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1.신경정신의학

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Early detection is a crucial milestone in the prevention and treatment of schizophrenia spectrum psychosis, which might alter the course of schizophrenia. Currently, there are two complementary approaches to characterizing the clinical-high risk state of psychosis : the ultra-high risk (UHR) and basic symptoms criteria. Individuals at UHR have two phase-specific problems : heightened risk for the potential pathology of schizophrenia spectrum psychosis and the symptoms, distress and psychosocial functional impairment, which make them seek help. The clinical characteristics of UHR are similar to those of overt psychotic disorders in terms of psychopathological symptoms dimensions, psychosocial disability, neurocognitive and socio-cognitive impairments, history of trauma and abuse experience, lack of protective factors and dysfunctional metacognitive beliefs, and the comorbidity of psychiatric illness. Regarding the risk, the pretest risk probability of a psychotic disorder in each high-risk clinic is considered an important factor for predicting the power of an early detection strategy. For the distress and psychosocial disability, the strategies of the therapeutic intervention will be a focus of clinical attention. On the follow-up, one of third of the UHR individuals have sufficient positive symptom to fulfil the at-risk criteria. Most of the UHR individuals have suffered from comorbid psychiatric illness at the times of both baseline and follow-up, and there is no improvement of psychosocial functioning. Currently, it is essential to optimize the early detection and intervention strategy according to the referring and recruitment characteristics of each high-risk clinic in Korean practice situations.
조현병 재발방지를 위한 약물치료 전략
조현병 재발방지를 위한 약물치료 전략
김지현(Jihyun Kim),박염홍(Yanhong Piao),신광범(Quangfan Shen),정영철(Young-Chul Chung)
신경정신의학 제57권 제3호/ 2018
225-229 (5 pages)
의약학>정신과학
초록보기
Successful treatment is very high in patients with first episode schizophrenia (FES). On the other hand, the problem is a frequent relapse often caused by non-compliance. The non-compliance rate in patients with FES is 40–60% within 1 year. The causes of non-compliance are diverse, such as poor insight, drug side effects, attitude of caregiver, social stigma, etc. Clinicians should be able to provide appropriate psychosocial intervention and long acting injectable antipsychotics (LAI) to overcome non-compliance. Recently, there is solid and accumulating evidence demonstrating superiority of LAI over oral medication in terms of reducing relapse or rehospitalization. In particular, a substantial portion (approximately 30–50%) of patients and caregivers prefer LAI to oral medication. Shared decision-making is the process that clinicians and patients/caregiver should go through in order to obtain the full benefits from LAI.
A large proportion of patients with schizophrenia show a poor response to first-line antipsychotic drugs, which is termed treatment-resistant schizophrenia. Previous studies found that a different neurobiology might underlie treatment-resistant schizophrenia, which necessitates the development of different therapeutic approaches for treating treatment-resistant schizophrenia. This study reviewed previous studies on the pathophysiology of treatment-resistant schizophrenia and the pharmacological intervention, and forthcoming investigations of treatment-resistant schizophrenia are suggested.
Treatment of schizophrenia has as its ultimate goals, the functional recovery of the patients and improvement of their quality of life. While antipsychotic medication is the fundamental method for treating schizophrenia, it has certain limitations in terms of treating the illness beyond its positive symptoms. Therefore, psychosocial intervention should be used in tandem with pharmacological methods in treating schizophrenia. The efficacy of several modes of psychosocial intervention for improving outcomes in schizophrenia is well attested. Approximately 10 modes of psychosocial intervention have been recommended based on existing evidence, including family intervention, cognitive behavioral therapy, supported employment, early intervention services, lifestyle intervention for physical health enhancement, treatment of comorbid substance abuse, assertive community treatment, cognitive remediation, social skills training, and peer support. Ideally, these interventions are offered to patients in combination with one another. Over the last decade, increased emphasis has been placed on early detection and intervention, with particular focus on long-term recovery. Early intervention with comprehensive psychosocial interventions should be enacted promptly from the initial detection of schizophrenia.
양극성장애 환자용 한국어판 기분 기록 스마트폰 어플리케이션의 개발 및 임상적 적용
양극성장애 환자용 한국어판 기분 기록 스마트폰 어플리케이션의 개발 및 임상적 적용
송가영(Kayoung Song),이세정(Saejeong Lee),윤 운(Woon Yoon),김창윤(Changyoon Kim),주연호(Yeonho Joo),이중선(Jungsun Lee),전명욱(Myong-Wuk Chon)
신경정신의학 제57권 제3호/ 2018
244-251 (8 pages)
의약학>정신과학
초록보기
Objectives The aim of this study was to develop a Korean version of a mood chart application on an Android platform. Methods This application is based on the traditional mood chart. Eighteen adults with DSM-5 bipolar disorder were enrolled from November 2016 to March 2017. They were asked to rate their daily mood scores and severity of irritability and impulsivity for six months. Their clinicians rated their symptom severity monthly using the Clinical Global Impression-7 (CGI-7) scale. After six months, the participants completed an anonymous questionnaire regarding their satisfaction with the application. Results Of the 18 patients, one withdrew their consent from this study and six were males (35.3%) ; their mean age was 31.71±8.56 years. The mean follow-up duration was 159.12±49.45 days and the period of application use was 143.65±52.11 days. The mean total response rate was 59.45% and the mean response rate on the same day was 43.06%. The adherence to using the application decreased significantly declined over the duration since enrollment [odds ratio (OR)=1.008, p=0.008] but tended to increase according to age (OR=0.958, p=0.002). The application mood scores were correlated significantly with the manic (β=0.307, p=0.004) and depressive (β=-0.701, p<0.001) subscale, and the total (β=1.026, p=0.002) of the CGI-7 (linear mixed models). The majority of subjects agreed that the application helped them manage their symptoms (92.86%), stating that the application was easy to use (78.57%). Conclusion This application could be a valid and useful tool to monitor the mood symptoms of patients with bipolar disorder in Korea.
부천시 노인 인구의 자살에 대한 허용적 태도와 자살 인식에 관한 연구
부천시 노인 인구의 자살에 대한 허용적 태도와 자살 인식에 관한 연구
이도은(Doeun Lee),이소영(Soyoung Irene Lee),이지원(Jeewon Lee),김신겸(Shin-Gyeom Kim),정한용(Han-yong Jung)
신경정신의학 제57권 제3호/ 2018
252-260 (9 pages)
의약학>정신과학
초록보기
Objectives The aim of this study was to investigate the variables influencing acceptability and perception towards suicide among the elderly in Bucheon city, South Korea. Methods A total of 1099 elderly over 65 years old participated in this study. The subjects completed a self-questionnaire including their demographic characteristics, psychiatric characteristics, factor 1 and 4 of the Attitudes Towards Suicide-20, and Geriatric Depression Scale Short Form Korea Version. One-way analysis of variance was performed to identify the variables associated with the acceptability and perception towards suicide. Results As result of this study, the demographic characteristics (older age, lower education level, lower economic state, bereavement, divorce or separated marital status, and life without spouse) and psychiatric characteristics (psychiatric past history, treatment history, and suicidal attempt history) were found to be associated with a more acceptable attitude toward suicide. In addition, a lower education level, no psychiatric history, and no psychiatric treatment history influenced the lack of perception to suicide. Conclusion For public services to prevent suicide of the elderly population who lack spontaneity and accessibility to suicidal evaluations, it would be important to focus on the variables identified in this study for enhancing the effectiveness of the services.
알츠하이머병 환자에서 해마 위축과 정신병적 증상
알츠하이머병 환자에서 해마 위축과 정신병적 증상
정희정(Hee Jeong Jeong)이영민(Young Min Lee),박제민(Je Min Park),이병대(Byung Dae Lee),문은수(Eun Soo Moon),김수연(Soo Yeon Kim),이강윤(Kang Yoon Lee),김지훈(Ji-Hoon Kim),정영인(Young-In Chung)
신경정신의학 제57권 제3호/ 2018
261-265 (5 pages)
의약학>정신과학
초록보기
Objectives This study examined the difference in the volume or thickness of the medial temporal lobe between Alzheimer’s disease patients with psychosis (AD+P) and those without psychosis (AD-P). Methods Overall, 31 AD+P patients and 29 AD-P patients were included from the Memory impairment clinics of Pusan National University Hospital in Korea. AD+P was diagnosed according to Jeste and Finkel’s proposed diagnostic criteria for psychosis of Alzheimer’s disease. AD-P included AD patients with no psychotic symptoms during a 5-year follow-up period. Medial temporal volume or thickness was measured by 3-tesla MRI and freesufer analysis. Analysis of variance was used to examine the difference in the volume or thickness of medial temporal lobe between AP+P and AD-P after controlling for age, gender, education years, Clinical Dementia Rating scale-Sum of Box, and total intracranial volume. Results The hippocampal volume in AD+P was smaller than that in AD-P. Conclusion These findings suggest that AD+P is associated with a reduced hippocampal volume.
주의력결핍 과잉행동장애 환아들의 인지 행동적 특성과 정량 뇌파와의 관계
주의력결핍 과잉행동장애 환아들의 인지 행동적 특성과 정량 뇌파와의 관계
오수환(Soohwan Oh),정유숙(Yoo Sook Joung),윤희준(Hee Joon Yoon),이동익(Dong Ik Lee),김병욱(Byung Wook Kim),박정아(Jung Ah Park),이서지(Suzie Lee),이빛나(Bitna Lee)
신경정신의학 제57권 제3호/ 2018
266-273 (8 pages)
의약학>정신과학
초록보기
Objective This study examined the association between the wave form in quantitative electroencephalography (QEEG) and the cognitive and behavioral characteristics measured by the Korean version of Wechsler Intelligence Scale for Children 4th edition (K-WISC-IV), Korean version of the attention deficit/hyperactivity disorder Rating Scale (K-ARS), and Korean version of Child Behavior Checklist (K-CBCL) in children diagnosed with ADHD. Method A retrospective cross-sectional study was performed on children aged 8 to 13 years, who were diagnosed with ADHD at Samsung Medical Center from November 2011 to March 2017. A total of 57 ADHD children were selected by a medical chart review. Their QEEG findings and psychological test results, including K-WISC-IV, K-CBCL, and K-ARS (n=42), were collected. The QEEG was analyzed by the ranges of Hz: delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), and beta (12–25 Hz) and transformed to the z-scored relative power. The collected data were analyzed using Pearson and Partial correlation analysis. Results The Letter-Number Sequencing scores of K-WISC was positively correlated with fronto- central alpha. The hyperactivity/impulsivity scores of K-ARS were positively correlated with the theta/beta ratio. Among the items of K-CBCL, social immaturity was positively correlated with delta and theta, and negatively correlated with alpha. Social competence was negatively correlated delta and theta, and positively correlated with alpha. Conclusion These results suggest that the resting state QEEG results of children with ADHD may reflect their cognitive and behavioral characteristics, especially in working memory/executive function, hyperactivity/impulsivity, and sociality.
ERRATUM : 발달장애 문제행동 치료 가이드라인 제작을 위한 다학제적 접근
ERRATUM : 발달장애 문제행동 치료 가이드라인 제작을 위한 다학제적 접근
홍경기(Kyungki Hong),송호광(Hokwang Song),오매화(Maehwa Oh),오윤혜(Yunhye Oh),박수빈(Subin Park),김예니(Yeni Kim),최성구(SungKu Choi)
신경정신의학 제57권 제3호/ 2018
274-274 (1 pages)
의약학>정신과학
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