알코올 사용 장애에서 양극성 장애 선별 질문지들의 타당성 및 임상적 유용성 비교를 위한 예비연구

박소현,손인기,이규항,함웅,서정석 대한우울조울병학회 2016 우울조울병 Vol.14 No.2

Objectives : The objective of this study is to evaluate the validity of the Korean version of Mood Disorder Questionnaire (K-MDQ), the Korean version of Hypomania Checklist-32 (K-HCL-32) and the Korean version of Bipolar spectrum diagnostic scale (K-BSDS) as screening tools for bipolar disorder (BD) in patients with alcohol use disorder. Methods : 161 admitted patients with alcohol use disorder completed the K-MDQ, K-HCL-32, K-BSDS and all participants were assessed with the Structured Clinical Interview for DSM-IV to diagnose BD. Results : Among 161 patients with alcohol use disorder, 21 patients (13.0%) met criteria for a lifetime diagnosis of bipolar I disorder. In this study, we found that scores associated with increased energy and sexual activity are significantly high in comorbid group while scores associated with irritability/impulsivity are not. The K-HCL-32 showed higher sensitivity (0.809) and specificity (0.742) than K-MDQ or K-BSDS with cut-off score of 16. Conclusion : These results indicate that among the three screening tools for bipolar disorder, K-HCL-32 is the most valid and useful tool in alcohol use disorder patients with cut-off score of 16. In addition, this study propose that questions about increased energy and sexual activity are key point for detecting BD in alcohol use disorder patients.

가족 역할을 중심으로 본 한국 여성의 섭식장애

권다예,김정선 한국보건사회학회 2017 보건과 사회과학 Vol.0 No.44

This study attempts to examine the social dimension of eating disorder among adolescent girls in Korea, particularly focusing on the role of family. Recent studies on the cause of eating disorder in adolescent girls pointed out physical, psychological, and social factors such as BMI, stress, and pressures of media or friends are important in framing eating habits and perception of eating disorders. To examine the important dynamics of personal and social factors of eating disorder in adolescent girls in Korea, a survey was carried out in a girls’ high school in Daegu. In addition, to back up a survey data, in-depth interviews were conducted to 17 women with eating disorder problems. Several significant results are as follows: First, 13.4% of the respondents are have eating disorder and 28.4% are classified as “high risk for eating disorder group” in this survey. Eating disorder is serious problem in adolescent girls. Second, stress, family diet pressure, diet-will and media diet pressure affected Eat-26 (p<0.001). Especially, family diet pressure is the most influential factor in the level of Eat-26 (B=.248, t=3.849). Third, from the in-deapth interviews of 17 people who have experienced eating disorder, it is found that family’s diet pressure and abuse by family were key to start to diet which led them to eating disorder. It is found that family played a significant role in overcoming eating disorder. In conclusion, this study suggests that we should look for multiple dimensions as cause of eating disorder among adolescent girls, including physical and mental aspect at individual level and various aspects of social factors. The result especially implies the crucial role of family in the whole process of eating disorder. 섭식에 불편함을 겪는 섭식 장애는 ‘정신 질환(mental disease)’으로 분류되지만, 섭식 장애가 여성이라는 특정 성, 15세에서 25세라는 특정 연령, ‘음식이 풍부한 선진 국가’라는 특정 지역에 주로나타난다는 사실은 섭식 장애가 사회 경제적 요인을 함께 고려해야 하는 ‘질병(illness)’의 성격을 지니고 있음을 함의 한다. 본 연구는 실제 섭식 장애 경험자 17명을 대상으로 한 심층 면접과 지방의한 여자고등학교 학생들을 대상으로 한 설문조사를 바탕으로 섭식장애에 영향을 미치는 다양한 요인들을 분석하였다. 그 결과 440명의 응답자 중 약 13.4%가 섭식 장애를 경험하는 것으로 추정되었으며, 28.4%가 섭식 장애 위험군으로 분류되었다. 섭식장애에 영향을 미치는 사회적 요인을 분석하기위해 회귀분석을 한 결과 BMI지수로 본 신체적 요인, 본인의 다이어트 의지, 스트레스 등과 같은 인지적 요인, 미디어나 가족의 압력 등과 같은 사회적 요인들이 유의미한 변수로 파악되었다. 특히 가족들의 다이어트에 대한 압력이 섭식 장애에 가장 큰 영향력을 미치고 있는 것으로 파악되었다. 이러한 양적분석의 결과는 심층면접 결과로도 확인되는데 가족들의 다양한 층위의 다이어트 압력 외에도음식을 통한 가족의 학대, 가족의 강압적 분위기 등이 섭식 장애와 관련이 있다는 점이 드러났다. 동시에 섭식 장애의 극복에 있어서도 가족의 지지와 역할이 중요한 것으로 나타나, 섭식 장애의 발생과극복에 있어서 가족은 중요한 변수로 작용한다는 것을 확인할 수 있었다.

불안 장애, 우울 장애 및 정신증 환자군의 지적 기능 비교

전혜연(Hye-Yeon Jeon),박은희(Eun-Hee Park),전덕인(Duk-In Jon) 대한스트레스학회 2010 스트레스硏究 Vol.18 No.4

본 연구는 불안 장애 환자, 우울 장애 환자와 정신증 환자군의 지적 기능의 특성을 K-WAIS를 중심으로 살펴보았다. 불안 장애 47명, 우울 장애 56명과 정신증 62명을 대상으로 K-WAIS의 결과를 연령과 교육년수를 통제하고 MANCOVA를 실행하였다. 그 결과, 불안 장애 환자군이 우울 장애 환자군과 정신증 환자 장애군에 비하여 숫자 외우기 소검사에서 유의미하게 높은 점수를 받았다. 불안 장애 환자군과 우울 장애 환자군에 비하여 정신증 환자군이 산수 소검사, 동작성 지능과 주의지속능력 요인에서 유의미하게 낮은 수행을 보였다. 또한 정신증 환자군은 이해문제, 차례 맞추기, 모양 맞추기, 바꿔쓰기 소검사와 언어성 지능, 전체 지능, 지각적 조직화 요인에서도 불안 장애 환자군에 비하여 유의미한 수준으로 저조한 수행을 보이고 있었다. 세 집단의 지적 기능에서 유의한 차이를 보인 본 연구의 결과는 각 장애의 일상생활 기능의 손상 정도를 예측할 수 있게 해주는 중요한 정보가 될 수 있을 것으로 생각된다. This study was investigated about the characteristics of intellectual functions among patients with anxiety, depressive and psychotic disorder on the Korean-Wechsler Adult Intelligence Scale (K-WAIS). The participants were 47 patients with anxiety disorder, 56 patients with depressive disorder, and 62 patients with psychotic disorder. The data were statistically analyzed using multivariate analysis of covariance (MANCOVA) controlling for age and educational level. It was found that the anxiety disorder group acquired significantly higher scores in digit span subtest than the depressive disorder and psychotic disorder groups. The psychotic disorder group acquired significantly lower scores in arithmetic subtest, performance IQ, Freedom from Distractibility factor than the anxiety and depressive disorder groups. Moreover, the psychotic disorder group scored significantly lower in several subtests (comprehension, picture arrangement, object assembly, and digit symbol), verbal and full scale IQ, and perceptual organization factor than the anxiety disorder group. The result suggests that the three clinical groups are differential differences in terms of intellectual abilities. It implicates the probability that it would reflect the differences of functional level in everyday life in each group. (Korean J Str Res 2010;18:353∼362)

Does Post-traumatic Stress Disorder Impact Treatment Outcomes within a Randomised Controlled Trial of Mitochondrial Agents for Bipolar Depression?

Samantha E. Russell,Anna L. Wrobel,Melanie M. Ashton,Alyna Turner,Mohammadreza Mohebbi,MIchael Berk,Sue Cotton,Seetal Dodd,Chee H. Ng,Gin S. Malhi,Olivia M. Dean 대한정신약물학회 2023 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.21 No.3

Objective: Bipolar disorder often co-occurs with post-traumatic stress disorder, yet few studies have investigated the impact of post-traumatic stress disorder in bipolar disorder on treatment outcomes. The aim of this sub-analysis was to explore symptoms and functioning outcomes between those with bipolar disorder alone and those with comorbid bipolar disorder and post-traumatic stress disorder. Methods: Participants (n = 148) with bipolar depression were randomised to: (i) N-acetylcysteine alone; (ii) a combination of nutraceuticals; (iii) or placebo (in addition to treatment as usual) for 16 weeks (+4 weeks discontinuation). Differences between bipolar disorder and comorbid bipolar disorder and post-traumatic stress disorder on symptoms and functioning at five timepoints, as well as on the rate of change from baseline to week 16 and baseline to week 20, were examined. Results: There were no baseline differences between bipolar disorder alone and comorbid bipolar disorder and post-traumatic stress disorder apart from the bipolar disorder alone group being significantly more likely to be married (p = 0.01). There were also no significant differences between bipolar disorder alone and comorbid bipolar disorder and post-traumatic stress disorder on symptoms and functioning. Conclusion: There were no differences in clinical outcomes over time within the context of an adjunctive randomised controlled trial between those with bipolar disorder alone compared to those with comorbid bipolar disorder and post-traumatic stress disorder. However, differences in psychosocial factors may provide targets for areas of specific support for people with comorbid bipolar disorder and post-traumatic stress disorder.

게임이용장애의 질병코드화의 법적 문제점

황성기 한국정보법학회 2019 정보법학 Vol.23 No.3

세계보건기구(WHO)가 제72차 총회 중인 2019. 5. 25. 국제질병‧사인분류(ICD)의 제11차 개정판에 게임이용장애(gaming disorder)를 행위중독의 하위분류로 등재시키는, 즉 게임이용장애에 대해서 질병코드를 부여하는 최종결정을 내렸다. 향후 우리나라 통계청이 관리하는 한국표준질병‧사인분류(KCD)가 이를 수용 및 반영할 것인지가 문제되고 있고, 이에 관해서는 현재 우리 사회에서 그 찬반에 관한 치열한 논쟁이 벌어지고 있다. 이 연구는 게임이용장애의 질병코드화의 문제점을 법적인 관점에서 분석하는 것을 목적으로 한다. 분석 결과 게임이용장애의 질병코드화의 법적 문제점은 다음과 같다. 첫째, 게임이용장애의 질병코드화의 법적 의미는, “공중보건의학적 관점에서의 게임이용장애라는 질병이 법적 구속력을 갖는 일반적‧추상적 규범화된다.”는 것을 의미한다. 둘째, 게임이용장애의 질병코드화는 우리나라 헌법의 기본원리인 문화국가원리에 반한다. 게임이용장애의 질병코드화는 문화국가원리가 허용하는 차원의 문화영역에 대한 국가 개입의 범위를 유월하기 때문이다. 셋째, 게임이용장애의 질병코드화에 대해서는 표현의 자유 보장법리에 따른 헌법적 통제가 필요한데, 게임이용장애의 질병코드화는 과잉금지원칙을 위반하여 표현의 자유를 침해한다. 넷째, 게임이용장애의 질병코드화는 예술의 자유가 보호하고자 하는 가치를 몰각시키고, 예술의 자유 중에서 예술창작의 자유와 예술표현의 자유를 침해할 가능성이 매우 높다. 다섯째, 게임이용장애의 질병코드화는 문화생활과 관련되어 있는 기본권으로 이해될 수 있는 문화향유권을 침해하거나 형해화시킬 위험성이 매우 크다. 여섯째, 게임이용장애의 질병코드화는 문화콘텐츠산업에 관한 현행 법체계와 조화를 이루지 못하는 것이고, 따라서 체계정당성을 충족하지 못할 가능성이 높다. 일곱째, 게임이용장애의 질병코드화는 특정한 행위나 성향을 개인적‧사회문화적 맥락을 배제한 채 무조건 질병으로 분류하는 것으로서 그 자체가 문제이다. The World Health Organization(WHO) listed the ‘gaming disorder’ as a subclass of behavioral addiction in the 11th edition of the International Classification of Diseases on May 25, 2019. It is questioned whether Korean Standard Classification of Disease and Cause of Death, which is managed by Korea National Statistical Office in the future, will accept and reflect it. In this regard, there is intense debate about the pros and cons in our society. The purpose of this study is to analyze the problems of disease coding of gaming disorder from the legal point of view. Particularly, the legal problems concerning disease coding of gaming disorder are as follows. First, the legal meaning of the disease coding of gaming disorder is that “the disease of gaming disorder from the public health medical point of view becomes a general and abstract norm with legally binding force.” Second, disease coding of gaming disorder is contrary to the principle of cultural state, which is the basic principle of the Korean Constitution. This is because disease coding of gaming disorder transcends the range of state interventions in cultural areas at the level allowed by the principle of cultural state. Third, the disease coding of gaming disorder requires constitutional control according to the law of guaranteeing freedom of expression. The disease coding of gaming disorder infringes on the freedom of expression by violating the principle of proportion. Fourth, the disease coding of gaming disorder is very likely to invade the value that art freedom seeks to protect and to infringe on the freedom of art creation and freedom of expression of art. Fifth, the disease coding of gaming disorder has a high risk of infringing on right to culture, which can be understood as basic right related to cultural life. Sixth, the disease coding of gaming disorder is inconsistent with the current legal system of the cultural contents industry, and therefore, the possibility of failing to satisfy the system legitimacy is high. Seventh, the disease coding of gaming disorder is problematic in itself that classifies specific behavior or disposition as a disease without any personal and sociocultural context.

불안장애

정한용,Jung, Han-Yong 한국생명보험의학회 2010 保險醫學會誌 Vol.29 No.1

Anxiety disorders Anxiety disorders are among the most prevalent mental disorders in the general population. Anxiety disorders can be viewed as a family of related but distinct mental disorders, which include following as classified in the text revision of fourth edition of Diagnostic and Statistical Manual Disorders(DSM-IV-TR): (1) panic disorder with or without agoraphobia; (2) agoraphobia with or without panic disorder; (3) specific phobia; (4) social phobia; (5) obsessive-compulsive disorder; (6) posttraumatic stress disorder; (7) acute stress disorder; (8) generalized anxiety disorder. An acute intense attack of anxiety accompanied by feeling of impending doom is known as panic disorder. The term phobia refer to an excessive fear of a specific object, circumstance, or situation. Obsessivecompulsive disorder is represented by a diverse group of symptoms that include intrusive thoughts, rituals, preoccupations, and compulsions. Posttraumatic stress disorder is a condition marked by development of symptoms after exposure to traumatic life events. Generalized anxiety disorder is defined as excessive anxiety and worry about several events or activities for most days during at least a 6-month period.

한국 여성 섭식장애 환자에서 알코올 사용 장애의 공동이환율

이선구(Seon-Koo Lee),이정현(Jung-Hyun Lee),신미연(Mi-Yeon Shin),김준기(Joon-Ki Kim),남궁기(Kee Namkoong),정영철(Young-Chul Jung) 한국중독정신의학회 2009 중독정신의학 Vol.13 No.2

Objectives:This study assessed the prevalence and clinical characteristics of eating disorder patients with alcohol use disorder in Korea. Methods:We assessed 418 female eating dis-order outpatients on demographics, eating psychopathologies, personal characteristics, and alcohol-related problems via semi-structured interviews. Results:17.2% of the patients reported the comorbidity of alcohol use disorder. Eating disorder combined with alcohol use disorder was more prevalent in patients with anorexia nervosa, (binge-eating/purging type) and bulimia nervosa than in those with anorexia nervosa (restricting type). Also, patients with an eating disorder combined with alcohol use disorder were more impulsive than were eating-disorder patients without alcohol use disorder. Conclusion:We found a meaningful subgroup of patients in Korea with both eating disorder and alcohol use disorder, having distinct sociodemographic characteristics and symptoms.

Schizoaffective Disorder

Andreas Marneros 대한조현병학회 2012 대한조현병학회지 Vol.15 No.1

Schizoaffective disorders are a controversially discussed but existing nosological category describing an episodic condition meeting the criteria of both schizophrenia and mood disorders and lying on a continuum between these two prototypes. Both DSM-IV and ICD-10 classify them within the group of “schizophrenia, schizotypal and delusional disorders” with ICD-10 not requiring the absence of mood symptoms for a certain time. Cross-sectionally, schizoaffective disorder can be subdivided into schizodepressive, schizomanic and mixed types. In a longitudinal way, unipolar and bipolar types are distinguished. The division into schizo-dominated and mood dominated types is based on the severity and dominance of the schizophreniform symptomatology and implies significant consequences for treatment and prognosis. In addition, concurrent types should be differentiated from sequential types. Schizoaffective disorder is not rare; lifetime prevalence is estimated at 0.3%. About one third of all psychotic patients suffer from schizoaffective disorder. About two thirds of the patients do not only have schizoaffective episodes but also pure schizophreniform or mood episodes or episodes of acute and transient psychotic disorder. In more than 50% of the patients, symptoms remit more or less completely. The others suffer from light, moderate or severe residual states, which might affect their social adaptation. The suicide rate in schizoaffective disorder is about 12%. The treatment of schizoaffective disorder primarily is a combination of antipsychotics and mood stabilizers or antidepressants. Long-term prophylactic treatment mainly consists of antipsychotics and mood stabilizers. Differential diagnosis of schizoaffective disorder is not at all easy. It must be distinguished from psychotic mood disorder, where the psychotic symptoms are mood-congruent. Although DSM-IV allows even mood-incongruent psychotic symptoms in psychotic mood disorder, these cases should better be allocated to schizoaffective disorder. Schizoaffective disorder must also be distinguished from schizophrenia with mood symptoms. In the latter, the mood symptoms are not complete and not so prominent to meet the criteria of a mood episode, or they occur after the schizophreniform have remitted. Sometimes, schizoaffective disorder is mixed up with acute and transient psychotic disorder, although these two conditions do not have very much in common.

MMPI-2-RF로 살펴본 불안장애, 우울장애, 불안장애와 우울장애 공병 환자군의 임상적 특성

이주연,최준호,김은경 한국정신신체의학회 2020 정신신체의학 Vol.28 No.1

Objectives:The purpose of this study was to explore comparison of clinical characteristics among Anxiety disorder, Depressive disorder, and Co-morbid of Anxiety disorder and Depressive disorder. Methods:Since January, 2017 to May, 2019, patients were recruited from the department of psychiatry of Hanyang University Guri Hospital. Participants were diagnosed Anxiety disorder, Depressive disorder, and Co-morbid of Anxiety disorder and Depressive disorder using DSM-5 criteria by board certified psychiatrists or clinical psychologists. And each of participants tested with MMPI-2 and clinical psychologists were converted MMPI-2 to MMPI-2-RF. The data were analyzed using SPSS 18.0. Results:The results indicated EID, RC2, HLP, SAV, and INTR-r were the highest in Co-morbid of Anxiety disorder and Depressive disorder group. And BXD, RC4, JCP, and AGGR-r were the highest in Depressive disorder group. Conclusions:The results indicated that Co-morbid of Anxiety disorder and Depressive disorder group were more severe internalizing dysfunction like lower positive emotion, helplessness, social avoidance and discomfort than single-diagnosed group. Single Depressive disorder group were more serious externalizing dysfunction like anger and aggression than single Anxiety disorder and Co-morbid of Anxiety disorder and Depressive disorder. The implications and limitations were discussed. 연구목적본 연구는 불안장애, 우울장애, 불안장애와 우울장애를 공병으로 지닌 환자군의 심리적 특성을 탐색하기 위해 시행되었다. 방 법2017년 1월부터 2019년 5월까지 한양대학교 구리병원 정신건강의학과에 내원 및 입원하여 심리평가를 진행한 환자들 중 정신건강의학과 전문의 혹은 임상심리사에 의해 DSM-5에 근거하여 불안장애, 우울장애, 불안장애와 우울장애를 공병으로 진단받은 환자를 대상으로 이루어졌다. 참가자들이 실시한 MMPI-2를 연구자들이RF로 변환한 뒤 SPSS를 활용하여 집단 간 차이에 대하여 검증하였다. 결 과MMPI-2-RF의 결과 EID, RC2, HLP, SAV, INTR-r가 공병 집단에서 가장 높았다. 또한 BXD, RC4, JCP, AGGR-r가 우울 집단에서 가장 높았다. 결 론공병 집단은 단일 집단에 비하여 낮은 긍정 정서와 무력감 등과 같은 우울 증상, 사회적 회피 및 불편감과 같은 내면화 증상이 더 심각한 수준으로 나타났다. 또한 우울 집단은 불안 집단과 공병 집단에 비해 분노감과 공격성과 같은 외현화 증상이 더 많은 것으로 밝혀졌다. 이러한 연구 결과를 토대로 본 연구의 의의와 제한점에대하여 논의하였다.

소아청소년 틱 장애(Tic disorder) 환자의 임상적 특성과 심리분석

우샛별,심영석,이건희,김성구 대한소아신경학회 2012 대한소아신경학회지 Vol.20 No.2

Purpose : Tic disorder is a neurodevelopmental disorder which begins in early childhood and continues into adolescence and adults. Tic disorder affects 1-2% of the population. In order to make a correct diagnosis and treatment of tic disorder, the clinical psychological analysis is needed because children with tic disorder tend to have higher rates of emotional and behavioral difficulties than those of the general population. The aim of this study was to evaluate the clinical and psychological characteristics of child with tic disorder. Methods : The sample consisted of 69 patients with tic disorder who visited to the pediatric neurology clinic of Kangnam sacred heart hospital from January 2007 to June 2010. Fifty patients who visited our clinic without tic disorder were included in the control group. Patients were classified as the DSM-IV, Tourette’s disorder, chronic motor or vocal tic disorder, tran- sient tic disorder and tic disorder not otherwise specified. Korean child behavior checklist (K-CBCL), K-WISC-III, ADS, K-ARS was conducted in the tic disorder patients and T score of K-CBCL was compared with the control group. Results : Male to female ratio was 2.5:1 in the study group and the mean age was 9.5±3.2 years old. The symptom period was 16.7±17.2 months at their first visit. Twelve subjects (18%) presented with Tourette syndrome, 14 subjects (20%) had multiple chronic motor or phonic tic disorder, 20 subjects (29%) had transient tic disorder and 23 subjects (33%) had tic disorder not otherwise specified. The Medications were given in 26 patients and risperidone was the primary drug for most of them. The mean T scores of K-CBCL were 55.5±6.1 for attention scale, 56.9±6.9 for anxiety-depression scale, 56.5±7.4 for withdrawn scale, 52.0±3.4 for emotional lability scale. All of them were higher than control group (P