• Title/Summary/Keyword: 정신과외래

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A CASE OF CLOZAPINE TRIAL FOR A MANIC EPISODE SUFFERED BY AN ADOLESCENT RECOVERING FROM NEUROLEPTIC MALIGNANT SYNDROME (신경이완제 악성증후군 회복후 지속되는 조증에 Clozapine을 사용한 청소년 환자 1례)

  • Cho, Soo-Churl;Hong, Kang-E;Kim, Yong-Sik;Chung, Sun-Ju;Bahn, Geon-Ho
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.9 no.2
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    • pp.247-252
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    • 1998
  • Neuroleptic malignant syndrome(NMS) is an acute, potentially fatal, idiosyncratic reaction to neuroleptic medication. Early recognition and intensive care are crucial. An important issue is whether NMS will recur after initial recovery and subsequent use of neuroleptic medication. The authors presented with a male adolescent who had suffered a bipolar disorder manic episode and been taking clozapine after recovering from MNS. He had been admitted into a psychiatric ward once before and similarly diagnosed. On the second admission, he showed muscle rigidity, autonomic instability, mild fever, severe diaphoresis, and altered mental status on the fourth hospital day following a haloperidol injection. He was diagnosed with NMS, according to the clinical signs and laboratory data. After the use of antipsychotics was discontinued, he was moved to intensive care unit and given dantrolene. His condition began to improve about 48 hours after the onset of NMS. Due to manic behavior, he returned to the psychiatric ward. On the 21 st hospital day, clozapine was administered to counter the manic symptoms. The final dose was 350mg and showed good remission signs without further recurrence of NMS.

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Psychophysiological Response by Imagination and Talking about Anger-Provoked Event in Hwa-byung:Cardiovascular Response (소위 '홧병'에서 분노유발사건의 상상과 이야기작업에 의한 정신생리반응:심혈관계 반응)

  • Chung, Sang-Keun;Shin, Jun-Ho;Hwang, Ik-Keun
    • Sleep Medicine and Psychophysiology
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    • v.7 no.2
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    • pp.109-114
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    • 2000
  • Objectives: This study was performed to examine the characteristic cardiovascular response patterns associated with the imagination and discussion of anger-provoked events in patients with hwa-byung. Methods: Forty-three female patients with hwa-byung were evaluated with the Korean version of the State-Trait Anger Expression Inventory, the State-Trait Anxiety Inventory, Hamilton Rating Scale for Anxiety, Beck Depression Inventory, and Hamilton Rating Scale for Depression just before the task. Subjective Units of Distress (SUDS) and Vividness of the event (VIVID) during the imagination and discussion of the event were evaluated immediately after tasks. Blood pressure (BP) and heart rate (HR) during baseline, rest, and tasks were also evaluated. Results: Both startle and recovery responses of BP, startle response of HR, SUDS, and VIVID in discussion task were significantly larger than in the imagination task. Conclusion: Results suggest that it is undesirable for the patients to excessively and repeatedly recall and talk about the anger events.

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Quantitative Electroencephalographic Findings in Obsessive-Compulsive Disorder (강박 장애의 정량화 뇌파 소견)

  • Youn, Tak;Kwon, Jun Soo;Cho, Maeng-Je;Kim, Yong Sik;Rhi, Bou-Yong
    • Korean Journal of Biological Psychiatry
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    • v.3 no.2
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    • pp.216-221
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    • 1996
  • The quantitative EEGs of obsessive-compulsive disorder patients were analyzed using spectral analysis and compared to age and sex-matched controls. The subjects were 19 patients(men=15, women=4) suffering from obsessive-compulsive disorder(DSM-III-R). Absolute power, relative power and interhemispheric asymmetry of EEG were used to compare obsessive-compulsive disorder patients with controls. In order to fit the EEG data to a normal distribution, a log transformation of power values of every bandwidth in each deviation was calculated prior statistical analysis. The Wilcoxon rank test was performed to compare obsessive-compulsive group to the control group. In obsessive-compulsive disorder, abnormalities of quantitative EEGs are prominent in fronto-central. These results ore compatible with other brain imaging studies of obsessive-compulsive disorder and suggested that fronto-central area plays an important role in the pathophysiology of obsessive-compulsive disorder.

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BORDERLINE DISORDER OF CHILDHOOD : 8 CASES (아동기 경계선 장애 : 8증례)

  • Hong, Kang-E;Lee, Jeong-Seop;Shin, Min-Sup
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.6 no.1
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    • pp.3-17
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    • 1995
  • The so-called borderline children are characterised by disturbances in the sense of reality and interpersonal relationships, lack of control, fluctuation of functioning, uneven development and excessive anxiety. But the concept of borderline disorder of childhood is very difficult to define and diagnose in current classification system. The present study adapted the consensus symptoms in borderline children by Bemporad and Vera eight cases aged 7-11 were examined in 37 variables. Results are as follows 1) All subjects are boys and girl hardly be diagnosis n current diagnostic system and have many concurrent diagnoses. Common chief complaints in the sense of reality. 2) In KEDI-WISC test, the borderline children showed average intelligence, but performance IQ tends to be higher than verbal IQ. In Rorscharch test, they showed high thought disorder index, emotional instabilities and aggressive impulses. The results of TOVA suggested attentional deficit in half of the subjects. The organicity is not prominent. 3) Many of the borderline children were unwanted baby. Although primary care takers of all the subjects were their mothers there were moderate problems in caring attitude of their children and marital relationship with their husband. Sccioeconomic status was generally below middle class. Most of all subjects have delayed language development, but have overcome subsequently. Many subjects were rejected by peers because of their aggression. 4) The first visit of the subjects was about 6 years of age. Average duration of treatment was 2 years. All of them were treated in the outpatient basis except one. The effect of pharmacotherapy was doubtful and the necessity of long term play therapy was suggested. Although there were many limitations of method in present study, it was suggested that further research is needed for diagnostic criteria, epidemiology and treatment.

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6-months Prospective Follow-up Study of Panic Disorder Treatment (공황장애 환자 치료 결과에 대한 6개월간의 전향적 추적조사)

  • Yu, Je-Chun;Lee, Chul
    • Korean Journal of Psychosomatic Medicine
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    • v.9 no.1
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    • pp.58-65
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    • 2001
  • Objectives : It is well known that pharmacologic and behavioral therapies of panic disorder show remarkable acute treatment outcome, however the course of panic disorder in clinical settings is often chronic and relapsing. The purpose of this study is to investigate the treatment outcome of panic disorder and the factors related to good treatment outcome by prospective follow-up study after 6 month in clinical settings. Methods : Twenty nine patients were diagnosed to have panic disorder by SCID(Structured Clinical Interview for DSM-III-R), among the patients who had visited the psychiatric out-patients clinic of the Asan Medical Center for the first time. We determined the initial clinical and demoraphic features of each patient and reevaluated them after 6 months, investigating the treatment outcome by anxiety, phobia, impairment scales. We looked into the rate of the patients who showed good treatment outcome and determined the factors that had relation with good treatment outcome among demographic and clinical features. Results : Nineteen out of 29 patients could be followed after 6 months. Among them, 10 patients 52.6%) on the impairment scale and phobia scale each, and 8 patients(42.1 %) on the anxiety scale showed good treatment outcome. 8 patients(42.1 %) showed good treatment outcome on the all three scales. High score in initial phobia scale had significant relation with good treatment outcome. Short duration of illness did not have significant relation with good treatment outcome however there was a trend(p=0.07). Conclusion : About half(42.1 %) of the panic disorder patients showed good treatment outcome on all three scales. Severe initial phobic symptom and short duration of illness were expected to have relation with good treatment outcome.

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Anxiety, Depression and Pressure Pain Threshold in Patients with Posttraumatic Stress Disorder (외상후 스트레스장애 환자의 불안 및 우울 증상과 압통역치 간의 비교 연구)

  • Kim, Eun-Young;Na, Chul;Nam, Bum-Woo;Cho, Ju-Youn
    • Korean Journal of Psychosomatic Medicine
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    • v.7 no.1
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    • pp.51-60
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    • 1999
  • This study was designed to evaluate anxiety & depression symptoms and pressure pain threshold in patients with posttraumatic stress disorder(n=23) and to find out the relationship between the affective symptoms and the pressure pain threshold scores. And this was compared with healthy control subjects(n=18). The scores of pressure pain threshold were checked with algometer. The results were as follows : PTSD patients showed higher scores of anxiety & depression symptoms than that of the control group. In contrast with our hypothesis, pressure pain threshold in PTSD patients presented statistically significant higher scores than that of the control group. These results may be derived from following factors. First, chronic depression has influenced the pain perception of patients with PTSD rather than anxiety symptoms, second, abnormal state of the opiate system in PTSD patients, third, the sick role of the PTSD patients, fourth, the socio-environmental factor of the PTSD patients. In conclusion, affective symptoms, especially depression, were related to the chronic pain in patients with PTSD, however, the causality of elevated pressure pain threshold was uncertain in this study. To understand more clearly the relation between affective symptoms and chronic pain, it will be necessary to control the other specific factors.

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A Comparison of Perceived Family Support among Patients with Somatoform Disorders, Psychosomatic Disorders and Depressive Disorders (신체형장애, 정신신체장애 및 우울장애 환자들간의 가족지지도지각의 비교)

  • Koh, Kyung-Bong;Woo, Yong-Il
    • Korean Journal of Psychosomatic Medicine
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    • v.7 no.1
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    • pp.79-86
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    • 1999
  • A comprison was made regarding perceived family support among patients with somatoform disorders, psychosomatic disorders and depressive disorders. The subjects included 49 patients with somatoform disorders, 43 patients with psychosomatic disorders, and 50 patients with depressive disorders. Perceived social support-family scale was used to measure the extent of family support. The patients with somatoform disorders were significantly lower in family support than the patients with psychosomatic disorders. However, no significant differences were found between patients with somatoform disorders and those with depressive disorders, as well as between patients with psychosomatic disorders and those with depressive disorders. Patients with older age had significantly higher scores on family support than those with younger age. Married patients were significantly higher in family support than unmarried ones. These results suggest that low family support may be associated with either the etiology or the sequelae of somatization. Thus, it is emphasized that the role of family support is essential in evaluation and treatment of somatization. In addition, longitudinal studies will be required to investigate the causative role of low family support in somatization.

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A Study of Anxiety Scale Applied to Patients with Anxiety Disorder (불안 환자에 대한 불안척도의 연구)

  • Lee, Jung-Hoon;Park, Byung-Tak
    • Journal of Yeungnam Medical Science
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    • v.9 no.1
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    • pp.156-166
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    • 1992
  • The authors studied anxiety, using Zung's self-rating anxiety scale(SAS), in the subjects of 127 male and 38 female patients with anxiety disorder. The authors investigated 165 patients in Yeungnam university hospital from January, 1987 to June, 1991. In order to analyze the data on anxiety scores Pearson's product moment coefficient correlation method and factor analysis were carried out by SPSS/PC+ program. The results were as follows : There was significant difference in the mean averages of total anxiety scores among patients with anxiety, disorder and male and female college freshmen: patients with anxiety disorder scored $42.40{\pm}7.74$, male students scored $32.91{\pm}5.70$, female students scored $34.48{\pm}6.00$. The anxiety scores relating to the items of body aches & pains, fatigue, anxiousness, panic, and urinary frequency were relatively high in patients with anxiety disorder. The anxiety scores on the items of restlessness, apprehension, dyspnea, sweating, and insomnia were relatively low in patients with anxiety disorder. Twenty-nine anxiety disorder group(17.5%) showed significantly high anxiety scores of 50 or over. The inter-rater reliability of Zung's self-rating anxiety scale was 0.71.

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The Comorbidity of Attention Deficit Hyperactivity Disorder and the Effect of Methylphenidate on it (주의력 결핍 과잉 운동 장애 환자들의 약물치료 효과 및 Comorbidity에 관한 연구)

  • Lee, Jong-Bum;Park, Hyung-Bae
    • Journal of Yeungnam Medical Science
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    • v.10 no.1
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    • pp.166-178
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    • 1993
  • The objectives of this study were to evaluate the effect of methylphenidate on attention deficit hyperactivity disorder (ADHD) and the comorbidity of the disorder, using child attention problem checklist to 56 (male: 38, female: 18) patients from, March 992 to February 1993. The results were as follows: Among 56 subjects, ADHD alone were 20 (335.71%) subjects, and with one additional diagnosis were 31 (55.35%) subjects and with two additional diagnosis were 5 (8.93%) subjects. There was significant improvement on symptoms in the scores rated by teachers in 7th and 28th day after menthlphenidate administration compared to baseline score (P<0.05) and 28th day score showed significant improvement compared to 7th day score (P<0.05) and 28th day score showed significant improvement compared to 7th day score (P<0.05). There was significant improvement on symptoms in the scores rated by parents in 28th day after methylphenidate administration improvement compared with 7th day score. In single administration of methylphenidate in Sunday morning score compared to afternoon score (P<0.05). In the administration of significant improvement on symptoms compared with the Sunday morning rating score of parents (P<0.05) and the 28th day comparison was also showed significant improvement on symptoms in the scores rated by teachers compared with the scores rated by parents on symptoms (P<0.05). Among group comparison, all groups showed significant improvements (P<0.05) except conduct disorder & oppositional defiant group.

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The Burden of Main Caregivers in the Family with Schizophrenic Patient (정신분열병환자 가족 주보호자의 부담에 관한 연구)

  • Hur, Bok-Sim;Ryu, So-Yeon;Park, Jong;Kim, Ki-Soon;Kim, Yang-Ok;Kim, Hack-Ryul
    • Journal of agricultural medicine and community health
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    • v.24 no.2
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    • pp.351-368
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    • 1999
  • The objective and subjective burden was evaluated toward 115 main caregivers in the family with schizophrenic patient by interview with structured questionnaire and self-report using Family Burden Scale (FBS) of family with schizophrenic patient in Korea. The results were as follows : 1) The mean age of onset by schizophrenic patient were 23 years old in male and 26 in female. 2) The mean scales of objective and subjective burden were 1.5 and 1.6. 3) By Logistic regression objective burden was significantly affected by family support (P<0.001), religion (P<0.05), occupation (P<0.05). 4) Subjective burden was significantly affected by family support (P<0.01) and family total income (P<0.05). 5) Total objective and subjective burden was significantly affected by family support (P<0.001), religion (P<0.05). In conclusion, this study suggests that main caregivers need family support from other family members. For them religion and social support are also helpful to cope with the burden to take care of the schizophrenic patients.

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