1995년 대한폐경학회 연수 심포지움 : 갱년기 정서장애

우행원 대한폐경학회 1995 연수심포지움 Vol.- No.-

Due to increasing aveage lift time length, most of women must to face menopause which induces much somalic and psychological reaction. Although physiohgical chages are similar in climacteric women, their somatic and psychologic reactians are much different among women. attempts to summarize biological, psychosocial, psychodynamic aspect of menapause and common psychiatric disarder at that time were made through review of articles. As a result, many somatic symptoms and psychological symptoms are interrelated each other, especialty irritability is influenced by menorrhagia, sexual dysfunction is influened by vaginal atrophy, and insomnia is influenced by night sweat. There is a suggestion of a peak in the excess of females over males in tbe onset of first attacks of affective disarder and minor peak in the prevalence of psychiatric disorder in the peri menopausal yaus. It is uncertain why psychiatric disarders are incereased at tbat time. Maybe dysfunctional hypothalamic feedback mechanisms, poor premorbid adjustment, empty nest syadrome, marital dysharmony, cultural factors ate attribute to psychological symptoms and psychiatric illness at peri-menopausal year. The most impartant treatments are adequate psychialric consultation and adequate educations about menopause to climacteric women.

Alcoholism과 우울

우행원 大韓神經精神醫學會 1986 신경정신의학 Vol.25 No.1

Alcoholism and depression are major psychiatric problems and any evidence pointing toward a shared etioloical factors should have great impact on the practice of psychiatry, the burden of cost, and suffering born by society, patients, and their families. Then the author intented to evaluate the correlation between those researches on alcoholism and depression. With a thorough review of the literatures, the author reached the following results. Before looking at research findings, we must be careful about the meaning of terms. The word "depression" used in broad scale: a sad or dysphoric mood, insomnia, anorexia, loss of concentration or psychomotor retardation. Alcohol dependence syndrome used in broad scale also: alcoholism, alcoholics and alcohol intoxication. Other definition of the word will must be specified. Symptom that are similar to some of those of depressive illness are common in both the drinking and withdrawal alcoholic. These however, are not typical of serious endogenous illness. They are marked by dysphoria and mixed with the anxiety. Response to medication aften used in the treatment of depression(antidepressants, neuroleptics and lithium) is seen but is not yet demonstrably specific. Among those alcoholic patients who do suffer from serious depressive illness and a high rare of suicidal behavior, a family background of serious depressive illness is more common than expected. Furthermore, a subset of families in whom alcoholism is prevalent tends to have a large numbers of family members especially female, who suffer from depression alone and not alcoholism. This depression is essentially, indistinguishable from that seen in a typical endogenous depression. Some unstable personality characteristics and a chaotic social life tend to characterize these patients. Bipolar affective disease has yet to be linked with alcohlism conclusively.

Tranquilizer를 투여한 백서 간 뇌조직의 3-Hydroxy-3-Methylglutaryl-Co A 및 Cholesterol 및 생합성에 대하여

우행원 梨花女子大學校 醫科大學 醫科學硏究所 1981 EMJ (Ewha medical journal) Vol.4 No.3

The incidence of mental illness in the modern society has been increasing and the use of the tranquilizer for the treatment of these illnesses has been increasing also. The side effects of the tranquilizer are reportedly, minimal and the long term use of the medicine is widely practised in this field. But the question of its effect on cardiovascular system has been discussed previously and the level of cholesterol and triglyceride was found to increase in patients who have been on the tranquilizer for a long period of time. The current study was undertaken to find out the effect of tranquilizer(chlorpromazine, thioridazine, perphenazine, haloperidol, and pimozide) given to the animals for 4 weeks. And the results are summarized as follow: 1) In the animal group given chlorpromazine, thioridazine, and perphenazine, the level of total serum cholesterol was increased and the activity of microsomal HMG-Co A reductase was also increased. However, in the group given haloperidol and pimozide, there was no increase of cholesterol level or activity of microsomal HMG-Co A reductase. 2) The correlation of serum total cholesterol level and the activity of HMG-Co A reductase in the liver and brain was significant. From the Above results, it could be concluded that the effect of the long term use of tranquilizer on the cadiovascular systerm should be reevaluated.

우울증 환자에서의 호중구 및 임파구 기능장애

우행원 大韓神經精神醫學會 1989 신경정신의학 Vol.28 No.4

Regulation of the quantity of different types of leukocytes has not been adequately investigated in patients with psychiatric illness. Kronfol et al have noted a significant association between leukocyosis, neutrophilia, and mania, and lymphopenia and depression. In this study, leukocytes especially neutrophills and lymphocytes were counted in 20 untreated depressive patients, 43 untreated schizophrenic patients and 36 neurotic patients. A significant increase numbers of neurophils and significant decrease in the numbers of lymphocytes were found in the depressive patients. Furthermore, when compared to normative values from the general population, depressive patients showed higher frequencies of both reutrophilia and lymphopenia than the schizophrenic and neurotic patients. Glucocorticoids have for a long time been associated with hematologic changes consisting of neutrophlia and lymphopenia. Changes very similar to this, were observed in depressed patients in this study. Since depression is more frequently associated with hypercortisolemia than are the schizoprenic disorder and neurosis, it is reasonable to attribute the hematologic differences between depression and, schizophrenic disorder and neurosis, at least in part, to excess cortisol in the depressive patients. However, since cortisol levels were not obtained in my patients, this issue remains a matter of speculation but regardless of the mechanism involved, the present data indicate significant differencs in the regulation of blood cell elements in depressive, schizoprenic and neurotic patients.

응급실을 통하여 입원한 정신과 환자에 대한 임상적 고찰

우행원 梨花女子大學校 醫科大學 醫科學硏究所 1988 EMJ (Ewha medical journal) Vol.11 No.4

Hospital records of neuropsychiatric patients admitted to Ewha Womans University Hospital via the emergency room from January 1, 1982 to December 31, 1986 were reviewed, and the following results were obtained. 1) Patients admitted via the emergency room comprised 6.65% of total neuropsychiatric admission The rate of emergency admission were 3.98% at 1982, 3.48% at 1983, 8.5% at 1984, 7.9% at 1985, 9.4% at 1986 which seems increasing tendency. 2) The male : female sex ratio of the patients was 1 : 1.03. 43% of the emergency room admission patients were in their twenties and 20% of the patients were thirties, 63% of them were in their twenties or thirties. 3) 82% of them were in the middle class of socioeconomic level, 46% of the patients had college education level and 51% of them were married status. 4) Presenting problems, in the order of frequency, were delusion and hallucination, somaticsymptom, anxiety and phobia, exciting and assultive behavior, convulsion, suicide attempt, behavior disorder, sleeping disturbance, consciousness disorder and homicide tendency. 5) In most cases the duration of hospitalization was 2 weeks or less for neurosis and over 2 weeks in schizophernic disorders. 6) 21.5% of the emergency room patients were diagnosed as schizophrenic disorder which was the most frequent diagnosis in all patients. 7) 23% of the emergency room patients were discharged against medical advice.

동기간에 발생한 정신분열병환자들의 임상적 연구 : 가족역동과 가족병리를 중심으로 Focusses on Familydynamic and Familial Psychopathology

우행원 梨花女子大學校 醫科大學 醫科學硏究所 1985 EMJ (Ewha medical journal) Vol.8 No.4

Author attempted of find out whether there were any characteristic findings in the sibling schizophrenics family(family in which more than two members of sibling were schizophrenia) including clinical features, interpersonal relationship and some of sociodemographyic aspects. Data for the sample were obtained 17 schizophrenics from 8 sibling schizophrenics families who were admilted to neuropsychiatric department EWHA Womens University Hospital from March 1st 1973 to February 28th 1983. Results obtained were summerized as follows; The members of sibling were larger in the schizophrenics families than that of normal and the first born childrens and last born childrens were affectes more frequently than subseguent ones. Sibling schizophrenics were tended to be heigh educates, no employed and low middle socioeconomic class. In the familial history, sibling schizophrenic's father proband had more frequently affectes than mother proband. Usually mother's characters were found to be over protective and active but father's were indifferent and passive. Their father and mother had mother dominent and hostile relationship. Interpersonal relationship between sibling schizophrenics had relative affective(41.2%) in the majority. Comparative analysis of the above finding showed no differences from the family in which only one child was afflicted schizophrenia.

양극성 정동장애에서 Lithium 투약에 따른 혈청 칼슘, 이온화 칼슘 및 인산염의 변화

우행원 梨花女子大學校 醫科大學 醫科學硏究所 1992 EMJ (Ewha medical journal) Vol.15 No.4

This study was conducted to investigate the effect of lithium treatment on the serum total calcium, ionized calcium and phosphate in bipolar disorder. The subjects were 20 patients. The total calcium, ionized calcium and serum phosphate were measured before and after lithium treatment, and the values were statistically analyzed. The results are summarized as follows: 1) Serum total calcium level was significantly increased after lithium treatment(p<0.01). 2) Ionized calcium level was significantly increased after lithium treatment(p<0.05). 3) Phosphate level was significantly increased after lithium treatment(p<0.05).

Transdermal Scopolamine(Kimite$^{(R)}$)으로 인해 유발된 섬망 2례

우행원,임원정,이유진,Woo, Haing-Won,Lim, Weon-Jeong,Lee, Yu-Jin 한국정신신체의학회 1999 정신신체의학 Vol.7 No.2

섬망은 두부손상, 혈관성 질환, 뇌종양 등의 중추신경계 질병뿐 아니라 여러 가지 신체 질병(대사 장애 및 내분비장애, 감염, 심혈관 질병)과 약물에 의해 야기되는 각성 수준의 감퇴, 지남력 장애, 수면-각성 주기 장애, 기억력 장애, 지각장애 등을 특징으로 하는 증후군이다. 1) 섬망을 일으킬 수 있는 약물의 하나인 scopolamine(Kimite$^{(R)}$)은 차멀미 예방을 위해 흔히 사용되며 피부 부착형으로 사용하는데 항콜린성 작용을 갖는belladonna akaloid제제이다. 저자들은 차멀미 예방 목적으로 사용된 transdermal scopolamine(Kimite$^{(R)}$)으로 유발된 섬망 2례를 경험하였기에 이를 문헌 고찰과 함께 보고하였다. 두 증례의 공통점은 여자 노인 환자였다는 점, 멀미 예방을 위해 transdermal scopolamine부착 후 여행지에서 갑자기 증상이 발생하였다는 점, 증상이 2~3일이내에 호전되어 추적 관찰상 아무런 이상이 없었던 점 등이다. Transdermal scopolamine(Kimite$^{(R)}$)으로 인한 섬망의 예방을 위해 사용자와 판매자 모두에게 올바른 사용법에 관해 교육하는 것이 필요할 것으로 사료된다.

Diagnostic and Statistical Manual(DSM)Ⅲ 진단에 의한 노인입원 정신질환자에 대한 임상적 연구

우행원 梨花女子大學校 醫科大學 醫科學硏究所 1986 EMJ (Ewha medical journal) Vol.9 No.4

This article reviewed the thoretical unerpinnings of the DSM Ⅲ classification system, with particular emphasis on psychogeriatic practice. Advantages of a descriptive approach, use of operational criteria, and the utility of a multiaxialsystem in developing comprehensive treatment program were examined. A retrospective study, 5 years after the implementation of DSM Ⅲ, was conducted on all consecutive admissions to the neuropsychiatry department of Ewha Womans University, College of Medicine, and the results were as follows. The thirty cases of the senile mental disorders showed the following characteristic pictures. 1) Majority of the cases(53.4%) were distributed in the decade of their sixties and male. 2) In the diagnostic distribution, 53.4% of the cases were categorized as organic mental disorder and 30.0% as major affective disorder. 3) The ratio of male patient and female patient was 4.3:1 in organic mental disorder and 2:1 in major affective disorder. 4) In the age distribution, 50.0% of the cases were categorized as organic mental disorder and 55.6% as major affective disorder. Both of the cases were aged between 60 and 64. 5) Their educational level revealed that 40.0% of the patients were primary school graduates. 6) As to the occupational distrubution, the jobless occupied the larger percentages, but patients who have job their age distribution was 60-64. 7) As to their religious affiliation the most population was 30.0% of protestant. 8) In the distribution of physical disorders, hypertension occupied the highest rate of 26.7%. 9) As to the marital status, 73.3% of the cases were living with their spouses. 10) There were no relation between premorbid social psychological stress and premorbid adaptation.

만성 가장성 신체장애, Munchansen 증후군 : Munchausen Syndrome

우행원 梨花女子大學校 醫科大學 醫科學硏究所 1983 EMJ (Ewha medical journal) Vol.6 No.4

Chronic factitious disorder with physical symptoms is an appropriate diagnosis in patients who consciously distort their medical history and produce misleading physical finding and laboratory results through self-inflicted lesions. By simulating patterns of physical diseases, these patients may subject themselves to painful and dangerous diagnostic and treatment procedures. Munchausen syndrome represents a special pattern within the group of chronic factitious disorder with physical symptoms. The typical patient presents at a hospital as an acute emergency and usually has a lurid yet plausible medical and social history, which is laterfound to be entirely false and fabricated. After several fruitless investications with or without surgical operations, a diagnosis cannot be made and the patient eventually discharges himself and goes to another hospital where the process is repeated. It is importent to diagnose these patients early to avoid unnecessary medical and surgical interventions and to introduce psychiatric treatment. A typical case of Munchausen syndrome is reported with a brief review of literatures. This is believed to be the first reported case of Munchausen syndrome in Koera.