정신과에 입원한 청소년 정신 장애자의 병원 체제에 대한 저항 유형 분석

An Analysis of Resistances Toward Therapeutic Milieu Among Hospitalized Adolescents with Mental Disorders

The purpose of present study was to investigate the characteristics of clinical manifestations according to subtypes of resistances toward therapeutic milieu among hospitalized aeolescents with mental disorders, and to set the guidelines on effective measures to cope with the resistances of them and their parents. The subjects in this study composed of 318 adolescents, who were admitted to the Department of Psychiatry in Chung Ang University Pildong Hospital and Yongsan Hospital from January 1981 to December 1991, including 76 cases of persistant avoidance type, 67 outright-rebelliousness type, 58 somatization type, 23 over-summissiveness type, 21 pseudo-stupidity type，20 cases of the other types, and 53 cases without resistance. Data were analysed on their resistances, socio-demographic characteristics, clinical diagnosis & personality traits, admission history, and pharmacologic treatment in order to try to revleal the differences between 7 subtypes of resistances. Data were precessed by SPSS/PC + Program and were statistically analysed by chi-square test. Summaries of the results were as follows: 1) The 83.3% of 318 hospitalized adolescents with mental disorders showed various resistances toward the therapeutic milieu of the hospitals. The persistent avoidance was shown by 76 patients(23.9% ) ，and 67 patients(21.1 % ) resisted against the treatment by outright rebelliousness, 58 patients(1 8 .2 % ) by somatization, 23 patients(7.2%) by over-summissiveness and 21(6.6%) by pseudo-stupidity. 2) There were no significant differences in sex, age, and educational level between the types of resistances. 3) The 60.4% among the parents of hospitalized adolescents with mental disorders had various resistances toward their hospitals therapeutic milieu, and these parental resistance were closely related with their children’s resistance, particularly in the persistent avoidance type and the over-submissiveness type. 4) Summary of the clinical characteristics of adolescent psychiatric in-patients according to each subtypes of resistances were as follows : (1) The persistent avoidance type, the most frequent one of all resistances, was managed mainly with the supportive psychotherapy, and the patients who showed that type of resistance were likely to be diagnosed as the major depression, showing dependent schizoid, and avoidant personality traits. During hospitalization, they were apt to adm it to open ward and to be treated mainly by antidepressants. (2) The outright rebelliousness type of resistances was tried to alleviate through the physical restraints or groundpass. On clinical features, psychotic disorders and manic state of bipolar disorder were frequent and so were antisocial, schozitypal, and narcissistic personality traits in this type of resistances. They were likely to be admitted to closed ward, and to be treated by antimanic or antipsychotic drugs. (3) The somatization type was inclined to be treated with the chemical sedation or supportive psychotherapy. The patients of this type were likely to be diagnosed as the neurotic disorder or psychoactive substance use disorder, and to show the histrionic personality trait. During hospitalization, they were chiefly admitted to open ward, and treated by antianxiety drug or antidepressants. (4) Over-submissive type of resistances was managed by supportive psychotherapy. The p atients who showed the over-submissive type were frequently diagnosed as the m ajor depression, the neurotic disorder, or the adjustment disorder, and were inclined to have the obsessive-compulsive or paranoid personality traits. Many of them were admitted to the open ward and treated by antianxiety drugs. (5) The psychotic disorders and organic mental disorders were f