精神治療 個人指導監督에 대한 被監督者들의 意見調査Ⅱ

柳凡熙,趙斗英 大韓神經精神醫學會 1991 신경정신의학 Vol.30 No.2

This study is to investigate the opinions of supervisees on the individual supervision of psychotherapy. The subjects of the study are 3rd-year psychiatric residents working for the training hospitals all over the country in 1989 and psychiatric specialists certified in the same year. 112 persons, whose addresses were identified, were included in the study. The data for the investigation were collected from July 18 to October 28 in 1989 by means of a questionnaire sent by post. Among the 50 respondents, there were 28 psychiatric residents and 22 psychiatric specialists. We analyzed the content of the questionnaire. Results are as follows; 1) Among the respondents, the proportion of psychiatrists practicing psychotherapy is 70% in this study. This is lower than that from the previous study by the authors which was carried out on psychiatric residents working for Seoul National University Hospital and psychiatric specialists trained in the same university hospital. But It is higher than 58% derived from the other domestic study. 2) Conditions to be a good supervisor preferred by supervisees are `age of fifties' and `great experience'. The opinion that the sexual difference of supervisors is not important is somewhat more common than the opinion that men are preferred to women as supervisors. 3) The advantage of having more than one supervisor simultaneously is varieties of instructions' and `being more neutral and objective', and there are a lot of more positive responses. 4) The supervisees favor once per week as the ideal frequency of supervision and an hour per session as the ideal time. A standard for how to choose a case to be discussed in the supervision is to feel difficulty in treating patients. In the supervision, most of supervisees expect help from supervisors and have curiosity for learning, and some of them become tense or anxious. Most of them favor the 2nd-year residency as a good period for beginning supervision and believe that the individual supervision of psychotherapy is needed even after the residency training. 5) Most of supervisees favor 4-6 months as the ideal duration of supervision by one supervisor, but they want the supervision to be deeper and more analytic. Supervisees are usually satisfied with the psychotherapy supervision even though they often get angry with their supervisors. Considering these contradicting attitudes we are concerned that they are somewhat confused in understanding the nature of supervision. 6) The most appropriate method of the case presentation in supervision is verbatim-method and the best place for supervision is the personal office of a supervisor. 7) Most of the supervisees believe that the personal intimacy and good matching between supervisors and supervisees have a great effect on supervision. All of them expressed need to choose their supervisors freely for themselves, but they are skeptical about the practicality of the idea. 8) In the previous study by the authors, psychiatric residents tended to accept the opinions of supervisors more frequently than psychiatric specialists did when they had different ones, and the subjects of this study have a similar tendency to the psychiatric residents. Besides this, most of supervisees imitate supervisors more or less. 9) Among important learnings from supervisors, supervisees choose therapeutic attitudes to deal with patients' and `to know their own problems'. They believe that the most desirable improvement in supervision is to get deeper and more enthusiastic supervision.

지연성 운동장애와 양성, 음성 정신분열병 환자에서의 인지기능 장애

유범희,김지혜,배주미,이강욱,우종민,김승태 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

저자들은 정신분열병 환자에서 양성, 음성 증후군에 따라 각각 특징적으로 어떤 인지기능의 장애를 보이는지 알아보며, 또 지연성 운동장애의 존재 여부가 인지기능에 어떤 영향을 미치는지 조사해보고자 지연성 운동장애 환자 31명과 대조군 32명에게 PANSS 검사를 시행하였고, 인지기능 검사로는 KWIS 검사와 Grooved Pegboard test, Trail making test A/B, Wisconsin card sorting test, Wecshler memory scale을 시행하였다. 그 결과 다음과 같은 성적을 얻었다. 1) KWIS 지능검사상 이해 소검사에서 양성 증후군 환자들이 음성 증후군에 비해 우수한 수행도를 보였으며 빠진 곳 찾기 소검사에서는 지연성 운동장애가 없는 집단이 있는 집단에 비해 우수한 수행도를 보였다. 2) Trail making test A형에서 양성 정신분열병 환자 집단이 음성 정신분열병 환자 집단에 비해 전반적으로 빠르고 효율적인 수행을 보였다. 3) 그밖의 다른 인지기능 검사상에서는 양성, 음성 정신분열병과 지연성 운동장애 유무에 따른 검사 결과의 차이는 보이지 않았다. 결론적으로 음성 증후군 환자들의 경우 양성 증후군에 환자들에 비해 실행 기능과 같은 전두엽 기능의 장애와 기억 능력의 저하가 좀더 분명하게 나타나 음성 증상과 인지기능 장애 사이에 통계적으로 의미있는 상관관계가 있는 것으로 나타났다. 반면 지연성 운동장애의 경우는 음성 증후군과 함께 나타날 때만 현실 검증력, 주의력의 저하가 두드러져서 지연성 운동장애 자체만으로 인지기능의 장애가 유발된다고 보기는 어려웠다. Objective : The goal of this study was to examine cognitive dysfunctions in positive and negative schizophrenic patients and investigate the effect of tardive dyskinesia on cognitive dysfunctions in them. Methods : Thirty two schizophrenic patients with tardive dyskinesia and thirty two schizophrenic patients without tardive dyskinesia as a control group were selected from psychiatric inpatients at a lunatic asylum and the cognitive dysfunctions of these patients were assessed with some neuropsychological tests including KWIS test, Grooved Pegboard test, Trail making test A and B, Wisconsin card sorting test, and Wechsler memory scale test. From these patients, we classified eighteen schizophrenic patients as a positive syndrome group and twenty five patients as a negative syndrome group with positive and negative syndrome scale and compared the results of neuropsychological tests between these two groups. Results : Patients without tardive dyskinesia showed better performances than those with tardive dyskinesia on picture completion subtest of KWIS. Positive schizophrenic patients showed better performances than negative schizophrenic patients on comprehension subtest of KWIS and trail making test A. Conclusion : Negative schizophrenic patients showed frontal lobe dysfunction and more memory impairment than positive schizophrenic patients. In conclusion, negative syndrome of schizophrenia is significantly associated with cognitive dysfunctions although tardive dyskinesia is not.

주관적 각성도의 日週期 리듬이 교통사고 발생에 미치는 영향

유범희,조두영,정도언 大韓睡眠-精神生理學會 1994 수면·정신생리 Vol.1 No.1

뇌종양 수술 후 방사선치료에 의해 발생한 이차성 조증

유범희,우종민,신형진,김승태 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.5

국소적 대뇌 병변에 의한 이차성 조증은 드물게 보고되어 왔다. 저자들은 정신과적 병력이 없던 사람이 좌측 측두엽 뇌종양의 종양 절제술을 받은 뒤 별다른 문제없이 잘 지내다가 수술 후 방사선치료를 받은지 약 4개월만에 조증 삽화를 보인 증례를 경험하였다. 정위적 조직검사 결과 이는 방사선치료에 의한 후유증으로 지연성 손상이 일어나 우측 해마 부위가 괴사되었기 때문이 것으로 밝혀졌다. 본 증례를 통해 저자들은 이차성 조증의 발병과 우측 해마 부위의 병변이 밀접하게 관련되어 있음을 확인할 수 있었다. 이처럼 이차성 조증과 뇌의 국소적 병변 부위 사이의 관련성을 밝히는 것은 앞으로 일차성 조증의 신경해부학적, 신경생물학적 원인을 규명하는 데에도 크게 기여할 수 있으리라 생각된다. Secondary mania associated with focal brain lesion has only rarely been reported. The authors report a case of secondary mania after postoperative radiation therapy for primary brain tumor. Localized necrotic lesion was found in the right basotemporal lobe involving hippocampus, which might be the result of late delayed damage of the postoperative radiation therapy. This case suggests that secondary mania is closely related to focal, right basotemporal lesions. Knowing the relationship between the location of brain lesions and manic syndrome may be helpful to us in understanding the neuroanatomical and neurobiological mechanism of primary mania.

강박신경증의 정신분석적 정신치료

柳凡熙 대한신경정신의학회 1994 신경정신의학 Vol.33 No.3

I treated a young man who had suffered from severe obsessive ideas. He took a psychoanalytic psychotherapy twice per week for about 8 months. While I couldn't completely help him with the various problems related to his deep psychological confilcts including transference phenomena, his obsessive symptoms improved very much after 50 psychotherapy sessions. This paper presents psychodynamic formulations of the patient with obsessive compulsive disorder and also shows how we can use the unconcious materials including the dreams from the patient in psychotherapy based on the psychoanalytic theories. I think psychotherapy may be more effective than pharmacotherapy or behavioral therapy in obsessive compulsive disorder because it can deal with some general problems of the patient's life indcluding his emotional conflicts and personality trait as well as simple obsessive compulsive symptoms

흰쥐 해마에서 경련에 의해 발현 유도된 MKP-1에 의한 MAPK 활성 조절

유범희,강웅구,안용민,정선주,전송희,박주배,김용식 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.4

연구목적 : 전기경련 충격(Electroconvulsive shock, ECS) 및 카이닌산(kainic acid)에 의한 경련은 흰쥐 해마에서 mitogen activated protein kinase(MAPK)를 활성화시키며, 동시에 MAPK 불활성화 효소인 MAPK phosphatase-1(MKP-1)의 발현을 일으킨다. 이 연구의 목적은 경련에 의해 발현된 MKP-1이 역시 경련에 의해 활성화된 MAPK의 불활성화에 관여하는지를 알아보고자 하는 것이다. 방 법 : 흰쥐에 ECS를 가하여 해마에서 MKP-1 발현을 일으킨 뒤 다시 ECS를 가하고, 두 번째 ECS에 의한 MAPK의 일시적 활성화가 MKP-1의 발현상태에 의해 영향받는지를 알아보았다. 또한 흰쥐에 지속적인 MAPK 활성화 및 MKP-1 발현을 일으키는 카이닌산을 투여한 뒤 해마에서 MKP-1의 발현과 MAPK 활성과의 관계를 알아보았다. 결 과 : ECS후 해마에서 타이로신 인산화 면역블롯 및 효소활성으로 측정한 MAPK의 인산화 및 활성은 MKP-1의 발현이 일어나 있는 경우와 그렇지 않은 경우 사이에 차이를 보이지 않았다. 카이닌산의 투여에 의해 MAPK 활성화가 일어나는 경우, 뒤이어 MKP-1 발현이 일어나지만, 이렇게 발현된 MKP-1은 MAPK 활성을 충분히 감소시키지 못하였다. 결 론 : MKP-1은 흰쥐 해마에서 ECS 및 카이닌산에 의한 MAPK의 활성화를 차단하는데 큰 역할을 하지 않는다. Objectives : Both electroconvulsive shock(ECS)- and kainic acid-induced seizures activate mitogen-activated protein kinases(MAPKs) in rat hippocampus. They can also induce the expression of MAPK phosphatase-1(MKP-1) in rat hippocampus. MKP-1 is known as a specific MAPK deactivator. This study aimed to elucidate the role of MKP-1 in the deactivation of MAPKs in rat hippocampus. Methods : In order to induce MKP-1 in the hippocampus, ECS was given to the rats. At the time points when MKP-1 was sufficiently induced, the second ECS was given to them and the subsequent phosphorylation or activation of MAPKs were measured in the hippocampus. A second group of rats were injected with kainic acid and the relationship between MKP-1 expression and MAPK phosphorylation was examined in their hippocampi. Results : The expression of MKP-1 did not influence the phosphorylation or activation of MAPKs following ECS in rat hippocampus. Kainic acid-induced expression of MKP-1 did not significantly reduce the phosphorylation of MAPKs. Conclusion : MKP-1 did not play a significant role in the deactivation of MAPKs which were activated by ECS or kainic acid in rat hippocampus.

4% 차아염소산 나트륨 음독 후 발생한 위 유문부 협착 1례

김범주,진용호,이재백,유희철 대한응급의학회 2000 대한응급의학회지 Vol.11 No.2

Ingestion of sodium hypochlorite bleach is usually benign, leading most emergency departments to advocate conservative home management. We report a rare case of household bleach ingestion. A 54-year-old male ingested unintentionally an unknown quantity of household bleach (4% sodium hypochlorite, pH<12). He was transferred to our department for further evaluation and management from a local general hospital because of continuous vomiting and suspicious gastric malignant lesions on the endoscopic findings. The results of repeated gastrointestinal endoscopy were corrosive injury to the stomach and the esophagus. About 60 days following ingestion of the bleach, he underwent a hemigastrectomy due to pyloric stenosis. The literature regarding corrosive injury following bleach ingestion is reviewed.

공황장애에서 Paroxetine 치료반응을 예측할 수 있는 생물학적 지표

박주언,유범희 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.2

Objectives : Previons studies reported altered beta-adrenergic receptor (βAR) responsiveness in panic disorder, but few studies reported to see the effect of pharmacotherapy on βAR function in panic patients. This investigation examined βAR responsiveness in patients with panic disorder before and after pharmacotherapy with paroxetine. Methods : After assessment using the Anxiety Disorder Interview Schedule for DSM-FV, 27 acute panic patients whose illness duration did not exceed 1 year were assigned to 12 weeks of paroxetine treatment. Twenty seven normal control subjects with no previous history of major medical and psychiatric illnesses were matched by age, sex, exercise, and body mass index. The Hamilton rating scaIe for anxiety (HAM-A), Hamilton rating scale for depression (HAM-D), Spielberger state-trait anxiety inventory-State (STAI-S) and Trait (STAI-T), acute panic inventory (API), anxiety sensitivity index (ASI), and Beck depression index (BDI) were performed to assess clinical states in the panic patients before and after treatment. The HAM-A, HAM-D, STAI-S and STAI-T, and BDI were also performed in the normal control subjects. We measured the βAR density (Bmax), affinity (l/Kd), and sensitivity (cyclic AMP ratio of isoproterenol-stimulated cAMP to basal cAMP)in all subjects. Results : Panic patients showed much lower scores of the HAM-A, STAI-S, STAI-T, API, ASI, HAM-D, and BDI after 12 weeks ofparoxetine treatment than those before the treatment. There was no significant difference in the means of Bmax and cAMP ratio between control subjects and panic patients before and after the treatment. However, Pretreatment Kd(R²=0.314, β=-0.876, p=0.001) and Bmax (R²=0.230, β=-0.575, P=0.019) significantly accounted for API scores after the treatment and change of Bmax according to the treatment accounted for the improvement of anxiety sensitivity (R²=0.353, β=0.594, P=0.015). The pretreatment Kd value was significantly higher in the panic patients compared with that of control subjects (78.35≥26.20 vs. 59.15≥29.33, p=0.014), which was significantly reduced after the treatment (79.43≥26.83 vs. 56.38≥28.79, p=0.002). The pretreatment Kd value significantly accounted for the improvement of API scores (R²=0.316, β=0.562, p=0.029) and the decrease in trait anxiety (R²=0.246, β=-0.513, P=0.025). Conclusion : In acute panic patients, only βAR affinity was reduced before the treatment, which was contrary to our ex-pectation. Decreased ,βAR affinity was normalized after paroxetine treatment. Decreased βAR affinity and increased βAR density before the treatment predicted good treatment response in acute panic patients. Thus, βAR affinity and density could be useful biological markers that predict the treatment response of paroxetine in panic disorder.

편두통: 정신과적 문제와 바이오피드백 치료

박주언,유범희 대한두통연구회 2004 두통 Vol.5 No.1

umu-test에 의한 2-bromopropane의 遺傳毒性 調査

金永煥,池用熙,邊子眞,金範錫,柳寅晟 高麗大學校 倂設 保健大學 保健科學硏究所 1996 保健科學論集 Vol.22 No.1

Genotoxicity/mutagenicity of 2-bromopropane and toluene, benzene, trichloroethylene was investigated using umu-test with a Salmonella typhimurium TA1535 strain. The tester strain was derived by introducing plasmid pSK 1002, which carried a umu C-lac Z fussion gene into S.typhimurium TA1535, and tester strain in the presence of microsomal activation proved to be the more sensitive maker of genotoxcicity. Among the chemicals examined 4 compound induced umu gene expression, which could be defined on a basis of increased β-galactosidase activity in all 2- fold over the background level. But β-galactosidase activity appearance in all experiment chemical was not so high in compared with that background level.