• 정신신체의학
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• 제19권1호
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• pp.28-33
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• 2011

연구목적: 본 연구는 신설대학병원에서 개원 이후 약 5개년간 이루어진 자문의뢰 상황과 특성을 분석하고자 하였다. 방 법: 2004년 5월부터 2008년 12월까지 정신과에 자문 의뢰된 입원 환자들에 대한 후향적 연구로, 연구 자료는 의무기록 검토를 통해 수집되었다. 결 과: 총 1,852건의 자문의뢰 중 정신상태 변화(mental change)가 20.5%로 가장 흔한 자문사유였고, 우울기분(16.8%), 불면(12.8%), 불안(7.9%) 등의 순이었다. 가장 흔한 정신과적 진단은 섬망(39.7%)이었고, 우울장애(28.2%), 적응장애(7.9%), 불안장애(4.1%) 등 정서적 문제도 흔하였다. 섬망으로 진단된 환자의 평균 연령이 다른 진단군에 비해 유의하게 높았다. 남성 환자에서는 섬망이 47.1%, 여성 환자에서는 우울증이 48.3%로 각각 가장 빈번하였다. 수술을 받은 환자에서 받지 않은 환자 보다 섬망의 발생이 유의하게 빈번하였다. 결 론: 정신과 자문의뢰 중 가장 빈번한 진단은 섬망이었고, 다음으로 우울장애였다. 섬망은 남성에서 빈번하였고, 우울장애는 여성에서 빈번하였다.

• Journal of Preventive Medicine and Public Health
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• 제42권6호
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• pp.416-423
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• 2009

Objectives : This study was performed to examine medical care utilization of psychiatric patients and to explore patients' characteristics associated with extended hospitalization. Methods : Data were extracted from information of Korean Health Insurance Review and Assessment Service. All data associated with admission and outpatient clinic visit were analysed by patient characteristics. We selected first psychiatric admission patients who diagnosed mental and behavioral disorders due to use of alcohol (main disease code: F10), schizophrenia and related disorders (F20-29) and mood disorders (F30~33) from January to June 2005. We analysed status of admission, mean length of stay, regular access to outpatient clinic and rates of extended hospitalization during 3 years. Bivariate and multivariate analyses were conducted to identify factors associated with extended hospitalization. Results : The number of psychiatric patients during the first six month of 2005 was 30,678. The mean length of stay was longest for schizophrenia and related disorders but shortest for mood disorders. Patients who experienced an extended hospitalization were 18.8% of total subjects. An extended hospitalization was more common in schizophrenia and related disorders than other diagnostic groups. The factors associated with the extended hospitalization were age, sex, diagnostic group, type of insurance and medical care utilization groups. Conclusions : The study indicates the problem of an extended hospitalization for psychiatric patients in Korea. It is suggested that variations in rates of extended hospitalization among medical care utilization group may need an active early intervention system in psychiatric treatment service. Particular attention needs to be devoted to planning and funding for reducing extended hospitalization.

• 동의신경정신과학회지
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• 제22권3호
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• pp.115-125
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• 2011

Objectives : This study was aimed to review the trend of clinical studies in Journal of Oriental Neuropsychiatry since 2001 to 2010. Methods : We collected 260 clinical studies and analyzed them for publish year, sorts of disease or symptoms, pattern identification diagnosis, and classification of clinical studies. Among them, we selected 46 clinical experimental studies and these studies were further analyzed for publish year, research institution, sort of disease or symptoms, sorts of treatments, number of subject, and pattern identification diagnosis. Results : The number of clinical studies in Journal of Oriental Neuropsychiatry have increased since the year of 2001. There were 62 kinds of diseases and symptoms and Hwa-Byung had the highest number of studies followed by depression, headache, insomnia and so on. The clinical experimental studies, which took up 17% of the clinical studies, have increased since 2001 and was varied with year. There were 13 reserch institutions for clinical experimental studies and they studied about stress, dementia, Hwa-Byung, and so on. Most of studies researched treatment about acupuncture, herb medicine, and meditation treatment for persons under 144. There are only 22% of studies using pattern identification diagnosis. Conclusions : For the development of oriental medicine for psychiatric disease, we need more qualifying clinical studies like RCT. We hope more researchers for psychiatry disease of oriental medicine will be interested in the publication of clinical studies and this will serve to produce advance of oriental medicine as evidence based medecine.

• 수면정신생리
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• 제10권1호
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• pp.26-31
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• 2003

Restless leg syndrome (RLS) and periodic limb movement of sleep (PLMS), often concurrent, come under diagnosed disorders of sleep and treatable condition. RLS symptoms are evoked in the limbs at rest and increase in the evening and during the night. PLMS is characterized by periodic episodes of repetitive limb movements caused by muscle contractions during sleep. RLS is often associated with a sleep complaint and PLMS. Both RLS and PLMS represent one of the most commonly encountered sleep disorders in a primary care setting. The circadian rhythm and the presence of PLMS cause sleep disturbances in RLS. The emphasis on pathophysiology includes consideration of central nervous system localization, neurotransmitter, and the role of iron metabolism. Dopaminergic agents are considered the treatment of choice for RLS and PLMS. With proper diagnosis and effective treatment patients' ability to fall asleep and maintain sleep improves, and their sense of well being increases.

• 생물정신의학
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• 제22권4호
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• pp.195-204
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• 2015

Objectives This study investigated the patterns of psychotropic medications prescribed to patients admitted to an open psychiatric ward. Methods We reviewed 4282 medical records of patients who were discharged from an open psychiatric ward from May 2003 through April 2014. Data were collected on each patient's age, sex, length of hospital stay, number of past admissions, discharge diagnosis, and kinds and dosages of psychotropic medications at discharge. Results Among the 1384 male and 2898 female patients, 3.56 psychotropic medications were prescribed on average, with the number increasing across years, from 3.30 in 2003-2008 to 3.76 in 2009-2014. Prescription rates of antipsychotics, anxiolytics, and hypnotics significantly increased in patients with depressive disorders, bipolar disorders, anxiety disorders, delirium, dementia, and amnestic and other cognitive disorders. Only lithium prescription rates decreased significantly. Prescriptions for two or more anxiolytics and antipsychotics increased during the survey years, while antidepressant polypharmacy rates decreased. Conclusions Recently, there has been a significant increase in the number of psychotropic medications prescribed, including antipsychotics, anxiolytics, and hypnotics. Caution should be exercised when prescribing medications to avoid cost increases and the risk of side effects, with uncertain gains in the quality of care.

• 대한불안의학회지
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• 제6권2호
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• pp.131-136
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• 2010

Objectives : In this study, we aimed to elucidate the demographic and psychological characteristics of maladaptive soldiers in the Republic of Korean Army. Methods : Study participants included 110 male conscripts who had participated in the Green camp, which was a form of group psychosocial treatment program for maladaptive soldiers. All participants were interviewed and diagnosed by a psychiatrist, and classified into two groups according to whether they left or rejoined the army. We analyzed the differences between these two groups in terms of demographic features, psychiatric diagnosis and the Minnesota Multiphasic Personality Inventory (MMPI) subscores. Results : Compared with soldiers who rejoined their units, those who left military service exhibited significantly lower educational level (p=0.041) and a higher rate in psychiatric treatment prior to enlistment (p=0.011). Among the 106 subjects, 63 (59.4%) and 23 (21.7%) were diagnosed with personality disorder and adjustment disorder, respectively. Further, those who left military service were diagnosed more frequently with mood disorder (p=0.001) and schizophrenia (p=0.014) than those who rejoined their units. Additionally, the MMPI scores of soldiers who left military service were significantly higher on the psychasthenia (p=0.028) and schizophrenia (p=0.039) scales than those of soldiers who rejoined their units. Conclusion : Most of the maladaptive soldiers were diagnosed with mental disorders. The results of this study suggest that systematic, consistent psychiatric evaluation and intervention for maladaptive male conscripts is crucial in the Republic of Korean army.

• 정신신체의학
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• 제5권1호
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• pp.31-42
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• 1997

This study was aimed to investigate dysfunctional attitudes, stress coping strategies and depressive symptoms in psychiatric patients. The subjects of this study consisted of 210 patients(138 schizophrenic patients, 29 depression patients, 43 alcohol dependence patients) according to DSM-IV criteria. Futhermore, the instruments were K-BDI(Beck Depression Inventory-Korean version), DAS(Dysfunctional Attitude Scale) and multidimensional coping strategy scale. The results were the following. 1) There were statistically significant correlations between depressive symptoms and dysfunctional attitudes in psychiatric patients. 2) In terms of coping strategies, there were positive correlations between depressive symptoms and focus on and venting emotions, accommodation, active forgetting, self-criticism, positive comparison, fatalism, passive withdrawal. Whereas, there was significant negative correlation between depressive symptom and active coping. 3) In terms of coping strategies, there were significant correlations between dysfunctional attitudes and focus on and venting emotions, active forgetting, self-criticism, positive comparison, fatalism, passive withdrawal. 4) Depression groups reported significantly higher BDI scores than schizophrenia groups. 5) In depression groups, DAS scores were significantly higher than those in schizophrenia groups. 6) In terms of coping strategies according to diagnosis, there were significant differences in venting emotions, active forgetting and self-criticism. As for venting emotions, alcoholic groups were scored significantly higher than schizophrenic groups. As for active forgetting, depression groups were scored significantly higher than schizophrenic groups. In self-criticism, depression groups and alcohol dependence groups reported significantly higher scores than schizophrenic groups.

• 대한임상독성학회지
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• 제12권2호
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• pp.54-62
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• 2014

Purpose: The purpose of this study was to compare prescription patterns and clinical features according to clinical departments in sedative-hypnotic intoxication. Methods: This was a retrospective study of histories, substances of poisoning, acquisition routes, clinical courses, and outcomes of patients treated for acute intoxication in a single emergency medical center from January, 2011 to December, 2013. Results: A total of 769 patients were treated for acute intoxication, 281 patients ingested sedative hypnotics during the study period. Among 281 patients, 155 patients were prescribed by psychiatric department and 80 patients were prescribed by non-psychiatric department. Benzodiazepines were more likely to be prescribed by psychiatrists, and zolpidem was preferred by non-psychiatrists (p<0.001). Non-psychiatrists were more likely to prescribe short acting benzodiazepines than psychiatrists (p<0.001). However, there was no statistically significant difference in the clinical outcomes, including prevalence of admission to ICU, ventilator care, and length of stay in ICU. In patients prescribed by non-psychiatrists, there were more patients prescribed without psychiatric diagnosis and diagnosed as major depression disorder after hospitalization. Conclusion: To promote rational prescribing of sedative hypnotics, proper psychiatric evaluation should be performed before prescribing, and educational programs including the contents of interactions and side effects of sedative hypnotics are needed.

• 정신신체의학
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• 제27권2호
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• pp.119-129
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• 2019

연구목적 본 연구는 군대 내 부적응이 우려되어 군 복무 적합성 판정을 위해 내원한 환자들의 인지적 및 심리적 특성을 알아보기 위해서 이루어 졌다. 방 법 2017년 1월~2018년 9월까지 경기도 소재 대학병원 정신건강의학과에 병사용 진단서 발급을 위해 내원한 140명을 대상으로 이들의 인지적 및 심리적 특성을 조사하였다. 이들은 정신건강의학과 전문의로부터 DSM-5에 근거하여 진단을 받았고, 진단명이 분석에 활용되었다. 또한 각각의 환자들은 임상심리사로부터 웩슬러 지능검사 4판과 간이정신진단검사(K-SCL-95)를 받았다. 총 136예가 분석에 포함되었다. 수집된 자료를 분석하기 위해 SPSS 18.0을 사용하였으며, 기술 통계 분석, 독립표본 t-검증을 사용해 알아보고자 하였다. 결 과 전체 환자들 중 24.6%가 전체 지능(FSIQ)이 70 미만인 매우 낮은 수준의 지능에 해당되었다. 또한 경계선 수준은 10.8%에서 나타났으며, 평균 하 수준의 지능은 26.3%에서 관찰되었다. 아울러 평균 수준은 18.0%의 환자에서 나타났고, 마지막으로 평균 상 수준은 4.2%에 해당하였다. 다음으로 심리적 특성에 대한 분석 결과, 우울, 불안, 공포불안-임소불안, 자살이 주의 및 위험 수준에 해당하였고, 외상 후 스트레스 장애 소척도의 T점수 평균은 75.57로 정신건강 문제 발생 가능성이 시사되는 문제 수준으로 나타났다. 다음으로, 환자들을 병무청 신체검사 시 군대 내 부적응이 우려되어 군 복무 적합성 판정을 권유받은 집단과 훈련소 과정에서 군대 내 부적응이 우려되었던 집단으로 분류하여 통계 분석을 하였으나, 두 집단의 심리적 특성에는 유의한 차이가 발견되지 않았다. 아울러 단일 진단을 받은 집단과 2개 이상의 정신과적 진단을 받은 공병 집단 간 차이를 보고자 한 분석에서는 공병 집단이 단일 진단 집단에 비해 더 우울하고, 분노감과 공격성이 높았으며, 더 심각한 자살 사고 경향을 보이며 스트레스에 취약하고 낮은 자기조절력을 보인다는 결과를 얻었다. 결 론 본 연구를 통하여 공병 집단이 단일 진단 집단에 비해 우울감, 분노감 등의 심리적 고통감을 크게 느낀다는 것을 알 수 있었다. 또한 본 연구에 포함된 환자들은 정신건강의학과 전문의의 진단, 지능검사와 주관적 증상 설문 결과로 볼 때 본 연구 집단은 낮은 인지기능과 여러 정신 증상의 문제를 보였다. 이러한 연구 결과를 토대로 본 연구의 시사점과 제한점에 관하여 논의하였다.

• 정신신체의학
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• 제7권2호
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• pp.174-183
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• 1999

본 연구는 자동차사고 이후 신체적 증상에 대한 치료를 받은 후 정신과적 진단 및 치료 또는 정신감정을 위해 정신과로 의뢰되었던 44명의 환자를 대상으로 자동차사고와 외상후 스트레스장애와의 관계를 평가하기 위한 것이다. 외상후 스트레스장애 진단은 외상후 스트레스장애 척도(CAPS)를 사용하여 DSM-IV 진단기준에 따라 분류하였고, 축소형 부상척도(AIS)를 사용하여 신체적 손상과 외상후 스트레스장애 증상과의 관계를 조사하고 외상후 스트레스장애와 Axis I 공존질환 유무에 대해 알아 보았다. 자동차 사고후 정신과에 의뢰된 대상자 44명중 20명(45.5%)이 외상후 스트레스장애로 진단되었고 13명(29.5%)이 아증후성 외상후 스트레스장애에 속하였다. 신체적 부상의 정도는 외상후 스트레스장애 증상을 예견하는 것으로 나타났다. 외상후 스트레스장애군은 외상후 스트레스장애 진단 기준 BCD 모든 증상에서 높은 비율을 나타냈고, 아증후성 외상후 스트레스장애군은 기준 B와 D 증상에서 비교적 높은 비율을 나타냈으며, 두 군 모두 기준 B 가운데 '사건에 대한 반복된 꿈' 항목의 비율이 가장 높았다. 외상후 스트레스장애군의 55%가 주요우울증을 동반하였다. 결론적으로 본연구의 결과는 외상후 스트레스장애가 자동차사고 이후 흔히 올 수 있는 정신장애임을 시사하고 있다. 따라서 자동차사고 후 신체적 손상에 대한 치료를 받고 마지막으로 정신과에 의뢰된 환자들에 대해서는 적어도 치료계획에서 외상후 스트레스장애라는 진단을 정규적으로 고려해야만 할 젓이고. 특히 취약성이 있는 환자들에 대해서는 조기 중재가 외상후 스트레스장애 증상을 예방할 수 있을 것이라고 생각된다.