정상 지능의 경도 외상성 뇌손상 환자에서 실행기능 장애 및 K-WAIS 점수들과의 관련성

이대보,윤인선,김선경,노승호,박민철,이상열,Lee, Dae-Bo,Yoon, In-Seon,Kim, Seon-Kyung,Rho, Seung-Ho,Park, Min-Cheol,Lee, Sang-Yeol 한국정신신체의학회 2012 정신신체의학 Vol.20 No.1

연구목적 : 본 연구는 경도 외상성 뇌손상(Mild traumatic brain injury, MTBI) 환자 중에서 일반지능이 정상수준에 있는 환자들을 대상으로 실행기능의 결손 정도를 알아보고, 이들의 한국판 웩슬러 성인용 지능검사(K-WAIS) 결과를 비교하여 K-WAIS 점수들과 실행기능과의 상관관계를 알아보고자 한다. 방 법 : 2005년 3월부터 2010년 12월까지 원광대학교병원과 군산의료원에서 치료받은 경도 외상성 뇌손상 환자들 중에서 K-WAIS 검사를 통해 정상 범위의 일반지능 수준을 갖는 59명의 환자들을 대상으로 관리지능검사(Executive Intelligence Test, EXIT)를 시행하였고 관리지능지수(executive intelligence quotient, EIQ)에 의해 두 집단을 나누었다. 결 과 : 전체 피험자를 분류한 결과 50.8%의 환자들이 EIQ 저하 집단에 포함되었다. 대상 집단의 K-WAIS 검사 특징은 전체지능과 동작성지능에서 낮은 점수를 보였으며 소검사 항목에서는 차례맞추기, 바꿔쓰기, 숫자외우기, 토막짜기, 모양맞추기, 이해문제 항목에서 통계적으로 유의미한 차이를 보였다. 효과크기의 비교에서는 차례맞추기가 가장 컸으며 이후 바꿔쓰기, 토막짜기, 모양맞추기 순서였다. K-WAIS 소검사와 관리지능지수 결과와의 관련성 검사에서는 전체지능과 동작성지능이 정적 상관을 갖는 것으로 나타났고, 소검사 항목에서는 차례맞추기, 바꿔쓰기, 숫자외우기, 토막짜기, 모양맞추기, 이해문제가 정적 상관을 갖는 것으로 나타났다. 결 론 : 정상 범위의 지능을 갖는 MTBI 환자들에서 관리지능지수가 정상하 수준 이하의 환자들의 빈도는 매우 높았으며, K-WAIS 검사 중 전체지능과 동작성지능이, 소검사 중에서는 차례맞추기, 바꿔쓰기, 숫자외우기, 토막짜기, 모양맞추기, 이해문제 항목의 결과가 특징적으로 관련되어 있을 것을 시사한다. Objectives : This study examined the selective deficits of executive function in patients with mild traumatic brain injury that in normal range of general intelligence level and aimed to analysis of the correlation between K-WAIS result and executive function. Methods : 59 subjects were included in this study, who were diagnosed as mild traumatic brain injury(MTBI) and they have visited in neuropsychiatric department of Wonkwang University Hospital during from March, 2005 to September, 2010. For measurement of general intelligence quotient, the Korean-Wechsler Adults Intelligence Scale(K-WAIS) was administered and for measurement of executive intelligence quotient(EIQ), Executive Intelligence Test(EXIT) was administered. Results : Of patients, 50.8% included at abnormal EIQ group. The patients of abnormal EIQ showed poorer full scale IQ(FIQ), performance IQ(PIQ) and in subscale that picture arrangement, digit symbol, digit span, block design, object assembly and comprehension were significantly different. In terms of relationships between K-WAIS and EIQ, FIQ and PIQ have positive correlation with EIQ. And in subscale, picture arrangement, digit symbol, digit span, block design, object assembly and comprehension show positive correlation with EIQ. Conclusion : This study suggest that MTBI patients with have normal range of general intelligence level may have deficit of executive function is common. The decline of FIQ, PIQ and some subscales of K-WAIS may suggest executive dysfunction in MTBI patients.

고위험 임신군에서 Nonstress Test의 의의

보소자,김영준,이대윤,김혜신 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.7

국립법무병원의 조현병 및 조현정동장애 입원환자에 대한 정신약물 치료 경향

김선경,이대보 대한법의학회 2017 대한법의학회지 Vol.41 No.4

The National Forensic Hospital is the only forensic psychiatric hospital in Korea. As of January 2016, the average number of patients assigned to each psychiatrist is more than 120. In this situation, the role of psychopharmacologic treatment becomes very important. To investigate the prescription patterns of major psychotropic medications (i.e., antipsychotics, mood stabilizers, and antidepressants), we reviewed the medical records of the patients diagnosed with schizophrenia and schizoaffective disorder who were admitted in January 2016. The data from 418 patients (403 with schizophrenia and 15 with schizoaffective disorder) were retrospectively collected and analyzed. The average number of major psychotropic medications prescribed for each patient during hospitalization was as follows: antipsychotics, 3.5±1.8; mood stabilizers, 0.5±0.7; and antidepressants, 0.5±0.8. The three most frequently prescribed antipsychotics were risperidone (21.7%), olanzapine (15.5%), and quetiapine (14.4%). More than half of the patients (233, 55.9%) were prescribed an antipsychotic polypharmacy regimen. This study found that patients with schizophrenia and schizoaffective disorder in forensic psychiatric hospital tend to be prescribed many psychotropic medications.

집단음악치료가 통원치료 중인 조현병 환자의 사회적 기능과 대인관계에 미치는 영향

이혜진,이대보,박민철,이상열 대한신경정신의학회 2014 신경정신의학 Vol.53 No.1

Objectives The purpose of this study was to examine the effect of group music therapy onsocial function and interpersonal relationships in outpatients with schizophrenia. Methods A total of 24 outpatients with schizophrenia were randomly assigned to either an experimentalgroup (with music therapy : 12 patients) or a control group (without music therapy : 12patients). Patients assigned to the experimental group received 18 sessions of group music therapyat Iksan Community Mental Health Center. Twenty individuals with schizophrenia completeda battery of measures, including the Positive and Negative Syndrome Scale (PANSS), Global Assessmentof Functioning (GAF), Social Skill Scale, Korean-Social Functioning Scale (SFS-K), InterpersonalFunctioning Scale, and the Relationship Change Scale at baseline and end point. Results After 18 sessions of group music therapy, the experimental group showed significantimprovements compared with the control group in the PANSS (positive, negative, general psychopathology),GAF, social skill, interpersonal relationship, some SFS-K domains (social withdrawal,recreation, independence performance), and some Relationship Change Scale domains(communication, confidence, affection, openness, understanding). Conclusion These results suggest that group music therapy seems to be effective for treatmentof psychopathology, social function, and interpersonal relationships of schizophrenic patients. However, the small sample size was a limitation of this study. 본 연구는 통원 치료 중인 조현병 환자에게 집단음악치료를 시행한 후 사회적 기능과 대인관계에 어떠한 영향을 주는지 알아보기 위하여 시행하였으며 다음과 같은 결과를 얻었다. 집단음악치료 후 PANSS 일반 정신병리 영역, GAF, 대인관계기능은 집단의 주 효과, 측정 시기의 주 효과, 집단과 측정시기 간의 상호작용 효과 모두 유의하였고 PANSS 양성및 음성 증상, 사회생활기술, 사회기능의 위축과 대인관계변화의 의사소통, 개방성에서는 측정 시기의 주 효과, 집단과 측정시기 간의 상호작용 효과, 실험집단의 사전-사후 비교는 유의하였으나 집단의 주 효과는 유의하지 않았다. 또한사회기능의 여가활동, 독립수행과 대인관계 변화의 신뢰감,친근감, 이해성에서는 집단과 측정시기 간의 상호작용에서만 유의하였고 사회기능의 의사소통, 친사회성, 독립능력,직업과 대인관계 변화에서 만족감, 민감성에서는 모두 유의하지 않았다. 이와 같은 결과를 볼 때 통원치료 중인 조현병 환자에게집단음악치료를 시행한 경우 통제집단에 비하여 양성 및 음성 증상은 유의하게 감소시켰고 사회적 기능을 유의하게 증가시켰으며 GAF 및 대인관계기능을 유의하게 호전시켰다. 따라서 집단음악치료가 통원치료 중인 조현병 환자의 사회적 기능과 대인관계를 향상시킬 수 있는 재활치료로 유용하게 적용될 수 있음을 시사한다.

일 대학병원 유방암 환자의 우울증상과 삶의 질

장승호,이대보,최운정,이광만,이상열,Jang, Seung-Ho,Lee, Dae-Bo,Choi, Un Jong,Lee, Kwang-Man,Lee, Sang-Yeol 한국정신신체의학회 2013 정신신체의학 Vol.21 No.1

연구목적 유방암 환자에서 우울증상의 동반 빈도는 매우 높은 것으로 알려져 있으며 우울증상은 건강과 연관된 삶의 질에 영향을 미칠 수 있다. 본 연구는 일 대학병원 유방암 환자의 우울증상의 유병율을 알아보고 우울증상이 건강과 연관된 삶의 질과, 우울증상과 삶의 질에 미치는 인구 사회학적 및 임상적 변인을 알아보고자 하였다. 방 법 원광대학교병원 외과에서 2010년 11월 1일부터 2011년 5월 31일까지 유방암으로 진단 및 수술을 받고 통원치료 중인 19세 이상 75세 미만인 여성 환자 52명에서 이전에 기분장애로 진단을 받았거나 평가 설문지 및 의학적 정보가 부족한 11명을 제외한 41명을 연구대상으로 하였다. 연구 대상자의 인구통계학적 변인 및 유방암에 대한 임상적 특성은 의무기록지를 통하여 조사하였다. 우울증상은 Beck 우울척도, 불안은 성격평가질문지의 불안 하위 척도를 이용하였으며, 건강과 관련된 삶의 질은 한국판 단축형 36항목 건강 설문지(Short Form 36 health Survey-Korean Version)를 사용하였다. Beck 우울 척도에 따른 우울증상 군과 비우울증상 군의 건강과 관련된 삶의 질을 비교하였으며, 인구사회학적 변인 및 임상적 변인을 예언 변인으로 하고 우울증상과 삶의 질을 준거 변인으로 한 중다회귀분석을 시행하였다. 결 과 유방암 환자 중 우울증상의 유병율은 36.4%였다. 우울 증상을 나타내는 유방암 환자의 건강과 연관된 삶의 질에서 신체 기능(p<.01), 신체 역할(p<.001), 전반적 건강(p<.05), 사회 기능(p<.001), 정서 역할(p<.001), 정신 건강(p<.001)의 하위 척도가 우울증상을 동반하지 않은 환자군에 비하여 유의하게 낮았다. 그러나 신체 통증 및 활력의 하위척도에서는 유의한 차이가 없었다. 유방암 환자의 우울증상은 불안과 교육 정도, 항암치료 시행 여부와 유의한 것으로 나타나 전체 우울증상의 63.6%의 설명 변량을 나타냈다. 유방암 환자의 건강과 관련한 삶의 질은 우울증상, 수술형태, 연령이 유의하였으며 55.8%의 설명 변량을 나타냈다. 결 론 유방암 환자의 우울증상은 36%에서 나타났으며 우울증상은 건강과 연관된 삶의 질을 낮추었다. 우울증상은 삶의 질에 높은 설명 변량을 가지고 있으며, 불안은 우울증상을 동반한 유방암 환자에서 높은 설명 변량을 갖고 있었다. 따라서 유방암 환자의 삶의 질을 높이기 위하여 우울증상에 대한 평가 및 치료가 필요할 것으로 여겨진다. Objectives : This study was designed to investigate the prevalence of depressive symptoms in patients with breast cancer and to identify demographic variables and clinical characteristics impact on depressive symptoms and health related quality of life in patients with breast cancer in a university hospital. Methods : Fourty-one patients with breast cancer were selected, who had visited the department of General surgery of the Wonkwang University hospital with a diagnosis of breast cancer regularly during the period November, 2010-May, 2011. All of subjects were evaluated for the depression, anxiety and the health related quality of life with Beck Depression Inventory(BDI), anxiety subscale of Personality Assessment Inventory(PAI) and Short-Form 36 Health Survey-Korean version(SF-36-K). Patients were divided into depressive symptoms and non-depressive symptoms group according to the BDI score. We compared SF-36-K between two groups, and analized multiple regression with depression and health related quality of life as criterion variables and demographic and clinical characteristics. Results : The prevalence of depression in patients with breast cancer in a University hospital was 36.4%. Compared to the non-depression, depressed patients with breast cancer appeared significantly lower mean scores on six subscales in SF-36-K : Physical function(p<.01), Role-physical(p<.001), General health(p<.05), Social function(p<.001), Role-emotional(p<.001) and Mental health(p<.001). But there was no significant difference between two groups in Vitality and Bodily pain. Anxiety, level of education and presence of enforcement of chemotherapy(63.6%) were significant explanation variables for depressive symptoms. And type of surgery and age(55.8%) were significant explanation variables for health related quality of life. Conclusions : The prevalence of depressive symptoms in patients with breast cancer in a University hospital was 36%. The depressive symptoms had not only negative impact on the health related quality of life but also important explanation variable for health related quality of life. These results suggest that depressive symptoms in patients with breast cancer should be evaluated and treated for improving patient's health related quality of life.

우울증 환자에서 양극성장애로의 전환을 예측하는 재발성 주요우울삽화 횟수의 절단값 산정 : 일 대학병원의 5년 후향적 의무기록 연구

최원준,이대보,왕희령,우영섭,전태연,박원명 대한우울조울병학회 2015 우울조울병 Vol.13 No.1

Objectives : The aim of this study was to determining the cut-off for recurrent depressive episode to predict diagnostic conversion from unipolar depression to bipolar disorder by means of retrospective reviews of medical records. Methods : The medical records of 250 patients with a diagnosis of major depressive disorder for at least 5 years were retrospectively reviewed for this study. We reviewed DSM-IV diagnosis and detailed clinical information at the index admission with assessments made every year after discharge to determining the cut-off for recurrent depressive episode to predict diagnostic conversion from unipolar depression to bipolar disorder. Optimal cut off scores were developed through the use of receiver operating characteristic (ROC) curves. Results : Receiver operating characteristic curve analysis indicated that the cut-off scores for recurrent depressive episode of more than three times would predict bipolar disorder (area under curve=0.647, sensitivity=0.435, specificity=0.819, positive predictive value=0.351, negative predictive value=0.865). Conclusion :These findings suggest that it could predict the best diagnostic conversion from unipolar depression to bipolar disorder when depressive episodes are recurrent more than three times. Based on these findings, it will be able to promote the accuracy of diagnosis and the efficiency of treatment. To validate our results, longitudinal follow up studies will be needs.

일 중소도시 노인의 양극성 범주 장애와 관련요인: 예비연구

장승호,이혜진,이대보,이상열 대한정신약물학회 2013 대한정신약물학회지 Vol.24 No.3

일 중소도시 노인에서 K-MDQ를 통해 조사하고 국내 표준화 연구에서 제시하는 기준으로 평가한 양극성 범주 장애의 유병률은 3.3%였다. 양극성 범주 장애 유무에 따른 집단간의 비교에서는 성별, 수면시간에서 통계적으로 유의한 차이가 있었다. 노인의 양극성 범주 장애는 자아존중감, 사회적지지, 수면시간과는 부적인 상관관계를 보였고 스트레스와는 정적인 상관성이 있었다. 이들 요인이 노인의 양극성 범주 장애의 9.2%를 설명했다. Objective This study was aimed to investigate the prevalence of bipolar spectrum disorder and to analyze the factors influencing on bipolar spectrum disorders. Methods Data of this study was collected from over 65 years old who were located in Ik-san, Jeollabuk-do province. 320data sheets were collected among them 300 were used in analysis. All of subjects were evaluated for the bipolar spectrum disorder, self-esteem, social support, stress with Korean version of Mood Disorder Questionnaire (K-MDQ), Rosenberg Self-Esteem Scale, Scale of Social Support (SSS), Brief Encounter Psychosocial Instrument Korean Version (BEPSI-K). We compared bipolar spectrum disorder among multiple factors and analyzed multiple regression with bipolar spectrum disorder as criterion variables and demographic characteristics. Results The prevalence of bipolar spectrum disorder in elderly was 3.3%. There were significant differences in result of the test about the bipolar spectrum disorder figuring out from sex (χ2=-2.058, p<0.01), sleep (t=-1.125, p<0.05). There were significant relation among bipolar spectrum disorder with stress (r=0.242, p<0.01), social support (r=-0.127, p<0.05), sleep (r=-0.136, p<0.05) and self esteem (r=-0.052, p<0.05). These factors accounted for 9.2% of bipolar spectrum disorder. Conclusion These results showed that the most important variable that influencing on bipolar spectrum disorders was stress.

Effects of Hippotherapy on Psychosocial Aspects in Children With Cerebral Palsy and Their Caregivers: A Pilot Study

장철환,주민철,노세응,이상열,이대보,이성호,김호균,박효인 대한재활의학회 2016 Annals of Rehabilitation Medicine Vol.40 No.2

Objective To investigate the effects of hippotherapy on psychosocial and emotional parameters in children with cerebral palsy (CP) and their caregivers.Methods Eight children with CP were recruited (three males and five females; mean age, 7.3 years; Gross Motor Function Classification System levels 1–3). Hippotherapy sessions were conducted for 30 minutes once weekly for 10 consecutive weeks in an indoor riding arena. The Gross Motor Function Measure (GMFM), Pediatric Balance Scale (PBS), and the Korean version of the Modified Barthel Index were evaluated. All children were evaluated by the Children’s Depression Inventory, Trait Anxiety Inventory for Children, State Anxiety Inventory for Children, Rosenberg Self Esteem Scale, and the Korean-Satisfaction with Life Scale (K-SWLS). Their caregivers were evaluated with the Beck Depression Inventory, the Beck Anxiety Inventory, and the K-SWLS. We assessed children and their caregivers with the same parameters immediately after hippotherapy.Results Significant improvements on the GMFM, dimension E in the GMFM, and the PBS were observed after hippotherapy compared with the baseline assessment (p<0.05). However, no improvements were detected in the psychosocial or emotional parameters in children with CP or their caregivers. None of the participants showed any adverse effects or accidents during the 10 weeks hippotherapy program.Conclusions Hippotherapy was safe and effectively improved gross motor and balance domains in children with CP. However, no improvements were observed in psychosocial or emotional parameters.

Therapeutic Effects of Leuprorelin (Leuprolide Acetate) in Sexual Offenders with Paraphilia

최종혁,이재우,이장규,장소영,유미,이대보,홍정원,노일석,임명호 대한의학회 2018 Journal of Korean medical science Vol.33 No.37

Background: This study examined the clinical effects of leuprolide acetate in sexual offender with paraphilic disorders evaluated by means of objective psychiatric assessment. Methods: The subjects of this study were seven sexual offenders who were being treated by means of an injection for sexual impulse control by a court order. They had been diagnosed with paraphilia by a psychiatrist based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and had been put on probation by the Ministry of Justice between January 2016 and December 2016. Results: After twelve months, we observed significant improvement in symptoms, as decrease of abnormal sexual interest and activity, sexual fantasy, Clinical Global Impression- Severity (CGI-S), and Clinical Global Impression-Impulsivity (GCI-I). There were a mild feminization of the body shape, feelings of fatigue, and mild hot flushes. No other adverse effect was reported. Conclusion: These results suggested that the clinical effects of leuprolide acetate in sexual offenders might be an effective treatment and safety strategy.