대안 정신보건프로그램에 관한 연구: 정신장애인 취업활동 증진을 위한 비약물 접근을 중심으로

다국어 초록 (Multilingual Abstract)

This study has started from the question of whether psychiatric drugs can enhance vocational activities of people with mental disabilities. Many previous studies have reported that long-term use of psychiatric drugs has not only physical risks but also the risks of developing other mental disabilities due to brain damage, warning the long term use of drugs because it can outweigh the efficacy of the drugs. Accordingly, the purpose of this study is to explore alternative mental health programs based on non-drug or minimized-drug practice and to seek ways to prevent the risks from long-term use of psychiatric drugs or daily crisis in vocational activities of people with mental disabilities. In order to achieve the research purpose, we analyzed Open Dialogue of Finland, Soteria Bern of Switzerland, and Bethel House of Japan. As a result, the commonality of the alternative programs was converged to be replacing the “prescription by an expert – family care” support system with an alternative support system of “collective care including peers.” Based on the results, this study proposes the following seven ways to adapt alternative mental health programs to vocational rehabilitation facilities. First, the care system by a few families should be disorganized and the structure for care by multiple persons should be formed in the community. Second, the care and support system with multiple persons, including peers and neighbors, must be intentionally organized and managed in the community. Third, the composition of care and support groups should be based on the feeling of security of the person concerned. Fourth, the self-determination of psychiatric drugs should be encouraged in the new care system. Fifth, the place of collective care and support can be freely selected and the choice of the person concerned must be respected. Sixth, if the person concerned is in a crisis, the group should be collected immediately and the person concerned should be encouraged to talk about his/her difficulties in life or his/her symptoms in a crisis in the group meeting. Seventh, using an advanced mental health care directive that describes self-determination about crisis situations through the collective process can make the person concerned feel a sense of security.

참고문헌 (Reference)

1 이용표, "핀란드 오픈다이얼로그에 대한 탐색적 연구 - 정신장애에 관한 정신의학적 모델의 수정을 중심으로 -" 한국장애인복지학회 40 (40): 291-319, 2018

2 송태욱, "지금 이대로도 괜찮아" 삼인 2006

3 이용표, "정신장애인의 항정신병약물 복용 경험에 대한 연구: 하이데거의 기술 비판을 중심으로" 한국장애인복지학회 44 (44): 5-43, 2019

4 배진영, "정신장애인의 약물 중단 경험에 대한 연구" 가톨릭대학교 2020

5 김호현, "정신장애인대안공동체 연구" 203-247, 2016

6 이진의, "정신장애인 '당사자연구' 참여경험에 관한 연구" 가톨릭대학교 2017

7 이용표, "일본 베델의 집은 정신장애인 대안공동체인가? - 사회복지프로그램의 관점을 중심으로 -" 한국사회복지교육협의회 42 : 57-84, 2018

8 송태욱, "베델의 집 사람들" 궁리출판 2008

9 べてるしあわせ研究所, "베델의 집 렛츠! 당사자연구" EM 커뮤니티 2016

10 박경수, "발달장애인의 직업활동" EM 커뮤니티 2014

11 김상환, "라깡의 재탄생" 창비 2002

12 Scull, A. T., "광기와 문명: 성경에서 DSM-5까지, 문명 속의 광기 3000년의 역사" 뿌리와이파리 2017

13 Alanen, Y. O., "Towards a more humanistic psychiatry : Development of need‐adapted treatment of schizophrenia group psychoses" 1 (1): 156-166, 2009

14 IMS Health Incorporated, "Top therapeutic classes by prescriptions"

15 McCreadie, R. G., "The scottish first episode schizophrenia study: VII. two‐year follow‐up" 80 (80): 597-602, 1989

16 Capite, S., "The relapse rate and predictors of relapse in patients with first-episode psychosis following discontinuation of antipsychotic medication" 12 (12): 893-899, 2018

17 Goldsmith, L., "The psychoactive effects of antidepressants and their association with suicidality" 6 (6): 115-121, 2011

18 Ciompi, L., "The pilot project ‘Soteria Berne’clinical experiences and results" 161 (161): 145-153, 1992

19 Seikkula, J., "The open dialogue approach to acute psychosis : Its poetics and micropolitics" 42 (42): 403-418, 2003

20 Lakeman, R., "The finnish open dialogue approach to crisis intervention in" 20 (20): 28-, 2014

21 Ciompi, L., "The concept of affect logic : An integrative psycho-socio-biological approach to understanding and treatment of schizophrenia" 60 (60): 158-170, 1997

22 Nasrallah, H. A., "The case for long‐acting antipsychotic agents in the post‐CATIE era" 115 (115): 260-267, 2007

23 Bond, G. R., "The Role of Medications in the Employment of People with Schizophrenia" 65 (65): 1999

24 Bond, G. R., "The Impact of Atypical Antipsychotics on Vocational Outcomes in a Psychiatric Rehabilitation Agency (Final Report to Eli Lilly)" Indiana University-Purdue University Indianapolis 1998

25 PAXIL®, "Tablets and oral suspension. Prescribing information"

26 Mosher, L. R., "Soteria-california and its american successors : Therapeutic ingredients" 6 : 7-24, 2004

27 Ciompi, L., "Soteria berne : An innovative milieu therapeutic approach to acute schizophrenia based on the concept of affect-logic" 3 (3): 140-, 2004

28 Ciompi, L., "Soteria Berne: 32 years of experience" 168 (168): 10-13, 2017

29 Noordsy, D. L., "Risperidone versus olanzapine among patients with schizophrenia participating in supported employment : Eighteen-month outcomes" 95 : 299-307, 2017

30 Gaebel, W., "Relapse prevention in first-episode schizophrenia--maintenance vs intermittent drug treatment with prodrome-based early intervention : Results of a randomized controlled trial within the german research network on schizophrenia" 72 (72): 205-218, 2011

31 Wunderink, L., "Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy : Long-term follow-up of a 2-year randomized clinical trial" 70 (70): 913-920, 2013

32 Bola, J. R., "Psychosocial treatment, antipsychotic postponement, and low‐dose medication strategies in first‐episode psychosis : A review of the literature" 1 (1): 4-18, 2009

33 Breggin, P. R., "Psychiatric drug-induced chronic brain impairment(CBI) : implications for long-term treatment with psychiatric medication" 23 (23): 193-200, 2011

34 Breggin, P. R., "Psychiatric drug withdrawal: A guide for prescribers, therapists, patients and their families" Springer 2013

35 Hamilton, S. H., "Olanzapine versus placebo and haloperidol : quality of life and efficacy results of the North American double-blind trial" 18 (18): 41-49, 1998

36 Teal, J., "Nothing personal : an empirical phenomenological study of the experience of"being-on-an-SSRI" 40 (40): 19-50, 2009

37 Räkköläinen, V., "Need-adapted treatment of schizophrenic processes : The essential role of family-centered therapy meetings" 13 (13): 573-582, 1991

38 Marynowski-Traczyk, D., "Mental health presentations to the emergency department : A perspective on the involvement of social support networks" 22 (22): 162-167, 2019

39 Miller, R., "Mechanisms of action of antipsychotic drugs of different classes, refractoriness to therapeutic effects of classical neuroleptics, and individual variation in sensitivity to their actions : Part II" 7 (7): 315-330, 2009

40 Littrell, K., "Maximizing schizophrenia treatment outcomes : A model for reintegration" 19 (19): 75-, 1995

41 Chen, E. Y., "Maintenance treatment with quetiapine versus discontinuation after one year of treatment in patients with remitted first episode psychosis: Randomised controlled trial" 341 : c4024-, 2010

42 Whitaker, R., "Mad in America: Bad science, bad medicine, and the enduring mistreatment of the mentally ill" Basic Books 2001

43 Lindström, L. H., "Long-term effect on outcome of clozapine in chronic therapy-resistant schizophrenic patients" 12 : 353s-355s, 1997

44 Ho, B. C., "Long-term antipsychotic treatment and brain volumes : a longitudinal study of first-episode schizophrenia" 68 (68): 128-137, 2011

45 Fisher, D. B., "Heartbeats of Hope" Massachusetts National Empowerment Center 2017

46 김현수, "Haloperidol Induces Calcium Ion Influx Via L-Type Calcium Channels in Hippocampal HN33 Cells and Renders the Neurons More Susceptible to Oxidative Stress" 한국분자세포생물학회 22 (22): 51-57, 2006

47 Wunderink, L., "Guided discontinuation versus maintenance treatment in remitted first-episode psychosis : Relapse rates and functional outcome" 68 (68): 654-, 2007

48 Kane, J. M., "Fluphenazine vs placebo in patients with remitted, acute first-episode schizophrenia" 39 (39): 70-73, 1982

49 Kilbourne, A. M., "Excess heart-disease-related mortality in a national study of patients with mental disorders : identifying modifiable risk factors" 31 (31): 555-563, 2009

50 Ljung, R., "Ethnic differences in antidepressant treatment preceding suicide in Sweden" 59 (59): 116-117, 2008

51 Squire, L. R., "Effects of lithium carbonate on memory and other cognitive functions" 1980

52 Noordsy, D. L., "Effectiveness of combining atypical antipsychotics and psychosocial rehabilitation in a community mental health center setting" 60 : 47-, 1999

53 Meyer, P. S., "Comparison between the effects of atypical and traditional antipsychotics on work status for clients in a psychiatric rehabilitation program" 2002

54 Gitlin, M., "Clinical outcome following neuroleptic discontinuation in patients with remitted recent-onset schizophrenia" 158 (158): 1835-1842, 2001

55 Razzano, L. A., "Clinical factors associated with employment among people with severe mental illness : Findings from the employment intervention demonstration program" 193 (193): 705-713, 2005

56 Dumont, G. J. H., "Biomarkers for the effects of selective serotonin reuptake inhibitors(SSRIs)in healthy subjects" 59 (59): 495-510, 2005

57 Cavanna, A. E., "Behavioral and cognitive effects of anti-epileptic drugs" 9 (9): 138-144, 2010

58 Boonstra, G., "Antipsychotic prophylaxis is needed after remission from a first psychotic episode in schizophrenia patients : Results from an aborted randomised trial" 15 (15): 128-134, 2011

59 Wils, R. S., "Antipsychotic medication and remission of psychotic symptoms 10years after a first-episode psychosis" 182 : 42-48, 2017

60 Goldberg, J. F., "Antidepressant‐induced mania : an overview of current controversies" 5 (5): 407-420, 2003

61 Henry, C., "Antidepressant-induced mania in bipolar patients : identification of risk factors" 62 (62): 249-255, 2001

62 Medco Health Solutions, "America’s state of mind"

63 Seikkula, J., "Alternatives Beyond Psychiatry" 223-240, 2007

64 Ciompi, L., "Affect logic: An integrative model of the psyche and its relations to schizophrenia" 164 (164): 51-55, 1994

65 Calton, T., "A systematic review of the Soteria paradigm for the treatment of people diagnosed with schizophrenia" 34 (34): 181-192, 2008

66 Crow, T. J., "A randomised controlled trial of prophylactic neuroleptic treatment" 148 (148): 120-127, 1986

67 Harrow, M., "A 20-year multi-followup longitudinal study assessing whether antipsychotic medications contribute to work functioning in schizophrenia" 256 : 267-274, 2017