만성정신질환자들을 위한 인터넷 추구 서비스 시험 구축

이영렬(Young Ryeol Lee) 대한사회정신의학회 2001 사회정신의학 Vol.6 No.2

연구목적: 본 연구개발사업의 최종목적은 인터넷을 이용하여 정신장애인들을 포함한 만성정신질환자들을 원격진료·원격관리할 수 있는 재가(在家) 서비스를 연구·개발하는 것이다. 연구방법 및 결과: 주)한국인터넷데이터센터 내에 웹서버를 구축하고, 연구용 웹사이트(국립 사이버 정신병원, www.ncmh.go.kr)를 개통하여 개별적 일정관리가 가능한 원격화상진료 서비스, 데이터 분석이 실시간으로 이루어지는 온라인 문진(問診) 서비스, 집단치료 등에 활용할 수 있는 전용 대화방 서비스, 개별 메일 계정이 제공되는 메일 서비스, 환자별 로그분석 서비스 등을 일정기간 시험 운용하면서 서비스의 기술적 문제점 등을 점검하였다. 그리고 시험 운용의 결과로 얻어진 이용자의 반응과 운영자의 경험을 토대로 서비스 메뉴들의 기술적 신뢰도와 임상적 유용성을 평가하여 이를 반영한 새 웹사이트(NCMH ver 2.0)를 구축하고 있다. 결 론: 만성정신질환자들을 위한 인터넷 정신의료 서비스 연구개발은 만성정신질환자들의 정보 복지 실현을 위해 매우 중요한 일이고 일반적인 정보통신 기술로도 충분히 구현 가능한 일이지만, 임상현장에 적용하기에는 아직 여러 가지 제한점을 가지고 있는 단계이다. 특히, 인터넷이라는 미디어에 대한 연구가 부족하고 인터넷 원격진료에 대해 법적·제도적 뒷받침이 없는 것은 큰 장애요인이다. 따라서, 향후 만성정신질환자들을 위한 인터넷 정신의료 서비스가 바람직한 방향으로 발전해 나가기 위해서는, 의사소통 도구로서의 인터넷에 대한 다각도의 연구와 인터넷 원격진료에 대한 법적·제도적 뒷받침이 필요하며 나아가 온라인 정신의료 서비스들의 효율성에 대한 연구들이 많이 이루어져 적절한 방향제시를 해 주어야 할 것이다. Objectives:To develop home-based mental health service system that manages chronic mentally ill patients through internet. Methods and Results:A web server of cyber mental hospital has been constructed in the Korea Internet Data Center Co., and the web site(National Cyber Mental Hospital, www.ncmh.go.kr) has been operated to provide the following services:telemedicine service with image files, which enables individuals to manage their schedule;online diagnosis service with real time data analysis;private communication service which can be used for group therapy;e-mail service which provides individual email accounts;log analysis for each patient. These services were experimentally provided to mentally ill patients for a certain period, and technical reliability and clinical utility were evaluated based on patients’ responses. Based on evaluation of the web site operation, new web cite(NCMH ver 2.0) has been developed. Conclusions:To develop psychiatric service through internet for chronic mentally ill patients is very meaningful for their welfare in the internet era. And present information technology has made possible home-based mental health service through internet for chronic mentally-ills. But this service has some limits and is not suitable for clinical field yet. Especially we don't have sufficient research data about internet as media and legal basis for internet telemedicine. Accordingly, we need further studies about internet as a communication tool in many directions and legal basis for internet telemedicine. Also a lot of cost-benefit analysis about online psychiatric services should be conducted for proper development of internet telemedicine.

학교 기반 정신건강증진 및 학교폭력 예방 프로그램 단기적 실시의 효과에 대한 예비연구

이다영(Da-Young Lee),노은미(Eun-Mi Roh),김인영(In-Young Kim),고귀녀(Guy-Nueo Ko),최정원(Jung-Won Choi),이영렬(Young-Ryeol Lee),김예니(Yeni Kim) 대한소아청소년정신의학회 2014 소아청소년정신의학 Vol.25 No.4

Objectives:The purpose of this study is to evaluate the preliminary effects of school-based short term mental health awareness and school bullying prevention programs. Methods:From April to December 2013, the Child and Adolescent Mental Health Promotion team of Seoul National Hospital conducted school-based short term social skill training (N=56, 4 sessions), mental health awareness (N=84, 4 sessions) and school bullying prevention programs (N=171, 1 session) in elementary and junior high schools located in Seoul. The changes in the subjects before and after the program were assessed. Results:The a social skills training program improved the ‘helping’ behaviors in boys (t=-2.355, p<.05) and ‘sharing’ (t=-3.223, p<.01), ‘cooperation’ (t=-2.235, p<.05), and ‘comforting’ (t=-2.830, p<.01) behaviors in girls, assessed using the Prosocial Behavior Questionnaire. The mental health awareness program improved ‘general health awareness’ (t=2.620, p<.05), measured using the Korean General Health Questionnaire. The school bullying prevention program resulted in decreased ‘self esteem’ (t=3.769, p<.01), measured using the Self Esteem Scale and decreased ‘anger’ (t=4.198, p<.01), assessed using the Novaco Anger Scale. Conclusion:The results of our preliminary analysis suggest that school-based mental health awareness and school bullying prevention programs may be effective even when conducted for a short term. Future investigation is necessary in order to validate the long term effects of these programs.

알코올 의존 환자에서 사진자극과 문자자극에 대한 암묵적 연상검사 결과 비교

전철인(Cheol-In Jeon),이영렬(Young-Ryeol Lee),이 은(Eun Lee),이재원(Jaewon Lee),이수정(Soo Jung Lee),안석균(Suk Kyooun An),박진영(Jin-Young Park) 한국중독정신의학회 2010 중독정신의학 Vol.14 No.2

Objectives:The Implicit Association Test (IAT) is a paradigm designed to assess individual difference in implicit cognition. This study investigated the difference of IAT effect of alcohol related pictures and words in alcohol dependent patients, heavy drinkers and control subjects. Methods:23 alcohol dependence patients, 23 heavy drinkers and 22 controls were included. All subjects per-formed two IAT, one of which was composed of alcohol related pictures and the other was made of words. Results:Repeated measurement ANOVA showed significant main effect of ‘Type of stimuli’ [F(1,65)=29.38, p<0.001], and IAT effect was more prominent by words than pictures. But there was no significant interaction of ‘Type of stimuli’ and ‘Group’ [F(1,65)=1.466, p= 0.238]. In between group analysis, there was the significant main effect of ‘Gorup’ [F(2,65)=4.007, p=0.023], and control group had significantly negative implicit cognition to alcohol than heavy drinker group. Conclusion:IAT effect was marked in alcohol related word than picture. But IAT effect pattern of each group was not changed by stimulus. Overall alcohol related word and picture show difference in IAT effect power but both alcohol related picture and word IAT was useful for estimate alcohol related implicit cognition.

정신분열병과 양극성 장애 환자의 분할적 주의력에 대한 예비연구

송영훈(Young-Hun Song),이재원(Jaewon Lee),이영렬(Young-Ryeol Lee),김정란(Jeong-Lan Kim) 대한생물치료정신의학회 2009 생물치료정신의학 Vol.15 No.2

목적 본 연구는 정신분열병 환자 및 양극성 장애 환자에서 분할적 주의집중력의 장애 여부를 알아보고 정신분열병과 양극성 장애에서 그 차이가 있는 지를 알아보고자 수행하였다. 방법 총 33명의 정신장애 환자(정신분열병 환자 21명, 양극성 장애 I형 환자 12명)와 15명의 정상대조군이 포함되었다. 분할적 주의집중력을 평가하기 위해 시청각 통합 지속수행검사(IVA CPT)를 시행하여 12개의 하위 척도 값을 비교하였다. 결과 두 환자군과 정상군에서 IVA CPT의 12개 하위척도 값을 비교하였을 때, 반응 조절 영역에서 정신분열병 및 양극성 장애 I형 환자군은 시각 및 청각 자극에 대한 일관성이 유의하게 낮았고, 시각 지속성에서 양극성 장애 I형 환자군이 다른 두 군에 비해 유의하게 감소되었다. 주의력 영역에서는 청각 집중력 및 시각 신속성에서 두 환자군이 정상군에 비해 유의하게 감소하였고, 정신분열병 환자군이 다른 두 군에 비해 청각 신속성 및 시각 집중력에서 유의한 감소를 보였다. 결론 본 연구의 결과는 정신분열병과 양극성 장애 I형 환자들이 분할적 주의집중력의 장애가 있을 가능성을 시사한다. 향후 보다 많은 수의 환자군을 대상으로 한 통제된 연구가 필요하다. Objectives: Although previous research have shown that impaired sustained attention is common in individuals with psychosis, few studies have examined whether divided attention was impaired in patients with schizophrenia and those with bipolar I disorder. The goal of this study was to determine whether patients with schizophrenia or with bipolar I disorder would have divided attentional disturbances. Methods: Twenty one patients with schizophrenia, 12 patients with bipolar I disorder, most recent episode manic and 15 healthy comparison subjects completed the Integrated Visual and Auditory Continuous Performance Test(IVA CPT) to examine their divided attention function. Results: Both patient groups showed significantly lower scores of consistency of the response control area for both visual and auditory stimuli as well as scores auditory focus and visual speed than the healthy group did. While the score of visual stamina of the response control area were significantly lower in the bipolar I disorder group than in the others, the score of auditory speed and visual focus of the response control area were significantly lower in the schizophrenia group than in the others. Conclusion: These findings suggest that patients with schizophrenia as well as those with bipolar I disorder may have impairments in several areas of the divided attention. Further study is needed to confirm these results with a reasonable sample size.

BART와 K-DOSPERT로 알아본 한국인의 위험감수경향

홍종인(Jong In Hong),이영렬(Young Ryeol Lee),김경희(Kyoung Hee Kim),박진영(Jin Young Park),박성혁(Sung Hyuk Park),이건석(Gunsuk Lee),이재원(Jaewon Lee) 대한사회정신의학회 2010 사회정신의학 Vol.15 No.1

연구목적: 위험감수경향을 5개의 항목별로 평가할 수 있는 영역별 위험감수척도(Domain-specific Risk-taking Scale;DOSPERT)의 한국어판인 K-DOSPERT를 제작하여 표준화하고, 전산화된 위험감수경향 검사인 풍선위험검사(Balloon Analogue Risk Task;BART)와 K-DOSPERT를 사용하여 한국 정상인의 위험감수경향성을 알아보고자 하였다. 방 법: 150명의 성인 남녀가 K-DOSPERT 표준화 연구에 참여하였다. 신뢰도 평가를 위해 Cronbach's alpha 계수를 산출하였고 타당도 평가를 위해 제 11 판 한국판 바렛충동성검사(Barratt Impulsiveness Scale; BIS)와의 상관관계를 알아보았으며, 위험 행동 및 위험인지점수의 상관성을 기존 외국 연구와 비교하였다. 또한 41명의 성인 남녀를 대상으로 BART와 K-DOSPERT 를 시행하여 두 검사결과를 비교하고, 성별 및 손잡이에 따른 위험감수경향을 알아보았다. 결 과: K-DOSPERT의 Cronbach’ s alpha 계수는 위험감수 및 위험인지 모두 0.84였고, 항목별로는 사회성을 제외한 나머지 위험 항목이 0.6 이상으로 나타나 높은 내적 일치도를 보였고, BIS와 비교한 결과 위험감수경향이 높을수록 충동성이 높은 모습을 보였다. 위험행동과 위험인지점수는 서로 역 상관관계를 보여(r=-0.55, p<0.01) 외국의 결과와 유사하게 나타났다. BART와 K-DOSPERT를 함께 시행한 결과 BART지수가 높게 나타난 집단이 K-DOSPERT 결과 위험감수성이 높게 나타났고, 남자및 오른손잡이는 여자 및 왼손잡이를 포함한 양손잡이에 비해 위험감수경향이 높게 나타났다. 결 론: K-DOSPERT는 한국인의 위험감수경향을 평가하는 도구로 적합하며, 위험감수경향의 평가가 필요한 개인 및 특정 집단에 대한 BART와 K-DOSPERT의 이용을 통해 추후 사회문제의 예방 및 대책마련에 도움이 될 수 있을 것이라 기대된다. Objectives:This study aims to make and standardize Korean version of Domain-specific Risk-taking scale(KDOSPERT) that can evaluate risk-taking propensity according to five risk domains, and look into risk-taking propensity of Koreans by using computerized behavioral task Balloon Analogue Risk Task(BART) and K-DOSPERT. Methods:150 men and women participated in K-DOSPERT standardization study. For the reliability evaluation, the study calculated Cronbach’s alpha coefficient, looked into relations with Barratt Impulsiveness Scale(BIS), and compared relations with risk taking and risk perception with existing oversea researches. In addition, it conducted BART and K-DOSPERT to 41 men and women to compare results of the two tests and examine risk-taking propensity according to the gender and the handedness. Results:K-DOSPERT’s Cronbach’s alpha coefficient indicated that both risk taking and risk perception were 0.84, and risk domains except for social domain were shown more than 0.6 and had high internal consistency. According to the comparison with BIS, the higher risk-taking propensity was, the higher impulsiveness was found. As risk taking and risk perception showed negative correlation (r=-0.55, p<0.01) which is similar to foreign study result. BART and K-DOSPERT were carried out at the same time, and the result showed that the group with high BART index had higher risk-taking propensity according to K-DOSPERT results, and men and the right-handed had higher risk-taking propensity than women and the left-handed and the mixed-handed. Conclusion:K-DOSPERT is suitable as a tool to evaluate risk-taking propensity of Koreans, and it is expected to help prevent social problems and prepare for countermeasures by using BART and K-DOSPERT to individuals and specific groups that need the evaluation of risk-taking propensity.

위험음주자 선별을 위한 한국판 알코올사용장애 선별검사(AUDIT-K), 알코올 소비 점수(AUDIT-C), 3번 문항(AUDIT3)의 유용성과 최적 절단값

우성목(Seong-Mok),장옥진(Og-Jin Jang),최화경(Hwa-Kyung Choi),이영렬(Young-Ryeol Lee) 한국중독정신의학회 2017 중독정신의학 Vol.21 No.2

Objective : This study was conducted to evaluate the availability and optimal cut off score for screening of hazardous drinking using AUDIT-K, AUDIT-C and AUDIT3. Methods : Participants in this study were recruited from an online site. Selected panel members participated in the survey through ‘Do It Survey’ (www.dooit.co.kr) February 10-15, 2016. A total 509 participants (males : 265, females : 244) were recruited. Subjects responded to the questionnaire about their drinking pattern, amount of alcohol consumption and AUDIT-K. The criteria for hazardous drinking were based on the NIAAA criteria. AUC of the ROC curve were calculated to evaluate availability and cut off scores for hazardous drinking of AUDIT-K, AUDIT-C and AUDIT3. Results : In AUDIT-K, suggestible cut off score for screening hazardous drinking based on the NIAAA criteria was 11 for males and 7 for females. AUDIT-C and AUDIT3 also available for detecting hazardous drinking. And suggestible cut off scores of AUDIT-C and AUDIT3 for hazardous drinking were 7 and 3 for males and 6 and 3 for females. Conclusion : Our findings suggest that AUDIT-C and AUDIT3 were available for detecting of hazardous drinking base on the NIAAA criteria. We also suggest that cut off scores for screening hazardous drinking.

위험음주와 음주문제의 주관적 인식에 따른 한국어판 알코올사용장애 선별검사(AUDIT-K)와 변화준비도 검사(RCQ)의 차이

장옥진(Og-Jin Jang),최화경(Hwa-Kyung Choi,),이영렬(Young-Ryeol Lee),김세훈(Se-Hoon Kim) 한국중독정신의학회 2017 중독정신의학 Vol.21 No.2

Objective : This study was conducted to evaluate the differences in sub-scores for the AUDIT-K and Readiness to Change Questionnaires (RCQ) relative to hazardous drinking and subjective perceptions of alcohol problems. Methods : A total of 162 male participants were recruited and responded to the questionnaire. Subsequently, respondents were classified in the following groups depending on the presence of hazardous drinking and subjective perception of alcohol problems. HP group : Hazardous drinkers with subjective perception of alcohol problems. HD group : Hazardous drinkers with subjective denial of alcohol problems. NP group : Non-hazardous drinkers with subjective perception of alcohol problems.ND group : Non-hazardous drinkers with subjective denial of alcohol problems. Results : In the HP group (the highest AUDIT-K score), high consumption and dependence sub-scores and RCQ scores were observed. In the HD group (the second highest AUDIT-K scores), high consumption and dependence sub-scores were observed, but the RCQ score was low. In the NP group, AUDIT-K, consumption and dependence sub-scores were low but the highest harmful alcohol use sub-score and second highest RCQ score was observed. In the ND group, the lowest scores were observed for all mea-sures. Conclusion : Our findings suggest that there are differences in AUDIT-K and RCQ sub-scores associated with hazardous drinking and subjective perception of alcohol problems.

사회성 증진 프로그램이 감정표현불능증에 미치는 효과에 대한 예비연구

김민수(Min-Soo Kim),신정욱(Jung-Uk Shin),이영렬(Young-Ryeol Lee),이연우(Yeon-Woo Lee),정경애(Kyung-Ae Jung),정둘남(Dool-Nam Jung),박미리(Mi-Ri Park),송강식(Gang-Sik Song),서상수(Sang Soo Seo) 대한소아청소년정신의학회 2016 소아청소년정신의학 Vol.27 No.3

Objectives: The purposes of this study are to evaluate the effect of a school-based social skills training program on the emotional regulation of children and adolescents and to assess the plan for effective school-based mental health services. Methods: The Child and Adolescent Mental health promotion team of Bugok National Hospital conducted school-based social skills training (N=90, 7 sessions) for elementary and middle school students. Evaluations were conducted before and after the application of the program using a prosocial behavior questionnaire, a cohesiveness questionnaire, the Korean version of the 20-item Toronto Alexithymia Scale, a self-esteem scale, and the Novaco anger scale, in order to identify any changes. Results: The social skills training program increased the prosocial behavior and cohesiveness of the children and adolescents and decreased their alexithymic tendency and degree of anger, but did not significantly change their self-esteem. Conclusion: The social skills training program positively influences the emotional and behavioral levels of children and adolescents. The emotional regulation program based on a social skills training program is expected to have positive results in school-based mental health services. Future investigations are needed to validate the long term effects of this program.

노인 대상 비대면 운동지도 프로그램에 관한 연구

김예성 ( Kim Ye-sung ),하웅용 ( Ha Woong-yong ),이영렬 ( Lee Young-ryeol ),김효정 ( Kim Hyo-jeong ) 국제문화&예술학회 2022 국제문화예술 Vol.3 No.2

연구목적: COVID-19로 인해 일상생활에서 심각한 위기를 겪었던 지난 기간 동안 노인들은 신체적 정신적 건강저하의 위험성을 더욱 크게 경험하였다. 본 연구는 노인들의 건강을 향상시키기 위해 비대면 운동지도 프로그램을 개발하여 진행하고 그 과정과 의미에 대해 분석하고자 수행되었다. 연구방법: 이를 위해 프로그램 참여 노인들의 만족도를 측정하는 한편 운동 프로그램 지도자, 프로그램 참여 노인, 참여 복지관 담당자들을 대상으로 FGI를 실시하고 이들의 경험과 의견을 수렴하여 분석하였다. 프로그램 진행은 복지관의 상황에 따라 노인들이 복지관에 모여 운동에 참여하는 집합형과 각자의 집에서 참여하는 재택형 두 가지 유형으로 진행되었다. 연구결과: 비대면 운동지도 프로그램은 노인들에게 COVID-19 기간 동안 제한되었던 신체 활동과 사회적 소통의 기회를 제공하였으며, 짐스틱을 활용한 프로그램은 운동에 대한 흥미를 유발하는 데에 효과적인 것으로 나타났다. 프로그램 참여 노인들은 우려와 달리 비대면 상황에 비교적 잘 적응하였으며 프로그램에 참여하는 과정에서 온라인 활용 능력이 향상되기도 하였다. 결론: 본 연구를 통해 노인 대상 비대면 운동지도의 가능성을 확인할 수 있었다. 향후 노인들의 온라인 시스템에 대한 접근 가능성과 온라인 기기 활용 가능성을 높임으로써 노인 대상 비대면 운동지도 프로그램을 활성화시켜 가야 할 것이다. Purpose: This study was conducted to develop and proceed with a non-face-to-face exercise guidance program to improve the health of the elderly and to analyze its meaning. Methods: The satisfaction of the elderly who participated in the program was measured, and FGI was conducted for the exercise program leader, the elderly who participated in the program, and staff at the participating welfare center, and their experiences and opinions were collected and analyzed. Depending on the situation of the welfare center, the program was conducted in two types: the group type, in which the elderly gathered at the welfare center to participate in the exercise, and the at-home type, in which they participated in their own homes and the satisfaction level was slightly higher in the group type. Result: The non-face-to-face exercise guidance program provided opportunities for exercise and social communication to the elderly with reduced physical and social activity due to COVID-19 and the program using a gym stick was found to be effective in arousing interest in exercise. Although there were concerns about the ability of the elderly to use online, the participating elderly responded relatively well to non-face-to-face situations, and their online adaptation ability improved in the process of participating in the program. Conclusion: It was possible to confirm the possibility of non-face-to-face exercise guidance for the elderly. In order to further vitalize non-face-to-face programs in the future, the problems of accessibility to online systems and the use of online devices will have to be resolved.