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性機能障碍에 對한 最近槪念 : DSM-Ⅲ-R을 中心으로 Centered on DSM-Ⅲ-R criteria
兪桂濬 大韓神經精新醫學會 1988 신경정신의학 Vol.27 No.5
The author presented introductory remarks including the brief historical review of the changes in sexual concepts from Freud's thinking to the recoent trends of human sexuality, and also described the differential comments on classification and definition of sexual dysfunctions according to DSM-Ⅱ, ICD-9, DSM-Ⅲ and DSM-Ⅲ-R, and finally centered to emphasize them adopted by DSM-Ⅲ-R. In DSM-Ⅲ, sexual dysfunctions constitute a separate category of Axis I disorders and eight distinct syndromes(table 1), and the sexual response cycle is divided into four phases : appetitive, excitement, orgasm and resolution. Before DSM-Ⅲ, sexual dysfunction was based on a biphasic model of the human sexual response and of sexual disorders, dividing them into two classes ; those characterized by disturbances of the exicitement phase, namely impotence and inhibited female excitement, and the orgasm phase dysfunctions ; premature ejaculation and retarded ejaculation in male and inhibited female orgasm. DSM-Ⅲ-R, the various observations led to the conceptualization of the triphasic concept of the human sexual responses, and to the development of specific more effective treatment approaches for the desire phase disorders. Thus, it became apparent that the sexual response cyele is comprised of three phase: desire, excitement and orgasm. DSM-Ⅲ emphasized a lack of sexual desire which previously had not been recognized as a distinct clinical entity. The notion that inhibited sexual desire constitutes a distinct clinical entity was rapidly accepted to the extent that the triphasic concept provided the theoretical basis for the new classification for sexual dysfunction adopted by DSM-Ⅲ. More recently, disorders of sexual desire have been further subdivied into two separate clinical entities in DSM-Ⅲ-R : Hypoactive sexual desire and sexual aversion disorder. The author described briefly classification and definition of six major categories of sexual disorders listed in DSM-Ⅲ-R(Table 2).
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Diphenylhydantoin과 Chlorpromazine의 倂用治療가 精神分裂症患者의 思考, 情緖 및 行動에 미치는 影響 : A Double-Blind Study
兪桂濬,梁元淑,金種柱 최신의학사 1977 最新醫學 Vol.20 No.7
The present study investigated the effects of a combined treatment of diphenylhydantoin and chlorpromazine on thought, affect and behavior of schizophrenic patients, comparing with chlorpromazine and placebo as a double-blind study. The number of patients selected for this study were 22 hospitalized patients. They were 5 acute schizophrenic episodes, 1 schizoaffective, 10 paranoid type and 6 chronic undifferentiated type which they showed rather acutely vivid symptoms, even though they were all relapsed and readmitted. Patients were randomly divided to two groups of D. P. H. +C. P. Z, and C. P. Z. +Placebo. Daily recommended dosages were 300mg for D. P. H, and between 150mg and 600mg for C. P. Z. They were all received drugs orally for two weeks for the study. Using the psychiatric rating scale and psychological testings (Rorschach and Korean Wechsler Intelligence Scale), the authors applied them to the before and after medication, and obtained the following results. 1) On the hyperside of psychopathology in the affect and behavior such as irritability, excitability, hyperactivity, hostility and anger etc, it seemed that the combination of two drugs have statistically significance to compare with C. P. Z. only, and totally they showed the trends of reducing the symptoms deviated from normality at the end of two weeks. But on the hyposide of it such as depression and hypoactivity etc, they showed little effect, both. 2) On thought process and content of thought, the two groups showed statistically no significance at the end of two weeks.
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정신분열병 치료효과에 대한 신경인지기능의 예측력에 관한 연구
오병훈,이희상,최의헌,현명호,조현상,유계준 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.6
연구목적 : 신경인지기능검사가·정신분열 병 환자의 혜후 및 치료에 대한 반응을 예측할 수 있는 인자로 작용할 수 있다는 연구결과들이 있었다. 이들 연구에서는 인지기능을 측정하는 검사도구 중 일부를 이용하여 치료 결과를 예측해 본 것이므로 저자들은 보다 광범위한 신경인지기능검사를 이용하여 이들 중 어떤 검사결과가 정신분열 병 환자들에 대한 치료결과를 얼마나 예측해 줄 수 있는지를 알아보기 위해 본 연구를 수행하였다. 방법: 연구대상은 BSM-IV 진단기준에 의거 정 신분열병으로 진단된 입원 환자 33명을 대상으로 최소 1주일 이상의 약물세척 후 약물투여 직전에 K-WAIS. WMS-R Vienna Test System 중 Signal Detection,Decision-Reaction Timer. Motor Performance Series 등의 신경인지기능검사를 시행하였다. 치료에 대한 반응의 평가는 Brief Psychatric Rating Scale(BPRS)와 Clinical Global Impression(CGI)을 사용하여 약물투여 전과 약물투여 후 8주에 시행하였다. 연구대상을 약물투여후 8주째의 BPRS점수가 약물투여 전의 BPRS 점수에 비해 20% 이상 호전이 있으면서 CGl 점수가 3이하인 경우를 기준으로 호전군과 비호전군으로 나눈 다음 두 군 사이의 신경인지기능검사 결과를 비교해보았다. 결 과: 신경인지기능정사에서 K-WAIS 중 언어성지능, 전체지능 Vienna Teat System 중 신호탐지력검사의 정확한 반응수, 반응 결정시간검사의 정확한 반응수 등에서 호전군과 비호전군 사이에 통계적으로 유의한 차이가 있었다. 이들 변인을 가지고 호전군과 비호전군을 구분하는 판별분석을 시행한 결과 66.7%의 환자를 정확하게 핀별하여 주었으나 통계적으로 유의하지는 않은 것으로 나타났다. 결론 : 판별 분석에 의하여 신경인지기능검사로써 환자군을 호전군과 비호전군으로 구분한 결과는 통계적으로 유의한 수준은 아니었으나, 신경인지기능검사가 정신분열병의 치료결과를 예측할수 있는 인자로 활용 될 가능성이 있음을 시사 한다. Objectives : This study was to investigate a wider range of neurocognitive function tests to find out how accurately each subtest could predict the outcomes of treatment in schizophrenics. Methods : The subjects were 33 inpatients diagnosed as schizophrenia according to DSM-IV. Each subject had a drug wash-out period of at least 1 week and had been given K-WAIS, WMS-R, and Signal Detection, Derision Reaction Timer, and Motor Performance Series in Vienna Test System just before drug administration. Treatment response was evaluated with BPRS and CGI scales before and 8 weeks artier drug treatment. We divided the subjects into responders and non-responders according to the outcomes of the above clinical scales in week 8. The responder group was defined with having 20% increase in BPRS score and a CGI score of less than 3.Then we compared the neuropsychological test results between the two groups. Results : Significantly different results between responders and non-responders were Verbal IQ and Full Scale IQ in K-WAIS, the number of correct responses in Signal Detection and Decision Reaction Timer in Vienna Test System. In discrimination analysis of the two groups using these subtests as variables, we could predict the responders with 66.7% accuracy, even though statistically non-significant. Conclusion : Although discriminating between responders and non-responders using negro-cognitive function tests were proven to be statistically non-significant, the possibility that neurocognitive function tests can be utilized to predict the treatment outcome in schizophrenia cannot be completely ruled out.
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