Objective : The sensation of dysphagia, heartburn, globus hystericus, and functional dyspepsia are common symptoms of the functional upper gut disorders. This study was designed to investigate quantity of perceived stress, depression, and anxiety in the patients with functional upper gut symptoms whose esopahgeal manometry(EM) and gatroesophageal reflux (GERT) test were normal. Methods : A total of 38 patients who complained of the symptoms had been tested with 24-hour ambulatory EM and conventional GERT in our gastrointestinal clinic. Thirty patients whose tests had been normal(patients group) were assessed with Symptom Checklist-90-Revision(SCL-90-R), Beck Depression Inventory(BDI), and Spielberger Stait-Trait Anxiety Inventory(STAI) and compared with 30 patients(control group) without functional upper gut symtpoms in the hepatobiliary clinic. The two groups were also assessed by quantity of perceived stress during the last year through self-report. Results: 1) These patients tended to be predominently female, older, and possessed a lower education than control group. 79% of 38 patients who had been tested were normal. 2) Compared to the control group, the patients had significantly higher mean scores on four subscales(somatization, depression, anxiety, and positive symptom distress index). 3) The patient group had significantly more perceived stress than the control group. 4) The patients group had significantly higher levels of depression than the control gorup, but there was not any significant difference in the STAI. 5) There were significant positive correlations between the BDI score and the STAI-trait, the STAI-stait and the STAI-trait, the quantity of perceived stress and the STAI-trait. Conlusion : The patients with functional upper gut symptoms displayed more, psychological distress, sornatization, anxiety, and deperssion. Among them, patients had higer depression than control group. Functional upper gut symtoms could be more appropriately viewed as somatic symptoms of depression. These findings suggest that such patients need to have psychiatric intervention and treatment.

본 연구의 목적은 타과 의사들의 정신과에 대한 태도를 알아보기 위해 시행되었다. 타과의사 129명을 대상으로 설문을 이용하여 알아본 결과는 다음과 같다. 대부분의 의사들은 정신과교육, 정신과자문, 정신분석학, 학생들의 정신과선택, 정신과의사에 대해 긍정적인 반응을 보였다. 스탭들은 전공의들보다, 상급 스탭들은 하급 스탭들보다 정신과에 대해 더 긍정적인 견해를 보였다. 한편 내과계 스탭들이나 전공의들이 외과계 스탭들이나 전공의들보다 일부 정신과에 대한 태도에 있어서 더 호의적인 반응을 보였으나 전체적으로 내과계와 외과계의사들 간의 정신과에 대한 태도는 유의한 차이를 보이지 않았다. 한편 과거 정신과에 대한 관심도가 높을수록 학문으로서 정신과에 대한 매력 및 발전에 대한 인지도가 긍정적인 것으로 나타났다. 연령이 많을수록 정신과의 위치 및 효율성, 정신과의사의 역할과 기능에 있어서 긍정적인 반응이 더 많았다. 이상의 결과들은 과거 정신과에 대한 관심도, 연령 및 오랜 임상 경험이 정신과에 대한 태도에 긍정적인 영향을 미치는 요인들임을 시사한다. 또한 향후 타과 의사들의 정신과에 대한 태도를 향상시키기 위해서는 이들을 위한 정신과 교육에 관한 모형을 개발할 필요가 있을 것이다.

DSM-IV 진단 기준에 의하여 신체화 장애, 미분화 신체형 장애, 그리고 달리 분류되지 않은 신체형 장애여성 환자 13명과 정상 여성 20명을 대상으로 압통에 대한 통각 역치와 혈청 testosterone을 측정하여 다음과 같은 결과를 얻었다. 1) 가변 하중 압통 예민도 측정기 (Variable Weight Pressure Algometer)로 측정한 통각 역치는 환자군이 153.8${\pm}$39.5gm/$0.05mm^2$로서 대조군의 197.5${\pm}$66.7gm/$0.05mm^2$보다 유의하게 낮았다(p<0.05). 2) 혈청 testosterone치는 환자군에서는 0.175${\pm}$0.081ng/ml였고, 대조군에서는 0.174${\pm}$0.108ng/ml로서 양군간에 유의한 차이가 없었다. 3) Testosterone과 통각 역치와의 상관관계를 보면, 환자군에서는 혈청 testosterone치와 통각 역치 사이에 유의한 정적 상관관계가 있었으나(r=0.632, p<0.05, two tailed, Pearson's correlation test), 대조군에서는 유의하지 않았다(r=-0.405). 이상의 결과로 보아 신체화 장애 환자와 정상인 사이에 통각 예민도 조절 기전이 서로 다를 수 있다고 사료 된다.

Objective: This study was designed to evaluate the etiological factors of the PTSD(post traumatic stress disorder) by examining the relationship between severity of physical trauma and subsequent the severity of PTSD symptom in traffic accident related PTSD patients. Method: Subjects were 21 psychiatric inpatients with history of traffic accident related PTSD(DSM-IV criteria), the purpose of evaluation of mental disability and no evidence of organic brain leisons. The severity of physical trauma was assessed by McBride number of nonpsychiatric department and the presence / absence of loss of conciousness. The severity of PTSD symptom was assessed by Hovens' self rating inventory for PTSD. And then we evaluated the correlation between these two factors. And we also evaluated relationship between severity of PTSD symtom and clinical variables. Results : There were no significant relationship between McBride number of nonpsychiatric department severity and symptomatic severity(r= 0.17, p<0.05), the presence / absence of loss of conciousness and symptomatic severity(p>0.05). And significant relationship between symptomatic severity and clinical varibles such as sex, education level, marital status(p<0.05). Conclusions : These data did not support data of previous studies that traumatic severity was correlated with symptom severity but, suggested that other variables affecting the severity of PTSD symptom is more important indirectly. And that the 'trauma' in PTSD is psychological meaning rather than physical meaning is also suggested.

Objectives : The purpose of this study was to determine correlation between coping strategies to disease and quality of life in chrome viral B hepatitis patients ; to investigate difference of coping strategies to disease and quality in life between chronic viral B hepatitis patients and normal persons ; and to identify major variables related to quality in life of chronic viral B hepatitis patients. Methods: The authors used Weisman coping strategy scale for measuring coping ability and efficacies, and the questionnaire for measuring quality of life including physical, psychological, social and economical aspects and satisfaction of sexual life was made by authors based on related literatures. Data were collected through questionnaire survey over a period from Sep 15, 1994 to Nov 11, 1994. Subjects served for this study consisted of 94 chronic viral B hepatitis patients visited to department of internal medicine at one general hospital and 100 normal persons visited to one general hospital for routine check up of health. The collected data were analyzed by SAS and the statistical methods for analysis were Chisquare, t-test and multiple regression analysis. Results : 1) It was revealed that coping strategies to disease significantly correlated to individual's quality of life. 2) There was no significant difference in coping strategies to disease between chronic viral B hepatitis patients and normal persons. However, chronic viral B hepatitis patients showed the lower scroes of quality of life in physical, psychological and economical aspects. 3) The most important variables which were influenced upon quality of life were coping strategies to disease and satisfaction of sexual life. That is, the more active coping strategies to diseases and the higher satisfaction of sexual life, consequently the higher quality of life was. Especially male patient group or normal persons showed each other the higher scores of quality of life in physical and psychological area than female group or patient group. 4) No statistically significant difference in coping strategies to disease and quality of life was found between HBeAg positive group and HBeAg negative group. Conclusions : The authors suggest that chronic viral B hepatitis patients may show the lower score of quality of life than normal person. Therefore, quality of life assessment should become an integral part of all clinical area that seek to assess the effectiveness of treatment. Also, through the interdisciplinary approach, a comprehensive paradigm that can better account for the effects of chronic disease on the individual' s quality of life should be developed.

Objectives : This study was performed to evaluate the status of psychiatric consultation at a newly opened university hospital, to explore problems related to psychiatric consultation and to contribute for future consultation to be more systematic and more efficient. Methods: The subjects of this study were 284 patients hospitalized at Inha University Hospital between September 1, 1996 and August 31, 1997, who were referred for psychiatric consultation during hospitalization. This study was evaluated demographical characteristics of referred patients, resons for referral, recommendations by psychiatric consultant, clinical diagnoses, psychiatric diagnoses, relationship between referral time and hospitalization following the day of consultation and consultation referral types based upon psychiatrists' reports and patients' medical charts. Results : Most common patients referred to consultation were females aged 20s who visited at the department of internal medicine and related to the risk of suicidal attempts. Mood disorder was the most frequent psychiatric diagnosis, and the most common recommendations were to use psychopharmacological treatment along with outpatient visits. The 30% of subjects were referred to consultation within a day after hospitalization. In the case of consultation referral timing within two days and after three days, there was significant difference between early consultation and shorter hospitalization following the day of consultation. Most frequent type of consultation(29.6%) was categorized as IIIa type(physical complication type as a "Mending" request type). Conclusion : In review of consultation referral timing and consultation referral type of the subjects, who were referred for psychiatric consultation for one year at a newly opened University Hospital, referrals were found to be made within two days after their admission to hospital(50.7%), which was observed to be early request. We found that there was significant association between early consultation and shorter hospitalization following the day of consultation. The physical complication type(29.6%) which belongs to "Mending" request type was found to be the most frequent consultation referral type. This result indicates that more systematic psychiatric consultation is needed for the future.

Objectives: This research was performed to know severity of depression and anxiety, the psychopathology of hemodialysis patients and kidney transplantation patients using Minneesota Multiphasic Personality Inventory(MMPI) and Zung's Self-rating Depression Scale (SDS), Zung's Self-rating Anxiety Scale(SAS), MMPI Subscales. Methods: We surveyed 31 hemodialysis patients and 119 kidney transplantation patients. 119 kidney transplantation group(KT) was investigated at ; 1) Before kidney transplantation (KT-1), 2) Three days after kidney transplantation(KT-2), 3) Three weeks after kidney transplantation(KT-3),4) Follow up at OPD(F/U). Results: 1) According to dermographic data, mean age was KT 33.1, HD 42.2, Control 33.1 years old and KT, HD were belonged to lower economic states and lower educational level than Control. 2) In the depression scale for SDS, KT-1 was more depressed than F/U and Control but depression scale was significantly decreased at KT-2 in comparison with HD. In the anxiety scale for SAS, KT-1 was more anxious than Control but anxiety scale was not different within IT subgroups and in comparison with HD. 3) In comparison of MMPI scales, Hs, D, Pt, Ma at KT-1, Pd, Pa, Pt, Ma at KT-2, F, D, Pd, Pt, Pa, Sc, Ma at KT-3, Pt at F/U were more high scores than Control.

Alternative medicine is defined as the practices used for the prevention and the treatment of diseases that are not taught widely in medical schools, nor generally available inside hospitals. Alternative medicine or therapy is of growing interest to the general public. We conducted a survey to determine the prevalence and patterns of using alternative medicine such as herbal medicine acupuncture, folk medicine, health food and diet, yoga, qi therapy, shiatsu, chiropractics, homeopathy etc.. Based on 794 completed questionnaires, 484 respondents(61%) reported using at least one form of alternative medicine for their medical problems. The major medical conditions for which they used alternative medicine were back pain(85.6%), arthritis(85.4%), hypertension(85.2%), cerebrovascular disorders(86.4%), and insomnia(84.6%). The types of alternative medicine frequently used were herbal medicine, acupuncture, folk medicine, and health food. The reasons why the vast majority of people sought after alternative medicine was that: less side-effect, it is not harmful, it is more effective, there is a shorter waiting time, and a better explanation fur the conditions and a kinder therapist. We found that the frequency of using alternative medicine in the health care system was high. Physicians need to be more aware that many patients may be using alternative medicine. Further survey of the nation-wide prevalence of alternative medicine, and scientific study into the efficacy of this medicine should be followed. In the meantime, we suggest paying attention to possible harmful effects caused by some sorts of alternative medicine.

저자들은 뇌졸중후 우울증보다 매우 드물게 발생하는 뇌졸중후 양극성장애 증례를 경험하여 보고하였다. 좌반구 기저핵 뇌경색이후 뇌졸중후 우울증을 앓아오던 환자에서 조증 에피소드가 발병하여 원인을 규명하는 과정에서 자기공명영상을 시행한 결과, 이차성 양극 성장애와 연관되는 것으로 보고되어온 우반구 기저핵의 새로운 뇌경색이 밝혀졌다. 한 환자에서 좌반구 뇌졸중이후 우울증, 우반구 뇌졸중이후 양극성장애의 발생이 시간적 연관성을 보였으며, 한편 뇌졸중후 우울증과 이차성 양극성장애 각각이 병변 위치와 특이한 연관성을 보여주고 있다. 문헌 고찰에 의하면, 이차성 조증이 주로 피질의 병변과 연관성을 보이는 반면, 양극성 장애는 피질하 병변에서 호발하는 것으로 보고되어왔으며, 이차성 조종의 위험인자로는 정신장애의 가족력과 경한 피질하 위축이 제시되었다. 이 증례에서도 우반구 피질하 병변과 경한 피질하 위축이 관찰되었다. 뇌졸중 병변위치와 기분장애의 상관성 및 위험인자에 대한 연구는, 일차성 기분장애의 신경생물학적 연구에 기여할 수 있을 것이며, 임상에서도 뇌졸중 환자의 정신증상 치료에서 조중 유발의 위험성을 인식하는데 도움이 될수 있을 것이다.

심인성기침은 반복적으로 지속되는 마른 기침, 개짓는 듯한 소리의 기침, 수면시 증상의 중단, 증상에 대한 무관심, 뚜렷한 이차적 이득, 객관적, 방사선학적, 다른 실험실검사에서의 정상소견, 내과적 약물치료에 대해 반응을 보이지 않는 것, 정신치료후 증상의 호전, 갑작스러운 증상의 호전등이 특징적이다. 저자는 지속적인 마른 기침을 주소로 정신과에 자문의뢰된 심인성 기침 환자 2례를 경험하였으므로 이를 문헌고찰과 함께 보고 하는 바이다.