정신증환자의 입원중 증상변화에 관한 조사

Abstract

현재 정신과적 치료경향은 권위주의를 탈피하여 치료환경에 대한 하나의 통합체로서의 병원환경을 추구하고 있다. 본 조사의 목적은 집단치료를 중심으로 하여 치료환경을 제공한 특수치료의 효과를 평가하여 증상변화의 시기를 예측하고 다른 단독치료효과와 비교고찰하여 향 후의 치료지침을 삼고자 함에 있다. 저자는 1976년 1월부터 1978년 12월까지 3년동안 이화여대부속병원 신경정신과병동에서 입원가료 후 퇴원한 정신증환자 210명을 대상으로 하였다. 자료는 임상병상기록, 집단치료기록 및 사례연구기록을 이용하였고 별도의 평가기준에 의하여 장애유형을 행동, 정서, 사고, 지각 및 통찰력의 다섯장애로 나누어 각 장애의 수준을 다섯 단계로 구분 평점하였다. 평가시기는 입원시, 입원후 매주간, 퇴원시로 하였다. 결과는 다음과 같다. 1. 입원 후 3주에는 행동장애 58%, 정서장애 43%, 사고장애 35%, 지각장애 51%, 통찰력 29%가 첫 호전을 보였고, 행동장애 47%, 정서장애 21%, 사고장애 31%, 지각장애 84%, 통찰력 31%가 퇴원에 만족한 수준까지 호전되었거나 장애가 없게 되었다. 2, 입원 후 6주에는 행동장애 88%, 정서장애 81%, 사고장애 76%, 지각장애 81%, 통찰력 58%가 첫 호전을 보였고, 행동장애 66%, 정서장애 36%, 사고장애 49%, 지각장애 90%, 통찰력 39%가 퇴원에 만족한 수준까지 호전되었거나 장애가 없게 되었다. 3. 장애유형별로는 행동장애·지각장애·정서장애·사고장애·통찰력의 순서로 첫 호전을 빨리 보인 반면, 지각장애·행동장애·사고장애·통찰력·정서장애의 순서로 퇴원에 만족한 수준까지 빨리 호전되었다. 4. 행동장애와 지각장애는 비교적 치료초기에 사고장애는 치료중기에 정서장애와 통찰력은 치료후기에 많은 호전을 보였다. 5. 입원시에 장애를 가장 적게 보인 것은 지각장애며 입원기간 가장 빨리 치유되었다. 6. 정신분열증군의 호전순서는 행동·지각·정서·사고장애 및 통찰력이었다. 7. 정서정신증군의 호전순서는 지각·행동·사고·정서장애 및 통찰력이었다. 8. 정서정신증군이 정신분열증군 보다 호전시기도 빨랐고 호전폭도 컸다. 9. 집단치료와 치료적 환경은 민주적이고 자유롭고 개방적이며 인도주의적이고, 가정과 사회와의 빈번한 유대를 강조하였고, 이러한 환경에서의 증상호전이 보다 희망적일 수 있고, 복합치료가 단독치료보다 효과적이다.;This study investigated the improvement of each disorder of behavior, affect, thought, Perception, and insight, as clinical aspects. The author studied the therapeutic effect of the millieu therapy which had been used with a type of group tyerapy as the main therapeutic too. The subjects consisted of 210 psychotics who had adminitted in Ewha Medical hospital, department of neuropsychiatry from Jan. 1, 1976 to Dec. 31, 1978. The data were collected and analyzed by in-patient medical record, group therapy record, and case conference record. The results were as follows: 1. On 3 weeks after admission, the first improvement was noted in 58% of the subjects in behavior, disorder, 43% of them in affect disorder, 35% of them the thought disorder. 51% of them in perception disorder, and 29% of them in insight. Among them, 47% reached to the satisfactory level for discharge or became well funtioning in behavior disorder, 21% in affect disorder, 31% in thought disorder, 84% in perception disorder, and 31% in insight. 2. On 6 weeks after admission, the first improvement was noted in 88% of the subjects in behavior disorder, 81% in affect disorder, 76% in thought disorder, 81% in perception disorder, and 58% in insight. Among them, 66% reached to the satisfactory level for discharge or became well functioning in behavior disorder, 36% in affect disorder, 49% thought disorder, 90% in percept disorder, and 39% in insight. 3. Compared with each symptom of disorders, the first improvement was obtained as behavior, perception, affect, thought, and insight in the order. But the improvement to satisfactory level for discharge was obtained as perception, behavior, thought, affect and insight in the order. The improvement of disorders of behavior and perception were recognized at early phase of hospitalization, disorder of thought at middle phase, and disorders of affect and insight at late phase. 5. Number of the subjects with perception disorder was the lowest among all disorders at the time of admission, and this disorder showed the best improvement. 6. In the group of schizophrenics, the improvement of each disorder was obtained as behavior, perception affect and thought disorder, and insight in the order. 7. In the group of affective psychotics, the improvement of each disorder was obtained as perception, behavior, thought and affect disorder, and insight in the order. 8. The improvement was recognized better in affective psychotics than schizophrenics. 9. The group therapy and therapeutic milieu were humanistic, permissive, open, democratic, reality-oriented and living learning situation, and were emphasized the close relations between the hospital and the patient's family and community. Under this environment, the improvement of symptoms is more hopeful and multiple treatment is more effective.