• Title/Summary/Keyword: 신체적 기능장애

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Clinical Characteristics and Heart Rate Variability in Patients with Comorbid Panic Disorder and Major Depressive Disorder (주요우울장애가 동반된 공황장애 환자의 임상 특징과 심박변이도)

  • Choi, Young-Hee;Kim, Won;Kim, Min-Sook;Yoon, Hye-Young;Choi, Seung-Mi;Woo, Jong-Min
    • Sleep Medicine and Psychophysiology
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    • v.12 no.1
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    • pp.50-57
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    • 2005
  • Objectives: This study was designed to evaluate the differences in clinical characteristics and severity of symptoms between panic patients with and without comorbid major depressive disorder, and to ascertain the differences in the function of the autonomic nerve system measured by heart rate variability (HRV). Methods: The subjects were 60 patients who have panic disorder without major depressive disorder and 19 patients who met DSMIV criteria for both panic disorder and major depressive disorder. First, they drew up symptom checklists and self-rating scales, and were measured by Anxiety Disorder Inventory Schedule-Panic Attack & Agoraphobia (ADIS-P&A), Clinical Global Impression (CGI), Hamilton Rating Scale for Depression (HAM-D), Panic Disorder Severity Scale (PDSS) and Heart Rate Variability (HRV). For statistical analysis, we performed t-test to compare the scores of self reported scales and clinician’s rating scales in panic patients with comorbid major depressive disorder and those without major depressive disorder. ANCOVA was used to compare the variables of HRV, considering age as a covariate. Results: The subjective severities of depression and anxiety that comorbid patients complained of were higher than those of patients with only panic disorder. Futhermore, comorbid patients were more sensitive to anxiety and physical sensations, and they tend to be more negative in their thinking. The scores of clinician-rating scales such as CGI and PDSS were also higher in the comorbid patients. However, there were no significant differences in HRV variables between both groups, despite a tendency to low heart rate variability in the comorbid group. Conclusion: This study suggests that patients with panic disorder and comorbid major depressive disorder tend to complain of more symptoms and to be more sensitive to various symptoms than those with panic disorder without comorbid depression. However, in this study comorbid major depressive disorder did not have a significant impact on the HRV variables of patients with panic disorder.

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A Model based Vocational Evaluation for People with Psychiatric Disabilities (정신장애인 직업재활모델과 직업평가 - 직업기능척도 개발을 위한 예비연구 -)

  • Lee, Seong-Gyu;Kim, Sang-Hee
    • Korean Journal of Social Welfare
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    • v.54
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    • pp.123-147
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    • 2003
  • It is well known that one of essential features of psychiatric disability is vocational impairment. Since the year of 2000 when psychiatric disability was declared as one of disability categories in Korea, vocational rehabilitation programs have been actively administered. At this point, it is compelling that vocational evaluation serves as a means of screening out the most promising candidates, identifying their vocational deficits and strengths, designing the individualized vocational interventions, and evaluating vocational outcomes. Still, vocational evaluation for people with psychiatric disabilities has been more problematic than for any other group with disabilities. The authors argued that vocational evaluation for people with psychiatric disabilities should be based on a certain vocational rehabilitation model to address those problems. It is because there exists an indispensible relationship between the vocational rehabilitation model and vocational evaluation. In other words, the main purposes, measurement time points, and focus of vocational evaluation may depend on which of vocational rehabilitation models to make a choice of. In addition, the vocational rehab model(i.e., vocational readiness model or graduation model) underlying traditional vocational evaluation does not seem to work for people with psychiatric disabilities. Authors argued that accelerating model fits for psychiathric characteristics which are often unpredictable and turbulent. As a preliminary step of developing vocational functioning instrument incorporating the demand characteristics of the accelerating model, post-hoc analyses were done on data from a vocational functioning measure and the results were critically examined from viewpoints of accelerating model. For these purposes, discussions were made about a) general functioning of vocational evaluation, (b) relation between vocational rehabilitation model and vocational evaluation, (c) the reasons why the accelerating model is more appropriate to the characterstics of psychiatric clients than the graduation model, (d) post-hoc analytic results reviewed from viewpoints of accelerating model-based vocational evaluation This study is significant in that it attempted model-based, model-specific vocational evaluation as a preliminary step for developing vocational functioning assessment instruments ill future.

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Disappearance of Hysteria(Conversion Disorder) and the Evolutionary Brain Discord Reaction Theory (히스테리아(전환장애)의 소실과 진화적 뇌신경 부조화 반응 가설)

  • Song, Ji Young
    • Korean Journal of Psychosomatic Medicine
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    • v.24 no.1
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    • pp.28-42
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    • 2016
  • Objectives : The author tried to find out reasons why and how hysteria(and conversion disorder) patient numbers, which were so prevalent even a few decades ago, have decreased and the phenotype of symptoms have changed. Methods : The number of visiting patients diagnosed with conversion disorder and their phenotype of symptoms were investigated through chart reviews in a psychiatric department of a University hospital for the last 12 years. Additionally, the characteristics of conversion disorder patients visiting the emergency room for last 2 years were also reviewed. Those results were compared with previous research results even if it seemed to be an indirect comparisons. The research relied on Briquet P. and Charcot JM's established factors of the vicissitudes of hysteria(and conversion disorder) which has been the framework for more than one hundred and fifty years since hysteria has been investigated. Results : The author found decreased numbers and changes of the phenotype of the hysteria patients(and conversion disorder) over the last several decades. The decreased numbers and changes of the symptoms of those seemed to be partly due to several issues. These issues include the development of the diagnostic techniques to identify organic causes of hysteria, repeated changes to the symptom descriptions and diagnostic classification, changes of the brain nervous functions in response to negative emotions, and the influence of human evolution. Conclusions : The author proposed that the evolutionary brain discord reaction theory explains the causes of disappearance of and changes to symptoms of hysteria(conversion disorder). Most patients with hysteria(conversion disorder) have been diagnosed in the neurological department. For providing more appropriate treatment and minimizing physical disabilities to those patients, psychiatrists should have a major role in cooperating not only with primary care physicians but with neurologists. The term 'hysteria' which had been used long ago should be revived and used as a term to describe diseases such as somatic symptom disorder, functional neurological symptoms, somatization, and somatoform disorders, all of which represent almost the same vague concept as hysteria.

Applying Rasch Analysis for Validation of School Function Assessment (학교기능평가(School Function Assessment)도구의 구성타당도 검증을 위한 라쉬분석의 적용)

  • Park, Kyoung-Young
    • The Journal of the Korea Contents Association
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    • v.14 no.3
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    • pp.269-276
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    • 2014
  • The purpose of this study is to investigate validation of the School Function Assessment(SFA) for Korean Version using Rasch analysis. The subjects were recruited 98 students with disabilities in Seoul, Kyoung-Ki, Chung-cheung. The data were analysed using Rasch analysis to investigate unidimensionality and rating scale model. The 4 items out of SFA Part II were found to be misfts. The 18 items out of physical tasks, the 14 items out of cognitive/behavioral tasks in Part III were found to be misfit. All rating scale in SFA was appropriate. Further studies are needed to investigate validity and criterion cut-off score for many students with disabilities.

The Definition of Frail Elderly and the Frailty Screening Assessment Tool: A Systematic Review (허약노인의 정의 및 허약 선별 평가도구에 관한 체계적 고찰)

  • Lee, Gyeong A;Park, Ji-Hyuk
    • Therapeutic Science for Rehabilitation
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    • v.10 no.3
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    • pp.43-56
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    • 2021
  • Objective : The objective of this study was to present the components of frailty by organizing the definitions of frail elderly and analyzing the tools used to screen them. Methods : This study searched for articles at involved frailty screening assessments in the elderly. Databases including CINAHL, Embase, Medline Complete, and PubMed were searched. The search terms were "assess" AND "frailty" AND "screening" AND ("frail elderly" OR "elderly"). Results : A total of 539 articles were identified by the search and 11 articles were selected. Frailty occurs due to the depressed function of multidimensional factors, and a frail elderly person is defined as one at high risk of health degeneration, functional impairment, and occurrence of disability, and having a high level of threat to life. Seven tools were selected from 11 articles. The most frequently used tool was the frailty phenotype, which was used in five articles (45.4%). The identified components of frailty were physical, activity participation, nutrition, psychological, social, overall health, and age. Conclusion : The results confirmed the definition and components of frailty. This study is expected to contribute to the future development of standardized evaluation tools for screening frail elderly individuals and intervention programs for the management of the frail elderly.

The Effect of a Participatory Rehabilitation Program on the Physical Activity of Adults with Developmental Disability (참여형 재활프로그램이 의료취약계층 성인발달장애인의 신체활동 능력에 미치는 영향)

  • Seo, Tae-Hwa;Kim, Jin-Young;Lee, Dong-Woo
    • Journal of Korea Entertainment Industry Association
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    • v.13 no.8
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    • pp.619-626
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    • 2019
  • This study was conducted to investigate the effects of a participatory rehabilitation program on sit-rise and rise-to-walk test performances, and perception and motor skills in adults with medically vulnerable individuals and, adults with developmental disabilities in particular. Seventeen adults with developmental disabilities participated in a participatory rehabilitation program using resistance bands and exercise balls, for 60 minutes once weekly over 13 weeks. Their performances were measured before and immediately after the intervention, and 12 weeks after. The findings were as follows. In the sit-rise test, the number of times rising from sitting posture increased after the intervention versus before, but the difference was not statistically significant. In the rise-to-walk test, the performance showed statistically significant difference over time, and the post-hoc test showed a significant effect after the intervention versus before. There was no significant difference in perception and motor skills. In sum, the participatory rehabilitation program positively influenced dynamic balancing related to functional activities but had no significant effect on perception and motor skills, which is related to motor control and motor learning. It is suggested that to increase the participation in community activities, reduce fall risk, and improve dynamic balancing abilities in adults with developmental disabilities, participatory rehabilitation programs should be utilized to promote the physical wellbeing.

Association between Thyroid-Related Hormones and Cognitive Function in Patients with Alzheimer's Disease and Mild Cognitive Impairment (알츠하이머병 및 경도인지장애 환자에서 갑상선 관련 호르몬과 인지기능과의 상관관계)

  • Park, Da Yun;Kim, Hyun;Lee, Kang Joon
    • Korean Journal of Psychosomatic Medicine
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    • v.27 no.1
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    • pp.60-68
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    • 2019
  • Objectives : The association between thyroid-related hormones and cognitive function has been controversial. The purpose of this study is to compare the levels of thyroid-related hormones in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Furthermore, we investigated the relationship between thyroid-related hormones and cognitive function. Methods : From January 2011 to December 2018, we retrospectively reviewed 105 patients who were diagnosed with AD and MCI by visiting a dementia clinic at Ilsan Paik Hospital. Thyroid-related hormones [triiodothyronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH)] was measured using chemiluminescent immunoassay. An independent sample t-test was performed to analyze the mean value of thyroid-related hormones in patients of AD and MCI. To investigate whether thyroid-related hormones correlate significantly with Global deterioration scale (GDS), Clinical dementia rating (CDR) and scores of each The Korean version of the consortium to establish a registry for Alzheimer's disease items, we conducted a partial correlation analysis with geriatric depression scale-Korean version (GDS-K) scores as covariates. Results : There was no significant difference in the mean serum T3, T4 and TSH levels between patients of the AD and the MCI, but the Construction Praxis Test (CPT) showed a significant positive correlation with the serum TSH concentration (p-value=0.004). Conclusions : In our study, the positive correlation between serum TSH level and the CPT associated with executive function was found to be helpful in understanding the association between thyroid-related hormones and the pathophysiology of dementia. Prospective studies in regard of the pathophysiology of thyroid-related hormones on cognitive function will be necessary in the future.

The Relationship between the Cognitive Impairment and Mortality in the Rural Elderly (농촌지역 노인들의 인지기능 장애와 사망과의 관련성)

  • Sun, Byeong-Hwan;Park, Kyeong-Soo;Na, Baeg-Ju;Park, Yo-Seop;Nam, Hae-Sung;Shin, Jun-Ho;Sohn, Seok-Joon;Rhee, Jung-Ae
    • Journal of Preventive Medicine and Public Health
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    • v.30 no.3 s.58
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    • pp.630-642
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    • 1997
  • The purpose of this study was to examine the mortality risk associated with cognitive impairment among the rural elderly. The subjective of study was 558 of 'A Study on the Depression and Cognitive Impairment in the Rural Elderly' of Jung Ae Rhee and Hyang Gyun Jung's study(1993). Cognitive impairment and other social and health factors were assessed in 558 elderly rural community residents. For this study, a Korean version of the Mini-Mental State Examination(MMSEK) was used as a global indicator of cognitive functioning. And mortality risk factors for each cognitive impairment subgroup were identified by univariate and multivariate Cox regression analysis. At baseline 22.6% of the sample were mildly impaired and 14.2% were severely impaired. As the age increased, the cognitive function was more impaired. Sexual difference was existed in the cognitive function level. Also the variables such as smoking habits, physical disorders had the significant relationship with cognitive function impairment. Across a 3-year observation period the mortality rate was 8.5% for the cognitively unimpaired, 11.1% for the mildly impaired, and 16.5% for the severly impaired respendents. And the survival probability was .92 for the cognitively unimpaired, .90 for the mildly impaired, and .86 for the severly impaired respondents. Compared to survival curve for the cognitively unimpaired group, each survival curve for the mildly and the severely impaired group was not significantly different. When adjustments models were not made for the effects of other health and social covariates, each hazard ratio of death of mildly and severely impaired persons was not significantly different as compared with the cognitively unimpaired. But, as MMSEK score increased, significantly hazard ratio of death decreased. Employing Cox univariate proportional hazards model, statistically other significant variables were age, monthly income, smoking habits, physical disorders. Also when adjustments were made for the effects of other health and social covariates, there was no difference in hazard ratio of death between those with severe or mild impairment and unimpaired persons. And as MMSEK score increased, significantly hazard ratio of death did not decrease. Employing Cox multivariate proportional hazards model, statistically other significant variables were age, monthly income, physical disorders. Employing Cox multivariate proportional hazards model by sex, at men and women statistically significant variable was only age. For both men and women, also cognitive impairment was not a significant risk factor. Other investigators have found that cognitive impairment is a significant predictor of mortality. But we didn't find that it is a significant predictor of mortality. Even though the conclusions of our study were not related to cognitive impairment and mortality, early detection of impaired cognition and attention to associated health problems could improve the quality of life of these older adults and perhaps extend their survival.

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A Convergence Study on Factors Influencing Health-related Quality of Life in Patients with Chronic Neck Pain (만성경부통증 환자의 건강관련 삶의 질 영향요인에 대한 융합연구)

  • Park, Hyun-Hyang;Song, In-Ja
    • Journal of the Korea Convergence Society
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    • v.9 no.6
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    • pp.299-310
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    • 2018
  • A Convergence study was conducted to investigate the factors influencing the health-related quality of life in patients with chronic neck pain and to present a strategy for effective program development. The participants of this study were 92 patients with chronic neck pain in a region and collected data by self-reported questionnaire. Data were analyzed using PASW 18.0 program, that descriptive statistics, t-test, ANOVA, correlation analysis and stepwise multiple regression analysis were performed. According to the results of stepwise multiple regression, the identified influencing factors were disability(${\beta}=-.403$, p<.001), depression(${\beta}=-.313$, p<.001), age(${\beta}=-.194$, p=.008), muscle disorder(${\beta}=-.176$, p=.009), education(${\beta}=-.151$, p=.043) with health-related quality of life in patients with chronic neck pain. The explanatory power($R^2$) by 5 variables was 67.1%(F=38.118, p<.001). It was found that it is important to consider the individual characteristics, physical function improvement and psychological support for improving the health-related quality of life in patients with chronic neck pain. Therefore, it is necessary to develop a health promotion program based on the factors influencing on the health-related quality of life and analyze its application effect.

Association of Cognitive Dysfunction with Thyroid Autoantibody (갑상선 자가항체와 인지기능 저하의 연관성)

  • Han, Dong Kyun;Cheon, Jin Sook;Choi, Young Sik;Kim, Ho Chan;Oh, Byoung Hoon
    • Korean Journal of Psychosomatic Medicine
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    • v.24 no.2
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    • pp.227-235
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    • 2016
  • Objectives : The aims of this study were to know the frequency of cognitive dysfunction among patients with autoimmune thyroid disorders, and to reveal influencing factors on it, especially to clarify association with autoimmune thyroid antibodies. Methods : From sixty-five female patients with autoimmune thyroid disorders, demographic data were obtained by structured interview. Their cognitive funtions were measured using the MMSE-K and the MoCA-K tests. Depression was evaluated by the K-HDRS. Results : 1) Among patients with autoimmune thyroid disorders, 7.69% of them were below 24 on the MMSE-K, while 10.77% were below 22 on the MoCA-K. The frequency of cognitive deficit was not significantly different according to having positivity to antimicrosomal antibodies or not. 2) The antimicrosomal antibody-positive patients had significantly higher antithyroglobulin antibody titers, antimicrosomal antibody titers, and TSH concentration, while had significantly lower free T4 levels(p<0.05, respectively). 3) The total scores of the MMSE-K and the MoCA-K had significant correlation with age, marital status, antithyroglobulin antibody titers and K-HDRS(p<0.05, respectively). 4) The regression analysis revealed that variables such as age, education, autoimmune thyroid antibodies, thyroid function and depression did not influence on cognitive function of patients with autoimmune thyroid disorders. Conclusions : Our results could not support that cognitive function of patients with autoimmune thyroid disorders had correlation with autoimmune thyroid antibodies.