공황장애 환자에서 인지행동치료의 약물 감량 효과

최영희,김경미,박기환,윤혜영 대한정신약물학회 2003 대한정신약물학회지 Vol.14 No.4

Objective : The purpose of this study is to determine whether CBT is effective in tapering or discontinuing medication regardless of the type of medication and its maintenance effects after long-term follow up. Method : 224 patients meet DSM-IV criteria for panic disorder with or without agoraphobia completed 12 weekly sessions of Panic Control Therapy (PCT; Barlow et al.). 80 patients who were using benzodiazepines alone and 144 patients who were using benzodiazepines and Antidepressants were measured with several screening scales at the pre- and post-treatment. The scales were Beck Depression Inventory (BDI), Spielberg State Anxiety Inventory (STAI-State), Spielberg Trait Anxiety Inventory (STAI-Trait), Body Sensation Questionnaire (BSQ), Agoraphobic Cognition Questionnaire (ACQ), Anxiety Sensitivity Index (ASI), Panic Belief Questionnaire (PBQ). These patients were assessed at 3 months, 6 months, 12 months of follow up and they were also assessed for their medications, panic frequency, and End-State Functioning. Results : After the completion of PCP, both benzodiazepines alone group and benzodiazepines and antidepressants combination group showed significant improvement (P<0.001) in all the results of 7-self reported questionnaires. 54% of patients discontinued their medication and 90.9% of patients were in HES at post-treatment. 70 % of patients were in HES at 3 month, 6 month, and 12 month follow up. The patients who could not discontinue medication also tapered their medication afterwards. The rate of discontinuing medication was significantly higher for the patients using benzodiazepines alone (86.3%) than patients using combination of benzodiazepines and antidepressants (56.3%). Conclusion : These findings support cognitive behavioral therapy can replace medication and these effects seem to last long. 목 적:공황장애 환자들에 대한 인지행동치료가 치료 약물의 종류와 무관하게 약물을 중단하는데 도움을 주며, 장기간에 걸쳐 호전 상태를 유지할 수 있는지 여부를 검증하기 위해 이 연구를 시행하였다. 방 법:DSM-Ⅳ 진단에 따라 공황장애로 진단 받고 약물치료중인 24명의 환자를 대상으로 12회기 집단 인지행동치료를 실시하였다. 인지행동치료 전 복용 약물을 벤조다이아제핀계 약물 복용 군 80명과 벤조다이아최영희 등 375 제핀과 항우울제 병합요법군 144명의 환자군으로 나누어, 치료 전과 후에 시행한 Beck Depression Inven -tory(BDI), Spielberg State Anxiety Inventory(STAI -State), Spielberg Trait Anxiety Inventory(STAI-Trait), Body Sensation Questionnaire(BSQ), Agora-phobic Cognition Questionnaire(ACQ), Anxiety Sen -sitivity Index(ASI), Panic Belief Questionaire(PBQ)의 결과를 분석하였다. 또한, 3개월, 6개월 12개월 추적조사를 통해 각 약물군별 약물복용 여부와 최종상태기능(End-State Fungtioning)을 평가하여 분석하였고, 12개월 추적조사기간동안 약물 복용양 변화와 약물군별 차이, 최종상태기능 사이의 관계를 분석하였다. 결 과:인지행동치료 전 사용 약물의 종류와 상관없이, 인지행동치료 이후 모든 임상 변인이 통계적으로 유의미하게 향상되었다. 인지행동치료 직후, 대상군의 54%의 환자들이 약물을 끊었고 이들 중 90.9%가 상위 최종 상태를 유지되고 있었으며, 3개월, 6개월, 12개월 추적조사에서 이들의 약 70%는 여전히 상위최종상태를 유지하고 있었다. 또한 약물 복용을 중단하지 못한 환자들도 지속적으로 약물 복용을 감량하여 3개월 뒤에는 약 6%, 6개월 및 12개월 추적조사 시에는 약 68%의 환자가 약물 복용을 중단하였고 이들 역시 약 70%에서 상위최종상태를 유지하고 있었다. 벤조다이아제핀 단독 투여군의 경우 86.3%의 환자가 인지행동치료 이후 약물복용을 중단하여 이후 추가적인 약물복용이 필요하지 않았으며 이들의 약 70%는 약물 복용 없이 상위최종상태를 유지하고 있었고, 2.7%만이 약물 감량 이후 재복용 하였다. 반면 벤조다이아제핀계 약물과 항우울제 병합요법군은 57.0%의 환자가 인지행동치료 이후 약물복용을 중단하여 지속적으로 약물복용을 하지 않았다.

壬辰倭亂史에서의 倭峙大捷의 意義

崔永禧 충남대학교 사학회 2000 忠南史學 Vol.12 No.-

귀선(龜船)에 관한 몇 가지 문제점

최영희 한국과학사학회 1979 한국과학사학회지 Vol.1 No.1

신바람 나는 십대-나무를 타자

최영희 우리신학연구소 2001 갈라진 시대의 기쁜소식 Vol.- No.509

기질측정의 타당성 조사연구

최영희 숙명여자대학교 대학원원우회 1989 원우논총 Vol.7 No.-

For a sample of 81 infants whose temperament were investigated at 5-8 months and 2 infants who wanted to participate in this research, assesment of temperament by Toddler Temperament Questionnaire (TTQ) was obtained at 12-15 months of age. The item reliability was acceptable, and 9 temperamental categories were divided into four factors. Factor Ⅰ consisted of rhythmicity, adaptability, and mood, factor Ⅱ of approach and threshold, factor Ⅲ of activity, persistence, and distractibility, and factor Ⅳ of intensity. There were moderate stability of temperamental characteristics across 5-8 and 12-15 months. Of the 9 temperamental categories, 6 categories (rhythmicity, approach, adaptability, mood, intensity, and persistence) showed significant relations between the two research period. And fifty-three percent of the infants still remain in the same diagnostic groups during the 7-months intervals. The result of this study demonstrated the utility of TTQ and the validity of temperament assessment.

父母敎育 프로그램을 開發을 위한 一硏究 : 수원지역을 중심으로

崔泳嬉 수원대학교 1991 地域社會開發 Vol.3 No.-

This study was performed to collect the basic materials for creating a parent education program. The questionnaire was deviced to catch the goal and content of the program. The research was done with mothers living in Suwon community. Two hundred and ninty-four mothers who have pre-school children responded the questionnaire. Informations about what are the mothers' expectations for their children, what are the children's problems, with whom they consult the problems, and whether they trust the parent education. The result showed that mothers have ambivalent expectations for their children. They wanted their children to be obedient, and at the same time to be independent. Obedience and independence are the opposite concept each other. This revealed that mothers have troubles with caring children. And they wanted to consult the problems with specialists and to have parent education. It is indicated that social support systems like consultation and parent education programs are needed for the community.

치과 임플랜트 보철 수복시 각 상부구조의 형태에 따라 발생되는 응력의 광탄성학적 분석

최영희,조인호 단국대학교 치의학연구소 1992 논문집 Vol.4 No.-

The osseointegrated implant conducts the stress directly to the bone due to lack of cushoning effect of periodontal ligament. So, the design and material quality of superstructure plays an important role in resolution and diffusion of stress. Recently, the vaious superstructures have been developed to improve esthetics and resolve various complicated conditions. The purpose of this study was to evaluate the stress induced by various system on the osseointegrated implant using UCLA abutment, EsthetiCone abutment, Anatomic abutment as well as Branemark conventional abutment. The stress distribution was evaluated by the photoelastic method which can simultaneously observe all around stress distribution. The superstructures embedded in epoxy resin specimen were loaded at various angle with a force of 15 Kg to analyse the stress distribution of the fixture. The results of this study were obtained as follows : 1. Under vertical loading, the large and broad stress was distributed below the fixture in all systems. 2. The fringe order of the stress was increased in proportion to tilting the specimen. The largest stress was shown in 25 angled degree tilting case. 3. The Branemark conventional abutment showed the lowest value, and EsthetiCone abutment, Anatomic abutment and UCLA abutment showed the stress value in accending order.

집단 인지행동치료의 약물 대치 효과

최영희 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

Objectives : The purpose of this study is to verify hypothesis that cognitive behavioral therapy is effective in treatment of panic disorder, and patient who undergo cognitive behavioral therapy may stop medication and alternate pharmacotherapy when coping ability to panic and anxiety improves through congnitive bahavioral therapy. Subjects and methods : 259 patients who had diagnosed as panic disorder with agoraphobia by the diagnostic creteria of DSM-IV were randomly assigned to panic group cognitive bahavioral therapy. The treatment effects was measured with Beck Depression Inventory(BDI), Spielberg State Anxiety Inventory (STAI-State), Spieberg State Anxiety Inventory (STAI-Trait), Anxiety Sensitivity Index(ASI), Panic Belief Questionnaire (PBQ), Body Sensation Questionnaire (BSQ), Agoraphobic Cognition Questionnaire (ACQ), Fear Questionnaire (FQ). Also, the author assessed the panic attack frequency, the clinical severity rating(CSR), the end-state functioning(ES), the success rate of stopping or reducing medication at the pre-treament, post-treatment and 3-month, 6-month, 12-month follow-up. Results : In all ratings. the results showed the significant improvement after the treatment compared with the pre-treatment scores. The results of the effectiveness of cognitive behavioral therapy to the patient that undergo pharmacotherapy among patients who have been taking medicine before treatment, and also assessed panic free state of these patients after the treatment compared with the pre-treatment scores and 3-,6-,12-month follow-up, show that superior panic free state immediately after treatment than before cognitive behavioral therapy while show panic arrack rate is increases gradually as time passes. Conclusions : Through this study, cognitive behavioral therapy is effective in panic disorder, if panic disorder patients who have been received cognitive behavioral therapy as substitute for or assissted to pharmacotherapy improve coping ability to panic and anxiety through cognitive behavioral therapy, they can stop medication and it can substitute for pharmacotherapy.

신바람 나는 십대-안타까워 찾으시는 주님

최영희 우리신학연구소 2001 갈라진 시대의 기쁜소식 Vol.- No.506

아동의 자기능력지각과 어머니의 양육태도 : 도시와 농촌 비교

崔泳姬 水原大學校 社會科學硏究所 1997 社會科學論集 Vol.9 No.-