• 한방재활의학과학회지
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• 제31권3호
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• pp.149-157
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• 2021

This study aims to report the effectiveness of complex Korean medicine (KM) therapy on a somatic symptom disorder (SSD) patient. A 58-year-old woman had severe somatic pain for more than six months and showed accompanying anxiety and depression. KM doctors administered complex KM therapy to control her pain and psychological conditions. Her pain was rated using the numerical rating scale and her anxiety and depression symptoms with beck anxiety inventory and beck depression inventory. The somatic symptoms as well as the anxiety and depression significantly improved after KM treatment. This study suggests that complex KM therapy for SSD may be effective to manage both somatic and psychological symptoms.

• 대한불안의학회지
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• 제3권2호
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• pp.116-122
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• 2007

Objective : The purpose of this study was to investigate the strategies used to cope with stress and the cognitive characteristics of somatic symptom perception in patients with panic disorder. Methods : A total of 101 patients who met the DSM-IV criteria for panic disorder and 60 normal controls were recruited for participation in this study. We evaluated the subjects using The Way of Stress Coping Questionnaire (SCQ), Somato-Sensory Amplification Scale (SSAS), Symptom Interpretation Questionnaire (SIQ), and the Panic Disorder Severity Scale (PDSS). We analyzed the data using an independent t-test and Pearson correlation analysis (p<0.05). Results : The patients who used emotionally focused coping strategies scored significantly lower on the SCQ. The patients with panic disorder showed greater amplification of body sensations in the SSAS, a significantly higher score on the physical interpretation subset of the SIQ, and a lower score on the environmental interpretation subset of the SIQ than the normal controls. The PDSS scores were positively correlated with the SSAS score and physical interpretation score on the SIQ. Conclusion : These results show that patients with panic disorder have poor emotionally focused strategies for coping with stress, greater amplification of body sensations, and a tendency towards a physical interpretation of somatic symptoms.

• 대한한방소아과학회지
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• 제15권2호
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• pp.201-208
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• 2001

The somatoform disorder are distinguished by physical symptoms suggesting a medical condition, yet the symptoms are not fully explained by the medical condition, by substance use, or by another mental disorder. This is that an unconscious intrapsychic conflict, wish, or need is converted to a somatic symptom and clinically express various symptoms such as headache, dizziness, nausea, vomiting dyspepsia, diarrhea and constipation, etc. We report a case of somatoform disorder patient, who was 9 years old female and complained of nausea, vomiting and dysdipsia. She had her case diagnosed as somatoform disorder in Yong-dong severance hospital and took anti-depressant (chlomipramine) with counseling for 2 months. After treatment, her emotional instability and depression were improved, yet the somatic symptoms remain same. We diagnosed her case as vomiting induced by deficiency of the stomach(胃虛嘔吐) and administered Bihe-yin(比和飮) to her. After administration of Bihe-yin(比和飮) for one month, her somatic symptoms of nausea, vomiting and dysdipsia were almost disappeared and she got acquired her confidence in school life.

• 생물정신의학
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• 제22권4호
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• pp.216-222
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• 2015

Objectives The principal aim of the present study was to investigate the characteristic depressive symptoms in patients with social anxiety disorder (SAD) and panic disorder in comparison to patients with depressive disorder. Methods This study included 132 patients with SAD, 128 panic disorder and 64 depressive disorder (major depressive disorder, dysthymia etc.) patients without comorbid psychiatric disorders. The Beck Depressive Inventory (BDI) is used to measure depressive symptoms. We divided BDI into three categories originally described by Shafer AB, including negative attitude toward self, performance impairment, and somatic symptoms. We compared the depressive symptoms of SAD, panic disorder and depressive disorder by using ANOVA. Results Negative attitude toward self was noticeable in SAD (SAD $0.54{\pm}0.23$, panic disorder $0.41{\pm}0.17$, depressive disorder $0.46{\pm}0.11$, p < 0.001). Performance impairment and somatic symptoms were remarkable in panic disorder than in SAD and depressive disorder (performance impairment : SAD $0.39{\pm}0.21$, panic disorder $0.44{\pm}0.14$, depressive disorder $0.40{\pm}0.09$, p = 0.009 ; somatic symptoms : SAD $0.07{\pm}0.10$, panic disorder $0.15{\pm}0.12$, depressive disorder $0.14{\pm}0.08$, p < 0.001). Conclusions The results facilitate an approach to optimal treatment for patients with comorbidity of anxiety disorder and depression.

• 대한상한금궤의학회지
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• 제13권1호
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• pp.45-59
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• 2021

Objectives: This study was conducted to confirm the reproducibility of the diagnosis of greater yin disease (太陰病) and the efficacy of herbal treatment using Gyejigajakyak-tang or Gyejigadaehwang-tang in somatic symptom disorder (SSD). We also further refined the characteristics of greater yin disease in SSD. Methods: We analyzed the demographic and treatment data of seven patients with SSD from four Korean medical clinics. The reliability of diagnosis and the efficacy of the treatments were evaluated by the Beck Anxiety Inventory (BAI), a numerical rating scale (NRS), and the patients' statements. Finally, we analyzed patients according to the diagnostic points of Shanghanlun provision 273. Results: Seven SSD patients took Gyejigajakyak-tang or Gyejigadaehwang-tang. The mean age of the patients was 52.1±15.8 years old, and the herbal medication period was 82.2±38.2 days. At the first visit, the patients showed hypochondriasis, obvious stress, and a severe BAI score (40.4±10.9). The NRS significantly decreased from 8.9±1.6 to 0.7±0.7 after the treatments. There were no side effects reported. As a result of analyzing these 7 cases, hypochondriasis, obvious stress, and anxiety were identified, which had been previously suggested as 自痛, 因爾, and 結硬. Conclusions: We confirmed the reproducibility of greater yin disease in 7 SSD cases from 4 medical institutions. These results imply that there could be a considerable relation between SSD and greater yin disease as defined by the Shanghanlun provisions.

• 동의신경정신과학회지
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• 제28권3호
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• pp.217-230
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• 2017

Objectives: This study was conducted to review studies on somatization disorder in traditional Chinese medicine. Methods: We reviewed studies in the China National Knowledge Infrastructure (CNKI) to 2017. Keywords were 軀體化障碍, Somatization disorder, somatic symptom disorder. We included Randomized Controlled Trial (RCT), and excluded non-Randomized Controlled Trial (nRCT), non-related somatization disorder or traditional Chinese medicine, non-clinical trials, dissertations for degrees. Jadad scale and Cochrane Library's Risk of Bias (RoB) were used for assessment of the quality of studies. Results: Twelve studies were selected. The Chinese Classification of Mental Disorders-3 (CCMD-3) was most frequently used as diagnostic criteria for somatization disorder. As for outcome measurement, Hamilton Rating Scale for Depression (HAMD) was used most commonly. Meta-analysis of 10 studies revealed effective rate of Chinese Herbal Medicine groups (CHM) was significantly higher than Western Medicine groups (WM) (RR: 1.14, 95% CI: 1.02 to 1.27, p=0.02, $I^2=40%$). There was no significant difference in effective rate of CHM+WM and WM (RR: 1.12, 95% CI: 0.84 to 1.49, p=0.46, $I^2=83%$). And also, effective rate of Acupuncture group (Acu) revealed no significant difference compared to that of WM (RR: 1.17, 95% CI: 0.95 to 1.44, p=0.13, $I^2=84%$). For HAMD, there was significant difference in CHM vs, WM group and Acu vs. WM group. Quality of selected 12 RCTs was low. Conclusions: Therapies practiced in traditional Chinese medicine may be effective options for somatization disorder. treatment. For further clinical studies in Korean medicine, this study could be groundwork for development of diagnosis and treatment on somatization disorder.

• 대한불안의학회지
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• 제16권2호
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• pp.49-56
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• 2020

Objective : The present study aims to investigate differences in anger-related features in patients with somatic symptom disorder (SSD) compared to healthy controls, and to examine whether anger trait and anger regulation strategy are associated with clinical characteristics in patients with SSD. In addition, we examined the relationship between childhood adversity and SSD. Methods : 26 patients with SSD and 28 healthy controls were included. Anger-related features were assessed with State-Trait Anger Expression Inventory (STAXI). Clinical somatic symptoms were assessed using the somatization subscale of the Symptom Checklist-90-Revised and the Somatosensory Amplification Scale. Childhood adversity was assessed by the Childhood Traumatic Events Scale. Multivariate analysis of covariance was performed. Results : Disease status of SSD had a significant overall effect on anger-related features (Wilks λ=0.725, F(5, 44)=3.332, p=0.012). Patients with SSD showed a significantly high Trait-Anger (p=0.017) and they had a high score in both Anger-Out (p=0.013) and Anger-In (p=0.001) of anger expression styles. In particular, a directed inward style of anger expression was significantly associated with somatization symptom severity (p=0.003). Regarding childhood adversity, more childhood extreme illness was experienced by the SSD group than the control group (p=0.012). Within the SSD group, childhood extreme illness was associated with higher Trait-Anger (p=0.027) and Anger-Out (p=0.001). Conclusion : The present findings suggest that trait anger, anger expression styles, and childhood adversity of extreme illness may be involved in SSD. Further studies are needed to explore the role of anger-related features and its relationship with childhood adversity in the pathophysiology of SSD.

• 정신신체의학
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• 제31권2호
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• pp.108-117
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• 2023

연구목적 신체 증상 장애(Somatic Symptom Disorder, SSD)는 다양한 신체 증상의 발현을 특징으로 하며, 현재까지 환자군 내에서 증상 심각도에 따른 자율신경계 활성의 차이에 대해서는 연구된 바가 거의 없다. 이에 본 연구에서는 신체 증상 장애 환자군에서 심박변이도(Heart Rate Variability, HRV) 차이를 검정하여 증상 심각도에 따른 자율신경계 변화를 반영하는 대표적 지표를 분석하였다. 방 법 2020년 9월 18일부터 2021년 10월 29일까지 강남세브란스병원 정신건강의학과에 내원했던 환자 중, DSM-5 진단 기준에 따라 SSD로 진단받은 환자 총 51명의 의무기록을 후향적으로 수집하였다. 이후, 집단 간 인구사회학 및 임상적 선택편의 보정을 위해 역확률 가중치(Inverse Probability Treatment Weighting, IPTW)를 적용하여 HRV 지표 차이 검정을 실시하였다. 결 과 신체 증상 심각도와 LF (nu), HF (nu), LF/HF, 그리고 SD1/SD2, Alpha1/Alpha2는 통계적으로 유의한 상관관계를 보였으며, IPTW 적용 후 비중증군은 27명(53.0%), 중증군은 24명(47.0%)로 보정되었고, 인구사회학적 요인 및 임상적 특성 차이가 유의미하지 않아 동질성이 확보되었다. 본 모형 분석 결과 고위험군일수록 시간 영역의 RMSSD (β=-0.70, p=0.003), pNN20 (β=-1.04, p=0.019), 주파수 영역은 LF (nu) (β=0.29, p<0.001), HF (nu) (β=-0.29, p<0.001), LF/HF (β=1.41, p=0.001), 그리고 비선형 영역에서는 SampEn15 (β=-0.35, p=0.014), SD1/SD2 (β=-0.68, p<0.001), Alpha1/Alpha2 (β=0.43, p=0.001)에서 유의미한 차이가 검정되었다. 결 론 신체 증상 심각도에 따른 HRV 지표의 차이는 시간과 주파수 영역, 그리고 비선형 영역 전반에서 검정되었으며, 신체 증상이 심할수록 교감신경의 과활성화 및 부교감신경의 저하를 시사하는 HRV 지표들이 유의미하게 높은 경향성을 보였다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제32권2호
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• pp.71-78
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• 2021

Objectives: This study was conducted to investigate the reliability and validity of the Korean version of the DSM-5 Level 2 Cross-Cutting Symptom Measure-inattention [Swanson, Nolan and Pelham, version IV (SNAP-IV)] and anger [Patient-Reported Outcome Measurement Information System (PROMIS) Anger] for parents and guardians of children aged 6-17 years. Methods: We included 104 children and adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD), ADHD with anxiety and depression, depressive disorder, anxiety disorder, and tic disorder with somatic symptoms (ADHD=41, depression=9, anxiety=14, ADHD+anxious depression=11, tic+somatic symptoms=29). Their ages ranged from 8 years to 15 years. The participants' mothers completed the SNAP-IV, PROMIS Anger scale, Korean version of the IOWA Conners Rating Scale (K-IOWA), and Korean ADHD Rating Scale (K-ARS) so that the reliability and validity of the SNAP-IV and PROMIS Anger scales, which are DSM-5 scales for assessing inattention and anger of children and adolescents, could be examined. Results: The reliability coefficient of SNAP-IV (Cronbach's α) was 0.94. The correlation coefficients between SNAP-IV, K-IOWA inattention, and K-ARS inattention scores ranged from 0.73 to 0.86. The mean SNAP-IV scores of the ADHD and the ADHD+anxious depression groups were significantly higher than those of the anxiety and the tic+somatic symptoms groups. The reliability coefficient of the PROMIS Anger was 0.91. The correlation coefficient between PROMIS Anger and K-IOWA oppositional/defiant scores was 0.75. The PROMIS Anger mean score of the ADHD+anxious depression group tended to be higher than that of the other groups. Conclusion: These results suggest that the Korean version of the DSM-5 Level 2 Cross-Cutting Symptom Measure-inattention and anger for parent and guardian of child age 6-17 might be a reliable and valid test and may be useful for screening children and adolescents with ADHD.

• 정신신체의학
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• 제26권1호
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• pp.1-8
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• 2018

연구목적 본 연구에서는 기능성 위장질환(Functional gastrointestinal disorder, 이하 FGID)이 동반된 정신질환자들의 정신사회적 특성을 알아보고자 하였다. 방 법 일 대학병원 정신건강의학과 외래를 방문한 환자를 대상으로 Rome III questionnaire - Korean version에 따라 FGID를 선별하여 144명의 자료를 분석하였다. 인구학적 요인을 조사하였으며, 정신사회적 요인을 평가하기 위해 Hospital Anxiety Depression Scale, Patient Health Questionnaire-15, Childhood Trauma Questionnaire-Korean, State-Trait Anger Expression Inventory를 사용하였다. 통계분석은 독립표본 t-검정(independent t-test)과 교차분석(chi-square test)을 사용하였다. 결 과 FGID에 따른 집단간 비교에서 학력에 따른 차이가 나타났다(${\chi}^2=10.139$, p=0.017). FGID 집단에 따른 정신질환의 차이에서는 과민성 대장증후군(Irritable bowel syndrome, 이하 IBS) 집단에서 유의한 차이가 있었다. (${\chi}^2=11.408$, p=0.022) IBS 집단은 불안(t=-3.106, p=0.002), 우울증상(t=-2.105, p=0.037), 신체증상(t=-3.565, p<0.001), 특성분노(t=-3.683, p<0.001), 분노-억제(t=-2.463, p=0.015), 분노-표출(t=-2.355, p=0.020)에서 높은 점수를 나타냈다. 기능성 소화불량(Functional dyspepsia) 집단에서는 불안(t=-4.893, p<0.001), 우울증상(t=-3.459, p<0.001), 신체증상(t=-7.906, p<0.001), 특성분노(t=-4.148, p<0.001), 상태분노(t=-2.181, p=0.031), 분노-억제(t=-2.684, p=0.008), 분노-표출(t=-3.005, p=0.003)지표가 유의하게 높았다. 비미란성 위식도 역류증(Nonerosive reflux disease) 집단에서는 불안(t=-4.286, p<0.001), 우울증상(t=-3.402, p<0.001), 신체증상(t=-7.162, p<0.001), 특성분노(t=-2.994, p=0.003), 상태분노(t=-2.259, p=0.025), 분노-억제(t=-2.772, p=0.006), 분노-표출(t=-2.958, p=0.004)에서 유의미하게 높은 수준을 나타냈다. 결 론 본 연구에서는 정신질환자에서 FGID의 유병률이 매우 높고, 다양한 정신사회적 변인들이 이에 영향을 미치는 것으로 나타났다. 따라서 이러한 정신의학적 접근은 FGID 환자를 더 잘 이해하고 치료하는데 있어서 도움이 될 것으로 생각된다.