• 제목/요약/키워드: Childhood.adolescence

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소아청소년정신과영역의 새로운 항우울제 (NEW ANTIDEPRESSANTS IN CHILD AND ADOLESCENT PSYCHIATRY)

  • 이수정
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제14권1호
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    • pp.12-25
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    • 2003
  • 새로운 항우울제가 다량 개발되어 임상에 도입되면서 항우울제의 약리 작용에 대한 이해도 넓어졌다. 그에 따라 얻어진 새로운 정보와 이론을 소아청소년기 우울증 치료에 반영할 필요가 있다. 소아청소년기 최신지견에 따라 합리적인 우울증 치료 지침 마련을 위하여 고려하여야 할 주요 사항들과 새로운 항우울제의 특징들을 살펴보고자 하였다. 전자문헌 데이터베이스 검색 도구를 사용하여'new', 'antidepressant', 'children'의 검색어로 얻어진 97개 고찰 문헌 가운데 특히 치료 지침과 새로운 항우울제의 정신약리작용에 관한 것을 선별하여 중점적으로 고찰하였다. 아울러 새로운 항우울제 각 약물에 대한 치료 효과에 대한 문헌을 추가로 선택 참고하였다. 또 약물상호 작용과 안전성에 관하여 미국 식품보건국과 보건후생부의 공식사이트에서 제공되는 문헌을 참고하였다. 1) 우울 장애의 임상 경과, 치료 기간, 및 치료 효과는 성인기 치료 지침에서 제시된 바를 채택한 경우가 많았다. 2) 소아청소년기 우울증에 대한 항우울제의 효과에 대한 연구 결과는 TCA가 효과와 부작용에서 SSRI보다 뒤져서 소아청소년 우울장애의 일차 치료제로 권장 된다. 3) 새로운 항우울제는 아직 소아청소년에게 치료 경험과 임상 연구 결과가 부족하다. 4) SSRI와 새로운 항우울제들은 두 개 이상을 병용할 때 약동학적 및 약력학적인 상호작용이 있을 수 있다. 5) 소아청소년기 항우울제의 임상적 효과가 성인기와 다른 것은 발달적 측면에서 설명할 수 있겠으나 직접적인 증거가 좀더 쌓일 필요가 있다. 소아청소년기 우울증의 약물 치료 지침은 임상 연구 소견과 임상적 경험을 종합하여 세울 수 있다. 그러나 약물 치료 지침은 임상가가 합리적인 판단을 내릴 수 있도록 하는 참고 자료이며 그 목적을 다하기 위하여 새로운 연구 결과가 있을 때 마다 새로 개정 되어야 할 것이다. 중 외톨이-왕따에 해당되는 청소년의 어머니는 비외톨이 청소년의 어머니보다 자녀들의 사고 문제 및 우울/불안 등의 정서적 문제를 더 높게 평가하였다. 그러나, 자녀들에 대한 양육 태도에 대해서는 차이를 두지 않는 것으로 보인다. 향후 보다 많은 환자들을 대상으로 한 추가 연구가 필요할 것이다. 강압적인 양육행동을 변화시키기 위해서는 주의력결핍과잉행동장애 아동 부모의 양육 스트레스, 아동에 대한 역기능적 사고 및 양육 효능감을 다루어야 할 뿐 아니라, 부모의 우울감을 치료 시 고려해야 할 것이다.순차처리항목과 계산능력에서 유의하게 높았고(p<.05), KEDI-WISC를 이용한 평가에서는 ADHD- HI형은 대상수가 소수여서 비교할 수 없었으며, ADHD-C형과 ADHD-Ⅰ형 사이에 유의한 차이는 보이지 않았다. CPT, WCST, SST를 이용한 신경심리학적 실행기능의 비교에서 아형간 계량적인 차이는 있었으나 통계적으로 유의한 차이는 보이지 않았다. 결 론:결론적으로 ADHD 세 아형은 임상적으로 뚜렷한 차이를 보였지만, 실행기능상 유의한 차이를 발견할 수 없었다. 향후 보다 잘 고안 된 연구와 발달중인 아동에 적절한 신경심리 평가 도구의 개발을 통해 결과를 보완해야 할 것으로 사료된다.었으나, 주의력에서는 전두엽의 실행능력(executive function)과 관련되는 검사들에서 산소흡입이 특이한 효과를 보여준다는 것이 확인되었고, 기억능력에서는 단기기억능력 평가에서 산소흡입군이 대조군보다 유의한 효과를 보여주는 것으로 평가되었다. 이러한 연구결과는 산소흡입이 전두엽과 관련된 수행능력, 작동기억능력 향상에 도움이 될 가능성이 있음을 시사하는 결과라고 생각된다.증 1명(5%)이었다. 모든 대상 아동이 주 진단 이외의 2∼6개 이상의 다양한 공존진단을 보였다. 공존진단에는 주의력결핍-과잉운동장애, 우울병, 경계선지능 및 정신지체, 학습장애,

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가족구조와 사회화가 강박구매에 미치는 영향에 관한 연구: 태국의 인생행로연구를 중심으로 (The Effects of Family Structure and Socialization Influences on Compulsive Buying: A Life Course Study in Thailand)

  • Nguyen, Hung Vu;Moschis, George P.;Shannon, Randall;Gotthelf, Kristian
    • 마케팅과학연구
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    • 제19권2호
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    • pp.27-39
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    • 2009
  • Compulsive consumption is regarded as a global phenomenon that can adversely affect consumer well-being. Although the topic has been studied in different cultural settings, we have seen relatively little theory development and explanations of compulsive behavior Nearly all previous empirical studies attempt to explain this behavior by correlating measures of compulsive behavior with independent variables taken within the same time frame. However, recent developments in social sciences suggest that such a phenomenon may best understood in the context of the person's earlier-in-life experiences. Using the life course paradigm as an overarching framework, the present research extends previous work on this topic. Following hypotheses were drawn from literature review: H1: The earlier in childhood and adolescence a person experiences family dislocation, the greater his or her likelihood of exhibiting compulsive behaviors in adulthood. H2: The earlier in life the young person experienced family dislocation, the greater the number of family disruption events the young person experienced prior entering adulthood years. H3: Family dislocation leads to (a) increased frequency of socio.oriented family communications and (b) decreased frequency of concept-oriented family communication. H4: Young adults who were raised in families characterized by a strong socio-oriented communication structure are more likely to exhibit compulsive consumption tendencies than those who were raised in families characterized by a weak socio-oriented family communication structure. H5: Young adults who were raised in families characterized by a strong concept-oriented communication structure are less likely to exhibit compulsive consumption tendencies than those who were raised in families characterized by a week concept-oriented family communication structure. H6: The relationship between family disruption events experienced during adolescence and perceived stressfulness of these events is moderated by (a) global family support, (b) emotional family support, and (c) material family support. Those reporting higher levels of family support as teenagers are less likely to report experiencing stress due to family disruption events. H7: Perceived stressfulness of family disruption events experienced during adolescent years are associated with compulsive consumption tendencies in early adulthood. H8: The greater the number of family disruption events young adults experienced during their adolescent years the more frequent was their communication about consumption with their peers. H9: The more frequent was the young persons' communication with their peers about consumption during their adolescent years, the more likely they are to report compulsive buying tendencies as young adults. We use a sample of 120 Thai undergraduate students attending classes taught in English as part of a four-year international program. Product-moment correlations, hierarchical regression analysis and partial correlation were used to analyze data. Results of testing hypotheses showed that hypothesis 2, 4, 7 and 9 were supported and hypothesis 1, 3, 5, 6 and 8 were not supported. Our study did not find a significant relationship between the age when a person experienced family dislocation and their compulsive behavior tendencies expressed as young adults. We did not find a significant relationship between family dislocation and family communication structures. But we found a significant positive relationship between socio-oriented communication structure and compulsive buying and a significant relationship between our peer communication and compulsive buying measures. Also we found perceived stressfulness due to the disruptive events to have a significant positive relationship between the perceived stressfulness and compulsive buying. Implications from these findings, limitations of this research and future research suggestions were discussed.

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소아와 조기청소년에서 보이는 주의력결핍 과잉행동장애와 간질의 공통적 특성 (Common Features of Attention Deficit Hyperactivity Disorder and Epileptic Disorder in Childhood and Early Adolescence)

  • 김시형;김태형;최말례;김병조;송옥선;장영택;은헌정
    • 정신신체의학
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    • 제19권2호
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    • pp.101-108
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    • 2011
  • 연구목적: 주의력결핍 과잉행동장애(Attention Deficit Hyperactivity Disorder, ADHD)와 간질 사이에서 나타나는 공통적 특성을 연구할 목적으로 Korea-Child Behavior Checklist(K-CBCL)과 ADHD Diagnostic System (ADS), Electroencephalogram(EEG)를 평가하여 두 질환군의 공통적 특성(Common features)을 알아보고자 하였다. 방 법: 6세부터 16세까지의 소아,청소년들을 대상으로 ADHD군 30명 간질군 34명 그리고 대조군은 29명이었다. 평가도구는 K-CBCL과 자가보고 도구인 ADS를 사용하였으며 뇌파를 측정하였다. 모든 결과의 분석은 다중변량분석(MANOVA)과 교차분석(${\chi}^2$-test)을 이용하였다. 결 과: 간질군, ADHD군 간의 공통적 특성으로 뇌파에서 비정상 뇌파 소견(대조군 13.8%, 간질군 97.1%, ADHD군 40%)을 보인 것과 ADS에서 부주의, 반응시간 표준편차 항목에서 유의미한 차이가 있음이 확인되었다. 결 론: 간질군과 ADHD군에서 비정상 뇌파 소견, 부주의, 반응시간 표준편차라는 공통적 특성이 있음을 확인하였다.

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Development of the Korean Practice Parameter for Adult Attention-Deficit/Hyperactivity Disorder

  • Bahn, Geon Ho;Lee, Young Sik;Yoo, Hanik K.;Kim, Eui-Jung;Park, Subin;Han, Doug Hyun;Hong, Minha;Kim, Bongseog;Lee, Soyoung Irene;Bhang, Soo Young;Lee, Seung Yup;Hong, Jin Pyo;Joung, Yoo-Sook
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제31권1호
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    • pp.5-25
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    • 2020
  • Objectives: Adult attention-deficit/hyperactivity disorder (ADHD) is an important mental health problem that needs resolution, especially considering the high rates of ADHD continuation from childhood to adolescence/adulthood and the high prevalence of ADHD in adults. Adults with ADHD have lifelong negative impacts and require close monitoring with long-term follow-up. Hence, the establishment of a Korean practice parameter for adult ADHD is necessary to minimize discontinuation of treatment and enable information sharing among Korean mental health professionals. Methods: The Korean practice parameter was developed using an evidence-based approach consisting of expert consensus survey coupled with literature review. Results: According to the expert consensus survey, the most commonly used diagnostic methods were clinical psychiatric interview (20.66%) and self-report scales (19.25%) followed by attention (14.71%) and psychological tests (14.24%). Key evaluation instruments currently available in Korea are the World Health Organization Adult ADHD Self-Report Rating Scale, Korean Adult ADHD Rating Scale, Diagnostic Interview for ADHD in Adults, Barkley Deficits in Executive Functioning Scale for adults, Comprehensive Attention Test, Conners' Continuous Performance Test, and the subtests of Wechsler Adult Intelligence Scale, Digit Span and Letter-Number Sequencing. Although pharmacotherapy is recommended as the first-line of treatment for adult ADHD, we recommend that it be followed by a multimodal and multidisciplinary approach including psychoeducation, pharmacotherapy, cognitive behavior therapy and coaching. Conclusion: The Korean practice parameter introduces not only general information for the diagnosis and treatment of adult ADHD on a global scale, but also the process of diagnosis and treatment options tailored to the Korean population.

파절된 미성숙 영구 전치의 수복 (ESTHETIC RESTORATION OF FRACTURED IMMATURE PERMANENT INCISORS)

  • 이인영;김현정;김영진;남순현
    • 대한소아치과학회지
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    • 제36권1호
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    • pp.126-132
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    • 2009
  • 외상에 의한 영구치의 손상은 소아와 청소년기에 많이 발생하며, 특히 상악 중절치가 가장 많이 손상을 받는 것으로 알려져 있다. 그 중 치관 파절은 영구치열에서 25-76%의 빈도로 나타나며, 이러한 치관 파절시 심미적, 기능적으로 만족스러운 수복을 하기 위한 다양한 노력이 시도되어 왔다. 성인에서 영구 전치 치관 파절이 발생한 경우에는 도재 소부 전장관, 라미네이트 등의 보철적 치료로 심미적인 수복이 가능하지만, 미성숙 영구 전치의 파절이 발생한 경우에는 치근 성장이 완료되지 않아 보철적 치료가 힘들고, 근관 치료가 필요한 경우 근관 치료를 완료하는데도 오랜 시간이 소요된다. 따라서 이러한 경우 과거에는 교정용 밴드, 기성 금속관, 글래스 아이어노머 시멘트 등을 이용한 수복이 시행되었는데, 심미적으로는 만족스러운 결과를 얻지 못하였다. 그러나 근래에는 수복 치과재료의 발달로 파절편을 재부착하거나, 광중합 복합 레진 수복을 통해 심미적 수복이 가능하게 되었다. 본 증례들은 경북대학교 치과병원 소아치과에 외상에 의한 상악 중절치 파절을 주소로 내원한 환아들로, 적절한 치수 처치 후, 치아 파절편 부착과 복합 레진 수복을 통해 심미적으로 양호한 결과를 얻었기에 이를 보고하고자 한다.

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기분부전장애에서 Moclobemide와 Amitriptyline의 치료 효과와 내약성 비교 연구 (Efficacy and Tolerability of Moclobemide Compared with Amitriptyline in Dysthymic Disorder)

  • 이민수;남종원;유승호;차지현;김용구
    • 생물정신의학
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    • 제6권1호
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    • pp.96-101
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    • 1999
  • Background : Since dysthymia begins in late childhood or adolescence and has a chronic course, long-term pharmacotherapy may be required. New generation antidepressant, moclobemide, with more acceptable side effect profiles, is effective in the treatment of dysthymia. The main objective of this study was to determine whether they exhibit comparable efficacy and tolerability in dysthymia to amitriptyline. Method and Materials : The efficacy and tolerability of the moclobemide and amitriptyline, were compared in a eight-week single-centre double-blind study in patients(n=37) with dysthymia using he HAMD-17, the Clinical Global Impression Scale(CGI), the Montgomery-Asberg Depression Rating Scale (MADRS), Efficacy Index-Therapeutic Index(EITE), 4-point Index Side Effect Scale(4-PISES), and Efficacy Index- Side Effect Scale(EISE). Results : A total of 37 patients entered the study, 19 were randomly assigned to the moclobemide group and 18 to be amitriptyline group. Demo-graphic and illness characteristics were similar in both groups. There were no significant difference between two groups at the total 17-HDRS score, the HAMD-17% improvement, the total MADRS score, CGI response, and the EITE. In the comparison of EISE between two groups, the scores of the moclobemide group were relatively lower than the amitriptylinen group in full treatment. And the differences were significant(moclobemide group $1.39{\pm}0.61$ ; amitriptyline group $2.00{\pm}0.85$, p<.001). At the 4-PISE, There was no serious or treatment threatening side effects. And there was no specific difference in side effects between two groups. The moclobemide group reported higher EIR scores than the amitriptyline group at every follow up day, but the differences were not significant. And, there was no significant differences in the scores of five HRQOL subcategories which is compared between two groups at every follow up days. Conclusions : In terms of 17-HDRS and MADRS, moclobemide and amitriptyline are equally effective at least in allevating dysthymic symptoms. But moclobemide tended to be less troubling and better tolerated than amitriptyline. Therefore, moclobemide treatment can be used as a safe, and higher satisfactory treatment strategy for the dysthymia.

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비만 청소년의 과거 12년간 Body Mass Index 변화 - 서울시내 일부 고등학생을 대상으로 - (Twelve-year Study on Body Mass Index Changes of Obese Adolescents)

  • 강윤주;서일;홍창호;박종구
    • Journal of Preventive Medicine and Public Health
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    • 제27권4호
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    • pp.665-676
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    • 1994
  • The purpose of this study is to observe the longitudinal changes in BMI (Body Mass Index) of obese and non-obese 3rd. grade high school students in Seoul for 12 years and to see the trends of overt weight gain in obese adolescents. The results are as follows; 1. The average annual increasing rates of body mass Indices in male students were $1.14kg/m^2$ in obese group and $0.59kg/m^2$ in non-obese group. In female students, the average annual increasing rates of body mass indices were $0.93kg/m^2$ in obese group and $0.53kg/m^2$ in non-obese group. 2. The change rate of BMI for 12 years was significantly higher in obese group than non-obese group. 3. Puberty had less influence on the change rate of BMI in obese group compared to non-obese group. 4. In obese group, 71.8% of the variance in BMI at 17 can be predicted by BMI at 16 years in male students. In female students 44.4% can be predicted by BMI at age 16. 5. Among the 17-year-old obese students, 58.8% of the males and 56.2% of females were found not to have been obese at 7 years of age. 6. Among the 17-year-old obese students, those who were obese at 7 years of age were found to have higher BMI at later ages than those who were in the non-obese group. Obese adolescents were more likely to be obese in their childhood than non-obese group. There was no optimal age for the significant weight gain and the increasing rate of BMI was constantly higher in obese group than in non-obese group. Due to the fact that child obesity in early age contributes to obesity in adolescence, close observation is advised. On the other hand, a large proportion of obese adolescents can be preventable by early interventions, because about 50% of obese adolescents were not obese in early elementary school age.

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여자 중학생의 체형분류에 관한 연구 - 교복패턴개발을 중심으로 - (A study on the classification of body types for female junior high school students - Focused on the development of school uniforms -)

  • 신장희
    • 한국의상디자인학회지
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    • 제22권3호
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    • pp.99-110
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    • 2020
  • In terms of junior high school girls' growth patterns during early adolescence, are unlike childhood when relatively balanced growth patterns are found and high school years in which the normal adult body type is nearly reached, growth patterns displayed are imbalanced and rapid. In fact, diverse size changes by body part growth occur significantly different from individual to individual. Therefore, it has been hard for junior high school students to select their proper size when buying school uniforms. This study attempted to acquire basic data needed to address adolescent body shapes and school uniform patterns for junior high school girls, using the data from the 7th Size Korea Survey (2015). Specifically, it provides basic data for the development of school uniform patterns through the classification of their body into particular types, After extracting body shape components and a cluster analysis using ANOVA. According to a factor analysis conducted to determine body shape components, six factors were obtained: Factor 1: bulk and horizontal size, Factor 2: body height and length, Factor 3: shoulder shape and length, Factor 4: shape of upper body, Factor 5: lower drop, Factor 6: upper drop with a variance of 81.46%. To classify junior high school girls' body shape and determine their characteristics, a cluster analysis was performed with the variables obtained using factor analysis. Body shape was classified into three different types: Type 1 accounted for 30.7%. This was a short, slender body with the smallest bulk, size, and upper drop. Type 2 accounted for 24.9%. This was the largest in bulk and horizontal size and highest and length as well. Type 3 accounted for 44.5%. This type was close to average in terms of horizontal size, length and height, and high drop values. To develop school uniforms with great accuracy and body fit for junior high school students, there should be further studies on changes in body shape and their causes. The study results can serve as basic data for comparing branded school uniform patterns for junior high school girls and developing school uniform patterns based on body shape, using 3D virtual clothing simulations.

석회화 건막 섬유종 - 증례 보고 - (Calcifying Aponeurotic Fibroma - A Case Report -)

  • 백승삼;장기석;;김형종;노원일;이성필;이광현
    • 대한골관절종양학회지
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    • 제9권2호
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    • pp.233-237
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    • 2003
  • 목적: 석회화 건막 섬유종은 소아 및 청소년층에서 수장부를 가장 많이 침범하는 양성이나 공격적 성향을 띈 섬유성 종양이다. 저자들은 최근에 15세 소년의 수부에 발생한 석회화 건막 섬유종의 치료를 경험하였기에 이를 문헌 고찰과 함께 보고하고자 한다. 증례: 15세 소년이 좌수의 소지구 부위에 재발하는 종물을 주소로 내원하였으며 이 소년은 7년전에 타 병원에서 국소 마취 하에 동일 부위에 발생한 종물을 제거한 기왕력을 가지고 있었다. 종물은 단단하였으며 압통이 있었다. 단순 방사선 촬영상에는 종물 내에 다소성으로 산재된 미세 석회 침착이 보였다. 수술 소견상 종물은 주변과 명확히 구분되지 않았으며 단단하고 옅은 회색빛의 석회화를 동반한 침습성의 결절성 형태를 보였으며 가이언 관내의 척골 신경과 척골 동맥이 바로 인접하고 있었다. 수술 후 제거한 종물을 현미경적으로 관찰한 결과 종물은 많은 석회 침착이 되어 있으면서 이형성 연골양 분화를 보이는 조직이 중간 중간에 섞여 있는 빽빽한 섬유 조직의 증식으로 이루어져 있었고 주변부는 명확히 경계 지어지지 않으며 분엽상을 보이고 있었다. 결론: 이 질환에 있어서 가장 바람직한 치료법은 기능적인 면과 주요 조직을 보존할 수 있는 한도내에서 광범위 절제를 시행하는 것이며 이렇게 치료하더라도 많게는 50 %이상의 재발율이 보고되고 있는 실정이다.

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여성의 개인적 특성과 생활양식요인을 이용한 골량감소 예측모형 (Prediction Model for Reduced Bone mass in Women using Individual Characteristics & Life Style Factors)

  • 이은남;이은옥
    • 근관절건강학회지
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    • 제5권1호
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    • pp.83-109
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    • 1998
  • This study was carried out to identify the Important modifiable risk factors for reduced bone mass and to construct prediction model which can classify women with either low or high bone mass. Through the literature review, individual characteristics such as age, body weight, height, education level, family history, age of menarche, postmenopausal period, gravity, parity, menopausal status, and breast feeding period were identified and factors of life style such as past milk consumption, past physical activity, present daily activity, present calcium intake, alcohol intake, cigarette smoking, coffee consumption were identified as influencing factors of reduced bone mass in women. Four hundred and eighty women aged between 28 and 76 who had given measurement bone mineral density by dual energy x-ray absortiometry in lumbar vertebrae and femur from July to October, 1997 at 4 general hospitals in Seoul and Pusan were selected for this study. Women were excluded if they had a history of any chronic illness such as rheumatoid arthritis, diabetes mellitus, hyperthroidism, & gastrointestinal disorder and any medication such as calcium supplements, calcitonin, estrogen, thyroxine, antacids, & corticosteroids known affect bone. As a result of these exclusion criteria, four hundred and seventeen women were used for analysis. Multiple logistic regression model was developed for estimating the likelihood of the presence or absence of reduced bone mass. A SAS procedure was used to estimate risk factor coefficient. The results are as follows For lumbar spine, the variables significant were age, body weight, menopause status, daily activity, past milk consumption, and past physical activity(p<0.01), while for femoral Ward's triangle, age, body weight, level of education, past milk consumption, past physical activity(p<0.001). Past physical activity, present daily activity and past milk consumption are the most powerful modifiable predictors in vertebrae and femur among the predictors. When the model performance was evaluated by comparing the observed outcome with predicted outcome, the model correctly identified 74.1% of persons with reduced bone mass and 84.5% of persons with normal bone mass in the lumbar vertebrae and 82.9% of persons with reduced bone mass and 75.0% of persons with normal bone mass in the femoral Ward's triangle. On the basis of these results, a number of recommendations for the management of reduced bone mass may be made : First, those woman who are classified as high risk group of the reduced bone mass in the prediction model should examine the bone mineral density to further examine the usefulness of this model. Second, the optimal amount of milk consumption and a regular weight bearing exercise in childhood, adolescence, and early adult should be ensured.

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