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정신질환자의 계속입원치료 심사에서 불승인에 미치는 요인
이산수,오소영,박민철 圓光大學校 醫科學硏究所 2008 圓光醫科學 Vol.23 No.2
정신보건법에 의한 계속입원치료 심사청구는 해마다 증가하고 있다. 이에 계속입원치료 심사의 청구서에 기재되어 있는 항목들을 바탕으로 일 지역 정신보건심판위원회의 계속입원치료 불승인 현황과 그 불승인에 영향을 주는 요인에 대해 조사하였다. 2002년 1월부터 2006년 12월 까지 5년간 정선보건심판위원회에 요청된 계속입원치료 심사청구는 총 14,782 건이었다. 이 중 불승인은 1,832건으로 약 12.4%의 불승인율을 보였다. 각 요인별 불승인율을 보면, 시설은 정신병원 10.6%, 정신요양원 14.6%이었고, 의료보장 형태는 의료보험 10.5%, 의료보호 12.9%이었고 모두 유의하게 차이가 있었다. 진단에 따른 불승인율은 알코올 중독 27.9%, 기타 17.1%, 정신지체 16.4%, 기분장애 12.5%, 정신분열병 11.5%, 기질성 정신장애 8.6% 순이었으며 유의한 차이가 있었다. 계속입원치료 심사청구 횟수와 진단에 따른 불승인율을 보면 기분장애, 정신지체, 기타 환자들은 3회-6회 사이에서 불승인율이 높았다. 심사청구 횟수와 시설을 보면, 정신병원은 4회 이상에서 정신요양원은 6회 이상에서 불승인율이 높았다. 계속입원치료 심사에 가장 영향을 주는 요인은 시설, 심사청구 횟수, 진단이었으며 주로 정신병원 입원, 알코올중독, 의료보험, 자해 및 타해의 위험성이 낮고 지남력이 좋은 환자들에서 불승인이 되는 경우가 많았다. The number of applications for judgment of continuing hospitalization by the Mental Health Act is increasing every year. Thus, the present study surveyed the current state of continuing hospitalization disapproval by the Mental Health Judgment Board of an area, and factors affecting the disapproval based on items recorded in the application for the judgment of continuing hospitalization. During the 5 years' period from January 2002 to December 2006, there were a total of 14,782 applications for judgment of continuing hospitalization to the Mental Health Judgment Board. Among them, 1,832were disapproved, showing a disapproval rate of around 12.4%. As to disapproval rate related to each factor, according to facility, the disapproval rate was 10.6% for patients at mental hospitals and 14.6% for those at nursing homes for mental patients. According to medical security type, it was 10.5% for medical insurance patients and 12.9% for medical aid patients. These differences were all statistically significant. According to diagnosis, the disapproval rate was 27.9% for alcoholism, 17.1% for others, 16.4% for mental retardation, 12.5% for mood disorder, 11.5% for schizophrenia, and 8.6% for organic mental disorder, and the differences were statistically significant. According to the number of applications for judgment of continuing hospitalization and diagnosis, the disapproval rate was higher when the number of applications was 3~6 among patients with mood disorder, mental retardation, or others. According to the number of applications for review and facility, the disapproval rate was higher when number of applications was 4 or more among mental hospital patients, and when it was 6 or more among nursing home patients. The factors most influential on the judgment of continuing hospitalization were facility, the number of applications for review, and diagnosis, and the disapproval rate was high among mental hospital patients, alcoholics, those with medical insurance, and those with low risk of self-injury and injury by others and good orientation.
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선충류의 주사전자현미경적 관찰을 위한 마이크로웨이브 고정법
이산수,조경오,신길상,신성식,Lee, San-Soo,Cho, Kyoung-Oh,Shin, Kil-Sang,Shin, Sung-Shik 대한수의학회 2007 大韓獸醫學會誌 Vol.47 No.2
Conventional processing of biological materials including nematode parasites for scanning electron microscopy includes fixation with glutaraldehyde and osmium, followed by dehydration in an ascending grade of ethanol, and finally freeze drying. This procedure takes about 8 to 12 h depending on the characteristics of samples. Microwave irradiation of 2,450 MHz enhance the action of cross-linking fixatives and can greatly accelerate various stages of tissue processing. In this study, samples of nematode parasites, Setaria digitata, were fixed by a combination of conventional chemical fixation and the microwave irradiation during the process. The microwave irradiation was also incorporated in the serial dehydration process with ethanol. The complete procedure from the initial fixation to the completion of dehydration with ethanol was reduced to 1 h with good preservation of the ultrastructural details of the specimens.
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신장이식 후 Cyclosporine 사용 중 발생한 조증환자에 대한 Olanzapine 치험례
이산수(Sansoo Lee),이상열(Sangyeol Lee),홍정완(Jeongwan Hong) 대한생물치료정신의학회 2008 생물치료정신의학 Vol.14 No.2
We present the case of a 43-year-old woman with no previous diagnosis of bipolar disorder who underwent kidney transplantation for end stage renal disease. 7 years post-transplant, she exhibited manic symptoms including hyperactivity, elated mood, decreased need for sleep, grandiose and religious delusion, and pressured speech. Most reports about treatment of postoperative psychiatric problem-especially corticosteroid induced mood disor-der-have emphasized the use of Lithium, typical antipsychotics. We found a few case reports in which atypical antipsychotics were prescribed for those case but there is no one in which olanzapine was prescribed in a kidney transplanted patient. Olanzapine is an atypical anti psychotics which has antimanic and mood-stabilizing as wall as sedative properties. And we reasoned that this agent might be useful for the treatment of mania in a kidney transplanted patient who is taking cyclosporine, and we report a case that the olanzapine treatment was successful in the transplanted patient with manic episode.
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정신분열증 환자와 우울증 환자의 감별진단을 위한 성격평가질문지 타당성 연구
오상우,박민철,이산수 圓光大學校 醫科學硏究所 2008 圓光醫科學 Vol.23 No.1
배경: 성격평가질문지(PAI)의 DEP, SCZ척도 그리고 직업 유무와 결혼상태 등의 변인을 사용하여 정신분열병 환자와 우울장애 환자를 가려낼 수 있는지를 알아보았다. 방법: 정신분열병 환자 85명, 우울장애 환자 85명을 대상으로 PAI의 DEP, SCZ척도 직업유무, 결혼상태를 예언변인으로 하고, 진단을 종속변인으로 하여 이항 로지스틱 회귀 분석을 하였다. 결과: PAI 척도의 DEP척도를 예언변인으로 한 첫 번째 모델을 분석한 결과 정신분열병 환자와 우울장애 환자를 가려낼 수 있는 예언치는 67.1%로 나타났다. 또한 PAI 척도의 DEP, SCZ 척도를 예언변인으로 한 두 번째 모델을 분석한 결과 두 장애를 가진 환자를 구분할 수 있는 예언치는 77.1%로 증가하였다. 마지막으로 PAI의 DEP, SCZ척도와 직업유무, 결혼상태를 예언변인으로 한 세 번째 모델을 분석하였을 때, 두 장애를 가진 환자를 가려낼 수 있는 예언치는 증가하였으나, 직업유무와 결혼상태가 예언변인으로 두 장애를 가진 환자를 가려내는데는 실패하였다. 결론: 정신분열병 환자와 우울장애 환자를 가려낼 수 있는 예언변인은 PAI의 DEP, SCZ 척도인 것으로 나타났다. Background: The present study was examined the validity of the personality assessment inventory for differential diagnosis in patients with schizophrenia and depression. Methods: Subjects were 85 patients with schizophrenia and depression each other. The depression scale and schizophrenia scale of the PAI, job and marital status in demographic variables were used as tools of assessment in the study. Materials were analysed statistically by t-test and binary logistic regression analysis. Results: The results were as follows, 1) One model, probability to be discriminated patients with schizophrenia and depression by using depression scale of the PAI was 67.1%. 2) Two model, probability to be discriminated patients with schizophrenia and depression by using depression scale and schizophrenia sacle of the PAI was 77.1%. 3) Three model, probability to be discriminated patients with schizophrenia and depression by using depression scale and schizophrenia scale of the PAI, job and married states in demographic variables was low. Conclusion: Predictive variables to be discriminated patients with schizophrenia and depression were depression scale and schizophrenia scale of the PAI.
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