스트레스 평가와 관리

조숙행 대한의사협회 2004 대한의사협회지 Vol.47 No.3

월경전 불쾌기분장애 환자의 광치료 임상 시도

조숙행,김진세,김승현,김린,Joe, Sook-Haeng,Kim, Jin-Se,Kim, Seung-Hyun,Kim, Leen 대한수면의학회 1999 수면·정신생리 Vol.6 No.1

Objectives: Patients with premenstrual dysphoric disorder(or PMDD) have impairments of the social, occupational or academic function due to psychological or somatic symptoms, which have the characteristic pattern of symptom exacerbation in the week before menses begin and remission shortly after the onset of menses. In the chronobiological view, many researchers have assumed that the etiology of PMDD is the advanced circadian rhythm. It has been suggested that light has a therapeutic effect on PMDD, because evening light results in phase delay of circadian rhythm through the biochemical changes including melatonin. Methods: The authors investigated the therapeutic effect of light therapy on four patients with prospectively diagnosed PMDD by DSM-IV criteria using clinical psychiatric interview, Premenstrual Assessment Form(PAF) and Daily Rating Form(or DRF). In the evening(6:30pm-8:00pm), the 2,500 lux light administered for seven consecutive days during the symptomatic late luteal phase of menstrual cycle. Beck Depression Inventory(or BDI), Hamilton Rating Scale for Depression(or HAM-D), Spielberg State Anxiety Inventory(or SA), and DRF were evaluated before and after seven days of light therapy. Results: Premenstrual symptoms of PMDD could be effectively treated with the evening bright light therapy, especially in PMDD patients with atypical symptoms. In addition, the light therapy seemed to more effective on the psychologic symptoms than the somatic symptoms of PMDD. There was no significant side-effect of light therapy, except the transient and mild eye-strain in one case. Conclusions: In spite of the results of limited data from our clinical trial, the authors suggest that the potential use of light therapy as an alternative to the pharmacological management of patients with PMDD.

자가 면역성 갑상선 질환이 수반된 단기 순환형 정서장애

조숙행,이민수,정인과,곽동일 대한신경정신의학회 1989 신경정신의학 Vol.28 No.4

The authors experienced one case of rapid cycling affective disorder with autoimmune thyroiditis. The case was a 28-year-old female patient who showed rapid cycling with only recurrent manic attacks and poor response to conventional treatment of bipolar disorder. We observed that overt clinical hypothyrodism with high titer of thyroid autoantibodies (antimicrosomal and antithyroglobulin) occured during treatment with lithium, chlorpromazine and carbamazepine. Although hypothyroidism returned to euthyroid state with the use of replacement L-thyroxine, manic attack recurred, so we suggested that the course of rapid cycling has no relation with thyroid dysfunction. However, further evaluation of the relationship between rapid cycling affective disorder and thyroid dysfunction will be required. Recent studies have suggested that rapid cycler have higher prevalence of both clinical hypothyroidism and abnormal thyroid function test than non-rapid cycler, and especially in presence of latent autoimmune thyroiditis, lithium likely to cause clinical hypothyroidism. Therefore we considered that both baseline and periodic asessment of thyroid function and monitoring antithyroid antibodies during lithium treatment should be required.

중추신경계에 대한 에스트로겐의 효과와 작용기전

조숙행,김정웅 대한정신약물학회 2003 대한정신약물학회지 Vol.14 No.4

후기황체기 불쾌기분장애(LLPDD) 환자의 광선치료 1례

조숙행,Joe, Sook-Haeng 대한수면의학회 1994 수면·정신생리 Vol.1 No.2

The author reports a 32 years old female patient with late luteal phase dysphoric disorder who received evening bright light treatment for 7 consecutive days during the late luteal phase of menstrual cycle. After the treatment, beneficial clinical effects were observed. This result suggests that bright light can be an alternative treatment for LLPDD. However, the placebo effects should be ruled out completely. Further controlled studies with more patients will be needed.

임신 및 출산 후의 우울증

조숙행 대한가정의학회 2002 Korean Journal of Family Medicine Vol.23 No.4

월경 전기 평가서 (Premenstrual Assessment Form : PAF)의 신뢰도, 타당도 연구 - 청소년을 대상으로 -

조숙행,이현수,곽동일,고승덕,Joe, Sook-Haeng,Lee, Hyeon-Soo,Kwak, Dong-Il,Ko, Seung-Duk 한국정신신체의학회 1996 정신신체의학 Vol.4 No.1

This study was attempted to investigate reliability and validity of premenstrual assessment form(PAF). PAF was administered to 230 high school students who had reported premenstrual changes. PAF revealed considerable diversity in premenstrual symtom changes of the subjects. The items with most frequent reported premenstrual changes were 21 items out of 95. Cronbach's internal consistency was .95, and test-retest reliability was .80. Validity test was performed by constructional validation analysis. 8 factors(impulsive & unstable factor, depressive factor, withdrawal & social functioning impairment factor, anxiety & cognitive dysfunction factor, physiological factor, general discomfort factor, increased well-being factor, other factor) emerged at factor analysis. Each of them accounted for 33.97, 5.10, 3.70, 2.93, 2.64, 2.46, 2.12, 2.03 of total variance respectively. High school students experienced impulsive & unstable features of premenstrual symptoms more frequently. This study suggests PAF can be a reliable and valid tool as a initial screening and evaluation of premenstrual changes. finally, factor analysis result was compared with PAF typological categories.

우울증을 수반한 폐경기 여성환자에서의 항우울제와 경피 에스트라디올 호르몬의 병합치료 효과 : 우울증상 및 신체증상과 혈장 Gonadal Hormone, 5-Hydroxyindoleacetic Acid 농도를 중심으로

조숙행,김승현,이민수,Joe, Sook-Haeng,Kim, Seung-Hyun,Lee, Min-Soo 대한생물정신의학회 1995 생물정신의학 Vol.2 No.1

A on-off study was designed to evaluate the effects of addition of transdermal esrtradiol to tricyclic antidepressants on depression level, vasomotor symptom(hot flush), sexual functions and hormonal status, plasma 5-hydroxyindoleascetic acid(5-HIAA) level in postmenopausal women with depression. Plasma level of estradiol, progesterone, LH, FSH, prolactin and 5-HIAA was measured by Time-resolved fluoroimmunoassay and HPLC(High Performance Liquid Chromatography). To asses their symptoms, the BDI(Beck Depression Inventory) and modified symptom scale, extracted from women's health questionnaire were used. Depression score, sexual function score were decreased by the last 4-weeks of addition of transdermal estradiol to antidepressant treatment, not Significant, but vasomotor symptom (hot flushes) score was decreased significantly(p<0.05) by the last 4-weeks of the given treatment. Thus, during addition of transdermal estradiol to antidepressants treatment, only vasomotor symptom(hot flushes) was improved significantly, but depression level was not changed in postmenopausal women with depression. Plasma FSH, estradiol and prolactin level was not changed in postmenopausal women with depression. Plasma FSH, estradiol and prolactin levels were increased by the last 4-weeks of the treatment. There were not significant correlations between clinical symptoms and plasma hormonal status and 5-HIAA level in baseline. After the last 4-weeks of transdermal estradiol treatment, the change of depression score was correlated significantly with change of serum prolactin and 5-HIAA level and the change of vasomotor symptom score was correlated significantly with the change of plasma prolactin level.

靑少年精神障碍에 對한 臨床的 考察

조숙행 大韓神經精神醫學會 1979 신경정신의학 Vol.18 No.3

This study was attempted to assess the various clinical features of the adolescent patients for the past 10 years. Subjects were 1,364 adolescents who had various psychiatric problems and visited the Neuropsychiatric Department of Korea University Hospital during the period from September, 1968 to August, 1978. The results were as follows: 1. One thousand three hunderd sixty four adolescent patients with psychiatric disorders(7.89% of Total patients) were visited during this period. Males were 796 (58.35% of the subjects) and females 568(41.64%) by a ratio of 1.4 to 1. Although the adolescent patients had increased in number year by year for the past 10 years, the ratio of the adolescent patients to the total patients had not significantly changed. 2. The patients in the late adolescence were the highest in number of both sexes. 3. As to the age of onset, the 17 years old was the most frequently seen. 4. Many of the patients belong to the middle socioeconomical class. 5. As to the occupation, many (75.21% of the subjects) were students and there was tendency to increase in number of females with vocation. 6. In the ordinal position of the siblings, the highest numbers were the middle-born. 7. Family history revealed that 43.17% of their father had psychiatric problems and among these the most frequent one was personality disoder (32.82%) and 31.38% of their mothers had psychiatric problems and the most frequent one was neurotic problem (65.53%). History of the parental loss by death, separation and divorce were seen in 19.43% of the subjects. The loss of father was more predominant than that of mother. 8. The diagnostic distributions were composed of the neuroses (33.3%), the schizophrenias (25.7%), the organic brain syndromes (21%), the affective psychoses (7.3%), the psychophysiologic disorders (5.7%), the transient situational disturbances (2.6%), the personality disorders (2.4%), the behavior disorders (0.8%), the mental relardations (0.7%), and the special symptoms (0.4%), in order of descending frequency of their occurrences. There was tendency to increase in frequency of the schizophrenia, neurosis, affective psychoses and transient situational disturbance for the past 10 years.

과수면을 수반한 계절성 정동장애 1례 -광치료 전후의 수면다원검사 소견을 중심으로-

조숙행,김인,서광윤,Joe, Sook-Haeng,Kim, Leen,Suh, Kwang-Yoon 대한수면의학회 1998 수면·정신생리 Vol.5 No.2

Authors report the findings of nocturnal polysomnography and multiple sleep latency test(MSLT) before and after morning light treatment in a winter depressive patient with hypersomnia. On polysomnographic recordings, the sleep pattern of this case before light treatment was similar to that of narcolepsy exhibited, sleep onset REM period(SOREMP). After treatment, the shortened REM latency changed to normal condition, but, deep sleep percentage did not changed, and stage 4 sleep percentage was decreased. Depressive symptoms were improved on clinical interview with Hamilton Depressive Rating Scale. Sleep log showed shortened sleep latency and reduced sleep duration. These findings suggest that although light treatment could alter the sleep structure in seasonal affective disorder with hypersomnia, it does not necessarily imply that antidepressant response of light treatment is result of change of sleep structure.