非精神科 지료에 있어서의 Somatoform Disorder : 그 임상양상과 치료적 접근 it's Clinical Features and Therapeutic Approach

이만홍 최신의학사 1983 最新醫學 Vol.26 No.7

치료 공동체로의 구성과 추적평가

이기연,김형태,이만홍 大韓神經精神醫學會 1989 신경정신의학 Vol.28 No.1

We converted closed and custodial ward to therapeutic community ward at Bohoon Hospital during the past two years. We have investigated the effect of therapeutic milieu by comparing 3 periods; the period prior to the institution of milieu therapy, slump period and reactivation period. The changes of severat dependent variables-maintenance level of antipsychotics, and the number of parenteral injections, taking hypnotics, acting-out, restraints and maximum security roam(MRS) -were compared and the results were as follows : 1) While main tenance level of antipsychotics and the number of acting-out decreased in slump period of therapeutic community compared to the period prior to milieu therapy, the number of parenteral injections, restraints and MRS rather increased. Inactivation and confusion of therapeutic programs necessitated different methods of maintaining ward environment other than milieu therapy. 2) Especially during the reactivation period following institution of milieu therapy, pathological symptoms and acting-out decreased and therefore, the need for different methods other than milieu therapy to control them decreased, 3) Similar experimentations at other institutions wills be needed to verify our experience with therapeutic community.

의학적 병동에서의 환경 치료적 접근

전석균,이만홍 大韓神經精神醫學會 1987 신경정신의학 Vol.26 No.2

The authors conducted five times Ward Atmosphere Scale (WAS) to evaluate the therapeutic milieu according conversion from medically oriented ward to milieu therapeutic ward. With the abstracted data, was analyzed a changing process according time variable, was compared staff's perception with patient's that of ward atmosphere. Also, to grasp the problems changing in the process of change, it was practiced participant observation, analysis of recording, individual interview with staffs. The results showed that: 1) Owing to a increase of treatment activity program, went on increasing in participation both patient and staff, but have been stagnant a improvement according time variables, have been ineffective in a introducing stage. 2) About ward atmosphere, staffs perceived relatively more negative and pessimistic than patients. 3) In conversion of treatment form, appeared a inferior understanding of staff for milieu therapy, a resistance and anxiety on conversion, and remains a transitional stage rather than a fixational stage because of inharmonious communication and insufficient cooperation for Milieu Therapy.

일부 강원지역에 있어서의 자살기도자에 대한 사회정신의학적 연구

이성훈,이만홍 大韓神經精神醫學會 1982 신경정신의학 Vol.21 No.3

During a 6 month period from April to Sept. in 1979, 99 suicide attempters were brought to Emergency Room of Wonju Christian Hospital of Yonsei Univ.(located in Wonju city, KangwonDo). Complete psychiatric studies were performed with 37 attempters who were admitted, and through which social psychiatric materials were obtained. They were analyzed and compared with suicidal attempters in Seoul. The results were as follows: The male and female ratio was 1.2:1 and most attempters were in their 20s and 40s. In 70.3%, attempts were made without informing the suicidal intent previously. First attempters were 83.3%. 59.5% of the suicidal attempt was carried out between the day and the next after precipitating incidents took place. In 35.1% suicidal attempts were made between noon and 6 PM of the day. The herbicides and insecticides were used most frequently(40.4%), whereas psychotropic drugs were used by 22.2% of the subjects and 35% of attempters could not be diagnosed at the time studies. The main precipitating factors were the interpersonal conflict in the family(49.5%) and of finacial difficulty(13.5%). 56.7% of the relatives of attempters showed genuinely serious worry or concern for the attempters. These attitudes were 4 times as high as for male attempters than for female attempters. But the attitude of rage or hostility toward the attempters were 2 times as high as for female attempters than for male attempters. It seemed that most attempts(67.5%) were psychodynamically motivated by introjected hostility and loss of love object, and attempts were made more impulsively without prolonged psychopathology, and 62.6% of attempters regreted their impulsive acts after their attempt. It appears that these characteristic trends are related to the traditional sociocultural background, particularly Confucianism and Shamanism. And it is a known fact that Kangwon district is still maintaining stronger traditional sociocultural background than urban areas especially large cities in Korea.

정신분열병 환자를 위해 개발된 직업재활 프로그램의 효과

서진환,이만홍 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.1

연구목적: 정신분열병 환자의 심리·사회적 기능과 구직기술의 부족문제를 다루기 위한 훈련 프로그램을 개발하여 수행하고, 그 효과성을 검증함으로써, 정신분열병 환자의 직업재활에 중요한 영향을 주는 개인적 요소의 향상을 위한 전문적인 개입방안을 제시하고자 하였다. 방 법: 직업재활 프로그램을 개발하고, 이를 1998년 1월부터 3개월간 서울 근교의 다섯개 낮 치료기관에 다니고 있는 46명의 정신분열병 환자에게 매주 2회씩 총 21회에 걸쳐 제공하였다. 수행결과를 평가하기 위해 실험집단/비교집단, 사전/사후검사 실험디자인을 사용하였으며, 척도는 구직활동의 적극성 정도(AJHS), 직업생활영역에서의 문제해결기술의 평가, 그리고 양성음성증후군척도(PANSS)를 사용하였다. 결 과: 구직활동의 적극성정도와 문제해결기술정도에서 실험집단이 비교집단보다 통계적으로 유의미하게 증가하였으며(각각p<.05. p<.001). 양성음성증후군 척도상에서는 실험집단이 비교집단보다 증상의 정도가 감소된 것으로 나타났으나, 통계적으로 유의미한 정도는 아니었다. 결 론: 본 연구에서 수행한 직업재활 프로그램은 정신분열병 환자의 구직활동의 적극성 증가와 직업생활영역에서의 문제해결기술의 향상에 효과적인 것으로 나타났다. 훈련을 통하여 구체적으로 겨냥한 태도와 기술훈련의 변화가 증상의 의미있는 감소로 이어지지는 않았으나, 환자의 심리·사회적 기능수준을 향상 시키는데 영향을 준 것으로 나타났으므로, 환자들의 재활을 위한 효과적인 개입 프로그램으로서 중요한 역할을 했다고 볼 수 있을 것이다. Objectives: Despite growing interest in the area of vocational rehabilitation for persons with psychiatric disabilities, there exist few specialized vocational training facilities nor programs for schizophrenic patients in Korea. This study was intended to develop and evaluate a vocational rehabilitation program geared to improving personal factors identified to be the most significant barriers to schizophrenics`vocational rehabilitation. Methods: The effects of program were evaluated using experimental/control pretest-posttest design. An experimental group received the vocational training two sessions a week for three months and a control group received same day treatment except the vocational training. Results: The results indicated that the score of a training group was significantly increased compared to those of a control group on `The assertive job hunting survey` and `The job related problem-solving skill assessment`. The score of a training group on the PANSS was not significantly changed compared to those of a control group. Conclusion: The data provide useful information about the potential role of the program on assertiveness in job hunting activity and job related problem-solving skill. Although the impact of training on symptom reduction was not significant, the program seemed to suggest an important intervention method for schizophrenic patients` rehabilitation.

의과대학생의 도덕발달에 관한 연구

이길홍,문인원,이만홍 大韓神經精神醫學會 1989 신경정신의학 Vol.28 No.5

The purpose of this study is to assess the moral developmental stages among the diffrent grade groups of medical college students and non medical college students using the DIT teat. In order to achieve these set goals, DIT Questionnaires were applied to a total of 451 college students including 362 men and 125 women. Among these, 224 were medical students and 227 were non medical students. The results were as follows ; 1) The mean PM score of sophomore medical students(37.45) in DIT which measure principal morality was significantly higher(p<0.05) than that of freshmen premedical students(28.22) but there was no significant difference of PM score between freshman and senior students groups of non medical college students. 2) In the principal morality developmental stages of the medical college students, the PM scores did not show significant difference according to the variables such as sexs, district and birth order, while PM scores by the grade difference showed more signicant difference in the students without any religion than those with a religion.

신경증 환자들의 방어양상 : Focused on the Christian 기독교인을 중심으로

김임,황나영,이만홍 大韓神經精神醫學會 1992 신경정신의학 Vol.31 No.1

In order to study the relationship between defense mechanism and Christianity in neurotic patient, we measure the ego defense mechanism by Defense Style Questionarre(DSQ) and survey the cause of illness and treatment modality in 155 subjects who are classified as more religious, less religious, and not religious groups by their religiousness. The following results were obtained using computer analysis : 1) In the defense mechanism, more religious group characteristically use denial, anticipation. reaction formation. dissociation(p<0.05) and not religious group characteristically use consumption(p<0.0l). 2) In the Hierachy of maturation proposed by Bond(l983), self sacrificing defense is used in more religious group, less religious group, and not religious group in decreasing order of frequency. The difference is statistically significant(p<0.0l). 3) In the cause of illness and treatment modality, more religious group have most religious attitude among all groups. But interestingly less religious group show intermediate attitude in the cause of illness and have same treatment modality as that of not religious group.

특집 : 우울해 죽겠어요: 현대인과 우울증

이만홍 기독교대한성결교회 활천사 2008 활천 Vol.654 No.-

일부 대학생 집단에서의 주정중독,담배의존,병적과 식욕증 및 병적도박의 유병율과 상관관계에 대한 연구

김광호,신정호,이만홍 大韓神經精神醫學會 1988 신경정신의학 Vol.27 No.6

This study was conducted to estimate prevalences and correlations among alcohol use disorder, tobacco dependence, bulimia and pathologic gambling in a group of college students. A field survey was conducted using the diagnostic interview schedule-Ⅲ(DIS-Ⅲ) for 416 dormitory students of Yonsei University Wonju Campus from November 1, 1986 to November 30, 1986. The results were as follows: 1) 28.0% of male students and 5.8% of female students, total 24.3% showed tobacco dependence. 21.1% of male students, 2.9% of female students, the total18.0% were alcohol abuser. In alcohol dependence, male students formed 7.2% ,female students 2.9% and then the total 6.5%. None of the study subjects were found to be bulimic 18.7% of male students and none of the females were pathological gambler. 2) 12.7% of students had two or more diagnostic categories. Tobacco use disorder and alcohol use disorder(7.7%), pathologic gambling and tobacco use disorder(0.9%), alcohol use disorder and pathologic gambling(2.4%) were coexisting. 3) The odds ratio of pathologic gambling, alcohol use disorder and tobacco use disorder was significantly high; 2.40-2.72. Pearson’s correlation in every two of pathologic gambling, alcohol use disorder and tobacco use disorder were statistically significant(r=0.3358-0.4919).

정신과 병실의 치료환경에 대한 평가-( I ) 병실환경 평가척도의 신뢰도 검사 및 몇가지 변인에 관한 고찰

이만홍,신정호,박정주,임경호 대한신경정신의학회 1985 신경정신의학 Vol.24 No.2

The importance of milieu characteristics in inpatient psychiatric treatment programs has been widely recognized and a number of instruments has been developed to measure these milieu characteristics. Among these instruments, the Ward Atmosphere Scale (WAS), which was developed by Dr. Moos and his colleagues in the Social Ecology Laboratory at Stanford University, is one of the most widely used and the most reliable test to assess the social environment of hospital-based psychiatric treatment programs. As it contains characteristics of culture and value systems of the background society which the psychiatric ward is belonged to, it is necessary to assess reliability and applicability of the instrument again before we use generally in clinical application in a different culture. For this reason, the authors administered the Ward Atmosphere Scale to 291 subiects including patients, students and staff from three different psychiatric inpatient wards: Custodial ward(UUW), Medically oriented ward (MOW) and the authors. Therapeutic community (TCW) to assess the reliability of WAS and it’s stability with consideration of several variables. The results were as follows: 1. The WAS is considered to be a reliable test with moderate to substial interal consistencies of item-total and subscale-total in most :cases, and with low subscale-subscale intercorrelations. However, some of item-subscale internal consistencies dropped to the low level of 0.3,suggesting that the revision of several related items w ill be inevitable. 2. From the result of one-way ANOVA, the WAS showed large significant differences between subiects* perceptions by different therapeutic milieu typology (CUW, MOW, TCW) and by different subjects,status (staff, student, patient), but the evidence indicated that these perceptions are not dependent on several background characteristics such as age, sex and admission (working) days.