The Symptom Frequency Characteristics of the Hamilton Depression Rating Scale and Possible Symptom Clusters of Depressive Disorders in Korea: The CRESCEND Study

Sae-Heon Jang,Young-Nam Park,Young-Myo Jae,전태연,이민수,김재민,Seung Hee Jeong,Jung Bum Kim 대한신경정신의학회 2011 PSYCHIATRY INVESTIGATION Vol.8 No.4

Objective This study analyzed the symptom frequencies of 17-item Hamilton Depression Rating Scale (HDRS-17) to understand the characteristics of each item and to propose the possible symptoms clusters. Methods From psychiatric clinics of 18 Hospitals in Korea, 1,183 patients, diagnosed with major depressive disorder (psychotic or non-psychotic), dysthymia or depressive disorder not otherwise specified. according to DSM-IV criteria, participated in this study from January 2006 to August 2008. The frequencies of each item of HDRS-17 were analyzed according to sex and severity. In addition, we compared this study with a previous study performed in England by Hamilton and with two studies performed in Korea by Kim et al. Results The frequencies of HDRS-17 items varied widely in this study, ranging from 95.8% in work and activities to 37.4% in loss of weight. But, depressed mood, psychic anxiety and work and activities items exhibited constant and higher frequency or rank regardless of study, the severity of depression or sex. Insomnia early, somatic gastrointestinal, genital symptoms and insight showed relatively constant but lower frequency or rank in disregard of studies or the clinical variables. Other symptoms had variable frequencies or ranks according to the variable clinical situations (culture, time, sex, severity of depression). Conclusion We propose three clusters of symptoms in depressive disorders: core symptoms cluster, an associated symptoms, and a situation-specific symptoms. We can use these possible symptom clusters of depression in simplifying diagnosis of depression, increasing diagnostic specificity in special situation and indexing disease severity.

소음인병증(少陰人病證) 내에서의 소증(素證)의 임상적 의미와 소증(素證)에 따른 현증(現證) 전개양상에 대한 고찰(考察)

이준희,이의주,고병희,Lee, Jun-Hee,Lee, Eui-Ju,Koh, Byung-Hee 사상체질의학회 2012 사상체질의학회지 Vol.24 No.3

Objectives We aimed to analyze the meanings of ordinary symptoms and the developing aspects of present symptoms according to the ordinary symptoms based on the Soeumin pathology, and present the new methodology to make use of the ordinary symptoms in the clinical field. Methods The Soeumin symptomatology and pathology of the Sinchuk Edition (the upgraded and revised edition) of "Donguisusebowon" were reviewed and examined for relevant information on the ordinary symptoms. Results and Conclusions 1) In the Soeumin symptomatology, the representative symptoms, by which the aspects of whole physio-pathological conditions can be decided, were showed as ordinary symptoms, and especially the aggravated state of the deflection of Seong-Jeong are presented additionally in the ordinary symptoms of the unfavorable patterns of Exterior and Interior symptomatologies. 2) In the Soeumin symptomatology, the ordinary symptoms have the clinical meanings as 'pathological predisposition', and can be estimated as one symptomatology in the whole schemes of symptomatology. 3) In the Soeumin symptomatology, the ordinary symptoms can affect the present symptoms, and can be the principal factors in the pattern identifications of the present symptoms and the determinations of therapeutical prescriptions. 4) In the Soeumin symptomatology, the ordinary symptoms can develop to the present symptoms across the Interior or the Exterior symptomatologies within the categories of the favorable and unfavorable patterns, and this developing aspects can be explained from the Soeumin pathological perspective.

조현병 환자에서 음성증상과 사회인지의 연관성

현지원(Jie Won Hyun),우정민(Jung Min Woo),정철호(Chul Ho Jung),김희철(Hee Cheol Kim),김양태(Yang Tae Kim) 대한생물치료정신의학회 2016 생물치료정신의학 Vol.22 No.2

Objectives:Although negative symptoms play important role in daily functioning of patients with schizophrenia, it remains unclear which symptoms clearly related to each other, and whether these symptoms develop sequentially or simultaneously. The current study examined negative and positive symptoms along with social cognition ability, to determine which symptoms are more strongly correlated. We also examined two subdomains of negative symptom, motivation/pleasure and expression, to investigate which subdomain has more strong correlation with social cognition. Methods:120 patients with schizophrenia were enrolled from three different hospitals. All patients were evaluated with Scale for the Assessment of Negative Symptoms(SANS), Positive And Negative Symptom Scale(PANSS), Clinical Assessment Interview for Negative Symptoms(CAINS), Korean Facial Expressions of Emotion(KOFEE) and Eyes task. Correlation analysis, structural equation modeling(SEM), and stepwise regression analysis were used to analyze data. Results:Social cognition was significantly correlated with negative symptoms rather than positive symptoms. Eyes task was negatively correlated with CAINS total score and both two subdomains. Although Eyes task was a significant predictor for both subscales of CAINS, it had more explanatory power for motivation/pleasure subdomain than expression subdomain. The results of SEM, model that KOFEE effects Eyes task and Eyes task effects each negative symptoms, motivation/pleasure, expression indicated most good fit. Conclusion:These findings confirmed the hypothesized relations that social cognition has more strong correlation with negative symptoms rather than positive symptoms. In addition these results provide empirical support for pathway which reduced social cognition ability impacts on developing negative symptoms.

소화기 증상을 주소로 내원한 외래환자 991명에 대한 위장관 증상 및 동반 증상 분석

나병조(Byung-Jo Na),최서형(Seo-Hyung Choi) 대한한의학회 2012 대한한의학회지 Vol.33 No.1

한국인 우울증상 성인의 소화기 장애

문혜리,장정남,윤수인,조진아 충북대학교 생활과학연구소 2022 생활과학연구논총 Vol.26 No.2

Background/Objectives: Recent research has revealed gastrointestinal (GI) symptoms are one of the most prominent clinical manifestations of depression. The goal of this study is to find out the link between GI symptoms and depressive symptoms in a population of individuals who have not yet diagnosed with depression. Methods: A total of 179 research participants were recruited offline and online, with 134 in the normal group and 45 in the group with depressive symptoms. The subjects' GI function and symptoms were evaluated with a validated GI questionnaire, and depressive symptoms were assessed with the Hamilton Depression Rating Scale (HDRS). The statistics were examined using SPSS version 26. Results: Those with depressive symptoms were significantly more likely to be single, have a higher level of education, and engage in significantly fewer physical activities than those in the control group. In addition, the depressive symptom group experienced significantly more stomach discomfort, heartburn, regurgitation, abdominal rumbling, bloating, empty feeling, nausea, vomiting, loss of appetite, postprandial fullness, worsening stool issues, and GI pain compared to the normal group. Conclusion/Implications: In this study, we discovered an intriguing lifestyle phenotype within the depressive symptom group as well as a link between depressive symptoms and GI symptoms. This research indicates that psychological variables play a substantial impact in the presence of gastrointestinal problems.

공황 장애 환자의 공황 발작 증상의 특성

임기영,김창기,노재성 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.4

공황 장애가 새로운 질병으로 분류된지 16년이 경과하였으나 공황 발작과 공황장애의 본질과 특성에 관해서는 아직 명확히 알려져 있지 않다. 또한 현재의 DSM-IV 진단 기준 역시 공황 발작과 공황 장애의 정의 및 진단에 대해 상호 모순되는 기술을 하고 있음을 발견할 수 있고 공황 발작의 각 증상에 대해서도 나열에 그치고 있을 뿐 어떤 것이 더 중요하고, 어떤 것이 최초 증상인지 등을 밝혀 주지 못하고 있다. 따라서 저자들은 공황 장애 환자들의 공황 발작 증상의 특성을 보다 자세히 알아보기 위하여 아주대학교 병원 정신과 외래 및 응급실로 내원한 40명의 공황 장애 환자들을 대상으로 공황 발작 설문지, 불안 민감도 검사, 상태-특성 불안 검사, Beck의 불안 검사를 실시하여 다음과 같은 결과를 얻었다. 1) 공황 장애 환자들이 공황 발작시 최초로 경험하는 증상들은 대부분 신체 증상(90%)이었으며, 공황 발작의 인지 증상과 신체 증상은 높은 상관관계(0.741, P<0.01)가 있었다. 2) 인지 증상(0.695, P<0.01)과 신체증상(0.599, P<0.01) 모두는 임소공포증적 회피의 정도와 유의한 정적 상관 관계를 나타내었다. 그러나 신체 증상을 통제 변인으로 하여 인지 증상과 임소공포증적 회피와의 부분상관을 구한 결과는 유의한 상관이 있었으나(0.467, P=0.003), 반대로 인지 증상을 통제변인으로 하여 신체 증상과 임소공포증적 회피의 부분 상관을 구한 결과는 통계적으로 의미 있는 상관 관계가 없었다.(0.173, P=0.291). 3) 인지 증상은 ASI상의 불안 민감도 (0.563, P<0.01), STAI상 상태(0.324, P<0.05) 및 특성 불안(0.484, P<0.01), BAI상의 불안(0.456, P<0.01)과 정적 상관을 보였다. 신체 증상은 ASI 상의 불안 민감도(0.528, P<0.01), STAI 중 특성불안(0.411, P<0.01), 그리고 BAI 상의 불안(0.348, P<0.05)과는 정적상관을 나타내었으나, STAI 중 상태 불안(0.171)과는 의미 있는 상관이 나타나지 않았다. 4) 인지 증상과 신체 증상과 신체 증상 각각에 대해 상대 증상을 통제 변인으로 하여 부분 상관을 구해 본 결과, 신체증상은 각종 불안 검사상의 불안 및 민감도와 통제적으로 의미 있는 상관을 보이지 않았지만 인지 증상은 의미 있는 상관을 나타내었다. 이상의 결과들은 공황 발작이 본질적으로 신체증상이 선행되고, 인지 증상이 부수되는 복합현상이며, 인지증상의 정도에 따라 심리적 불안의 정도와 불안 민간도가 높아져서 공황 증세로 진행되고, 역시 인지 증상의 정도에 따라 임소공포증적 회피가 결정됨을 시사한다. 따라서 공황 발작의 13가지 진단 기준 항목은11가지 신체 증상만으로 줄이고, 2가지 인지 증상(죽을 것 같은 공포 및 미치거나 자제력을 잃게 될 것 같은 공포)은 공황 장애의 진단 기준에 포함시키며 이때 공황이 일어난 상황으로부터 벗어나려는 생각을 공황 장애의 인지 증상에 추가하는 것이 보다 정확한 진단 기준이 될 것으로 판단된다. It has been 16 years since panic disorder was first classified as a psychiatric disease entity. However, the nature and characteristics of panic attacks and panic disorder are not fully understood yet. The Diagnostic and Statistical Manual, Fourth Edition(DSM-IV) carries conflicting statements regarding the definitions and diagnostic criteria of the panic attacks and panic disorder. Moreover, the DSM-IV only checks the presence or absence of each symptom, while failing to clarify which of each panic symptom are the earlier or more important symptoms. This study was designed to investigate the nature and characteristics of the panic attack symptoms. Forty outpatients diagnosed with DSM-IV panic disorder criteria were the subjects. All the subjects completed Panic Attack Questionnaire, Anxiety Sensitivity Index, State-Trait Anxiety Inventory, and Becks Anxiety Inventory. Results were as follows : 1) Majority(90%) of the subjects experienced somatic symptoms as the first symptom of their panic attack, and there was a significant correlation (0.741, P<0.01) between the somatic symptoms and the cognitive symptoms of panic attack. 2) Both cognitive symptoms(0.695, P<0.01) and somatic symptoms(0.599, P<0.01) showed significant correlation with agoraphobic avoidance. However, in partial correlation using somatic and cognitive symptoms as control variables for each other, only cognitive symptoms showed significant correlation with agoraphobic avoidance(0.467, P=0.003). 3) Cognitive symptoms showed significant correlation with the anxiety sensitivity(0.563, P<0.001), state anxiety(0.324, P<0.05), trait anxiety(0.484, P<0.01), and Becks anxiety(0.456, P<0.01). Somatic symptoms also showed significant correlation with the anxiety sensitivity(0.528, P<0.01), trait anxiety(0.411, P<0.01), Becks anxiety(0.348, P<0.05), but not with the state anxiety(0.171). 4) In partial correlation using somatic and cognitive symptoms as control variables for each other, cognitive symptoms showed statistically significant correlation with anxiety sensitivity and anxiety levels, while the somatic symptoms did not show such correlations. These results suggest that panic attack is a complex phenomenon in which the somatic symptoms are "triggers", and the cognitive symptoms are secondary reactions to the somatic symptoms. Psychological anxiety and anxiety sensitivity increase in proportion to the cognitive symptoms of the panic attack, which are important in the clinical process of panic disorder. The severity of cognitive symptoms also determines the development of agoraphobic avoidance. The authors propose to revise the diagnostic criteria of panic attack by the somatic symptoms only, and include cognitive symptoms, such as the desire to escape from the scene of panic attack, as necessary diagnostic criteria for panic disorder.

중년 여성이 호소하는 갱년기 증상에 관한 연구

이종화(Jong Hwa Lee),정연강(Yeon Kang Chung),박형무(Hyoung Moo Park),박재순(Jai Soon Park),유미코 하야마(Hayama Yumiko),염순교(Soon Gyo Yeoum) 대한폐경학회 2000 대한폐경학회지 Vol.6 No.2

N/A The purpose of this study was to serve as a basis for creating better quality of life for the midlife or the elderly, by preventing or easing the physical or mental problems that might possibly occur in climacteric. The subjects in this study were the midlife women whose age ranged from 40 to less than 60, living in Seoul or Kyonggi Province. They were surveyed from March 27 though April 10, 2000, and among the collected data, the responses from 234 women were selected for analysis. For symptom-related information, the responses from 214 were analyzed, excluding 20 who had ever received hormone therapy. The findings of this study were as follows: I) The mean age of experiencing menarche was 15.3, and the mean menopause age was 49.7(smoker 48,4, non smoker 49.8), the menstrual period of 47.9% was 28 to 29 days. Before menopause, they generally experienced menstrual irregularity for about 6 through 36 months, but some of them reached menopause with no menstrual irregularity. The most common period of menstrual irregularity was 12 months(66.7%), There was a correlational relationship between menarche age and menopause age(r=.264, p<.001). 2) The most frequently exhibited climacteric symptom was joint pain(93.9%), followed by psychological symptom(93.6%), osteological symptom(92.1%), other symptoms(87.4%), vasomotor symptom(83.2%), urogenital symptom(81,3%), symptom caused by the loss of collagen (77.6%), and cardiovascular symptom(66.8%) in the order named. More concretely, what they suffered from most was dry eyes(81.3%), followed by frequent fatigue(77.6%), beckache(72,4%), knee pain(72.4%), frequent forgetting (69.6%), and dry mouth(6.8%) in the order named. As a result of scoring the extent of climacteric symptoms on the basis of 4 scale, other symptoms appeared to be mast severe(2.00), and the next most severe one was joint pain(1.94), followed by vasomotor symptom(1.85), psychological symptom (1,82), symptom caused by the loss of collagen(1.68), urogenital symptom(1.61), cardiovascular symptom (1,52), and osteological symptom(1.31) in the order named. Concretely, what they suffered from most severely was backache(2.70), followed by knee pain(2.53), dry eyes(2.42), frequent forgetting(2.38), and frequent fatigue(2.32) in the order named. 3) The climacteric symptom that appeared first was psychological one, followed by vasomotor one, urogenital one, joint pain, symptom caused by the loss of collagen, other symptoms, and osteological one in the order named. The one that disappeared first was joint pain, followed by psychological symptom, vasomotor one, urogenita1 one, other symptoms, cardiovascular one, symptom caused by the loss of collagen, and osteological one in the order named. But just some of the women who suffered from joint pain got rid of that pain, and most of them continued to carry that pain with them.

갱년기 증상과 고통 경험에 관한 연구

김영주 충남대학교 간호과학연구소 2008 충남대 간호학술지 Vol.11 No.1

The purpose of this study were : (1) to explore the menopause history of the climacteric women and appearance frequency, degree of symptom, the time for appearance and disappearance, duration of symptom, degree of suffering of climacteric symptoms. (2) to identify the relationship between duration of symptom and degree of suffering of climacteric symptom. The subjects in this study were the climacteric women whose age ranged from 40 to 60, living in Daejeon. They were surveyed from April 21 through July 31, 2003 and total 67 women data collected. As a method for data collection, the questionnaire investigation method was used through individual interview with climacteric women. The findings of this study were as follows : 1) The mean menopause age was 49.8. Before menopause, they generally experienced menstrual irregularity for about 3 to over 36months, but some of them reached menopause with no menstrual irregularity. The most common duration of climacteric symptom was 36months over(43.3%). 2) The most frequently exhibited climacteric symptom was vasomotor symptom(23.0%). As a result of scoring the degree of climacteric symptoms on l0cm continuous scale, vasomotor symptom and joint pain(5.5cm) appeared most severe. The climacteric symptom that appeared first was symptom caused by the loss of collagen and cardiovascular symptom(48.7years). The climacteric symptom that disappeared first was osteological symptom(48.5years). The most common duration of climacteric symptom was other symptoms(3.3years). As a result of scoring the degree of suffering on from 1 to 10, they suffered from most was joint pain(6.2). 3) Scoring degree of climacteric symptoms and scoring degree of suffering were positive correlation in 47 items. Finally, Degree of climacteric symptoms and degree of suffering were different experiences. This results can be used for nursing intervention and care program for creating better quality of life of climacteric women.

노인성 치매 환자의 정신병적 증상

이형영,이수인 全南大醫大 2003 전남의대학술지 Vol.39 No.4

The Relationship between Depressive Symptoms in Outpatients with Chronic Illness and Health Care Costs

Na, Yu-Mi,Kim, Kwang-Soo,Lee, Kyoung-Uk,Chae, Jeong-Ho,Kim, Jin-Ho,Kim, Dai-Jin,Bahk, Won-Myong,Jang, Yun-Sig,Lee, Ae-Kyoung,Woo, Young Sup,Lee, Pyeoung-Soo Yonsei University, College of Medicine 2007 Yonsei medical journal Vol.48 No.5

<P><B>Purpose</B></P><P>To evaluate the relationship between depressive symptoms and health care costs in outpatients with chronic medical illnesses in Korea, we screened for depressive symptoms in 1,118 patients with a chronic medical illness and compared the severity of somatic symptoms and health care costs.</P><P><B>Patients and Methods</B></P><P>Data were compared between outpatients with depressive symptoms and those without depressive symptoms. Depression and somatic symptoms were measured by Zung's Self-rating Depression Scale (SDS) and Patient Health Questionnaire (PHQ)-15, respectively. We also investigated additional data related to patients' health care costs (number of visited clinical departments, number of visits made per patients, and health care costs). A total of 468 patients (41.9%) met the criteria for depressive disorder.</P><P><B>Results</B></P><P>A high rate of severe depressive symptoms was found in elderly, female and less-educated patients. A positive association between the severity of somatic symptoms and depressive symptoms was also identified. The effects of depressive symptoms in patients with chronic illnesses on three measures of health services were assessed by controlling for the effects of demographic variables and the severity of somatic symptoms. We found that the effects of depressive symptoms on the number of visited departments and number of visits made per patients were mediated by the severity of somatic symptoms. However, for health care costs, depressive symptoms had a significant main effect. Furthermore, the effect of gender on health care costs is moderated by the degree of a patient's depressive symptoms.</P><P><B>Conclusion</B></P><P>In summary, there is clearly a need for increased recognition and treatment of depressive symptoms in outpatients with chronic medical illnesses.</P>