• 대한불안의학회지
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• 제11권1호
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• pp.12-18
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• 2015

Objective : The current study investigated the personality characteristics in the victims of sexual violence, by using the Minnesota Multiphasic Personality Inventory (MMPI) test which are commonly used in clinical medicine. Methods : A total of 40 victims of sexual violence (only female) completed the Korean version of the MMPI. 31 (77.5%), and theywere patients with posttraumatic stress disorder. These victims of sexual violence had been admitted to the Dankook University Hospital in Cheonan. Results : The MMPI scores of the sexual victims were significantly higher on Hs, D, Hy, Pd, Pa, Pt, Sc, and Si, than the comparison group by ANCOVA. Conclusion : The victims of sexual violence may have developed the following characteristics: hypochondriasis, depression, hysteria, psychopathic deviate, paranoia, psychasthenia, schizoid and social introversion. The finding suggests psychotic psychopathology rather than neurotic psychopathology. These results suggested that the psychopatholgy in the victims of sexual violence may be different, compared to the control group.

• Safety and Health at Work
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• 제10권2호
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• pp.245-247
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• 2019

Occupational risks are often underestimated in midwifery. It is not commonly known that occupational risks were originally described by the Italian physician Bernardino Ramazzini (1633-1714) at the beginning of the 18th century. Our aim was to describe occupational risks in midwifery from Ramazzini to modern times. The original text by Bernardino Ramazzini was analyzed. A review of modern scientific articles on occupational risks in midwifery was conducted. Ramazzini identified two major occupational risks in midwifery: infections and awkward postures. Modern literature seems to agree with his considerations, focusing on infection, use of universal protection and personal protective equipment, and musculoskeletal problems. Modern studies also evidenced posttraumatic stress disorder that was probably postulated by Ramazzini himself. The poor number of articles in literature on midwives' occupational risks shows a lack of interest toward this issue. Prevention should therefore be emphasized in this field, so high-quality studies on occupational risks in midwifery are needed.

• Journal of Trauma and Injury
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• 제35권3호
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• pp.151-158
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• 2022

Purpose: There is a strong correlation between trauma and pain. Pain increases the rate of depression, posttraumatic stress disorder, and even mortality in trauma patients. Methods: This institution-based, provider-blinded and patient-blinded, observational study was conducted among trauma patients treated at Tikur Anbessa Specialized Hospital. Over the course of 3 months, this study included patients who had no prior pain management at other hospitals before presentation, and who presented within 24 hours of the traumatic event. Results: Of the 74 patients evaluated, none of the patients had their pain level scored. The researcher-provided pain scale showed a severe subjective pain score for 79.7% of the patients and a severe functional activity score for 59.5% of the patients. Analgesia was provided at an average of 55.4 minutes after presentation and all patients received either diclofenac or tramadol. Satisfactory pain reduction after analgesia was 28.8% for patients initially complaining of severe pain, 54.6% for moderate pain, and 66.7% for mild pain, with the difference being statistically significant (P<0.05). Forty percent of patients discharged home received no analgesia after the first dose provided upon presentation. Conclusions: Pain scoring was nonexistent during the course of the study. The poor utilization rate of analgesia combination and opioids led to unsatisfactory pain outcomes in patients evaluated and followed for 24 hours after presentation.

• 영어영문학
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• 제57권5호
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• pp.889-910
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• 2011

Heracles has been adored as one of the bravest mythical heroes all times and all places because it was thought that he protected his people and lands from invasion, plunder, or enslavement. However, I argue Heracles should be criticized as a war machine of violence and murder. War is homicide itself, which means humans kill humans, unlike other violent and sensual animals such as dogs, apes or pigs. It is ironically ambivalent to celebrate an excellent hero in homicide in this age of nuclear weapons. This irony leads to S. Freud's 'Death instinct' or Malcolm Potts's 'war genes'. Unlike Freud, Malcolm Potts insists that humans' war genes can be changed into peace genes because they were just remains of Stone Age. According to Apollodoros' myth or Euripides' tragedies, he was mad enough to kill his own sons and wife after he had murdered the king Lycos in Thebes. Though Rene Girard says that his madness was derived from contagion of violence and blood, I think that his madness came from horrible experiences of cruel wars as well as Hera's maltreatment in his childhood. It will be demonstrated to be war neurosis, that is, PTSD(Posttraumatic Stress Disorder). In a different way from the modern media in which Heracles is being glorified as a purest macho and war machine, his old myths show the ambivalence of his violence and murder, and his daily misfortunes owing to his madness. In this sense, his myth is a kind of warning to the humans not to kill each other, or to stop wars.

• 대한불안의학회지
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• 제2권1호
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• pp.39-44
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• 2006

Objective : Chronic posttraumatic stress disorder (PTSD) is defined by the coexistence of symptoms (reexperiencing, avoidance and hyperarousal), persisting for more than months or years that causes significant impairment in social occupational functioning. This study was conducted to evaluate the effects of terazosin on posttraumatic nightmares which is one of chronic PTSD symptoms. Methods : Twenty patients with chronic PTSD and severe trauma-related nightmares were treated with terazosin (3-7 mg/day) for 8 weeks. Recurrent distressing dreams item of the Clinician administered PTSD Scale (CAPS), Total CAPS score, Clinical Global Impressions-Severity Scale (CGI-S) and Clinical Global Impressions-Change Scale (CGI-C) were performed at baseline, 4-week and 8-week. Mississippi Scale for Combat-Related PTSD and Combat Exposure Scale (CES) were used to evaluate PTSD symptom pattern and degree of exposure. Results : Significant decrease in recurrent distressing dreams item, reexperiencing, avoidance and hyperarousal symptom score and total CAPS score were at 4-week and 8-week treatment compared to baseline (recurrent distressing dreams item : $2.70{\pm}1.88$ and $1.25{\pm}1.49$ ; reexperiencing, avoidance and hyperarousal symptom score : $2.30{\pm}2.49$, $1.20{\pm}1.05$, $3.10{\pm}1.68$ and $4.00{\pm}3.59$, $1.55{\pm}1.50$, $5.60{\pm}3.23$ ; total CAPS score : $8.20{\pm}6.26$ and $5.40{\pm}5.89$). There were significant correlation between dosage of terazosin and improvement of PTSD symptoms. Adverse effects such as fatigue and orthostatic hypotension were showed, which were mild and self-limited. Conclusion : These results suggest that terazosin may improve severe trauma-related nightmares and overall PTSD symptoms. Randomized controlled study with more subjects would be necessary in the future.

• 대한영상의학회지
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• 제81권3호
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• pp.676-687
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• 2020

목적 외상 후 스트레스 장애(posttraumatic stress disorder; 이하 PTSD)가 없는 외상에 노출된 소방관들에서 뇌 구조의 변화와 휴식기 뇌기능 변화를 연구하고자 한다. 대상과 방법 모든 피험자는 휴식기 기능 뇌자기공명영상(resting-state functional MRI; 이하 rsfMRI) 검사를 시행하였다. PTSD가 없는 40세 이상의 31명의 소방관(31명, 평균 연령, 49.8 ± 4.7세)이 포함되었다. 26명의 외상을 받지 않은 건강한 대조군(26명, 평균 연령, 65.3 ±7.84세)도 포함되었다. Voxel-based morphometry 분석을 시행하여 뇌 해부학상의 국소적 차이를 조사하였으며, 휴식기 뇌기능의 차이를 조사하기 위해 seed-based functional connectivity analysis 분석을 시행하였다. 결과 서울언어학습결과(Seoul Verbal Learning Test)의 평균 z 값을 비교했을때 소방관은 건강한 대조군에 비해 즉각회상(immediate recall), 지연 회상(delayed recall), 통제단어연상검사(Controlled Oral Word Association Test; 이하 COWAT)의 동물(animal)과 음소(phonemic) 항목에서 점수가 유의하게 낮았으며, 신경인지 기능이 감소한 것으로 나타났다. 소방관은 좌위마루이랑(left superior parietal gyrus)과 좌하관자이랑(left inferior temporal gyrus)의 회색질 부피가 건강한 대조군에 비해 감소되어 있었다. 소방관은 방추향이랑(fusiform gyrus)과 소뇌(cerebellum) 등을 포함한 여러 부위에서 rsfMRI 값의 변화를 보였다. 결론 구조적 뇌 및 휴식 상태 기능 이상은 외상에 노출된 소방관의 변화를 확인하는 데 유용한 이미징 바이오 마커일 수 있다.

• Journal of Trauma and Injury
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• 제36권4호
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• pp.376-384
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• 2023

Purpose: The Armed Forces Trauma Center of Korea was established in April 2022. This study was conducted to report our 1-year experience of treating soldiers with open fractures of the lower extremity. Methods: In this case series, we reviewed the medical records of 51 Korean soldiers with open fractures of the lower extremity between April 2022 and March 2023 at a trauma center. We analyzed patients with Gustilo-Anderson type II and III fractures and reported the duration of transportation, injury mechanisms, injured sites, and associated injuries. We also presented laboratory findings, surgery types, intensive care unit stays, hospital stays, rehabilitation results, and reasons for psychiatric consultation. Additionally, we described patients' mode of transport. Results: This study enrolled nine male patients who were between 21 and 26 years old. Six patients had type II and three had type III fractures. Transport from the accident scene to the emergency room ranged from 75 to 455 minutes, and from the emergency room to the operating room ranged from 35 to 200 minutes. Injury mechanisms included gunshot wounds, landmine explosions, grenade explosions, and entrapment by ship mooring ropes. One case had serious associated injuries (inhalation burn, open facial bone fractures, and hemopneumothorax). No cases with serious blood loss or coagulopathies were found, but most cases had a significant elevation of creatinine kinase. Two patients underwent vascular reconstruction, whereas four patients received flap surgery. After rehabilitation, six patients could walk, one patient could move their joints actively, and two patients performed active assistive movement. Eight patients were referred to the psychiatry department due to suicidal attempts and posttraumatic stress disorder. Conclusions: This study provides insights into how to improve treatment for patients with military trauma, as well as medical services such as the transport system, by revising treatment protocols and systematizing treatment.

• 정신신체의학
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• 제26권1호
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• pp.35-43
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• 2018

연구목적 복합 외상을 겪는 경우에는 PTSD의 증상을 넘어선 증상들이 다양하게 나타난다. 그러나 그러한 다양한 증상을 평가하는 도구가 부족한 실정이다. 외상 증상 체크리스트-40은 자기보고식 검사로 아동기 혹은 성인기의 외상 경험과 관련된 이러한 다양한 증상들을 측정하기 위한 도구로 원척도 연구에서 높은 신뢰도와 타당도가 검증된 검사 도구이다. 이번 연구의 목적은 정신건강의학과 외래 환자를 대상으로 한국판 외상 증상 체크리스트-40 (KTSC-40)의 타당도를 검증하기 위해 설계 되었다. 방 법 한양대학교 구리병원 정신건강의학과 외래를 진료 목적으로 방문한 367명의 환자를 대상으로 하였다. 환자들의 자기보고식 평가 자료를 사용하였으며 외상 증상 체크리스트-40 (TSC-40), 사건 충격척도 개정판(IES-revised), 일생 사건 체크리스트(LEC), Zung 자가평가 우울척도(Zung's Self-Rating Depression Scale), Zung 자가평가 불안척도(Zung's Self-Rating Anxiety Scale)를 이용하였다. 신뢰도는 내적 일치도(Cronbach's ${\alpha}$)로 산출하였고, 요인타당도는 Varimax 직각 회전을 이용한 탐색적 주성분 분석, 각 척도와의 수렴 및 공존 타당도를 위해서는 Spearman 상관분석을 하였다. 결 과 KTSC-40은 Varimax 직각회전을 이용한 주성분 요인 분석을 통해 7개의 요인을 추출하였고, 총 분산의 59.55%를 설명하였다. 이는 원척도 연구에서의 6개의 요인, 5개의 요인과 요인 수는 다르지만 그 내용은 비슷하였다. KTSC-40은 Cronbach's ${\alpha}$ 값이 0.94로 높은 내적 일치도를 가졌다. 또한 다른 PTSD scale과 우울, 불안 척도와의 비교에서 높은 수렴 및 공존 타당도를 보였다. 결 론 KTSC-40의 정신측정학 성질을 조사하여 우수한 타당도를 보이는 것을 확인하였다. 다만, 요인 분석에서의 원척도와의 약간의 차이를 보였는데 이는 문화적인 요소와 외상 관련 질환이 아닌 정신건강의학과 환자군 등 이질적인 외래 구성 집단에 따른 것으로 보인다. 결과적으로 KTSC-40은 높은 타당도로 향 후 다양한 임상영역에서 외상과 관련된 증상들을 평가 하는데 유용할 것으로 예상된다.

• 대한교통학회지
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• 제28권5호
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• pp.17-29
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• 2010

본 연구는 도로교통사고 비용의 추계에 있어 미국, 일본, 영국 등 일부선진국에서 추계항목에 포함된 고용주 비용(미국의 고용주 비용, 일본의 사업주체의 비용, 영국의 인간적 비용)의 도입 필요성을 검토하고, 이를 저감시키기 위한 대책마련을 진행하였다. 이를 위해, 교통사고 발생 시 상대적으로 관심권 밖에 위치한 교통사고 가해자의 PTSD (Posttraumatic Stress Disorder) 심각성과 현황을 파악하고, 개인별 특성이 반영된 PTSD 심각도 수준별 대책을 마련하였다. 그 결과를 정리하면, 첫째, 교통사고 가해자를 대상으로 추정만 해 오던 교통사고 PTSD 현황과 심각성을 설문조사를 통해 파악할 수 있었다. 둘째, PTSD 특성별 유 무에 따른 판별분석모형을 구축하였는바, 판별식의 변수로는 '사고로 인한 불면증', '사고 상황 또는 유사 상황에서 운전 중 심리적 위축'이 변수로 선정되었다. 셋째, PTSD의 심각도를 추정할 수 있는 순서형 프로빗 모형 구축 결과, 주요변수는 '최대피해자 심각도', '사고 상황 악몽', '불면증 경험', '운전 중 위축', '성별', '주요 운전 지역'으로 나타났으며, 실제 추정치가 실제 응답치에 근접함을 확인할 수 있었다. 넷째, 성별, 지역별 특성이 반영된 PTSD 심각도별로 선호하는 치료방법을 제시할 수 있었다. 이렇게 분석된 결과를 통해 교통사고 가해자의 사회 업무 복귀를 앞당기고 작업능률의 저하와 같은 피해를 최소한으로 저감 시킬 수 있는 방법을 제시할 수 있었으며, 이는 결국 이들 운전자들이 몸담고 있는 직장의 고용주에게 발생할 수 있는 직 간접적인 피해를 최소한으로 줄일 수 있을 것이라 사료된다.

• 정신신체의학
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• 제6권2호
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• pp.136-146
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• 1998

Objectives : This study was performed to evaluate the effects of PTSD on memory function, to investigate the difference of memory function between PTSD and non-PTSD patients, and to identify major variables correlated to PTSD scale and Memory Assessment Scale. Methods: The authors used PTSD-scale(Mississippi scale and Combat Exposure Scale) for measuring PTSD severity. And, Beck Depression Inventory was also used. Memory assessment scale was assessed by well trained psychologist. Thirty one Vietnam veterans who had been hospitalized were collected consecutively. These patients were evaluated by psychiatrists with interview and measurement for fifteen months since March, 1997. The collected data were analyzed by SPSS and the stastistic methods used for analysis Chi-square, t-test, and Pearson's correlation. Results : 1) There were significant differences in short-term memory and verbal memory between PTSD and non-PTSD in Vietnam veterans. 2) Mississippi scale and Combat Exposure Scale were negatively correlated to short-term memory and verbal memory(Pearson's correlation). 3) Religion status was a significant variable between PTSD and non-PTSD in Vietnam veterans. 4) There is no significant difference in visual memory and total memory scale between PTSD and Non-PTSD in Vietnam veterans Conclusions : Neuropsychological changes were found in the posttraumatic stress disorder. There were significant differences in short-term memory and verbal memory between PTSD and non-PTSD in Vietnam veterans. Mississippi scale and Combat Exposure Scale were negatively correlated to short-term memory and verbal memory. We suggest that neuropsychological test might be used for an objective assessment of patients with the combat related PTSD and be considered helpful in the assessment of patients with the diagnosis. And we also suggest rehabilitation strategies would be used to compensate for memory deficits in PTSD patients.