불안과 GABA 체계

양종철,Yang, Jong-Chul 대한불안의학회 2006 대한불안의학회지 Vol.2 No.2

Anxiety and anxiety disorders are related to many neurotransmitters, such as norepinephrine, serotonine, dopamine, glutamate, and Gamma-aminobutyric acid (GABA). GABA, the main inhibitory neurotransmitter of the CNS, is known to counterbalance the action of the excitatory neurotransmitters and control anxiety. GABA acts on 3 GABA receptor subtypes, $GABA_A$, $GABA_B$, and $GABA_C$. $GABA_A$ and $GABA_c$ receptors are oligomeric transmembrane glycoproteins composed of 5 subunits that are arranged around a central chloride channel. $GABA_B$ receptor comprises two 7-transmembraneis-spanning proteins that are coupled to either calcium or potassium channel via G proteins. This article highlights neurobiological interactions between anxiety and GABA system.

방사선치료 중인 암 환자의 심리와 삶의 질

양종철(Jong-Chul Yang),정웅기(Woong-Ki Chung) 대한방사선종양학회 2004 Radiation Oncology Journal Vol.22 No.4

목적: 본 연구의 목적은 방사선치료 중인 암 환자의 심리적 특징과 삶의 질을 조사하고, 삶의 질에 영향을 미치는 변인들을 파악함으로써 암 환자의 심리에 대한 이해와 치료적 접근 및 삶의 질 향상을 위한 기초 자료를 제공함에 있다. 대상 및 방법: 전남대학교병원 방사선종양학과에서 방사선치료를 받고 있는 암 환자 36명과 정상대조군 20명을 대상으로 하였다. 환자들의 사회 인구학적 자료 및 임상적 특성을 조사하였고, 심리적 특징은 symptom checklist- 90-revised, Rosenberg의 self-esteem scale을 통해 평가하였으며, 삶의 질은 World Health Organization Quality of Life Assessment Instrument를 통해 비교 분석한 후, 이들 간의 상관관계를 조사하였다. 결과: 암 환자는 정상대조군에 비해 신체화 경향, 우울, 불안, 적대감 등이 유의하게 높았고, 자아존중감과 삶의 질은 유의하게 낮았다. 사회 인구학적 변인에 따른 심리, 자아존중감, 삶의 질의 비교에서는 유의한 차이가 없었다. 임상적 특성과 연관성 조사에서는 전이가 있는 군에서는 불안, 공포, 경계심이 높고, 통증이 있는 경우에 신체화가 높게 나타났으며, 체중감량이 심할수록 신체화가 높았다. 우울, 불안, 적대감이 높을수록 자아존중감이 낮았으며, 신체화, 우울, 불안, 적대감이 높을수록 삶의 질이 낮은 것으로 나타났다. 결론: 방사선치료를 받고 있는 암 환자의 치료에 있어서는 신체화 경향, 우울, 불안, 적대감 등의 심리적 문제에 대한 이해와 치료적 접근이 병행되어야 하고, 특히 삶의 질을 개선하기 위해서 이러한 심리적인 문제의 해결과 통증 관리가 중요한 것으로 나타났다. Purpose: The object of this study is to investigate sociodemographic and clinical characteristics, psychology, self-esteem and quality of life in cancer patients on radiation therapy and to provide useful information for therapeutic approach to cancer patients on radiation therapy. Materials and Methods: The subjects were 36 patents who had been treated with radiation therapy and 20 normal people. Sociodemographic information and clinical characteristics of cancer patients on radiation therapy were investigated, and symptom checklist-90-revised, Rosenberg Self-esteem Scale for self esteem, World Health Organization Quality of Life Assessment Instrument for quality of life were administered to subjects. And Spearman's correlation analysis was used among these. Result: The tendency of somatization, depression, anxiety and hostility in cancer group were significantly higher than normal group. Self esteem and quality of life in cancer group were significantly lower than normal group. No significant difference was found in comparison of psychology, self esteem and quality of life according to sociodemographic variables. Among clinical characteristics, in the presence of metastasis in cancer patients, the scores of anxiety, phobia and paranoid ideation were higher. In patients with pain, the score of somatization was higher. And in case of weight loss, the score of somatization was higher. The higher score of depression, anxiety and hostility were significantly associated with lower self-esteem. And higher score of somatization, depression, anxiety and hostility were significantly associated with lower quality of life. Conclusion: Understanding and management of psychological symptoms, such as somatization, depression, anxiety, and hostility, and pain control are necessary to improve quality of life in cancer patients on radiation therapy.

공황장애 약물 치료에 대한 한국형 알고리듬 개발(3) - 인지행동치료 -

이상혁,양종철,윤세창,서호석,김찬형,유범희,김민숙,Lee, Sang-Hyuk,Yang, Jong-Chul,Yoon, Se-Chang,Suh, Ho-Suk,Kim, Chan-Hyung,Yu, Bum-Hee,Park, Min-Sook 대한불안의학회 2008 대한불안의학회지 Vol.4 No.1

Objective : A working group of psychiatrists from the Korean Academy of Anxiety Disorders was established to determine the appropriate medication algorithm for treating patients with panic disorder. In this article, we discussed the consensus among psychiatrists regarding the use of cognitive behavior therapy (CBT) in the development of a treatment algorithm for panic disorder in Korea. Methods : Based on the guidelines or algorithms published by the American Psychiatric Association, National Institute for Clinical Excellence, and Canadian Psychiatric Association, we constructed questionnaires regarding the core components and contents of CBT for patients with panic disorder. Fifty-four experts in panic disorder completed the questionnaires. Results : There was statistically significant consensus among the experts in the belief that cognitive reconstruction and psychological education are the core components of CBT for the treatment of patients with panic disorder. However, there was some inconsistency between the opinions of some experts regarding the content and frequency of CBT and the results of studies published outside of Korea. Conclusions : CBT, especially the psychological education and cognitive reconstruction components, should be considered when treating patients with panic disorder. However, further consideration needs to be put into the design of a more detailed treatment guideline for the use of CBT in the treatment of patients with panic disorder.

외상후스트레스장애 환자에 대한 음악요법의 적용 일례

권순재,양종철,박태원,정영철,정상근,Kwon, Soon-Jae,Yang, Jong-Chul,Park, Tae-Won,Chung, Young-Chul,Chung, Sang-Keun 대한불안의학회 2012 대한불안의학회지 Vol.8 No.1

Music therapy had been widely used in the area of psychiatry. However recently, participation of psychiatrist has been decreased, due to recent trends of emphasizing biological psychiatry and rapid effectiveness of pharmacotherapy. A 46 years old male PTSD patient was admitted to psychiatric ward. He has suffered from PTSD symptoms, such as intrusive distressing recollection of his past traffic accident, social avoidance, insomnia and depression. Music therapy, which is conducted by a psychiatrist and a music therapist, was applied. This case suggests the positive role of music therapy in treatment of PTSD and emphasizes the importance of participation of psychiatrist, as an organizer during music therapy.

Subsyndromal Anxiety Disorder의 특징과 임상적 중요성

강남인,양종철,Kang, Nam-In,Yang, Jong-Chul 대한생물정신의학회 2011 생물정신의학 Vol.18 No.4

Subsyndromal anxiety disorder indicates mental states of having anxiety symptoms not fulfilling criteria for anxiety disorders. Despite of the lack of previous objective findings of the subsyndromal anxiety disorder, its clinical importance has increased. It can cause many kinds of clinical anxiety symptoms and functional disabilities. But the early intervention and early treatment make it possible not only to attenuate the anxiety symptoms and functional disabilities but also to prevent disease progression to a full syndromal anxiety disorder. In this article, we will review the previous studies about the subsyndromal anxiety disorder and discuss its clinical characteristics and importance.

두통의 약물학적 치료

나은진,박종일,양종철,Na, Eun-Jin,Park, Jong-Il,Yang, Jong-Chul 한국정신신체의학회 2016 정신신체의학 Vol.24 No.1

두통은 대부분의 사람들이 평생 한번씩은 경험하는 가장 흔한 신체증상이다. 심각한 상황을 야기하는 뇌종양과 같은 일부의 원인을 제외하고, 두통의 대부분은 편두통이나 긴장성 두통과 같은 일차성 두통으로 알려져 있다. 두통의 정확한 진단은 임상의들의 자세한 병력 청취와 신체 검사로부터 시작된다. 본 종설에서는 두통의 세부진단과 진단과정에 대해 고찰하고, 효과적인 약물치료 전략에 대해서 논의하고자 한다. Headache is one of the most common physical symptoms which almost everyone experience at least once during a life. Headache is often associated with disability, but rarely with secondary headache which could result in a serious life-threatening illness, i.e. brain tumor. However, in most cases, headache is a benign illness which comprises a primary headache, i.e. migraine or tension-type headache. The accurate diagnosis of headache is critical for clinicians and it begins with history taking and physical examination since there are no diagnostic tests for primary headaches. Nowadays, there are a wide variety of pharmacological treatments according to each headache disorder. The specific purposes of this review are introducing history of classification of headache disorder and presenting diagnostic process of headache disorder. Then, we discuss the effective pharmacological treatment strategies of each headache disorder.

외상 후 스트레스 장애의 역동정신치료

김중영,박종일,양종철,Kim, Jung-Young,Park, Jong-Il,Yang, Jong-Chul 대한불안의학회 2015 대한불안의학회지 Vol.11 No.2

In psychodynamic therapy, trauma related symptoms are considered as an attempt to overcome the traumatic experiences. Therefore, psychodynamic psychotherapy regards the symptom not as a patient's defect but as an adaptive reaction. In contrast to other therapies, psychodynamic theory places heavy emphasis on the understanding and resolution of the patient's symptoms. In addition, transference is a distinctive feature of this theory, which plays a significant role of reflecting the realistic evaluation on the therapist's characteristics, and in guaranteeing the therapeutic alliance. The psychodynamic therapist inducts meaning from the patient's unconscious mind. The therapist's task is to help the patient to better understand defense mechanisms guide their management of experiences and reactions, and facilitate a better understanding of their personal experiences.

자살 시도자에서 혈장 Brain-Derived Neurotrophic Factor 농도 저하

원성두,심세훈,양종철,이헌정,이분희,한창수,김계현,김용구,Won, Seong-Doo,Shim, Se-Hoon,Yang, Jong-Chul,Lee, Heon-Jeong,Lee, Bun-Hee,Han, Chang-Su,Kim, Kye-Hyun,Kim, Yong-Ku 대한생물정신의학회 2005 생물정신의학 Vol.12 No.2

Objects:Some studies have suggested that brain-derived neurotrophic factor(BDNF), one of the most important neurotrophins, is involved in pathophysiology of depression and suicide. This study was performed to determine whether there is an abnormality in plasma BDNF concentration in suicidal attempters. Methods:The subjects were 71 suicidal attempters who visited emergency rooms in multi-medical centers. All subjects had been interviewed by using Structured Clinical Interview for DSM-IV(SCID), Hamilton Depression Rating Scale(HDRS), Young Mania Rating Scale(YMRS), and Positive And Negative Syndrome Scale(PANSS). The severity of the suicidal behavior was measured by Lethality of Suicide Attempt Rating Scale(LSARS) and Risk-Rescue Rating(RRR) system. Seventy-one age, sex, and diagnosis matched non-suicidal psychiatric patients who were consecutively admitted to a psychiatric ward during the same period recruited as psychiatric controls. They were drug-naive or drug-free at least more than 2 months. In addition, 80 healthy controls were randomly selected as normal controls. Plasma BDNF level was measured by the enzyme linked immunosorbent assay(ELISA) methods. Results:In overall F-test, differences of the plasma BDNF levels among the groups were statistically significant(F=20.226, p<0.001). In the multiple comparisons(Scheffe), while mean levels of plasma BDNF between normal controls and non-suicidal psychiatric patients were similar(p=0.984), the BDNF levels of suicidal attempters were lower than those of other two groups(p<0.001). LSARS and RRR did not reveal any significant correlations with BDNF levels in suicidal attempters. Conclusion:These results suggest that reduction of plasma BDNF level is related to suicidal behavior and BDNF level may be a biological marker of suicidal behavior.

공황장애의 임상적 특성과 Brain-Derived Neurotrophic Factor 농도와의 관계

황인호,박종일,양종철,Hwang, In-Ho,Park, Jong-Il,Yang, Jong-Chul 대한불안의학회 2015 대한불안의학회지 Vol.11 No.2

Objective : Brain-derived neurotrophic factor (BDNF) is implicated in the pathophysiology of several neuropsychiatric disorders. However, there are few studies on BDNF of panic disorder. In this study, we investigated plasma BDNF levels in patients with panic disorder, and evaluated whether there are associations between clinical characteristics of panic disorder and plasma BDNF levels. Methods : We included 110 patients with panic disorder and 110 health controls in the current study. Plasma BDNF levels were measured by the enzyme-linked immunosorbent assay (ELISA). Plasma BDNF level differences were evaluated according to the clinical characteristics, such as duration of illness, recent stressful life event, agoraphobia, and insomnia. Results : The mean plasma BDNF levels of patients with panic disorder were significantly lower, as compared with those of controls (192.50 pg/mL vs. 693.75 pg/mL, t=8.838, p<0.001). The mean plasma BDNF levels of patients who had recent stressful life events were significantly higher, as compared with those who did not ($269.79{\pm}358.96pg/mL$ vs. $136.94{\pm}187.06pg/mL$, t=-2.525, p=0.013). Conclusion : These results suggested that BDNF plays a potential role in the pathophysiology of panic disorder.

범불안장애 환자의 스트레스 대처방식과 신체증상 지각에 대한 인지적 특성

김용,박종일,박태원,정상근,양종철,Kim, Yong,Park, Jong-Il,Park, Tae-Won,Chung, SangKeun,Yang, Jong-Chul 대한불안의학회 2017 대한불안의학회지 Vol.13 No.2

Objective : The purpose of this study was to investigate strategies used to cope with stress and the cognitive characteristics of somatic symptom perception in patients with generalized anxiety disorder(GAD). Methods : A total of 55 patients meeting DSM-5 criteria for GAD and 55 normal controls were recruited for participation in this study. We evaluated subjects using The Way of Stress Coping Questionnaire (SCQ), Somato-Sensory Amplification Scale (SSAS), Symptom Interpretation Questionnaire (SIQ), and the Generalized Anxiety Disorder for 7 Item (GAD-7). We analyzed data using an independent t-test and Pearson's correlation analysis. Results : In terms of SCQ, GAD patients presented significantly lower scores on seeking social support and higher scores on wishful thinking than normal controls. GAD patients had significantly greater amplification of physical sensation in SSAS and higher scores in physical, psychological interpretation subsets of SIQ than normal controls. GAD-7 scores were positively correlated with physical interpretation scores on SIQ. Conclusion : Results reveal that patients with GAD have insufficient coping strategies for stress, greater amplification of body sensations, and tendency towards a physical, psychological interpretation of somatic symptoms.