전공의의 노인정신의학 교육

이민수(Min Soo Lee) 대한노인정신의학회 2000 노인정신의학 Vol.4 No.2

최근 우리사회의 인구통계학적 변화와 함께 노인정신의학의 효과적이고 체계적인 교육의 필요성이 증가되고 있다. 1994년 우리나라도‘대한노인정신의학회’가 창립되어 활발한 활동을 하고 있지만 교육적인 측면에서는 아직도 시작에 불과하다. 하지만 다가오는 나이의 물결‘age wave’을 대비하기 위해 우리는 노인을 위해서 과연 무엇을 할 수 있는가를 계획할 필요가 있다. 계획성이 있는 다양한 전략 중의 하나가 교육이다. 따라서 향후 노인정신의학 발전 방향에 도움을 주고자 오스트레일리아와 뉴질란드 노인정신의학(The Royal Australian and New Zealand College of Psychiatrists : RANZCP) 상급수련위원회의 세칙1-3)과 미국의 전공의 교육교과과정4)을 소개하고, 2000년도 전공의 수련실태조사서5)에 근거한 노인정신의학에 대한 현황을 알아보고자 한다. 끝으로 노인정신건강 교육의 필요성과 전략에 대한 추천사항6)을 살펴보고자 한다. Recently, the effective and systematic education for residents in geriatric psy-chaitry has been receiving needed attention and interests. However, in Korea, the position of the education in geriatric psychaitry is still in first step. So, the author review the bylaws for advanced training in old age psychiatry from the Royal Australian and New Zealand College of Psychiatrists(RANZCP), and a curriculum for education in geriatric psychiatry presented by the several universities in USA. Also the author let the psychiatrists in Korea know the present situation with the research in the actual condition of the residents in training hospitals performed by the Korea Neuropsychiatric Association in 2000. Finally review the specific recommendations for addressing the increased needs.

대한노인정신의학회의 정체성

박종한(Jonghan Park) 대한노인정신의학회 2004 노인정신의학 Vol.8 No.1

Identity of the Korean Association for Geriatric Psychiatry (KAGP) was discussed in terms of identity of geriatric psychiatry, past history and current status of the KAGP, and KAGP's future tasks. To sum up, the KAGP was successful in a variety of scientific and educational activities for a decade since its coming out to the world 10 years ago. However and at the same time, it has many long ways to go in the future.

대한노인정신의학회 창립초기의 회고

곽동일(Dong Il Kwak) 대한노인정신의학회 2005 노인정신의학 Vol.9 No.1

As a founding president of the Korean Association for Geriatric Psychiatry, I would like to look back on not only the quickening period of the association that was thirteen years ago but also on its early works and activities. This association was founded in 1994 in order to improve mental health of the aged in Korea and to help them live with dreams and ambitions. Starting with forty two members, the association has developed as one of the biggest associations, where approximately four hundred out of 2,221 psychiatrists in Korea are enrolled as regular members. In addition, it has made an eye-opening progress in terms of education, research and treatment. I hope that with the advent of an aged society, our association will play an influential role in helping the aged live creatively with hope and dignity by carrying out a psychogeriatric subspecialist system and by paying endless attention to their mental health.

Psychogeriatric Education

Byoung Hoon Oh(오병훈) 대한노인정신의학회 2000 노인정신의학 Vol.4 No.2

노인정신의학은 노년기 정신의학 또는 노인에게 생기는 정신질환으로 불리우기도 한다. 현재 노인인구의 급속한 증가는 노인정신의학 분야의 잘 교육된 전문가의 수요를 요구하고 있다. 발전된 노인정신과 전임의 교육 프로그램은 임상 및 교육부분의 전문교육 프로그램을 제공하고 있으며, 임상 및 연구 부분의 체계적인 경험을 필요로 하고 있다. 일반적으로 노인전임의 교육 프로그램은 2년간의 기간을 필요로 하며, 첫 1년간은 전문화된 임상 교육에, 2년째에는 노인분야의 연구에 중점을 두고있다. 임상교육 프로그램은 입원환자, 외래환자 및 자문.조정은 물론 지역사회 및 가정에서의 치료 프로그램으로 준비되어 있다. 연구프로그램은 알쯔하이머병을 중심으로 한 치매, 우울장애 등의 기분장애는 물론, 망상장애, 불안장애, 수면장애에 이르기까지 폭넓은 노인정신질환의 기초 및 임상연구를 포함하고 있다. 이러한 노인정신과 전임의 교육 프로그램은 1980년대에 미국을 시작으로 현재 캐나다, 영국 및 호주 등지에서 활발하게 실시되고 있으며, 체계적인 발전이 이루어지고 있다. 저자는 특히 호주의 노인정신과 전임의 교육 프로그램과정을 소개하고져 한다.

임상의사가 흔히 실수할 수 있는 노인 약물치료의 사례와 그 대처방안

오병훈(Byoung Hoon Oh) 대한노인정신의학회 2003 노인정신의학 Vol.7 No.1

Psychotropic drug use in the aged from 7-92% in institutional settings and up to 30% in medical settings. And older patients received an average of 5-12 medications per day in general hospitals. I reviewed common errors during psychotropic drug treatment and suggest the proper management guideline. In general, physical illness, medical drugs, drug-drug interactions and age-related physiological changes may alter psychotropic drug pharmacokinetics and it induced the severe adverse reactions from psychotropic agents. To proper management for the elderly patients with psychotropic drug treatment, the clinician must have skilled experiences of the effective drug administration and understand the unique characteristics of elderly individuals. And in addition, geriatric psychiatrist must be emphasized the psychosocial problems that may decrease drug compliance.

노인에서의 약물 유도성 섬망

김신겸(Shin Gyeom Kim),정한용(Han Yong Jung) 대한노인정신의학회 2008 노인정신의학 Vol.12 No.2

The elderly is accompanied by an increased likelihood of illness, and old people take a disproportionate amount of self-administered and prescribed medications. They are more likely to develop delirium as a result of taking medications than younger patients. Psychoactive drugs such as narcotics, long acting benzodiazepines, and tricyclic antidepressants are important causes of delirium. Drug induced confusion with nonpsychoactive drugs is often idiosyncratic in nature, and the diagnosis is easily missed. Anticholinergic medications are the most common causes of drug induced delirium in the elderly. Successful treatment of delirium depends on identifying the contributing factors, and drugs are the most common reversible cause of delirium. This article provides an clinical approach to prevent, recognize, and manage drug induced delirium.

노인요양병원 운영의 현황 및 전망

강홍조(Hong Cho Kang) 대한노인정신의학회 2005 노인정신의학 Vol.9 No.2

酒精이 白鼠의 短期記憶에 미치는 影響 : 酒精性 痴의 機轉

田珍淑(Jin-Sook Cheon) 대한노인정신의학회 1997 노인정신의학 Vol.1 No.1

주정의 만성적이고도 과다한 사용은 경미한 뇌손상을 초래하여 정신과정의 지연 및 추상적 사고장애를 포함하는 여러 기질성 정신장애를 일으키며, 또한 학습과 최근 기억의 장애를 초래한다고 알려졌다. 이러한 현상은 영양결핍에 의한다는 학설도 있으나, 이보다는 주정의 직접적인 신경독작용에 의해 전준두피질 또는 이와 관련된 피질하 구조물의 경미한 뇌병변에 기인된다는 학설이 더욱 지지받고 있다. 본 연구에서 주정투여가 단기기억에 어떠한 변화를 초래하며, 이는 뇌의 조직적 변화와 일치하는지, 또한 이러한 병변이 관계된 신경전달물질의 효현제나 길항제에 어떠한 반응을 보이는지 규명해 보고자 한다. 실험 1에서 체중 400∼500 gm 내외인 노령의 Sprague-Dawley 흰쥐 10마리, 실험 2 및 실험 3에서 체중 200∼300 gm 내외의 성인 Sprague-Dawley 수컷 45마리, 전체 55마리가 실험에 사용되었다. 실험 1에서 정상노화된 흰쥐 10마리에 대해 T-미로검사를 시행하고, 이를 5마리씩 두구으로 나누어 한 군은 atropine 투여 30분, 60분, 120분 후에 T-미로검사를 시행하고 나머지 한 군은 대조군으로 정하였으며, 행동시험이 끝난 후 phosphate buffered 10% formaldehyde 용액으로 심장내관류하여 뇌조직을 적출하고 H & E 염색을 하여 전전두피질 및 해마의 세포수를 측정하였다. 실험 2에서 정상 성인 흰쥐 10마리에 대해 T-미로검사를 시행하고 이를 5마리씩 양분하여 한군은 식수를, 나머지 한군은 14% ethanol을 상음시킨 후 매주마다 반복해서 T-미로검사를 시행하고 4주째 동일한 방법으로 조직검사를 시행하였다. 실험 3에서 35마리의 흰쥐에게 주정투여전 T-미로검사를 시행하고 이를 5마리씩 구분해서 매 2일마다 1군은 생리식염수, 2군은 fluoxetine, bromocriptine, bethacholine, nimodipine, clonidine, ketamine을 근육주사하고 매주마다 T-미로검사를 반복하고 4주째 동일한 방법으로 희생시켜 조직검사를 시행하였다. 1) 노령의 흰쥐에서 atropine 투여군은 atropine 투여 120분후 시행한 T-미로검사의 수행시간이 지연되는 경향을 보였으나 정상노화 대조군에 비해 통게적으로 유의한 수준의 차이를 보이지는 않았다. 2) 주정투여군은 주정비투여군에 비해서 T-미로검사 수행시간이 지연되는 경향을 보였고, 이는 특히 3주째에 현저하였으나 통계적 유의성은 없었다. 그러나 조직학적 검사에서는 CA1, CA3, 치상회, 전전두피질의 세포수가 주정투여군에서 주정비투여군 보다 유의하게 감소되었다(p Chronic and excessive alcohol consumption produces a subtle brain damage, which induces such organic mental disorders as delayed mental processes, abstract thinking impairment, and disturbances in learning and recent memory loss. These phenomena had been known to be caused by malnutrition. However, recent researches showed that it could be caused by mild brain lesions by direct neurotoxic effect of alcohol on the prefrontal cortex, or its related subcortical structures. This study was tried to evaluate the effect of alcohol on the short-term memory function, to compare with the histological changes, and to find out responses to the agonists and antagonists of possibly related neurotransmitters. For experiment 1, 10 aged male Sprague-Dawley rats weighed about 400-500 gm were used. 45 younger adult male Sprague-Dawley rats weighed about 200-300 gm were used for experiment 2 and 3. Therefore, 55 rats were totally used. In experiment 1, T-maze test with 10 nomal aged rats were done first, and then it was divided into 5 atropine-administered group and 5 control group. For the atropine-administered group, T-maze test was repeated on every 30, 60, 120 minute after the atropine injection. After the completion, of behavioral tests, the rats were sacrificed by the intracardiac perfusion with phosphate buffered 10% formaldehyde solution, and the brain specimen was stained with hematoxylin-eosin to count cells in the prefrontal cortex and the hippocampus. In experiment 2, T-maze test with 10 normal younger adult rats were done first, and then it was dividied into five 14% (v/v) ethanol administered group and 5 control group raised with tap water. T-maze test was repeated on every week for a month. After the completion of behavioral tests on the 4th week, histology was done by the same procedure. In experiment 3, Tmaze test with 35 normal younger adult rats were done first, and then it was divided into seven groups with five rats each other. 14% (v/v) ethanol was administered ad libitum. In addition, normal saline, fluoxetine, bromocriptine, bethacholine, nimodipine, clonidine, and ketamine were intramuscularly injected on every other day. T-maze test was repeated on every week for a month. After the completion of behavioral tests on the 4th week, histology was done by the same procedure. 1) The reaction time of T-maze test was more delayed on 120 minutes after atropine injection in atropine-administered rats than those in normal aged rats without statistical significance. 2) The reaction time of T-maze test was more delayed in ethanol-treated rats, especially most prominent on the 3rd week, than those in normal younger adult rats without statistical significance. However, cell numbers in the CA1, CA3, dentate gyrus and the prefrontal cortex were significantly reduced in ethanol-treated rats on histology (p

알츠하이머 치매와 경도인지장애에서 우울증상의 유병률과 특징

김윤아(Yoona Kim),박기창(Kichang Park),노현진(Hyunjean Roh),김민혁(Min-Hyuk Kim) 대한노인정신의학회 2013 노인정신의학 Vol.17 No.2

Objectives:This study aimed to identify the characteristics of depression in early dementia and mild cognitive impairment patients. Methods:We included 412 community-dwelling elderly. They were assessed with Mini-Mental Status Examination in the Korean version of the CERAD Assessment Packet (MMSE-KC), Clinical Dementia Rating Scale (CDR), Korean version of Geriatric Depression Scale (GDS) and Korean version of Hamilton Depression Rating Scale (HDRS). All patients were divided three groups, nondemented group (ND), mild cognitive impairment group (MCI), and early dementia group (ED). We compared depressive symptoms between three groups using each items of HDRS. Results:Prevalence of depression (GDS≥16) was 24.6% in ND, 33.3% in MCI and 41% in ED. Several items of HDRS, depressed mood, feeling of guilt, loss of work & interests, psychomotor retardation, psychomotor agitation, psychic anxiety, somatic anxiety, and gastrointestinal symptoms, were significantly associated with cognitive decline in all subjects. However, no item of HDRS was significantly associated with cognitive decline in depressive patients. Conclusion:This study suggests that the prevalence of depression may increase as cognitive function declines. There was no difference in depressive symptoms between three groups.

우울증이 치매조기검진에서 간이정신상태검사의 선별검사 예측 정확도에 미치는 영향

김세범(Se Beom Kim),이정재(Jung Jae Lee),이석범(Seok Bum Lee),이경규(Kyung Kyu Lee),백기청(Ki Chung Paik) 대한노인정신의학회 2016 노인정신의학 Vol.20 No.2

Objective:Depression and cognitive impairment are closely associated in old age. In this study, we investigate the influence of depression on the prediction accuracy of Mini-Mental State Examination (MMSE) as screening test for early detection of dementia. Methods:Three hundred and twenty one dementia patients and five hundred and thirty five normal control subjects were enrolled in this study. We administered both the Mini International Neuropsychiatric Inventory and the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet clinical and neuropsychological battery. We diagnosed depressive disorders according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition diagnostic criteria, and evaluated the severity of depressive symptoms using the revised Korean version of the Geriatric Depression Scale. Subjects were divided into two groups : 1) depressed group, 2) non-depressed group. We compared sensitivity, specificity, positive predictive value, negative predictive value, receiver operating characteristic curve, and areas of under the curve (AUC) of MMSE between two groups. Results:AUC of total group was 0.803 [95% confidence interval (CI)=0.774-0.833]. AUC of non-depressed group was the higher (0.855 ; 95% CI=0.823-0.887) than that of depressed group (0.767 ; 95% CI=0.710-0.824, p<0.009). Conclusion:In non-depressed group, diagnostic accuracy and positive predictive value were higher than those of depressed group. Depression should be considered for effective and efficient national dementia screening and registry program.