• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제9권2호
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• pp.247-252
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• 1998

신경이완제 악성증후군(NMS)은 치사율이 높은 관계로 집중적인 치료를 요하는 부작용이며, NMS 에서 회복된 후에도 NMS 발생 이전의 기존 정신증상이 지속될 경우에 언제, 어떤 항정신병 약물을 투여할 것인가 하는 문제가 있다. 본 증례는 조증 증세를 보인 18세 남자 청소년에서 NMS에서 회복된지 약 2주경부터 clozapine을 사용하여 NMS의 재발없이 조증의 호전을 경험하였기에 보고하는 바이다. 환아는 1995년 11월경 발병한 양극성 정동장애, 경조증삽화로 1996년 2월 13일부터 동년 3월 29일까지 서울대학교 병원 소아정신과에 입원하였다. 퇴원후 약물치료를 계속하였고, 1998년 3월말부터 엉뚱하고 난폭한 행동이 나타나 1998년 3월 31일 재 입원하였다. 입원후 일일 haloperidol 8mg까지 투여하였고, 입원 4일째 근육경직과 의식혼탁이 나타났다. 임상증상과 혈액검사 소견상 NMS로 판단되어 항정신병 약물 투여를 중단하였고, dantrolene과 bromocriptine을 투여하였다. 입원 6일째부터 혈액 검사소견이 호전되기 시작하였고 임상적으로도 호전되었다. 이후 전형적인 조증증세가 나타나기 시작하였다. Thioridazine을 최대 일일 50mg까지 투여하였으나 증상조절이 되지 않아서 기존 사용약물을 모두 끊고 입원 21일째부터 clozapine을 투여하기 시작하였다. 입원 46일째 clozapine 투여량은 일일 350mg 이었다. 이후 동량을 유지하였고 NMS 증상의 악화나 재발없이 조증 증세 호전되어 입원 58일째 퇴원하여 현재까지 외래 통원치료중이다.

• 동서간호학연구지
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• 제24권1호
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• pp.70-80
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• 2018

Purpose: This study was conducted to explore the mediating effects of internalized stigma on the relationship between hospitalization stress and quality of life among patients with mental illness in closed wards. Methods: A cross-sectional study design was employed. The participants were 141 hospitalized patients with mental illness in the closed wards of K university hospital and Y psychiatric hospital in Korea. Data were collected using self-report questionnaires including hospitalization stress, internalized stigma and quality of life. Data were analyzed using SPSS 21.0 and AMOS 21.0 programs and the mediating effects were examined by the method suggested by Baron and Kenny. Results: There was a significant correlation between hospitalization stress, internalized stigma and quality of life of psychiatric patients. In addition, internalized stigma was found to have a partial mediating effect on the relationship between hospitalization stress and quality of life. Conclusion: The results suggest that the internalized stigma plays an important role in improving the quality of life of the people with mental illness in a closed unit. Therefore, it is necessary to develop a program focusing on internalized stigma for improving the quality of life in hospitalized patients in a closed unit.

• 대한간호
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• 제31권4호
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• pp.62-76
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• 1992

The intent of chis descriptive study is to investigale lhe patients perceived effect and expectance of activity therapy. The subjects for this study were 56 patients from the psychiatric ward in Severance Hospital. The data were collected during Lhe period from June 1, 1991 to January 18, 1992. The effect and expectance of the activity therapy was measured using a questionnaire developed by this study's investigators. The date were analyzed by descriptive statistics, t-test ancl one-way ANOVA, using the SPSS program. The results of this study can ue summarized as following ; 1. For motivatiorc for the accivity therapy, the response range was from 64.;] % to 89.3 %, that is, it showed a relatively positive response. 2. For the degree of improvement according to the nurse's method in the activity therapy, it was shown that the nurses need professional skill and meeting after activity therapy. 3. For the relevance of the nurse in the activity therapy, 90 % of the subjects had a positive answer for all of the activity therapy except the painting therapy. 4. For the perceived effect of the activity therapy, the following results were obtained. 1) 92% of the subjects had a positive response to the dance therapy, that is-I am vigorous physically. 2) 90 % of the subjects had a positive response to the reading therapy, that is-I acquire good ideas and instruction. 3) 98.1 % of the subjects had a positive response to the recreation therapy, that is-I am joyful. 4) 88.9% of the subjects had a posilive response to the writing therapy, that is-I am interested and become acquainted with other patients. 5) 86.8 % of tbe subjects had a positive response to the occupation therapy, that is-I am happy when I work. 6) 92.6 % of the subjeccs had a positive response to lhe painting therapy, that is-I can express myself in painting. 7) 87.3% of the subjects had a positive response to the musie therapy, that is-I am comforted. 5. For the expectance related to the activity therapy, 97.1 % the subjects had the most postive response to the music therapy which is a pleasant comfortable time. From the above-mentioned findings, it is suggested that psychiatric nurses need to development systematic and professional group activity therapy, and know the patient premorbid hobbies, interests and occupations.

• 생물정신의학
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• 제17권2호
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• pp.94-102
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• 2010

Objectives : Eye movement desensitization and reprocessing(EMDR) is a novel, time-limited psychotherapy originally developed for treatment of psychological trauma. The effectiveness of this therapy has been validated only for posttraumatic stress disorder ; however, EMDR is often applied to other psychiatric illnesses, including other anxiety disorders and depression. This pilot study tested the efficacy of EMDR added to the routine treatment for individuals with acute stage schizophrenia. Methods : This study was conducted in the acute psychiatric care unit of a university-affiliated training hospital. Inpatients diagnosed with schizophrenia were randomly assigned to either three sessions of EMDR, three sessions of progressive muscle relaxation(PMR) therapy, or only treatment as usual(TAU). All the participants received concurrent typical treatments(TAU), including psychotropic medication, individual supportive psychotherapy and group activities in the psychiatric ward. The Positive and Negative Syndrome Scale(PANSS), the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale were administered by a clinical psychologist who was blinded to the patients' group assignment. Results : Forty-five patients enrolled and forty patients(89%) completed the post-treatment evaluation. There were no between-group differences in the withdrawal rates of patients during the treatment or at the three-month follow-up session. All three groups improved significantly across each of the symptomatic domains including schizophrenia, anxiety, and depressive symptoms. However, a repeated measures ANOVA revealed no significant differences among the groups over time. Effect size for change in total PANSS scores was also similar across treatment conditions, but effect size for negative symptoms was large for EMDR(0.60 for EMDR, 0.39 for PMR and 0.21 for TAU only). Conclusion : These findings supported the use of EMDR in treating the acute stage of schizophrenia but the results failed to confirm the effectiveness of the treatment over the two control conditions in three sessions. Further studies with longer courses of treatment, more focused target dimensions of treatment, and a sample of outpatients are necessary.

• 대한간호학회지
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• 제27권3호
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• pp.520-530
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• 1997

Antineoplastic agents may exhibit effects not only in patients therapeutically exposed, but also in health workers who prepare and administer these drugs. This study was done to clarify whether nurses who handle anticancer drugs show signs of drug absorption. The experimental group was 14 nurses handling anticancer drugs at three medical wards of a hospital in J city ; the control group was 12 psychiatric nurses at the same hospital. The test materials were the nurses' 24hr urine specimens, which were concentrated by XAD-2 column chromatograpy. Tester strains were TA98(±S9mix), TA100(±S9 mix), TA1535(±S9 mix) and TA1537(±S9 mix) : the salmonella mammalian microsomal test (Ames test) was used for the urinary mutagenicity assay. The results are summarized as follow : 1. In qualitative analysis of the results, both experimental group and control group showed 15.4% urine toxicity. 2. The experimental group revealed significantly higher urinary mutagenicity both in the activation method test and non-activation method test of the tester strains TA98, TA100 and TA1535. In the case of TA1537, the two groups showed no difference in the non-activation method test, but the activation method revealed a difference. 3. In urinary mutagenicity of the experimental group by ward career, there was a significant difference between the group with more than 20 months experience and the group with less than 20 months on the tester strains TA98, TA100, and TA1537. No Significant difference was found between two groups by the tester strain TA1535.

• 대한불안의학회지
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• 제8권1호
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• pp.50-54
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• 2012

Music therapy had been widely used in the area of psychiatry. However recently, participation of psychiatrist has been decreased, due to recent trends of emphasizing biological psychiatry and rapid effectiveness of pharmacotherapy. A 46 years old male PTSD patient was admitted to psychiatric ward. He has suffered from PTSD symptoms, such as intrusive distressing recollection of his past traffic accident, social avoidance, insomnia and depression. Music therapy, which is conducted by a psychiatrist and a music therapist, was applied. This case suggests the positive role of music therapy in treatment of PTSD and emphasizes the importance of participation of psychiatrist, as an organizer during music therapy.

• 보건행정학회지
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• 제29권2호
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• pp.105-111
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• 2019

On December 31, 2018, an incident occurred where a doctor was attacked and killed by a patient carrying a lethal weapon in the outpatients' clinic of the psychiatric department of a tertiary general hospital. The suspect was diagnosed with bipolar affective disorder (manic depressive disorder) and has been hospitalized and cared for in the psychiatric ward of this hospital. This incident illustrates the necessity of more active cures and therapeutic intervention for mental patients with intellectual developmental disorders who require treatment considering the fact that a radical outcome has been caused by such a patient. However, on the other hand, there is also a need for an approach and analysis from the perspective of crime prevention for all medical departments. The reason for this is that even a tertiary general hospital equipped with the largest human resources, medical devices, facilities, and so forth, is susceptible to violence. As for illegal actions perpetrated against health and medical service personnel in medical institutions, such as verbal abuse, assault, injury, etc. there have neither been understanding shown for the current extent of damage in detail, nor discussions of active institutional improvement related to the seriousness of the act. It can be said that violence in the field of medical treatment is a realm requiring serious discussion and appropriate remedial actions. This is because when such incidents take place, if a patient who is supposed to get treatment from the damaged health care provider is in an urgent situation or on the waiting list of serious cases, he or she could suffer serious damage caused by deprivation of treatment opportunity, or secondary damage might be caused to the patient and/or a guardian who can hardly have an opportunity to take action. Accordingly, in this review, we would like to help create the necessary conditions for both health and medical service personnel and patients/guardians, respectively, to provide and receive medical treatment in a more secure environment. Therefore, objective assessment of the institution and issues relating to this aforementioned incident and general cases of violence occurring in medical institutions, and by suggesting legal and institutional improvements and solutions.

• 한국심리학회지ㆍ건강
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• 제16권1호
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• pp.1-14
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• 2011

정신건강에서 강제적인 치료는 오랫동안 철학적 임상적 논쟁이 되고 있다. 이념과 실제가 서로 모순된다는 점에서 아직까지 중요한 문제가 남아있다. 이 연구는 정신장애를 가진 사람의 지각된 강요에 초점을 두고 정신장애특성(정신병적 증상, 심리사회적 기능, 통찰, 치료필요성의 인식)과 입원과정에서 경험(법적상태, 강요조치, 절차적 정당성)이 지각된 강요를 어떻게 예측할 수 있는지를 분석하였다. 이 연구의 참여자는 302명의 입원환자이며, 195명(64.6%)이 남자이고 106명(35.1%)은 여자였다. 참여자들은 MAES, BPRS, GAF, 통찰, 법적상태, 강요조치, 치료필요성의 인식 등을 측정하는 질문지에 응답하였다. 회귀분석결과, 정신장애 특성 가운데 통찰과 치료필요성의 인식이 지각된 강요의 중요한 예측변인이었고, 또한 입원할 때 경험하는 특징인 절차정당성, 강요조치 그리고 법적상태가 모두 지각된 강요를 유의하게 예측하였다. 본 연구 결과가 지각된 강요를 감소시키기 위한 실제적인 개입방법의 측면에서 지니는 함의와 본 연구의 제한점에 대해서 논의하였다.

• 간호행정학회지
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• 제10권1호
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• pp.11-23
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• 2004

Purpose: The objective of this study was to collect the basic data for improving the quality of nursing education by identifying the teaching efficiency of the ordered clinical nursing education by preceptor which was accepted by Gachongil College since 2001. Method: The data was collected from 30 Sept to 20 Oct 2002. The subjects of this study were 240 nursing students, junior 2nd term trained by the preceptors and 137 preceptors of 12 hospitals located in Inchon, Gyong Ki-do, and Seoul. The scale for measuring the teaching effectiveness, developed by Kim Miae et al.(1998), was employed as a tool for me study. The data was analysed by SPSS using mean value(SD), and ANOVA. Results: Mean value of teaching efficiency of preceptors evaluated by me nursing students scored 3.68(maximum 5). For 5 causal factors classified en the teaching efficiency, the factor of "teaching method and evaluation" showed the highest score, but "available as resource person" get the lowest. Items showing high score en teaching efficiency were "overall effectiveness of teacher", "was able to work with staff in cooperative manner", but the item of was unclear in instructions given to me showed the lowest. The psychiatric ward get the highest score, but cardiac catheterization room showed the lowest. The hospital 10 showed the highest score, but the hospital 8 get the lowest. Conclusion: As the findings from this study, the ordered clinical nursing education by preceptor showed higher teaching efficiency than the conventional education. Thus, cooperative relationship between nursing colleges and hospitals shall be suggested for improving the quality of clinical nursing education, and ordered clinical nursing education system.

• 대한간호학회지
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• 제27권4호
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• pp.727-739
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• 1997

The purpose of this study was to present an effective nursing intervention for helping the patients of mental illness by determining the effect of nursing-logotherapy on purpose in life and finding meaning, and hope of the patients of mental illness by developing and applicating program of nursing-logotherapy The data was collected from March to September in 1995, and its subjects were the patients of mental illness who was appropriate to the standard of this study among the patients of mental illness who hospitalized into Neuro-Psychiatric ward of M. and B. hospital located in Pusan area. They were all 60 subjects, thirty of them for an experimental group and the rest for a control group. The research design was an equivalent control group pre-test and post-test design as an quasi-experimental research and the conceptual frame- work was an interpersonal model. The data analysis was computerized by using SP-SS/PC$^{+}$ and hypothesis testing was done with 2-way ANCOVA and simple correlation. Results were summarized as follows : 1. There were significant changes of purpose in life and finding meaning in an experimental group be-fore and after treatment and a control group be-fore and after. 2. There were significant changes of hope in an experimental group before and after treatment and a control group before and after. 3. The positive correlation between purpose in life and finding meaning and hope of the patients of mental illness were observed. Consequently, nursing-logotherapy could significantly increase the purpose in life and finding mean-ing, and of hope, so it could be said an effective nursing intervention for helping the healing of the patients of mental illness.s.