• Title/Summary/Keyword: psychiatric disorder

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Anxiety Hastened Depressive Recurrence in Bipolar Disorder : An Interim Analysis of Prospective Follow-Up Study (양극성 장애 환자에서 불안이 질병 경과에 미치는 영향 : 전향적 추적관찰에 대한 중간분석)

  • Kim, Soojeong;Kim, So Jeong;Song, Hye Hyun;Lee, Wonhye;Chon, Myong-Wuk;Nam, Yoon Young;Park, Dong Yeon
    • Korean Journal of Biological Psychiatry
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    • v.28 no.1
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    • pp.13-22
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    • 2021
  • Objectives Despite growing attention to anxiety in bipolar disorder (BD), little research has assessed anxiety symptoms in the course of BD. The current prospective follow-up study examines the influence of subjectively and objectively measured anxiety symptoms on the course of BD. Methods A total of 49 patients with BD were followed-up prospectively for average of one year at an average of four months interval. The Korean version of the Beck Anxiety Inventory (K-BAI), the Hamilton Anxiety Rating Scale, heart rate variability (HRV) were used to measure anxiety subjectively, objectively and physiologically. Participants were divided into high and low anxiety groups based on their K-BAI scores. Kaplan-Meier survival analysis was performed to compare the recurrence of mood episode, suicide attempt, emergency room visit, and psychiatric hospitalization between two groups. Mediators were investigated with Cox proportional hazards models. Results Compared to the low anxiety group, the high anxiety group reported significantly higher impulsiveness (p = 0.016) and lower high frequency component on HRV (p = 0.007) after controlling for severity of BD. Regarding survival analysis, the high anxiety group showed hastened depressive episode recurrence (p = 0.048) and suicidal ideation was the mediator of the hazard ratio (HR) 1.089 (p = 0.029) in the Cox model. Moreover, the high anxiety group showed a tendency of accelerated suicide attempt (p = 0.12) and impulsivity was the risk factor of suicide attempt (HR = 1.089, p = 0.036). Conclusions This interim analysis of prospective study suggests that high anxiety level in BD may anticipate unfavorable course. Further studies are needed to understand the multifactorial mechanism of anxious bipolar patients.

Factors Affecting the Duration of Untreated Psychosis in Community-Dwelling Patients with Schizophrenia Spectrum Disorder (지역사회 거주 조현병 범주 장애 환자의 정신증 미치료 기간 관련 요인)

  • Kim, Mina;Kim, Jae-Kyeong;Jhon, Min;Kim, Ju-Wan;Lee, Ju-Yeon;Kim, Jae-Min;Shin, IL-Seon;Yoon, Jin-Sang;Lee, Myung-Soo;Kim, Sung-Wan
    • Korean Journal of Schizophrenia Research
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    • v.23 no.1
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    • pp.1-7
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    • 2020
  • Objectives: This study aimed to identify factors affecting the duration of untreated psychosis (DUP) in patients with schizophrenia spectrum disorder. Methods: Six-hundred patients with schizophrenia spectrum disorder were recruited from mental health welfare centers in Gwangju Metropolitan City and Gyeonggi-do. Subjects were categorized into two groups according to median DUP. Demographic and clinical characteristics were compared between the two groups. Results: The mean DUP was 80.8 weeks, and the median DUP was 15.9 weeks. Patients with Medicaid, higher age, and longer duration of the schizophrenia prodrome were more likely to have a longer DUP. The DUP was shorter in patients who were consulted by family/relatives prior to treatment. Patients visiting university hospitals were more likely to have a shorter DUP compared with those visiting psychiatric clinics or small-sized mental hospitals, i.e., with less than 100 beds. A multivariate regression analysis showed that the duration of the prodrome was a factor that significantly affected DUP. Conclusion: The vulnerable group of patients with schizophrenia with a long DUP should be monitored closely. Moreover, it is necessary to develop a strategy to identify patients who have an insidious course of psychosis to reduce the DUP.

Characteristics Involved in Internet Addiction Tendency of Adult Males with Attention Deficit/Hyperactivity Disorder (성인 남자 주의력결핍 과잉행동장애 환자에서 인터넷 중독 성향에 관여하는 특성)

  • Noh, Dong Hyun;Kim, Jun Won;Min, Kyung Joon;Lee, Young Sik;Kim, Bung Nyun;Cheong, Jae Hoon;Ahn, Jee Young;Han, Doug Hyun
    • Journal of Korean Neuropsychiatric Association
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    • v.53 no.3
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    • pp.154-161
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    • 2014
  • Objectives This study was conducted in order to investigate characteristics of temperament, depression, anxiety, attention, and impulsivity in adult males with Attention Deficit/Hyperactivity Disorder (ADHD) and internet addiction tendency. Methods The survey participants were 181 (121 patients and 60 healthy control subjects) adult males older than 19 years of age in Chung-Ang University Hospital and Gongju National Hospital. Subjects were divided according to ADHD with internet addiction tendency (AI), pure adults with ADHD (AD), and healthy control subjects (HC). All groups completed the Adult ADHD Scale (AADHD), Wender-Utah ADHD Rating Scale (WUADHD), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), the Korean Version of Young Internet Addiction Scale (YIAS-K), Barratt Impulsiveness Scale (BIS) and Temperament Character Inventory-Revised Short version for identification of relationship between ADHD and internet addiction tendency. Results AI groups were found to have higher AADHD, WUADHD, BDI, YIAS-K, and Novelty Seeking scores, compared to the AD and HC groups. The Cooperativeness score of the AI group was significantly lower than that of the AD group and HC group. The BAI and BIS scores of the AI group and AD group were significantly higher than those of the HC group. The Self-Directedness scores of the AI group and AD group were decreased, compared to the HC group. YIAS-K scores were partially related to BDI scores in the AI group. Conclusion The results of this study indicate an association of higher score of BDI with internet addiction tendency in adult patients with ADHD. Management of temperament characteristics, depression, anxiety, attention, and impulsivity may be important for adults with ADHD and internet addiction tendency.

The Relation of Bipolar Tendency with Type A Behavior Pattern, Perceived Stress, and Lifestyle:Comparison between Mood Disorder Questionnaire Positive and Negative Respondents (양극성 경향과 스트레스 취약성:기분장애설문지 양성 반응군과 음성 반응군에서 지각된 스트레스, A형 행동, 그리고 생활습관의 비교)

  • Kim, Byung-Su;Kim, Seong-Yoon;Choe, Jae-Won;Joo, Yeon-Ho;Yoon, Dae-Hyun;Han, Nae-Jin;Kim, Yoo-Shin;Kim, Seon-Ok
    • Korean Journal of Psychosomatic Medicine
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    • v.18 no.1
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    • pp.19-29
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    • 2010
  • Objectives:Authors hypothesized that bipolar tendency of non-psychiatric person would be associated with stress vulnerability. To test the hypothesis, we compared perceived stress level, Type A Behavioral Pattern (TABP) and unhealthy lifestyle between person with and without bipolar tendency. Methods:The study cohort consisted of 1987 subjects without past and current psychiatric history. In this study, bipolar tendency was determined by MDQ response which requires endorsement of at least 7 of the 13 "yes or no" questions. We compared the scores of Perceived Stress Scale, A/B lifestyle questionnaire, and unhealthy lifestyle(alcohol, smoking, lack of exercise, irregular meal) between MDQ positive and negative respondents. Results:We identified the bipolar tendency group determined by the MDQ positive response were 329 subjects(16.6%). The overall score of the bipolar tendency group was significantly high on the A/B lifestyle questionnaire compared to the non-bipolar tendency group(125.4 vs. 115.9, p<0.001), and the rate of the subjects defined as TABP was also significantly high(41.3% vs. 30.1%, p<0.001). In comparison of subjectively perceived stress level, the bipolar tendency group was observed to be significantly higher than the non-bipolar tendency group (18.5% vs. 16.5%, p<0.001). The bipolar tendency group was significantly higher than the non-bipolar tendency group on the rate of answering:'irregular eating habit' (20.1% vs. 14.3%, p=0.002), '4-or-more-times alcohol intake per week' (29.8% vs. 16.5%, p<0.001), 'currently smoking' (41.9% vs. 23.0%, p<0.001), '2-or-less-times physical exercises per week' (63.2% vs. 55.1%, p=0.007). Conclusion:By clinical diagnosis, even a person who does not meet the criteria of bipolar disorder has a high risk of stress-related behavioral pattern, and perceived stress when possessing bipolar tendencies such as the (hypo) maniac tendency or affective instability. Such individual has significantly higher risk of having unhealthy life-style such as smoking, drinking, irregular eating habit and lack of exercise compared to non-bipolar tendency group. Since these risk factors lead to increase the risk of obesity, metabolic syndrome, diabetes, and cardiovascular diseases, the individual with the bipolar tendency requires a more effort to manage stress and to maintain healthy lifestyle.

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A study on educational need of nurses for home care (간호사의 가정간호를 위한 교육요구 분석)

  • Moon Jung-Soon
    • Journal of Korean Public Health Nursing
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    • v.5 no.2
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    • pp.5-25
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    • 1991
  • This study was conducted from July to December 1990, in order to diagnose nurses' educational need for home care. The study subjects consisted of 145 nursing educators, and the 3 groups of nurses, namely 250 senior nursing students of diploma and collegiate program, 235 health center nurses, 521 university' hospital nurses in Seoul. Four types of questionaires were formulated by Delphi method. Two questionaires for the nursing educators were designed to measure their expectations of nurses' knowledge and of their skill for home care, and another two questionaires for the nurses to measure their actual home care knowledge and skill. The results of the study were as follows : 1) The mean scores of educators' expectation for home care knowledge were 17.68 for the care of dependence on medical equipment, 17.44 for the care of mobility impairment patient, 16.56 for the care of cardiopulmonary impairment patient, 16.40 for the care of nutrition and elimination impairment patient, '1.20 for the care of psychiatric disorder patient and 9.03 for the care of cancer and terminally ill patient,. 2) The mean scores of nurses' home care knowledge tested by 20 items were 14.36 for the care of mobility impairment patient, 13.28 for the c8;re of dependence on medical equipment, 13.78 for the care of cardiopulmonary impairment patient, 12.92 for the care of nutrition and elimination impairment patient, and those of tested by 10 items were 7.08 for the care of psychologic disorder patient, 7.80 for the care of cancer and terminally ill patient. The sum of means marked 69.23. As for the nurses' home care knowledge categorized by tasks in terms of the group, significant difference were shown in the care of mobility impairment(P=0.00), cancer and terminally ill(P=0.03), nutrition and elimination impairment(P=0.00) and psychologic disorder patient(P=0.00). No significant difference were shown in the care of dependence on medical equipment and cardiopulmonary impairment patient. 3) Regard to educational need of nurses' home care knowledge categorized by task according to the group it was found that all sampled nurses had educational need in the care of mobility impairment, dependence on medical equipment, cardiopulmonary impairment, cancer and terminally ill patient. It was found that health center nurses had educational need in the care of psychologic disorder. No educational need were found in the health center nurses whose career less than 2 years, in the care of mobility impairment, cardiopulmonary impairment and psychologic disorder patient, and in those of career with 2-5 year in the care of psychologic disorder patient. No educational need were found in the hospital nurses whose career more than 15 years, in the care of cardiopulmonary impairment patient and in those of career with 11-15 year, in the care of cancer and terminally ill patient. 4) The mean scores of educators' expectation for home care skill measured by Likert 5 points scale were 4. 21 for assessing, 4.49 for planning, 4.29 for basic care, 4.42 for curative care, 4.40 for rehabilitative care, 4.36 for emergency care, 4.53 for medication, 4.31 for nutritional care, 4.32 for other means for care, and 4.38 for evaluation. 5) Regard to nurses' home care skill measured by Likert 5 points scale of self evaluation, there was a significant difference between the nurses' home care skill and group(P=0.00l). The higher scores reported by students were vital sign checking and basic care while the scores of below medium were curative care and emergency care. The higher scores reported by health center nurses were vital sign checking, other means for care and care of specimen while the scores below medium were curative, emergency and nutritional care. The higher scores reported by hospital nurses were vital sign checking, care of specimen and basic care, while the score below medium was emergency care. 6) Regard to educational need of nurses' home care skill by nursing process activity according to the group it was found that health center nurses had educational need in all nursing skills including vital sign checking, care of specimen, health assessment, socioeconomic assessment, nursing diagnosis, care plan, basic care, curative care, rehabiitative care, psychological care, emergency care, medication, nutritional care, other means for care and evaluation. And students had educational need in all nursing skills except vital sign checking, and hospital nurses had educational need in all nursing skills except vital sign checking, care of specimen and basic care. 7) In short, the result of this study suggests that the curriculum should be organized in accordence with nurses' educational background and their career for the education of nurses for home care. It should be considered to develop the short term educational program focused on curative and rehabilitative care for health center nurse or community health nurse practitioner and which was focused on family care for hospital nurse. Concerning about this field practice for home care nurse, they are required not only community practice but also . clinical practice including emergency, curative and rehabilitative care.

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Analysis of Coexistence Rates of Attention Deficit/Hyperactivity Disorder Symptoms in Patients with Depression (우울감을 주소로 내원한 환자들에서 주의력 결핍/과잉행동장애 증상의 공존율 분석)

  • Jeong, Mi Young;Park, Seo Young;Kim, Jung Ho;Im, Woo Young;Lee, Yeon Jung
    • Korean Journal of Psychosomatic Medicine
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    • v.27 no.2
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    • pp.147-154
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    • 2019
  • Objectives : Cognitive dysfunction, including inattention, is often observed in patients with depression. Inattentive symptoms in patients with depression is similar to those among attention deficit/hyperactivity disorder (ADHD) patients. It is important to diagnose the two diseases accurately, because the treatment varies depending on the cause of inattention. This study aimed to investigate the coexistence rate of ADHD and the correlation between ADHD symptoms and depression in patients with depression. Methods : Participants in this study were 158 outpatients presenting with depression, who visited the psychiatric department from March 2015 to July 2018. Participants divided into a depression and a non-depression group according to the Korean version of the Center for Epidemiological Studies-Depression Scale (CES-D) score and were administered the following : a sociodemographic variables form (age, sex, academic background, occupation), the self-reporting test for adult ADHD (Adult Attention Deficit/Hyperactivity Disorder self-report scale-V 1.1; ASRS V1.1), and the Korean version of the Connors adult ADHD rating scale (K-CAARS). Descriptive statistical analysis, crossover analysis, t-tests, and Pearson's correlation coefficient were conducted on the data. Results : The coexistence rate of adult ADHD symptom was as high as 36.7% in patients with depression (p<0.001). In K-CAARS, the depression group (Inattention=1.80, Hyperactivity=1.92, Impulsivity=1.56, Self-concept=2.06) showed higher average scores on ADHD symptoms than the non-depressive group (Inattention=1.28, Hyperactivity=1.25, Impulsivity=1.09, Self-concept=1.42, p<0.001). Conclusions : This study confirmed that ADHD symptoms coexist in the depression group. When evaluating the symptoms of patients who complain of depression, it is suggested that they should be accurately diagnosed and appropriately treated with interest to the coexistence of ADHD symptoms and the possibility for ADHD diagnosis.

A Study on the Characteristics and Consultation Type of Inpatients Referred for Delirium and Depressive Disorder (섬망 및 우울장애로 자문 의뢰된 입원환자의 임상적 특징 및 의뢰 형태에 관한 연구)

  • Seong min Lee;Seung-Ho Ryu;Jee Hyun Ha;Hong Jun Jeon;Doo-Heum Park
    • Korean Journal of Psychosomatic Medicine
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    • v.31 no.1
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    • pp.10-18
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    • 2023
  • Objectives : The purpose of this study is to investigate the characteristics of patients referred for delirium and depressive disorder and to find direction of improvement of consultation-liason psychiatry in general hospital. Methods : We performed a retrospective computed chart review of the 4,966 inpatients hospitalized at Konkuk University Hospital who were referred to the Department of Psychiatry from August 1, 2005 to December 31, 2011. Results : Depressive disorder shows the order of frequency of consultation type Parallel-Complementary-Mending. Delirium shows the order of frequency of consultation type Mending-Parallel-Complementary. When comparing 'follow up consultation' and 'without follow up consultation' group within the depressive disorder, the proportion of men in the 'follow up consultation' group was higher. In the analysis of the consultation type, the 'follow up consultation' group showed the order of consultation type Parallel-Mending- Complementary, and type Parallel-Complementary-Mending in the 'without follow up consultation' group. When comparing 'follow up consultation' and 'without follow up consultation' group within the delirium, the proportion of the surgical field in the 'follow up consultation' group was higher. In the analysis of the consultation type, both group showed the order of consultation type Mending-Parallel- Complementary. Conclusions : Doctors in each department and psychiatrists should pay attention to delirium symptoms that may occur in surgical inpatients and preventive measures should be taken. Screening tests should be conducted in medical patients to properly evaluate coexisting psychiatric diseases. Risk factors of Delirium and Depressive disorder should be identified from the time of hospitalization, and actively discussing treatment plans and early interventions could improve the quality of medical services.

A CASE OF CLOZAPINE TRIAL FOR A MANIC EPISODE SUFFERED BY AN ADOLESCENT RECOVERING FROM NEUROLEPTIC MALIGNANT SYNDROME (신경이완제 악성증후군 회복후 지속되는 조증에 Clozapine을 사용한 청소년 환자 1례)

  • Cho, Soo-Churl;Hong, Kang-E;Kim, Yong-Sik;Chung, Sun-Ju;Bahn, Geon-Ho
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.9 no.2
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    • pp.247-252
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    • 1998
  • Neuroleptic malignant syndrome(NMS) is an acute, potentially fatal, idiosyncratic reaction to neuroleptic medication. Early recognition and intensive care are crucial. An important issue is whether NMS will recur after initial recovery and subsequent use of neuroleptic medication. The authors presented with a male adolescent who had suffered a bipolar disorder manic episode and been taking clozapine after recovering from MNS. He had been admitted into a psychiatric ward once before and similarly diagnosed. On the second admission, he showed muscle rigidity, autonomic instability, mild fever, severe diaphoresis, and altered mental status on the fourth hospital day following a haloperidol injection. He was diagnosed with NMS, according to the clinical signs and laboratory data. After the use of antipsychotics was discontinued, he was moved to intensive care unit and given dantrolene. His condition began to improve about 48 hours after the onset of NMS. Due to manic behavior, he returned to the psychiatric ward. On the 21 st hospital day, clozapine was administered to counter the manic symptoms. The final dose was 350mg and showed good remission signs without further recurrence of NMS.

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Relationship of Level of Stress, Life Style, Subjective Symptoms and Clinical Diagnosis in Clients taken Multiphasic Screening Program (종합검진 수검자의 스트레스 수준과 생활습관, 자각증상 및 임상적 진단의 관련성)

  • Park, Jun-Han;Chun, Jin-Ho;Kang, Jang-Mi;Son, Byung-Chul;Kim, Dae-Hwan;Lee, Chang-Hee;Jeong, Kui-Won;Urm, Sang-Hwa
    • Journal of Preventive Medicine and Public Health
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    • v.31 no.4 s.63
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    • pp.728-739
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    • 1998
  • To improve wellness and quality of life by recognizing the health efforts of stress, the author estimated the relationships between stress, subjective symptoms and clinical diagnosis through a questionnaire and a battery of specified laboratory tests; electrocardiography, blood pressure, cholesterol, aspartate aminotransferase(AST), alanine aminotransferase(ALT), gamma glutamyl transferase$(\gamma-GTP)$, fasting blood sugar, gastro-endoscopy or UGI, abdominal sonography, etc. The data was gathered from 337 clients who were undergoing multiphasic screening program at a University Hospital from January to March 1998. The mean age of subjects was $46.5{\pm}11.2$ years and the mean of body mass index was $24.0{\pm}3.7kg/m^2$. The mean vol of stress was $18.5{\pm}6.0$ expressed as the score out of 40. By general characteristics and lift style among male, mean level of stress was significantly higher in case of lower socioeconomic status, habitual drug use, longer daily working time(>10 hours), no regular exercise, drinkers, irregular meal, skip-ping breakfast(p<0.05). In case of female, that was significantly higher in case of lower education, lowe. socioeconomic status, longer daily working time(>10 hours), no regular exercise, drinkers, smokers, irregular meal, skipping breakfast(p<0.05). Significant correlations were observed between stress and subjective symptoms in all kinds of organ system (p<0.01). Correlation coefficients of stress among male were relatively high with neuro-psychiatric symptom$(\gamma=0.476)$ and cardio-vascular symptom$(\gamma=0.361)$ in order, and correlation coefficients of stress among female was highest with neuro-psychiatric symptom$(\gamma=0.371)$. The prevalence of the diagnosis through the battery of laboratory tests was high in upper gastrointestinal disorders and hypercholesterolemia in order in both sex group. Among male the mean score of stress was significantly high in ulcerative peptic disorder of upper gastrointestine and hepatopathy in order (p<0.05) . Among female that was significantly high in diabetes mellitus. In summary, it is likely that there are associations between stress, subjective symptoms and clinical diagnosis. To promote wellness and quality of life it would be of value that periodic stress evaluation program and stress management including apropriate control of smoking and drinking, regular exercise and meal.

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Study on Influencing Factors on Subjective Quality of Life and Family Burden of Caretaking Family Members who have a Patient with a Psychiatric Disorder - Comparison between Schizophrenia and Alcohol Dependence - (정신과 환자 주 보호자의 삶의 질과 부담 영향 요인 - 정신분열병과 알콜 의존 환자의 보호자 비교 -)

  • Ryu, Seuk-Hwan
    • Korean Journal of Psychosomatic Medicine
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    • v.12 no.1
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    • pp.56-65
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    • 2004
  • Objectives: The aim of this study was to investigate the quality of life of caretaking family members who have a patient with psychiatric disorders. The results will be served as a basic data of ameliorating the quality of life of caregivers. Methods: 78 caretaking family members who have a patient with schizophrenia and 54 caretaking family members who have a patient with alcohol dependence, a total of 132 persons completed the questionnaire, and analyzed. The Korean version of the SmithKline Beecham Quality of Life Scale and the Family Burden Scale were applied. Results: There was no statistically significant correlation between burden and sex, age, income, and duration of living with patients before onset. The male caregiver showed higher quality of life than that of female. It showed statistically significant correlation between age and factor physical well-being and factor activity. 41% of variance of quality of life of caregivers were explained by the stress response, burden, and overall merits of the field of psychiatry, and the tension had the most explanatory power. Conclusion: The chronic illness may give a burden on caregivers, and that decrease the quality of life of caregivers. The longer duration of illness of patients, the lower quality of life of caregivers on competence factor. Therefore, the authors recommend the therapeutic modality must be offered to the caregivers who may experience the stress and burden.

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