• 제목/요약/키워드: depression scale

검색결과 1,770건 처리시간 0.027초

A Pharmacogenomic-based Antidepressant Treatment for Patients with Major Depressive Disorder: Results from an 8-week, Randomized, Single-blinded Clinical Trial

  • Han, Changsu;Wang, Sheng-Min;Bahk, Won-Myong;Lee, Soo-Jung;Patkar, Ashwin A.;Masand, Prakash S.;Mandelli, Laura;Pae, Chi-Un;Serretti, Alessandro
    • Clinical Psychopharmacology and Neuroscience
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    • 제16권4호
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    • pp.469-480
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    • 2018
  • Objective: Pharmacogenomic-based antidepressant treatment (PGATx) may result in more precise pharmacotherapy of major depressive disorder (MDD) with better drug therapy guidance. Methods: An 8-week, randomized, single-blind clinical trial was conducted to evaluate the effectiveness and tolerability of PGATx in 100 patients with MDD. All recruited patients were randomly allocated either to PGATx (n=52) or treatment as usual (TAU, n=48) groups. The primary endpoint was a change of total score of the Hamilton Depression Rating Scale-17 (HAMD-17) from baseline to end of treatment. Response rate (at least 50% reduction in HAMD-17 score from baseline), remission rate (HAMD-17 score ${\leq}7$ at the end of treatment) as well as the change of total score of Frequency, Intensity, and Burden of Side Effects Ratings (FIBSER) from baseline to end of treatment were also investigated. Results: The mean change of HAMD-17 score was significantly different between two groups favoring PGATx by -4.1 point of difference (p=0.010) at the end of treatment. The mean change in the FIBSER score from baseline was significantly different between two treatment groups favoring PGATx by -2.5 point of difference (p=0.028). The response rate (71.7 % vs. 43.6%, p=0.014) were also significantly higher in PGATx than in TAU at the end of treatment, while the remission rate was numerically higher in PGATx than in TAU groups without statistical difference (45.5% vs. 25.6%, p=0.071). The reason for early drop-out associated with adverse events was also numerically higher in TAU (n=9, 50.0%) than in PGATx (n=4, 30.8%). Conclusion: The present study clearly demonstrate that PGATx may be a better treatment option in the treatment of MDD in terms of effectiveness and tolerability; however, study shortcomings may limit a generalization. Adequately-powered, well-designed, subsequent studies should be mandatory to prove its practicability and clinical utility for routine practice.

폭식증 환자의 연극치료 사례 (Case study of dramatherapy for a bulmina nervosa patient)

  • 이효원
    • 한국연극학
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    • 제52호
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    • pp.359-397
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    • 2014
  • This paper describes dramatherapy with a bulmina nervosa patient. She was in her early 20s and has been under the various psychotherapies for cure of deep depression since 2005. We had 24 sessions and 3 persons - the patient, the therapist, and the assist-therapist- participated in dramatherapy. I found there's a big collision between her important roles in the course of initial interview and diagnosis. Those roles are 'a good daughter of mom' and 'an independent adult'. Therefore I defined her bulmina nervosa as 'an symbolic behavior repeats compulsively the failure of separation from her mother.' And I set the general goals, the separation from her mother, the awareness and expression of negative emotions, and the diminuation of overeating and vomiting. To attain these object, we had many different dramatic experiences in dramatherapy. We made a self-portrait, the mask of bulmina nervosa, family sculpture, figure work, the past I and the present I, psychodramatic scene and several stories. In order to objective assessment, I used behavioral observation and 6PSM(6 Pieces Story Making) analysis. First of all the most noticeable change was a rapid decrease in over-eating and vomiting. Before the dramatherapy she had overeaten 30 times per week. At the closure it has fallen off to 1 time per week. Another behavioral changes were shift of outward appearance, not going church, working for living, and having a date with only one. She made 3 stories on 1th session, 13th session, and 23th session. And I comparatively analysed those stories with both qualitative and quantitative method. For qualitative analysis, I classified 5 structures according to the substantial similrarity. On protagonist structure, there's no difference. Three protagonists are dead things. The type of task structure is changed from an escape, a traveling, to metamorphosis. The type of obstruction structure is changed from the protagonist to an outside object. The type of closure structure is changed from an exaggerated happy ending, sad ending to probable happy ending. To quantitify the aspects of transformation, I developed an assesment tool using likert scale. It is composed of 4 sub-categories-reality testing, imagination, ego-strength, optimism problem-solving. In reality testing category, a shift of score was 9-11-15, imagination 2-5-5, ego strength 3-2-2, optimism 6-3-7, and total score 20-21-29. This change of score reflects the growth of problem solving capacity. Viewed in this light, dramatherapy with this girl was successful on the whole. The thing had significant effect on it was psycho-dynamic approach focused on separation from her mother and defence mechanism to avoid negative emotion. And assessment method used in this case will be full of suggestions to researches to come.

학교모래놀이 집단상담이 아동의 정서, 행동에 미치는 임상효과 (The Clinical Effect of School Sand Play Group Counseling on Child Emotion and Behavior)

  • 곽현정;안운경;한길자;임명호
    • 한국콘텐츠학회논문지
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    • 제18권12호
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    • pp.54-61
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    • 2018
  • 본 연구는 초등학교 학생을 대상으로 학교모래놀이 집단상담이 아동의 정서 및 행동에 미치는 임상적인 효과를 국내에서 처음으로 알아보고자 하였다. ${\bigcirc}{\bigcirc}$시에 소재한 초등학교의 4-6학년 학생 113명을 대상으로 2015년 3월부터 7월까지 12주간 10회기의 학교모래놀이 집단상담을 시행하였다. 소그룹은 아동 10명-16명으로 구성되었으며, 회기는 Baseline 평가, 치료 10회기, 사후 평가회기 등 총 12회기로 구성되었다. 대상군은 남아 56명(49.6%), 여아 57명(50.4%)이었으며, 평가도구로는 역학 설문지와 한국아동청소년인성검사(Korea Child & Youth Personality Test, KCYP)를 Baseline 시점과 치료 후에 각각 평가하였다. 12주의 모래놀이 시행전후에서 KCYP의 임상척도 및 세부평가척도 점수를 각각 비교한 결과 학교모래놀이 집단상담 후 초등학생의 자존감이 향상되었으며 우울증상이 유의하게 감소하였다. 학교모래놀이 집단상담은 초등학생의 정서적 문제뿐만 아니라 자존감에 도움이 될 수 있을 것으로 생각된다.

유방암 감염성 림프부종 환자에서 성상신경절 블록이 미치는 영향 (The Effect of Stellate Ganglion Block on Breast Cancer-Related Infectious Lymphedema)

  • 이윤영;박학수;이연실;유승희;이희승;김원중
    • Journal of Hospice and Palliative Care
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    • 제21권4호
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    • pp.158-162
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    • 2018
  • 유방암에 의한 림프부종은 유방암 수술 이후 생기는 치료하기 힘든 부작용 중 하나로 여겨져 왔다. 환자들은 림프부종에 의한 신체적인 기능저하뿐만 아니라 삶의 질 저하로 인한 정신적인 우울감을 호소한다. 최근의 연구에서는 봉와직염이 유방암에 의한 림프부종의 위험성을 현저히 높인다는 결과가 있었고, 봉와직염 자체가 유방암에 의한 림프부종을 일으키는 위험 인자로 제시되어 왔다. 본 증례에서는 1달간의 성상신경절 블록으로 유방암에 의한 염증성 림프부종 환자의 증상 완화 및 팔 둘레의 현저한 감소에 대해 기술 하고자 한다. 우리는 환자의 팔 둘레를 4군데에서 측정하였는데 각각 팔꿈치를 기준으로 위 아래 5 cm, 10 cm에서 측정이 이루어졌다. 또한 통증 점수(NRS) 와 breast cancer questionnaire (LBCQ) 점수를 외래 방문마다 측정하였다. 두 번의 연속적인 성상신경절 블록 이후 환자의 통증 점수 및 팔 둘레는 감소하였고, 치료 중간에 봉와직염이 재발하여 다시 입원하여 항생제 치료와 병행하여 연속적인 성상신경절 블록을 시행하였고 환자는 시술의 결과에 대해 매우 만족하였다. 특히 환자는 통증 및 붓기의 완화와 어깨 관절의 움직임 개선에 큰 만족을 보였고, 결과적으로 환자의 삶의 질을 높이는데 기여하였다. 본 증례는 유방암에 의한 염증성 림프부종에 대한 성상신경절 블록의 효과에 대한 연구로, 스테로이드를 사용하지 않는 성상신경절 블록이 치료하기 힘든 염증성 림프부종 환자의 대체적이면서 보조적인 치료 방법으로 제시 될 수 있다는 것을 보여준다.

주의력결핍-과잉행동장애 초등학생에서 불안증상이 아동의 행동 및 주의력과 가지는 관련성에 관한 연구 (Associations of Anxiety Symptom with Behavior and Attention in Elementary School Children with Attention-Deficit/Hyperactivity Disorder)

  • 신준영;백기청;이경규;이석범;이정재;김도현;최재원;김경민
    • 대한불안의학회지
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    • 제15권2호
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    • pp.101-108
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    • 2019
  • Objective : This study aimed to investigate the associations of anxiety symptoms with behavior and attention in elementary school children with attention-deficit/hyperactivity disorder (ADHD). Methods : A total of 195 elementary school children with ADHD participated in the study. The Korean Version of ADHD Rating Scale (K-ARS) and Behavior Assessment System for Children(BASC-2) were used to measure the children's behavior. Anxiety and attention was assessed with State-Trait Anxiety Inventory for Children (STAIC) and ADHD Diagnostic System (ADS), respectively. Children with ADHD were categorized to two groups of ADHD with low anxiety (ADHD-LA) and ADHD with high anxiety (ADHD-HA) according to the total STAIC scores. Scores on K-ARS, BASC-2 and ADS were compared between two groups of ADHD-LA and ADHD-HA. Results : The Scores on K-ARS total and both subscales in ADHD-HA group were significantly higher than ADHD-LA group. Scores on the BASC-2 subscales including hyperactivity, aggression, conduct problem, anxiety, depression, somatization, withdrawal, attention problems were also significantly higher in ADHD-HA group compared to ADHD-LA group. In contrary, scores on ADS subscales were not significantly different between the both groups. Conclusion : Our study identified that the anxiety accompanied with ADHD was associated with the negative behavioral aspect in children with ADHD. However, the performances on attention task were not affected by the anxiety comorbid with ADHD. Future studies to reveal underlying mechanism are needed for further understanding the association with anxiety and ADHD.

군 병원 정형외과계 입원환자의 정서문제 유병률과 관련 요인 (Prevalence of Emotional Distress and Related Factors of Orthopedic Surgical Patients in a Military Hospital : A Cross-sectional Feasibility Study)

  • 오인목;홍민석;이수연;윤가희;이호;김명진;김현미;이상돈
    • 대한불안의학회지
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    • 제15권2호
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    • pp.115-121
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    • 2019
  • Objective : The purpose of this study was to investigate prevalence of psychiatric symptoms and determine predictors of emotional distress of military hospital surgical patients. Methods : This study examined 104 orthopedic patients admitted to the Armed Forces Military Hospital September-November 2018. For the study, every subject completed self-assessment inventories regarding depressive and anxiety symptoms (Hospital Anxiety and Depression Scale), sleep problems (Pittsburgh Sleep Quality Index), problematic alcohol and tobacco use (Cut off, Annoyed, Guilty, Eye-opener screening), and psychiatric history. We performed the Student's t-test and the chi-square test for the collected data to investigate the prevalence of psychiatric symptoms, including emotional distress. Logistic regression analysis was used to examine the risk factors related to emotional distress of hospitalized military personnel. Results : There were no significant differences in socio-demographic and psychiatric symptoms between soldiers and officers. The prevalence of depressive and/or anxiety symptoms (emotional distress) was 21.2% (n=21). In the logistic regression analysis, psychiatric history [Adjusted Odds Ratio (AOR)=18.99 ; 95% Confidence Interval (CI)=1.42-253.57 ; p=0.026] and low military life satisfaction (AOR=15.67; 95% CI=1.46-168.11 ; p=0.023) correlated with emotional distress. Conclusion : Soldiers admitted to the military hospital showed similar prevalence of emotional distress as those at general hospitals. Considering military circumstances, it is necessary to detect and intervene regarding soldiers with a psychiatric history and low military life satisfaction to promote mental health at military hospitals.

호스피스 완화의료에서의 초기평가와 돌봄 계획의 수립: 평가도구를 중심으로 (Initial Assessment and Care Planning in Palliative Hospice Care: Focus on Assessment Tools)

  • 박은주;고수진;천재경
    • Journal of Hospice and Palliative Care
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    • 제22권2호
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    • pp.67-76
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    • 2019
  • 포괄적이고 총체적 돌봄을 제공하는 호스피스 완화의료의 경우 평가도구를 사용하여 문제목록의 객관화하고 돌봄 계획의 구체화하는 것이 필요하다. 초기평가는 입원 당일 혹은 1일 이내에 환자의 증상과 사회적, 영적 문제, 완화의료에 대한 요구가 무엇인지 파악하며 개괄적인 돌봄의 방향을 설정하는 과정이다. 현재 병에 대한 인식과 예후를 파악하는 것부터 연명의료계획서 작성까지 함께 검토한다. 초기평가도구로는 간단하지만 포괄적으로 신체적, 정신적, 사회적, 영적 영역을 아우르는 13개의 간단한 질문으로 구성된 NEST를 추천한다. 초기평가에서 파악된 문제에 대하여 구체적인 평가도구들을 활용하여 돌봄 계획을 수립하며 입원 후 3일이내 시행하는 것이 좋다. 신체적 영역의 경우 기능상태를 포함하여 통증과 비 통증 증상, 삶의 질을 함께 파악할 수 있는 다증상 평가도구가 도움이 될 수 있다. 환자의 증상은 단독으로 의미를 가지는 것이 아니라 복합적인 상호작용으로 발생하며, 그에 따라 포괄적으로 접근해야 하기 때문이다. 정신심리적 영역은 심리적 고통과 불안, 우울을 평가한다. 사회적 영역의 평가는 의사결정, 사회경제적 환경 파악, 가족 평가 및 임종 준비의 단계로 이루어진다. 영적 평가 역시 중요한데 FACIT-Sp나 SHI를 사용할 수 있다. 평가도구를 활용하는 것은 환자의 고통을 경감시키고 삶의 질을 향상시킬 뿐 아니라 의료진이 체계적으로 훈련되는 방안이 될 수 있으며 그 과정 자체가 더 나은 돌봄 제공을 위한 발판이 될 수 있다.

과학자의 문제 해결 과정에서 탐색된 과학 공감 (Scientific Empathy Discovered in Scientists' Problem-Solving Process)

  • 양희선;강성주
    • 한국과학교육학회지
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    • 제39권2호
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    • pp.249-261
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    • 2019
  • 본 연구의 목적은 과학자들의 문제 해결 과정에서 공감요소를 추출하고 그 공감요소가 과학자들의 문제 해결 상황에서 어떤 영향을 주고 있는지 확인해보고자 한다. 이에 본 연구는 창의성 연구자들이 언급한 과학자들 중 공통인물 6명을 분석대상으로 선정하고 그들의 자서전 및 그들의 일대기에 관련한 논문을 통해 그들의 문제 해결 사례에서 공감요소를 추출하여 이를 유목화 하였다. 총 12개의 서적과 50여개의 논문에서 제시한 사례를 Davis의 공감척도를 분석틀로 분석하였고 공통요인을 추출하였다. 그 결과 총 182개의 사례에서 과학 공감요소가 추출되었고, 이 중 33개의 공통요소가 발견되었다. 과학교육전문가집단의 내용타당도 검사를 통하여 본 사례의 타당도를 확인한 결과, 전문가의 내용타당도 I-CVI 평균은 .86, S-CVI 평균 .90값이 확인되었다. 과학자들이 문제 해결사례에서 활용하고 있는 공감요소는 인지적 공감으로 관점 취하기 측면에서 3가지(다른 학문 분야를 통한 공감, 연구대상의 관점에서 공감, 다른 사람의 의견 수용), 상상하기 측면에서 3가지(관찰 근거의 상상, 사고 실험, 연구 대상에 대한 유기체적 느낌), 정서적 공감으로 공감적 관심측면에서 3가지(동료 연구자의 의욕에 따른 반응, 연구대상에 대한 감동, 더 연구하고 싶은 흥분), 개인적 각성 측면에서 2가지(타인의 연구실패에 대한 불편한 감정, 문제에 대한 민감성)가 추출되었다. 이는 Davis의 공감요소와 완벽하게 일치한다고 할 수 없었으나 과학자들의 사례에서 발견되는 이러한 공통되는 요소를 기초로 과학 공감요소에 대한 정의가 가능할 것이다.

Intravenous patient-controlled analgesia hydromorphone combined with pregabalin for the treatment of postherpetic neuralgia: a multicenter, randomized controlled study

  • Huang, Ying;Xu, Chenjie;Zeng, Tao;Li, Zhongming;Xia, Yanzhi;Tao, Gaojian;Zhu, Tong;Lu, Lijuan;Li, Jing;Huang, Taiyuan;Huai, Hongbo;Ning, Benxiang;Ma, Chao;Wang, Xinxing;Chang, Yuhua;Mao, Peng;Lin, Jian
    • The Korean Journal of Pain
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    • 제34권2호
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    • pp.210-216
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    • 2021
  • Background: Postherpetic neuralgia (PHN) is the most common complication of acute herpes zoster. The treatment of PHN remains a challenge for clinical pain management. Despite the effectiveness of anticonvulsants, antidepressants, and lidocaine patches in reducing PHN, many patients still face intractable pain disorders. In this randomized controlled study, we evaluated whether hydromorphone through intravenous patient-controlled analgesia (IV PCA) was effective in relieving PHN. Methods: Patients with PHN were randomly divided into two groups, one group received oral pregabalin with IV normal saline, another group received oral pregabalin with additional IV PCA hydromorphone for two weeks. Efficacy was evaluated at 1, 4, and 12 weeks after the end of the treatments. Results: Two hundred and one patients were followed up for 12 weeks. After treatment, numerical rating scale (NRS) score of patients in the hydromorphone group was significantly lower than that of the control group, and the difference of NRS scores between the two groups was statistically significant at 4 and 12 weeks after treatment. The frequency of breakthrough pain in the hydromorphone group was significantly lower than that in the control group 1 and 4 weeks after treatment. After treatment, the quality of sleep in the hydromorphone group was significantly improved compared with the control group. The most common adverse reactions in the hydromorphone group were dizziness and nausea, with no significant respiratory depression. Conclusions: IV PCA hydromorphone combined with oral pregabalin provides superior pain relief in patients with PHN, which is worthy of clinical application and promotion.

한국어판 HIV 감염인의 건강관리 자기효능감 도구의 타당도와 신뢰도 (Psychometric Properties of the Korean Version of Self-Efficacy for HIV Disease Management Skills)

  • 김광숙;김라영;심미소;백서영;김남희;박민경;이영진
    • 대한간호학회지
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    • 제53권3호
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    • pp.295-308
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    • 2023
  • Purpose: This study evaluated the validity and reliability of Shively and colleagues' self-efficacy for HIV disease management skills (HIV-SE) among Korean participants. Methods: The original HIV-SE questionnaire, comprising 34 items, was translated into Korean using a translation and back-translation process. To enhance clarity and eliminate redundancy, the author and expert committee engaged in multiple discussions and integrated two items with similar meanings into a single item. Further, four HIV nurse experts tested content validity. Survey data were collected from 227 individuals diagnosed with HIV from five Korean hospitals. Construct validity was verified through confirmatory factor analysis. Criterion validity was evaluated using Pearson's correlation coefficients with the new general self-efficacy scale. Internal consistency reliability and test-retest were examined for reliability. Results: The Korean version of HIV-SE (K-HIV-SE) comprises 33 items across six domains: "managing depression/mood," "managing medications," "managing symptoms," "communicating with a healthcare provider," "getting support/help," and "managing fatigue." The fitness of the modified model was acceptable (minimum value of the discrepancy function/degree of freedom = 2.49, root mean square error of approximation = .08, goodness-of-fit index = .76, adjusted goodness-of-fit index = .71, Tucker-Lewis index = .84, and comparative fit index = .86). The internal consistency reliability (Cronbach's α = .91) and test-retest reliability (intraclass correlation coefficient = .73) were good. The criterion validity of the K-HIV-SE was .59 (p < .001). Conclusion: This study suggests that the K-HIV-SE is useful for efficiently assessing self-efficacy for HIV disease management.