• 제목/요약/키워드: Psychiatric Outpatient

검색결과 65건 처리시간 0.023초

Factors Affecting the Downward Mobility of Psychiatric Patients: A Korean Study of National Health Insurance Beneficiaries

  • Kim, Un-Na;Kim, Yeon-Yong;Lee, Jin-Seok
    • Journal of Preventive Medicine and Public Health
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    • 제49권1호
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    • pp.53-60
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    • 2016
  • Objectives: The purpose of this study is to examine the magnitude of and the factors associated with the downward mobility of first-episode psychiatric patients. Methods: This study used the claims data from the Korean Health Insurance Review and Assessment Service. The study population included 19 293 first-episode psychiatric inpatients diagnosed with alcohol use disorder (International Classification of Diseases, 10th revision [ICD-10] code F10), schizophrenia and related disorders (ICD-10 codes F20-F29), and mood disorders (ICD-10 codes F30-F33) in the first half of 2005. This study included only National Health Insurance beneficiaries in 2005. The dependent variable was the occurrence of downward mobility, which was defined as a health insurance status change from National Health Insurance to Medical Aid. Logistic regression analysis was used to assess factors associated with downward drift of first-episode psychiatric patients. Results: About 10% of the study population who were National Health Insurance beneficiaries in 2005 became Medical Aid recipients in 2007. The logistic regression analysis showed that age, gender, primary diagnosis, type of hospital at first admission, regular use of outpatient clinic, and long-term hospitalization are significant predictors in determining downward drift in newly diagnosed psychiatric patients. Conclusions: This research showed that the downward mobility of psychiatric patients is affected by long-term hospitalization and medical care utilization. The findings suggest that early intensive intervention might reduce long-term hospitalization and the downward mobility of psychiatric patients.

증상의 발현부터 치료의 시작까지 : 한국인의 공황장애 인식도 변화가 치료적 접근에 미친 영향 (From the Onset of Panic Symptoms to Getting to a Psychiatric Treatment : The Change by Improved Public Awareness of Panic Disorder in Korea)

  • 최용원;서호준;한상우;홍진표;이경욱;김세주;임세원;이상혁;양종철;이승재;박선철;김민숙;채정호
    • 대한불안의학회지
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    • 제15권2호
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    • pp.61-67
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    • 2019
  • Objective : This study aimed to investigate the general process from the symptom onset to the psychiatric treatment in Korean panic patients and the effect of improved public awareness on it. Methods : This study has a retrospective design. The subjects were the new patients with panic disorder who visited the psychiatric outpatient clinic in twelve university-affiliated hospitals all across Korea. The medical chart was reviewed retrospectively and the data were collected including chief complaints of symptoms, recent stressors, the time to visit the psychiatric outpatient clinic, and visit of other departments and diagnostic approaches for their symptoms. Results : A total of 814 participants were included in the study. The most common department other than psychiatry the panic patients visited were cardiology (28.3%), general internal medicine (16.0%) and neurology (11.4%). The most frequently used diagnostic tests were a echocardiography (17.9%), 24-hour Holter monitoring (11.2%), and brain MRI (8.2%). Only 37.3% of participants visited psychiatric clinic directly. About 80% of participants visited psychiatric department within 1 year after their first panic symptoms and it took $13.8{\pm}13.7weeks$ on average. Comparing before and after 2012, the number of participants increased who visit directly the psychiatric clinic without visiting other departments (p=0.002) and without visiting emergency room (p<0.001). Conclusions : Our results suggest that a substantial number of patients visit departments other than psychiatry when they experience first panic symptoms. However, most patients begin psychiatric treatment within 1 year after their first symptoms and the number of patient are increasing who visit psychiatric department directly without visiting other departments.

자살시도자의 정신건강의학과 치료 연계 형태에 따른 동반질병 심각도의 차이 (Severity of Comorbidities among Suicidal Attempters Classified by the Forms of Psychiatric Follow-up)

  • 이혁;오승택;김민경;이선구;석정호;최원정;이병욱
    • 정신신체의학
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    • 제24권1호
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    • pp.74-82
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    • 2016
  • 연구목적 자살시도자는 일반적인 경우에 비해 의사결정 능력이 떨어지며, 다시 자살을 시도할 위험성이 높기 때문에 재시도 전에 정신건강의학과 치료로 연계하는 것이 중요하다. 특히 신체적 질병이 있는 사람은 자살시도를 할 확률이 높고, 사망률 역시 높아진다. 이 연구는 자살시도자의 특성을 조사하고, 자살시도 후 응급실에 방문하여 정신건강의학과 치료를 받기로 결정하는 데 신체적 질병이 어떤 영향을 주는지 분석하였다. 방 법 2012년 1월부터 12월까지 경기도의 일 종합병원 응급실에 내원한 132명의 자살시도자를 대상으로 하였다. 환자의 의무 기록을 후향적으로 검토해 인구통계학적, 임상적 요인을 조사하였고 정신건강의학과 치료 연계여부에 따라 분석하였다. 결 과 입원과 외래 상관 없이 정신건강의학과 치료를 받는 것에 영향을 주는 요인은 정신건강의학과 진단 유무, 직업 유무, 정신건강의학과 치료 과거력, 자살시도 과거력이었다. 정신건강의학과 치료 형태를 입원과 외래로 나누어 동반된 의학적 질병의 심각도(Charlson comorbidity index)를 비교했을 때, 입원을 통해 정신건강의학과 치료를 받은 자살시도자와 치료 자체를 거부한 자살시도자는 외래에서 치료를 받은 자살시도자보다 동반된 의학적 질병의 심각도가 높게 나타났다. 결 론 이 연구 결과 응급실에 내원한 자살시도자에게 동반된 의학적 질병의 심각도(Charlson comorbidity index)가 정신건강의학과 치료 형태에 영향을 미친다는 점을 알 수 있었다. 따라서 정신건강의학과 의사는 응급실에 내원한 자살시도자에 대해 의학적 동반질병의 여부 및 심각도를 평가하여 동반된 의학적 질병이 상대적으로 심각함에도 불구하고 자의퇴원을 진행하려고 하는 자살시도자에게 좀 더 합리적인 의사결정을 할 수 있도록 도움을 줄 수 있어야 한다.

Clinical Characteristics of Disability in Patients with Indoor Aire-Related Environmental Intolerance

  • Vuokko, Aki;Karvala, Kirsi;Suojalehto, Hille;Lindholm, Harri;Selinheimo, Sanna;Heinonen-Guzejev, Marja;Leppamaki, Sami;Cederstrom, Sebastian;Hublin, Christer;Tuisku, Katinka;Sainio, Markku
    • Safety and Health at Work
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    • 제10권3호
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    • pp.362-369
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    • 2019
  • Background: Chronic nonspecific symptoms attributed to indoor nonindustrial work environments are common and may cause disability, but the medical nature of this disability is unclear. The aim was to medically characterize the disability manifested by chronic, recurrent symptoms and restrictions to work participation attributed to low-level indoor pollutants at workplace and whether the condition shares features with idiopathic environmental intolerance. Methods: We investigated 12 patients with indoor aire-related work disability. The examinations included somatic, psychological, and psychiatric evaluations as well as investigations of the autonomic nervous system, cortisol measurements, lung function, and allergy tests. We evaluated well-being, health, disability, insomnia, pain, anxiety, depression, and burnout via questionnaires. Results: The mean symptom history was 10.5 years; for disabling symptoms, 2.7 years. Eleven patients reported reactions triggered mainly by indoor molds, one by fragrances only. Ten reported sensitivity to odorous chemicals, and three, electric devices. Nearly all had co-occurrent somatic and psychiatric diagnoses and signs of pain, insomnia, burnout, and/or elevated sympathetic responses. Avoiding certain environments had led to restrictions in several life areas. On self-assessment scales, disability showed higher severity and anxiety showed lower severity than in physician assessments. Conclusion: No medical cause was found to explain the disability. Findings support that the condition is a form of idiopathic environmental intolerance and belongs to functional somatic syndromes. Instead of endless avoidance, rehabilitation approaches of functional somatic syndromes are applicable.

정신과 환자의 낮병원 직업재활 프로그램 참여 경험에 관한 질적 연구 (Qualitative Study on Vocational Rehabilitation Program Participation Experience of Mentally Ill Patients in Psychiatric Day Hospital Care)

  • 엄광진;김정유
    • 산업진흥연구
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    • 제8권4호
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    • pp.209-220
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    • 2023
  • 본 연구는 일반적 질적 연구와 집단 포토보이스(G-Photovoice) 방법을 활용하여 정신과 환자의 낮병원 직업재활 프로그램 참여 경험을 연구하였다. 연구자는 낮병원 직업재활 프로그램 참여 경험이 있는 정신과 환자 5명을 대상으로 2회 이상 면담을 실시하였으며 낮병원 이용과 외래 진료 이후 추가 면담을 실시하였다. 더불어 사진을 활용한 반 구조화된 집단 면담을 진행하였다. 연구결과 연구 참여자들의 낮병원 직업재활 프로그램 참여 경험은 '직업 활동의 어려움을 경험함', '함께 일하는 것에 대한 즐거움', '안정감을 얻음', '자신이 성장했음을 느낌'으로 나타났다. 이러한 연구결과에 기반하여 본 연구에서는 낮병원 직업재활을 활성화하고 정신과 환자의 성장을 촉진시킬 수 있는 함의를 논의하였다.

종합병원 외래진료부문 정신건강의학과의 공간구성 및 이용현황에 관한 연구 (A Study on the Use and Spatial Composition of Outpatient Department of Psychiatry in General Hospital)

  • 문하늬;노재성;채철균
    • 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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    • 제21권1호
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    • pp.17-26
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    • 2015
  • Purpose : This study examined the social and environmental change in the outpatient department of psychiatry, were analyzed disease characteristics and using characteristics of the mental illness. Thus, this aims to provide a material that can be used for efficient spatial composition of psychiatry. Methods : This study was conducted through a literature review, observation surveys, interviews. Results : Psychiatry is aware of the need to respond to the current needs of ambulatory space, there are concerns that the spatial configuration for your needs. In accordance with the results of studies conducted are as follows: 1) Specialty care programs and space needs based on segmentation and specialization of the disease 2) Considered in conjunction with the layout of essential space and other departments 3) Spatial composition and furnishings for characteristic of psychiatry 4) Spatial configuration taking into account the patient's characteristic. Implications : This study looked at the change of social change and the environment related to psychiatry. Grasp the present state of spatial composition in psychiatry. And the use characteristics of patients and guardians were investigated. Meanwhile, studies of psychiatric outpatient department is still lacking. As a result, its significance is to analyze the spatial composition requirements.

일 대학병원 정신분열병 환자의 퇴원 후 경과에 미치는 치료적 요인 (The Therapeutic Factors Affecting Post-discharge Course of Schizophrenia Patients in a University Hospital)

  • 남정현;노성원;최준호;이경우
    • 생물정신의학
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    • 제13권1호
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    • pp.26-31
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    • 2006
  • Object : To evaluate how the therapeutic factors affect post-discharge course of patients with schizophrenia, we analyzed relationship between each therapeutic factor and outcome of inpatients with schizophrenia in Hanyang University Hospital. Methods : This study is a retrospective report. Subjects were schizophrenic inpatients who were discharged from Hanyang University Hospital from January 1, 2003 through December 31, 2004. We obtained demographic and clinical data from review of inpatient and outpatient charts. Results : We analyzed the records of 104 patients with schizophrenia(44 males and 60 females). Patients who had longer first admission days have fewer number of readmission. There were no significant correlation between psychiatric rehabilitation and course of schizophrenia. Courses, such as duration of outpatient department follow-up and number and duration of rehospitalization, did not differ according to the existence of extrapyramidal symptoms or types of antipsychotics prescribed. Conclusion : Among the therapeutic factors, longer duration of the first admission only affected better post-discharge course of patients with schizophrenia.

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정신과 환자 자녀의 우울, 불안, 자기 개념 그리고 가정환경의 특성에 대한 연구 (IMPACT OF PARENTAL PSYCHIATRIC DISORDER ON OFFSPRING'S DEPRESSION, ANXIETY, SELF CONCEPT AND PERCEPTION OF FAMILIAL RELATIONSHIP)

  • 이정법;조수철
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제9권1호
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    • pp.54-66
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    • 1998
  • 본 연구의 목적은 정신과 환자의 자녀가 정상인의 자녀와 비교하여 불안, 우울 등의 정신병리와 자기 개념, 가정환경에 대한 인식에 있어서 차이가 있는지를 알아봄으로써 부모의 정신병리가 자녀에게 어떤 영향을 주는가를 밝히기 위함이다. 아울러 환자집단 내에서 환자의 성별에 따라, 환자의 발병 당시의 자녀의 나이에 따라, 환자 진단에 따라 자녀의 불안, 우울 등의 정신병리와 자기 개념, 가정환경에 대한 인식에서 차이가 있는가를 알아보고자 하였다. 1997년 6월부터 1998년 4월까지 서울, 경기지역의 신경정신과 성인 외래 환자 39명을 대상으로 하여 이들의 자녀 중 초등학교 4학년부터 고등학교 3학년까지의 남녀 학생 52명에게 한국형 소아 상태-특성불안척도, 한국형 소아 우울 척도, 한국형 소아자기개념척도, 한국형 가정환경척도를 작성하도록 하고 이를 동 수의 정상인 자녀와 비교하였다. 그리고 환자의 자녀 내에서는 환자가 남자인지 혹은 여자인지, 환자의 발병 연령이 자녀가 3세 이전이었는지 이후였는지, 환자의 진단이 어떤 것인지에 따라 척도들을 비교하였다. 결과는 다음과 같다. 1) 정신과 환자의 자녀들이 정상인의 자녀들과 비교하여 가정환경척도 중 표현력 척도에서 유의하게 낮은점수를 보였고 상태 불안 척도에서는 유의하게 높은 점수를 보였다(p<0.05). 그러나 소아 자기개념척도의 지적 및 학업 상태 소척도와 인기도 소척도에서는 오히려 환자의 자녀가 정상인의 자녀보다 유의미하게 높은 점수를 보였다(p<0.05). 2) 환자군 내에서 환자의 남녀 성별에 따른 자녀의 척도들의 차이는 없었다. 3) 환자군 내에서 환자가 자녀 나이 3세 이전에 발병한 경우가 3세 이후에 발병한 경우보다 가정환경척도 중 조절성 소척도 점수는 유의하게 낮고 특성불안척도는 유의하게 높았다(p<0.05). 4) 환자군 내에서 환자의 진단(정신분열병 범주 장애-정동장애-신경증)에 따른 자녀의 척도들의 차이는 없었다. 자기 보고식 설문으로 측정한 우울, 불안 등의 정신병리는 환자의 자녀와 정상인의 자녀간 유의미한 차이를 보이지 않았다. 환자의 진단이나 남녀 성별의 차이 역시 자녀에게 영향을 주지 않는 것으로 밝혀졌으나 자녀가 3세 이전에 부모가 정신질환에 이환 될 경우에는 자녀의 특성불안이 높은 경향을 보였다. 향후 고위험군 자녀의 발달학적 측면에서 영향을 주는 요인을 밝히는 연구를 위해서는 자녀의 자기보고 이외에도 부모, 선생님 등의 관찰과의 일치도에 대한 조사, 직접적인 면담 등이 필요할 것으로 보이며 통제된 환경에서의 전향적 연구가 필요할 것이다.

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Determinants of Mental Health Care Utilization in a Suicide High-risk Group With Suicidal Ideation

  • Kim, Hyun-Soo;Lee, Moo-Sik;Hong, Jee-Young
    • Journal of Preventive Medicine and Public Health
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    • 제49권1호
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    • pp.69-78
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    • 2016
  • Objectives: The suicide rate in Korea is increasing every year, and is the highest among the Organization for Economic Cooperation and Development countries. Psychiatric patients in particular have a higher risk of suicide than other patients. This study was performed to evaluate determinants of mental health care utilization among individuals at high risk for suicide. Methods: Korea Health Panel data from 2009 to 2011 were used. Subjects were individuals at high risk of suicide who had suicidal ideation, a past history of psychiatric illness, or had utilized outpatient services for a psychiatric disorder associated with suicidal ideation within the past year. The chi-square test and hierarchical logistic regression were used to identify significant determinants of mental health care utilization. Results: The total number of subjects with complete data on the variables in our model was 989. Individuals suffering from three or more chronic diseases used mental health care more frequently. Mental health care utilization was higher in subjects who had middle or high levels of educational attainment, were receiving Medical Aid, or had a large family size. Conclusions: It is important to control risk factors in high-risk groups as part of suicide prevention strategies. The clinical approach, which includes community-based intervention, entails the management of reduction of suicidal risk. Our study identified demographic characteristics that have a significant impact on mental health care utilization and should be considered in the development of suicide prevention strategies. Further studies should examine the effect of mental health care utilization on reducing suicidal ideation.

주의력결핍 과잉행동장애의 산전 및 주산기 위험인자 (Prenatal, Perinatal and Developmental Risk Factors of Attention-Deficit Hyperactivity Disorder)

  • 여진영;최세진;주연호;김효원
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제26권2호
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    • pp.112-119
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    • 2015
  • Objectives : The purpose of this study was to examine the prenatal, perinatal and developmental risk factors of attention-deficit hyperactivity disorder (ADHD), compared to unaffected siblings (SIB), and typically developing children (TC). Methods : Subjects with ADHD, their SIB, and TC were recruited from the child psychiatry outpatient clinic of the Asan Medical Center Children's Hospital. The parents of the children completed questionnaires on perinatal and developmental risk factors. Results : Fifty-eight subjects with ADHD (41 boys, $7.7{\pm}1.3years$), 21 SIB (8 boys, $8.2{\pm}1.8years$), and 22 TC (8 boys, $8.5{\pm}2.1years$) were included. The ADHD group showed higher rates of maternal stress during pregnancy than the SIB group (p=.002), and the ADHD group showed higher rates of familial psychiatric history than the TC (odds ratio, 8.76 ; 95% confidence interval, 1.69 to 45.45). Conclusion : These findings suggest that among perinatal and developmental factors, maternal stress during pregnancy contribute to the development of ADHD. Future prospective studies will be needed in order to determine the causal relationship between perinatal risk factors and development of ADHD.