정신과 입원환자에서 발생한 중수염에 대한 고찰

A Clinical Study on The Appendicitis among Psychiatric Inpatients

The 10 cases of appendicitis experienced among psychiatric in patients in EwhaUniv. Hospital from Jan . 1977 to Mar. 1981 were retrospectively reviewed. The authers tried to find out characteristics of the clinical features and laboratory data, and the nclarify probable causes of reduced peristalsis which was presumed as the primary process for minglum in al obstruction in view of anticho linergic effect of psychotropic drugs and psychogenic factors, and finally to suggest existing problems in diagnosing and managing psychiatric patients with surgical illness. The following results were obtained； 1. Schizophrenic disorder was the most frequent psychiatric diagnosis. Most of patients showed active psychotic symptoms. Dynamic formulations were mainly composed of guilty or shame (50.0%), hostility and anxiety. 2. It occurred most frequently in the twenties (40 .0% ), and in winter (50.0%). 3. The clinical symptom began with constipation (70.0%) prior to the onset of pain on the R .L .Q . (70.0%) which was the most frequent subjective symptom of appendicitis. Most of patients showed direct tenderness, decreased bowel sound (60.0%) and abdominal distention (40.096) as physical signs. 4. The simple abdomen showed gaseous distention and other ileus sign in 7 cases (87.5%). The hematologic findin g showed normal number of leukocyte in 44.4% and leukocytosis in 33.3%. 5. Most of cases were operated with in 5 days’ lapse after the onset of appendicitis. 6. The operative and histopathological findings showed 9 cases of appendiceal lumen filled with fecalith (90.0% ). 5 cases (50.0%) were acute focal appendicitis, 2 cases normal appendix, another 2 cases acute suppurative appendicitis, and 1 case was chronic appendicitis. 7. Most of patients were hospitalized for 8 days (60.0% ). 8. During stay in the G-S ward, the postoperative psychiatric course showed 1 case of aggrav ation and 9 cases (90.0%) of improvement or no change. But, after discharge, it showed 7 cases of improvement (70.0%) and 3 cases of aggravation (30.096). 9. 4 cases (40.0%) were medicated with one kind of neuroleptic drug combined with anticho linergic drug, 1 case (10.0%) with over two kinds o f neuroleptics combined with anticho linergic d ru g & tricyclic antidepressant, and 5 cases (50.0%) with over two kinds of neuroleptics & anticholinergic drug.