정신분열증 환자의 거식증에 관한 정신의학적 연구

THE PSYCHIATRIC STUDY ON REFUSAL OF FOOD IN HOSPITALIZED SCHIZOPHRENICS

In this study, it was attempted to reveal the psychodynamics and the ideal psychiatric care for the cases with refusal of food in 30 cases of hospitalized schizophenics including 10 cases of the hyperactive, 10 cases of the underactive, and 10 cases of the paranoid patients admitted to the department of Neuropsychiatry, Chung Ang University Hospital from Jan. 1974 to Dec. 1974. The results were as follows; 1. Among 30 cases of hospitalized schizophrenics, it was revealed that paranoid schizophrenia is highest rate of diagnostic category as 66.7%, the ratio of male to female is 1.7 to 1, and the mean age of total patients is 24.9. 2. In the analysis of the result, larger numbers of the cases were observed in schizoid personality, of adviced admission, of episode of readmission, of hospitalization more than one month, of suspicious and anxious facial expression at the time of hospitalization, whose parents blamed for the refusal of food, yet they are still living with patients, and those cases who were able to start eating within a week. 3. In the psychodynamic explanation, deep seated inner conflicts such as feelings of inferiority, damaged self-esteem, chronic rage, withdrawal and escape from reality are the major roles for the formation of the refusal of food. 4. For the ideal psychiatric care for the cases of refusal of food, it was necessary to set up anxietyfree, warm, and pleasant climate of hospital milieu, so that the milieu terapy, total push therapy, supportive psychotherapy and adequate feeding schedule are higly recommended. 5. Most of the hyperactive schizophrenics showed the schizoid personalty, shorter duration of hospitalization, and anxious, irritable, hostile and aggressive facial expressions. Their psychodynamics are closely related with overtly rejective responses in the frustrated situations arising from their hostile and aggressive impulses similar to those cases of hypertension. And therfore firm approaches such as punishment, isolation, sedation and physical restraint are supposed to be the most effective method of treatment for refusal of food. 6. Most of the underactive -schizophrenics showed the episode of being adviced admissions, longer duration of hospitalzation, seclusive, withdrawn, mute and depressive facial experessions, longer duration of treatment for refusal of food, and their parents are significant objects for refusal of food. Their psychodynamics are closely related with overtly rejective responses in the frustrated situations by their infantile dependent impulses as seen in the cases of anorexia nervosa. Warm approaches such as formation of pleasant hospital climate, supportive psychotherapy, and total push therapy are supposed to be the most effective method of treatment for the refusal of food in this group. 7. Most of the paranoid schizophrenics showed the paranoid personality, higher age groups, evasive, demanding, cynical and suspicious facial expressions, and their spouses are significant objects for refusal of food. The psychodynamics of the group are closely related with suspicious and projective responses in the frustrated situations by their delusions and hallucinations. Psychotherpy such as reapsurance, encouragement, and ventilation are considered to be the most effective method of treatment for the refusal of food.