자살과 정신 장애

제영묘 대한생물치료정신의학회 2004 생물치료정신의학 Vol.10 No.1

자살은 정신장애와 밀접한 관계를 가지고 있고, 정신장애를 가진 환자의 과도한 사망율에 기여한다. 이런 연관성을 자살에 대한 정신 부검 연구와 특정 질환의 자살 사망율을 연구함으로써 평가되어 왔다. 이런 접근법은 자살 당시에 자살자의 90% 이상에서 하나 이상의 정신장애를 가지고 있고, 어떤 정신장애는 자살 위험을 증가시킨다는 것이다. 자살에 있어서 아주 중요한 정신의학적 요인들은 우울장애, 물질사용장애, 정신분열병 등이며, 이에 관한 많은 연구들의 결과를 종합해 볼때, 대부분의 정신장애가 자살 혹은 자살 기도와 뚜렷한 관련이 있다는 것이다. 이 논문에서는 자살과 정신장애에 관한 이전의 여러 문헌을 조사하여 자살과 정신장애의 연관성을 고찰해 보았다. Suicide has a strong association with mental disorder and contributes to the excess mortality of the mentally ill. This association has been assessed by 'psychological autopsy' of consecutive series of suicides and by studying the suicide mortality of particular disorders. These approaches have shown that more than 90% of persons who die from suicide satisfy the criteria for one or more psychiatric disorders at the time they kill themselves and that certain mental illnesses have increased suicide risks. Highly significant psychiatric factors in suicide include depressive disorders, substance abuse, schizophrenia and other mental disorders. Numerous studies have documented a strong association between mental disorders and suicide or suicide attempt. The purpose of this review article is to describe the nature of the relationship between suicide and mental disorders by searching of some previous suicide/mental disorder literature.

공황 장애의 인지치료

제영묘 釜山大學校 醫科大學 精神科學敎室 1997 釜山精神醫學 Vol.6 No.-

In recent years, it is received that cognitive therapy have considerable effects in the treatment of anxiety disorders. In the case of panic disorder, the cognitive treatment strategy is well developed, the resulting treatment has been extensively evaluated, and is highly effective. Comparisons with other psychological interventions and waiting-list control groups indicate that cognitive therapy is an effective and specific treatment for panic disorder. A key prediction of the cognitive model of panic is that individuals with panic disorder will be more likely to interpret bodily sensations in a catastrophic fashion than individuals who do not experience panic attacks. Cognitive therapy for panic disorder is intended to help patients identify and modify the negative thoughts that accompany panic attacks and the beliefs on which these thoughts are based. Also, cognitive therapy includes detailed exploration of patients' idiosyncratic evidence for their negative beliefs and the modification of safety behaviors. I provided here an overview of the cognitive approach to the conceptualization and treatment of panic disorder and review controlled trials evaluating the effectiveness of cognitive therapy.

정신분열병 환자의 가족부담 척도 개발에 대한 예비연구

김철권,조진석,서지민,김용관,김호찬,김현수,김상수,제영묘 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.3

연구목적 : 정신분열병 환자의 가족이 느끼는 부담을 측정하기 위한 가족부담 척도를 개발하기 위함이다. 방 법 : 200명의 정신분열병 환자 가족과의 비구조적 면담과 외국 부담척도 고찰을 통하여 94문항을 수집하였고 그 다음에 전문가들과 가족들이 문항 및 영역을 분류하고 통합하여 최종적으로 36문항을 선정하였다. 그리고 정신분열병 환자의 가족 135명, 불안장애 환자의 가족 22명, 기분부전장애 및 신체화 장애 환자의 가족 26명, 치매 환자의 가족 49명을 대상으로 신뢰도와 타당도를 검증하였다. 결 과 : 자료분석 결과 검사-재검사 신뢰도, 내적 일치도, 감별타당도 모두 높게 나타났으며, 요인분석을 통해 다섯 가지 구성요인이 추출되었다. 결 론 : 본 가족부담 척도는 정신분열병을 포함한 만성 정신질환을 앓고 있는 환자의 호전과 가족의 부담을 덜어주기 위한 다양한 프로그램의 효과를 검증하는데 유용하게 사용되어질 수 있을 것이다. Objectives : This preliminary study was carried out to develop the Family Burden Scale(FBS) of the schizophrenics. Methods : Ninety-four items were collected by interviewing in a free unstructured format with one relative of each 200 schizophrenic patients and reviewing foreign FBS's. Several professionals and relatives were asked to group and integrate them into several categories. Finally 36 burden items were chosen to constitute a FBS. The FBS was administered to the relatives of 135 schizophrenic, 22 anxiety disorder, 26 dysthymic disorder and somatization disorder, and 49 dementia patients for examining the reliability and validity. Results : The FBS showed high test-retest reliability, internal consistency, and discriminant validity. The results of the factor analysis revealed five-factor solution. Conclusion : The FBS can be used to evaluate the effectiveness of various programs intended not only to reduce decompensation among schizophrenics, but also to alleviate family burden.

남성화된 암컷 생쥐의 통각반응 양상과 에스트로겐-α 수용체의 발현 양상

제영묘(Young-Myo Jae),박제민(Je-Min Park),백선용(Sun-Yong Baek),최병무(Byung-Moo Choi),김명정(Myung-Jung Kim) 대한생물치료정신의학회 2005 생물치료정신의학 Vol.11 No.1

암컷 생쥐를 출생 직후 테스토스테론에 노출시키면 성장 후 통각반응과 중추신경계 통각조절부위의 estrogen-α 수용체(ERα)의 발현에 영향을 주는지를 조사하고자 하였다. 갓 태어난 생쥐(Institute for Cancer Research)에게 생후 24시간 이내에 testosterone propionate 100㎍(남성화군) 혹은 sesame oil 50㎕(대조군)씩 복강내 주사하였다. 13주째에 각 군을 반으로 나누고 naloxone HCI 5㎎/㎏ 혹은 동량의 생리식염수를 복강내 주사하였다. 15분 뒤에 Tail immersion test로 통각예민도(TFL, sec)를 2회 측정하였다. 이어서 모든 군에게 testosterone propionate 1㎎/㎏씩 복강내 주사하고, 15분 후에 같은 방법으로 TFL을 측정하였다. 8개월 째 식염수 전처치군의 뇌를 적출하여 일차감각대뇌겉질, 시상, 중간뇌수도관주위회색질, 큰솔기핵 및 허리와 엉치척수분절 부위를 분리하였다. 각 부위별 ERα를 Western blot 분석으로 반정량하였다. 그 결과는 다음과 같다. 생리식염수 전처치군에서 대조-암컷은 기저 TFL과 테스토스테론 투여 후 TFL이 대조-수컷 보다 유의하게 예민하였다. 테스토스테론은 모든 군에서 TFL을 유의하게 연장시켰다. 날록손 전처치-대조-암컷은 수컷이나 남성화-암컷 보다 유의하게 예민하였다. 남성화-암컷은 기저 TFL이 수컷 보다 예민한 경향이 있었고, 날록손이 테스토스테론의 진통효과를 감소시키는 경향이 있었다. 그 외는 수컷과 유사한 반응을 보였다. 남성화-암컷은 대조-암컷 보다 사상의 ERα western band의 광 밀도가 낮은 경향이 있었다. 그 외 부위는 세 군간 차이가 없었다. 대조-암컷은 수컷이나 남성화-암컷에 비하여 다른 부위 보다 시상에 밀집되어 있고, 큰솔기핵에는 적었다. 남성화-암컷은 수컷에 비해 중간뇌수도관주위회색질의 밀도가 다른 부위에 비해 낮은 경향이 있었지만, 다른 부위는 차이가 없었다. 이상의 결과로부터 출생직후 암컷 생쥐를 테스토스테론에 노출시키면 통각에 대한 반응이나 중추신경계 통각조절 부위의 ERα 발현 양상이 수컷과 비슷해진다는 결론을 얻었다. Objectives : The object of this study was to investigate the effects of neonatal exposure to testosterone in female mice on the pain responses and the expression of estrogen-α receptors(ERα) in the pain control areas of the CNS in their later life. Methods : Testosterone propionate 100㎍ or sesame oil 50㎕ was injected intraperitoneally to neonatal mice within 24 hours after birth. In the 13th week of age, animals of each group(Androgenized-Female : AF ; Control-Female : CF ; Control-Male: CM) were divided into two and pretreated with naloxone HCI 5㎎/㎏ or saline 15 minutes before tail immersion test. Tall flick latencies(TFLs) were measured before and 15 min after administration of testosterone propionate 1㎎/㎏ i p.(intra-peritoneal) In the 8th month, mice were sacrificed and brains were dissected into primary sensory cortex, thalamus, periaqueductal gray, nucleus raphe magnus and lumbosacral spinal cord. ER α protein was assayed by Western blot analysis. Results : In saline-pretreated groups, TFLs of CF measured before and after testosterone injection were significantly shorter than those of CM. Testosterone prolonged TFLs signficantly in all subgroups. Among naloxone-pretreated groups, CF was significantly more sensitive than CM and AF. TFL profiles of AF did not differ from that of CM, except that baseline TFLs were slightly shorter and naloxone seemed to decrease analgesic effect of testosterone in AF, though statistically not significant. 66kDa Western bands were detected in all 5 regions. Optic density(OD) of each area did not differ across 3 groups, except that OD of ER α In the thalamus in AF was lower than in CF. Percent OD of a region to sum of the 5 areas(OD%) showed significant difference in the thalamus and nucleus raphe magnus. CF showed higher OD% in the thalamus than in CM and AF, and lower OD% in nucleus raphe magnus than in CM and AF. Western bands profile of AF did not differ from that of CM. Conclusion : These findings suggested that the pain response patterns and the expression of ER α in the pain control areas of CNS are grossly similar between androgenized female and control male mice.

불안장애의 위험주제

제영묘,김명정 大韓神經精神醫學會 1985 신경정신의학 Vol.24 No.1

In order to investigate the presence and the contents of the ideational components of the patients with the anxiety disorders, the authors studied 44 out-and inpatients of anxiety disorders diagnosed by the DSM-Ⅲ criteria at the neuropsychiatric department of Pusan National University Hospital. The results obtained were as follows. Forty three subjects out of 44 patients with anxiety disorders reported to recognize the ideational components of the themes of danger associated with anxiety experiences. 79.5 percent of the subjects had fears of physical disasters; 70.5 percent had psychological and 25 percent, social disasters. Twenty five of them reported two or three themes of danger simultaneously and 18 had themes of either physical or psychological disasters. Particularly there were many who had fear of death and fear of insanity simultaneously. A tendency of more prominent themes of physical disasters was noted in males, cases of acuteonset, cases with panic attacks and those with agoraphobia, and that of psychological disasters in females, cases of insidious onset and generalized anxiety disorder. But statistics failed to show significant difference probably due to insufficient numbers of the subjects. Surveying the contents of each theme, physical disasters were represented by fear of dying or death, psychological disasters by fear of insanity and social disasters by interpersonal rejection or social failure. From these results, the authors suggest that 1) themes of danger are consistently recognied by those with anxiety disorders during experiences of anxiety 2) the content and the intensity of the themes of danger have certain relationship with the intensity of anxiety 3) and the content of the themes of danger can be interpreted as the fear of annihilation.

주요우울장애 환자와 범불안장애 환자의 성격 특성 비교 연구

백대업,제영묘,김상엽,이대수,김현진,조정녀,최진혁 대한생물치료정신의학회 2003 생물치료정신의학 Vol.9 No.1

연구목적: 주요우울장애와 범불안장애는 병발율이 높아 두 질환의 관련성에 관한 연구가 있어 왔다. 본 연구는 성격평가 질문지(Personality Assessment Inventory)를 적용하여 두 환자군에서 성격 특성을 비교해 보고자 하였다. 연구방법: 2001년 8월1일부터 2001년 11월 30일 사이에 종합병원 정신과를 방문한 환자들을 대상으로 하여 전문의의 면담을 통한 진단과 DSM-Ⅳ 진단 기준에 의한 SCID-Ⅰ을 적용하여 최종 진단된 16명의 주요우울장애 환자 및 12명의 범불안장애 환자를 대상으로 성격평가 질문지를 적용하였다. 연구결과: 긍정적 인상척도(positive impression)가 주요우울장애 환자군에서 범불안장애 환자군에 비하여 의미 있게 높았다. 결 론: "남에게 잘 보이려는 경향"이 범불안장애 환자군에 비하여 주요우울장애 환자군에서 많았다. Objectives : The purpose of this study is to compare characteristics of personality in the patients with major depressive disorder and those with generalized anxiety disorder by using the PAI(personality Assessment Inventory) Methods : PAI(Personality Assessment Inventory) was applied to 16 patients with major depressive disorder and 12 patients with generalized anxiety disorder. Results : PIM(positive impression) score was significantly higher in the patients with major depressive disorder than those with generalized anxiety disorder. Conclusion : The patients with major depressive disorder have more "faking good"tendency than those with generalized anxiety disorder.

한국판 스미스클라인 비챰의 '삶의 질'척도를 이용한 공황장애 환자의 삶의 질에 관한 연구

이승호,제영묘,김상엽,이대수,최은영 대한생물치료정신의학회 2000 생물치료정신의학 Vol.6 No.1

Objectives : In this study, we researched the change of 'quality of life(QOL)' of patient with panic disorder by KvSBQOL and the predictors affecting the change of 'quality of life'. Methods : 30 outpatient with panic disorder were tested by questionnare for panic disorder and KvSBQOL. Frst, they were classified as when healthy before panic episodes(a point of time 1), when first diagnosed as panic disorder in the psychiatry(a point of time 2), and when treated after diagnosis(a point of time 3). Second, the change of QOL scores in five factors at each point was observed, Third, the correlation between the change of QOL scores(point 3 score-point 2 score) and the several predictors(Onset age, Degree of change in panic symtom, Degree of change in anticipatory anxiety, Degree of change in agraphobia, Spended time to diagnose panic disorder, Duration of treatment) were studied. Results : 1) QOL mean scores of a point of time 1,2 and 3 were 166.267±38.24, 94.367±34.00, 161.367±34.37, respectively. 2) The change of QOL scores in all five factors of KvSBQOL(factor1 Competence, factor2 Psychological well-being, factor3 Stability, factor4 Physical well-being, factor5 Activity)at each point was significant(P<.000). 3) The change of QOL mean scores(point 3 score-point 2 score) have significantly negative correlation with the change of score in anticipatory anxiety but not other predictors. Conclusions : Difference in QOL scores between a point of time 1 and 3 is 4.9, indicating that the psychiatric treatment is important in improvement of QOL, the anticipatory anxiety is an important predictor of QOL(P<.001). and it suggested that diminished anticipatory anxiety is very important to maintain of high QOL in patient with panic disorder.

범불안장애환자와 주요우울증환자 간에 인지적 형태와 스트레스 대처 방식의 비교

김현진,제영묘,이대수,백대업,조정녀 대한생물치료정신의학회 2002 생물치료정신의학 Vol.8 No.1

흉통 환자에서의 정서, 자존감 및 삶의 질에 대한 예비 연구

박숙현,제영묘,이대수,장세헌,최진혁,이한철,Park, Sook Hyun,Jae, Young Myo,Lee, Dae Su,Jang, Saeheon,Choi, Jin Hyuk,Lee, Han Cheol 한국정신신체의학회 2012 정신신체의학 Vol.20 No.2

연구목적 : 흉통을 호소하여 방문한 환자를 대상으로 우울, 불안, 자존감, 그리고 삶의 질 을 조사하고, 전형적 흉통과 비전형적 흉통에 따른 차이를 비교하였다. 방 법 : 39명의 흉통 환자와 40명의 대조군을 대상으로 하였으며, 순환기 내과 전문의의 문진과 심장 전산화 단층촬영, 답차운동부하검사, 관상동맥조영술 등을 시행하여 전형적 흉통과 비전형적 흉통을 감별하였다. 우울, 불안, 자존감, 그리고 삶의 질을 평가하기 위해 BDI(Beck's Depression scale), STAI(State trait anxiety inven-tory), RSES(Rosenberg Self-esteem Scale), SBQOL(SmithKlein Beecham Quality of Life Scale)를 적용하였다. 결 과 : 심질환의 위험인자는 가족력을 제외하고는 전형적 흉통군, 비전형적 흉통군, 그리고 대조군 간에 차이가 없었다. 우울은 대조군에 비해 두 가지 흉통군 모두에 더 높았으나 흉통군 간에는 차이가 없었다. 불안은 대조군에 비해 두 가지 흉통군 모두에서 더 높았고, 전형적 흉통군에 비해 비전형적 흉통군에서 더 높았다. 자존감과 삶의 질은 대조군과 전형적 흉통군에 비해 비전형적 흉통군에서 더 낮았다. 결 론 : 흉통환자에서 불안과 우울에 대한 평가와 개입이 필요하며, 특히 비전형적 흉통환자에서는 자존감과 삶의 질 저하에 대한 접근도 병행이 되어야 함을 시사한다. Objectives : The objective of this study is to measure and to compare the rate of depression, anxiety, self-es-teem and the quality of life of the patients with chest pain. Based on the result of this study, the necessity of the psychiatric assessment and treatment of the patients with chest pain is emphasized. This study is a preliminary research for a larger scale investigation to be carried out in the future. Methods : Thirty nine patients with chest pain who visited Cardiovascular Division of Dept. of Internal Medicine Pusan National University Hospital and fourty normal control group(NC) were included in this study. The patients were classified into typical chest pain group(TCP, N=19) and atypical chest pain group(ACP, N=20) based on the cause of the pain. The cause was determined by cardiac computed tomography, exercise stress test, coronary angiography, and questionaires by a cardiology specialist. The patients were assessed with Beck Depression Inventory(BDI), State-Trait Anxiety Inventory(STAI), Rosenberg Self-Esteem Scale(RSES) and Korean version of the Smith Klein Beecham 'Quality of Life' scale(KvSBQOL). Results : 1) When the risk factors of cardiac disease is compared, most of the factors(Hypertension, Diabetes, Hyperlipidemia, Cerebral infarction) did not differ significantly among the two chest pain groups, except for the family history, for which TCP group showed higher risk than ACP group did. 2) As for the self-report questionaires scores, BDI score, which indicates the rate of depression, of both ACP group and TCP group was significantly higher than that of NC group in BDI for depression. STAI score, which measures anxiety, was also significantly high in both groups. Especially, STAI score was significantly higher in ACP group than TCP group. 3) In the aspect of self-esteem and quality of life, ACP group scored significantly lower than TCP group and NC group. The scores for TCP group and NC group did not differ significantly. Conclusions : The patients with chest pain showed more depression and anxiety than normal control group, regardless of the cause of the pain. However, TCP group did not show significantly larger drop in self-esteem and quality of life than ACP group did. This result implies that early psychiatric assessment and treatment is needed for the patients with such chest pain, since it is highly likely that the pain would lead to lower quality of life of the patients.

공황장애환자에서 광장공포증 동반여부에 따른 스트레스대처방식의 차이

최은영,제영묘,이대수,정영인 대한생물치료정신의학회 2001 생물치료정신의학 Vol.7 No.1

In an attempt to know the factors affecting the development of agoraphobia following panic attacks, the author investigated whether there are differences between coping strategies of panic disorder with and without ago-raphobia. Thirty-seven patients meeting the criteria of DSM-IV panic disorder were divided into 2 subgroups, one group with agoraphobia, another without agoraphobia. Questionaires for the severity of panic symptoms, and of anticipating anxiety for panic attacks, multidimensional coping scale for stress were administered to panic subjects. The results were summarized as follows. 1) Group of panic disorder with agoraphobia complaints trembling or shaking more than group of panic disorder without agoraphobia. 2) There was no differences of degree for the severity of anticipating anxiety between two groups. 3) Group of Panic disorder with agoraphobia had higher score on BDI than Group of panic disorder without agoraphobia. 4) Group of panic disorder with agoraphobia had lower score on active coping, positive interpretation, acceptance than group of panic disorder without agoraphobia, and the differences of these strategies between two groups were not correlated with the score on BDI at the time of investigation. In conclusion, these results suggest that the coping strategies for stress may be a predictor of agoraphobia in patients with panic disorder.