DUE ANNI DI OBSERVAZIONI NEUROPSICHIATRIGHE NELL5 OSPEDALE DELLA C.R.I. IN KOREA

대한신경정신학회 대한신경정신의학회 1962 신경정신의학 Vol.1 No.2

1952년 9월부터 54년 9월까지의 만 2년간 이태리적십자병원 (영등포)에서 나는 그 병원을 찾아온 총환자 18 만명 중 2,386명의 신경정신과환자를 관찰할 수 있었는데 이 논문은 그 경험의 대요를 보고하는 것이다. 단 이 것은 한국어와 영어를 통하여 2중으로 통역된 말의 내용을 가지고 간단히 노오트하였 던 것 을 기준으로 한것 인 만 큼 여러 가지 난점과 정확성을 기하기 어려운 애로점이 있었던 것을 미리 말해 둔다. 환자의 종류는 단순한 신경피로로부터 전형적인 정신분열증에 이르는 각종 정신질환자와 경한 감각 및 운등 장해와 중한 척수 및 뇌수질환 등의 신경학적 질환이 많이 있었다. 대부분이(약 80%) 외래치료를 받았는데 짧은 것은 단 1회의 치료를 받았고 긴 것은 상당기간의 치료를 받은 것도 있었다. 입원치료를 받은 것은 약 20%이 었으나 모두 신경 학적 질환이 었고 정 신과 환자는 시설이 없었기 때문에 입원까지는 시키지 못하였다. 가장 많이 경험한 것은 신경통 특히 좌골신경통환자들 이었는데 그것의 거의 다가 r류마치스j 성 같았고 전염 성, 독소성, 또는 비타민 결핍 둥으로 인하여 발생하는 다발성 신경염 같은 것은 무척 적 었다. Guillan-Barr은증후 는 1례가 있었는데 퍽 홍미 있었다. 척수염, 소아마비 등도 적지 않게 관찰하였다. 다이빙올 하다가 척수출혈이 되 어 Brown-Sequard증후가 나타난 예 도 하나 있었다 상당히 진행된 근육마비와 위축이 있는 몇몇 케이스들이 면밀한 병리시험 검사결과 매독성에 의한 것으로 관명된 것도 있었다. 그러나 내가 여기에 강조하고 싶은 것은 한국에 있어서 는 구라파에서 보 는것보 다 신경계통의 매독성질환이 놀랄 정도로 적은 것 같이 느꼈다. “Tabes” 의 케이스는 단 2례 밖에 없었다. 진행성마비형의 신경매독은 6례 있었는데 그 중 2례는 특유한 우울형 증후상 을 보였고 하나는 심한 치보상태가 진행되어 경련발작 까지 나타났었다. 모든 진행마비 케이스에 있어서 예후 는 좋지 못하였다. 「비스무트」와 다량의 r페니실린」올투여 하였으나 좋은 효과를 보지 못하였다. 2례의 뇌염 후 Parkinson증후를 보았고 소수의 Chorea (무도병)도 보았는데 후자는 류마치스성으로 온 것만 보 았다. 유아의 뇌수질환은 비교적 많이 눈에 띄었는데 뇌염 및 뇌수종 등이 원인으로 되어있는 예가 많았다. 소 아들 중에는 선천적으로 온 정신박약의 예도 많았다. 간질환자는 소아들에게서나 성인에게서나 다 같이 많이 볼 수 있 었는데 전신발작 Jackson 발작 감각 및 내 장증 후의 발 현둥 가지가지의 증후군 보였고 정 신발작을 일으키는 예도 있었다. 이 런 간질발작이 과거 및 현재의 어면 세균의 감염과 관련이 있는 것으로 보여진 예가 많았다. 어면 예에 있어서는 장내(腸內)기생충에 의한 것으로 보인것도 있었다. 물론 저자는 간질병에 있어서 소인 (素因) 을 무시 하는 입 장은 아니 다. 간질환자 중에는 알코올중독 또는 그 양친의 알코홀중독이 증명되는 경우도 많았다. 한국의 소주를 많이 마시는 사람에게 알코올중독에 의한 뇌수중독증이 있는 케이스도 가끔 눈에 띄어 주목하 였다. 마약중독은상당히 많았던 것으로 보는데 정신증상 및 경련 기타의 신경학적 증상을 보이는 예도 적지 않았 다. 자살기도로 젊은 여인네들이 r발비탈J중독이 되어 온 예도 더러 있었는데 그 중의 하나는 중독상태에서 깨 어난 후 보니까 정신분열증이라는 것이 판명되어 전문병원으로 전원시킨 것도 있다. 정 신분열증은 자주 본 편이 다. 2년 등안에 약 100케이스나 진단할 수 있었는데 제 일 많은 것은 파과 (破瓜)형 이 었는데 이것은 구라파에서 보는 예와 별다를 것 없이 전형적인 증상이 유사함을 브았다. 다른 형 (型)의 분열증 은 드물었고,정 동성 질 환 (조울병)은 퍽 드물었다. 순환(循環)병이라고도 하는 이 병의 경과가 정말 주기성으 로 나타나는 것은 거의 보지 못했다. 우울증의 한 케이스는 단순하기도 하지만 퍽 의미 깊은 것일지도 몰라 간단히 소개해 둔다. 1952년 11월에 미군의 소개로 내원한 한국인이었는데 대퇴부골절로 입원케 되 었다. 그런데 이 환자에는 동시 에 상당한 우울 증이 있었다. 나중에 알고보니 까 내 원 약 7개 월 전에 출혈열 (出血熱)을 앓고 난 것이 발견되 었는데 그• 이외 에는 아무런 탈도 없었다. 순환병의 발작도 한 번 없었다. 그러니까 이 우울증이 출월병과 직접 관련된 것이라고 즉시 결론을 내리는 데는 주저 하는 바이 지 만 일단 그런데 관심을 두고 관찰해 보는 것도 홍미 있는 일이라고 느꼈다. 내가 본 정신과 환자는 혼히 홍분성이었다. 불안형은 비교적 적었다. 치 보상태 에 이르른 케 이스도 많았다. 전쟁으로 인한 정신과적 질환도 많이 보았다 특히 그것은 내가 한국에서 근무하던 첫 해가 치

第二編 詐病의 臨床的 理論的 考擦

대한신경정신학회 대한신경정신의학회 1966 신경정신의학 Vol.5 No.1

The Personality characteristics of malingerers, simulated grandmal epileptic convulsion and admitted to army hospital was studied with MMPI and Machover test in comparison with normals, epileptics and hysterics. And the clinical value of the two tests in differencial diagnosis between malingering from epilepsy and hysteria was also evaluated in this paper. 1) MMPI of the malingerimg revealed a significantly neurotic pattern. This pattern was very similar to those of hysteria and epilepsy except higher Pd to hysteria and higher L to epilepsy. 2) Machover test of the malingering revealed significantly higher total problem index in contrast with normals, and was similar to that of delinquent pattern. No distinction of the malingering to hysteria could be evaluated in total problem index and each scale, and malin gering revealed definitely higher score in total problem index and Sch, Ps, in comparison with epilepsy. 3) The personality characteristics of the malingerers may be considered as a hysterical pattern with mild psychpathic tendency. 4) The significance of MMPI in differencial diagnosis between malingering from hysteria and epilepsy could not be found in our sample. 5) Machover test did not give any meaning to differenciation between malingering from hysteria, but gave some meaning differenciation fronx malingeres. Part II: Clinical and of the Malin gTehreerosr.etical study This part took the focus to study some antecdent factors, clinical problems and dynamic relationship between hysteria and malingering with case analysis and discussion. 1) Our malingerers revealed the relatively higher status in the socio-economico-cultural pattern. 2) In birth order, 73 per cent of the malingerers were the first son or the solitary. This interesting pattern was closely related to the overprotective child rearing of their parents. Many of them were passive and immature in premorbid personality. With above several patterns the similarity in some factors of early life history. and personality developement of hysteria and malingering was discussed with dynamic concept. 3) The soldiers begin to simulate some convulsive: disorders in the period of fresh-man who feels a difficulty in army adjustment. 73 per cent of cases were admitted to hospital with simulation within first 6 month of service, others within first 12 month, and all of them, under the private P. F. C. in army rank. 4) The clinical value of the various diagnostic methods was discussed in the light of the previous authors and my experience. Prognosis was partly depend upon the method of control Early detection and “early return to duty” with proper punishment were considered as the desirable methods. 5) Psychodynamically, malingering revealed many similarity to hysteria, in birth order, child rearing, pattern of personality developement and motivation of simulation, except conscious identification of the symptom in malingering With an interesting case who revealed alternately malingering and hysteria, I discussed also their similarity and concluded that hysteria, and malingering were a clinical transitionand not different entity in the meaning of dynamic concept.

學術用語

대한신경정신학회 대한신경정신의학회 1962 신경정신의학 Vol.1 No.1

精神障碍患者에서 相異한 大小集團間의 相互作用 및 意見一致度에 關한 硏究

대한신경정신학회 대한신경정신의학회 1964 신경정신의학 Vol.3 No.2

精神障碍患者間의 社會測定學的 地位와 個A 適應度에 關한 硏究

대한신경정신학회 대한신경정신의학회 1964 신경정신의학 Vol.3 No.2

우리나라 정신건강의학과 전공의의 자살에 대한 지식, 태도 및 경험에 대한 고찰 : 횡단연구

이경린,이강욱,황준원,한상우,대한신경정신의학회 수련위원회 대한신경정신의학회 2015 신경정신의학 Vol.54 No.4

Objectives This study investigated the effects of the grade of residents, sociodemographic vari¬ables, and clinical experience with suicidal patients on the knowledge and attitudes toward sui¬cide among psychiatric residents in Korea. Methods A self-reporting survey including 30 questions was conducted together with an inves¬tigation of the sociodemographic background of the research subjects. The questionnaire was com¬posed of general knowledge questions on suicide, suicide-related personal experience, attitudes toward suicide, and the treatment experience of suicide attempt patients. Chi-square test and bi¬nary logistic regression analysis were used to determine the differences and associations among the attitudes toward suicide, clinical experience of suicide, and sociodemographic characteris¬tics. Results A significantly higher response rate was presented in the 4th grade on general knowl¬edge of suicide and treatment experience with suicide attempt patients than in the 1st grade. Residents with previous history of psychiatric treatment suicide plans, or attempts presented a significantly higher level of permissive attitude toward suicide. Residents who had a previous his¬tory of suicide attempt among their own patients were more likely to think that they were more capable to prevent suicide of patients. Conclusion Effective clinical practices are essential considering the fact that the highest sui¬cide risk groups will inevitably be referred to psychiatric clinical services. The authors expect that the study results regarding suicide-related knowledge, attitudes, and the experience of psychiat¬ric residents will contribute to the development of effective resident training programs for suicide-related clinical practice in Korea.

정신치료 수련의 질과 역량에 관한 정신건강의학과 전공의 인식도 조사

김예지(Ye Ji Kim),견영기(Yeong Gi Kyeon),이승재(Seung Jae Lee),전명욱(Myong-Wuk Chon),이상원(Sang Won Lee),정성원(Sung Won Jung),이강욱(Kang Uk Lee),대한신경정신의학회 수련위원회(The Committee of Residency Training of the Korean Neurop 대한신경정신의학회 2021 신경정신의학 Vol.60 No.3

Objectives This study surveyed the quality of psychotherapy training and psychotherapy competencies during residency in Korea. Methods A questionnaire developed by The Committee of Residency Training of the Korean Neuropsychiatric Association was completed by fourth-year residents of Korean psychiatry (n=120). The questionnaire examined their demographic characteristics, their experience of clinical psychotherapy training, their degree of satisfaction in the quality of psychotherapy training, and self-rated competence regarding the six types of psychotherapies, including supportive psychotherapy, cognitive behavioral therapy, interpersonal psychotherapy, psychoanalytic psychotherapy, group psychotherapy, and family psychotherapy. Results The degree of satisfaction of the residents with the psychotherapy training was diverse among the types of psychotherapy and contents of training. Across all types of psychotherapies, the satisfaction levels of the quantity and quality of supervision education were low, except for psychoanalytic psychotherapy. Overall, more than 70% of residents were not satisfied with the theoretical education, clinical practice, and supervision education in three types of psychotherapies, including interpersonal psychotherapy, group psychotherapy, and family psychotherapy. A positive correlation was found between the degree of satisfaction with the quality of training experience and self-rated competence of psychotherapy. Specifically, the self-rated competence of psychotherapy was more highly correlated with the experience of clinical cases and supervision than theoretical education Conclusion This study showed the quantitative and qualitative status of psychotherapy training in Korean psychiatry residency programs, and the satisfaction level of psychotherapy education was low except for psychoanalytic psychotherapy. There is a strong need for the improvement of psychotherapy training programs in Korea.

우리나라 정신건강의학과 전공의의 수련 실태 설문 조사

김지훈,견영기,김종우,오홍석,이상민,서정석,정성원,이강욱,대한신경정신의학회 수련위원회 대한신경정신의학회 2019 신경정신의학 Vol.58 No.3

Objectives The authors evaluated the environment and conditions of Korean psychiatric residents to identify important factors for them in determining their satisfaction with training programs. Methods Questionnaires on the residency training program were administered to 513 Korean psychiatric residents from 2016 to 2017. The questionnaire was composed of sociodemographic background, work environment and status of the training program. The authors analyzed questionnaire according to the residents’ grade and hospital type and identified the significant factors for satisfaction with their training. Results Compared to the 1st grade, the 4th grade psychiatric residents have significantly less working time, duty days, and more sleep time, mealtime, and annual salary. In the hospital type, the residents of general hospitals and university hospitals have more working time, annual salary, and accessibility to educational material than mental hospitals. The satisfaction with their training is higher in the 1st grade than in the 4th grade, in those with more than six hours of sleep time, and in residents who are satisfied with the accessibility of educational materials. Conclusion Compared to the 1st grade, the working intensity of 4th grade psychiatric residents is lower and their welfare is better. To improve the satisfaction with the training program, it is necessary to make efforts to increase the sleep time of residents, improve the accessibility of educational material, identify the problem of the training program, particularly in the 4th grade, and make institutional improvements.

정신건강의학과 수련교육의 질과 임상역량에 대한 전공의와 전문의의 인식도 조사

김형준,견영기,최종혁,오홍석,이상민,정성원,이강욱,대한신경정신의학회 수련위원회 대한신경정신의학회 2020 신경정신의학 Vol.59 No.2

Objectives This study surveyed the quality of the residency training program and clinical competence of Korean psychiatry residents and psychiatrists Methods Questionnaires regarding the quality of residency training and clinical competence were administered to Korean psychiatry residents (n=102) and psychiatrists (n=157). The authors analyzed the quality of training education according to the training environment and the correlation between the quality of training and the self-assessment competence level. Results The average score of the quality of training evaluated by the residents (n=102) was 3.57 (±1.00). Groups with more than or equal to three residents (annual) scored higher (3.69±1.03) than the groups with less than or equal to two residents (3.52±0.99). Groups with more than or equal to seven teaching psychiatrists scored higher (3.42±1.03) than the groups with less than or equal to six teaching psychiatrists (3.42±1.03). The quality of training and self-assessment competence showed a significant static correlation in the residents (R2=0.488, p<0.01) and psychiatrists (R2=0.508, p<0.01). Conclusion This study shows that the quality of residency education varies according to the clinical area and the environment. The importance of training education is emphasized by the static correlation between the quality of education and clinical competence.