• 수면정신생리
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• 제8권2호
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• pp.90-97
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• 2001

The reason for exploring dreams is to understand the of patient's conflicts and unconscious motivation. Even if the therapeutic value of dreams is considerably faded these days, I can not deny that dreams are still very useful. From the beginning of human history, dreams have been an appealing subject for many people. In the past, dreams chiefly had the value of prophetic meaning, and in our tradition attention was paid to dreams in terms of good and bad dichotomy. Freud's discovery of the Unconscious and technical development of its exploration is reinforced by dream interpretation. In contemporary terms, although dreams are not the royal road to the Unconscious, they surely present a short-cut. I suggest that dreams as a treasure island of the Unconscious have a useful therapeutic value, and that stressing the importance of dreams is by no means anachronistic. I believe that practical sessions without dreams are like a river without bridges.

• 심성연구
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• 제39권1호
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• pp.129-183
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• 2024

본 연구는 알코올 중독의 심적 진실에 좀 더 가까이 다가가 보고자 하는 하나의 시도이다. 이를 위해 선행연구들을 검토한 후, 여러 알코올 환자들의 경험 지평을 의식뿐 아니라 무의식도 포괄하며 살펴보았다. 무의식 측면에 다가가기 위해서는 환자들이 보고한 일련의 꿈들에 대한 분석심리학적 해석을 시도하였다. 꿈 분석은 치료 작업에의 환자의 참여, 치료자-환자 동맹 관계에도 유익하였으며, 환자의 무의식과 의식 모두를 함께 보다 잘 살필 수 있도록 도움을 주었다. 이로부터 본 연구자는 환자들의 의식에 자리한 문제로서 진솔한 감정 표현의 오랜 소외, 감정 재경험의 필요성, 모성의 품에 대한 오랜 갈망과 모성 재경험의 필요성, 이에 동반되는 부성 재경험의 필요성 등을 확인할 수 있었으며, 아울러, 무의식 심층에서부터 이런 의식의 상황에 반응하여 강력한 원형적 정신활동이 활성화되고 있음을, 이에 수반하여 파괴적인 그림자 콤플렉스의 문제 또한 나타나고 있음을, 확인할 수 있었다. 보고된 꿈들은 의식의 관점·태도를 수정하며 치유적 변화를 이끌어가는 무의식의 섬세한 보상 과정이 알코올 중독에서도 일어나고 있음을 잘 보여주었다. 무의식은 알코올 중독에서도 의식의 변화를 위한 창조적 에너지를 비축하고 이에 의식이 반응하도록 인도하는 작용을 성실히 전개하고 있었다. 종합해 볼 때 알코올 중독은 의식에 범람하는 무의식의 에너지로 인해 현실의 삶이 파괴될 수 있는 위험이면서 동시에, 새로운 의식성과 새로운 삶의 지평을 창조하고자 하는 전체적 정신활동의 의도와 목적이 담긴 조건이기도 했다. 이는, 진정한 회복은 당사자가 내면의 심적 진실에 눈을 돌리는 것에서 시작되며 이를 돕는 데 있어 치료자의 중요한 역할이 있음을, 다양한 치료적 방편들도 결국은 이러한 성찰에 이바지하게 될 때 더욱 값진 의미를 획득하게 되는 것임을 시사한다. 심적 진실을 외면하며 그릇된 대상에만 집착하는 한, 무의식의 창조성은 활용되지 못하고 오히려 왜곡되어 부정적·파괴적 영향을 삶에 주게 될 것이기 때문이다.

• 의료법학
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• 제10권1호
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• pp.263-305
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• 2009

Is it lawful to withhold or withdraw life-sustaining treatment applied to a patient in a terminal condition or permanent unconscious condition? In Korea, there are no such laws or regulations which control affairs related to the withholding or withdrawal life-support treatment and active euthanasia as the Natural Death Act or the Death with Dignity Act in the U. S. A. And in addition there has had no precedent of Supreme Court. Recently Supreme Court has pronounced a historical judgment on a terminal care case. The court allowed the withdrawal of life-sustaining treatment from a patient in a permanent unconscious state. Fundamentally the court judged that the continuation of that medical treatment would infringe dignity and value of a patient as a human being. And the court required some legal grounds to consider such withdrawal or withholding of medical care lawful. The legal grounds are as follow. First, the patient is in a incurable and irreversible condition and already entered a stage of death. Second, the patient executed a directive, in advance, directing the withholding or withdrawal of life-support treatment in a incurable and irreversible condition or in a terminal condition. Otherwise, at least, the patient's will would be presumed through his/her character, view of value, philosophy, religious faith and career etc. I regard if a patient is in a incurable and irreversible condition or in a terminal condition, the medical contract between a patient and a doctor would be terminated because of the actual impossibility of achievement of it's purpose. So I think the discontinuation of life-sustaining care would be legally allowed without depending on the patient's own will.

• Journal of Nutrition and Health
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• 제28권4호
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• pp.345-354
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• 1995

Blenderized diets are not recommended because of difficulties in providing a constant content of nutrients, phoblems with viscosity and osmolarity, time needed for preparation, and increased risk of contamination. To determine the possibility of substituting commercial formulas for blenderized diets, 27 unconscious patients were randomized into two different groups : blenderized diet group(n=11) and commercial formula group(n=16). Blenderized diets were composed of food sources such as rice, milk, egg, juices and others, and its energy percentage of protein, fat, and carbohydrate was 15%, 30%, and 55%, respetively. Commercial enteral formulas provided 1 kcal/ml and the energy percentage of protein, fat and carbohydrate was 25%, 20% and 55% in greenbia(G) and 20%, 20%, and 60% in Greenbia-DM(GD), repectively. In commercial formula group, five patients with diarrhea, constipation, and high blood glucose level received GD, and the other eleven patients received G. All patients received their lipuid diet for 4 weeks through 16 French rubber nasogastric tube by bolus feeding 6 times daily. The patients in commercial formula group had a similar mean daily calorie intake to the patient in blenderized diet group, 32-34kcal/kg/d and 30-35kcal/kg/d, respectively. Patients given commercial formula gained an averge of 1.7kg in weight but those given blenderized diet lost an average of 2.6kg. There was a trend toward an increase in percent ideal body weight in commercial formula group(94$\pm$5 vs 99$\pm$6%). However, blenderized diet group showed a trend toward a decrease in percent ideal body weight(106$\pm$5 vs $101\pm$6%). The initial levels of total lymphocyte counts, serum albumin and tranferrin were below the normal rante, The mean daily protein intake was significanlty higher for commercial formula group(2.0-2.1g/kg/d) than for blenderized diet group(1.1-1.3g/kg/d). Patient fed cormmercial formula for 4 weeks showed a trend toward an increase in serum albumin(8.1%) and a significant increase in serum transferrin(32.1%) without increasing the levels of blood glucose. GOT, GPT, blood urea nitrogen and serum creatinine. In the blenderized diet group, however, no significant improvement were obseved in the concentration of serum albumin and transferin, compared to initial value. There was a trend toward a decrese in the level of hemoglobin and hematocrit in blenderized deit group but no significnat change in commercial formulas goups. All patients tolerated both diets well and no significant complications were encountered. The results indicate that the commercial enteral formulas tested in this study can be an effective substitution for blenderized diet in unconscious tube-fed patients.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제27권5호
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• pp.457-463
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• 2001

In the unconscious patient with general muscle rigidity, the natural teeth can be luxated and then bite wounds may be occurred around lip, owing to the pathologic involuntary self-biting habit. If the forceful biting is generated continuously, the teeth may be avulsed and aspirated into the aerodigestive tract with the infection of biting wound. For the prevention of pulmonary aspiration of the teeth and wound infection, the biting teeth should be cared before the fact. The authors treated the teeth as endodontic drainage with removal of the crown or iodoform gauze drainage into the socket with extraction of the teeth. The prognosis was more favorable without biting wounds.

• 의료법학
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• 제9권2호
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• pp.77-107
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• 2008

In Republic of Chaina (Taiwan), Natural Death Act named "Anning Huauhe Yiliao Tiaoli" which means palliative and hospice care act was enacted in year of 2000. And enforced in the same year. Many scholars say that Taiwan's Act took Many U.S.A.'s acts such as 'Federal Patient Self-Determination Act 1990', 'California Natural Death Act 1976' and 'Washington Natural Death Act 1979' for a model. Taiwan's Act adopts a few outstanding systems - 'advance declarations' including 'living will' and 'durable power of attorney for health care', 'family-determination system' for a patient who is in a persistent unconscious state. This paper disusses this Act. 'The content is as follow: 1. A background of legislation. 2. The purpose of legislation. 3. The concept of terms. 4. Patient's self-determination. 5. Subrogated determination by family. 6. Keeping documents. 7. Punitive provision. 8. The relationship with euthanasia. 9. Controversial issues.

• 대한불안의학회지
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• 제11권2호
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• pp.106-113
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• 2015

In psychodynamic therapy, trauma related symptoms are considered as an attempt to overcome the traumatic experiences. Therefore, psychodynamic psychotherapy regards the symptom not as a patient's defect but as an adaptive reaction. In contrast to other therapies, psychodynamic theory places heavy emphasis on the understanding and resolution of the patient's symptoms. In addition, transference is a distinctive feature of this theory, which plays a significant role of reflecting the realistic evaluation on the therapist's characteristics, and in guaranteeing the therapeutic alliance. The psychodynamic therapist inducts meaning from the patient's unconscious mind. The therapist's task is to help the patient to better understand defense mechanisms guide their management of experiences and reactions, and facilitate a better understanding of their personal experiences.

• Journal of Hospice and Palliative Care
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• 제15권3호
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• pp.147-154
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• 2012

목적: 본 연구의 목적은 의식 없는 말기환자 가족의 연명치료 중단 결정 경험을 이해하기 위함이다. 방법: 자료는 의 없는 말기환자의 연명치료 중단 결정을 한 8명의 가족으로부터 심층면담을 통해 수집하였다. Colaizzi의 현상학적 분석 방법이 자료 분석을 위해 사용되었다. 결과: 주제는 12개의 주제모음으로 분류되었고, 12개의 주제모음은 마침내 5개의 범주로 통합되었다. 5개의 범주는 환자상태로 인한 절망감, 의료진의 권고에 마음을 비움, 환자의 바램, 돌봄으로 인한 가족의 소진, 연명치료와 관련된 과거의 경험이었다. 결론: 다섯 개의 범주를 통하여 의식 없는 말기환자 가족의 연명치료 중단 결정 과정에서 발생할 수 있는 현상들을 이해함으로써 적절한 상담과 간호를 제공하여 보다 바람직한 호스피스 완화의료 중재가 필요하다고 본다.

• 대한한의학회지
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• 제22권4호
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• pp.158-163
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• 2001

Clinical symptoms of acute stroke include loss of consciousness, aphasia, dysphagia, hemiplegia, without urination or defecation, headache, dizziness, chest discomfort, etc. As methods of oriental medical treatment at acute stroke state, acupuncture, fumigating, emetic, sternutatory therapy etc. were known. We treated a 69-year-old female patient who was unconscious after acute stroke with acupuncture and herbal medicine. Also, we chose Croton seed (Crotonis Fructus) Tansy (Artemisiae Argi Folium)-hwan for treatment and fumed it on the patient's nose once a day. After 7 days of treatment with fumigating therapy, we observed improvement in consciousness on the Glasgow coma scale, and other symptoms (aphasia, dysphagia, hemiplegia, without urination or defecation)

• Journal of Chest Surgery
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• 제28권11호
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• pp.1049-1053
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• 1995

Although neoplastic involvement of the pericardium is frequently present postmortem, cardiac manifestations before death are uncommon, and cardiac tamponade as the initial presentation of cancer is rare. We are presenting a metastatic pericardial tumor with cardiac tamponade of unknown primary neoplasm. The patient brought to hospital in a state of unconscious. The chest x-ray film showed cardiomegaly with a globular heart shape and right pleural effusion. We underwent an anterior thoracotomy and pericardial window was created. The histopathologic finding of pericardium, pleural and pericardial effusion show a metastatic adenocarcinoma. The patient subsequently received adjuvent radiotherapy and chemotherapy, but he expired on the postoperative 132 day.