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.

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.

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.

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.

한국 노인의 사기에 영향을 미치는 요인

전진숙(Jin Sook Cheon),변인우(In Woo Byun),송혜란(Hae Ran Song),오병훈(Byoung Hoon Oh) 대한노인정신의학회 2004 노인정신의학 Vol.8 No.1

Objectives:The aims of this study were to assess the morale of Korean elders, to analyze the affecting factors, and to look for the ways to raise their morale. Methods:The structured interviews and measurements of depression (Four-Item Geriatric Depression Scale and Vulnerability Factors), cognitive function (Short Portable Mental Status Questionnaire) and morale(Measurement of Morale in the Elderly Scale, MMES) were taken for the 50 Korean elders (28 females and 22 males) with age over 65 who were visiting Jong Myo during January to February in 2004. Results:1) In Korean elders, the mean scores of total MMES were 100.82±12.36. According to the items, mean scores of Satisfaction were 43.52±5.14, Equanimity 36.80±7.53, Will-to-live 20.00±4.43. 2) The total MMES scores were significantly affected by variables such as income (p<0.05), economy (p<0.005), elder abuse (p<0.01) and depression (p<0.001). While other variables including age, residence, education, number of children, sex, religion, spouse, job, illness and cognitive function were not related. Conclusion:To encourage morale in the Korean elders, economic support by welfarism, socio-legal prevention of elder abuse, and active involvement of geropsychiatrists into the early detection and treatment of depression must be needed.

알쯔하이머 질환의 분자신경생물학적 소견

김영훈(Young-Hoon Kim),이정구(Chung-Goo Rhee),김용관(Yong-Kwan Kim),김성수(Sung-Soo Kim) 대한노인정신의학회 1998 노인정신의학 Vol.2 No.1

알쯔하이머 질환은 heterogenous disorder이다. 가족성 혹은 비가족성 알쯔하이머 질환의 원인이 되거나 위험인자로 작용하는 유전인자에 대하여 정리하면 다음과 같다. 염색체 21번의 APP 유전자 돌연변이는 NP의 핵심물질인 Aβ42를 양산하고, 염색체 19번에 위치한 위험인자 Apo-E e4 allele는 Aβ를 효과적으로 제거하지 못해 Aβ40의 축적이 일어나며, 염색체 14번과 1번의 presenilin 돌연변이는 역시 섬유화 성향(fibrillogenic)이 높은 Aβ42, 43를 생산하여, 결과적으로 이들 모두 NP에 Aβ가 침착되는 것을 촉진한다(Table 4). Aβ의 침착이나, PHFtau로 형성된 NFT는 신경세포를 죽이고, 환자를 치매에 이르게 하는 최종공통경로(final common pathway)로 생각된다. 그러나 알쯔하이머 질환의 신경병리기전은 현재 그 일부만이 겨우 밝혀져 있을 뿐이다. 이 분야는 현재 뇌의 노화에 대한 과학적 접근과 중첩되는 분야로서, 기초과학적 욕구뿐만 아니라 사회의학적 관심도 고조되어 있어, 현재 어느 분야보다도 더 집중적인 연구가 이루어지고 있다. Alzheimer's disease (AD), the most common dementia in the elderly, is associated with a characteristic neuropathology:extracellular neuritic plaques (NPs) and intraneuronal neurofibrillary tangles (NFTs). AD is diagnosed clinically on the basis of progressive cognitive impairment. However, the diagnosis of AD is only reliable if a histopathological examination at autopsy shows high numbers of NPs and NFTs particularly in the hippocampus and cerebral cortex. The major component of NP is β-amyloid protein (Aβ), a fragment of the amyloid precursor protein (APP). NFTs are largely composed of paired helical filaments (PHFs) containing abnormally phospholylated form of the microtubule-associated protein (MAP), tau. A genetic etiology for AD has been established based on population survey. It is revealed that 25-40% of the AD patients are familial and the disease is inherited as an autosomal-dominant trait in most families. Age at onset patterns of AD patients in affected families had indicated that its distribution is bimodal with a cut-off age 58 years. Several mutations in the APP gene, located on chromosome 21, are linked to early-onset AD (EOAD). However, these account for only a small fraction of cases of EOAD. The remaining cases are associated with mutations in two other genes:one on chromosome 14 that encodes S182 (presenilin 1) and the other on chromosome 1 that encodes STM2 (presenilin 2). It is also known that inheritance of specific apolipoprotein E (apoE) alleles, located on chromosome 19, determines the risk and mean age of onset of late-onset AD (LOAD). In this review, we will briefly discuss the biology and hypothetical mechanisms of Aβ, presenilins, apoE and tau protein, those involved in the pathogenesis of AD.

여성노인의 성공적 노화를 위한 정체성과 정신건강의 관계

김일빈,안동현 대한노인정신의학회 2014 노인정신의학 Vol.18 No.1

Objective:The aim of this study was to explain what the relationship is between identity and psychological well-being and how these are related to successful aging of old-aged women. Methods:The subjects were thirty females above 60 years old in the first study where we interviewed each ten subjects for 2 hours in three groups. In the second study we surveyed 320 old-aged men and women by questionnaire for about 15 minutes. Results:From focus-group interview we found the freedom from everything in life was perceived as an important change in old-aged women. But their identity was mainly derived from family relationship in aspects of economy and/or care of their grand-son/-daughter. The results from analyses of questionnaire survey (n=320) were as follows ; first, women were more positive than men (female 63.1% versus male 56.5%) in the evaluation of their past life. Second, women were also more positive (female 23.7% versus male 15.2%) in the expectation for the future. Third, the successful aging had positive relationships with acceptance for aging, cohabitation with family members, income, female gender and age (65-69 years) ; and negative relationships with stress and loneliness/depression, but no relationships with decreased memory and poor sleep. Conclusion:We concluded that identity for the successful aging in old-aged women is mainly derived from family relationship.

노인 뇌졸중 환자에서 수면의 질과 연관된 임상 특징들

오민균(Min Kyun Oh),이철순(Cheol Soon Lee),박철수(Chul Soo Park),김봉조(Bong Jo Kim),차보석(Bo Seok Cha),김선미(Sun Mi Kim),이소진(So Jin Lee),신희석(Hee Suk Shin),김아람(A Ram Kim) 대한노인정신의학회 2011 노인정신의학 Vol.15 No.1

Objectives:Although sleep problem is a common complaint in stroke survivors, there is paucity of studies on quality of sleep in old patients with stroke. The purpose of this study was to investigate the clinical characteristics associated with quality of sleep in old patients with stroke. Methods:A comprehensive clinical and psychiatric assessments was performed in 30 patients who were admitted in rehabilitation department. Quality of sleep was evaluated with the Pittsburgh sleep quality index (PSQI). Other rating scales such as Modified Barthel Index, Korean mini mental state examination, Hamilton rating scale for anxiety, and Hamilton rating scale for depression were also performed to evaluate the clinical characteristics. Results:Thirteen patients (43%) were ‘poor sleeper’ defined as a global PSQI score 〉5. In the partial correlation test, poor sleeper group were significantly associated with anxiety (r=0.69, p〈0.01) and depression (r=0.76, p〈0.01). In the multivariate logistic regression analysis, depression symptoms (OR=1.51, p=0.01) were only significant predictor of ‘poor sleep’ compared with other factors including age, sex, stroke type, stoke location, stroke site, past medical history, anxiety, and cognitive function. Conclusion:The results may suggest that it is important to assess depression when old patients with stroke show decreased quality of sleep. Further following studies will be needed for finding relation with other clinical factors.

자살보도에 관한 객관적 평가 척도의 타당성 연구

박종익(Jong-Ik Park),황현국(Hyun-Kuk Hwang),서영은(Young-Eun Seo) 대한노인정신의학회 2016 노인정신의학 Vol.20 No.2

Objective:This study was conducted to develop the evaluating scale of adherence to guideline 2.0 for suicide reporting declared by Ministry of Health and Welfare and the Korea Suicide Prevention Center. Methods:Four hundred and fifty one subjects who work in suicide prevention center or mental health center across the country participated in survey. They responded to 20 items after reading media report regarding suicide episode. Two hundred and twenty six cases of recruited data were analyzed. Reliability and validity were assessed by Chronbach-α and exploratory factor analysis. Then, confirmatory factor analysis based on another 225 data was conducted. Results:The Results of exploratory factor analysis shows three factor structures. The validity of previous three factor structure based on confirmatory factor analysis was appropriate and the three factor structure consisted of 10 questionnaires with three subconcepts such as ‘glorification’, ‘lasciviousness’, and ‘providing information’. Conclusion:Three factor structures in the scale on media reports regarding as suicide is appropriate and this scale will contribute to evaluating suicide report on media.

노인의 우울 증상이 일반 및 암 건강검진 수검에 미치는 영향

조승원,김석현 대한노인정신의학회 2023 노인정신의학 Vol.27 No.1

Objective: In this study, we investigate the effect of depressive symptoms in elderly on general and cancer health screening participation using the large epidemiological study data in South Korea. Methods: This study was conducted on 1,977 people who responded to a health examination questionnaire among 2,360 adults aged 60 or older who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) in 2020. Depressive symptoms were measured by the Patient Health Questionnaire-9 and classified as minimal (0-4), mild (5-9), and moderate and severe (10-27). To investigate the relationship between depressive symptoms and health screening participation, a multiple logistic regression model controlling covariates was used. Results: Compared to the group with minimal depressive symptoms, the mild group did not show a significant difference (odd ratio [OR]=0.71, 95% confidence interval [95% CI]=0.45-1.13), but the moderate to severe group showed a significant negative relationship with general health screening participation (OR=0.59, 95% CI=0.35-0.99). There was a significant negative relationship between depressive symptoms and cancer health screening participation (mild group OR=0.77, 95% CI=0.48-1.23; moderate to severe group OR=0.50, 95% CI=0.28-0.87). Conclusion: This study showed that people with depressive symptoms are less likely to get a general and cancer health screening. In order to promote health screening participation, policies that consider health behavior promotion programs and psychiatric interventions targeting moderate to severe depressive symptom groups are necessary