암의 원인, 과정 및 예후와 심리적 특성 또는 행동변인들(behavioral variables) 사이에 연관성이 있는지, 있다면 어떻게 영향을 미치는지 아직 결정적인 증거는 제시되지 않고 있다. 이에 대해서는 동질(homogeneous)집단을 대상으로 치밀하게 고안된 전향적 (well-designed, prospective) 연구계획을 통하여 장기간의 추적조사가 필요할 것으로 생각된다. 또한 암환자에서 나타나는 정신과적 문제에 신속하게 대처하기 위하여 종양전문의와 정신과 의사간의 긴밀한 자문체계가 수립되어야 할 것이다. 정신종양학 분야에서 정신과 의사의 역할과 연구의 촛점은 다음과 같이 될 수 있다. 1. 암 예방: 원인적 측면에서 암의 발생과 연관되는 것으로 알려진 정신사회적, 요인들을 감소 또는 제거시키는 역할(예를 들면 스트레스, 흡연, 주정중독 등). 2. 암 치료: 1) 암의 각종 치료에서 환자의 순응(compliance)을 강화시켜 주는 역할. 2) 암환자에서 병발한 정신장애의 치료. 3) 암환자의 동통이나 오심 등의 치료. 4) 암환자의 삶의 질(quality of life)에 대한 지각을 향상시키도록 도와주는 역할. 3. 암 연구: 1) 암의 발생 또는 암환자의 생존에 영향을 미치는 정신사회적 요인들의 조사. 2) 심리반응 또는 정신사회적 요인들과 면역반응사이의 연관성 조사. 3) 암환자에서의 정신치료와 인지-행동치료의 효과규명. 4) 화학요법제 또는 방사선치료가 정신병리와 인지기능에 미치는 영향 조사 등.

The author reviewed the effect of psychological factors on the development and course of cancer. Cancer is a bilogical disease, but it also has a large number of psychological aspects. There have been no reports that specific personality types had tendency to cause cancer. In some studies, however, type A personality was reported to have relevance to a higher incidence of cancer and a better prognosis. And in other studies, type C personality was reported to have relevance to a higher incidence of cancer. It was reported that people who had strong tendency to control their anger and regarded the rationality and antiemotionality in their behavior as important things were susceptable to cancer. In the course of cancer, the patients who had more positive and aggressive attitude and 'fighting spirit' to their disease tended to have a better prognosis than those who accepted their disease as fate. Some studies showed that feeling of helplessness and loss of control had a negative offset on cancer. It was reported that, in the early stage of cancer, the psychological factors had great influence on the prognosis, but in the middle and late stage, the influence decreased. For the future studies, cancer should not be regarded as a single disease and a single condition. The kinds and stages of cancer should be difined for studies. The scales for psychological evaluation for cancer patients should be sensitive and selected carefully, considering the complexity of the cancer patients mind. The need for prospective studies is emphasized. Finally, as the cured cancer patients have great difficulties in returning to their work and daily life, rehabilitation of cancer patients is also emphasized.

The author presented several points of experienced materials obtained from the joint meetings of consultation-liaison Psychiatric division with oncologic department in Kyung Hee University Hospital. The joint meetings which have been held regularly every other week were very helpful not only for the psychiatrist but also for the cancer department stags to manage the cancer patients actively. The joint meetings have been progressed into more cohesive and active communication as time goes by. Most of the subjects discussed in the meeting was focused on the psychological and behavioral problems of the cancer patients. Besides, the difficulties arising from the chemotherapy were discussed. Probably the most difficult task for the treatment team was to provide complete information while respecting the patient's right to deny their situation The liaison psychiatrist usually gave comments to the charge doctor and/or nusing staff how to evaluate the patient's behavior and what would be the influential factors in developing the doctor-patient relationship. It was found that many cancer patients and their family members had their own peculiar illness behavior and disease concept which led patients to take non-medical or moreover, anti-therapeutic care. The family members were found to play an influential role in the choice of treatment method and progression of the disease. Another role of the liaison psychiatrist in the oncology ward was to encourage the treatment team members. In the practical point of view, it was not easy for the liaison psychiatrist to have time regularly for the cancer patients to encourage the liaison activities. And it seems to be fundamental that the consultation fee for the liaison psychiatrist should be set up at the resonable level.

The author reviewed psychosomatic aspects of bronchial asthma including psychological aspect of bronchial asthma, patients' reactions to illness, reactions of therapists and families, effect of bronchial asthma on mental function, psychotherapy and pharmacotherapy. The therapists' understanding of these aspects is likely to be helpful in their predicting and understanding the type of adaptation their asthmatic patients are making to their illness. Thus, the therapists need to recognize the asthmatics' psychological needs. They also should understand the vicious cycle of anxiety-hyperventilation-panic-fear-avoidance in patients with bronchial asthma and should try to break this cycle. To make it possible, the patients' panic-fear level should be assessed and sometimes it will require psychiatrists' advice. On the other hand, the asthmatics should be trained to be shaped to relate subjective feeling of pulmonary function with objective pulmonary measures, which will enable these patients to perceive their early symptoms and to cope with asthma attack effectively. The therapists need to pay attention to their emotion during evaluation and treatment of patients with bronchial asthma, because they are less likely to perceive stress and express their emotion.

Model' is one of the well-used, but poorly understood word in the neurobehavioral research. After Darwin's evolutionary theory, it has been generally believed that human is different from animals in terms of the complexity, not of the essential. This notion could be applied to the mind as well as body. Therefore, it became possible to establish animal models in the scientific field of mind. Experimental analysis of the animal behavior becomes an important area for establishing an animal model of human psychopathology because behavior is the ambassador of the mind. A model emphasizes a structural correspondence between sets of causally related variables in two different domains such as the animal and the human. The first selection of elements of the two domains in correspondence called the initial analogy. Once the initial analogy is formed. causally related variables in the two domains are examined and arrayed The structural parallel is the formal analogy of a model, and similarities between corresponding variables are called material analogy. Models may serve any of three major functions ; heuristic, evidential and representative. In many cases, utilizing models may be more practical than directly assessing the domain of primary interest, since technical and/or ethical problems are more serious in the human domain. Although modeling is important to study human psychopathology, rare animal models approved to be a good model for the human psychopathology up to now. Developing the appropriate model is urgent to solve many problems raised from human psychopathology.

The relationship between mind and body was reviewed from the perspecive of oriental medicine. Shin represents sout and hyung represents body. Health indicates the state in which shin and hyung are united as a whole one. On the other hand, disease means the state in which shin and hyung are spearated. And if such separation goes to extremes, death follows.

본 연구는 정신신체장애, 불안장애 및 우울장애 환자들 간에 alexithymia의 정도를 비교하기 위해서 실시되었다. 연구대상은 정신과 외래에 내원 하였거나 타과에서 정신과에 자문의뢰된 정신신체장애 환자 100명(긴장성 두통환자 47명 포함), 불안장애환자 52명, 우울장애환자 50명으로 하였다. 조사방법은 반체계적 면담용 평가도구인 Alexithymia provoked Response Questionnaire(APRQ)를 사용하였다. 정신신체장애환자들은 불안장애 및 우울장애환자들보다 alexithymia의 정도가 더 낮았으나 세 군간에 유의한 차이는 없었다. 반면 긴장성 두통환자들은 불안장애 및 우울장애환자들에 비해 alexithymia의 정도가 각각 유의하게 더 높았다. 우울장애환자들이 불안장애환자들보다 aluithymia의 정도가 더 높았으나 양군간에 유의한 차이는 없었다. 성별, 연령, 교육수준, 종교 및 직업유무와 같은 인구학적 특징들은 조사대상 모든 군에서 alexithymia와 유의한 관계가 없었다. 이 결과들은 일반적으로 정신신체장애환자들이 alexithymia를 보인다는 기존 보고와 다르게 정신신체장애 중 긴장성 두통과 같은 특정 정신신체장애환자들에서 alexithymia가 현저함을 시사한다. 따라서 긴장성 두통환자들에서의 치료전략으로 감정표현을 유도하는 특수한 형태의 면담방법이 개발될 필요가 있다.

저자들은 동통을 가진 신체형장애 환자들에서 물리적인 외부자극에 대한 지각과 외부자극에 따른 언어행동의 관계성을 파악하기 위해서 본 연구를 시행하였다. 환자 34명 (남 10, 여 24)과 건강대조군 37명 (남 19, 여 18)을 대상으로, 물리 적 자극에 대한 지각도의 측정은 압통역치 측정기(algometer)를 이용하였으며, 감정표현능력의 측정은 Toronto Alexithymia Scale을 이용하였다. 한편 신체증상의 정도와 부모-자녀 결합형태검사를 시행하였다. 전체환자의 81.4%는 6개월이상 증상을 지속적으로 많이 호소하는 만성화 특성을 보였다. 그리고 alexithymia의 정도, 신체증상 호소정도, 압통역치가 모두 환자군에서 유의하게 높았다. 그리고 환자군의 44.1%는 alexithymia라고 할 수 있었다. 한편 압통역치와 alexithymia간에 유의한 상관성은 없었다. 결론적으로, 동통을 가진 신체형장애환자들이 정상인에 비해 외부 동통자극에 덜 민감하며, 이는 병의 만성화와 관련되는 것 같다. 이들은 또 외부자극에 따른 적절한 감정표현능력도 떨어져 있는 경우가 많은데, 이것은 신체화의 한 조건이 되며, 한편으로는 정신치료적 접근을 방해하는 한 요소가 될 수 있음을 시사한다.

Objective : Cosmetic surgery, as a psychosocial intervention, is unique in that its foundation rests solely on the individual motivations, internal or external, of the patient We investigated the ego-identity in women who seek double eyelid operation, to understand one aspect of internal motivation for cosmetic surgery. Methods : Subjects of this study were 47 young women, visited to plastic surgery clinics in Kwangju from June 1993 to October 1993, and 58 women who did not want double eyelid operation were chosen as controls. Each subject's ego-identity was scored using Dignan's ego-identity scale. Results : The total and stability subscale's scores of ego-identity of double eyelid operation group were significantly lower than those of control group. Conclusion : More psychosocial research on the ego-identify of patients seeking double eyelid operation is required to understand the psychological motives for requesting surgery.

GARS스트레스지각척도 및 BDI우울척도를 이용하여 위암환자들과 위염환자들 간의 스트레스지각 및 우울의 정도를 비교하였다. 위암환자들의 50%, 위염환자들의 38%가 BDI우울척도에서 우울에 해당되었다. 위암환자군과 위염환자군 간에 스트레스지각점수는 유의한 차이가 없었다. 한편 BDI우울척도점수에 있어서는 통계적으로 유의한 차이가 없었으나 위암환자군이 위염환자군보다 더 높은 경향을 보였다. 위암환자들에서는 정신적 고통의 정도와 우울의 정도가 유의하게 양상관성을 보인 반면 위염환자들에서는 신체증상의 심한 정도와 우울의 정도가 유의하게 양상관성을 보였다. 즉 위암환자들의 우울은 신체증상의 정도보다는 정신적 고통의 정도와 더 밀접하게 관련되는 것으로 나타났다. 양군에서 각각 여자환자들은 남자환자들보다 스트레스지각이 유의하게 더 높았고, 연령은 스트레스지각과 유의하게 음상관성을 보였다. 결론적으로 동일한 장기의 기질적인 병리의 심한 정도가 스트레스지각 및 우울의 정도와 관련되지 않은 것은 위암환자들의 부정이 관련될 가능성이 있다. 따라서 위암환자들의 치료에서 정신사회적 접근 특히 정신과 자문조정활동의 필요성이 강조된다.

The authors investigated 131 nonpsychiatric physicians' attitudes toward psychiatric consultation, using questionnaires. A comparison was made as regards psychiatric consultation from nonpsychiatric physicians over position(staffs vs. residents) and department(medical vs. surgical). These findings are as follows ; 1) 51.9 percent of nonpsychiatric physicians estimated that less than 30 percent of their patientshadpgychiatricproblems. 2) The percentage of the patients referred for psychiatric consultation were 30 or less than 30 percent 3) Staffs tried to refer their patients to psychiatric department for psychiatric consultation more frequently than residents. 4) Medical physicians tried to refer their patients to psychiatric department for psychiatric consultation more frequently than surgeons. 5) Psychiatric consultation was estimated to be most frequently requested for overt psychiatric symptoms(23.0%) and past history of psychiatric treatment(20.8%). 6) The most frequent causes of not referring to department of psychiatry were found to be the patients' rejection(46.8%) and non-psychiatric physicians' dissatisfaction with the results of consultation (22.2%). 7) Medical physicians tended to explain the reasons for psychiatric consultation more adequately than surgeons. 8) Residents more specifically wrote the reasons for psychiatric consultation on the chart than staffs. The results suggest that staffs are more active in psychiatric consultation than residents, whereas medical physicians are more active than surgeons. Thus, education should be more emphasized for surgeons and residents, especially for the latter for effective consultation-liaison activity. On the other hand, psychiatrists should try to improve nonpsychiatric physicians' dissatisfactions with the results of psychiatric consultations, which will positively change their attitudes toward psychiatric consultation.

The authors tried to look into the process of the individual psychotherapeutic experience of a 18-year-old male diagnosed as somatoform pain disorder or chronic pain syndrome. The patient had showed strong resistance to acceptance of his psychological problems. Some issues such as indications of psychotherapy for chronic pain, changing the mode of the treatment some problems around changing the therapist secondary gain and parents' attitude were discussed considering their relatedness to the outcome. The psychotherapy had lasted about 2 years and the result was estimated as fair.