Journal of the Korean Academy of Child and Adolescent Psychiatry
- Volume 10 Issue 2
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- Pages.244-251
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- 1999
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- 2233-9183(eISSN)
A CASE OF PERVASIVE DEVELOPMENTAL DISORDER NOS WITH REPETATIVE SELF-INJURIOUS BEHAVIOR
반복적으로 머리를 때리는 전반성발달장애 환아 1례
- Kim, Jeong-Lim (Child and Adolescent Psychiatry Ward, Seoul National University Hospital) ;
- Chung, Bo-In (Department of Rehabilitation, College of Health Science, Yonsei University) ;
-
Cho, Soo-Churl
(Department of Child and Adolescent Psychiatry, Seoul National University Hospital) ;
- Hong, Kang-E (Department of Child and Adolescent Psychiatry, Seoul National University Hospital) ;
- Lim, Myung-Ho (Department of Child and Adolescent Psychiatry, Seoul National University Hospital)
- 김정림 (서울대학교 어린이병원 소아청소년정신과) ;
- 정보인 (연세대학교 보건과학대학 재활학과) ;
-
조수철
(서울대학교 어린이병원 소아청소년정신과) ;
- 홍강의 (서울대학교 어린이병원 소아청소년정신과) ;
- 임명호 (서울대학교 어린이병원 소아청소년정신과)
- Published : 1999.12.31
Abstract
Self-injurious behavior is often showed in mental retardation, especially in autism. Self-injurious behavior has been regarded as a symptom cluster rather than a disease but it is an emergent clinical situation that can directly affect mortality. This case is about a refractory autistic patient who showed a self-injurious behavior of hitting the head repetitively. He was hospitalized and was treated by pharmacotherapy and behavior therapy and for this reason this clinical experience is reported with literature review. The patient is a 7-year old boy who was ward admitted from 1999 April 20 till July 10 into OO hospital OO ward because of self-injurious behavior. During the 12 weeks he had admission treatment. As for the pharmacotherapy, haloperidol was dosed up from 0.5mg to 1.0mg from the 4th week and combination drug therapy was done during the admission with naltrexone 25-50mg. As for the behavioral therapy, Differential Reinforcement of Other behavior was used and regular play therapy was done. To remove the physical restraint, headgear and hard sleeve was used. Currently, OPD follow up treatment is being done and haloperidol 0.5mg and naltrexone 50mg is maintained. The patient’s mother is educated and play therapy is done an hour daily at home. When the patient was released form the hospital, self-injurious behavior was decreased more than the moderate state and remission state is still being maintained at the outpatient clinic.
자해행동은 정신지체에서 자주 나타나며, 특히 자폐증에서 더욱 많이 나타난다. 자해행동은 질환이라기보다는 하나의 증상군으로 다루어져왔지만, 사망률에 직접적인 영향을 줄만큼 응급인 임상적 상황이다. 본 증례는 반복적으로 머리를 때리는 자해행위를 보이는 난치성 자폐증 장애 환아가 입원한 상태에서 약물요법과 행동치료를 병행하여 치료하였기에 임상경험을 문헌고찰과 함께 보고하는 바이다. 환아는 7세된 남아로 99년 4월 20일 자해행동을 주소로 OO대학교 어린이병원 소아정신과에 내원하였으며 7월 10일까지 12주간 입원치료를 받았다. 약물치료로는 입원 4주경부터 haloperidol 0.5mg에서 1.0mg으로 증량하였고, naltrexone을