DSM-IV에 의한 주요 우울장애의 진단적 안정성 : 일 대학병원의 4년 후향적 의무기록 조사연구

김현준,우영섭,전태연,김광수,박원명 대한우울조울병학회 2013 우울조울병 Vol.11 No.2

Objectives : The aim of the study was to determine the stability of a diagnosis of major depressive disorder (MDD) according to the DSM-IV by means of retrospective reviews of medical records. Methods : Retrospective chart review of patients admitted to a university hospital with a primary diagnosis of MDD in a period from January 2005 to August 2008 was conducted. We reviewed DSM-IV diagnoses and detailed clinical information at the index admission with assessments made every 6 months for 4 years after discharge to determine diagnostic stability. Results : There were 440 patients diagnosed with MDD at the first contact. The data showed that 88.6% of the patients maintained their initial diagnosis of MDD during follow up periods. About 11.4% of patients, the initial diagnosis of MDD ultimately changed during follow up to other diagnoses. A total of 227 patients were diagnosed MDD at subsequent period. Among these, 218 (96.0%) were diagnosed with MDD at the first contact. Conclusions : This study showed the diagnostic stability of MDD, among Korean patients. When the DSM-IV diagnoses are used in clinical practice, the diagnostic stability of MDD has a low stability over time. The results demonstrated that a longitudinally based diagnostic process is needed.

한국형 우울장애 약물치료 알고리듬 2017(Ⅵ) : 안정성, 부작용, 동반 신체질환을 고려한 항우울제 선택

이정구,심세훈,박영민,김원,왕희령,우영섭,서정석,정종현,전덕인,민경준,박원명 대한우울조울병학회 2017 우울조울병 Vol.15 No.2

Objectives : This study was undertaken to revise guidelines for the Korean Medication Algorithm Projects for Depressive Disorder 2012 (KMAP-DD 2012). The main purpose of the current study was a revision of the antidepressant choices based on their safety, adverse events and comorbid physical illnesses. Methods : A 44-item questionnaire was developed ; an expert consensus was obtained on the pharmacological treatment strategies regarding the choice of an antidepressant (AD), with respect to its safety and adverse effects. Multiple response sets were used for statistical analysis. Results : Our results showed the 1st line of treatment for various afflictions were as follows: Bupropion (sexual dysfunction), Fluoxetine (sedation), Mirtazapine (control of sleep disturbance and nausea), and Escitalopram (for patients with anticholinergic side effects). For patients exhibiting comorbid conditions, escitalopram was the 1st line of recommendation for diabetes, thyroid disease, liver disease and kidney disease. Conclusion : The pharmacological treatment strategy of KMAP-DD 2017 is similar to KMAP-DD 2012. Particularly noteworthy is that escitalopram was recommended for most of the medical comorbid conditions.

지역사회에서 주산기 우울감을 호소하는 산모의 치료 연계율

노승훈,엄유현,김성민,김태원,서호준,홍승철,한진희,정종현 대한우울조울병학회 2017 우울조울병 Vol.15 No.2

Objectives : This study investigated the referral rates of professional psychiatric care in community-dwelling peripartum women with depressive symptoms. Methods : Totally, 127 peripartum women were enrolled in a community mental health center located in Suwon city, Korea. The Edinburgh Postnatal Depression Scale (EPDS) determined the risk of peripartum onset depression (EPDS≥10). The percentage of patients who received professional care was examined in the high risk group. Results : Among the 3743 peripartum women enrolled at the Suwon’s Community Mental Health Center, 1009 women (27%) were at a high risk of peripartum depression. Of these, 127 peripartum women visited the Suwon Mental Happiness Promotion Center to receive additional counseling, and were re-evaluated for depression risks. Of the re-evaluated women, 99 were identified as having high risk of depression, but only 8 cases were referred to professional psychiatric care. Conclusion : The actual referral rates to professional psychiatric care in community-dwelling peripartum women are relatively low, which is thought to be attributable to the social stigma attached to psychiatric treatment, increased parental burden and cultural disparities. Further studies on measures to promote professional psychiatric care in community-dwelling peripartum women are reqiured.

한국 일반인구에서 울분증상의 빈도, 인구학적 특성 및 우울증과의 연관성

이승훈,전상원,윤서영,신철민,고영훈,김용구,윤성도,한창수 대한우울조울병학회 2017 우울조울병 Vol.15 No.2

Objectives : In this article, we verified demographic features of embitterment symptoms among the Korean population using the posttraumatic embitterment disorder (PTED) symptoms scale and studied the relationship between PTED and depression. Methods : The PTED self-rating scale (PTEDS), patient health questionnaire-9 (PHQ-9) results and demographic characteristics were collected from 2101 participants via an e-mail survey of the Korean population. Results : The mean PTEDS score of all participants was 1.48±0.87, and the prevalence of PTED (PTEDS score ≥1.6) was 42.7%. As the severity of depression increased, the PTEDS score also increased demonstrating a significant relationship between PTEDS and PHQ-9 score (r=0.771, p<0.001). Higher PTEDS scores were reported in the 30 to 39 years old and lowest income groups. Lower PTED scores were observed in the group living with a partner. There were no significant differences in PTEDS scores between different educational levels, however, in the group with 17 or more years of education, PHQ-9 scores were significantly lower. PHQ-9 score explained 60% of PTEDS scores (F=3076.32, p<0.001). Conclusion : Prevalence of embitterment symptoms is high among the Korean population. Depression is significantly related to embitterment symptoms, but the demographic features of the two diseases were similar with slight differences

아동기 외상 경험이 대학생의 우울 증상에 미치는 영향 : 긍정심리자원의 조절 효과를 중심으로

정영은,양현주,유정원,김문두 대한우울조울병학회 2018 우울조울병 Vol.16 No.3

Objectives : The purpose of this study was to examine effects of traumatic experiences in childhood, on depressive symptoms of college students, and to determine how depression depended on positive psychological resources. Methods : A total of 430 students were recruited, from two universities in Jeju area. All participants completed self-report questionnaires, that included demographic variables, Adverse Childhood Experience (ACE) Scale, Patient Health Questionnaire-9, and Positive Resources Test (POREST). Results : Prevalence of depression was 47.9%, and a total of 133 (30.9%) college students reported traumatic experiences in childhood. Students with depressive symptoms, were likely to report more traumatic experiences in childhood, and less positive psychological resources. Results from regression analyses indicated that, while controlling for a range of demographic variables, positive psychological resources moderated the association, between traumatic experiences in childhood and depression. Conclusion : Based on results, professionals must consider positive psychological and social resources, for treatment to reduce depressive symptoms in patients with history of childhood adversity.

한국형 양극성 장애 약물치료 알고리듬 2018 : 노인

정영은,김문두,박원명,윤보현,전덕인,서정석,김원,이정구,우영섭,정종현,손인기,심세훈,송후림,민경준 대한우울조울병학회 2018 우울조울병 Vol.16 No.3

Objectives : The fourth revision of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was performed to provide more proper guidelines for clinicians. In this study, we evaluated treatment strategies of elderly patients with bipolar disorders of KMAP-BP 2018. Methods : Sixty-one psychiatrists of the review committee with vast clinical experiences in treating bipolar disorders, completed the survey. An expert consensus was obtained, on pharmacological treatment strategies for elderly patients with bipolar disorder. The executive committee analyzed results, and discussed the results to produce the final algorithm. Results : In elderly patients with bipolar disorder, first-line treatment option for acute manic episode is monotherapy, with atypical antipsychotics or mood stabilizer, and a combination of mood stabilizer and atypical antipsychotics. First-line treatment option for acute depressive episode, was a combination of mood stabilizer and atypical antipsychotics, monotherapy with atypical antipsychotic or mood stabilizer, and atypical antipsychotics with lamotrigine. Conclusion : In KMAP-BP 2018, the recommendation for treatment option in elderly patients with bipolar disorder, was newly introduced. We expect this algorithm may provide valuable information, and facilitate treatment of elderly patients with bipolar disorder.

지역사회 노인의 자살사고에 영향을 미치는 심리사회적 요인 : 전남지역을 대상으로

차용호,김경민,윤보현,강한고은비,시영화,박수희 대한우울조울병학회 2018 우울조울병 Vol.16 No.3

Objectives : The purpose of this study was to examine psychosocial factors influencing suicidal ideation of community dwelling elderly, using the senior community center in Jeonnam Province. Methods : A total of 2,202 subjects (369 males, 1,833 females) were recruited. We evaluated sociodemographic factors, using a self-reporting questionnaire. Subjects completed the Geriatric Depression Scale-Short Form Korean Version (SGDS), Multi-dimensional Scale of Perceived Social Support (MSPSS), Korean version of the General Health Questionale-12 (GHQ-12) and Satisfaction with Life scale (SWLS), to assess psychosocial factors affecting suicidal ideation. Results : Among 2,202 subjects, 179 (8.1%) reported recent suicidal ideation. Self-perceptive health status (p<0.001) and physical disease (p=0.002) revealed differences between two groups. The scores of four scales in the suicidal group were significantly different from the control group: SGDS (p<0.001) and GHQ-12 (p<0.001) were higher, while MSPSS (p<0.001) and SWLS (p<0.001) were lower, in the suicidal ideation group than the control group. Multivariate logistic regression analysis revealed that physical disease (OR 2.575, 95%CI 1.022-6.492), SGDS (OR 1.181, 95%CI 1.120-1.246) and GHQ-12 (OR 1.192, 95%CI 1.108-1.283), were significantly associated with suicidal ideation. Conclusion : Findings support that physical disease, depression, and general mental health may correlate to suicidal ideation in the elderly.

한국형 양극성 장애 약물치료 알고리듬 2018 : 안정성과 내약성

손인기,박원명,윤보현,전덕인,서정석,김원,이정구,우영섭,정종현,김문두,정영은,심세훈,송후림,민경준 대한우울조울병학회 2018 우울조울병 Vol.16 No.3

Objectives : Treatment for bipolar disorder is often complicated by various clinical situations. We undertook a survey of expert opinions to facilitate clinical decisions in special situations such as weight gain, metabolic syndrome, hyperprolactinemia, genetic counseling, and treatment adherence. Methods : A written survey that asked treatment strategies related to safety and tolerability, was prepared focused on weight gain, antipsychotic related hyperprolactinemia, lamotrigine related skin rash, treatment non-adherence and genetic counseling. Sixty-one experts of the review committee completed the survey. Results : In the case of weight gain related to medications, experts preferred exercise and education for diet-control. First chosen medications were lamotrigine, aripiprazole and ziprasidone. Recommendations based on expert survey results for treatment of bipolar patients in other special situations are outlined. Conclusion : With limitation of expert opinions, authors hope that results of this study provide valuable information to make clinical decisions about treatment of bipolar disorder in complicated situations.

한국형 우울장애 약물치료 알고리듬 2017(VII) : 비약물학적 생물치료

정종현,이정구,심세훈,박영민,김원,왕희령,우영섭,서정석,전덕인,민경준,박원명 대한우울조울병학회 2017 우울조울병 Vol.15 No.2

Objectives : Depression is widely managed by pharmacological treatments. However, due to the continuous introduction of newer agents, pharmacological treatment strategies are also changing. Methods : A survey was emailed to 144 psychiatrists having vast clinical experiences in depressive disorders. Of these, 79 surveys were repeated. Results : Electroconvulsive therapy (ECT) was recommended as the initial strategy for major depressive disorder, and for severe cases showing suicidal risk but without any accompanying psychotic features. It was considered as a second strategy for non-responders on antidepressant monotherapy or combination therapy, associated with other physical illness. In cases with major depressive disorders and those with severe psychotic features, ECT was preferred as a treatment of choice for patients showing urgent suicidal risk ; however, it was the second strategy for nonresponders on antipsychotics and antidepressants combination therapy, and combined with physical illness. Conclusion : ECT was the preferred initial strategy in severe episode with/without psychotic features having urgent suicidal risk, and was the second choice in case of non-responders, associated with physical illness and pregnancy. Combination with complementary therapy was a second strategy for treating refractory patients

정신건강의학과 외래에서 시행한 마음챙김 명상 프로그램이 우울 및 불안장애 환자들의 긍정자원과 긍정정서에 미치는 영향

박예나,채정호 대한우울조울병학회 2017 우울조울병 Vol.15 No.2

Objectives : Mindfulness meditation has recently become a major component in mainstream modern cognitive behavioral therapy. The purpose of this study was to examine effects of a mindfulness meditation program on positive resources of outpatients with depressive disorder and anxiety disorder. Methods : Participants were 55 psychiatric clinic outpatients. Participants received eight weekly sessions in a mindfulness meditation training program, that was approximately 90 minutes each. Measures included the Positive Resources Test (POREST), Acceptance and Action Questionnaire-16 (AAQ-16), Life Satisfaction Expectancy Scales (LSES), and Subjective Happiness Scale (SHS). Variables were measured at two time points : pre- and post-implementation (eight weeks later). Results : Paired t-test results of participants before and after the mindfulness meditation program revealed statistically significant improvement in positive resources (t=-5.847, p<.001), acceptance (t=-4.090, p<.001), life satisfaction expectancy (t=-3.892, p<.001), but not in subjective happiness. Conclusion : Results suggest mindfulness meditation may be effective to enhance positive resources, acceptance, and life satisfaction in outpatients with depressive disorder and anxiety disorder. Mindfulness meditation may be a factor in improving psychological well-being and positive psychological features in outpatients with depressive disorder and anxiety disorder.