일본 정신병원의 시설현황과 병동특성에 관한 연구

주용선 대한건축학회 2007 대한건축학회논문집 Vol.23 No.2

So far, it is observed that the healing environment is often neglected and hampered by merely protecting patients through guarding them with metallic lattices and such. A psychiatric hospital deserves to be a psychological healing environment for the patients. This feature calls for a deliberate understanding toward psychiatric patients in planning psychiatric hospital. This is a study on the physical environment of psychiatric hospitals in Japan. The study includes data from 554 psychiatric units, 8,214 patient's rooms, 28,195 patients from 129 facilities located in Japan since the year 2000. Insufficiencies in the room space of general patients are evident in most of the cases. The ratio of multi-bed rooms is also considerably higher than the expected level. The existence of protective measures in the patients’rooms is quite prevalent while the required ancillary facilities like wash basins, toilets, tables, and wardrobes, etc. are observed considerably less than the expected level.About characteristics of psychiatric patients in each ward, there are many patients possessing different diseases and symptoms in the same ward. The ward classification by the present building standard is questionable it will function better as a system of the treatment environment, which deliver medical services properly to psychiatric patients, because each patient needs a different physical environment. To build an effective environment in a psychiatric ward for patients, it is important to plan ward characteristics which fit for patients’ treatment, before differentiating wards through the arranging of medical personnel and patients.

국군○○병원 정신과 입원환자의 추적조사

반건호,오동재 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.2

Objects : This study was aimed at 1) the comparison between rejoin and CD groups and 2) the rate of diagnostic agreement and evaluation on discharge between psychiatrists in the army hospitals. Method : This study was designed to follow up 150 inpatients in the department of Neuropsychiatry of 00 Armed Forces Hospital(abbreviated as field hospital) or evacuated via that field hospital from July 1, 1991 to December 31, 1992. They were soldier below the rank of sergeant first class. Results : Among 150 patients, 99 soldier rejoined their unit after proper treatment(abbreviated as rejoin group) and 51 patients were discharged from the service(abbreviated as CD group, compassionate discharge group) in field hospital, evacuation hospital or general hospitals. The rate of onset of psychiatric illness before enlistment was 58.8% in CD group. In rejoin group, 75.7% had the onset of psychiatric illness before private first class. In diagnosis, adjustment reaction and conversion disorder patients were 73.7% in rejoin group. In CD group, almost all were epileptics, major depressions, personality disorders, or mental retardations. Average duration of hospitalization was 76.9±54.6 day in all subjects. There was a statistically significant difference, especially for general hospital(F=32.6176, df=2, p〈.01). Evaluation on discharge was as follows : 1) 34.0% were discharged from the service because of psychiatric illness. 2) 27.3% were expected to serve without further psychiatric symptoms or problems. 3) Even though it is not resolved, 26.7% were expected to serve. The rate of diagnostic agreement between doctors in field-evacuation-general hospital was 84.2%. Conclusion : We have to keep in mind that 58.8% of CD group began to show their psychiatric symptoms and 49.0% had psychiatric problems prior to enlistment. The critical period for the rejoin group was from the beginning of private to private first class. The average duration of hospitalization in the army was longer than that of civilian hospitals. One of the main reasons was due to the characteristic of the evacuation system in the army. With due regard to the evluation on discharge and the rate of diagnostic agreement, army doctors, especially psychiatrists, were excellent at diagnosing and treating the psychiatric patients.

한국 정신보건시설 입원/입소에 대한 재원 적절성 분석

이영문,김현수,이호영 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.5

연구목적 : 한국에서 정신보건시설에 입원중인 환자들의 재원 적절성을 분석하여 재원적절성의 상황을 평가하고 입원중인 환자의 재분류를 위한 기초자료를 마련하여 한국 정신보건의 정책과 대안의 방향을 모색하고자 함이다. 방 법 : 재원적절성을 평가하기 위해 모집단에서 표본집단을 추출하였고 이들에게 재원적절성 평가도구를 실시하였다. 정신보건요원과 정신과 의사에 의해 척도평가와 임상평가가 실시되었으며 이를 다시 종합평가함으로 결과를 도출하였다. 모든 자료는 SAS(Statistical Analysis System) 프로그램에 따라 분석되었으며 Chi-square test에 의해 검정되었다. 결 과 : 종합적 평가에 의하면 한국 정신보건시설에서의 재원적절성은 45.1%로 나타났으며, 척도평가에 의한 재원적절성 판정을 하는데 기여한 주요 요인들을 분석한 결과, 조사기관과 연령이 재원적절성 판정에 가장 큰 영향을 미친 변수임을 알 수 있었다. 그 다음으로는 성별, 진단분류 등의 순이었다. 결 론 : 한국 정신보건시설 입소/입원 환자에 대한 재원적절성 분석의 결과는 향후 지속적인 추후조사가 필요할 것으로 생각되며 재원부적절에 대한 연구도 더 조사되어져야할 필요가 있을 것으로 생각된다. Objectives : We tried to judge appropriate psychiatric hospitalization in Korea. Mental health policy necessitates the evaluation and discussion of the appropriateness for psychiatric hospitalization. This consideration will be the important index for mental health in Korea. Method : We selected samples by probability proportional to size(PPS). And we used Appropriateness Evaluation Scale(AES) developed by us. Criteria assessment and clinical assessment were done by mental health professionals and psychiatrists. Overall assessment followed our flow chart. Data were analyzed with SAS(Statistical Analysis System) using Chi-square test. Results : In the overall assessment, the rate of appropriate psychiatric hospitalization was 45.1%. The most contributing factors to appropriate psychiatric hospitalization were the kind of institutions, age, sex, the classification of diseases in descending order. Conclusion : We think that the results of this studies for appropriate psychiatric hospitalization will be followed by next other research and also the inappropriate psychiatric hospitalization will be scrutinized further.

국군O O 병원 정신과 입원환자의 추적조사

반건호,오동재 대한신경정신의학회 1995 신경정신의학 Vol.34 No.2

Objects : This study was aim ed at 1) the com parison between rejoin and C D groups and 2) the rate o f diagnostic agreement and evaluation on discharge between psychiatrists in the army hospitals. Method • This study was designed to follow up 150 inpatients in the departm ent o f Neuropsychiatry o f 00 Arm ed Forces Field Hospital ( abb reviated as field hospital) or evacuated via that field hospital from July 1,1991 to December 31,1992. They were soldiers below the rank of sergeant first class. Results : Am ong 150 patients, 99 soldiers rejoined their unit after proper treatment(abbreviated as rejoin group) and 51 patients were discharged from the service(abbreviated as C D group, compassionate discharge group) in field hospital, evacuation hospital or general hospitals. The rate of onset of psychiatric illness before enlistment was 58.8% in CD group. In rejoin group, 75.7% had the onset of psychiatric illness before private first class. In diagnosis, adjustment reaction and conversion disorder patients were 73.7% in rejoin group. In CD group, almost all were epileptics, m ajor depressions, personality disorders, or mental retardations. Average duration of hospitalization was 76.9± 54.6 days in all subjects. There was a statistically significant difference, especially for general h o sp ital(F = 32.6176, df= 2 , p 〈.01). Evaluation on discharge was as follows : 1) 34.0% were discharged from the service because o f psychiatric illness. 2) 27.3%were expected to serve without further psychiatric symptoms or problems. 3) Even though it is not fully resolved, 26.7% were expected to serve. The rate of diagnostic agreement between doctors in field-evacuation-general hospital was 84.2% Conclusion : We have to keep in mind that 58.8 % of CD group began to show their psychiatric symptoms and 49.0% had psychiatric problem sprior to enlistm ent The critical period for the rejoin group was from the beginning of private to private first class. The average duration of hospitalization in the army was longer than that of civilian hospitals. One of themain reasons was due to the characteristics of the evacuation system in the army. With due regard to the evluation on discharge and the rate of diagnostic agreement, army doctors, especially psychiatrists, were excellent at diagnosing and treating the psychiatric patients.

정신과 거역 퇴원 환자들의 외래 추적 치료에 대한 순응도와 관련된 요인

한영훈(Young Hoon Han),이도윤(Do Yun Lee),손용표(Yong Pyo Son),박창증(Chang Jeung Park),이광헌(Kwang Hun Lee),사공정규(Jeong Kyu Sakong),곽경필(Kyung Phil Kwak) 대한사회정신의학회 2010 사회정신의학 Vol.15 No.1

연구목적: 이 연구는 정신과 입원 환자 중 거역 퇴원을 한 환자들을 대상으로 어떠한 요인이 퇴원 후 외래 추적 치료에 대한 순응도에 영향을 미치는가에 대해 알아보고자 하였다. 방 법: 2006년부터 2009년까지 4년 동안 동국대학교 경주병원 정신과에서 거역퇴원을 한 163명의 환자들의 진료기록부를 조사하여 퇴원 후 외래 추적 치료를 나온 군과 나오지 않은 군으로 나누고, 외래 추적 치료를 나온 군을 다시 6개월 이상 추적 치료가 지속되는 군과 지속 되지 않는 군으로 나누어 각 군에 영향을 미칠 수 있는 요인들을 비교분석하였다. 결 과: 거역퇴원 후 외래 추적 치료에 한 번도 나오지 않은 환자는 43명이었고 한번이라도 나온 환자는 120명이었다. 그 중 6개월 이전에 외래 추적 치료를 중단한 환자는 49명이었으며 6개월 이상 치료를 지속하는 환자는 71명이었다. 외래 추적 치료의 여부에 영향을 미치는 요인은 거역퇴원의 이유와 거역퇴원 당시의 환자의 상태, 입원 기간이었다. 환자가 환자의 병을 부정하거나 치료에 불만족하여 거역퇴원을 한 경우는 외래 추적 치료가 잘 되지 않았고, 퇴원 당시의 상태가 좋거나 입원 기간이 긴 경우에는 외래 추적이 잘 되었다. 이러한 요인들 가운데 6개월 이상 외래 추적 치료가 지속되는 것에 영향을 주는 요인은 입원 기간뿐 이었다. 이러한 요인 외에 진단명, 사회 인구학적 특성, 입원 경로, 입퇴원 요일, 주치의 성별 및 연차 등 어떤 것도 외래 추적 치료에 영향을 주지 못했다. 결 론: 거역퇴원 환자의 외래 추적 치료에 환자의 병에 대한 인식과 입원 기간이 큰 영향을 미친다는 것을 알 수 있었다. 실제 임상 에서 거역퇴원 환자라 하더라도 외래 추적 치료를 잘 받을 수 있도록 하는 치료진의 노력이 필요할 것이다. Objective:The purpose of this study is to research factors which affect Outpatient department(OPD) follow up and consistency in psychiatric inpatients discharged against medical advice from psychiatric hospitalization. Methods:The subjects in this study were 163 patients who were discharged against medical advice from Department of Neuropsychiatry at Dongguk University Hospital between January 1, 2006 and December 31, 2009. Patients were divided into two groups:patients who came for OPD follow up treatment and patients who did not. The group of patients who came for OPD follow up treatment was then subdivided into two groups:a group with patients who continuously came for OPD follow up treatment for more than 6 months and a group with patients who were lost be-fore 6 months. After classifying the patients, we compared and analyzed the factors which could influence each group. Results:After being discharged against medical advice, 43 patients did not show up for OPD follow up treatment at all and 120 patients came for OPD follow up treatment more than once. 49 patients were lost before 6 months and 71 patients continued to come for OPD follow up treatment for more than 6 months. Factors that affected OPD follow up treatment were the reasons for the patient’s discharge against medical advice, result of treatment and the duration of psychiatric hospitalization. When the reason for discharge against medical advice was complete denial of illness or dissatisfaction with staffs, patients were not well followed up at the OPD. On the other hand, when result of treatment was good at the time of discharge or when the duration of psychiatric hospitalization was long enough, patients were well followed up at the OPD. Among these factors, duration of psychiatric hospitalization was the only one that could affect the continuance of OPD follow up treatment for more than 6 months. Apart from these reasons, diagnosis, so-ciodemographic characteristics, mode of admission, day of admission, day of discharge and gender or grade of doctor did not influenced the OPD follow up treatment. Conclusion:Insight of their own psychiatric illness and the duration of psychiatric hospitalization affected OPD follow up treatment in patients who were discharged against medical advice. In clinical application, even if patients are discharged against medical advice, psychiatrist should make efforts to get those patients to receive OPD treatment.

프랑스의 공중보건법상 비자의(非自意) 정신치료 제도의 특징과 시사점

김영식(Kim Young Sik) 한국법학회 2020 법학연구 Vol.79 No.-

프랑스는 1838년 6월 30일의 ‘정신이상자에 관한 법률’의 제정으로 현재와 같은 자의입원, 제3자의 청구에 의한 입원, 그리고 행정기관에 의한 입원이라는 체계를 갖추게 되었다. 이후 2011년 현재 정신질환자 관리의 근간을 이루게 된 ‘정신치료 대상자의 보호 및 권리, 치료절차와 방식에 관한 법률’이 제정되어 구법을 대체하였고, 비자의 입원치료에 대하여 사법심사제도를 의무화 하였다. 프랑스 정신보건법제가 주는 시사점은 비자의 정신치료 대상자의 권리보호가 단계별 3중으로 보장되고 있다는 점이다. 3중 보장제는 전문가, 행정청, 사법부(인신구속판사)로 구성되고 각 단계별 비자의 정신치료를 위한 세부적인 절차가 법률에 명확하게 규정되어 있어 절차적 권리를 보장할 뿐만 아니라 객관성과 공정성을 담보할 수 있다. 전문가적 심사는 정신과의사의 진단과 소견을 통해 비자의 정신치료의 필요성을 판단한다. 그리고 행정청의 비자의 정신치료 적합성 심사는 치료시설의 장과 도지사(파리의 경우 파리경시청장) 및 도(département)정신치료위원회가 역할을 담당한다. 이들은 각각의 권한의 범위 내에서 상호 보완적 관계이면서 견제 역할을 수행한다. 비자의 정신치료에 관한 사안은 1심법원인 지방법원(le tribunal de grande instance) 소속법관인 인신보호판사가 담당한다. 비자의 정신치료 과정에서 사법심사가 갖는 의의는 독립적이고 객관적인 제3자에 의한 심사와 결정이라는 점이다. 또한, 결정과정에서 처분결정의 청구자와 대상자간의 변론이 보장되고, 인신구속판사의 처분 결정에 대해서는 항소법원에 항고를 할 수 있도록 한다. With the enactment of the “Mental Disorders Act” of June 30, 1838, France has established the current system of voluntary hospitalization, hospitalization at the request of a third party, and hospitalization by administrative agencies. In 2011, the “Act on the rights and protection of persons undergoing psychiatric care and the terms and conditions of their care” which formed the basis of the management of mentally ill patients, was enacted, replacing the old law, and mandating the judicial review system for involuntary hospitalization. The implication of the French mental health legislation is that the protection of the rights of persons subject to involuntary psychiatric treatment is guaranteed in three stages. The triple guarantee system is composed of experts, the administrative agency, and the judiciary, and detailed procedures for mental treatment of each stage are clearly stipulated in the law, ensuring procedural rights as well as objectivity and fairness. Expert examination judges the necessity for involuntary psychiatric treatments through diagnosis and opinions of psychiatrists. In addition, the administrative agency’s examination of the suitability for involuntary psychiatric treatments is carried out by the head of the treatment facility, the provincial governor (in Paris, the head of the Paris Police Department), and the department psychotherapy committee. They are complementary to each other within the scope of each authority and play a role of check. Cases concerning involuntary psychiatric treatments are handled by Liberties and Detention Judges. The significance of judicial review in the process of involuntary psychiatric treatments is that it is an independent and objective review and decision by a third party. In addition, in the decision-making process, the argument between the claimant and the subject is guaranteed, and the decision of the judge can be appealed to the appeals court.

조선대병원에서의 정신과 자문 현황

주경채,박상학 大韓神經精神醫學會 1993 신경정신의학 Vol.32 No.3

We reviewed the medical records of 177 inpatients who were referred for psychiatric consultation from January 1, 1991 to December 31, 1991 at Chosun University Hospital. The results as were follows : 1) 1.41% of all inpatients were referred for psychiatric consultation. There were more men than women. Most of the patients were in their 30's. 14.7% were over 60 years of age. 2) Department of internal medicine referred patients for psychiatric consultation most frequently(49.2%). 3) Most of the patients were referred during the month of May, followed by march and April. 4) The most common reason for psychiatric consultation was physical symptoms which showed no laboratory abnormalities(23.2%). 5) Organic mental disorder was the most common psychiatry diagnosis by consultants after evaluation. 6) Consulting psychiatrists recommended psychotropic medication and psychological management most frequently. 7) In 14.7% transfer to psychiatric ward was recommended and 76.9% among these were actually transferred.

Psychiatric Findings in Suspected and Confirmed Middle East Respiratory Syndrome Patients Quarantined in Hospital : A Retrospective Chart Analysis

HyunChung Kim,SoYoung Yoo,BunHee Lee,SoHee Lee,HyoungShik Shin 대한신경정신의학회 2018 PSYCHIATRY INVESTIGATION Vol.15 No.4

Objective-Little is known about the psychiatric complications or risk factors for depression in suspected or confirmed Middle East Respiratory Syndrome (MERS) patients quarantined in hospital. Methods-A retrospective chart review was performed of all the patients admitted to the acute MERS inpatient unit at the NMC during the 2015 outbreak. Results-30 (75%) were confirmed to be MERS-CoV positive among 40 admitted cases. Among the 24 MERS survivors, 17 (70.8%) exhibited psychiatric symptoms and 10 (41.7%) received a psychiatric diagnosis and medication during their hospital stay. Suspected MERS patients did not exhibit psychiatric symptoms or receive a psychiatric diagnosis. 27 suspected or confirmed MERS patients (age 41.15±18.64, male 37.0%) completed psychological assessments. A multiple linear regression analysis revealed that the Korean National Health and Nutrition Examination Survey-Short form and the Impact of Event Scale-Revised scores were significantly positively correlated with Patient Health Questionnaire-9 scores. Conclusion-Our findings indicate that the acute treatment of MERS-CoV infections in quarantine had a significant impact on the patients’ mental health. Furthermore, assessment of the risk factors for depression may identify vulnerable patients who require psychiatric care and attention during hospital quarantine.

동국대 경주병원에서의 정신과 자문 현황

이광헌,사공정규 동국대학교 경주대학 1998 東國論集 Vol.17 No.1

1997년 1월 1일부터 1997년 12월 31일까지 1년동안 동국대학교 경주병원 입원환자 11988명중 정신과에 의뢰된 132명중에서 병록지를 통한 조사가 가능했던 118명을 대상으로 조사분석한 결과 다음과 같은 결과를 얻었다. 1) 전체 입원 환자에 대한 자문율은 1.10%였고, 남자가 더 많았으며, 연령별 분포는 남녀 모두 30대(24.6%)가 가장 많았고, 40대(17.0%), 50대(17.0%) 순이었고, 60대 이상의 노인들이 25.4%로 이전의 연구들에 비해 많았다. 2) 자문의뢰과는 내과가 50.8%로 가장 많았고, 신경외과(14.4%), 신경과(10.2%), 정형외과(9.3%) 순서였다. 과별입원환자에 대한 자문율에서는 재활의학과(7.02%), 신경외과(2.50%), 신경과(2.33%), 내과(2.32%) 순으로 나타났다. 월별로 살펴보면 9월, 6월, 11월, 4월이 많았고, 10월, 2월, 8월이 자문의뢰가 가장 적었다. 3) 자문의뢰된 이유는 불안, 우울 등의 감정적인 문제가 있는 경우(23.7%)와 알콜 및 약물남용 문제, 이학적 이상 소견 없이 신체증상이 지속되는 경우 등의 순으로 나타났다. 의뢰 환자들의 주증상으로는 위장관계(39.0%)와 두부와 중추신경계(26.3%)가 가장 많은 것으로 나타났다. 4) 자문전에 향정신성 약물이 사용되고 있던 경우는 38.1%였으며, 항불안제가 가장 빈번히 사용되었다. 5) 자문후 진단은 기질성 장애(42.5%)와 우울장애(26.2%)가 많은 것으로 나타났다. 6) 자문의의 권고사항은 약물치료가 92.3%로 가장 많았으며, 가장 많이 처방된 약물은 항우울제와 항불안제였다. 이상의 소견들에 대해 국내외의 자료들과 비교 검토하였다. To obtain relevant data on current trends of psychiatric consultation in a general hospital, the authors reviewed 118 cases of inpatients who referred for psychiatric consultation from January 1. 1997 to December 31. 1997 at the Dongguk University Kyongju Hospital. The results were as follows: 1) The overall consultation rate was 1.1% of all inpatients, and age distribution was heavily concentrated at the age of 30's, 40's and 50's. 2) A majority of referrals came from the department of internal medicine(50.8%) and department of neurosurgery(14.4%). 3) The most common reason of psychiatric consultation were to evaluate excessive emotional reactions(23.8%), while the most frequent symptoms of the referred patients where those related to gastro-intestinal systems(39.0%). 4) The rate of psychotropic drugs use prior to psychiatric consultation was 38.1% and the most frequently prescribed ones were antianxiety drugs(47.3%). 5) Organic mental disorders(42.5%) and depressive disorders(26.2%) were the most common diagnoses given after psychiatric consultation. 6) Use of psychotropic drugs was the most frequent recommendations given after psychiatric consultation.

앙토냉 아르토와 정신병원

박형섭 부산외국어대학교 지중해지역원 2019 지중해지역연구 Vol.21 No.2

Antonin Artaud, a poet of cruelty, suffered from mental illness for life. He has been suffering from mental illnesses such as meningitis in his early days and neurosis since his youth. His writing and artistic activities can not be separated from psychosis. Artaud did not stop writing despite being in custody at a psychiatric hospital. It was the only means of communicating with the outside world as a patient of chronic disease. His morbid state and existence, his dissatisfaction with the absurdity of the world, and mysticism. In psychiatry, this obsession with art therapy is referred to as graphomania. After his expulsion from Ireland, Artaud was transferred to the psychiatric hospital of Sotteville-lès-Rouen in October 1937; then, interned at Sainte-Anne in Paris in April 1938 and finally transported, placed in a straitjacket, to the psychiatric hospital of Ville-Évrard, in the suburbs of Paris, in February 1939. He remained there for four years, until his death. Providential transfer to Rodez in February 1943. Providential, because Ville-Évrard had proved to be a real “deathbed”. The patients fell like flies with being reduced to famine. Today, research on Artaud is continuing in many fields. The texts he had produced are still subject of decryption. Especially, writings confined in psychiatric hospitals are read not only in literature, art, but also in psychiatry. In particular, the writings and paintings of Artaud raise the problem of absolute solitude of human mind, despair of language, manifestation of social maladjustment. The extraordinary world is dominated by poets like Artaud, fantasists, madness owners, and neurotic patients. Their mysterious persuasive powers have given birth to religion and art, and will open a new future. If they say their creative inspiration is poetry, it will at some point come into contact with mental illness. That is the case with Artaud. This study explored writing as a mental illness of this sick-Artaud, the detention of the hospital, and the release of poets.