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정신분열병 환자의 주관적 증상과 객관적 정신병리와의 관련성
주연호,김용식,정성훈,신민섭,이창인 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.4
연구목적 : 주관적 증상평가도구인 K-FBF(Kyung Hee-Frankfurter Beschwerde-Fragebogen)가 정신분열병 환자의 어떤 증상 영역을 반영하는지, 특히 정신분열병의 병태생리와 밀접한 관련을 가지며 객관적 평가도구로는 파악이 어려운 음성 증상 또는 인지 장애의 측면들을 반영하는지 조사하고자, 정신분열병 환자의 K-FBF 결과를 객관적 정신병리 평가도구인 PANSS(Positive and Negative Syndrome Scale for Schizophrenia), 대표적인 자기보고식 다차원 증상목록(multidimensional self-report symptom inventory)인 간이정신진단검사(SCL-90-R)의 평가 결과와 비교 분석하였다. 방 법 : 고졸이상의 학력으로 DSM-IV진단기준에 의한 정신분열병 환자 중 급성기가 경과한 66명을 대사으로 연구를 수행하였다. K-FBF, SCL-90-R을 시행한 날, 두 명의 정신과 의사가 PANSS를 수행하였다. K-FBF의 질문항목에 대한 반응양상을 조사하고, 10개 소척도에 대하여 요인분석을 시행하였다. K-FBF와 연령, 성별, 병식과의 상관관계를 조사하였다. 또한, K-FBF, PANSS, SCL-90-R제반 척도간에 상관관계 분석을 시행하였다. 결 과 : K-FBF는 높은 연령일수록 호소하는 항목의 수나 그 정도가 감소하였으며, 유병기간을 조절변수로 삼았을 때도 동일한 결과를 보였다. K-FBF의 소척도를 요인분석하여 두개의 합산척도를 추출, 각각 자각된 고통(RD, Recognized Distress)과 지각왜곡(PA, Perceptual Alteration)으로 명명하였다. 위의 합산척도와 PANSS의 상관관계에서, K-FBF 표준화 총점을 조절변수로 하여 편상관을 조사한 결과 PA척도와 PANSS 음성척도가 상관관계를 보였다. 이는 Huber의 기본증상이란 정신분열병의 음성증상을 주관적 측면에서 접근한 것이라는 평가와 관련된다. 한편, K-FBF표준화 총점과 SCL-90-R총점은 강한 상관관계를 나타낸 반면, SCL-90-R총점과 PANSS총점은 비록 통계적으로는 유의하지만 매우 미미한 상관관계만을 보였다. 따라서 평가척도의 상관성은 그 내용보다는 평가하는 주체에 더 큰 영향을 받는다고 판단되었다. 결 론 : 본 연구결과 K-FBF로 측정된 Huber의 기본증상은 정신분열병의 음성증상을 보다 더 반영하는 것으로 평가되었으며, 또 객관적 평가도구인 PANSS보다는 자기보고형 도구인 SCL-90-R과 더 높은 상관관계를 보인 것으로 나타났다. 그러나, 본 연구결과의 일반화를 위해서는 다른 질병단계, 다른 인구학적 변인을 가진 환자들을 대상으로 한 연구가 계속되어야 할 것이다. Objectives : Kyung Hee-Frankfurter Beschwerde-Fragebogen(K-FBF) is a representative subjective symptom measuring tool of schizophrenic patients. We performed psychopathology measurements using K-FBF, Positive and Negative Syndrome Scale(PANSS) and Symptom Checklist-90-Revised(SCL-90-R) in patients with schizophrenia and then compared the results of these three examinations one another, in order to examine which psychopathologic aspects K-FBF might reflect and to measure the possibility whether this instrument reflect the negative symptoms or cognitive impairments, which are difficult to measure by conventional objective instruments measuring psychopathology. Methods : All 66 patients satisfying DSM-IV criteria for schizophrenia, were approached. Their education level was more than high school and they were not in the acute stage of schizophrenia. They performed K-FBF and SCL-90-R, and at the same day, they were interviewed by one of both psychiatrists using PANSS. We examined the patterns of K-FBF response and performed facor analysis about 10 subscales. We examined the correlation between K-FBF and age, sex and insight. Also, we performed correlation analysis among the K-FBF, PANSS and SCL-90-R. Results : As for K-FBF, with increasing age, the number of positive response items and the symptom severity were decreased. Even when controlling prevalence period as control variable, the correlation remained unchanged. Performing factor analysis to the K-FBF subscales, we created 2 factors, ie summation subscales. We named those recognized distress(RD) and perceptual alteration(PA) each. Using K-FBF standardized total scores as controlling variable, we performed partial correlation between PA and PANSS negative symptom scale. The result was PA and PANSS have statistically significant correlation. This correspons with the view that Huber's basic symptoms are reflecting subjective approach of negative symptoms of schizophrenia. While K-FBF standardized total scores and PANSS total scores had statistically strong correlations, SCL-90-R total scores and PANSS total scores had statistically significant, but very mild correlations. So, we had the judgement that the correlations among the psychopathology measurement tools are more influenced by the rater than the contents of tools. Conclusion : We concluded that Huber's basic symptoms, measured by K-FBF, reflect more negative symptoms of schizophrenia than other symptoms. And K-FBF has more correlation with the PANSS, objective psychopathology. Measuring tool, than the SCL-90-R, self-report quetionnaire. But, more studies using patients with another disease stages and another demographic variables are needed in order to generalize the results of this study.
주연호,안지영,김종훈,김용식 대한신경정신의학회 2003 신경정신의학 Vol.42 No.3
Objectives:To explore the possibilities of finding a heritable phenotype(s) in patients with psychosis, we examined the similarities of clinical variables between psychotic sibling patients who share the half of genetic information. Methods:We recruited a group of sibling patients, whose diagnoses were schizophrenia, schizoaffective disorder and bipolar disorder and confirmed the diagnosis using SCID-RV(Structured Clinical Interview for DSM-IV, Research Version). Using 30 sets of sibling patients, we examined concordances or similarities of diagnosis, diagnostic subtypes, clinical symptoms, and longitudinal outcomes. Results:There were significant concordances in terms of age of onset, auditory hallucination persisted for more than 7 years, general level of functioning. No significant similarities or concordances were found in diagnosis, diagnostic subtypes, delusion, negative symptom, and thought disorder between sibling patients. Conclusion:Above mentioned similarities have the possibilities of genetically determined phenotypes that could be used in the future genetic studies. Concordance of hallucination persisted for more than 7 years, not the presence or absence of auditory hallucination between sibling patients suggests that it is more important to examine longitudinal patterns of symptoms than to merely examine the presence of symptoms at specific cross-sectional time points in terms of genetic studies