외상후 스트레스 장애 환자에서 해마용적과 기억기능

정문용,정화용,유현,정혜경,최진희,Chung, Moon-Yong,Chung, Hwa-Yong,Ryu, Hyun,Chung, Hae-Gyung,Choi, Jin-Hee 대한생물정신의학회 2001 생물정신의학 Vol.8 No.1

This study was conducted to evaluate the effect of PTSD on memory function and hippocampal volume, and to identify major variables correlated to hippocampal volume and memory function. Thirty four Vietnam veterans were collected for this study, among whom eighteen were PTSD patients and sixteen were combat control subjects. The author used Impact of Event Scale(IES), Combat Exposure Scale(CES), Hamilton Depression Rating Scale(HDRS) and Beck Depression Inventory (BDI). Korea Memory Assessment Scale(K-MAS) was assessed for memory function. Magnetic resonance imaging(MRI) was used to measure hippocampal volume. There were significant differences between PTSD and Non-PTSD veterans in IES, HDRS and BDI. Significant difference was found in verbal memory and total memory of K-MAS between PTSD and Non-PTSD veterans. There was significant difference in hippocampal volume between PTSD and Non-PTSD veterans. Short term memory, verbal memory and total memory were positively correlated to hippocampal volume. Hippocampal volume was negatively correlated to IES, HDRS, and BDI. These results suggest that PTSD severity be associated with hippocampal atrophy and memory dysfunction. Reduced or smaller hippocampal volume may be preexisting risk factor for stress exposure or the development of PTSD on combat exposure.

외상 후 스트레스장애 환자의 악몽치료에서 Terazosin의 효과 : 예비 연구

정문용,정지영,이태영,강석훈,김태용,최진희,정혜경,Chung, Moon-Yong,Jung, Ji-Young,Lee, Tae-Young,Kang, Suk-Hoon,Kim, Tae-Yong,Choi, Jin-Hee,Chung, Ha- Kyoung 대한불안의학회 2006 대한불안의학회지 Vol.2 No.1

Objective : Chronic posttraumatic stress disorder (PTSD) is defined by the coexistence of symptoms (reexperiencing, avoidance and hyperarousal), persisting for more than months or years that causes significant impairment in social occupational functioning. This study was conducted to evaluate the effects of terazosin on posttraumatic nightmares which is one of chronic PTSD symptoms. Methods : Twenty patients with chronic PTSD and severe trauma-related nightmares were treated with terazosin (3-7 mg/day) for 8 weeks. Recurrent distressing dreams item of the Clinician administered PTSD Scale (CAPS), Total CAPS score, Clinical Global Impressions-Severity Scale (CGI-S) and Clinical Global Impressions-Change Scale (CGI-C) were performed at baseline, 4-week and 8-week. Mississippi Scale for Combat-Related PTSD and Combat Exposure Scale (CES) were used to evaluate PTSD symptom pattern and degree of exposure. Results : Significant decrease in recurrent distressing dreams item, reexperiencing, avoidance and hyperarousal symptom score and total CAPS score were at 4-week and 8-week treatment compared to baseline (recurrent distressing dreams item : $2.70{\pm}1.88$ and $1.25{\pm}1.49$ ; reexperiencing, avoidance and hyperarousal symptom score : $2.30{\pm}2.49$, $1.20{\pm}1.05$, $3.10{\pm}1.68$ and $4.00{\pm}3.59$, $1.55{\pm}1.50$, $5.60{\pm}3.23$ ; total CAPS score : $8.20{\pm}6.26$ and $5.40{\pm}5.89$). There were significant correlation between dosage of terazosin and improvement of PTSD symptoms. Adverse effects such as fatigue and orthostatic hypotension were showed, which were mild and self-limited. Conclusion : These results suggest that terazosin may improve severe trauma-related nightmares and overall PTSD symptoms. Randomized controlled study with more subjects would be necessary in the future.

참전재향군인에서 외상후 스트레스 장애의 유병상태와 관련요인 분석

정문용(Moon Yong Chung),서일(Il Suh),정일진(Il Jin Jeong),김동기(Dong Ki Kim),민경호(Kyung Ho Min) 대한사회정신의학회 2002 사회정신의학 Vol.7 No.2

연구목적: 본 연구는 한국전과 월남전 참전 국가 유공자에서 외상후 스트레스 장애의 유병률을 조사하고 이들 집단의 여러 특징 변인들을 관찰함으로써 이들 인자들이 질병발생에 대하여 상호 관련 효과를 가지는지를 알아보기 위하여 조사하였다. 방 법: 서울에 있는 한국보훈병원에 입원하고 있는 전상환자 304명을 대상으로 1994년 9월부터 1996년 3월까지 전투 노출 척도 (Combat Exposure Scale), 미시시피 척도(Mississippi Scale for Combat Related PTSD), 우울 특정 도구(Beck Depression Inventory)를 사용하여 설문조사 및 정신과적 면담을 실시하였다. 변인들관의 관계를 알아보기 위하여 상관분석을 실시하였으며 외상후 스트레스장애에 영향을 미치는 변인을 알아보기 위하여 다변량분석방법인 로지스틱회귀분석을 실시하였다. 결 과: 한국전 참전 집단에서 외상후 스트레스 장애의 유병률은 204명중 18명으로 8.8%였고 월남전 참전집단에서 100명중 23명으로 23%였다. 한국전 참전 집단에서 결혼상태에 따라 외상후 스트레스 장애의 여부가 차이를 보였는데 독신상태에서 유의하게 많았으며(p<0.05) 월남전 참전집단에서 독신상태, 무직, 교육정도 고졸이상, 과거 정신과적 치료경험 등이 외상후 스트레스 장애 환자군에서 비환자군에 비하여 통계적 유의성이 있었다(p<0.05). 외상후 스트레스 장애에 관련된 요인을 로지스틱 회귀분석한 결과, 한국전 참전집단에서는 독신상태가 외상후 스트레스 장애에 영향을 주는 요인이었으며, 월남전 참전 집단에서는 교육수준이 높을수록, 독신상태, 수입이 낮을수록 장애에 영향을 주는 요인이었다. 결 론: 외상후 스트레스 장애는 감수성과 취약성을 가진 개체들에서 만성적, 치료 저항적 경과를 가져오기 쉬운 질환이다. 본 연구의 결과에서 결혼상태, 직업유무 및 교육정도가 외상후 스트레스 장애와 유의한 상호관련이 있었으며, 이들 참전 국가유공자의 건강한 사회 재적응을 위하여 반드시 고려해야 할 것으로 본다. Objectives:The purpose of this study was to investigate the prevalance of posttraumatic stress disorder in Korean War veterans and Vietnam War Veterans who had been hospitalized at Korea Veterans Hospital, and to find the correlation between the disorder and the characteristics of the variables. I also collected and analysed these data as a preliminary study for the management of the disorder and healthy social readjustment of the veterans. Methods:Two hundred and four Korean War veterans and one hundred Vietnam War veterans were collected consecutively who had been admitted to the hospital. These patients were evaluated using psychiatric interview and measurement instruments by psychiatrist for eighteen months since September, 1994. Results:The current prevalence of posttraumatic stress disorder in Korea War veterans and Vietnam War veterans were 8.8% and 23%, respectively. There was statistically significant difference in prevalence according to the marital status of Korea War veterans. Marital status, education level, occupation, and previous psychiatric treatment were statistically significant variables in Vietnam War veterans. From logistic regression analysis, I found that marital status in Korean War veterans, and education level, marital status, and low income in Vietnam War veterans were statistically significant variables. Conclusion:The posttraumatic stress disorder is chronic and treatment-resistant illness especially to the individuals who are sensitive and vulnerable. Marital status, education level and occupation have statistically significant relationship with the posttraumatic stress disorder. Based on the results of this study, we must consider these variables for the health social readjustment of war veterans in the future.

외상후 스트레스장애 환자에서 장기 치료에 따른 카테콜아민과 코르티솔 변화

강석훈,정문용,김태용,정혜경,Kang, Suk-Hoon,Chung, Moon-Young,Kim, Tae-Yong,Chung, Hae-Gyung 대한불안의학회 2008 대한불안의학회지 Vol.4 No.1

Objective : This study was conducted to evaluate the changes in the levels of neurotransmitters and cortisol in patients with chronic posttraumatic stress disorder (PTSD) and to evaluate their correlation with symptoms after long-term pharmacological treatment. Methods : Twenty-eight Vietnam veterans with chronic PTSD and 34 non-PTSD patients were consecutively recruited. The Combat Exposure Scale (CES), Mississippi Scale for Combat-Related Posttraumatic Stress Disorder (M-PTSD), Clinician Administered PTSD Scale (CAPS), Hamilton Rating Scale for Depression (HRSD) and Hamilton Anxiety Scale (HAS) were used to evaluate symptom severity. High performance liquid chromatography (HPLC) was used to measure the plasma levels of epinephrine, norepinephrine, and dopamine, and a radioimmunoassay (RIA) was performed to evaluate the plasma level of cortisol. Results : Plasma cortisol was significantly lower in PTSD patients than in control subjects, while there was no significant difference in plasma epinephrine, norepinephrine and dopamine between the two groups. The scores of M-PTSD, CAPS, HAMD and HAMA were signigicantly higher in PTSD patients than control group. Conclusion : After long-term treatment, the levels of neurotransmitters in PTSD patients returned to within the normal range, and the patients' symptoms showed some improvement. However, the core symptoms of PTSD continued to appear intermittently, and they are thought to be associated with hormonal systems, such as the HPA axis. It is also suggested that PTSD should be considered to be a complex disorder associated with multiple systems and that combinations of the effective medications for each system should be used to treat patients with PTSD.

혈장 세로토닌과 외상후 스트레스 장애 : 월남전 참전 재향군인을 대상으로

이수영,강석훈,정문용,이명희,김태용,소형석,정혜경,최진희,Lee, Soo-Young,Kang, Suk-Hoon,Chung, Moon-Yong,Lee, Myung-Hee,Kim, Tae-Young,So, Hyung-Seok,Chung, Hae-Kyung,Choi, Jin-Hee 대한불안의학회 2009 대한불안의학회지 Vol.5 No.1

Objective : The objective of this study was to examine the relationship between plasma serotonin concentration and posttraumatic stress disorder (PTSD) symptoms in chronic PTSD patients who have been taking medication. Methods : Plasma serotonin level of 14 PTSD patients and a control group of 28 Vietnam War veterans was measured by HPLC (high performance liquid chromatography). The Combat Exposure Scale (CES), Mississippi Scale for Combat-Related Posttraumatic Stress Disorder (M-PTSD), Clinician Administered PTSD Scale (CAPS), Hamilton Rating Scale for Depression (HRSD), and Hamiltion Anxiety Scale (HAS) were used to evaluate PTSD symptom severity. Results : Serotonin level was significantly higher in the PTSD group than in the control group (p=0.036, p=0.006, respectively). M-PTSD (p<0.001), CAPS (p<0.001), HRSD (p<0.001), and HAS (p<0.001) scale scores were significantly higher in the PTSD group than in the control group; however, the CES score failed to show a significant improvement (p=0.964). There were no significant differences between plasma serotonin and PTSD symptoms. Conclusion : In chronic PTSD patients who have been taking medications, we can not predict treatment effect and symptom severity by measuring only plasma serotonin levels. PTSD is a complicated disorder which may likely be related to a variety of neurotransmitter systems. Therefore, further research which investigate relationships with norepinephrine, dopamine, and other neurotransmitters as well as serotonin is needed to improve the treatment of PTSD.

베트남전 참전 퇴역 군인에서 외상후스트레스장애와 삶의 질과의 관계

엄세준,최진희,김태용,정혜경,정문용,소형석,Oum, Se-Joon,Choi, Jin-Hee,Kim, Tae-Yong,Chung, Hae-Gyung,Chung, Moon-Yong,So, Hyung-Seok 한국정신신체의학회 2011 정신신체의학 Vol.19 No.2

연구목적:외상후스트레스장애(posttraumatic stress disorder, PTSD)는 정신, 신체, 사회적 영역 등 다양한 영역의 삶의 질에 중대한 영향을 주는 것으로 알려져 있다. 이에 본 연구에서는 베트남전 참전 퇴역 군인에서 PTSD 발생 유무에 따른 삶의 질을 비교하고, 참전 퇴역 군인의 삶의 질에 영향을 주는 요인들을 알아보고자 한다. 방 법:연구에 참여한 전체 베트남전 참전 퇴역 군인 중 PTSD군 39명, 비PTSD군 43명을 대상으로, 한국판 Mini International Neuropsychiatric Interview-Plus, 한국판 임상가를 위한 외상 후 스트레스 장애 척도, 한국판 단축형 세계보건기구 삶의 질 척도, 전투노출척도 등을 실시하였다. PTSD군과 비PTSD군의 삶의 질 영역별 차이를 확인하기 위해 독립표본 t검정을 시행하였으며, 전체 베트남전 참전 퇴역 군인의 삶의 질과 관련이 있을 수 있는 변수들과 삶의 질 척도 각 영역 사이에 단계별 다중선형회귀분석을 실시하였다. 결 과: PTSD군은 비PTSD군에 비해 삶의 질의 모든 세부 영역들 및 전체 삶의 질 점수(p<0.01)에서 유의하게 저하된 소견을 보였다. 베트남전 참전 퇴역 군인의 삶의 질에 영향을 주는 요인들은 PTSD, 우울증, 교육 수준이었다. 이 중 PTSD는 전반적인 삶의 질 및 건강상태(${\beta}$=-1.411, $R^2$=0.180), 신체 건강영역(${\beta}$=-2.806, $R^2$=0.089), 전체 삶의 질(${\beta}$=-11.479, $R^2$=0.104)을 가장 잘 설명하였다. 결 론: 베트남전 참전 퇴역 군인에서 PTSD군이 비PTSD군에 비해 삶의 질이 저하된 소견을 보였다. 참전 퇴역 군인에서 PTSD는 다양한 삶의 질 영역에 영향을 줄 수 있을 것으로 생각된다. Objectives: Posttraumatic stress disorder(PTSD) has devastating effects on multiple aspects of the quality of life(QoL). Therefore, the purpose of this study is to compare the QoL between PTSD group and non-PTSD group, and identify the variables affecting the QoL of the Vietnam War veterans. Methods: We recruited 39 veterans with PTSD and 43 veterans without PTSD, all of whom had deployed to the Vietnam War. We used the Korean version of Mini International Neuropsychiatric Interview-Plus, the Korean version of Clinician-Administered PTSD Scale, Combat Exposure Scale and the Korean version of World Health Organization Quality of Life Assessment Instrument abbreviated version. We used independent samples t-test to identify the differences between PTSD and non-PTSD group in each domains of the quality of life. We also used stepwise multiple linear regression analysis to figure out the variables affecting the QoL of the Vietnam War veterans. Results: In the PTSD group, all domains of the QoL and the QoL total score(p<0.01) were significantly lower than those in the non-PTSD group. In the Vietnam War veterans, PTSD, major depressive disorder and education levels were the variables affecting the QoL. Among these, PTSD uniquely explained the QoL of the overall and general health(${\beta}$=-1.411, $R^2$=0.180), the physical health domain(${\beta}$=-2.806, $R^2$=0.089) and the total score (${\beta}$=-11.479, $R^2$=0.104). Conclusions: These results suggest that among the Vietnam War veterans, the QoL of the PTSD group is significantly lower than that of the non-PTSD group. Among the combat exposed veterans, PTSD may be one of the main reasons that affect the multiple domains of the QoL.

외상 후 스트레스 장애 환자의 혈청 테스토스테론치

김동수,김해정,방유진,고창민,정문용,강석훈,Kim, Dong Su,Kim, Hae Jung,Bang, Yu Jin,Go, Chang Min,Chung, Moon Yong,Kang, Suk Hoon 대한불안의학회 2013 대한불안의학회지 Vol.9 No.2

Objective : Several reports have found abnormal levels of androgen in post-traumatic stress disorder (PTSD) patients. This abnormality in androgen is hypothesized to due to chronic psychological stress effects on the hypothalamic-pituitary-gonadal (HPG) system. The present study was conducted to estimate serum testosterone levels in PTSD patients in comparison with normal subjects. Methods : Seventy-five male Korean veterans of the Vietnam War volunteered for the study, of which eleven were excluded because of incomplete psychological assessment. To measure basal serum testosterone, blood samples were collected between 8.00 and 9.30 a.m. The clinician administered PTSD scale (CAPS), the structured clinical interview for DSM-IV (SCID), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Rating Scale for Depression (HAM-D), Mini International Neuropsychiatric Interview Plus (Korean version of MINI-Plus), CES-K (Korean version of combat exposure scale). Results : The serum testosterone level of PTSD patients ($5.4{\pm}2.5ng/mL$) was higher than that of a control group ($3.1{\pm}1.7ng/mL$, p<0.001). Testosterone levels were significantly correlated with CAPS (r=.38, p<.01), HAM-A (r=.35, p<.01) and HAM-D (r=.28, p<.01) in all subjects. Conclusion : The results of the present study suggest that chronic psychological stress affects the HPG system.

월남전 참전 재향군인에서 도파민 D2 수용체 유전자 다형성과 외상후 스트레스 장애

이수영,정혜경,김태용,최진희,정문용,소형석,신한상,이시은,Lee, Soo-Young,Chung, Hae-Gyung,Kim, Tae-Yong,Choi, Jin-Hee,Chung, Moon-Yong,So, Hyoung-Seok,Shin, Han-Sang,Lee, Shi-Eun 대한불안의학회 2008 대한불안의학회지 Vol.4 No.2

Objective : Evidence from recent studies supports the role of genetic factors in the development of Posttraumatic Stress Disorder (PTSD). The primary aim of this study is to investigate the association between the dopamine D2 receptor (DRD2) TaqI A polymorphism and PTSD. The second aim is to examine the association between the DRD2 TaqI A polymorphism and clinical symptoms in patients with PTSD. Methods : We recruited 189 Vietnam veterans for participation in this study, among whom 99 were PTSD patients and 90 were control subjects. The presence of the DRD2 TaqI A polymorphism was determined by polymerase chain reaction (PCR). Several standardized research scales were used in the clinical assessment of PTSD, including the Combat Exposure Scale (CES), Clinician Administered PTSD Scale (CAPS), Beck Depression Inventory (BDI), and Clinical Global Impression (CGI). Results : There was no significant difference in the distribution of the DRD2 genotype, frequency and prevalence of the A1 allele, or the frequency of heterozygotes between the patients with PTSD and the controls. In the PTSD group, the patients with the A1 allele (A1A1, A1A2) scored higher on the CAPS-total (p=0.044), CAPS-avoidance symptoms (p=0.016) and BDI (p=0.024) than those without the A1 allele (A2A2). Conclusion : We could not find an association between the dopamine D2 receptor (DRD2) TaqI A polymorphism and PTSD. However, the A1 allele of DRD2 seemsto influence avoidance symptoms in patients with PTSD.

연천 사고 피해 PTSD 환자의 해마 용적 : 8개월 추적 연구

강석훈,김태용,이수영,정문용,최진희,정혜경,김재천,Kang, Suk-Hoon,Kim, Tae-Yong,Lee, Soo-Young,Chung, Moon-Young,Choi, Jin-Hee,Chung, Hae-Gyung,Kim, Jae-Chun 대한불안의학회 2007 대한불안의학회지 Vol.3 No.2

Objective : This study was conducted to evaluate the relation between symptoms and hippocampal volume in patients with posttraumatic stress disorder (PTSD). Methods : Eight patients with PTSD and five normal controls were enrolled in the present study. The severity of PTSD symptoms was measured using the clinician administered PTSD scale (CAPS), Hamilton Rating Scale for Depression (HAMD), Hamilton Anxiety Rating Scale (HAMA). Magnetic resonance imaging (MRI) was used to measure hippocampal volume. Results : There were significant differences in the CAPS, HAMD, and HAMA scores between the PTSD patients and normal controls. The left and right hippocampal volumes were smaller in the PTSD patients than in the normal controls, but this difference was not statistically significant. The results showed that PTSD symptoms were not related to hippocampal volume. Conclusion : In this study, we could not identify a difference in hippocampal volume between normal controls and patients with PTSD at eight months after trauma. Future research with different subjects and a larger sample size is needed in order to confirm the difference in hippocampal volume.

전투 관련 외상 후 스트레스 장애 진단에 있어서 임상가를 위한 외상 후 스트레스 장애 척도의 적용

김해정,김태용,최진희,소형석,정문용,김동수,방유진,정혜경,Kim, Hae Jung,Kim, Tae Yong,Choi, Jin Hee,So, Hyung Seok,Chung, Moon Yong,Kim, Dong Su,Bang, Yu Jin,Chung, Hae Gyung 대한불안의학회 2012 대한불안의학회지 Vol.8 No.2

Objective : The purpose of this study is to assess the utility of clinician administered posttraumatic stress disorder scale (CAPS) to diagnose combat related posttraumatic stress disorder (PTSD) in Korean veterans of the Vietnam War. Methods : Sixty-one Korean male veterans of the Vietnam war participated in this study. We compared the diagnostic values of CAPS, Korean version of mini international neuropsychiatric interview (MINI) against the Structured Clinical Interview for DSM-IV (SCID) in diagnosing PTSD. Results : The overall internal consistency of CAPS was 0.93. Compared to the SCID, total severity 45 (TSEV45) showed the best results among 5 CAPS scoring rules. In detail, sensitivity was 71.4%, specificity was 85.1, positive predictive value was 58.8%, negative predictive value was 90.9%, and accuracy was 82.0. Conclusion : CAPS was demonstrated as a reliable tool to diagnose combat related PTSD in the elderly. The optimum CAPS scoring was TSEV45.