알코올 중독 환자들의 성격 특성에 관한 탐색

윤해주(Hai-Joo Yoon),이민규(Min-Kyu Rhee),이태경(Tae-Kyung Lee),이종일(Jong-Il Lee) 한국중독정신의학회 2004 중독정신의학 Vol.8 No.2

The purpose of this study was to explore the influences of personality trait and behavioral aspects in alcoholics. A shorter version of Tridementional Personality Questionnaire, Aggression Questionnaire, Beck Depression Inventory-Korean version were administered to 156 male alcoholics. In doing so, this participants were distinguished by a difference of means from normal norms. In increasing age, sensation seeking tendency or behavioral undercontrol was on the decrease, and direct aggression showed a tendency to decrease, but overall aggressive level didn’t show significant relation with age. Using the K-means Cluster Analysis, four subgroups were extracted;that is, a depressiondirect aggression-verbal aggression-anger-hostility profile (n= 30), a depression-hostility profile (n=44), a verbal aggressionanger-hostility profile (n=44), a normal profile (n=41). At the conclusion, implication and limitations of this study were discussed.

중독 관련 행동 문제에 대한 일반인들의 인식조사

이소정(So-Jung Lee),윤해주(Hai-Joo Yoon),이태경(Tae-Kyung Lee),민성호(Seong-Ho Min) 한국중독정신의학회 2003 중독정신의학 Vol.7 No.1

The purpose of this survey was to obtain a comprehensive social attitude about alcohol, pathological gambling and internet addiction in a Korean city population. 425 volunteers living in Seoul were surveyed by questionnaire about the demographic data, attitude about behavioral problems related to addictions. They responded to these problems’severity about alcohol (82.1%), pathological gambling (75.3%), and internet (73%) addiction, But most of them answered that the perceived reason of alcoholism and internet addiction was social atmosphere (each 51.5%, 43.7%), and that the cause of pathological gambling was personality (38.2%). The rates of answer that chose the biological cause of addictions were 3.5% in alcoholism, 5.4% in pathological gambling, 3.6% in internet addiction. These results suggest that most of the people well recognized these addiction’s severity but they did not have a concept that addiction is a disease. Therefore, we concluded that to treat early, there should be systemic information and guidance about the clinical organizations or centers.

알코올 의존 환자에서 12개월간 Naltrexone과 Acamprosate의 투약 순응도 비교

정진영(Jin-Young Jeong),윤해주(Hai-Joo Yoon),김수룡(Suryong Kim),이계성(Kye-Seong Lee) 한국중독정신의학회 2011 중독정신의학 Vol.15 No.2

Objectives : Within the field of study concerning alcoholism, there is mounting evidence supporting an important relation-ship between medication compliance and drinking outcomes. Research has suggested that naltrexone’s effectiveness can be greatly influenced by the compliance of participants in clinical trials. The effect of medication compliance on the efficacy of acamprosate is less well studied. Thus, much more data is needed to be known about the differential impact of medication com-pliance on alcohol patients involved with different medications. Methods : The subjects were consecutively admitted alcoholic patients who were diagnosed with alcohol dependence ac-cording to DSM-IV diagnostic criteria from January, 1998 to December, 2007 in Incheon christian hospital. Medication compliance was defined as whether they had prescribed 80% or more of the maximum number of pills during treatment. The subjects were assessed at 3 month intervals over a 1-year OPD follow-up period by chart review. Results : Naltrexone group showed better medication compliance than no-medication group at 3, 6 and 12 month and acamprosate group at 3, 6 month. Acamprosate group had better medication compliance and OPD follow up rate than no-medication group at only 12 month. Conclusion : Acamprosate and no-medication group were found to be less effective than naltrexone in helping patients in terms of medication compliance that needs further study.

정신분열병의 결핍증후군과 비결핍증후군에서 QEEG와 sLORETA를 이용한 비교연구

이상은,임선진,이미경,이재원,한규희,이종일,심민영,윤해주,신병학,Lee, Sang-Eun,Yim, Seon-Jin,Lee, Mi-Gyung,Lee, Jae-Won,Han, Kyu-Hee,Lee, Jong-Il,Sim, Min-Young,Yoon, Hai-Joo,Shin, Byoung-Hak 대한수면의학회 2010 수면·정신생리 Vol.17 No.2

목 적: 본 연구는 정신분열병의 결핍증후군과 비결핍증후군이 다른 생물학적 동등성을 가진 독립된 질환일 수 있다는 가설 아래 quantitative EEG와 standardized LORETA (sLORETA)를 이용한 전기생리학적인 방법을 통하여 생물학적 병인을 파악하고자 시도되었다. 방 법: 정신분열병 환자를 대상으로 42명의 뇌파를 비교 분석하였으며 그 중 결핍증후군 환자군은 남자 10명과 여자 11명이었고 비결핍증후군 환자군은 남자 12명, 여자 9명이었다. 주파수 대역은 delta(1.5~4 Hz), theta(4~8 Hz), alpha(8~12 Hz), low beta(12~15 Hz), high beta(15~30 Hz)의 5가지로 분할하였고 EEG LAB을 이용한 파워스펙트럼 분석 및 standardized sLORETA software package를 이용하여 신호원을 국소화 하였다. 결 과: 파워 스펙트럼 분석에서 결핍증후군 집단은 비결핍증후군과 비교하였을 때 전두엽, 두정엽 및 측두엽 영역에서 delta파와 theta파의 유의한 활성도 증가를 보였으며 뇌파 스펙트럼은 간편 정신상태 평정 척도 중 철퇴/지연과 적대/의심 항목의 임상적인 특징과 유의한 상관관계를 보였다. sLORETA분석 결과에서는 배측 전대상피질에서 결핍증후군에서 유의하게 delta파의 활성도가 증가되었다. 결 론: 결핍증후군은 비결핍증후군과는 연관된 뇌 영역이 다를 수 있으며 특히 전두엽 영역의 신경회로 이상이 일차적 음성증상에 영향을 줄 것으로 생각된다. Objectives: Deficit schizophrenia (DS) constitutes a disease separate from non-deficit schizophrenia (NDS). The aim of the current study was to compare the quantitative EEG and low resolution electromagnetic tomography (LORETA) imaging between DS and NDS. Methods: This study was performed by 32 channels EEG for 42 schizophrenia patients who we categorized into DS and NDS using proxy instrument deficit syndrome (PDS). We performed the absolute power spectral analyses for delta, theta, alpha, low beta and high beta activities. We compared power spectrum between two groups using Independent t-test. Partial correlation test was performed with clinical parameters. Standardized LORETA (sLORETA) was used for comparison of cortical activity, and statistical nonparametric mapping (SnPM) was applied for the statistical analysis. Results: DS showed significantly increased delta and theta absolute power in fontal and parietal region compared with NDS (p<0.05). Power spectrum showed significant correlation with 'anergia' and 'hostility/suspiciousness' subscale of brief psychiatric rating scale (BPRS)(p<0.05). sLORETA found out the source region (anterior cingulate cortex/limbic part) that delta activity was significantly increased in DS (p=0.042). Conclusions: DS showed different cortical activity compared with NDS. Our results may suggest QEEG and LORETA could be the marker in differentiating between DS and NDS.

정신 분열병 환자 및 보호자의 장기 지속형 주사제에 대한 인식 조사

강권영(Gwonyoung Kang),강시현(Shi Hyun Kang),윤해주(Hai-Joo Yoon),이종일(Jong-Il Lee) 대한사회정신의학회 2010 사회정신의학 Vol.15 No.2

연구목적: 정신분열병 환자의 약물 비 순응은 재발의 주요 원인이며 결과적으로 낮은 예후의 원인이 된다. 장기지속형 주사제형은 약물 순응을 상승시켜 재발의 위험을 낮출 수 있지만 주사제에 대한 일반적인 인식조사는 정신분열병 환자에서 이루어진 적이 없었 다. 따라서 이 연구는 정신분열병 환자와 보호자들을 대상으로 장기지속형 주사제에 대한 인식조사를 목적으로 시행되었다. 연구방법: 연구자들은 2008년 11월부터 2009년 5월까지 병원을 방문한 1004명의 정신분열병 환자와 253명의 보호자를 대상으로 항정신병 약물 선호도와 그 이유에 대한 질문들로 구성된 설문지를 이용하여 조사하였다. 연구결과: 주사제형의 치료제에 대해 환자는 22.5%가 알고 있다고 응답한 반면에 보호자의 경우 14.1%만이 안다고 대답하여 양군간의 유의한 차이가 있었다. 27.6%의 환자와 27.5%의 보호자가 장기지속형 주사제에 대한 선호도를 보인 반면에 각각 55.6%와 50.4%의 환자와 보호자가 경구 약물에 대해 선호도를 보였다. 여자 환자는 남자 환자에 비해 주사제에 대해 통계적으로 유의한 높은 선호도를 보였다. 또한 외래방문 간격이 짧을수록 그리고 교육수준이 높을수록 주사제에 대한 선호도는 높았다. 대상자 들은 주사제에 대한 선호 이유로 효과적이고 안전하며 그리고 증상을 빠르게 조절해준다고 보고하였다. 반면에 싫어하는 이유로 비싸고 독하며, 부작용이 많고 마지막 치료 단계이며, 주사바늘에 대한 공포와 통증, 그리고 잦은 방문을 이유로 들었다. 결 론: 실제 국내 장기지속형 주사제의 처방률 0.7%보다 많은 27.6%의 환자들이 주사제에 대해 선호도를 보였다. 그러나 많은 대상자들이 장기지속형 주사제에 대해 잘못된 인식을 갖고 있어 약물교육 등이 필요할 것으로 생각된다. Objects:The poor compliance of patients with schizophrenia is the major cause of recurrence and lead to the poor prognosis. Long-acting injectable antipsychotic agent may be a benefit to lower the risk of relapse to elevate drug compliance. The general attitudes toward LAI(Long-acting Injection) have never been investigated in schizophrenics. Thus this study examined the general awareness and the perspective on LAI in patients with schizophrenia and their care-givers. Methods:We surveyed 1004 schizophrenic patients and 253 caregivers who visited the Seoul National Hospital on the attitudes toward LAI by questionnaires which include the type of antipsychotic medication and reasons to prefer. The study was conducted from November 2008 to May 2009. Results:Schizophrenic patients(22.5%) knew about LAI more than care-givers(14.1%). 27.6% of patients and 27.5% of care-givers preferred on LAI, but 54.6% and 50.4% preferred on oral agents respectively. Comparing according to demographic and clinical characteristic factors, female schizophrenic patients showed the more preference on LAI than male patients(p<0.05). Less intervals of out-patient visit and more educational level, subjects have a higher preference on LAI. Subjects reported the reasons about preference on LAI that are good efficacy, safety, and faster curing of symptoms, improvement of the compliance, and not to take daily. They reported the reasons about hatred that LAI is to be expensive and more toxic, to have more side effects, to be used on last stage of treatment , to make the phobia to needle and pain during injection and to need the frequent visiting. Conclusions:More subjects(27.6%) showed the preference on LAI in comparison of low real prescription rate(0.7%). But many subjects showed erroneous perception on LAI and need to educate about information of agent in schizophrenic patients and their care-givers.

조현병 환자에서 직업재활이 정신병리증상과 삶의 질에 미치는 영향 연구

이경진(Kyung Jin Lee),이종일(Jong Il Lee),윤해주(Hai Joo Yoon) 대한사회정신의학회 2013 사회정신의학 Vol.18 No.1

연구목적 : 본 연구는 조현병 환자에서 4개월간의 직업재활 후 삶의 질과 자존감, 그리고 정신병리증상의 변화를 연구하고자 계획되었다. 방 법 : DSM-IV-TR에 의거해 조현병으로 진단 받은 환자들을 대상으로 하였다. 실험 군과 대조 군은 사회경제학적 상태 조사와 함께 연구 시작 시점과 4개월 후 정신병리증상을 평가하기 위해 양성 및 음성 증상 척도(PANSS), 한국어판 Heinrichs 삶의 질 척도(K-QOLS), 자존감을 평가하기 위해 Rosenberg 자아존중감 척도(RSES)를 시행하였다. 결 과 : 실험 군은 대조 군에 비해 삶의 질 척도 모든 소 항목에서 유의미한 개선을 보고하였고, 정신병리증상에서는 음성증상에서 의미 있는 호전을 보고하였다. 일반정신병리에서는 의미 있는 호전이 있었지만 양군간의 차이는 없었다. 자존감에서도 실험 군은 대조 군에 비해 유의미한 호전을 보고하였다. 음성증상의 회복 정도는 삶의 질 척도의 회복 정도와 강한 상관관계를 보였다. 결 론 : 본 연구의 결과는 여러 제한 점에도 불구하고 직업재활이 조현병 환자에게 미치는 긍정적인 영향에 대해서 시사하는 점이 크다고 생각되며 직업재활이 조현병 환자의 재활에서 주요한 치료로 다뤄 져야 하는 근거라고 판단된다. Objectives : This study was designed to investigate the change of quality of life, self esteem and psychopathology of patients with schizophrenia who were participated in 4-month vocational rehabilitation program. Methods : The subjects of the experiment consisted of psychiatric patients who were diagnosed with DSM-IV-TR schizophrenia. The experimental group who participated in 4-month vocational rehabilitation program and the control group who participated in day-hospital rehabilitation program for 4 months were assessed on Positive and Negative Syndrome Scale(PANSS), Korean version of Heinrichs Quality of life scale(K-QOLS), Rosenberg self-esteem scale(RSES) at baseline and after 4-month. Results : All compartment of K-QOL and Negative symptom score of PANSS was shown to have improvement in the experimental group (p<.05), as opposed to the control group. While both group got a visible decrease in general psychopathology, the changes were not statically significant. Self esteem were significantly increased in the experimental group. The differences of negative symptom scores after vocational rehabilitation were highly correlated with the improvement of quality of life. Discussion : Despite of some limitations, These findings strongly suggest that vocational rehabilitation had a positive effect to improve negative symptoms and increase the self esteem and quality of life. We think this vocational rehabilitation program is shown to be one of the good method for rehabilitation in schizophrenia.

사행 산업 종사자들에 있어 도박 중독에 대한 인식조사 및병적도박, 알코올, 흡연, 우울증의 유병률

이학승(Hak-Seung Rhee),김진훈(Jin-Hun Kim),윤해주(Hai-Joo Yoon),이태경(Tae-Kyung Lee) 한국중독정신의학회 2006 중독정신의학 Vol.10 No.1

Object:1) The present study examined comprehensive social attitudes about pathologic gambling and 2) the prevalence of pathologic gambling and other health risks (alcohol, smoking, and depression) among gambling industry employees. Methods: A sample of 388 employees was surveyed by questionnaire about 1) social attitudes about behavior problems related to pathologic gambling, 2) pathologic gambling which was assessed with Korean form of Souths Oak Gambling Screen (KSOGS), alcohol-related problems which were assessed with Korean Version of Alcohol Use Disorder Identification Test (AUDITK), smoking, and depression which was assessed with Beck Depression Inventory. Result:This study found that gambling industry employees didn’t have higher prevalence of pathologic gambling, alcohol problem, smoking, and depression than that of the general population. In addition, 54.2% of the employees perceived pathologic gambling problematic and 83.5% of the employees perceived the medical treatment about pathologic gambling necessary. However, the majority (75.4%) of them perceived the reason of pathologic gambling personality problem and only 5.4% of them perceived the reason of pathologic gambling biological factor. Conclusion:Our study suggests that 1) majority of gambling industry employees recognize the pathologic gambling’s severity but they don’t yet have a concept that pathologic gambling is a disease and 2) the individuals exposed to an occupational environment of addictive behavior may show different social pattern of addiction with general population. Therefore, more clinical attention must be needed and gambling industry managers should consider increasing education and systemic information about pathologic gambling and other health risks.

증상의 안정기에 있는 만성 정신분열병 환자에서 직업 유무에 따른 증상의 차이

권하영(Ha-Young Kwon),김진훈(Jin Hun Kim),윤해주(Hai-Joo Yoon),고기형(Kee-Hyung Koh),최승순(Seung-Soon Choi),장동원(Dong-Won Chang) 대한사회정신의학회 2005 사회정신의학 Vol.10 No.1

목 적: 본 연구는 증상의 안정기에 있는 만성 정신분열병 환자를 대상으로 직업 유무에 따라 나누어진 두 군에서 현재의 증상의 차이를 알아보고자 시행되었다. 방 법: 국립 서울 병원 외래 진료를 받고 있거나 개인 낮병원을 다니고 있는 정신분열병으로 진단 받은 환자 80명을 대상으로 하였다. 연구 시작 시점으로부터 지난 6개월 동안 최소 1개월 이상 돈을 받고 일을 한 경험이 있는 군을 직업군(45명)으로 하였고 그렇지 않은 군을 비직업군(35명)으로 하였다. 모든 연구 참가자들에게서 일반 인구학적 특성, 직업적 특성, 양성 및 음성 증후군 척도, Beck 우울척도, Simpson-Angus 평가 척도 그리고 전반적 기능 평가척도 등의 평가가 개인 면담 및 설문지로 실시되었다. 결 과: 직업군의 음성증상의 합은 13.31±4.70으로 비직업군 17.80±4.87에 비해 유의하게 낮았다(F=0.46, df:78, p=0.00). 또한 GAF 점수가 직업군에서 유의하게 높았다(F=6.07, df:78, p=0.00). 결 론: 만성 정신분열병 환자를 대상으로 직업 유무에 따른 증상의 차이를 본 결과, 직업군에서 음성증상이 유의하게 낮다는 것을 알 수있었다. Objectives:This study of chronic & symptomatically stable schizophrenic patients was performed to evaluate differences in current psychiatric symptoms between the group with job and those without. Methods:80 schizophrenic patients, from outpatients of Seoul National Hospital and a local psychiatric day hospital, were divided into two groups:a group with job and a group without. Subjects were assessed by sociodemographic, occupational features, Positive and Negative Symptom Scale(PANSS), Beck Depression Inventory(BDI), SimpsonAngus Rating Scale(SAS), and Global Assessment of Functioning(GAF) through out the interview and questionnaire inquiry. Results:In the group of patients with job, the mean score of negative symptoms of the PANSS was 13.31±4.70 which is significantly low compared to 17.80±4.87 of that in those without job(F=0.46, df:78, p=0.00). GAF score in the group of patients with job was significantly high compared to that in the group of those without job(F=6.07, df:78, p=0.00). Conclusion:It is concluded that the score of negative symptoms of the PANSS was significantly low in the group of patients with job.

정신분열병 환자에서 항정신약물 유지치료 시 재발에 대한 연구

이종일(Jong-Il Lee),한희종(Hee-Jong Han),윤해주(Hai-Joo Yoon),정은기(Eun-Kee Chung),장동원(Dong-Won Chang),김성택(Sung-Taek Kim) 대한사회정신의학회 2006 사회정신의학 Vol.11 No.1

연구목적: 재발방지는 정신분열병 유지치료에서 가장 중요한 목표이다. 이 연구는 전형적항정신약물인 haloperidol과 비전형적항정신약 물인 risperidone과 olanzapine을 사용하는 경우 3년 동안의 추적조사를 통해 재발방지를 위한 효과를 비교하고자 계획되었다. 방 법: 연구자들은 성인외래치료를 받고 있는 대상자들의 병록기록을 조사하여 haloperidol군 305명, risperidone군 179명, 그리고 olanzapine군 40명을 선정하였다. 모든 대상자들은 안정된 임상상태를 유지하고 있었다. 연구자들은 3년 동안의 재발로 인한 입원 비율과 Kaplan-Meier 생존율을 분석하였다. 결 과: 재발이외의 이유로 분석대상의 약물이 중단된 경우는 haloperidol군 43.9%, risperidone군 31.3%, 그리고 olanzapine군 37.5% 였다. 이들을 제외한 결과 재발로 인한 재발률은 각각 38.0%, 18.7%, 36.0%이었다. Risperidone군이 haloperidol군에 비해 유의하게 낮은 재발률을 보였다(χ 2 =5.419, df=1, p=0.02). Kaplan-Meier 생존분석에서 재발위험률은 haloperidol군 65.1%, risperidone군 44.1%, 그리고 olanzapine군 60.0%이었다. 생존율은 각각 34.9%, 55.9%, 40.0%이었다. Risperidone군이 hal-operidol군에 비해 높은 생존률을 보여주었다(log-rank 18.29, df=1, p=0.00). 결 론: 임상적으로 안정된 상태의 성인 정신분열병 환자 외래통원치료 시 risperidone을 사용하는 경우 haloperidol을 사용하는 경우에 비해 낮은 재발률과 높은 생존율을 보여주었다. Objective:Prevention of relapse is a major goal of maintenance treatment in patients with schizophrenia. This study examined the treatment response of haloperidol, risperidone, and olanzapine by the way of relapse rates for 3 years in schizophrenic patients Methods:Authors examined medical records of subjects who have been taken medications at adult outpatient’s clinic. Data were analyzed from three groups of haloperidol(N=305), risperidone(N=179), and olanzapine(N=40) treatment. All of subjects have been in stable condition. We analyzed data by relapse rates and Kaplan-Meier survival analysis for 3 years. Results:Of the 305 patients to haloperidol, the 179 patients to risperidone, and the 40 patients to olanzapine who remained in the analysis of relapse, 43.9%, 31.3%, and 37.5%, respectively, discontinued treatment for reasons other than relapse. The Admission rate due to relapse was showed 38.0%, 18.7%, and 36.0%, respectively. Patients in the risperidone group had a lower admission rate than the haloperidol group(χ 2 =5.419, df=1, p=0.02). In Kaplan-Meier survival analysis, the risk of relapse was showed 65.1% in haloperidol group, 44.1% in risperidone group, and 60.0% in olanzapine group. Survival rate was 34.9%, 55.9%, and 40.0%, respectively. Patients in the risperidone group had a higher survival rate than the haloperidol group(log-rank 18.29, df=1, p=0.00). Conclusion:Adult outpatients with clinically stable schizophrenia have a lower risk of relapse and a higher survival rate if they are treated with risperidone than if they are treated with haloperidol.

여자 대학생들의 폭식 행동에 대한 애착, 충동성 및 강박성의 연관관계

박신영(Shin-Young Park):이소희(So-Hee Lee),이태경(Tae-Kyung Lee):윤해주(Hai-Joo Yoon),최종혁(Jong-Hyuck Choi) 한국중독정신의학회 2005 중독정신의학 Vol.9 No.2

Objective:The aim of this study was to investigate the relationships among binge eating behavior and attachment, impulsivity and compulsivity of the female undergraduates in Korea. Methods:205 female undergraduates completed the Bulimia Test-Revised for binge eating behavior, Revised Adult Attachment Scale for quality of attachment, Self-report Attachment Style Scale for attachment pattern, BAS/BIS (Behavioral Activation System/Behavioral Inhibition System) Scale for impulsivity and Padua-ICMA Scale for compulsivity. Results:As to the attachment quality, high score in ‘fear of rejection’ and high ‘intimacy’ were related to the binge eating behavior. As to the impulsivity and compulsivity, high score in BAS-drive, BASfun seeking, BIS and ICMA were related to binge eating behavior. But ‘dependability’ of attachment and BAS-reward responsiveness of impulsivity were not significantly related to binge eating behavior. Conclusion:‘Fear of rejection’ and ‘intimacy’ were positively correlated with the binge eating behavior. Impulsivity and impaired control over mental activity were positively correlated with the binge eating behavior.