• Journal of Korean Academy of Nursing
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• v.6 no.1
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• pp.80-90
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• 1976

정신과 영역의 환자를 위해 간호원의 역활을 필요로 한 이래 여러 가지 간호의 개념으로 간호원의 역할이 변화되어오고 있다. 정신과 환자의 안전만이 가장 큰 치료의 중심일 때는 병동열쇠의 위엄에 곁따라 보호관리에만 치중해 왔으며 정신의학에서 약물요법, 전기요법의 치료과정이 생기면서 간호원의 역할 변화 및 지식의 요구를 필요로 하게 되었으며, 환경과 개인의 밀접한 관계를 중시해오면서 치료적 환경속으로 환자의 인간적 치료가 강조되었을 때 의사소통과 대인관계의 인적 환경으로써 또한 간호원의 역활이 중요시 되어왔다. 이런 관점에서 치료적 환경에 대한 정확한 이해는 간호행위과정의 불완전을 제거하며 보다 활발한 정신과 환자간호에 기여하는 일 일 것이다. DR. Bartom은 병실 환경이 비생산적이고 비 치료적일때 성격의 변화는 물론 행동적 특성의 변화까지 가져올 수 있다고 말했다. 즉 무감동적이고, 무조건적 순종이 있으며 솔선하여 행하는 행위가 줄고 장래 계획에 대한 자극이 줄어들고 될대로 되어 가는 상태 그 자체에 머물러 있어 인간의 특징적 의미와 가치를 상실하게 된다는 것이다. 정신과 병실은 잠정적 체류지로 보아야 하겠고 이 체류지에서의 영향이 환자에게 보다 유익하게 끼칠려면 간호원이 지속적으로 치료적 분위기를 유지해야 할 것이다. 치료적 입장으로서의 간호의 활동 초점은 대인관계에서 환자의 의식수준과 자아관련 수준에서의 취급이 무의식 수준에서의 탐구조사보다 바람직하다. 치료적 가치로써 치료적 환경의 이론적 근거를 DR. Sullivan 은 인간의 상호관련 문제에 두고 있다. 즉 상호작용이 존재하는 환경은 어떠한 곳이든 성격에 영향이 있고 이 성격은 대인관계의 복잡성으로부터 결코 떨어질 수 없다는 얘기다. 자아구성 또한 환경의 영향을 받는데 Cumming은 병동환경과 자아구성 재동기간에 밀접성을 시사한바 있다. Visher와 O'sullivan은 정신과적 치료중에서 일상생활에서 경험되어지는 의사소통과 대인관계속에서 학습되어지는 여러 가지가 있기 때문에 매일의 활동획이 치료적 방향으로 계획되어 져야 한다고 말했다. Maxwell Jones 또한 치료적 환경의 유용한 가동은 전 직원의 기여에 있으며 이는 정신건강을 최적으로 올려 줄 것이다. 라고 말했다. 이러한 상황에서 간호원은 의미 없이 환자의 감정 욕구를 깨닫지 못하고 감정지지를 주지 못하며 정서적 긴장을 예방하지 못한 체 환자와의 관계를 유지한다면 현대간호의 개념에서 이탈되어지고 발달되어지지 못한 미숙아 현상이 유지 될 것이다. 보다 바람직한 치료적 환경 유지는 간호로써 환자에게 기여해 주는 일이다. 간호의 역활과 더불어 전문적 태도는 따뜻하고 포용성 있게 그리고 융통성 있게 대함은 물론 간호인 자신의 "자기이용"을 깊이 그리고 치료적으로 이용할 것을 깨달아야 할 것이다. 즉 정신과 병실에서의 간호원 존재 자제가 환자에게 미치는 영향도 고려해야 한다는 것이다. 덧붙여 환자를 위한 일주일 병동 행사표를 Model로 제시하였고 그 안에서의 간호원의 역활을 약술하였다.

• Journal of Korean Academy of Nursing
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• v.28 no.4
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• pp.1027-1035
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• 1998

The purpose of this study is to develop the first domestic professional hospice educational program. We investigated the present condition of Korean hospice education and analyzed the prerequisite need for a dedicated hospice course in the professional education process. Research was conducted between June and November 1996 for nursing professors teaching at each nursing education institute to find out how much hospice is being discussed and by whom, in which course it is being discussed, and also to find out the contents that needed to be included in the professional education process. From a total of 49 colleges(29 three year colleges, 20 four year colleges) out of 99, 162 nursing professors replied, the collection rate was 49.5%. The conclusions are as follows ; 1. The present condition of the hospice nursing education. 1) Whether hospice is included in the education program. \circled1 89.65% of 3 year colleges and 90% of 4 year colleges included hospice education in their education program. \circled2 In graduate studies three schools included hospice in their program and three schools expressed their plans to include hospice education 2) Hospice related education were commonly discussed in adult nursing(26.3%), fundamental nursing(22.8%), and psychiatric nursing(20.2%). In 3 year colleges its commonly discussed in the first and second year and in 4 year colleges it is taught in the second and third year. 3) Hospice related theory/practical education hours were averages of 6.5/7.0 hrs in 3 year colleges and 14.2/11.3 hrs in 4 year colleges. 4) The majority of professors in charge of hospice education were in the following order adult nursing, psychiatric nursing, and fundamental nursing. 5) The courses that are thought to be adequate to manage hospice related education were adult nursing(29.3%), community health nursing(21.7%) and the desired method of education was the method currently being used (36.5%). 2. The demand for hospice nursing education. 1) Over 70% demanded professional hospice education program, the highest demand was for the value and meaning of life followed by the role and qualification of the hospice team and the mental maintenance of a dying patient. 25 categories showed over 90% demand. 2) The highest demand was for the value and meaning of life (98.2%) and the lowest demand were for danjeon breathing(71.0%)and acupuncture(71.0%). 3) Other contents that need to be discussed in the professional hospice education program were hospice nursing, the attitude and reaction of death, bereavement care, and the prospects of hospice.

• 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.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.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.10 no.2
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• pp.178-185
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• 1999

Objective：This study was designed to examine the validity of the Ego Impairment Index(EII) in adolescent psychiatric patients(depression, depressive-conduct disorder, schizophrenia), and to explore the validity of the depressive-conduct disorder as a diagnostic entity. Method：19 depressives, 13 depressive-conduct disordered, and 10 schizophrenics with the age from 12 to 18 were selected based on DSM-IV and ICD-10 criteria, and their responses of the Rorschach and MMPI were analyzed. The EII was empirically developed by Perry and Viglione(1991) in order to assess the degree of ego impairment, and was derived from the Rorschach test. Results：It was founded that a single factor, ego impairment, was derived from the principal component analysis and explained 57.18% of total variances. The degree of ego impairment was grater in schizophrenics than in the other two groups, but there were no difference between depressives and depressive-conducts. Conclusions：These results offered support for the use EII as an empirical means of assessing the degree of ego impairment in adolescent patients. And these results suggest that depressive-conduct disorder group is more similar to the depressive group, implying that depressive-conduct disorder might correspond to so called masked depression. The clinical implication and limitation of present study were discussed.

• Journal of Korean Neurosurgical Society
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• v.64 no.1
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• pp.125-135
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• 2021

Objective : This study aimed to validate the Korean version of the Repeatable Battery for the Assessment of Neuropsychological Status Update (K-RBANS). Methods : We performed a retrospective analysis of 283 psychiatric and neurosurgery patients. To investigate the convergent validity of the K-RBANS, correlation analyses were performed for other intelligence and neuropsychological test results. Confirmatory factor analysis was used to test a series of alternative plausible models of the K-RBANS. To analyze the various capabilities of the K-RBANS, we compared the area under the receiver operating characteristic (ROC) curves (AUC). Results : Significant correlations were observed, confirming the convergent validity of the K-RBANS among the Total Scale Index (TSI) and indices of the K-RBANS and indices of intelligence (r=0.47-0.81; p<0.001) and other neuropsychological tests at moderate and above significance (r=0.41-0.63; p<0.001). Additionally, the results testing the construct validity of the K-RBANS showed that the second-order factor structure model (model 2, similar to an original factor structure of RBANS), which includes a first-order factor comprising five index scores (immediate memory, visuospatial capacity, language, attention, delayed memory) and one higher-order factor (TSI), was statistically acceptable. The comparative fit index (CFI) (CFI, 0.949) values and the goodness of fit index (GFI) (GFI, 0.942) values higher than 0.90 indicated an excellent fit. The root mean squared error of approximation (RMSEA) (RMSEA, 0.082) was considered an acceptable fit. Additionally, the factor structure of model 2 was found to be better and more valid than the other model in χ2 values (Δχ2=7.69, p<0.05). In the ROC analysis, the AUCs of the TSI and five indices were 0.716-0.837, and the AUC of TSI (AUC, 0.837; 95% confidence interval, 0.760-0.896) was higher than the AUCs of the other indices. The sensitivity and specificity of TSI were 77.66% and 78.12%, respectively. Conclusion : The overall results of this study suggest that the K-RBANS may be used as a valid tool for the brief screening of neuropsychological patients in Korea.

• Sleep Medicine and Psychophysiology
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• v.5 no.1
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• pp.54-70
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• 1998

Objectives : The purpose of this study is to evaluate the role of structural and functional changes of the brain in the pathophysiology of schizophrenia. Methods : The authors measured the regions of interest on the magnetic resonance imaging of the brain in 20 patients with paranoid schizophrenia(15 men and 5 women) and 23 control subjects(15 men and 8 women). We also assessed the neurocognitive functions with the Wisconsin Card Sorting Test, the Benton Neuropsychological Assessment, and the Weschler IQ test-Korean version, soft neurologic signs, and psychiatric symptoms in the patient group. Results : In the patient group, all ventricles and basal ganglia including caudate nucleus and globus pallidus were significantly enlarged. Although there were no significant differences between the two groups in the values of right frontal lobe and left temporal lobe, there was a tendency of decrease in the values of right frontal lobe and left temporal lobe. There were significant positive correlations between the values of ventricles and the frequency of previous hospitalization. However, there were no significant correlations between other values of regions of interest and clinical data. The value of the right frontal lobe was significantly correlated with the score of soft neurologic signs, which is suggestive of the neurodevelopmental abnormalities. There were significant correlations between the value of frontal lobe and the scores of the various subscales of Benton Neuropsychiatric Inventory. In contrast, the value of left amygdala and putamen showed significant correlation with the score of verbal IQ on the Weschler IQ test. Structural changes of the temporal lobe areas were related with the positive and general symptom scores on PANSS, while those of the basal ganglia were related with the negative symptom scores. Conclusions : These results suggest that the structural changes of the brain in the patients with schizophrenia show the dual process, which is suggestive that the enlarged ventricle show the neurodegenerative process, while enlarged basal ganglia, and shrinked right frontal and left temporal lobe show the neurodevelopmental abnormalities. Among these changes, structural changes of the frontal lobe related with various neuropsychological deficits, while those of left temporal lobe related with language abnormality. Relative to the relation between structural changes and psychiatric symptoms, structural changes of the temporal lobe areas were related with the positive and general symptoms, while those of the basal ganglia were related with the negative symptoms.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.8 no.1
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• pp.10-14
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• 2012

Self-injurious behavior (SIB) has been defined as the deliberate destruction or alteration of body tissue without conscious suicidal intent. It occurs in conjunction with a variety of psychiatric disorders as well as various developmental disabilities and some syndromes. The behavior is destructive and causes concern and distress to all involved in the care and treatment of the affected individual. A 13-year-old girl with autism, mental retardation and delayed development was reffered from her pediatrician because of severe and painful lower lip biting. An intraoral examination revealed a diffuse swelling of lower lip. It was covered with necrotic slough and the ulcer and scarring of the lower lip was observed. We chose to use an oral removable prosthesis for Conservative treatment. It was decided to use a soft silicone mouthguard in the maxillary arch. Initially, she could not tolerate the appliance inside her mouth but soon adapted with the appliance. After one month, she lost the mouth guard and started lip biting. So we made mouth guard again. There are no standard methods for preventing self-injurious behavior in a patient who is developmentally disabled. Appropriate preventive methods must be developed for each individual patient based on close observation and clinical findings. Behavior modification techniques, pharmacological treatment, extraction of teeth, orthognathic surgery and intra/extra oral appliances can be performed for adjust self-injurious behavior. A suitable oral guard could be tried initially before employing more invasive approaches.

• Anxiety and mood
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• v.7 no.2
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• pp.85-91
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• 2011

Objective : This study aimed to investigate the characteristics of the early maladaptive schemas in patients with panic disorder. Methods : Patients (n=35) included people who had met the DSM-IV-TR criteria for panic disorder. The normal control group (n=35) were those people who had no psychiatric disorder and had never experienced panic attack. The early maladaptive schemas and the severity of depression and anxiety were assessed by the Young Schema Questionnaire Short-form (YSQ-SF), the Beck Depression Inventory (BDI), and the Spielberger State-Trait Anxiety Inventory (STAI). Results : The scores on the STAI-S, STAI-T, and BDI were significantly higher in the patient group. Compared to the control group, the scores of vulnerability to harm and illness, and abandonment/instability schemas were significantly higher in the patient group. In the patient group, defectiveness/shame and subjugation schemas were found to predict BDI, dependent/incompetence, abandonment/instability schemas were found to predict STAI-S, and vulnerability to harm and illness, and abandonment/instability schemas were found to predict STAI-T. In normal controls, failure and insufficient self-control/self-discipline, failure, and emotion inhibition schemas were found to predict BDI, STAI-T, and STAI-S. Conclusions : Vulnerability to harm and illness and abandonment/instability schemas may be characteristic schema in patients with panic disorder.

• Korean Journal of Biological Psychiatry
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• v.8 no.2
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• pp.271-275
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• 2001

Hyposexuality after stroke has been frequently observed, but hypersexuality as a sequela of stroke has not been commonly documented. We report a patient who exhibited hypersexuality and obsessive-compulsive behaviors after stroke in the region of the left mesial frontal cortex and both basal ganglia. At 2 months after stroke, he visited psychiatric unit due to these symptoms. His motor function was almost full recovered. He was treated with fluvoxamine and perphenazine. With two-month medication, his hypersexuality and obsessive-compulsive behavior disappeared. This case may indicate that basal ganglia-thalamocortical circuit plays an important role in the mediation of sexual behavior and obsessive-compulsive behavior. Since changes in sexual activity may not be spontaneously reported, a systemic inquiry into patient's sexual functioning after infarction in frontal lobe or basal ganglia is warranted.