• 정신신체의학
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• 제12권2호
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• pp.103-121
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• 2004

감각 및 운동 이상 증상을 동반하면서 꾀병이 의심되는 환자를 가려내는 방법에 대해서 약술하고 몇 개의 증례를 예시하였다. 꾀병을 규명하기 위해서는 우선 전환 장애, 가장성 장애를 차례로 증명하여 제외시켜야 한다. 이를 위한 방법으로는 자세한 병력 수집과 조사, 면밀한 신경학적 검사, 심리검사, 장시간의 면담 그리고 광범위한 행동 관찰이 필요하다. 그러나 증상 형성의 동기나 의도의 본질을 파악하기란 어려워서 환자의 고백에 의해 알게되는 경우도 있다. 신경 심리검사를 포함한 임상심리 검사를 통하여 꾀병의 가능성을 가려내고, 질병행동 특성을 파악하거나 기계적인 측정도구를 이용하기도 한다. 그러나 아직 객관적으로 타당한 검사 방법은 부족하다. 최근, 통증 차단제를 이용한 진성(眞性) 통증 구별법은 객관적인 검사법의 하나이다. 사고나 보상 문제가 겹친 만성 통증 환자는 꾀병의 가능성이 엿보인다 하더라도 많은 수에서 시간 경과와 환경의 영향으로 인해서 정신사회적 합병증을 동반한다. 향후 임상 심리검사법이 발달되고 행동과 의도성에 관한 뇌 기능의 연구론 통해 신체 증상이나 행위의 진실성에 대한 구별력은 더욱 향상될 것이다.

• Clinical and Experimental Emergency Medicine
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• 제5권4호
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• pp.282-285
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• 2018

The objective is to review a case of pneumoparotitis and to discuss how knowledge of this unique presentation is important when making differential diagnoses in emergency medicine. A patient with recurrent subcutaneous emphysema of the head and neck is reviewed. Stenson's duct demonstrated purulent discharge. Physical examination revealed palpable crepitance of the head and neck. Fiberoptic laryngoscopy and barium esophagram were normal. Computed tomography demonstrated left pneumoparotitis and subcutaneous emphysema from the scalp to the clavicles. This is an unusual presentation of pneumoparotitis and malingering. Emergency physicians should be aware of pneumoparotitis and its presentation when creating a differential diagnosis for pneumomediastinum, which includes more life-threatening diagnoses such as airway or esophageal injuries.

• Journal of Korean Neurosurgical Society
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• 제48권6호
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• pp.506-517
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• 2010

Objective : We investigated whether Disability Evaluation (DE) situations influence patients' neuropsychological test performances and psychopathological characteristics and which variable play a role to establish an explanation model using statistical analysis. Methods : Patients were 536 (56.6%) brain-injured persons who met inclusion and exclusion criteria, classified into the DE group (DE; n = 300, 56.0%) and the non-DE group (NDE; n = 236, 44.0%) according to the neuropsychological testing's purpose. Next, we classified DE subjects into DE cluster 1 (DEC1; 91, 17.0%), DE cluster 2 (DEC2; 125; 23.3%), and DE cluster 3 (DEC3; 84, 15.7%) via two-step cluster analysis, to specify DE characteristics. All patients completed the K-WAIS, K-MAS, K-BNT, SCL-90-R, and MMPI. Results : In comparisons between DE and NDE, the DE group showed lower intelligence quotients and more severe psychopathologic symptoms, as evaluated by the SCL-90-R and MMPI, than the NDE group did. When comparing the intelligence among the DE groups and NDE group, DEC1 group performed worst on intelligence and memory and had most severe psychopathologic symptoms than the NDE group did. The DEC2 group showed modest performance increase over the DEC1 and DEC3, similar to the NDE group. Paradoxically, the DEC3 group performed better than the NDE group did on all variables. Conclusion : The DE group showed minimal "faking bad" patterns. When we divided the DE group into three groups, the DEC1 group showed typical malingering patterns, the DEC2 group showed passive malingering patterns, and the DEC3 group suggested denial of symptoms and resistance to treatment.

• 대한전자공학회:학술대회논문집
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• 대한전자공학회 2000년도 하계종합학술대회 논문집(5)
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• pp.103-105
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• 2000

Optokinetic nystagmus(OKN) testing is an useful tool for assessment of human visual function. Specially, this method has been used for assessing visual function in infants and malingering patients. OKN drum and OKN tape are the common devices currently used for clinical cases. In this paper, we present newly the automated and computerized method for the quantitative and objective assessment of visual acuity in OKN testing.

• 대한불안의학회지
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• 제8권1호
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• pp.22-30
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• 2012

Objective : We investigated whether Posttraumatic stress disorder patients have a higher tendency to exaggerate the extent of their psychological symptoms compared to other psychiatric patients. Methods : Medical records of patients, who had received psychiatric treatment at four university hospitals in Korea between January 2009 and December 2010, were retrospectively reviewed. We compared a group of 37 patients diagnosed with PTSD, and another group of 41 patients diagnosed with neurotic, stress-related and somatoform disorders according to the ICD-10. To compare the extent of malingering in the two groups, we compared the validity scales of MMPI-2 and Personality Assessment Inventory. We determined the number of participants in both groups feigning their responses by using various cutoff scores of the validity indicators. Results : The PTSD group showed significantly higher scores on the F (p=0.001), F (B)(p=0.000), F (P)(p=0.030), F-K (p=0.003) scale of the MMPI-2 compared to the other group of psychiatric patients. The PTSD group had a significantly higher NIM score (p=0.001) but a lower PIM score (p=0.020) of the PAI compared to the other group of psychiatric patients. Using the cutoff scores, the PTSD group showed a significantly higher number of patients who feigned responses compared to the other group ($Fb{\geq}75$ (p=0.010), $F-K{\geq}1$ (p=0.005), $F-K{\geq}10$ (p=0.011) from the MMPI-2, and $NIM{\geq}80$ (p=0.001) from the PAI). Conclusion : These results suggest that PTSD patients have a tendency to exaggerate their symptom. This group of patients overreported the severity of their condition during standardized personality assessment that included the MMPI-2 or PAI compared to patients diagnosed with other psychiatric disorders. Additional research is required to determine the factors influencing symptom exaggeration in PTSD.

• 동의신경정신과학회지
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• 제24권1호
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• pp.109-122
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• 2013

Objectives : To research the needed Buddhistic ethical beliefs and psychotherapy from representative medical records of oriental medicine. Methods : The baseline data this research used is Myeong-Ui-Lyu-An, Sok-Myeong-Ui-Lyu-An, Ui-Bu-Jeol-Lok and from the variety of medical records; we extracted 22 medical records that refer to Buddhist thoughts. The sequence of medical records is determined by analyzing the contents of all medical records and grouping them by their categories. Results : The representative ethical mind that a doctor needs is the 'mercy thought' from Buddhism. This way, the doctor has 'pity' on patients and expects no reward for what he had done. 'Spells and religious beliefs developed into medical treatment procedures by Buddhism and oriental medicine psychotherapy. Using the belief that everything is made of the mind, which is the point of the 'Hwa-Eum' theory and the realization that the psychotic factors have a big role in the occurrence and progress of sicknesses, we emphasized supportive psychotherapy or more specifically, the suggestive therapy. 'Anguish' is an important point in the occurrence and progress of illnesses. To solve this, we used 'Zen family's 'Zen self-discipline' and ascetic life from Buddhism. According to Buddhism, a human's metal conflict and love or malingering from obsession is the cause of all mind illnesses. To heal these, a doctor must have an insight of the patient's mind more than the symptoms. Conclusions : Buddhistic thoughts suggested clearly the mentality necessary for oriental medical psychotherapist and medical ethics for a doctor.

• Journal of Korean Neurosurgical Society
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• 제55권1호
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• pp.18-25
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• 2014

Objective : This study explored the relationships among demographic (DVs) and clinical variables (CVs), neurocognitive (NOs) and functional outcome (FO) that could be used as prognostic factors for old aged patients with traumatic brain injury (TBI) undergoing or appointed disability evaluation (DE) after treatment. Methods : A total of 162 subjects with TBI above the age of 55 years undergoing DE or appointed to do so after treatments were selected. The patients were divided into two subgroups according to age : a junior elderly group 55 to 64 years old and a senior elderly group over the age of 65. NOs and FO were evaluated using the Seoul Neuropsychological Screening Battery and Clinical Dementia Rating scale. Results : Gender, age, and education level were shown to significantly impact the recovery of NOs after TBI. Other DVs and CVs such as area of residency, occupation, type of injury, or loss of consciousness were not found to significantly affect the recovery of NOs after TBI. Analysis of the relationships among DVs, CVs and NOs demonstrated that gender, age, and education level contributed to the variance of NOs. In FO, loss of consciousness (LOC) was included to prognostic factor. Conclusion : Gender, age and education level significantly influence the NOs of elderly patients with TBI. LOC may also serve as a meaningful prognostic factor in FO. Unlike younger adult patients with TBI, old aged patients with TBI did not show global faking-bad or malingering attitudes to DE for compensation, but assume that they could faking their performance in a test set available visual feedback.

• 동의신경정신과학회지
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• 제17권3호
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• pp.87-96
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• 2006

Psychogenic neurological conditions account for 1% to 9% of admissions at neurological unit. They are considered manifestations of underlying psychiatry disorders such as somatoform disorders and factitious disorders or malingering. Diagnosis for psychogenic tremor is difficult because mimic tremor is occurred at the secondary of the organic disorders or coexist in a patient with tremors of organic origin. A patient in this case report was diagnosed as psychogenic tremor, and she also complained the severe anger. A patient did not improved with the chemical medication for a long time. The patient received relaxation training, herbal medication and acupuncture for 20 days and showed short-term alleviation on tremor and decreased anger problem and other somatic problems.

• 대한불안의학회지
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• 제8권1호
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• pp.31-40
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• 2012

Objective : The purpose of this study was to analyze the correlation between symptom severity and neurocognitive factors in traumatic head injury patients. In addition, the effect of frontal lobe damage on these parameters was examined. Methods : We selected 18 patients who had brain damage for the moderate to severe traumatic brain injury (MSTBI) group, and 17 patients who met the diagnostic criteria for post-traumatic stress disorder (PTSD) without the finding of brain damage for the comparison group. For the evaluation of neurocognitive function, K-WAIS, Rey-Kim Memory Test, K-FENT, WCST, and MMPI-2 were used. Results : The results of the comparison (using the malingering scale) revealed that the values of PDS and PK, which express the severity of symptoms, and the values of the validity scale F, F (B), and F (P) were significantly higher in the overly-expressed group. F (B) in overly-expressed group and PK, Pt, and Sc in the properly-expressed group had significant correlation with the severity of symptoms. F (B), S, and Stroop error inhibition in PTSD, and PK, Pt, Sc, and MQ in MSTBI had significant correlation with the severity of symptoms. The results of the comparison based on the finding of frontal lobe damage revealed that PDS, EIQ, and MQ ware significantly higher in the group without brain damage. Conclusions : It was revealed that each neurocognitive factor was correlated with the severity of symptoms. There was a decrease in complaints or symptoms reported by the frontal lobe injury group, and this is believed to be due to degenerative change in the personality and emotional functioning of these patients following frontal lobe damage.

• 시큐리티연구
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• 제36호
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• pp.417-442
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• 2013

고려건국 후 왕의 측근 친위군에 대한 제도적 정비는 성종시대에 이루어졌다. 건국 후 국가제도를 정비하는 법제의 확립과 더불어 2군 6위에 소속된 금군으로 거듭나게 되었다. 금군의 핵심부대는 견룡이며, 그들은 필요에 따라 국왕의 가까운 위치에서 호위하거나 궁성을 수비하고 방어하는 부대로 성장하면서 제도적 위상을 갖추었다고 볼 수 있다. 사적경호제도인 도방(都房)의 창설은 경대승이 신변 안전을 위하여 자신을 따르는 무술이 뛰어난 군졸들과 침식을 같이하면서부터 시작되었다. 경대승이 병사하고, 그의 도방도 곧 해체되었다. 최충헌은 집권 후 경대승의 도방을 부활시켜 이를 보완하고 발전시켰다. 최충헌은 그의 문하에 문무를 두루 겸비한 문객들이 많은 가운데 유능한 인물을 영입하여 군사기반을 강화하는 한편, 문신들의 조언도 받아들이며 도방의 세력을 확대하였다. 이로써 자신의 정권을 위협할 수 있는 금군의 힘을 약화시킴으로써 정치적 입지를 굳혔다. 최우의 집권 이후 6번 도방을 내외도방으로 확장, 개편하여 실질적인 도방으로 발전시켰다. 또 야별초를 창설하여 도방의 위기를 방지하는 효력도 발휘하였다. 고려시대의 공경호인 금군은 왕권이 무력화된 무신집권시대에도 그 제도는 존속되었으나, 군권을 위시한 실권은 사적경호 조직인 도방이 행사하였고 왕은 다만 상징적인 존재로 명맥을 유지하였다. 고려시대의 경호와 현대 경호를 비교해 볼 때 공통점과 차이점을 발견할 수 있으나, 경호의 본질에 있어서는 경호대상자의 안전을 보장한다는 공통점이 있다. 차이점으로는 고려시대의 충성심과 현대의 이익추구가 각각 그 특징으로 대비되며, 고려시대 경호가 무력에 의한 강압으로 다스려진 것이라면, 오늘날의 경호는 자유의지에 의한 의무와 책임감의 수행으로 이루어진 것이라고 볼 수 있다.