- 본 1. 환자에대한평가 1) 영양평가 - 론 370

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1 KISEP Review J Korean Neuropsychiatr Assoc Vol 41, No 3 감독하식사 - 이상식사행동의행동치료적관점 이혜경 1) 이영호 1) Supervised Diet-Behavior Modification of Abnormal Eating Behavior 국문초록 Hye Kyung Lee, M.A., 1) Young Ho Lee, M.D. 1) 중심단어 서 론 Nanum Eating Disorders and Obesity Clinic Corresponding author 369

2 - 본 1. 환자에대한평가 1) 영양평가 - 론 370

3 - - 2) 식사에대한과거력 371

4 Setting 의구성 1) 장소 2) 치료자 3) 구성 - 372

5 4) 영양상담 3. 감독하식사의단계 1) 준비단계 373

6 374

7 2) 1 단계 : 세끼의규칙적인식사습관의처방 375

8 Anxiety level Time Patient s perceived time course Actual time course Fig. 1. Schematic representation of the time course of an urge to purge. From Handbook of Treatment for Eating Disorders, Fairburn CG, Wilson GT, & Agras WS1997, pp ) 2 단계 : 금지된음식의시도및식사제한의중지 - 376

9 4) 3 단계 : 다양한상황에서의일반화 4. 감독하식사시고려해야될문제들 1) 이상식사행동관련인지수정 377

10 2) 식사후제거행동방지를위한대처전략 3) 재섭식시의부작용 - 378

12 - 4) 치료자들의태도 5) 행동요법의사용 380

13 6) 도움이되는병행치료 7) 기타문제들

14 결 론 382

15 참고문헌 1) Beumont PJV, Al-Alami MS, Youyz SW(1987):The Evolution of The Concept of Anorexia Nervosa. In: Handbook of Eating Disorders, Part I. Anorexia and Bulimia Nervosa. Ed by Beumont PJV, Burrows GD, Casper RC, New York, Elsevier, pp ) Treasure J, Todd G, Szmukler G(1995):The Inpatient Treatment of Anorexia Nervosa. In:Handbook of Eating Disorders:Theory, Treatment and Research. Ed by Szmukler G, Dare C, Treasure J, New York, John Wiley and Sons Ltd, pp ) Ryle JA(1936):Anorexia Nervosa. Lancet ii: ) Ventimiglia J(1993):The Eating Disorders. Ed by Ciiannini AE, New York, Springa-Verlag 5) Krause MV, Mahan LK(1984):Food, Nutrition, and Diet Therapy. 7th edition, Philadelphia, WB Saunders Company 6) Simko MD(1984):Nutrition Assessment. Rockville, MD, Aspen Publishers Inc. 7) 이영호 (2001): 신경성식욕부진증과신경성대식증치료에있어영양관리. 영양의학 ( 게재예정 ) 8) Boutachoff LI, Zollman MR, Mitchell JE(1989):Manual of Healthy Eating:A Meal Planning System. Minneapolis, University of Minnesota 9) 이민규, 이영호, 박세현, 손창호, 정영조, 홍성국, 이병관, 장필립, 윤애리 (1998): 한국판식사태도검사-26(The Korean Version of Eating Attitude Test-26: KEAT-26) 표준화연구 I: 신뢰도및요인분석. 정신신체의학 6(2): ) Garner DM, Olmsted MP, Bohr Y, Garfinkle PE(1982): The Eating Attitudes Test: psychometric features and clinical correlates. Psychol Med 12: ) Garner DM(1991):Eating Disorders Inventory-2. Odessa, FL, Psychological Assessment Resources 12) Fairburn CG, Cooper Z(1993):The Eating Disorder Examination. In:Binge Eating:Nature, assessment, and treatment. Ed by Fairburn CG, Wilson GT, New York, Guilford Press, pp ) Andersen AE, Bowers W, Evans K(1997) :Inpatient Treatment of Anorexia Nervosa. In:Handbook of Treatment of Eating Disorders. Ed by Garner DM, Garfinkel PE, New York, The Guilford press, pp ) 이영호 (1999): 신경성식욕부진증의입원치료 : 임상실제. 신경정신의학 38(3): ) Touyz SW, Beumont PJV, Glaun D, Phillips T, Cowie I (1984):A comparison of lenient and strict operant conditioning programmers in refeeding patients with anorexia nervosa. Br J Psychiatry 144: ) Treasure J, Szmukler G(1995):Medical complications of chronic anorexia nervosa. In:Handbook of Eating Disorders:Theory, Treatment and Research. Ed by Szmukler G, Dare C, Treasure J, Chichester, John Wiely & Sons Ltd, pp ) Andersen(1985):Inpatient Treatment of Anorexia Nervosa. In:Practical Compre- hensive Treatment of Anorexia Nervosa and Bulimia. Ed by Andersen AE, Baltimore, The Johns Hopkins University Press, pp ) Cuntz U, Frank G, Lehnert P, Fichter M(1999):Interrelationships between the size of the pancreas and the weight of patients with eating disorders. Int J Eating Disorders 20: ) Kaysar N, Kronenberg J, Polliack M, Gaoni B(1991): Sever hypophosphatemia during binge eating in anorexia nervosa. Arch Dis Child 66: ) Beumont PJV, Large M(1991) :Hypophosphatemia, delirium and cardiac arrhythmia in anorexia nervosa. Med J Aust 155: ) Cumming AD, Farquar JR, Bouchier IAD(1987) : Refeeding hypophosphatemia in anorexia nervosa and alcoholism. Br Med J 259: ) Gustavsson CG, Eriksson L(1989):Case report:acute 383

16 respiratory failure in anorexia with hypophosphatemia. J Intern Med 225: ) Kohn MR, Golden NH, Shenker IR(1998):Cardiac arrest and delirium : presen- tation of the refeeding syndrome in severely malnourished adolescent with anorexia nervosa. J Adolescent Health 22: ) Nusbaum JG, Drever E(1990):Inpatient survey of nursing care measures for treatment of patients with anorexia nervosa. Issues in Mental Health Nursing 11: ) Rorty M, Yager J, Rossotto E(1993):Why and how do women recover from bulimia nervosa? the subjective appraisals of forty women recovered for a year or more. Int J Eating Disorders 14: ABSTRACT J Korean Neuropsychiatr Assoc Vol 41, No 3, May, 2002 Supervised Diet-Behavior Modification of Abnormal Eating Behavior Hye Kyung Lee, M.A., Young Ho Lee, M.D. Nanum Eating Disorders and Obesity Clinic Supervised diet indicates the therapist to make meal with patients for the modification of their abnormal eating behaviors. It s purpose is to help the patients to confront with fear of eating and to manage secondary symptoms due to refeeding. It also modifies cognition, emotion and behavior related to eating and foods. Through these procedures, a healthy meal habit would be established by patients. Therefore, supervised diet is not only for the supervision of eating but it includes various therapeutic factors such as therapeutic alliance, therapist s attitude, therapeutic environment and therapeutic schedule which includes the comprehensive assessment. Supervised diet has many difficulties in clinical application and it consumes so much energy of the therapist. However, it is an important therapy by itself and it plays a role of a bridge to other therapies such as CBT and psychotherapy. Despite the usefulness of this method, it is difficult to find a clinic which practice the supervised diet in Korea. The literatures that report the supervised diet is also scarce. Therefore, the authors reviewed literatures and introduced our supervised diet treatment experiences with eating disorder patients at the Eating Disorders/Obesity Clinic of Seoul Paik Hospital. KEY WORDS:Supervised diet Eating disorders Abnormal eating behavior Behavior modification. 384

17 부록 1 감독하의영양회복프로그램-환자용 (Supervised Nutritional Rehabilitation) 385

18 386

19 1. 개념 : 부록 2 감독하의영양회복프로그램 : 치료자지침서 (Supervised Nutritional Rehabilitation) 2. 감독하식사시에부딪칠수있는문제점및접근방법 : 387

20 388

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ePapyrus PDF Document 육아지원연구 2008. 제 3권 1 호, 147-170 어린이집에서의 낮잠에 대한 교사와 부모의 인식 및 실제 이 슬 기(동작구 보육정보센터)* 1) 요 약 본 연구의 목적은 어린이집에서의 일과 중 낮잠 시간에 대한 교사와 부모의 인식 및 실제를 알아봄 으로써, 교사와 부모의 협력을 통해 바람직한 낮잠 시간을 모색해 보는 데 있었다. 연구 대상은 서울, 경기지역