만성 틱장애에서 공존증상에 따른 틱증상의 심각도와 혈장 Homovanillic Acid 와 5-Hydroxyindoleacetic Acid 농도의 차이

육기환,민성길,장순아 대한신경정신의학회 2001 신경정신의학 Vol.40 No.1

연구목적: 틱장애에서는 다른 정신장애가 공존하는 경우가 매우 많은데, 고통을 주는 증상으로 특히 주의력결핍과잉운동증상과 강박증상이 관심을 받아 왔다. 틱장애의 병태생리에 대한 연구에서 도파민계, 세로토닌계, 아드레날린계 등의 중추 모노아민계의 이상이라고 하며 강박증상과 주의력결핍 과잉운동증상도 도파민계, 세로토닌계, 아드레날린계의 이상이라고 하였다. 본 연구는 틱장애 아동군에서 주의력결핍 과잉운동장애나 강박장애의 공존유무에 따라 틱증상의 심각도에 차이가 있는지 알아보고 틱증사의 심각도와 공존증상에 따라 혈장 homovanillic acid(HVA)와 5-hydroxyindoleacetic acid(5-HIAA) 농도에 차이가 있는지 알아보고자 시행되었다. 방법: 본 연구는 50명의 만성 틱장애를 가진 환자를 대상으로 강박장애와 주의력결핍 과잉운동장애를 진단하였고 틱증상과 강박증상과 주의력결핍 과잉운동증상을 각각 Yale global tic severity scale(YGTSS).Leyton obsessional inventory-child version(LOI-CV), Conners parent rating scale로 평가하였으며 high performance liquid chromatography를 이용하여 혈장 HVA와 5-HIAA 농도를 측정하였다. 결과: 틱장애 전체 대상군에서 강박장애나 주의력결핍 과잉운동장애가 공존된 경우 58%였으며 두 장애가공존되어 있어도 틱증상의 정도와 혈장 HVA와 혈장 5-HIAA 농도에 차이는 없었다. 틱 증상의 정도가심할수록 혈장 HVA 농도와 정의 상관관계를 보였으나 혈장 5-HIAA 농도와는 상관성이 없었다. 강박증상의 저항과 방해척도는 혈장 5-HIAA 농도와 역 상관관계를 보였다. 결론: 틱장애에 강박장애나 주의력결핍 과잉운동장애가 공존되어 있어도 틱증상의 심각도에 영향을 주지 않았다. 틱증상의 심각도는 혈장 HVA 농도와 상관관계가 있고 혈장 5-HIAA 농도와는 상관성이 없어 틱증상은 도파민계의 이상과 관련있음이 시사된다. Objectives : Contemporary empirical studies have suggested high rates of comorbid attention-deficit hyperactivity disorder(ADHD) or obsessive compulsive disorder(OCD) in children with tic disorders. Not infrequently, ADHD or OCD is as source of greater impairment than are the tic symptoms. The studies in the pathophysiology of tic disorder have implicated abnormalities of dopamine, serotonin and norepinephrine. The studies in pathophysiology of ADHD or OCD also have implicated abnormalities of dopamine, serotonin and norepinephrine. This study was purposed to examine the differences in tic severities and in the levels of plasma homovanillic acid(HVA) and 5-hydroxyindoleacetic acid(5-HIAA) according to the presence of comorbid ADHD or OCD in patients with chronic tic disorders. Methods : In fifty chronic tic patients, OCD or ADHD was also diagnosed. And then tic symptoms, obsessive-compulsive symptoms, and attention-deficit hyperactive symptoms were assessed using Yale global tic severity scale(YGTSS), Leyton obsessional inventory-child version (LOI-CV), and Conners parent ration scale. The plasma HVA and 5-HIAA levels were measured using high performance liquid chromatography with electrochemical detection method. Results : Fifty-eight percent of the patients with chronic tic disorders had comobid ADHD or OCD. But severities of tic did not differ regardless of the presence of comorbid ADHD or OCD. There was a significant positive correlation between tic severities and plasma HVA levels but none between tic severities and plasma 5-HIAA levels. There was a significant inverse correlation between resistance and interferencd scores and plasma 5-HIAA levels. Plasma HVA levels showed significant positive correlations with plasma 5-HIAA levels. Conclusion : These results showed that tic severities didn't vary according to the presence of comorbidities, and that tic severities were correlated with plasma HVA levels, not with plasma 5-HIAA levels. These results suggested that the pathophysiology of chronic tic disorder was strongly correlated with abnormalities of dopaminergic system.

소아·청소년 정신장애의 종류

육기환 韓國學校保健學會 1998 韓國學校保健學會誌 Vol.11 No.2

Psychopharmacotherapy in Preschooler(일반적 고려사항과 적용)

육기환 대한소아청소년정신의학회 2011 대한소아청소년정신의학회 학술대회논문집 Vol.2011 No.4

한국인이 생각하는 나르시시즘(Narcissism)의 개념에 대한 예비연구

이만홍,육기환 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.3

Objects : In order to define different concepts of narcissism in Korean, this study was designed to compare the concept of narcissism by Korean laymen with that of DSM-Ⅲ-R. Methods : 1) Initially, 2 laymen & 4 psychiatric personnel were interviewed and made to describe in free association on narcissism. With these results and the DSM-Ⅲ-R diagnostic criteria of narcissistic personality disorder, we developed a semistructured interview. 2) Using this semistructured interview, authors interviewed 28 key informants(14 laymen, 14 psychiatric residents) an asked them to describe their own understanding of prototypical person of narcissism. Psychiatric residents were comparative subjects to laymen. Results : Laymen thought positively that narcissism was one part of personality, made them achieve self-confidence and a new vitality in life, and consequently made them more enthusiastic in one's work. Narcissism was thught to result in possible difficulties of interpersonal relationships espeually by psychiatric residents. There was a gender difference which concentrated on the differences-men thought level of education, job, success, fame and money more important whereas women took as important factors such as appearance, relationships with one's spouse or lover and his social standing. Men overtly require acceptance by others whereas women self-absorption and intellectual achievement. When one is denied, men directly show aggressive response whereas women show this indirectly and later. Laymen saw narcissism as normal, while some saw it as a personality disorder or mental disorder. Reasons contribute to narcissism were developmental factor and socioenvironmental factor. Conclusions : Concepts and psychopathology of narcissism did not seem little difference between opinions of laymen and DSM-Ⅲ-R. Laymen took narcissism more positively than psychiatric residents. It was taken as part of personality, required for normal development and professional capabilities are above average and have achievement and self-confidence. Narcissism did not require treatment or when necessary it would become better. Results suggested that narcissism has sex difference more or less.

학교폭력 피해 청소년의 정신의학적 후유증에 관한 사례 연구

송동호,육기환,이호분,노경선 대한소아ㆍ청소년정신의학회 1997 소아청소년정신의학 Vol.8 No.2

주의력결핍 과잉행동장애 아동에서 공존질환에 따른 OROS-Methylphenidate의 효과와 안전성

윤형준,육기환,전덕인,석정호,홍나래,조성식,홍현주 대한소아청소년 정신의학회 2008 소아청소년정신의학 Vol.19 No.3

Objectives : The purpose of this study is to evaluate the efficacy and tolerability of OROS-Methylphenidate(MPH) in children with Attention Deficit Hyperactivity Disorder(ADHD) according to comorbid psychiatric disorders. Methods : This is an 8-week open label study of OROS-MPH monotherapy. Subjects were 6-12 years of aged 113 children with ADHD. Outcome measures were Korean version parent ADHD rating scale(K-ARS), Korean version Conners parent rating scale(K-CPRS), Clinical Global Impression-Severity and Clinical Global Impression -Improvement. Side effects were monitored with the Barkley’s side effect rating scale. We compared change-over-time of mean scores of outcome measure according to comorbidity of disruptive behavior disorder, depressive disorder, anxiety disorder, and tic disorder. Results : Mean scores of K-ARS and K-CPRS were significantly decreased regardless of comorbidity. Mean doses of OROS-MPH and dropout rate were not different significantly according to comorbidity. For side effects, overall OROS-MPH was well tolerated despite comorbidity. However, children with tic disorder reported higher tics or nervous movements item than those without tic disorder from 2nd week to 8th week. Conclusion: OROS-MPH is efficacious for decreasing the symptoms of ADHD and well tolerated regardless of comorbid psychiatric disorders.

청소년 우울증에서 비자살적 자해에 영향을 주는 심리사회적 요인

예덕해,홍현주,육기환,최혜인,이지은,전진용,박일호,구민성,송정은 대한우울조울병학회 2012 우울조울병 Vol.10 No.2

Objective : The object of our study was to compare the psychosocial and clinical characteristics between depressed adolescents with a history of Non-suicidal self-injury (NSSI) and those without a history of NSSI. Method : We recruited 63 subjects, age 13-18 adolescents who were diagnosed as depressive disorders with Korean version of Kiddie-Schedule for Affective Disorder and Schizophrenia Present and Lifetime Version. Adolescents completed Beck depression inventory, Revised children’s manifest anxiety scale, Beck suicidal ideation Scale, physical abuse and emotional abuse scale. Results : Results showed that suicidal ideation score (21.88, p=0.01), emotional (32.62, p=0.003) and physical (31.70, p=0.001) abuse score were higher in adolescents with a history of NSSI than those without a history of NSSI. Regression analysis indicated that suicidal ideation have a small but significant influence on NSSI event (beta=0.144, p=0.017). Conclusion : Our findings suggested that clinicians should consider the possibility of abuse history and suicidality in adolescents with a history of NSSI.

전반적발달장애 아동 및 발달성언어장애 아동의 뇌 단일광자방출전산화단층촬영 소견에 대한 예비연구

이호분,신의진,육기환,유영훈,노경선,송동호 대한소아ㆍ청소년정신의학회 1997 소아청소년정신의학 Vol.8 No.2

주의력결핍 과잉운동장애 남아에서 중추신경자극제가 주의력과제 수행 중의 대뇌 기능적 국소화에 미치는 영향

전덕인,송동호,육기환,김경희,신동원,민성길 대한소아ㆍ청소년정신의학회 1998 소아청소년정신의학 Vol.9 No.2

청소년의 내재화 및 외현화 장애 평가와 진단에서 K-CBCL과 MMPI-A의 유용성

이슬아,김근향,육기환 한국임상심리학회 2012 Korean Journal of Clinical Psychology Vol.31 No.1

The purpose of this study was to examine the profiles of K-CBCL and MMPI-A in adolescents with internalizing or externalizing disorders. Parents of adolescents with internalizing disorders(n=34) and those with externalizing disorders(n=29) completed the Korean Child Behavior Checklist(K-CBCL). Adolescents in both groups completed the Korean MMPI-A. The subscales of K-CBCL well reflected the behavioral problems of each group. In the MMPI-A profiles, the internalizing disorders group showed elevated scores on F, Hs, D, Hy, Pd Pa, Pt, Sc, and Si. Moreover, in all subscales of MMPI-A except L and K, they showed higher scores than the externalizing disorders group, and the difference in some scales was statistically significant. Any subscales of MMPI-A was not elevated over 60T score in the profiles of the externalizing disorders group. MMPI-A profiles showed the emotional and psychological characteristics of adolescents with internalizing disorders but did not reflect well those of adolescents with externalizing disorders. It could be attributed to the personality characteristics of adolescents with externalizing disorders. Further studies need to recruit participants with more specific diagnosis. The results of the logistic regression analyses revealed that Pt scale was especially important in discriminating between the two groups. According to the pearson correlation analysis, some subscales of K-CBCL and those of MMPI-A showed mild correlation. Lastly, the limitations of this study and suggestions for further research are discussed.