심으로

이경숙 ( Kyung-sook Lee ),신의진 ( Yee-jin Shin ),정석진 ( Suk-jin Jung ),박미현 ( Mi-hyen Park ),김린 ( Rin Kim ) 한국영유아아동정신건강학회 2009 영유아아동정신건강연구 Vol.2 No.1

본 연구는 예비 부모세대인 대학생 441명과 중년기 기혼여성인 대학생의 어머니 354명을 대상으로 각각 출산의향 자녀수 및 추천 자녀수와 개인의 심리적 특성과의 관련성을 살펴보았다. 연구결과, 대학생은 현재 삶의 만족도가 높고, 불안 및 외로움이 낮고, 어머니와의 관계 만족도와 형제관계에 대한 만족도가 높을수록 출산의향 자녀수가 많아졌다. 그리고 형제수 및 형제유무에 따른 출산의향 자녀수에 차이를 보이지 않았으나 형제관계만족도가 높을수록 출산의향 자녀수가 증가하였다. 한편, 중년기 기혼여성은 현재 삶의 만족도가 높고 자녀와의 관계가 좋고 자녀양육시 부부갈등이 적고 부부간의 자녀에 대한 불만족이 적을수록 출산하도록 추천하는 자녀수가 증가하였다. 이러한 결과는 대학생과 중년기 기혼여성 모두 부모 및 자녀와의 관계 경험이 좋고 정신건강 상태가 안정적일수록, 형제관계 및 자녀관계를 긍정적으로 예측하게 하여 자녀출산 의향 및 추천 자녀수에 긍정적인 영향을 미친다는 것이다. This study examines the interrelation between personal psychological variables and the number of intended childbirths along with the recommended number of childbirths. The subjects are 441 university students in the parents-to-be generation and 354 middle-aged married women who are mothers of university students. The result shows that university students are willing to have more children when the level of their satisfaction with their present life is high, the degree of anxiety and loneliness is low, and they are content with their relationship with their mothers. Furthermore, the number of intended childbirths becomes higher when the level of satisfaction with sibling relationship is high. However, the existence or the number of siblings makes no difference. Middle-aged married women tend to recommend having more children when the level of satisfaction with their present life is high, their relationship with their children is good, they have less conflicts with their husbands in parenting, and they have less dissatisfaction with their children. It can be concluded that both university students and middle-aged women expect a positive relationship with siblings and children when their relationship with their parents and children has been good and their mental health is stable, which has a positive effect on the number of intended childbirths and recommended number of childbirths.

유아 자폐증 환아에서의 Tc - 99m ECD를 이용한 뇌 단일 광전자 방출 전산화 단층 촬영술상의 관류 저하 : 자기 공명 영상과의 비교 분석

유영훈,이종두,윤평호,김동익,오영택,이선아,이호분,신의진,이병희 ( Young Hoon Ryu,Jong Doo Lee,Pyeong Ho Yoon,Dong Ik Kim,Young Taik Oh,Sun Ah Lee,Ho Bun Lee,Yee Jin Shin,Byung Hee Lee ) 대한핵의학회 1997 핵의학 분자영상 Vol.31 No.3

주의력결핍 과잉행동장애에서 파탄적 행동장애의 공존과 약물치료

강제욱(Je Wook Kang),박은진(Eun Jin Park),김성찬(Seong Chan Kim),신의진(Yee-Jin Shin),신윤미(Yun-Mi Shin),정재석(Jaesuk Jung),천근아(Keun-Ah Cheon),육기환(Ki-Hwan Yook) 대한소아청소년정신의학회 2012 소아청소년정신의학 Vol.23 No.S

Disruptive behavioral disorders [oppositional defiant disorder (ODD) and conduct disorder (CD)] are common comorbid disorders in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). ODD/CD may be comorbid up to 60% of children and adolescents with ADHD. Comorbid ODD and CD symptoms can have a significant impact on the course and prognosis o f patients with ADHD. Stimulant medications have shown effectiveness in treating both core ADHD symptoms and oppositional symptoms. Assessment and management of comorbid disruptive behavioral symptoms is an essential part in evaluation and treatment of ADHD patients. Further research is needed to investigate the efficacy and safety of various behavioral and medication regimens for ADHD, comorbid ODD and CD and to examine the relationships between ADHD, comorbid ODD and CD.