• Journal of Trauma and Injury
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• 제36권4호
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• pp.354-361
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• 2023

Purpose: Ketamine has historically been contraindicated in traumatic brain injury (TBI) due to concern for raising intracranial pressure. However, it is increasingly being used in TBI due to the favorable respiratory and hemodynamic properties. To date, no studies have evaluated whether ketamine administered in subjects with TBI is associated with patient survival or disability. Methods: We performed a retrospective analysis of data from the multicenter Prehospital Tranexamic Acid Use for Traumatic Brain Injury trial, comparing ketamine-exposed and ketamine-unexposed TBI subjects to determine whether an association exists between ketamine administration and mortality, as well as secondary outcome measures. Results: We analyzed 841 eligible subjects from the original study, of which 131 (15.5%) received ketamine. Ketamine-exposed subjects were younger (37.3±16.9 years vs. 42.0±18.6 years, P=0.037), had a worse initial Glasgow Coma Scale score (7±3 vs. 8±4, P=0.003), and were more likely to be intubated than ketamine-unexposed subjects (88.5% vs. 44.2%, P<0.001). Overall, there was no difference in mortality (12.2% vs. 15.5%, P=0.391) or disability measures between groups. Ketamine-exposed subjects had significantly fewer instances of elevated intracranial pressure (ICP) compared to ketamine-unexposed subjects (56.3% vs. 82.3%, P=0.048). In the very rare outcomes of cardiac events and seizure activity, seizure activity was statistically more likely in ketamine-exposed subjects (3.1% vs. 1.0%, P=0.010). In the intracranial hemorrhage subgroup, cardiac events were more likely in ketamine-exposed subjects (2.3% vs. 0.2%, P=0.025). Ketamine exposure was associated with a smaller increase in TBI protein biomarker concentrations. Conclusions: Ketamine administration was not associated with worse survival or disability despite being administered to more severely injured subjects. Ketamine exposure was associated with reduced elevations of ICP, more instances of seizure activity, and lower concentrations of TBI protein biomarkers.

• 대한간호학회지
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• 제53권5호
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• pp.500-513
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• 2023

Purpose: Women are more vulnerable to post-traumatic stress (PTS) than men, causing several health problems. Nurses should understand and work with women who have experienced trauma and provide interventions to promote their physical, social, and mental health. Methods: This quasi-experimental pilot study used a one-group pre-test/post-test design. Data were collected from 14 women recruited between December 2019 and May 2020 from a self-sufficiency support center in South Korea for sexually-exploited women who had experienced trauma. The program consisted of six one-on-one intervention sessions per week for six weeks. Each session averaged 60~120 minutes. Participants were assessed at pre-test, post-test, and one-month follow-up. Changes in outcome variables over time were analyzed using the Wilcoxon signed-rank and Friedman tests. Results: The caring program for health promotion was divided into six sessions: understanding the self, sharing traumatic events and negative emotions, reframing the meaning of traumatic events, identifying thoughts and physical and emotional responses, developing health promotion activities, and maintaining a positive attitude during the process of change. As a result of the caring program, PTS (F = 36.33, p < .001), depression (F = 24.45, p < .001), health-promoting behaviors (F = 7.06, p = .004), and self-esteem (F = 19.74, p < .001) among the participants differed significantly at pre-test, post-test, and follow-up. Conclusion: This study provides foundational information for the implementation of a theory-driven program by nurses in clinical and community settings to provide comprehensive care for women who have experienced trauma.

• 한국대기환경학회지
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• 제32권3호
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• pp.237-247
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• 2016

Global climate change is becoming one of the greatest challenges facing humanity. This article proposes a psychological perspective of climate change adaptation. Climate change-related severe adverse weather events may trigger mental health problems, including increased post-traumatic stress disorder (PTSD), depression, anxiety, violence, and even suicide. Forced migration could be considered a coping method for dealing with weather events, but it may also pose a psychological threat. People respond to severe weather events in different ways based on their individual characteristics. Psychological risks from adverse weather events are mediated and moderated by these factors, which are influenced by personal cognition, affect, and motivation. Examinations from a psychological perspective, which have been neglected in the science of climate change thus far, may provide keys to successful adaptation and the prevention of serious psychological problems resulting from the experience of severe weather events. A new prevention strategy has been suggested for coping with climate threats through encouraging attitude change, establishing proactive support systems for vulnerable groups, establishing a PTSD network, and implementing a stress inoculation program.

• 생물정신의학
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• 제23권1호
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• pp.29-36
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• 2016

Objectives Firefighters and rescue workers are likely to be exposed to a variety of traumatic events; as such, they are vulnerable to the risk of post-traumatic stress disorder (PTSD). The psychometric properties of the Korean version of the PTSD Checklist (PCL), a widely used self-report screening tool for PTSD, were assessed in South Korean firefighters and rescue workers. Methods Data were collected via self-report questionnaires and semi-structured clinical interviews administered to 221 firefighters. Internal consistency, item-total correlation, one-week test-retest reliability, convergent validity, and divergent validity were examined. Content validity of the PCL was evaluated using factor analysis and receiver operating characteristic (ROC) analyses were used to estimate the optimal cutoff point and area under the curve. Results The PCL demonstrated excellent internal consistency (${\alpha}=0.97$), item-total correlation (r = 0.72-0.88), test-retest reliability (r = 0.95), and convergent and divergent validity. The total score of PCL was positively correlated with the number of traumatic events experienced (p < 0.001). Factor analysis revealed two theoretically congruent factors: re-experience/avoidance and numbing/hyperarousal. The optimal cutoff was 45 and the area under the ROC curve was 0.97. Conclusions The Korean version of the PCL may be a useful PTSD screening instrument for firefighters and rescue workers, further maximizing opportunities for accurate PTSD diagnosis and treatment.

• 동의신경정신과학회지
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• 제30권3호
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• pp.251-263
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• 2019

Objectives: The purpose of this study was to review the clinical research trends in the treatment of post traumatic stress disorder (PTSD) in Korean medicine (KM). Methods: We searched MEDLINE, CENTRAL, EMBASE, Google Scholar and five Korean databases through May 2019, for studies on KM to treat PTSD. Clinical research that conducted KM treatment of PTSD patients were included. Two researchers independently conducted study selection and data extraction process. Results: Totally, eight studies were included in this review. Types of traumatic events that patients experienced included physical violence/threatening, traffic accidents, sexual violence and personal tragic events. KM interventions performed included acupuncture, moxibustion, herbal medicine, physical therapy, and KM-based psychotherapy. Treatment duration varied from two days to more than five months. Follow-up began at least one week to three months after the end of treatments. It was reported that the major psychological and/or somatic symptoms of PTSD, such as anxiety, depression, insomnia, and musculoskeletal pain, subjectively improved, as well as other objective outcomes: Impact Event Scale-Revised Korean version (IES-R-K), Beck's Depression Inventory (BDI), State-Trait Anxiety Inventory, Hwabyung Symptoms/characters, Electroencephalography (EEG) change, etc. Statistical studies were conducted in three studies only. Outcomes such as Visual Analogue Scale (VAS), BDI, and IES-R-K showed statistically significant improvement after KM treatments. There was no study reporting adverse events during or after the interventions. Conclusions: According to this review, diverse types of KM treatments have been used among PTSD patients in eight studies. The KM treatments effectively improved psychological and somatic symptoms of PTSD patients. However, the lack of high quality research as well as the lack of standardization of KM treatments for PTSD are limitations. Further methodologically robust clinical trials should be performed, and the standardization of KM treatments for PTSD should be sought.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제29권3호
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• pp.137-143
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• 2018

Objectives: The present study aimed to investigate the relationships among the lifetime incidence of trauma, internalizing symptoms, and quality of life (QoL) in out-of-school youths (OSYs). Methods: We recruited 50 OSYs in South Korea. Participants completed the following surveys: completed Lifetime Incidence of Traumatic Events for children, Youth Self Report, and The KIDSCREEN-27 QoL measure for children and adolescents. Mediation analysis was conducted to test the research hypotheses. Results: The mean lifetime incidence of traumatic events among OSYs was 3.27 (standard deviation, 2.41). Internalizing symptoms significantly mediated the lifetime incidence of trauma and QoL. OSYs with fewer internalizing symptoms exhibited a better QoL in the domain of psychological well-being, although their lifetime incidence of trauma was higher. Conclusion: The results of current study suggest that assessment and therapeutic intervention with regard to internalizing symptoms are needed to increase the QoL of OSYs.

• 인간행동과 음악연구
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• 제12권2호
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• pp.79-97
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• 2015

본 연구의 목적은 PTSD 증상완화를 위한 새터민의 음악사용 실태를 파악하고 이와 관련된 특성을 탐구하는 것이다. 연구자는 수도권에 거주하는 80명의 새터민을 대상으로 외상경험, PTSD 증상, 증상 관련 음악활용에 대한 설문을 하였고 총 78부를 분석하였다. 분석 결과 설문에 참여한 모든 새터민이 외상사건에 직 간접적으로 노출된 경험이 있으며 이 중 32%가 하나 이상의 PTSD 관련 증상을 보이는 것으로 나타났다. 대다수의 참여자는 일상 뿐 아니라 PTSD 증상완화를 위한 음악활용의 필요성에 대해 긍정적으로 인식하고 있는데 38%만이 일상 속에서 활용하는 반면, 75%는 PTSD 증상완화를 위해 음악을 사용하고 있음을 보고하였다. 새터민들은 감상 위주로 음악을 접하지만 노래 부르기도 활용하였으며 음악활용의 목적으로 정서 안정과 환기를 가장 중요하게 평가했다. 보편적으로 남 북한 노래들을 모두 언급하였고 다양한 선곡의 이유와 고려사항들을 제시하였는데 이는 앞으로 새터민을 위한 음악의 치료적 활용에 있어 중요한 기초자료로써 의의가 있다.

• 비교문화연구
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• 제41권
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• pp.33-56
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• 2015

트라우마 연구는 개인과 집단이 경험하는 대재앙과 재난적 사건을 다루는 데 유용한 모델을 제공해왔다. 대부분 캐시 캐루스를 비롯한 구조주의 트라우마 연구관점이 전형적인 모델이 되어 우리 삶의 거의 모든 맥락에 적용되어왔다. "트라우마의 사건-기반 모델"로 일컬어지는 이 연구 모델의 관점은 트라우마적 사건이 있는 그대로 각인되고 과거를 직접적이고 정확하게 기억하는 것에 대해서 연구의 초점을 맞춘다. 이 관점에서 트라우마적 사건 당사자는 그 사건의 진실을 전송하는 수동적인 담지자가 된다. 트라우마적 주체는 단지 사건을 겪고 견뎌낼 뿐 트라우마를 구성하고 그것을 다루는 데 있어 능동적인 역할을 할 수 없는 것이다. 결국 트라우마적 진실은 트라우마 주체의 자율성과 그/그녀의 행위가능성을 대가로 얻어진다. 여기서 문제는 주체의 자율성을 대가로 획득된 진실이 트라우마적 경험을 둘러싼 많은 문제를 해결하거나 외상을 치유하는 데 도움이 되기보다는 오히려 피해 당사자에게 치명적인 타격을 준다는 것이다. 이것은 트라우마적 사건 자체보다는 트라우마적 주체의 편에서, 즉 인적인 입장에서 트라우마를 다루는 보다 능동적인 방편이 필요하다는 점을 시사한다. 더구나 최근에는 재난 사건의 이미지가 시청자들에게 생중계로 보여 지고 그리고 즉각적으로 공적인 담론을 통해 반복적으로 되풀이해서 보여 진다. 그 만큼 사건들은 보다 더 즉시 트라우마적이 되기 쉽기 때문에 사람들은 예전보다 더 그들 자신을 트라우마적 피해자로 볼 가능성이 높다. 피해자의 입장에서 트라우마를 다루는 능동적인 방편을 탐구해야 하는 이유가 바로 여기에 있다. 이 논문은 문학과 이론 텍스트를 통해서 트라우마 연구의 전형적인 모델, "트라우마 사건-기반 모델"의 한계를 비판적으로 검토함으로써 트라우마적 과거가 있는 그대로 도래하는 것이 피해자에게 어떤 치명적인 영향을 주는가를 드러내 보이고 트라우마 주체의 입장에서 트라우마를 다루는 능동적인 방편으로서 "서사 기억"을 제시하고자 한다.

• 한국콘텐츠학회논문지
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• 제14권9호
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• pp.247-254
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• 2014

최근 발생하고 있는 범죄는 심각하고 흉포화 되었다. 이러한 특성은 그 범죄를 수사하는 경찰에게도 심각한 영향을 미치고 있다. 이러한 범죄를 접하는 경찰관도 인간이기 때문에 심리적인 미칠 수 있다. 실제로 많은 수사관련 경찰관이 큰 사건을 겪은 이후 수사 부서를 떠나거나, 경찰직을 그만두고 있다. 이러한 문제에 대하여 본 연구에서는 외상 후 스트레스 장애(Post Traumatic Stress Disorder; PTSD)가 실제 경찰관에게 미치는 영향을 살펴보고 이러한 영향이 조직몰입에 미치는 영향을 살펴보고자 하였다. 연구의 목적을 달성하기 위하여 본 연구에서는 과각성, 회피, 침습, 수면장애를 외상 후 스트레스 장애의 하위영역으로 설정하고, 조직몰입을 정서적 몰입, 지속적 몰입, 규범적 몰입으로 하위영역으로 나누었다. 측정을 위하여 만들어진 설문지는 대구지방경찰청 소속 경찰관 중 수사경과를 가지고 있는 형사부서 경찰관을 대상으로 설문을 실시하여 미치는 영향을 살펴보았다. 그 결과, 외상 후 스트레스 장애의 하위요인 중 침습이 정서적 몰입에 유의미한 영향을 미치는 것으로 나타났으며, 회피는 지속적 몰입에 유의미한 영향을 미친다고 나타났고, 침습과 회피는 규범적 몰입에 유의미한 영향을 미치는 것으로 나타났다.

• 대한불안의학회지
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• 제5권2호
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• pp.133-138
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• 2009

Diagnosing post-traumatic stress disorder (PTSD) is challenging for several reasons: a lack of training in trauma assessment for most clinicians, underreporting and avoidance by patients, the overlapping of symptoms, and a high comorbidity with other mental disorders. Thus, a careful evaluation and differential diagnosis are essential for the treatment and management of this population. A concept of posttraumatic reaction in people with narcissistic vulnerability, called Trauma-Associated Narcissistic Symptoms (TANS) had appeared in the literature; this has not been, however, systemically investigated. This study examines three cases of TANS that developed after traumatic events such as traffic accidents and physical assault. TANS may mimic PTSD and can show similar features; however, a careful attention to the context and meaning of symptoms can help the clinicians in differentiating TANS from PTSD. Clinicians working with trauma and compensation evaluators should be on alert for this easily overlooked condition.