• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.13 no.1
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• pp.3-14
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• 2002

Childhood psychic trauma appears to be a crucial factor in the development of serious disorders both in childhood and in adulthood. Traumatized children show strong tendency to revisualize or re-feel a traumatic events. Play and behavioral reenactments are frequent manifestations of both the single blow and the long-standing traumas in childhood. Those children who suffer the results of single, intense terror appear to exhibit detailed memory, retrospective reworkings and misperceptions. In long-standing or repetitive trauma, children would show psychic numbing, self-hypnosis, dissociation and rage. Child's brain is undergoing critical and sensitive periods of differentiation. During this time, developing central nervous system is exquisitely sensitive to stress. Stressor-activated neurotransmitters and hormones can play major roles in neurogenesis, migration, synaptogenesis, and neurochemical differentiation. Internal opiate system operates in some trauma and causes the victim to fail to respond, to avoid, to shut off feelings. Evidence is also accumulating in traumatology that dysfuntion of locus coeruleus and ventral tegmental neucleus system leads to catecholamine receptors hypersensitivity. This change result in hypervigilance, increased startle, affective lability, and increased autonomic nervous system hyperreactivity. Another site of action of trauma on the brain is hypothalamic-pituitary-adrenal axis. Individuals with PTSD do not have enough cortisol to halt the alarm reaction. When children are exposed to long-standing extreme events, massive attempts to protect the psyche and to preserve the self are put into gear. These developmental traumas mobilize various kinds of defense mechanisms. Massive denial, dissociation, self anesthesia, identification with aggressor and aggression turned against the self often lead to profound character changes in the youngsters.

• Journal of Preventive Medicine and Public Health
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• v.31 no.4 s.63
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• pp.728-739
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• 1998

To improve wellness and quality of life by recognizing the health efforts of stress, the author estimated the relationships between stress, subjective symptoms and clinical diagnosis through a questionnaire and a battery of specified laboratory tests; electrocardiography, blood pressure, cholesterol, aspartate aminotransferase(AST), alanine aminotransferase(ALT), gamma glutamyl transferase$(\gamma-GTP)$, fasting blood sugar, gastro-endoscopy or UGI, abdominal sonography, etc. The data was gathered from 337 clients who were undergoing multiphasic screening program at a University Hospital from January to March 1998. The mean age of subjects was $46.5{\pm}11.2$ years and the mean of body mass index was $24.0{\pm}3.7kg/m^2$. The mean vol of stress was $18.5{\pm}6.0$ expressed as the score out of 40. By general characteristics and lift style among male, mean level of stress was significantly higher in case of lower socioeconomic status, habitual drug use, longer daily working time(>10 hours), no regular exercise, drinkers, irregular meal, skip-ping breakfast(p<0.05). In case of female, that was significantly higher in case of lower education, lowe. socioeconomic status, longer daily working time(>10 hours), no regular exercise, drinkers, smokers, irregular meal, skipping breakfast(p<0.05). Significant correlations were observed between stress and subjective symptoms in all kinds of organ system (p<0.01). Correlation coefficients of stress among male were relatively high with neuro-psychiatric symptom$(\gamma=0.476)$ and cardio-vascular symptom$(\gamma=0.361)$ in order, and correlation coefficients of stress among female was highest with neuro-psychiatric symptom$(\gamma=0.371)$. The prevalence of the diagnosis through the battery of laboratory tests was high in upper gastrointestinal disorders and hypercholesterolemia in order in both sex group. Among male the mean score of stress was significantly high in ulcerative peptic disorder of upper gastrointestine and hepatopathy in order (p<0.05) . Among female that was significantly high in diabetes mellitus. In summary, it is likely that there are associations between stress, subjective symptoms and clinical diagnosis. To promote wellness and quality of life it would be of value that periodic stress evaluation program and stress management including apropriate control of smoking and drinking, regular exercise and meal.

• Korean Journal of Psychosomatic Medicine
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• v.12 no.1
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• pp.56-65
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• 2004

Objectives: The aim of this study was to investigate the quality of life of caretaking family members who have a patient with psychiatric disorders. The results will be served as a basic data of ameliorating the quality of life of caregivers. Methods: 78 caretaking family members who have a patient with schizophrenia and 54 caretaking family members who have a patient with alcohol dependence, a total of 132 persons completed the questionnaire, and analyzed. The Korean version of the SmithKline Beecham Quality of Life Scale and the Family Burden Scale were applied. Results: There was no statistically significant correlation between burden and sex, age, income, and duration of living with patients before onset. The male caregiver showed higher quality of life than that of female. It showed statistically significant correlation between age and factor physical well-being and factor activity. 41% of variance of quality of life of caregivers were explained by the stress response, burden, and overall merits of the field of psychiatry, and the tension had the most explanatory power. Conclusion: The chronic illness may give a burden on caregivers, and that decrease the quality of life of caregivers. The longer duration of illness of patients, the lower quality of life of caregivers on competence factor. Therefore, the authors recommend the therapeutic modality must be offered to the caregivers who may experience the stress and burden.

• Korean Journal of Biological Psychiatry
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• v.24 no.2
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• pp.75-81
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• 2017

Objectives Obsessive-compulsive disorder (OCD) is a chronic and disabling psychiatric disorder. The duration of untreated illness (DUI) has been suggested as one of the predictors of clinical course and outcome in various psychiatric disorders. There is increasing evidence that cognitive dysfunction is associated with the prognosis of OCD. The aim of this study was to investigate the influence of DUI on the neurocognitive functions in patients with OCD. Methods Sixty-two patients with a DSM-IV diagnosis of OCD from the outpatient clinic were included in this study. We defined the short DUI if the DUI was 2-year or less and the long DUI if it was longer than 2-year. Neurocognitive functions were assessed by visuospatial memory function test and 4 subsets of K-WAIS such as vocabulary, arithmetic, block design and picture arrangement. Differences in neurocognitive functions as well as clinical variables between OCD patients with short DUI and those with long DUI were investigated. Correlation analyses were also performed to determine the correlation between DUI and neurocognitive functions. Results Compared with the short DUI group, the long DUI group performed worse in the block design test, which measures executive function. The long DUI group also had a higher level of compulsive symptom severity than the short DUI group. However, the DUI was not correlated with neurocognitive functions. Conclusions Findings in this preliminary study suggest that the long DUI in patients with OCD is associated with more severe executive dysfunction. Studies with larger samples and longitudinal design are needed to further confirm the prognostic role of the DUI in OCD.

• Journal of Oriental Neuropsychiatry
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• v.21 no.2
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• pp.157-169
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• 2010

Objectives : The aim of this study was to investigate the characteristics of Hwa-Byung(HB) patients, draw the clinical key issue of HB, and provide the data as the basis for development of Clinical Guideline of HB. Methods : The study participants included 151 subjects who thought they have HB in 9 site. For all patients, we used HB epidemiologic study protocol, which include the Korean version of the Structured Clinical Interview for the DSM-IV Diagnosis (SCID-1), diagnostic criteria of HB, symptoms check list, pattern identification tool, psychiastric psychological questionaires, and Framingham coronary risk score(FRS). Results : 1. For all participants, 62 % of subjects were diagnosed with HB. These patients had comorbid DSM-IV diagnoses with depression (65%) and anxiety (27%). But 22% of these patients had only HB. 2. HB patients had various physical symptoms when visiting, were diagnosed as various disease, and undergone medical treatments in the past. Among the diagonsed illness, Gastronitestinal diseases (51.6%), psychiatric disorders(40.9%), endocrine diseases(39.8%) were being the most frequent. The frequent physical symptoms of HB patients reported were chest discomfort, head ache, pallpitation, frequent sigh, amnesia, shoulder pain, dry mouth, eye fatigue etc. 3. HB patients had high scores in psychologic questionares, CES-D, STAI, and STAXI. It means that HB patients might be low-level emotional stability. 4. Participant had negative opinion about the treatment of HB that it would be difficult or impossible (65.7%), but they neglect the need of medical treatment. Conclusions : This result shows that HB is comorbid with various psychiatric disease, but it has different physio-psychological symptoms from others and there were only HB patients. so we identify HB is independent disease. Moreover, there were the wrong perception of HB which blocking treatments. These problems support that the neccesity of development of Clinical Guideline of HB.

• Anxiety and mood
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• v.5 no.1
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• pp.8-13
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• 2009

Objective : SCP-20, a yeast hydrolysate from Saccharomyces cerevisiae, has exhibited anti-stress, anti-anxiety, and antidepressant effects in animal studies. The objective of this study was to test the effects of SCP-20 on healthy controls and to assess its effects on stress response, depression and, anxiety. Methods : Sixty-one healthy volunteers (30 male, 31 female) were recruited and screened for significant psychiatric and medical conditions. Baseline measures of stress, anxiety, and depression were taken using questionnaires such as the Stress Response Inventory (SRI), Beck's Anxiety Inventory (BAI), Beck's Depression Inventory (BDI), and the physiological measure of heart rate variability (HRV). Each subject was assigned randomly to a group taking capsules containing either 70% SCP-20 (i.e. the SCP70 group), 99.5% SCP-20 (i.e. the SCP99.5 group), or a placebo. Follow up measures were taken at week 4. Results : Subjects taking SCP-20 showed significant improvement in SRI and BAI scores compared to those taking placebo. For BDI scores, there was no significant difference between groups. No significant adverse effects were reported. Conclusions : This study suggests that SCP-20 is effective in alleviating stress and anxiety symptoms in healthy individuals, and has little or no side effects. However, the role of of SCP-20 in alleviating depression needs further clarification. Studiess examining its effects in psychiatric populations are needed to establish its role in alternative medicine.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.2 no.1
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• pp.87-96
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• 1991

A double bhad, placebo controlled study was performed to evaluate the therapeutic effects of Carbamazepine in autistic children, 23 boys with the diagnosis of Pervasive Developmental Disorders according to the DSM-IIIR were selected for study subjects, from Child and Adolescent Psychiatric Outpatient Department of Seoul National University Children Hospital during Oct. $1989{\sim}Nov.$ 1991. Subjects with histories of medical disease or psychiatric diseases were excluded and all study subjects had drug free periods more than 2 Months. Study subjects were randomly assigned to Cabamazepine treatment group(N=12) and placebo group(N=11). After the baseline observation periods, the double blind drug treatment and observation were performed for 12 weeks. Several scales (Ritvo-Freedman Real Life atring Scale. Behavior Checklist) were employed to evaluate the effects of drug treatment during baseline observation periods and the drug treatment periods by two raters blind to the study. Interrater reliability of each scales were .4875~.6613, the socrodemographic variables and the rating scores during baseline observation periods were not significantly different between two groups. Reduction of total scores in Autsm Behavior Checklist scale, i.e.. improvement of global autistic symptoms were noted significantly in Carbamazepine treatment group. Improvement in significant social maturations according to Vineland Social Mataration scale were observed in both patient groups after drug treetment periods.

• Anxiety and mood
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• v.10 no.1
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• pp.11-16
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• 2014

Objective : Despite the high prevalence and clinical importance of panic disorder, studies on the clinical characteristics and course of panic disorder are relatively rare. This study is a multi-center, and retrospective study to examine the clinical characteristics and course of Korean panic disorder patients who visit university hospital. Methods : The study subjects were panic disorder patients who had visited the psychiatric outpatient clinics of 8 university hospitals in South Korea from January to December in 2008. Finally, 238 panic patients were included in this study. Their medical charts were retrospectively reviewed and reassessed by experienced psychiatrists to examine their clinical characteristics, demographic data and clinical course in repose to pharmacotherapy. Results : Among the 238 patients (121 males vs. 117 females), the mean age of disease onset was $41.3{\pm}12.7$ years and female patients showed 5 years older age of disease onset, compared with male patients. The mean score of PSR scale was $4.5{\pm}1.0$ at the first visit, reflecting a 'marked' level of severity of illness and impairment in functioning. Only 110 patients (46.4%) completed the whole follow up visits, whereas 128 patients (53.6%) dropped out during the treatment. After $17.7{\pm}0.5$ months of mean follow up period, the mean score of PSR scale at the last visit was reduced into $2.1{\pm}0.9$, reflecting a 'residual' severity of illness and impairment in functioning. The cumulative recovery rate was 62.1% in the completer group, whereas that of the drop-out group was 47.7%. Conclusions : The mean age of disease onset in Korean panic disorder patients who had visited university hospital was about 10 years older than that of Western panic disorder patients in previous studies, and the Korean panic disorder patients who had visited university hospital showed a relatively higher cumulative recovery rate. These differences might result from an ethnic difference in clinical characteristics and course in response to pharmacotherapy of panic disorder.

• Anxiety and mood
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• v.8 no.2
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• pp.93-98
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• 2012

Objective : Cortisol, a product of hypothalamus-pituitary-adrenal axis (HPA axis), is one of our defensive mechanisms in response to stress. The level of cortisol in the saliva is a major biomarker of the stress response by HPA axis and shows diurnal variation. We measured salivary cortisol level and its diurnal variation to compare the pattern of changes by degree of burn and Clinician-Administered PTSD Scale (CAPS) score. Methods : We measured the salivary cortisol levels of 37 subjects hospitalized in the burn center at our facility from March to June 2012. Salivary cortisol levels were measured at 6 : 00 AM and at 7 : 00 PM. All subjects were tested for CAPS to evaluate the severity of posttraumatic stress disorder and the Hamilton Depression Rating Scale to evaluate and to control the coexisting depression. Results : Factorial ANOVA test revealed that there was a statistically significant difference in terms of the effect of the interaction between the degree of burn and the patient's CAPS score. Unlike the mild burn group, in the severe burn group, the patients who had a low CAPS score didn't show a normal diurnal variation and the patients who had a high CAPS score showed the normal diurnal variation. After a few months follow up, we found a greater degree of psychiatric complications in severe burn patients that had a lower cortisol stress response. Conclusion : We suppose that the disappearance of the stress response changes in salivary cortisol seen in the severe burn group may be caused by an impaired stress response. Through followed observation of the subjects, this disruption of cortisol response may cause psychiatric problems afterwards.

• Korean Journal of Psychosomatic Medicine
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• v.23 no.2
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• pp.100-106
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• 2015

Objectives : The purpose of this study was to find out the clinical and sociodemographic characteristics of elderly suicide attempters visiting emergency room, compared to non-elderly adult suicide attempters. Methods : We enrolled suicidal attempters who were treated in the emergency room of the Inje University Ilsan Paik Hospital between June 2013 and July 2015. We conducted a retrospective chart review of 336 suicidal attempters, and compared sociodemographic and clinical characteristics between elderly and non-elderly adult suicide attempters. Results : During the study period, 336 patients visited the emergency room of the medical center after suicide attempts. Among these, there were 71 elderly(21.2%) and 265 non-elderly adult(79.8%) suicide attempters. The suicidal methods among elderly were poisoning(73.3%), hanging(19.7%), cutting(5.6%), and jumping(1.4%). Those in non-elderly were poisoning(73.2%), cutting(17.0%), hanging(6.8%), and jumping(3.0%). The elderly suicide attempters had the tendency to choose more dangerous methods and showed higher lethality compared to adult suicide attempters(20.6% vs. 1.9%, ${\chi}^2=34.565$, p<0.05). On the other hand, premorbid psychiatric disorders had been more commonly diagnosed in non-elderly adults than elderly suicide attempters(49.8% vs. 26.8%, ${\chi}^2=12.024$, p<0.05). Conclusions : The results provide evidence of different sociodemographic and clinical characteristics of elderly suicide attempters compared to non-elderly ones visiting the emergency room. Through this study, it can be seen that the suicide attempt in the elderly tends to be severer than in the non-elderly, but only a small portion of them seek for help from psychiatric intervention. Further study is required to provide effective suicide prevention programs for elderly population.