Public Policy

Life expectancy at birth (p.49) The gender gap in life expectancy increased substantially in many OECD countries during the 1970s and early 1980s to reach a peak of almost seven years in the mid-1980s, but it has narrowed since, reflecting higher gains in life expectancy among men than women. In 2015, life expectancy in OECD countries for women for men less than 80  years: Hungary, Latvia, Mexico more than 85 years: Japan, Spain, France, Korea, Switzerland less than 75 years: Latvia, Mexico, Hungary, the Slovak, Republic, Estonia , Poland over 80 years: Iceland, Japan, Switzerland, Norway, Australia, Sweden, Italy, Israel, Spain On average among 25 OECD countries for which recent data are available, people with the highest level of education can expect to live around six years longer than people with the lowest level of education at age 30 (53.4 versus 47.8 years). A higher education level not only provides the means to improve the socio-economic conditions in which people live and work, but may also promote the adoption of healthier lifestyles and facilitate access to appropriate health care. This is largely explained by older people in these countries having lower levels of education, and the greater prevalence of risk factors among men, such as tobacco and alcohol use.	OECD Health at a Glance 2017
Main causes of mortality (p.52) Diseases of the circulatory system and cancer are the two leading causes of death. First, population ageing is important since the main causes of death change with age. Second is the epidemiological transition from communicable to non-communicable diseases, which has already taken place in high-income countries and is rapidly occurring in many middle-income countries. For example, dementia is a more important cause of death for women than for men. In contrast, the rates of lung cancer and accident-related deaths were higher for men than for women. Social disparities are generally larger for the most preventable diseases, as deaths are amenable to medical intervention, behaviour change and injury prevention.
Mortality from circulatory diseases (p.54) Despite substantial declines in recent decades, circulatory diseases remain the main cause of mortality in most OECD countries, accounting for more than one-third (36%) of all deaths in 2015. Declining tobacco consumption contributed significantly to reducing the incidence of IHD (see indicator on “Smoking among adults” in Chapter  4), and consequently to reducing mortality rates. The initial rise in IHD mortality rates in Korea has been attributed to changes in lifestyle and dietary patterns as well as environmental factors at the time of birth, with people born between 1940 and 1950 facing higher relative risks. In 2006, Korea introduced a Comprehensive Plan to tackle circulatory diseases that encompassed prevention and primary care as well as better acute care, contributing to the reduction in mortality in recent years (OECD, 2012). The high prevalence of risk factors common to both diseases (e.g. smoking and high blood pressure) may explain this link. Since 1990, cerebrovascular disease mortality has decreased in all OECD countries, although to a lesser extent in Poland and the Slovak Republic. As with IHD, the reduction in mortality from cerebrovascular disease can be attributed at least partly to a reduction in risk factors as well as improvements in medical treatments (OECD, 2015; see indicator “Mortality following ischaemic stroke” in Chapter 6) but rising obesity and diabetes threatens progress in tackling cerebrovascular disease (OECD, 2015).
Mortality from cancer (p.56) The rising share of deaths due to cancer reflects the fact that mortality rates from other causes, particularly circulatory diseases, has been declining more rapidly than for cancer. Prevention, early detection and treatment remain at the forefront in the battle to reduce the burden of cancer. Substantial declines in mortality for men: stomach, colorectal, lung, prostate cancer for women: breast, cervical and ovarian cancer these gains were partially offset by increases in the number of deaths due to cancer of the liver, skin, pancreas trends the high number of females started smoking earlier diagnosis and better treatment→declined mortality an increase in the incidence of breast cancer a major cause of Colorectal cancer among both Prostate cancer become the most common cancer aged 65 years and over
Infant health (p.58) Birth defects, prematurity and other conditions arising during pregnancy are the main factors contributing to neonatal mortality in developed countries. In 2015, the average in OECD countries was less than four deaths per 1 000 live births. Despite this progress in reduced infant mortality, increasing numbers of low birth weight infants is a concern in some OECD countries. On average, one in 15 babies born in the OECD (or 6.5% of all births) weighed less than 2 500 grams at birth in 2015 (Figure 3.14). Risk factors for low birth weight include maternal smoking, excessive alcohol consumption, poor nutrition, low body mass index, lower socio-economic status, having had in-vitro fertilisation treatment and multiple births, and a higher maternal age. The increased use of delivery management techniques such as induction of labour and caesarean delivery, which have increased the survival rates of low birth weight babies, may also explain the rise in low birth weight infants.
Mental health (p.60) Lower stigma around depression may contribute to higher rates of self-reported illness, and higher rates of diagnosis. The social context, poverty, substance abuse, and unemployment are all associated with higher rates of suicide. Studies suggest that the gender gap for attempted suicide is smaller, but men tend to use more lethal means when attempting suicide. A range of interventions can both prevent and treat depression, and prevent suicide, but in many countries people with mental ill-health have difficulties accessing appropriate mental health care in a timely way.
Perceived health status (p.62) A commonly asked question is of the type: “How is your health in general?”. Despite the subjective nature of this question, indicators of perceived general health are a good predictor of people’s future health care use and mortality (Palladino et al., 2016). In addition, since older people report poor health more often than younger people, countries with a larger proportion of aged persons will also have a lower proportion of people reporting to be in good health. In many of these cases, though, adults consider themselves to be in fair health. Across the OECD, on average 9% of adults consider themselves to be in bad health. As expected, people’s rating of their own health tends to decline with age. causal link is also possible, with poor health status leading to lower employment and lower income. Greater emphasis on public health and disease prevention among disadvantaged groups, and improving access to health services may contribute to further improvements in population health status in general and reducing health inequalities.
Cancer incidence (p.64) These variations reflect not only variations in the prevalence of risk factors for cancer, but also national policies regarding cancer screening and differences in quality of reporting. in women breast(28%), colorectal (12%), lung (10%), and cervical (3%) The causes: not fully understood the risk factors: age, family history, breast density, exposure to oestrogen, being overweight or obese, alcohol intake, radiation and hormone replacement therapy among women breast cancer leading causes of death from cancer declined mortality rates since the 1990s due to earlier detection and improvements in treatments among men Prostate cancer: almost all OECD countries lung cancer: Hungary, Poland, Turkey and Greece colorectal cancer: Japan and Korea prostate cancer attributed to differences in the use of PSA testing Differences between countries’ rates can be partly Mortality rates decreased as a consequence of early detection and improvements in treatments
Diabetes prevalence (p.66) People with diabetes are more likely to suffer from cardiovascular diseases such as heart attack and stroke, sight loss, foot and leg amputation and renal failure. The International Diabetes Federation estimates that a further 33 million adults have undiagnosed diabetes in OECD countries. These trends mirror partly trends in population ageing, as well as the rise of obesity and physical inactivity, and their interactions (NCD Risk Factor Collaboration, 2016). Diabetes also disproportionately affects those in lower socio-economic groups and people from certain ethnicities. almost 230 000 children suffered from Type 1 diabetes in OECD countries in 2015. These burdens highlight the need for effective management of diabetes and its complications (see indicator on “Diabetes care” in Chapter 6), as well as appropriate preventive actions (see Chapter 4).
Smoking among adults (p.70) The WHO has estimated that tobacco smoking kills 7 million people per year across the world, of which 890,000 are due to second-hand smoke. It is the leading cause of death, illness and impoverishment. Men smoke more than women in all countries except Denmark and Iceland, where the gender gap is about one percentage point. Daily smoking has decreased in most OECD countries since 2000 Raising taxes on tobacco is the most effective way to reduce tobacco use (WHO, 2015).
Alcohol consumption among adults (p.72) Heavy drinking is associated with a lower probability of employment, more absence from work, and lower productivity and wages. On average, recorded alcohol consumption has decreased in the OECD since 2000 (Figure 4.3), from 9.5 litres per capita per year to 9 litres of pure alcohol per capita each year, equivalent to 96 bottles of wine. Although adult alcohol consumption per capita is a useful measure to assess long-term trends, it does not identify sub-populations at risk from harmful drinking patterns. All OECD countries have legally set maximum levels of blood alcohol concentration for drivers, but the enforcement of these regulations may be haphazard and varies widely across and within countries.
Smoking and alcohol consumption among children Early and frequent drinking and drunkenness is associated with detrimental psychological, social and physical effects, such as dropping out of high school without graduating. Trends for repeated drunkenness and regular smoking in 15-year-olds display similar patterns. Regular smoking displays the strongest decrease, as rates in boys and girls more than halved between 1997-98 and 2013-14. The gender gap for drunkenness has also shrunk since the 1990s. Worldwide, one third of youth experimentation with tobacco occurs as a result of exposure to tobacco advertising, promotion and sponsorship. To reduce youth tobacco use, its use in the general population must be denormalised. Young smokers are responsive to policies aiming to reduce tobacco consumption, including excise taxes to increase prices, clean indoor-air laws, restrictions on youth access to tobacco, and greater education about the effects of tobacco (Forster et al., 2007).
Healthy lifestyles among adults (p.76) Worldwide, diets low in fruit were the cause of nearly 3 million deaths in 2015, while low vegetable consumption caused nearly 2 million deaths, and low physical activity caused 1.6 million deaths. Including fruit and vegetables in the daily diet reduces the risk of coronary heart disease, stroke, as well as certain types of cancer (WHO, 2014). Regular physical activity improves muscular and cardiorespiratory fitness, and reduces the risk of hypertension, coronary heart disease, stroke, diabetes, and various cancers (WHO, 2017) Women consume more fruit than men in all countries, On average, 60% of people in the OECD consume vegetables daily (65% of women, and 55% of men) Across the OECD, an average of 66.5% of people perform 150 minutes of moderate physical activity per week, with 70.5% of men and 63% of women. Men are more physically active than women in all countries but Denmark.
Overweight and obesity among adults (p.80) Overweight and obesity are major risk factors for many chronic diseases, including diabetes, cardiovascular diseases, and cancer. Obesity has greatly risen in the past two decades, even in countries where rates have been historically low (Figure 4.16). Social media and new technologies have become tools for public health promotion, through mass media campaigns aiming to increase public awareness about healthier choices (Goryakin et al., forthcoming). Taxation policies have also been increasingly implemented to raise the price of potentially unhealthy products such as foods high in salt, fat, or sugar. Taxes on sugar-sweetened beverages are amongst the most popular, and there is reasonable evidence that appropriately designed taxes would result in proportional reductions in consumption, especially if fixed at 20% of the retail price or more (WHO, 2016). Comprehensive policy packages that include health promotion, education, interventions in primary care settings, and broader regulatory and fiscal policies, provide affordable and cost-effective solutions to tackle obesity (OECD, 2010).
Overweight and obesity among children (p.82) Obesity can affect a child’s physical health, through cardiovascular, endocrine, or pulmonary diseases, and psycho-social health, through the development of poor self-esteem, eating disorders, and depression (Inchley et al., 2016). Obesity can also affect educational attainment (Cohen et al., 2013). Furthermore, childhood obesity is a strong predictor of adult obesity, which has health and economic consequences (WHO, 2016). Several OECD countries have implemented policies aimed at tightening regulation of advertisements of unhealthy foods and beverages, specifically targeted toward children and young adults to prevent obesity (OECD, 2017).
Air pollution (p.84) Air pollution is a major environment-related health threat, especially to children and the elderly, as it can cause respiratory diseases, lung cancer, and cardiovascular diseases. It has also been linked to low birth-weight, dementia, and damage to DNA and the immune system (WHO, 2017). Outdoor air pollution in both cities and rural areas was estimated to cause 3 million premature deaths worldwide in 2012 (WHO, 2016), and can also have substantial economic and social consequences, from health costs to building restoration needs and agricultural output (OECD, 2015). Of particular concern for outdoor air pollution are carbon monoxide, nitrogen oxide and ozone, but also fine particulates, or PM2.5, whose diameter is 2.5 μm or smaller. The WHO has claimed that air pollution is one of the most pernicious threats facing global public health today and on a bigger scale than HIV or Ebola (WHO, 2017). Policies to limit air pollution consist of regulatory approaches, such as air quality standards, fuel quality standards or emission ceilings, as well as economic instruments, which include fuel taxes, road pricing or taxes on emissions.
Out-of-pocket medical expenditure (p.92) Financial protection through compulsory or voluntary health coverage can substantially reduce the amount that people need to pay directly for medical care. The burden of out-of-pocket medical spending (that is, excluding long-term care services) can be measured either as a share of total household income or consumption. The burden of out-of-pocket medical spending (that is, excluding long-term care services) can be measured either as a share of total household income or consumption. In most countries, a higher proportion of the cost is paid directly for pharmaceuticals, dental care and eye care than for hospital care and doctor consultations (Paris et al., 2016). In most OECD countries, spending on pharmaceuticals and outpatient care (including dental care) are the two main spending items for out-of-pocket expenditure (Figure 5.8). This may be due not only to co-payments for prescribed pharmaceuticals, but also high levels of spending on over-the-counter medicines for self-medication. Coverage for dental treatment is typically limited and as such dental care plays a significant part in outpatient and overall household spending, accounting for 20% of all out-of-pocket expenditure across OECD countries.
Diabetes care (p.106) It is a leading cause of cardiovascular disease, blindness, kidney failure and lower limb amputation. Globally it is estimated that over 400 million adults had diabetes in 2015 and by 2040 it is projected this will grow to over 640 million adults. Diabetes caused 5 million deaths in 2015 (IDF, 2015). Effective control of blood glucose levels through routine monitoring, dietary modification and regular exercise can reduce the onset of serious complications and the need for hospitalisation. Management of other key risk factors such as smoking, blood pressure and lipid levels are also important in reducing complications of diabetes. A positive relationship can be demonstrated between overall hospital admissions and admissions for diabetes, providing some indication that access to hospital care can also play a role in explaining international variation (OECD, 2015).
AvoidablMost health systems have developed a ‘primary level’ of care whose functions include health promotion and disease prevention, managing new health complaints, managing long-term conditions and referring patients to hospital-based services when appropriate. A key aim is to keep people well, by providing a consistent point of care over the longer-term, tailoring and co-ordinating care for those with multiple health care needs and supporting the patient in self-education and self-management.e hospital admissions (p.104) Asthma may affect up to 334 million people worldwide (Global Asthma Network, 2014). About 3 million people died of COPD in 2015, which is equal to 5% of all deaths globally that year (WHO, 2016). Heart failure is estimated to affect over 26 million people worldwide resulting in more than 1 million hospitalisations annually in both the United States and Europe (Ponikowskiet al., 2014). Asthma, chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are three widely prevalent long-term conditions.
Nurses (p.159) Nurses greatly outnumber physicians in most OECD countries, and they play a critical role in providing health care not only in traditional settings such as hospitals and long-term care institutions but increasingly in primary care settings (especially to manage the care of the chronically ill) and in home care settings. There are growing concerns in many OECD countries about possible future shortages of nurses, given that the demand for nurses is expected to rise in a context of population ageing and the retirement of the current “baby-boom” generation of nurses. The retention rate of nurses has increased in recent years in many countries either due to the impact of the economic crisis that have prompted more nurses to stay or come back in the profession, or following deliberate efforts to improve their working conditions (OECD, 2016). On average across OECD countries, the number of nurses on per capita basis has gone up from 7.3 per 1 000 population in 2000 to nine nurses per 1 000 population in 2015 (Figure 8.12). The number of nurses per capita increased in almost all OECD countries since 2000. In 2015, there were about three nurses per doctor on average across OECD countries, with about half of the countries reporting between two to four nurses per doctor (Figure 8.13).

Collaboration and Coordination Skill

①협력 Collaboration 과 ②조정 Coordination

→ 환자의 비용 및 치료의 질에 영향

팀워크 및 파트너십과 관련

서로 배우고 문제 해결하기 위한 상호작용을 통한 역동적인 대인관계 과정

감정 공유 및 지원 방법 개발 포함

 

① 대인관계 능력 및 의사소통, 지식·기술의 인정과 가치평가, 상호존중, 믿음, 공통 목적, 임상적 역량 및 책임관여

cf) 수평적 의사소통(→공유), 일방적인 타협(=선택양보), 가짜 협력, 수평적 기능(=분업), 정보교환, 공동 관리(책임 개별)

 

② 통합과 질서화를 말함. 분업화된 활동, 개인의 경쟁과 편견 방지, synergy 효과기대

The Team and Team Building

Group	Team
분명한 리더 개인적인 책임(1/n)과 산출물 통제적이고 시간효율적인 회의를 통해 책임부여를 함 공식그룹(의도적인 계획): 명령그룹(계선권한), 과업그룹, 위원회 비공식그룹(자치적임, 조직목표와 무관): 이익집단, 우호집단	참여하고 공유하는 리더십 상호공동의 책임과 산출물 상호보완적 기능 토론과 문제해결 중심으로 공동의 노력과 접근법을 추구함

Team building←조직개발비법

목표와 가치를 이해 및 수용

개인의 역할이 팀 전체 업무에 기여

개방적인 의사소통 및 의사결정에 헌신적 참여

구성원 간 신뢰 및 지원

 

장점: 문제점 명확화, 집단의 지식과 창조성 진단가능, 업무상의 혁신적인 관계 개선가능

 

① 문제인식: 문제 징후 파악 ex) 낮은 효과성

② 문제진단: 의사결정, 잠재적 문제, 갈등대처방식, 리더십의 효과, 목적 이해 및 수용, 신뢰와 존중, 팀 내외 관계, 사적인 감정

③ 문제 분석 및 반영(진단결과): 개방적인 태도로 구성원 간 공유필요(자기 방어적 또는 비난적 표현 금지)

④ 문제 확인 및 정리: 의견 수렴

⓹ 대책 수립: 담당자 선정

⓺ 실행 계획 실천: 대책 점검, 실천 관찰

⓻ 검토 및 평가(Feedback): 실천 현황 파악

 

장애요인 극복방안→ 상호의존적인 업무임을 인식, 직업적 존경과 협조, 부드러운 분위기 조성, 상호적 도움, 협조적 태도

 

팀기능 발전 방안→ Gate keeping 파수꾼: 의사소통 경로 개방, 문제 재집중, 갈등 확인 및 처리, 자존감 및 이해수준 향상, 참여 장려, 토의분위기 유도

∴ 심리적인 성장 경험, 인간관계 기술 개선

이상행동 양상

이상행동 양상

1. 행동장애(Disorders of behavior)

1) 증가된 활동(increased activity)

-정신운동항진으로 인해 행동의 속도와 양이 통상적인 범위를 넘어선 상태

-겉보기에 매우 바쁘고 활발한 것처럼 보이지만 합목적적 일관성이 결여된 경우가 많음

 

2)저하된 활동(decreased activity)

-정신운동지연으로 인해 행동의 빈도나 강도가 모두 저하된 상태

-욕구가 저하된 상태로 사고의 흐름도 느리고 말도 느림

 

3)반복행동(catalepsy)

·강직증(catalepsy)

-한 가지 자세에서 다른 자세로 바꾸지 못하고 계속 유지하려는 것

-타동적으로 취해진 자세를 유지하려는 경향으로 관절에서 움직임이 밀랍과 같은 것을 납굴증(waxy flexibility)이라고 함

·상동증(stereotype)

-의미 없는 행동을 반복하는 것

-가만히 서있지 못하고 왔다갔다하거나, 반복적으로 손을 비벼대는 행동

·기행증(mannersim)

-상동증과 유사하지만 상동증보다는 덜 지속적이고 덜 단조로움

-상동증과는 달리 그 사람의 성격과 어울리는 특유의 습관적이고 불수의적인 반복행동

·보속증(perseveration)

-다양한 외적 자극에 대응하여 다른 행동이나 말을 하려고 하지만 새로운 동작이나 말로 넘어가지 못하고 반복적으로 같은 동작만을 지속하는 것

·틱(tic)

-신체의 일부를 불수의적으로 반복해서 움직이는 버릇

-아동이 불안할 때 흔히 보이는 눈 깜빡거림이나 킁킁하고 소리를 내는 등의 반복행동

 

4)강박행동(compulsion)

-불합리한 줄 알면서도 불안을 감소시킬 목적으로 반복하는 행동

-흔히 강박사고를 동반함

-가스 밸브나 문이 잠겼는지 반복해서 확인하는 행동

 

5)자동행위(automatism)

·반향언어(echolalia)

-상대방의 말을 그대로 흉내 내는 것

·반향동작(echopraxia)

-상대방의 행동을 그대로 흉내 내는 것

·명령자동증(command automatism)

-자기의 의지가 없는 것처럼 타인의 지시에 무조건 복종하는 것

 

6)거부증(negativism)

-타인의 요구에 반대되는 행동을 하거나, 저항의 표시로 반응을 하지 않는 것

-상대방에 대한 분노감을 행동으로 표현한 것으로 다른 사람에게 불안을 야기시키려는 목적일 수 있음

 

7)충동적 행동(impulsion)

-욕구통제가 잘 되지 않아 예상치 못한 행동을 폭발적으로 일으켜 충동적인 행동으로 나타날 수 있음

-감정조절이 잘 되지 않거나 환경을 잘못 판단할 때 나타남

 

2. 기분장애(Disorders of mood)

1)기분(mood)

-타인들에 의해 관찰된 것뿐만 아니라 사람의 마음속에 나타나는 주관적인 정서상태

·다행감(euphoria)

-낙천적이고 즐거운 느낌이며 자신감과 확신에 찬 태도를 보이는 상태

·의기양양감(elation)

-평소보다 훨신 기분이 좋아 보이는 것으로 다행감에 행동상의 항진이 동반된 상태

-합리적 사고와 판단력에 장애가 있어 쉽게 흥분하거나 주변 사람들과 자주 의견 충돌을 일으키고 지나치게 독선적인 행동이 나타날 수 있음

·기고만장감(exaltation)

-자신감이 지나쳐 과대적인 생각이나 행동을 동반한 것

-과대적인 생각으로 타인과의 타협이 잘 되지 않으며 자신의 생각대로 되지 않으면 충동적이 되며 화를 잘 냄

·황홀감(ecstasy)

-어떤 일도 안 될 것이 없을 것 같은 무한한 자신감을 느끼는 상태

·우울(depression)

-슬픔의 정도가 비정상적으로 심하고 오래 지속되는 상태

·불안(anxiety)

-어떤 위험을 예견하고 걱정하는 상태

▶초조(agitation)

-심한 불안 때문에 안절부절 못하는 상태

▶공황(panic)

-극심한 공포와 불안을 느끼는 상태

·양가감정(ambivalence)

-어떤 한 가지 일에 대하여 동시에 두 가지 상반되는 감정을 가지는 상태

 

2) 정동(affect)

-객관적으로 관찰 가능하면서 일정기간 지속되는 정서 상태

·부적합한 정동(inapproprateness)

-어떤 상황이나 사고내용과 상응하지 못하는 감정상태

·불충분한 정동(inadequate affect)

▶제한된 정서(restricted affect)

-자신의 느낌의 폭이 외부로 표현되지 못하는 상태

▶둔한정서(blunted affect)

-제한된 정서보다 더 심한상태

▶정동둔마(flate affect)

-정동적 느낌의 표현이 거의 없는 상태

▶무감동(apathy)

-감수성이 무뎌져서 감정을 느끼지 못하는 상태

▶무쾌감증(anhedonia)

-즐거움과 기쁨의 감정이 전혀 표현되지 않는 상태

 

3. 언어장애(Disorders of speech)

1)실어증(aphsia)

·운동성 실어증(motor aphasia)

-말은 이해하나 말하지 못하는 상태

·지각성 실어증(sensory aphasia)

-말을 이해하지 못하는 상태

·명칭 실어증(nominal aphasia)

-대상에 맞는 이름을 발견하지 못하는 상태

 

2) 발음장애(dysarthria)

-단어 선택이나 문법은 적절하나 발음이 곤란한 상태

 

3) 언어압박(presure of speech)

-말이 많고 말의 흐름이 매우 빨라 중단시키기 어려운 상태

 

4) 언어빈곤(poverty of speech)

-말의 양이 적고 모든 질문의 대답이 단음절인 상태

 

5) 비자발적인 말(Nonspontaneous speech)

-직접적으로 상대방이 묻거나 말할 때만 대답하며, 자신이 먼저 말하지는 않는 상태

 

4. 지각장애(Disorders of perception)

1) 착각(illusion)

-실제적인 외부자극을 잘못 인식하는 현상

·거시증(macropsia)

-사물이 실제보다 크게 보이는 현상

·미시증(micropsia)

-사물이 실제보다 작게 보이는 현상

·기시감(deja vu)

-처음 경험하는 상화을 마치 과거나 꿈에 똑같은 경험을 한 것처럼 느끼는 현상

·미시감(jamais vu)

-이전에 경험했던 상황을 마치 처음 경험하는 것처럼 느끼는 현상

·이인증(depersonalization)

-자신의 몸이 자신의 것이 아닌 것처럼 느끼는 현상

·비현실감(derealization)

-지금의 현실이 비현실적으로 느껴지는 현상

 

2)환각(hallucination)

-외부자극이 실제로는 없음에도 마치 외부에서 자극이 있는 것처럼 인식하는 현상

·환청(auditory hallucination)

-실제로 없는 소리를 듣는 것

·환시(visual hallucination)

-실제로 존재하지 않는 사물이 보이는 것

·환후(olfactory hallucination)

-실제로 후각적 자극이 없는데도 냄새를 맡는 것

·환미(gustatory hallucination)

-실제로 없는 맛을 지각하는 것

·환촉(tactile hallucination)

-실제로 자극이 없음에도 어떤 물체가 피부에 접촉하고 있다고 느끼는 것

 

5. 사고장애(Disorders of thought)

1) 사고과정(thought process)

·사고의 비약(flight of idea)

-연상속도가 비정상적으로 빨라 통상적인 연상과정을 거치지 않고 한 가지 생각에서 다른 생각으로 급속히 진행되는 현상

-내용은 어느 정도 연관성이 있지만 항진된 내적 욕구와 주의산만 때문에 애초에 목표한 사고에 주의를 계속 집중시킬 수 없음

·사고의 지연(retardation of thought)

-연상속도가 매우 느려 사고와 말의 진행이 느리고 원활하지 못한 현상

-생각의 속도가 느려 말을 천천히 하며 생각이 잘 떠오르지 않아 말하기를 어려워 함

·사고의 두절(blocking of thought)

-어떤 생각을 끝내기 전에 갑자기 생각의 흐름이 중단되어 버리는 것

·비논리적 사고(irrelevance)

-상대방의 질문에 적절하게 대답하지 못하고 엉뚱한 대답을 하는 것

·우회증(circumstantiality)

-자신이 말하고자 하는 바를 불필요한 묘사를 거친 후 목적에 도달하는 것

·지리멸렬(incoherence)

-적절한 문장 법칙과 논리적 연결성이 없는 것

·보속증(perseveration)

-사고의 진행이 제자리에서 맴돌고 한 단어나 문장에서 벗어나지 못하고 같은 말을 반복하는 것

·음송증(verbigeration)

-의미 없이 완전히 단절된 낱말들만 조리 없이 되풀이하는 것

·신어조작증(neologism)

-자신만이 의미를 아는 새로운 단어나 표현을 만들어 내는 것

·음향연상(clang association)

-음에 따라 새로운 관념이 완성되는 것

-‘사’ 발음 때문에 ‘사랑, 사람, 사장, 사기’등의 무의미한 언어 연결을 보임

·말비빔(ward salad)

-비슷한 모양의 명사와 구들의 지리멸렬한 혼합

 

2) 사고내용(thought content)

·망상(delusion)

-현실에 맞지 않은 불합리하고 잘못된 믿음이나 생각

▶과대망상(grandious delusion)

-자신의 힘이나 능력을 실제보다 과장되게 생각하여 자신이 위대하거나 부자라고 믿는 것

▶피해망상(persecutory delusion)

-누군가가 자신이나 가족을 해치려고 하거나 감시한다고 믿는 것

▶관계망상(delusion of reference)

-실제로 자신과 관계가 없는 주변 상황을 자신과 관련이 있다고 잘못 믿는 것

▶색정망상(erotic delusion)
-모든 이성들이 자신을 사랑한다고 굳게 믿거나, 누군가 자신을 너무 사랑하고 있는데 다른 누군가가 방해를 해서 행동으로 표현하지 못하고 있다고 믿는 것

▶질투망상(delusion of infidelity)

-자신의 배우자나 애인이 부정하다고 믿는 것

▶빈곤망상(delusion of poverty)

-충분한 재산이 있음에도 자신이 재산을 다 잃고 알거지가 될 것이라고 믿는 것

▶죄책망상(delusion of sin)
-자신은 헤어나올 수 없는 죄를 지어서 세상에서 살 가치가 없다고 믿는 것

▶허무망상(nihilistic delusion)
-자신, 타인, 혹은 이 세계가 더 이상 존재하지 않거나 종말할 것이라고 믿는 것

▶신체망상(somatic delusion)

-많은 검사에서 이상이 없음에도 자신이 몹쓸 병에 걸려서 더 이상 살수가 없다고 믿는 것

▶조종망상(delusion of being controlled)

-자신의 생각이나 행동이 다른 사람에 의해 조종당하고 있다고 믿는 것

▶사고전파(thought broadcast)

-자신의 생각이 전파되어 퍼져나가 다른 사람들도 알게 된다고 믿는 것

▶사고주입(thought insertion)

-자신의 생각은 자기가 하는 것이 아니라 누군가 자신의 머릿속으로 생각을 주입했다고 믿는 것

▶사고유출(thought leakage)

-자신의 생각이 밖으로 빠져나간다고 믿는 것

·강박사고(obsessioin)

-내용이 비합리적이고 부적절하다는 사실을 잘 알고 의식적으로 생각하지 않으려 노력하지만 특정한 생각에서 벗어나지 못하고 반복적으로 떠올라 고통받는 것

·건강염려증(hypochondriasis)

-신체건강에 대해 과도한 관심을 갖는 것으로 실제로는 신체에 어떤 질병이나 이상이 없다는 의사의 상세한 설명에도 비정상적으로 자신의 건강상태에 관심이 집중되어 병이 반드시 있다고 생각하는 것

·공포증(phobia)

-어떤 특정 대상이나 상황에 대해 불합리하게 무서워하며 피하려고 하는 것

 

6. 의식장애(Disorders of consciousness)

1) 혼돈(confusion)

-가장 가벼운 의식장애로서 지남력 상실이 나타나는 상태

 

2) 혼탁(clouding)

-평상시에 충분히 지각할 수 있는 자극에 대하여 적절하게 반응하지 못하고 이해력과 기억력이 손상된 상태

 

3) 섬망(delirium)

-안절부절, 혼란, 지남력 상실, 착란과 환각, 지리멸렬한 사고, 정서적 불안정, 공포심 등을 나타내는 상태

 

4) 혼미(stupor)

-주위 환경에 대해 반응이 없고 지각하지 못하는 상태

 

5) 혼수(coma)

-모든 정신활동이 마비된 상태

 

7. 지남력장애(Disorders of orientation)

-시간, 장소, 사람에 대하여 올바르게 인식하지 못하는 상태

 

8. 기억장애(Disorders of memory)

1) 기억과다(hypermnesia)

-과거에 지각한 인상을 사소한 것까지도 자세하게 기억해내는 상태

 

2) 기억상실(amnesia)

·전향성 기억상실(anterograde amnesia)

-특정 시점 이후에 발생한 일들을 기억하지 못하는 상태

·후향성 기억상실(retrograde amnesia)

-특정 시점 이전에 발생한 일들을 기억하지 못하는 상태

 

3)기억착오(paramnesia)

·작화증(confabulation)

-기억이 잘 나지 않는 부분을 무의식적으로 상상이나 사실이 아닌 경험으로 메우는 것

·회상조작(retrospective fasification)

-강한 무의식적 동기 때문에 과거의 기억 중 자신에게 유리한 것만 선택적으로 기억하거나 잊거나 왜곡해서 기억하는 것

·병적거짓말(pseudologia fantastica)

-자신의 공상 속에서 이루어진 일을 마치 과거에 자신이 경험했던 것처럼 의도적으로 하는 거짓말