• Title/Summary/Keyword: 인지적 불안

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Differences of Illness Behavior in Depressive Patients According to the Presence of Somatization (우울증 환자에서 신체화 증상에 따른 질병행동의 차이)

  • Yoon, Chang-Young;Jang, Se-Heon;Jae, Young-Myo;Lee, Dae-Su;Choi, Jin-Hyuk
    • Korean Journal of Psychosomatic Medicine
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    • v.17 no.2
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    • pp.68-74
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    • 2009
  • Objectives : Illness behavior is defined as the persistence of an adaptive/maladaptive mode of perceiving, evaluating and responding to health status and symptoms according to the status. In a cognitive aspect, somatizing symptoms are regarded as being originated from distortions, including magnification and/or amplification, of perceiving, evaluating and responding to symptoms such as bodily sensations. That is somatization may be explained by maladaptive illness behavior. In this study, we tried to investigate differences of illness behavior in depressive patient according to the presence of somatization. Methods : We divided 45 patients who were diagnosed as depression with ICD-10 diagnostic criteria into two groups(somatizing and non-somatizing group) according to the somatization subscale of Korean Depression Scale and compared two groups in the differences of illness behavior using the Illness Behavior Questionnaire. Results : Somatizing group showed significantly higher scores than non-somatizing group on the disease affirmation subscale($6.79{\pm}2.08$ vs. 4.76, p=0.003) and the denial subscale($3.25{\pm}1.22$ vs. $2.10{\pm}1.41$, p=0.006). There were no significant differences between two groups on the general hypochondriasis subscale and the affective unstability subscale. In a logistic regression analysis, somatizing group also showed higher odds ratio (OR) scores on the disease affirmation subscale(OR=1.418, p=0.089) and the denial subscale(OR=1.880, p=0.083). Conclusion : The disease affirmation and denial may be a discriminative mechanism of somatization in depressive patients. These subscales of Illness Behavior Questionnare could be useful markers, and psychiatric illnesses with somatizing and depressive symptoms may be differentially diagnosed and be predicted through these subscales.

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Alexithymia in Somatoform Disorder and Diabetes Mellitus (신체형장애 환자와 당뇨병 환자에서의 Alexithymia)

  • Lee, Kyung-Kyu;Lee, Jeong-Yeob;Kim, Hyun-Woo;Choi, Sang-Jun
    • Korean Journal of Psychosomatic Medicine
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    • v.7 no.2
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    • pp.203-212
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    • 1999
  • Objectives : "Alexithymia" mean literally "no word for mood(or emotion)". It is not only a marked constriction in emotional functioning but a deficit in their cognitive processing. We designed this study to investigate the level of alexithymia, psychopathology and personality factors of patients with somatoform disorder and with diabetes mellitus. Methods : The subjects were consisted of patients with somatoform disorder(N=20), patients with diabetes mellitus(N=20), and normal control(N=20). The level of alexithymia, psychopathology and personality factors were assessed by the Toronto Alexithymia Scale(TAS), the Symptom Checklist 90-Revision(SCL 90-R), and the Sixteen Personality Factor Questionnaire(16-PF). And we compared demographic characteristics, psychopathology and personality factors among three groups, and assessed the relationship between alexithymia and psychopathology, and between alexithymia and personality factors. Results : The results were as follows. 1) Patients with somatoform disorder showed significantly higher TAS scores compared to patients with diabetes mellitus and the normal control group. 2) Patients With somatoform disorder showed significantly higher scores of somatization, anxiety scales than patients with diabetes mellitus and the normal control group, and showed significantly higher scores of obsessive-compulsive, depression, phobic anxiety, psychoticism scales than the normal control group by the SCL-90-R. 3) The normal control group showed high intelligence scores only as compared to patients with somatoform disorder by the 16-PF. 4) A significant relationship was found between TAS scores and psychopathology in patients with somatoform disorder. 5) All three groups did not shown any correlation between TAS and 16-PF. Conclusion : Patients with somatoform disorder showed higher TAS scores and more multiple psychopathology than patients with diabetes mellitus and the normal controls. A significant relationship was found between TAS scores and psychopathology in patients with somatoform disorder. We suggest that the therapeutic approach to patients with somatoform disorder to express emotions and manage psychopathology, and that the treatment methods of patients with diabetes mellitus aims to improve firstly physical conditions are more helpful.

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A Survey on the Perception of Food Sanitation Officers Toward the Genetically Modified Foods (유전자재조합식품에 대한 관련 식품위생공무원의 인지도 조사)

  • Oh Kyeung Nam;Lee Soon Ho;Lee Woo Young;Park Hye Kyung;Park Sun Hee
    • Journal of Food Hygiene and Safety
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    • v.20 no.1
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    • pp.22-35
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    • 2005
  • A survey was conducted to investigate the perception of food sanitation officers toward the Genetically Modified Foods. They were mainly from Regional Agencies of KFDA, City/Province office, and National quarantine station. Some of them were professors of university and researchers of research institute. Most of respondents had experiences of hearing or reading GM foods (over $95\%$) and over $90\%$ of respondents much needed the label of GM foods. Although some of officers of city/province office and national quarantine station showed less knowledge than other respondent groups, most of respondents had basic knowledge about biology. The frequency of respondents worked over 20 years and worked in the general administration was higher than that of other groups in the question of unsafe of GM foods. The answer frequency of careless treatment of foods was highest in the question of risk factor, and the frequency of GM foods was lowest ($4.4\%$). It was concluded that food sanitation officers had positive opinion about GM foods, but there were some differences in the knowledge among agencies. Therefore, it is necessary more educations and informations are needed for food sanitation officers.

The Current Status and Changing Pattern for 5 Years of Psychiatric Consultation in a General Hospital (일 종합병원에서의 자문 현황과 5년 추이에 대한 고찰)

  • Seol, Jang-Woo;Lee, Sang-Chul;Kim, Hyun-Chul;Hong, Sang-Eui;Lee, Tae-Byoung;Lee, Sang-Kyu;Kim, Do-Hoon;Son, Bong-Ki
    • Korean Journal of Psychosomatic Medicine
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    • v.13 no.2
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    • pp.75-84
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    • 2005
  • Objectives : This study was conducted to look over the current status of psychiatric consultation in a general hospital. Methods : We analyzed 664 medical records : 317 in 2002 and 347 in 1997, and compared the records of 1997 and 2002. Results 1) The average age of the patients increased from 45.9 years(1997) to 53.2 years of age (2002). Dividing the referred patients into 3 age-brackets as below 40, between 40 and 60, and above 60, the number of patients in the age group above 60 was significantly increased, more prominently in women. 2) Overall consultation rate was 2.29% in 2002 and 2.2% in 1997 .44.2% and 57.1% of the whole referrals were from the department of internal medicine in each year, and the department of rehabilitation medicine was leading in consultation rate in both years. 3) 'Mood disorders' and 'Substance related disorders' were the most frequent diagnoses in 2002 and 1997 respectively. 4) Use of psychotropic drugs was the most frequent recommendations of psychiatric consultation, in both years, and the most frequently prescribed drugs were anti-anxiety drugs in both years. The use of SSRI and atypical anti-psychotics were increased, while the use of typical anti-psychotics was decreased significantly in 2002. Conclusion : In 2002, compared with 1997, the average age of the patients was increased, and the consultation of the patients with the diagnosis of 'mood disorders' and 'cognitive disorders' was done more frequently than in 1997. The recommendation to use psychotropic drugs was well accepted, but the concern to diagnostic procedure was relatively low.

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Development of the Korean version of Postconcussional Syndrome Questionnaire (한글판 뇌진탕후증후군 척도의 개발)

  • Yoon, Mi-Ri;Ko, Young-Hoon;Han, Chang-Su;Joe, Sook-Haeng;Jeon, Sang-Won;Han, Chang-Woo
    • Korean Journal of Psychosomatic Medicine
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    • v.23 no.1
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    • pp.26-35
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    • 2015
  • Objectives:The purpose of this study was to evaluate reliability and validity of the Korean version of the Postconcussional Syndrome Questionnaire(KPCSQ) which was originally developed in 1992 by Lees-Haley. Methods:Patients with traumatic brain injury were recruited from April 2009 to December 2011 from the Korean University Ansan Hospital. We selected patients that met the ICD-10 diagnostic criteria of postconcussional syndrome and organic mental disorder including organic mood disorder, organic emotionally labile disorder, organic anxiety disorder and organic personality disorder. The KPCSQ, Trait and State Anxiety Inventory(STAI-I, II), and Center for Epidemiologic Studies Depression Scale(CESD) were administered to all subjects. Factor analysis of the items were performed and test-retest correlation were evaluated. Internal consistency of the KPCSQ and its subscales was assessed with Cronbach's alpha. External validity of the KPCSQ were examined by correlation coefficient with the STAI-I, II, and CESD. Results:The Cronbach's alpha coefficient of the total PCSQ was 0.956. The test-retest reliability coefficient was 0.845. The PCSQ showed significant correlation with STAI-I, II and CESD. The factor analysis of the PCSQ yielded 4 factors model. Factor 1 represented 'affective and cognitive symptoms', factor 2 represented 'somatic symptoms', factor 3 represented 'infrequent symptoms' and factor 4 represented 'exaggeration or inattentive response'. There was no significant difference between the PCS group and the organic mental disorder group in the score on each measure. The scores on KPCSQ and its subscales in the subjects that had scored 5 or more in 'exaggeration or inattentive response' are significantly higher than those in the subjects had scored 4 in 'exaggeration or inattentive response'. Conclusions:This study suggests that the Korean version of PCSQ is a valid and reliable tool for assessing psychiatric symptomatology of patients with traumatic brain injury. Further investigations with greater numbers of subjects are necessary to assess the clinical usefulness of the KPCSQ.

A study on the effect of collimator angle on PAN-Pelvis volumetric modulated arc therapy (VMAT) including junction (접합부를 포함한 PAN-전골반암 VMAT 치료 계획 시 콜리메이터 각도의 영향에 관한 고찰)

  • Kim, Hyeon Yeong;Chang, Nam Jun;Jung, Hae Youn;Jeong, Yun Ju;Won, Hui Su;Seok, Jin Yong
    • The Journal of Korean Society for Radiation Therapy
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    • v.32
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    • pp.61-71
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    • 2020
  • Purpose: To investigate the effect of collimator angle on plan quality of PAN-Pelvis Multi-isocenter VMAT plan, dose reproducibility at the junction and impact on set-up error at the junction. Material and method: 10 adult patients with whole pelvis cancer including PAN were selected for the study. Using Trubeam STx equipped with HD MLC, we changed the collimator angle to 20°, 30°, and 45° except 10° which was the default collimator angle in the Eclipse(version 13.7) and all other treatment conditions were set to be the same for each patient and four plans were established also. To evaluate these plans, PTV coverage, coverage index(CVI) and homogeneity index (HI) were compared and clinical indicators for each treatment sites in normal tissues were analyzed. To evaluate dose reproducibility at the junction, the absolute dose was measured using a Falmer type ionization chamber and dose changes at the junction were evaluated by moving the position of the isocenter in and out 1~3mm and setting up the virtual volume at the junction. Result: CVI mean value was PTV-45 0.985±0.004, PTV-55 0.998±0.003 at 45° and HI mean value was PTV-45 1.140±0.074, and PTV-55 1.031±0.074 at 45° which were closest to 1. V20Gy of the kidneys decreased by 9.66% and average dose of bladder and V30 decreased by 1.88% and 2.16% at 45° compared to 10° for the critical organs. The dose value at the junction of the plan and the actual measured were within 0.3% and within tolerance. At the junction, due to set-up error the maximum dose increased to 14.56%, 9.88%, 8.03%, and 7.05%, at 10°, 20°, 30°, 45°, and the minimum dose decreased to 13.18%, 10.91%, 8.42%, and 4.53%, at 10°, 20°, 30°, 45° Conclusion: In terms of CVI, HI of PTV and critical organ protection, overall improved values were shown as the collimator angle increased. The impact on set-up error at the junction by collimator angle decreased as the angle increased and it will help improve the anxiety about the set up error. In conclusion, the collimator angle should be recognized as a factor that can affect the quality of the multi-isocenter VMAT plan and the dose at the junction, and be careful in setting the collimator angle in the treatment plan.

FAMILY DYNAMICS OF INCEST PERCEIVED BY ADOLESECENTS (청소년이 지각한 근친상간의 가족역동)

  • Kim, Hun-Soo;Shin, Hwa-Sik
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.6 no.1
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    • pp.56-64
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    • 1995
  • Family is a primary unit of the major socialization processing for children. Parents among the family members are one of the most important figures from whom the child and adolescent acquire a wide variety of behavior patterns, attitudes, values and norms. An organization of family members product family structural functioning. Abnormal family structure is one of the most important reference models in the learning of antisocial patterns of behavior. Therefore incest and child sexual abuse including spouse abuse, elderly abuse, and neglect occurs in the abnormal family structural setting. In particular, incest, a specific form of sexual abuse, was once thought to be a phenomenon of great rarity, but our clinical experiences, especially over the past decade, have made us aware that incest and child sexual abuse is not rare case and on the increasing trend. Therefore, the aim of this study was to determine the family problem and dynamics of incest family, and character pattern of post-incest adolescent victim in Korea. A total of 1,838 adolescents from middle and high school(1,237) and juvenile correctional institute(601) were studied, sampled from Korean student population and adolescent delinquent population confined in juvenile correctional institutes, using proportional stratified random sampling method. The subjects' ages ranged from 12 to 21 years. Data were collected through questionnaire survey. Data analysis was done by IBM PC of Behavior Science Center at the Korea university, using SAS program. Statistical methods employed were Chi-square, principal component analysis and t-test etc. The results of this study were as follows ; 1) Of 1,071 subjects, 40(3.7%) reported incest experiences(sibling incest : 1.6% ; another type of incest : 2.1%) in their family setting. 2) The character pattern of post-incest adolescent victim was more socially maladjusted, immature, impulsive, rigid, anxious and dependent than non-incest adolescent. Also they showed some problem in academic performance and their assertiveness. 3) The other family members of incest family revealed more psychological and behavioral problem such as depression, alcoholism, psychotic disorder and criminal act than the non-incest family, even though there is no evidence of the context between them. 4) The family dynamics of incest family tended to be dysfunctional trend, as compared with non-incest family. It showed that the psychological instability of family member, parental rejection toward their children, coldness and indifference among family member and marital discordance between the parents had significant correlation with incest.

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Comparative Analysis of Community Health Practitioner's Activities and Primary Health Post Management Before and After Officialization of Community Health practitioner (보건진료원의 정규직화 전과 후의 보건진료원 활동 및 보건진료소 관리운영체계의 비교 분석)

  • Yun, Suk-Ok;Jung, Moon-Sook
    • Journal of agricultural medicine and community health
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    • v.19 no.2
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    • pp.141-158
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    • 1994
  • To provide better health care services to the rural population, the government has made the Community Health Practitioner(CHP) a regular government official from April 1, 1992. This study was carried out to study the impact of officialization of CHP on the activities and management system of Primary Health Post(PHP). Fifty PHPs were selected by two stage sampling, cluster and simple random, from 595 PHPs in Kyungnam and Kyungpook provinces. Data were collected by a personal interview with CHPs and review of records and reports kept in the PHPs. The study was done for the periods of January 1-March 31, 1992 (before officialization) and January 1-March 31, 1993 (after officialization). Ninety-six percent of the CHPs wanted to become a regular government official in the hope of better job security and higher salary. The proportion of CHPs who were proud of their iob was increased from 24% to 46% after officialization. Those CHPs who felt insecure for their job decreased from 30% to 10%. Monthly salary was increased by 34% from 802,600 Won to 1,076,000 Won and 90% of the CHPs were satisfied with their salary, also more CHPs responded that they have autonomy in their work planning, implementation of plan, management of the post, and evaluation of their activity. There were no appreciable changes in such CHPs' activities as assessment of local health resources, drawing map for the catchment area, utilization of community organization, grasping the current population structure in the catchment area, keeping the family health records, individual and group health education, and school health service. However, the number of home visits was increased from 13.6 times on the average per month per CHP to 27.5 times. More mothers and children were referred to other medical facilities for the immunization and family planning services. Average number of patients of hypertension, cancer, and diabetes in three months period was decreased from 12.7 to 11.6, from 1.5 to 1.2, and 4.3 to 3.4, respectively. Records for the patient care, drug management, and equipment were well kept but not for other records. The level of record keeping was not changed after officialization. The proportion of PHPs which had support from the health center was increased for drug supply from 14.0% to 30.0%, for consumable commodities from 22.0% to 52.0%, for maintenance of PHP from 54.0% to 68.0%, for supply of health education materials from 34.0% to 44.0%, and supply of equipment from 54.0% to 58.0%. Total monthly revenue of a PHP was increased by about 50,000 Won; increased by 22,000 Won in patient care and 34,700 Won in the government subsidy but decreased in the membership due and donation. However, there was no remarkable changes in the expenditure. The proportion of PHPs which had received official notes from the health center for the purpose of guidance and supervision of the CHPs was increased from 20% to 38% during three months period and the average number of telephone call for supervision from the health center per PHP was increased from 1.8 to 2.1 times(p<0.01). However, the proportion of PHPs that had supervisory visit and conference was reduced from 79% to 62%, and from 88% to 74%, respectively. The proportion of CHPs who maintained a cooperative relationship with Myun Health Workers was reduced from 42% to 36%, that with the director of health center from 46% to 24%, that with the chief of public health administration section from 56% to 36%, and that with the chairman of PHP management council from 62% to 38%. Most of the CHPs (92% before and 82% after officialization) stated that the PHP management council is not helpful for the PHP. CHPs who considered the PHP management council unnecessary increased from 4% to 16%(p<0.05). Suggestions made by the CHPs for the improvement of CHP program included emphasis on health education, assurance of autonomy for PHP management, increase of the kind of drugs that can be dispensed by CHPs, and appointment of an experienced CHP in the health center as the supervisor of CHPs. The results of this study revealed that the role and function of CHPs as reflected in their activities have not been changed after officialization. However, satisfaction in job security and salary was improved as well as the autonomy. Support of health center to the PHP was improved but more official notes were sent to the PHPs which required the CHPs more paper works. Number of telephone calls for supervision was increased but there was little administrative and technical guidance for the CHP activities.

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