大學病院 精神科에서 開始病棟과 閉鎖病棟의 治療的 價値의 比較

尹錫夏 慶北大學校 醫科大學 1971 慶北醫大雜誌 Vol.12 No.1

小兒癎疾 患者의 腦波所見

尹錫夏,朴寧雨 慶北大學校 醫科大學 1977 慶北醫大誌 Vol.18 No.1

小兒癎疾 患者에서 몇 가지의 臨床的 要因과 腦波所見과의 關係를 알아 보기 위해 1973年 2月부터 1976年 12月까지 慶北醫大附屬病院 腦波檢査室에서 原因 不明의 痙攣發作 때문에 腦波檢査를 실시한 15歲以下의 小兒患者 267名의 腦波記錄과 그들의 臨床資料를 調査分析했던 바 그 結果를 要約하면 아래와 같다. 267名의 全腦波記錄中 175名(65.5%)의 腦波記錄이 異常腦波 所見을 보였다. 異常腦波의 發顯率은 3-6歲의 年齡群에서 71%로 가장 높았고 3歲 以下의 年齡群이 55%로서 제일 낮았다. 男兒에 비해 女兒의 異常腦波 發顯率이 有意하게 높았고 年齡別로는 7-9歲群에서 女兒가 男兒에 비해 有意하게 높은 發顯率을 보였다. 異常腦波의 波形은 徐波 單獨만 볼 수 있는 것이 가장 많았고 다음으로 여러 가지 波形이 混在하는 것, isolated spike만 있는 것, spike & wave만 보이는 것 等의 順으로 많았다. 異常腦波를 보인 全對象中 異常波의 發顯部位가 局所性인 것이 43%, 全般性인 것이 역시 43%, 焦點性인 것은 14%였으며, 6歲以下의 低年齡群에서는 全般性인 것이 많고 7歲 以上의 高年齡群에서는 局所性인 것이 有意하게 많았다. 異常腦波의 出現部位는 前頭部가 57%로서 단연히 많았고 側頭部와 頭頂部가 各各 16% 後頭部가 11%의 順으로 많았다. 低年齡群에서는 程度가 심한 異常腦波가 많았고, 高年齡群에서는 輕度의 異常腦波가 有意하게 많았다. 發作의 頻度, 마지막 發作後 腦波檢査施 까지의 時間 經過의 長短, 抗痙攣劑의 服用 如否等은 異常腦波의 發顯率, 發顯範圍, 異常程度 等에 그다지 예민하게 反映된다고 볼 수 없었다. In order to determine the factors affecting EEG findings in childhood epileptics, the EEG records and clinical data in 267 children who had the episodes of convulsive seizure of unknown causes were analysed. The selected examinees were those who had been taken EEG examination at Kyungpook National University Hospital during the period of 1973-1976. Out of the total 267 cases 175(65.5%) showed abnormal EEG. The incidence of abnormal EEG stood highest in the age group under 3years (55%). The incidence of abnormal EEG in females was significantly higher than that in males, especially in the age group of 7-9 years. In the wave patterns of abnormal EEG, the most frequently encountered was slow waves, and followed by the mixture of various wave patterns, isolted spikes, spike and wave in the order of lesser frequency. The extent of abnormal waves was 43% for generalized, 43% for localized, and 14% of focal; the proportion of generalized abnormalities was significantly higher in the younger age group than in the older group, whereas in the older age group localized abnormalities were conspicuously greater in proportion. The frontal area was most frequent site of localization (57%), and next came temporal, parietal, occipital area in the order of decreasing frequency. In the degree of EEG abnormality with regard to age group, the proportion of severe abnormality in the younger group was prominently higher than that in older group. It seems likely that the frequency of seizure, the time elapsed from last seizure to EEG tracing, and anticonvulsant medication failed to have a sensitive influence on the degree, extent and incidence of abnormal EEG.

大學病院 精神科에서 開放病棟과 閉鎖病棟의 治療的 價値의 比較

尹錫夏 慶北大學校 醫科大學 1971 慶北醫大雜誌 Vol.12 No.1

大邱地域社會에서의 精神醫學에 對한 態度의 變化

尹錫夏 慶北大學校 醫科大學 1975 慶北醫大誌 Vol.16 No.1

1970年부터 1975年까지 5年間 慶北醫大病院의 一般醫師 看護員 및 大邱市內에 居住하는 一般人을 對象으 로 이들의 精神疾患과 精神科에 對한 態度의 變化를 알아 보았다. 調査方法은 1) 精神病의 原因, 治療, 豫後 2) 精神病患者에 對한 偏見과 拒否 3) 神經症과 精神生理障碍 및 精神治療 4) 精神科, 精神科醫師, 精神科病棟 等 모두 20項目의 選多式으로 된 設問紙를 使用했다. 이 質問紙로 1970年 3月에 慶北醫大病院의 醫師 看護員 84名과 市內에 居住하는 一般人 143名에게 調査 를 實施하고, 같은 質問紙를 사용하여 1975年에 慶北醫大病院의 醫師 看護員 78名과 一般人 475名을 對 象으로 調査하였다. 一般人은 1970年의 調査對象者와 年齡, 敎育程度, 職業等의 條件이 같은 143名을 1975년의 應答者中에서 選擇하여 比較하였고 醫師 看護員은 年齡, 敎育程度가 거의 同一하다고 보고 그 대로 1970年 調査와 1975年 調査 成績을 統計的으로 比較하였던 바 아래와 같은 몇 가지의 事實을 發見 하였다. 1970년 조사와 1975년 조사를 비교할 때 1. 醫師 看護員群에서 1. 變化가 없는 것은 1) 精神疾患의 原因과 精神病의 精神科的 治療에 對해서는 80% 以上이 올바른 知識을 가지고 있고 2) 80% 以上이 如前히 精神病疾患을 앓았던 사람이면 가까운 關係를 맺기를 꺼려하고 있다. 3) 約 半數의 應答者들은 여전히 精神病患者는 대부분 위험하다고 믿고 있으며 精神科病棟의 開放을 찬 성하는 者들은 30% 程度에 不過하다. 4) 醫師 看護員의 半程度는 綜合病院에서 精神科病棟을 獨立된 建物에 分離시키길 바라고 있다. 2. 變化를 보인 것은 1) 精神科病棟의 全的 開放에는 反對者가 아직많으나 精神病患者에게 보다 人道的이고 自由로운 入院에 찬성하는 者가 增加했으며 2) 精神病을 앓았던 사람이라도 皮相的 關係에서는 그들을 社會的으로 받아드리려는 者가 많아졌고 3) 精神病의 豫後에 대해서는 悲觀的 態度를 나타낸 者가 增加하였고 4) 精經病의 治療는 精神科에서 精神治療를 받는것이라는데 찬성하는 者는 줄고 "수양"이 좋다는 應答者 가 增加하였다. 5) 精神科醫師들에 對한 好意的 態度가 적어지고 그들의 分析的 態度에 不快하다는 態度를 가진者가 增 加하였다. 2. 一般人가운데서 1. 變化가 없는 것은 1) 應答者의 約 1/2이 如前히 精神疾患의 原因과 治療에 대하여 잘 알고 있지못하며 2) 約 30%는 神經症의 治療에 관해서도 알고 있지 못하고 3) 精神病이 모두 위험할 것이라는 態度를 보인 者가 如前히 過半數를 차지하며 4) 70% 以上은 精神生理障碍의 槪念에 對하여 多少 알고 있다. 2. 有意한 變化는 醫師 看護員들과 마찬가지로 精神疾患者들에 대한 보다 人道的 入院方法을 支持하는 者와, 깊은 關係가 아니라면 精神病을 앓은 者라도 社會的으로 받아드리려는 者들이 많아졌다. 그러나 醫師看護員들과는 달리 1) 精神治療의 效果와 精神病의 회복 정도에 對한 期待에서 肯定的인 者가 많아졌고 2) 神經症의 原因에 關해 올바르게 알고 있는 者는 줄어든 反面 "精經의 病"으로 誤解하는 者가 많아졌 고 3) 精神病을 모두 위험시하는 者와 가까운 관계를 꺼려하는 者들이 增加하였다. (本硏究를 하는데 여러가지로 도와주신 高麗神經精神科醫院의 金政輝 先生과 慶北醫大病院 腦波檢査室의 林美淑孃에게 심심한 감사를 드린다.) In order to implement the better care for the mentally ill and to promote mental health in general at the given community, it is utmost important to understand the attitude of the general public as well as medical professionals toward psychiatry. In the recent years, it is vaguely believed that the attitude about psychiatry has been much accepted than ever before, however, no systematic research has been done to confirm on the subject. This study is done to compare how the attitude has been changed over the past five years, from 1970 to 1975. In the year of 1970, we had conducted the study to analyze the general attitude about psychiatry by using the the questionaire form of multiple choice. The data were obtained from the random sampling of the staff at Kyungpook University Hospital and the general public in Taegu city. In 1975, five years later, we conducted the same study to compare with the previous findings by using the same questionaire form. Though the samples were not the same as the previous one, we tried to match sex, age and education accordingly. The summary of the study is made as follows: A) Among the medical professionals 1) No significant changes in attitude were noted in the following items: a) More than 80% showed a positive view on the prospect of mental illness. b) More than 80% were still reluctant to have an intimate relation with the mentally ill. c) About half of the respondents saw the mentally ill unpredictable and dangerous, and only 30% favored on the open ward system. d) In the general hospital setting, half of them were in favor of separating the psychiatric ward. 2) Significant changes in attitude were noted in the following items: a) Though they were against opening the psychiatric ward, the increasing trend was exprssed that the mentally ill should be handled more humanistically. b) They became more acceptable toward the mental patients, however, at a superficial level though. c) They became more pessimistic about the prognosis of the psychotic patient. d) The increasing numbers had showed the "rest" would be a preferable treatment for the neurotics. e) Psychiatrists were viewed lesser humanistic and their assumed analytic eyes made the respondent quite uncomfortable. B) Among the general public No significant changes: a) About half of them were still poorly informed about the etiology and treatment of the mental illness. b) About 30% had still held a misconcept on the treatment of neurotics. c) More than half had still seen the mentally ill unpredicatble and dangerous. d) More than 70% were well informed about the psychosomatic concept. Significant changes: Likely with medical professionals a) The increasing trend was expressed that the mentally ill should be handled more humanistically. b) They become more socially acceptable toward the mental patient. Unlikely with the medical professionals, b) They were becoming more positive about psychotherapy as well as about the prospect of psychotics. c) Those who were well informed about neurosis were decreasing in number and they tent to see it caused by the inflammation of "nerve" d) The increasing trend was noted in viewing the mentally ill as dangerous and in relutance to have an intimate relation.

最近 10年間 綜合病院 精神科에 來院한 老人患者에 對한 槪觀

尹錫夏 慶北大學校 醫科大學 1974 慶北醫大誌 Vol.15 No.1

In the recent years, as our nation becomes industrialized, a concern on the geriatric population has been grown. This overview is to provide some fundamental informations for the psychiatric problems among the geriatric population. Total of 319 psychiatric patients of over 60 years old from the psychiatric service of Kyungpook University Hospital and Dongsan Presbyterian Hospital for the past 10 years (1964-1973) have been studied. Some significant findings are summarized as follows; Comparing to the total number of psychiatric patient, geriatric cases comprised only 3.3% of outpatients and 3.2% of inpatients. However, number of outpatient tends to ncrease in recent years, whereas, inpatient to decrease. In the recent years, the elderly cases are more from the rural community, whereas in general. the psychiatric population at large comes from the urban area. Male cases outnumbered female in the entire psychiatric population including the elderly. Approximately 60% of the cases are aged between 60 and 64, and more than 75% are below 70's. Majority of the cases were diagnosed as neurosis, and more than half of which are subtyped as depressive in nature. While the affective psychosis tends to decrease remarkably in the recent years, depressive neurosis tends to increase to the certain extent. Those, who live alone, bereaved spouse, and separated from their eldest son, are seemingly quite prone to "depressive equivalent", ie, more of neurosis and psychophysiological ailment. In viewing the inpatient population, schizophrenia is the most common in 32% of total inpatient, and senile psychosis next in 15%. A third of total cases refused a medical care offered, especially the organic brain syndrome cases were more so up to 44%. Surprisingly, more than 65% of total cases had never made a follow up visit.

7大邱地域社會에서의 精神醫學에 對한 態度의 變化

尹錫夏 慶北大學校 醫科大學 1975 慶北醫大雜誌 Vol.16 No.1

精神科에 來院한 學生患者

尹錫夏 慶北大學校 醫科大學 1977 慶北醫大誌 Vol.18 No.2

中高等 및 大學生들의 情緖障碍를 일으키는데 관여하는 力動的 要因을 찾아보기 위하여, 1973年 부터 1976年까지 4年 동안 慶北醫大附屬病院 및 大邱東山 基督病院 外來에 來院한 學生患者中 functional mental disorder로 診斷된 男女 197名의 患者를 對象으로 이들의 臨床資料를 調査分析하였던바 그 結果를 要約하면 아래와 같다. 全患者中 高等學生이 52%로 가장많고 大學生 34%中學生 14%의 順이었으며 男學生이 女學生 보다5倍나 많았다. 中, 高等學生은 高學年 患者가 低學年 患者보다 많았으나 大學生은 新入生患者가 高學年患者 보다 더 많았다. 來院한 季節別로 보면 3월에서 5월사이의 學年初가 제일 많았고 學年末에 갈수록 적었다. 診斷別로는 神經症이 48%로 가장 많고 다음이 精神病 35%, 精神生理障碍나 人格障碍등은 10%미만이었다. 發病後 來院 까지의 期間이 1年以上인 경우가 47%나 되었고 來院後 治療를 권고해도 이를 받아들이지 않고 follow-up이 안된 患者가 63%나 되었으며 이것은 上級學校에 갈수록 심했다. 神經症群에서는 學習과 관계되는 頭痛, 注意集中 곤란, 기억장애등이 가장 빈번한 主症狀이 였으며 精神病群에서는 行動障碍와 思考障碍, 그중에서 with-drawal이 제일 많은 증상이었다. 死別, 離婚, 別居, 再婚等 父母의 결혼生活에 異常이 있는 患者가 全體의 34%나 됐고 精神病群에서는 44%에 達했다. 精神醫學的 面談을 통해 情緖障碍의 發病에 가장 중요한 力動的 要因으로 생각되는 문제로는 患者에 대한 父母의 잘못된 태도가 50%로 가장 많고, 그중에서 부모의 지나친 기대 때문에 환자가 부담을 느끼고 發病한 경우가 가장 많았다. In order to clarify the factors contributing to mental disorders of students, the clinical data were analysed on a group of 197 junior high and senior high student and college student patients diagnosed as functional mental disorders, who visited outpatient psychiatric department of Kyungpook National University Hospital and Taegu Dongsan Presbyterian Hospital during the period of 1973-1976. Results were summarized as followings: Fifty two percent of the study group were senior high school student, and 34% college students, 14% junior high school students, and the ratio of male to female was 5:1. Among junior high and senior high student patients, higher graders were larger in number, however, freshmen outnumbered juniors or seniors in college student patients. Visits of student patients were most frequent at the beginning of the school year, but less frequent towards the end of the school year. Forty eight percent of total cases were classified as neurosis, 35% as psychosis, 10% as psychophysiologic disorder, and eight percent as other diagnosis. The duration of visting clinic after onset of symptom manifestation was quit long. i.e. for 47% of total cases, it took more than one year to come. In the neurotic group, the most common chief complaint was headache, and next was difficulty in concentration and forgetfulness relating to schoolwork, but in psychotic group, bizarre behaviors and thought disturbances were more common. Sixty three percent of total cases made no follow-up visit after their initial interview, only 11 percent visited more than four times. Fewer college students willingly accepted a proposal for psychiatric treatment than junior high and senior high students. Abnormal marital status of parents such as bereavement, divorce, separation, remarriage, and marital discord were seen in 34% of total cases. Parents' morbid attitude towards students, especially emotional burden caused by parents' overexpectancy, seemed to be the most signigicant factor comtiributing to emotional breakdown.

强迫神經症의 精神治療에 對한 小考

鄭昌鎔,김상욱(?),姜錫憲,尹錫夏 大韓神經精神醫學會 1970 신경정신의학 Vol.9 No.1

1) From the authors' Psychotherapeutic experiences with obsessive neurotics Since 1964. they stressed the characteristic projection phenomena of inner feeling of dissatisfaction or disgust into alleged outer unfulfillment of performances in the repetitive and ritualistic activities of obsessive neurotics. 2) In the earlier phases of psychotherapy with obsessive neurotics, the authors' primary attention is focused on these projection phenomena with the aid of “logical dialogue”which is characterized by therapists' logical attacks at pseudological defensive operations of obsessive neurotics. 3) With these rather half-directed methods, the authors felt the psychotherapists could save much of unnecessary introductory plases of psychotherapy with obsessive neurotics.

敎師로서의 自覺이 精神病 經過에 미치는 影響

李詩炯,申泓湜,尹錫夏 大韓神經精神醫學會 1973 신경정신의학 Vol.12 No.3

This study is aimed at finding out the possible correlation on the influences of professional identity to the clinical symptomatology and progress among the schizophrenic patients. Eight of teacher patients, who were diagnosed as paranoid schizophrenia, over 40 years old, and have had more than 15 years of teacher carrier, were studied in the comparison with other schizophrenics with the same age range and dianosis. Result ; Teacher patients showed; 1) Regressive and aggressive behaviors were much lesser 2) Ward adjustment is better 3) Socialization and recover is faster 4) Precipitating event was identified in more cases In summary, teacher identity was well reflected on their symtomatology and progress, thus it had given a good outcome to their clinical course.

宗合病院 精神科에 入院한 알콜성障碍者들

吳太元,尹錫夏 大韓神經精神醫學會 1980 신경정신의학 Vol.19 No.3

The author has studied the clinical features, drinking patterns, social and family backgrounds of 100 alcoholic patients, who were admitted to the neuropsychiatric wards of Kyungpook National University Hospital and Taegu Dongsan presbyterian Hospital during the period of January 1967 to August 1978. The control group for this study consisted of patients with functional psychosis. The results were as follows: The admission rate of alcoholic patients was 3.1% of all admissions. Most of the alcoholics(70%) fell into the 33 to 40 year old age group. The ratio of alcoholism is 77% to 23%. Alcoholic psychotics showed the highest rate of delirium tremens(50%). There was a tendency for the alcoholics to come from bigger cities as compared with alcoholic psychotics. The socioeconomic levels of alcoholic psychotics was lower than that of the alcoholism. The drinking history showed that the majority of them began drinking in the third decade and drank over ten years. Seventy percent of them had a history of heavy drinking for more than one year. Seventy three percent of the patients drank almost everyday. The most common choice of the liquor was a distilled one("So-Ju"). The interpersonal relationships of the alcoholics were passive, submissive and relatively cooperative while sober. In the drunken state, however, they were found to be aggressive and destructive. Marital and familicts conflicts proved to be the most common pripitating factors(47%). Parental deprivation before puberty wad more prevalent in alcoholic psychotics than in alcoholism. Alcoholic parents were found mare in alcoholic patients than in functional psychotics. In premorbid personality, there was no significant differences between alcoholic patients and functional psychotics. As stated above, there were some rather significant differences of familial and social backgrounds between alcoholism and alcoholic psychotics than between alcoholic psychotics and functional psychotics.