정신분열병의 해리증상, 아동기 학대 및 임상증상의 관계

이경우(Gyeong Woo Lee),배활립(Hwallip Bae),김양석(Yangsuk Kim),박준성(June Sung Park),김대호(Daeho Kim) 대한생물치료정신의학회 2008 생물치료정신의학 Vol.14 No.1

Objectives : Studies consistently find high prevalence of early sexual or physical abuse among the schizophrenic population suggesting a possible linkage between psychological trauma and schizophrenia. This study sought for clinical correlates of dissociative symptoms in schizophrenia concerning childhood abuse and a variety of symptoms. Methods : Sixty-one inpatients with schizophrenia completed Dissociative Experiences Scale(DES), Symptom Checklist-90-Revised(SCL-90-R), Positive and Negative Syndrome Scale(PANSS), and a semistructured interview on abuse history. Results : The Global Severity Index(GSI) of SCL-90-R, positive symptom, chlorpromazine equivalent, and childhood abuse were significantly correlated with DES scores. However, multiple regression analysis yielded GSI and positive symptom accounting 57% of variance for DES scores. Conclusion : This finding suggests that the symptoms of dissociation in schizophrenia are rather associated with severity of general symptomatology and positive symptoms than history of childhood abuse. Some portion of schizophrenic population with high scores on DES need to be further investigated for their characteristics and pathophysiology.

알코올사용장애를 동반한 외상후스트레스 장애의 EMDR 치료 증례

한창우(Changwoo Han),배활립(Hwallip Bae) 한국중독정신의학회 2016 중독정신의학 Vol.20 No.1

Objectives : The aim of this study is to share the therapeutic potential of eye movement desensitization and reprocessing (EMDR) in post-traumatic stress disorder (PTSD) with alcohol use disorder. Methods : This case report concerns a Korean survivor of an earthquake that occurred in New Zealand in 2010. The subject was a female patient in her late 20s who presented with almost all symptoms of the PTSD. In addition, she had reached a degree corresponding to the diagnosis of alcoholism. Results : Four 90-min sessions were delivered weekly by the first author for 4 weeks with 1-week intervals between sessions. At 6 months post-EMDR, one additional EMDR was performed to treat residual symptoms. Conclusion : She became greatly stable after 3rd session. She was able to sleep without relying on alcohol and to return to her daily life. Before EMDR was car-ried out, the patient’s the clinician administered PTSD scale (CAPS) score was 78, the Alcohol Use Disorders Identification Test (AUDIT) score was 17, and the Korean version of the Alcohol Dependence Scale (ADS-K) score was 15. At 6 months after EMDR, her CAPS score was 28, which fell outside the diagnostic level for PTSD. AUDIT and ADS-K scores were 13 and 10, respectively.

군 병사들에서 인터넷 중독 경향에 따른 입대 후 심리특성 변화

강현묵,김현수,조현상,안석균,오병훈,이강수,홍창형,배활립,국소담,손상준,Kang, Hyun Mook,Kim, Hyun Soo,Cho, Hyun Sang,An, Suk Kyoon,Oh, Byoung Hoon,Lee, Kang Soo,Hong, Chang Hyung,Bae, Hwallip,Kook, So Dahm,Son, Sang Joon 대한생물정신의학회 2013 생물정신의학 Vol.20 No.3

Objectives The aim of this study was to find out the psychological changes associated with internet addiction between before and after the military drill among the young male army recruits. Methods All 1091 participants were army recruits aged from 19 to 22 years who participated in the 5-week military drill. They were assessed with some self-reported questionnaires [Sociodemographic questionnaires, Young's Internet Addiction Scale (IAS), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), the Barratt Impulsiveness Scale (BIS), the Attention-Deficit/Hyperactivity Disorder Self-Rated Scale (ASRS)]. They were divided into two groups, One is the internet addiction tendency group and the other is non-addiction group according to the IAS score. And the severity of the internet addiction tendency, depression, anxiety and impulsiveness were evaluated by the IAS, the STAI, the BDI, the BIS, the ASRS before and after military drill. Results The result of the paired t-test shows that the IAS, the STAI, the BDI, the BIS, the ASRS scores decreased after military drill in both non-addiction group and internet addiction tendency group. The result of the repeated measures ANOVA shows that there is an interaction effect between the changes of ASRS-hyperactivity (F = 23.437, p < 0.001), ASRS-impulsiveness (F = 4.896, p = 0.027), BIS-total (F = 4.057, p = 0.044), BIS-motor impulsiveness (F = 13.609, p < 0.001) scores and groups. The result of the generalized estimating equation shows that internet addiction tendency is associated with ASRS-inattention (${\beta}=0.075$, p < 0.001), ASRS-hyperactivity (${\beta}=0.092$, p = 0.002), STAI-trait anxiety (${\beta}=0.046$, p < 0.001), BIS-motor impulsiveness (${\beta}=0.119$, p = 0.028). Conclusions The results show that psychopathologies such as internet addiction tendency, depression, anxiety, impulsiveness may improve after military drill regardless of the groups. Internet addiction tendency may be related to the ASRS-inattention, ASRS-hyperactivity, STAI-trait anxiety, motor-impulsiveness. So these findings may be considered in the treatment of internet addiction in terms of the impulsiveness control.

공황장애 환자에서 인지행동치료 전후의 불안민감성의 남녀차이

이선혜(Sunhea Lee),김양석(Yangsuk Kim),오동훈(Dong Hoon Oh),배활립(Hwallip Bae),김석현(Seok Hyeon Kim),최주연(Jooyeon Choi) 대한스트레스학회 2008 스트레스硏究 Vol.16 No.3

이 연구에서는 공황장애 환자에서 인지행동치료 전후의 불안민감성의 남녀 차이를 조사하였다. DSM-VI에 따라 광장공포증을 동반하거나 동반하지 않은 공황장애로 진단된 남자 28명과 여자 31명에 대해 인지행동치료 시작전후의 불안민감성지표(ASI)를 측정하였다. 여자에서 치료전 ASI 총점 및 인지적 염려요인의 점수만이 유의하게 높았다. ASI 총점 및 각 소척도 점수가 남녀 모두에서 각각 유의하게 감소하였지만 남녀간의 차이는 유의하지 않았다. 인지행동치료 후에는 여자에서 인지적 염려요인 및 사회적 염려요인만이 높게 나타났다. 이는 인지적 염려요인이 공황장애의 병인 및 예후의 남녀 차이와 연관있을 가능성을 보여준다. 사회적 염려요인에 대해서는 추후 논의가 필요하다. This study examined gender differences in anxiety sensitivity in patient with panic disorder with or without agoraphobia that were treated with cognitive behavioral therapy (CBT). Fifty nine outpatients (men 28, women 31) with DSM-IV confirmed panic disorder completed the Anxiety Sensitivity Index (ASI) at baseline and after 12 week CBT. Women scored significantly higher than men in total ASI score and Mental Incapacitation Concern subscale score at baseline. And no significant gender differences were found in Physical Concern subscale score and Social Concern subscale score at baseline. This study also compared total ASI score and each subscale scores between baseline and post-treatment. Although total ASI score and each subscale scores decreased significantly in both sexes, no significant gender differences were founded. After CBT, women scored significantly higher than men on Mental Incapacitation Concern subscale and Social Concern subscale. But no significant gender differences were found in total ASI score and Physical Concern subscale score. This finding that women scored high Mental Incapacitation Concern subscale score both at baseline and after CBT and supports previous finding that Mental Incapacitation subscale can be associated with gender differences in pathogenesis and prognosis of panic disorder. Total ASI score, Physical Concern subscale score and decrease of anxiety sensitivity after treatment do not seem to be associated with gender differences in pathogenesis and prognosis of panic disorder directly. Further discussion is needed about Social Concern subscale.

조현병 환자의 항정신병 약물에 대한 부정적 태도 및삶의 질에 미치는 영향

한창우(Changwoo Han),신경민(Kyoung Min Shin),손상준(Sang Joon Son),국소담(Sodahm Kook),배활립(Hwallip Bae),정경희(Kyung Hi Jung),김현수(Hyun Soo Kim) 대한사회정신의학회 2013 사회정신의학 Vol.18 No.2

목 적 : 조현병은 다양한 정신병적 증상과 함께 인지능력 감소와 사회적 기능저하 등을 초래하여 일상생활에 장애를 일으킨다. 조현병 환자들이 삶의 질에 영향을 미치는 요인들은 다양한데, 그 중 환자들이 항정신병 약물에 대해서 갖는 태도는 조현병 환자들의 삶의 질을 떨어뜨릴 수 있는 주요 원인으로 알려져 있다. 따라서 본 연구에서는 조현병 환자들의 항정신병 약물에 대해서 갖고 있는 주관적 태도를 확인하고, 이것이 환자들의 삶에 질에 어떠한 영향을 주는 지를 알아보고자 하였다. 방 법 : 정신보건 센터에 등록된 조현병 환자 248명을 대상으로 구조화된 설문지를 사용하여 자기 기입 방식으로 정보를 수집하였다. 우선, 참가자들의 동반된 비정신과적 신체질환을 조사하였다. 신체질환이 있는 조현병 환자들을 대상으로 한국판 약물태도 검사(Korean version of Drug Attitude Inventory-10)을 사용하여 항정신병 약물에 대한 태도를 확인하였으며, 이것을 신체질환 약물에 대한 태도와 paired t-test를 실시하여 비교 분석하였다. 또한 조현병 환자들의 약물에 대한 태도가 삶의 질에 미치는 영향을 확인하기 위하여, 항정신병 약물에 대해서 한국판 세계보건기구 삶의 질 척도 단축형(WHOQOL-BREF)을 시행하고, Pearson 상관분석을 통해서 비교하였다. 결 과 : 조현병 환자들 중 신체 질환이 있는 환자들은 43.9%에 해당하는 107명 이었다. 신체질환이 있는 조현병 환자들의 항정신병 약물에 대한 태도 및 반응과 신체질환 약물에 대한 태도는 긍정적 태도 점수 및 전체 점수에서 유의한 차이가 나타나지 않았으나, 부정적 태도 점수에서는 유의미한 차이를 보였다. 삶의 질과 약물 태도의 상관관계를 분석해본 결과, 항정신병 약물에 대한 주관적인 긍정적 태도는 삶의 질 척도의 심리건강, 환경, 전체 평균 영역과 유의한 정적 상관관계를 보였으나 항정신병 약물에 대한 부정적 태도는 삶의 질 척도의 모든 영역과 유의미한 정적 상관을 보였다. 결 론 : 조현병 환자들은 항정신병 약물에 대해서 신체질환 약물보다 부정적인 태도를 보였다. 또한 조현병 환자들의 이러한 항정신병 약물에 대한 태도는 다양한 영역에서 환자들의 삶의 질에 영향을 미치는데, 항정신병 약물에 대한 부정적인 태도가 긍정적인 태도에 비해 다양한 영역에서 관련성이 있는 것으로 조사되었다. 따라서 조현병 환자들은 항정신병 약물에 대해서 부정적인 태도를 보이며, 이러한 항정신병 약물에 대한 태도는 조현병 환자들의 삶의 질에 영향을 미치는 중요한 요인이 될 수 있다. Objectives : The aim of this study was to examine the drug attitude toward antipsychotics in schizophrenic patients. This study also evaluated the relationship between drug attitude and quality of life in patients with schizophrenia. Methods : The study was carried out on the 248 patients with schizophrenia attending a Community Mental Health Center in Gangdong-gu. This study protocol included sociodemographic variables, information about physical health, Korean version of Drug Attitude Inventory-10 (KDAI-10), and World Health Organization Quality of Life (WHOQOL-BREF). Data were analyzed using One way ANOVA, χ 2 -test, paired t-test, and Pearson correlation coefficients with SPSS 17.0 program. Results : The participants showed significantly more negative attitude toward antipsychotics than somatic medicines. The nega-tive attitude toward antipsychotics was correlated with all domain of quality of life and the positive drug attitude toward antipsychotics was correlated with some domain of quality of life. Conclusion : The results of this study suggest that schizophrenic patients have the negative attitude toward antipsychotics. And the subjective attitude toward antipsychotics seems to be correlated with quality of life in schizophrenic patients.

불안장애 외래 환자의 대인관계 외상과 관련된 증상학적 요인

배활립,김대호,김양석,오대영 大韓神經精神醫學會 2008 신경정신의학 Vol.47 No.6

Objectives : Psychiatric patients report higher rates of interpersonal trauma, and they present with more symptoms and behavioral problems. However, less is known about other anxiety disorders, except for posttraumatic stress disorder. In this study, we investigated symptomatic correlates of interpersonal trauma (i.e., physical or sexual assaults) in patients with heterogeneous anxiety disorders. Methods : We surveyed a consecutive sample of 90 outpatients with DSM-IV anxiety disorders (panic disorder, generalized anxiety disorder, obsessive compulsive disorder, social phobia, anxiety disorder not otherwise specified) at the psychiatric department of a university-affiliated hospital. The questionnaire was comprised of the Symptom Checklist-90-Revised (SCL-90-R), Beck Depression Inventory, State and Trait Anxiety Inventory, and Impact of Events Scale-Revised. Results : Patients with interpersonal trauma (n=51) demonstrated a significantly higher level of interpersonal sensitivity, paranoid ideation, and obsessive-compulsive subscale of the SCL-90-R. However, logistic regression analysis suggested that interpersonal sensitivity alone was suggested as the best fitting model. Conclusion : Anxiety disorder patients with interpersonal trauma demonstrated difficulty in domains of interpersonal relationship. Clinicians treating this population should consider this finding for better engagement and management.

외상 후 강박장애의 연속 증례 : 6개월 추적 조사

배활립,김대호,안정우 大韓神經精神醫學會 2006 신경정신의학 Vol.45 No.5

A number of recent case reports and series indicate that obsessive compulsive disorder (OCD) can develop after traumatic experience as a comorbid conditon to post-traumatic stress disorder (PTSD). These descriptive studies consistently addressed that those patients respond poorly to treatments and had an unfavorable outcome. However, this conclusion was not supported by prospective follow up with objective measurement of symptomatology. This report presents three single trauma-related PTSD patients who developed full-blown OCD concurrently with or after the initiation of PTSD. These patients represent 10% of new PTSD outpatients at a PTSD clinic during one year period and 25% of PTSD patients who had been admitted, In all three cases compulsion seemed to distract or serve as avoidance to intrusive symptoms of PTSD. Despite Eye Movement Desensitization and Reprocessing (EMDR) and/or exposure therapy for PTSD together with at least two antidepressant trials for PTSD and OCD, at six month follow-up PTSD partially improved and OCD remained unchanged. This finding is consistent with previous reports from western literature.

정신분열병 환자의 정신병후 외상후 스트레스 장애 : 연속 증례

배활립,오대영,김대호 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.1

Objectives : A growing body of literature supports the view that experiences of psychotic symptoms or involuntary admission may act as traumatic events which cause post-traumatic stress disorder (PTSD). Authors report three cases of postpsychotic (PP) PTSD developed in the course of schizophrenic illness. Methods : Clinician-administered PTSD Scale (CAPS) and Positive and Negative Syndrome Scale for Schizophrenia (PA-NSS) were administered for evaluation of symptomatology. Results : Two cases represented PP/PTSD caused by psychotic symptoms, especially auditory and visual hallucination, and one case by forced involuntary admissions. All three cases met DSM-IV diagnostic criteria of PTSD. The severity was mild in therange of 48 to 51 by CAPS. Conclusion : PP/PTSD developed during or soon after psychotic episodes and persisted for as long as nine years, Clinicians working with individuals with psychotic disorders should keep in mind that some portion of their patients may suffer from lin-gering posttraumatic effect of psychotic episode -related experiences.

정신분열병 환자의 아동기 신체, 성학대와 MMPI 특성

김대호,김진훈,정승아,남정현,배활립,장혜진 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.3

Objectives : The symptomatic and behavioral correlates of childhood trauma in schizophrenia are beginning to emerge in the literature. This study aimed to investigate whether the association between personality traits and schizophrenia with childhood abuse can be replicated in Koreans using the Multiphasic Minnesota Personality Inventory (MMPI). Methods : Eighteen schizophrenias with childhood abuse and 24 schizophrenic comparisons without abuse history were recruited at the inpatient units of two general hospitals and the subjects completed the MMPI. Results : Subjects with schizophrenia plus childhood history of abuse had less educational years (p<.001). After controlling the educational year as a covariate, abused schizophrenic patients had higher scores in the Schizotypal (p=.003), Dependent (p=.014), Passive-aggressive (p=.034), Borderline (p=.045) subscales. For the validity and clinical subscales, significant differences were found in the F scale (p=.036), Hypochondriasis (p=.042), Depression (p<.001), Hysteria (p=.002), Per-sonality disorder (p=.001), Paranoia (p=.024), Psychasthenia (p=.001) and Schizophrenia (p=.006) subscales. Conclusion : Our findings suggest that childhood abuse in schizophrenia is associated with more complex features of Per-sonality characteristics rather than specific cluster B personality traits.