신체형장애, 우울장애 및 정신신체장애 환자들간의 질병행동의 비교

고경봉,기선완,Koh, Kyung-Bong,Ki, Sun-Wan 한국정신신체의학회 1997 정신신체의학 Vol.5 No.2

A comparison was made regarding illness behavior among patients with somatoform disorders, depressive disorders and psychosomatic disorders. The subjects consisted of out-patients with somatoform disorders(N=52), depressive disorders(N=52) and psychosomatic disorders(N=51). illness behavior was assessed by illness Behavior Assessment Schedule and the questionnaire about help-seeking behavior. The patients with somatoform disorders and psychosomatic disorders more often affirmed the presence of somatic disease, were more likely to have phobia of disease, had more preoccupation with ideas of disease and more frequently shopped around oriental clinics than the patients with depressive disorders. The patients with somatoform disorders more often attributed its cause to physical factors, less often attributed the origin of affective disturbance to psychological causes, showed Less depression and irritability, and were less likely to accept psychiatric treatment recommended by other physicians than depressive patients. The patients with somatoform disorders were more likely to report having been told that they suffered from a mild illness than those with psychosomatic disorders. The patients with somatoform disorders with psychological problems tended to inhibit expression of their emotion. Female patients with somatoform disorders more often affirmed the presence of psychological disorder and attributed its cause to psychological factors than male ones. These results suggest that in illness behavior, patients with somatoform disorders are different from depressive patients, whereas the former patients are similar to psychosomatic patients except the discrepancy between therapists and patients regarding evaluation of their symptoms. Thus, it is emphasized that first, therapists need to approach patients with somatoform disorders somatically with understanding of their underlying need to deny psychological problems, followed by either psychological or biopsychosocial approach. 본 연구는 정신과외래에 내원한 52명의 신체형장애, 52명의 우울장애, 51명의 정신신체장애환자들을 대상으로 질병행동을 비교하기 위해 실시되었다 질병행동을 평가하기 위해서 질병행동평가스케줄(illness behavior assessment schedule) 및 치료추구행태에 관한 설문을 사용하였으며 면담방법은 구조적인 형태로 이루어졌다. 신체형장애환자들과 정신신체장애환자들은 각각 우울장애환자들에 비해 신체적 질병에 대한 확신, 질병에 대한 공포, 질병에 대한 집착이 더 강하고 한의원의 이용빈도가 더 높았다. 신체형장애환자들은 우울장애환자들에 비해 질병의 원인을 신체적인 것으로 더 확신하고 정동장애의 원인을 심리적인 것으로 귀착시키는 경향이 낮으며 우울 및 안절부절못하는 정도 및 정신과에 대한 수용도가 각각 더 낮았다. 한편 신체형장애환자들은 정신신체장애환자들보다 질병의 정도가 더 경한 것으로 설명되었음을 확신하였다. 신체형장애환자들은 정신적 고통이 있는 경우에 감정표현의 억제가 더 현저하였다. 신체형장애환자들 중 여자들이 남자들보다 더 심리적 장애가 있고 병의 원인을 심리적인 인자로 귀착시켜 여자에 대한 정신과적 접근이 더 용이할 수 있음을 시사하였다. 이상의 결과들은 질병 행동에 있어서 신체형장애환자들이 우울장애환자들과는 다른 반면 증상의 평가에 있어서 치료자와 환자간의 차이를 제외하고는 정신신체장애환자들과 비슷한 양상임을 시사한다. 따라서 신체형장애환자들에 대한 접근은 이런 환자들의 심리적인 것을 부정하려는 욕구를 이해하면서 처음에는 신체적인 접근으로 시작하여 점진적으로 심리적 및 생물정신사회적인 접근으로 전환해야 할 필요성이 강조된다.조절되어진다는 사실을 제시한다. 하지만 태생어류에서 이 호르몬의 실질적 작용 메카니즘 및 명확한 작용시기에 대해서는 보다 많은 연구가 요구되어 진다.을 설계하는 것이 가능하였다.적(最適) 온도(溫度)는 $30^{\circ}C$, avicelase와 ${\beta}-glucosidase$의 최적(最適) pH는 5.0, CMCase는 pH 5.5 이었으며, 균사(菌絲) 생육(生育)은 pH 5.0에서 양호(良好)하였다. 배양(培養) 기간(期間)은 avicelase가 8일(日), CMCase가 10일(日), ${\beta}-glucosidase$는 16 일간(日間) 배양(培養)하였을 때 최대치(最大値)를 보였고, 균사(菌絲) 생육(生育)은 12일(日) 배양(培養)했을 때 가장 양호(良好)하였다.가한 반면, 중국인들은 고소한 향의 강도, 고소한 향의 기호도, 전체적인 맛에서 뚜렷하게 일본참기름을 우수하게 평가하였다.s의 항체(抗體)로 반응(反應)시킨 후 protein-A gold(15 nm)로 표식(標識)시킨 바 제일 바깥 상층(上層)의 keratinocyte에 있어서 세포막표면(細胞膜表面)을 따라 표식(標識)되어 세포막항원(細胞膜抗元)을 나타내었으며, 이와 같은 소견(所見)으로 미루어 정상피부(正常皮膚) 중층편평상피세포(重層扁平上皮細胞)에서도 동일(同一)한 소견(所見)을 관찰(觀察)할 수 있다고 본다.al remnants, Resorption of fetus로 관찰된 것이다. Fetal death는 수정후 $14{\sim}18$일까지의 사망으로써 Maceration of fetus로

한국인 남성 알코올 의존증에서 나타난 도파민 D2 수용체의 대립유전자형 빈도

이종섭(Jong Sub Lee),오미희(Mee Hee Oh),이창훈(Chang Hoon Lee),송경순(Kyoung Soon Song),배종훈(Jong Hoon Bae),기선완(Sun Wan Ki),이홍식(Hong Shick Lee),유계준(Kae Joon You) 한국중독정신의학회 1997 중독정신의학 Vol.1 No.1

Dopamine D2 receptor(DRD2) gene is known to have a strong effect on susceptibility of alcohol dependence and to play an important role on appetite such as alcohol seeking behavior. It is known that alcohol induces excitatory effects on dopamine neurons and stimulates brain reward systems by which man craves euphorogenic reward effect of drug(such as alcohol). And it has been suggested that DRD2 has a direct role on alcohol seeking behavior. This study investigated polymorphic patterns of DRD2 gene of Korean male alcohol dependence by restriction fragment length polymorphism(RFLP) and associations of Korean character traits with susceptibility on alcohol. Also, this study examined allelic association of DRD2 gene in various chara cteristics and alcohol-related of alcohol dependence. Subjects of this study consisted of 71 patients with alcohol dependence and 139 healthy male subjects without alcohol dependence for the study of allelic association of DRD2 gene in Korean male alcohol dependence. Allelic association of DRD2 gene between two groups was tested by chi-square test, and those in severity and family history of alcohol dependence, age onset of alcohol drinking, and duration of alcohol drinking history were tested by ANOVA and t-test. The results were as followings; 1) A1A1, A1A2, A2A2 genotype frequency of DRD2 gene in Korean male alcohol dependence were 19.7%, 29.6%, 50.7% and those of control group were 15.8%, 51.8%, 33.1%. There was statistically significant difference between two groups. 2) Ratios of Korean male alcohol dependence with and without A1 allele were 0.49, 0.51 respectively, and those of control groups were 0.67, 0.33 respectively. The difference between two groups were statistically significant. But the difference between two groups on ratio of presence of A2 allele was not statistically insignificant. 3) A1 and A2 allelic frequencies of Korean male alcohol dependence were 0.35 and 0.65 and those of control group were 0.42, 0.58 respectively. So there was no evidence of DRD2 A1 allelic association in Korean alcohol dependence. 4) According to Diagnostic Criteria of National Council on Alcoholism(NCA) on severity alcohol dependence, the genotype of the most severe alcohol dependence was A1A1. on the other hand, the less severe type was A1A2, and the least severe type was A2A2. And A1 and A2 allele frequency of severe alcohol dependence were 0.46 and 0.54 respectively and those of less severe alcohol dependence were 0.18 and 0.72 respectively. Therefore, there was allelic association of DRD2 gene in severity of Korean male alcohol dependence. 5) There were statistically significant differences among subgroups with A1A1, A1A2, A2A2 genotypes on scores of NCA in total patients with alcohol dependence and also significant differences between patients with alcohol dependence with and without A1 allele on scores of NCA. Therefore, there was statistically significant possibility in allelic association of DRD2 gene in NCA scores of patients with alcohol dependence. 6) There were no allelic associations of DRD2 gene in the variable characteristics(age, family history of alcohol dependence, onset age of alcohol drinking, and onset age of alcohol problems). 7) In comparing A1 allelic frequencies of DRD2 gene in this study with those in other studies on various populations, there were no differences statistically among Asians in controls and statistically significant differences, however, in other populations elsewhere. And there were also higher in A1 allelic frequencies in Korean and Japanese with alcohol dependence than the whites. In summarizing above results, there was no allelic association of DRD2 gene in Korean male alcohol dependence, but there was the possibility of A1 allelic association in severity of alcohol dependence. So this study implied that Korean alcohol dependence were influenced by extenal factor like severity of alcohol dependence rather than genetic factor. Therefore