The Impact of Prolonged Duration of Untreated Illness on Clinical Correlates in Chronic Schizophrenia: Exploring the Relationship With Suicide Risk

Ke Zhang,Chenxi Wang,Lei Gou,Yaxi Li,Cui Li,Guoshuai Luo,Xiangyang Zhang 대한신경정신의학회 2024 PSYCHIATRY INVESTIGATION Vol.21 No.4

Objective Studies on duration of untreated psychosis are common in patients with schizophrenia, but few studies have investigated the relationship between duration of untreated illness (DUI) and suicide, especially in patients with chronic schizophrenia. Therefore, we intended to investigate the relationship between DUI and suicide and clinical correlates in patients with chronic schizophrenia.Methods A total of 1,555 Chinese patients with chronic schizophrenia were enrolled in this study. DUI was measured in years, reflecting the prolonged untreated periods observed in this population. Clinical correlates were assessed, including symptoms, cognitive functioning, and body mass index. Suicidal ideation and attempts were also examined. Statistical analyses, including multivariate models, were employed to investigate the associations between DUI and clinical correlates while controlling for potential confounders.Results The study revealed a significant proportion (23.3%) of patients with chronic schizophrenia in China received their first treatment after a 4-year delay, with the longest untreated duration reaching 39 years. Patients with longer DUI exhibited more severe negative symptoms, lower immediate memory scores, a higher likelihood of being overweight, and surprisingly, a reduced likelihood of suicidal ideation and attempts. Each additional year of untreated illness was associated with a 3% decrease in the risk of suicidal ideation and attempts.Conclusion The findings underscore the prevalence of extended untreated periods in Chinese patients with chronic schizophrenia and highlight the impact of DUI on negative symptoms, cognitive function, and body weight. Intriguingly, a longer DUI was associated with a lower risk of suicidal ideation and attempts.

만성 조현병 환자에서 반복적 경두개자기자극에 대한 혈청 Brain-Derived Neurotrophic Factor의 반응 양상과 신경가소성의 특성

오지영(Ji-Young Oh),황누리(Nu-Ri Hwang),황태영(Tae-Young Hwang) 대한사회정신의학회 2017 사회정신의학 Vol.22 No.2

연구목적 : 본 연구는 정량화된 반복적 경두개자기자극에 대한 혈청 뇌유래신경영양인자 (Brain-Derived Neurotrophic Factor, BDNF)의단기 반응 양상을 통해 만성 조현병 환자의 뇌 신경가소성의 특성을 살펴보고 만성 조현병 환자의 치료적 접근에 대한 시사점을 찾고자 하였다. 방 법 : 오른손잡이인 20명의 만성 조현병 환자가 연구에 참여하였다. 2주 동안 연속적으로 좌측 배외측 전전두엽 피질 부위에 운동역치의 100%에 해당하는 20Hz의 반복적 경두개자기자극(총 20,000 자극)을 제공하였고 이후로 2주 동안은 자극을 제공하지 않았다. 기저 시점과 자극 개시 1주 및 2주 후 그리고 자극 종료 후 2주 시점에서 각각 혈청 BDNF를 측정하였으며 안정적인 약물 유지의 확인을 위하여 혈청 프로락틴 수치를 병행 측정하였다. 임상적 평가를 위하여 전반적 임상 인상 척도(Clinical Global Impression Scale, CGI)와 양성 및 음성 증후군 척도(Positive and Negative Syndrome Scale, PANSS)를 사용하였다. 결 과 : 총 18명이 연구를 완료하였다. 항정신병약물의 클로로프로마진 등가용량은 평균(표준편차) 1,325.69(767.58)mg이었다. 기저치 PANSS 전체 점수는 평균(표준편차) 68.44(6.05)였다. 혈청 BDNF 수치는 자극개시 후 2주 시점에서 기저치와 비교하여 유의한 차이를 나타내었다(p=0.038). 그러나 자극 종료 후 2주 시점에서는 차이의 유의성이 나타나지 않았다(p=0.185). 결 론 : 본 연구 결과는 만성 조현병 환자의 뇌 신경가소성이 제한적인 상태이며 일정 수준 이상의 지속적인 치료적 자극이 정신재활을 위한 치료적 측면에서 필요한 점을 시사하고 있다. Objective : For evidence-based activities for psychiatric rehabilitation in patients with chronic schizophrenia, it is necessary to investigate the capacity and characteristics in the brain neuroplasticity of patients with chronic schizophrenia. This study aimed at examining short-term response pattern of serum Brain-Derived Neurotrophic Factor (sBDNF) to the quantified stimuli applied with repetitive Transcranial Magnetic Stimulation (rTMS). Methods : Right-handed 20 inpatients with chronic schizophrenia were recruited. The handedness was assessed using Edinburgh Handedness Inventory. Consecutive 10-weekday sessions with 20Hz rTMS (a total of 20,000 stimuli) were applied over the left dorsolateral prefrontal cortex at 100% of motor threshold. There was no change in the medication for at least 2 weeks before enrollment and 4 weeks thereafter. Serum Prolactin level was co-measured for the reference of stable medication. Primary outcome measure was the change in the mean concentration of duplicated sBDNF (pg/ml). Clinical severity or change was measured using the Clinical Global Impression scale (CGI) and the Positive and Negative Symptom Scale (PANSS). Results : Eighteen participants (male, 10;female, 8) completed the study. The chlorpromazine equivalent (CPZE) of antipsychotics were 1,325.69 (761.58) mg. Baseline CGI-severity and total PANSS score were 4.61 (0.50) and 68.44 (6.05), respectively. In the level of sBDNF just after 2-week rTMS sessions, the differences from baseline were statistically significant (p=0.038). At 2 weeks after the completion of rTMS sessions, however, the significance in the level of sBDNF was not manifest (p= 0.185). Conclusion : The findings of this study showed that the neuroplastic capacity is limited in the brain of patients with chronic schizophrenia and persistent therapeutic stimuli over certain level in activities for psychiatric rehabilitation may be necessary due to the absence of cumulative effect, suggesting positive and negative implications to psychiatric rehabilitation in patients with chronic schizophrenia.

CASE REPORT : A Case Report of a Chronic Schizophrenia Treated with Combined Treatment of Korean and Western Medicine

( Na Eun Park ),( Jun Hyun Park ),( Dae Eok Kim ),( Young Min Seo ),( Sang Ho Kim ),( Dae Kyoo Chung ) 대한한방신경정신과학회 2015 동의신경정신과학회지 Vol.26 No.4

Objectives: Schizophrenia is difficult to treat effectively and the antipsychotics used have many side effects. However, few studies have focused on the combined treatment of Korean and Western medi-cine as an alternative. In this study, we reported an inpatient with chronic schizophrenia who was treated by a combination of Korean and Western medicine. Methods: We experienced a case of a diagnosed schizophrenia patient as whose chief complaint was avolition, diminished emotional expression and hallucination. The patient was treated with Western medicine and Korean traditional treatment including acupuncture, moxa and herbal medicine. The Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS) were used for assessment. Results: After treatment, symptoms involving avolition, diminished emotional expression and halluci-nation were improved; furthermore, the scores of the BPRS and the PANSS were decreased by approx-imately 50%, respectively. In addition, there were no notable side effects. Conclusions: The combined treatment of Korean and Western medicine can be an effective and well-tolerated treatment modality for patients with chronic schizophrenia.

중년기 만성 정신분열병환자를 위한 사회기술훈련의 효과: 예비 연구

김창곤 한국인지행동치료학회 2005 인지행동치료 Vol.5 No.2

만성 정신분열병 환자 대상의 인지행동치료와 사회기술훈련에 관한 선행 연구들이 비교적 많이 시행되고 있으나 중년기 이후 만성 정신질환자들에 대한 연구는 별로 시행되지 못하였다. 본 연구는 중년기 만성 정신분열병 환자를 대상으로 사회기술훈련의 효과를 알아보기 위한 예비 조사로 시행되었다. 대상자는 8명의 중년기 만성정신분열병 환자들이었고, 주 1회 60분씩, 8주간 Liberman의 사회기술훈련모듈에 근거한 훈련을 시행하였으며, 대인관계변화척도(RCS)와 자기주장척도(RAS)를 사용하여 프로그램을 사전 사후로 평가하여 프로그램의 효과를 알아보았다. 대상자들의 대인관계의 변화 점수(RCS)는 훈련 후 유의하게 증가하였으나, 자기주장점수(RAS)는 유의하지는 않았다. 본 예비 연구의 결과는 중년기 이후의 만성 정신분열병 환자에게도 사회기술훈련이 대인관계의 변화에 매우 효과적으로 사용될 수 있는 프로그램이 될 수 있음을 시사한다. Since most prior studies for cognitive behavior therapy and social skills training in patients with schizophrenia have usually involved subjects who were younger than 40 years old, the research in middle-aged and older patients is needed. The purpose of this preliminary study was to test the effect of social skill training in middle-aged patients with chronic schizophrenia. The subjects were 8 inpatients with middle-aged chronic schizophrenia. The social skill training had been applied with weekly session by Liberman's social skill training modules for 8 weeks. Before and after training, the level of social skills about participants were assessed by RCS(Relationship Change Scale)and RAS(Rathus Assertiveness Scale). Middle-aged patients with chronic schizophrenia showed improvement over the training period on interpersonal relationship. Total score of RCS were significantly increased (0.012). These results suggest that middle-aged patients with chronic schizophrenia may benefit from participation in social skill training. Further larger studies in middle-aged and elderly patients with schizophrenia would be needed to explore the effectiveness of social skill training in these subjects.

남성 만성 조현병 환자에서 혈중 테스토스테론 농도와 인지 기능의 상관관계

김우림(Woo Rim Kim),서재원(Jae Won Suh),이경한(Kyung Han Lee),김신겸(Shin Kyum Kim) 대한생물치료정신의학회 2014 생물치료정신의학 Vol.20 No.3

Objectives:The purpose of this study was to investigate the relationships between sexual hormone level and cognition in male patients with schizophrenia. Methods:Total 80 male patients with schizophrenia were involved in this study. Among them, 61 patients were classified into normal cognition group(NCG) and 19 patients for lower cognition group(LCG), according to the Korean version of Consortium to Establish a Registry for Alzheimer’s Disease(CERAD-K) and Korean-Color Word Stroop Test. LCG was identified who were included at the below 5 percentile in at least one domain of the cognitive test. All the participants completed Positive and Negative Syndrome Scale(PANSS), Simpson Angus rating Scales(SAS) and Hamilton rating scale for Depression(HAM-D). Sexual hormone levels of prolactin, total testosterone, free-testosterone and estradiol were also checked by blood hormonal assays. Results:The patients with higher total testosterone level on construction domain were more likely to be included in LCG than NCG. Statistically significant correlations were still observed after adjustment of the several covariants. Total testosterone, free testosterone and estradiol levels have statistically significant positive correlations between each other, but there were negative correlations between prolactin and other hormone levels in 80 male patients with schizophrenia. Conclusion:These results suggest that sexual hormone may modulate the cognitive deficits in patients with chronic schizophrenia. Sexual hormone levels would be considered as predictive factors about cognitive function of patients with chronic schizophrenia. Furthermore, longitudinal and large-scale control studies would be needed to confirm these results.

A Case Report of a Chronic Schizophrenia Treated with Combined Treatment of Korean and Western Medicine

Park, Na-Eun,Park, Jun-Hyun,Kim, Dae-Eok,Seo, Young-Min,Kim, Sang-Ho,Chung, Dae-Kyoo The Korean Society of Oriental Neuropsychiatry 2015 동의신경정신과학회지 Vol.26 No.4

Objectives: Schizophrenia is difficult to treat effectively and the antipsychotics used have many side effects. However, few studies have focused on the combined treatment of Korean and Western medicine as an alternative. In this study, we reported an inpatient with chronic schizophrenia who was treated by a combination of Korean and Western medicine. Methods: We experienced a case of a diagnosed schizophrenia patient as whose chief complaint was avolition, diminished emotional expression and hallucination. The patient was treated with Western medicine and Korean traditional treatment including acupuncture, moxa and herbal medicine. The Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS) were used for assessment. Results: After treatment, symptoms involving avolition, diminished emotional expression and hallucination were improved; furthermore, the scores of the BPRS and the PANSS were decreased by approximately 50%, respectively. In addition, there were no notable side effects. Conclusions: The combined treatment of Korean and Western medicine can be an effective and well-tolerated treatment modality for patients with chronic schizophrenia.

만성조현병 환자의 시치료 경험에 관한 연구: 소외된 자를 향한 기독(목회)상담적 접근

김채석,오화철 한국기독교상담심리학회 2020 한국기독교상담학회지 Vol.31 No.3

The purpose of this study is to collect and analyze the experiences of patients with chronicc schizophrenia, and conduct Poetry Therapy on the implications to promote their mental and social rehabilitation. The study participants are 12 Christians with chronic schizophrenia over 5 years of illness. The essence of the life they experienced is summarized as 'living a lonely life without hope and suffering discrimination after developing the schizophrenia and then enduring the life with the Absolute God and relying on Him.' The core of the meaning of Poetry Therapy they experienced was 'the discovery of hope for their lives' as 'the recovery of relationship and self- discovery through poetry.' On the research results, the conclusion presents practical suggestions of Christian (pastoral) counseling for chronic schizophrenic patients who are alienated within the society. And it suggests the implications for emotional change, promotion of social adaptation, and rehabilitation through Poetry Therapy. 본 연구의 목적은 만성조현병 환자가 겪어온 삶의 경험을 수집, 분석한 후, 그 시사점 위에서 시(詩)치료를 실시하여 그들의 정신적, 사회적 재활을 도모하고자 하는 것이다. 연구참여자들은 유병 기간 5년 이상의 만성조현병 환자 12명으로 이들은 모두 기독교인이다. 현상학적 방법에 의한 분석 결과, 이들이 경험한 삶의 본질은 ‘인생의 위기들을 지나오며 조현병에 걸린 뒤, 현실에서 낙오되고 편견과 차별 속에 살아가는 소망없는 외로운 삶을 절대자 하나님을 의지하며 견디어내는 삶’으로 요약할 수 있었다. 뒤이어 이루어진 ‘만성조현병 환자의 시치료 경험 연구’는 10회기 집단 시치료 참여를 통해 참여자들이 직접 경험하고 발견한 시치료의 의미와 치료요인에 관한 분석이다. 이들이 경험한 시치료 의미의 핵심은 ‘시(詩)를 통한 자기 발견 및 관계의 회복’으로서 ‘자신의 삶을 향한 희망의 발견’이라고 요약되었다. 연구결과를 토대로 결론에서는 Miller-McLemore의 목회 신학 이론에 기초하여 구조 안에서 소외되는 만성조현병 환자에 대한 기독(목회)상담의 실천적 제안을 제시하고, 시치료를 통한 정서적 변화, 사회 적응 촉진 및 재활로 이어지는 함의를 제시하였다.

만성정신분열병 환자의 희망, 자가간호역량, 정신건강의 관계

송효정 ( Hyo Jeong Song ),현미열 ( Mi Yeul Hyun ),이은주 ( Eun Joo Lee ) 한국간호과학회 정신간호학회(구 대한간호학회정신간호학회) 2011 정신간호학회지 Vol.20 No.2

Purpose: The purpose of this study was to identify the relationship between hope, self-care agency, and mental health in patients with chronic schizophrenia. Methods: The participants were 118 patients with chronic schizophrenia receiving care at a community mental health center. Data were collected from March 5th to May 29th, 2009 and were analyzed with using descriptive statistics, Pearson`s correlation coefficients, and stepwise multiple regression. Results: A significant positive correlation was found between hope and self-care agency; and a significant negative correlation between hope and mental health. Hope significantly predicted by mental health(p<.001) explained 34.9% of the variance in mental health. Conclusion: As the results indicate hope is significantly correlated with self-care agency and mental health in patients with chronic schizophrenia. It is recommended that intervention programs should be developed to increase hope and to evaluate more precisely factors related to mental health in this population.

재가 만성조현병 내담자의 심리상담 경험 연구

노청숙,한재희 한국기독교상담심리학회 2015 한국기독교상담학회지 Vol.26 No.3

The purpose of this study is to analyze the fundamentals of the psychological counseling experience of the patients with chronic schizophrenia. To this end, I selected five non–institutionalized chronic schizophrenia patients with more than a year of counseling experience and analyzed their in–depth interview data according to the phenomenological approach of Giorgi. The patients developed a positive relationship with their counselor and complied with the active therapeutic intervention by the counselor. The patients sought advice from the counselor for difficulties in everyday life. The patients learned how to distinguish the reality from hallucination and they were taught the importance of taking medications. They were given detailed instructions on how to deal with everyday tasks. The participants experienced conflicts at the beginning stage of counseling. However, they soon developed voluntary willingness towards the treatment and remained hopeful by participating in counseling and taking medications. The interventions by the counselor combined with the willingness by the patients resulted in emotional, practical, and subjective effects of counseling. 본 연구의 목적은 재가 만성조현병 내담자의 심리상담 경험의 본질과 의미를 심층적으로 탐구하는 것이다. 이를 위해 전문 심리상담자에게 1년 이상 상담을 받은 재가 만성조현병 환자 5명을 연구 참여자로 선정하여 심층인터뷰한 자료를 Giorgi의 현상학적 연구방법에 따라 분석하였다. 만성조현병 환자인 참여자들은 상담을 받기 시작하면서 상담자와의 따뜻하고 긍정적인 교류를 경험하면서 또한 상담자의 적극적인 치료적 개입을 경험하였다. 참여자들은 상담 초기 상담자와 신뢰관계가 형성되기 전에는 상담에 대한 갈등을 경험하였으나 점차 자발성을 발휘하며 상담에 적극적으로 임하게 되었고, 약물복용과 상담을 꾸준히 병행하면서 자신의 병에 대한 치료적 기대감을 유지하였다. 참여자들은 상담자의 개입과 자신의 자발성 발휘의 순환적 상호작용을 통해 정서적, 현실적, 주관적 측면의 변화를 경험하였다. 참여자들은 심리적 안정감을 갖게 되었고, 현실감을 유지하면서 일상생활이 가능해졌으며, 주변 관계가 이전보다 호전되었다. 또한 참여자들은 장기간의 상담을 통해 자신을 소중히 여기게 되고, 자신의 병을 수용하고 다스리면서 소망을 가지고 살아가는 긍정적인 변화를 경험한 것으로 발견되었다.

자아존중감 증진 프로그램이 재가 만성 정신분열병 환자의 자존감, 우울 및 대인관계에 미치는 효과

김정숙 ( Jung Sug Kim ),임영미 ( Young Mi Lim ) 한국간호과학회 정신간호학회(구 대한간호학회정신간호학회) 2010 정신간호학회지 Vol.19 No.4

Purpose: The purpose of this study was to determine the effects of self-esteem improvement program on self-esteem, depression, and interpersonal relationship in chronic schizophrenia patients living in the community. Methods: The research design was a non-equivalent pre and post control group design. One of two community mental health centers was randomly assigned to receive the intervention and the other served as a control. Eight patients in the intervention group and ten in the control group participated. For the intervention group, the self-esteem improvement program was provided in 60-minute session once a week for 12-weeks. Measurements were Korean version of self-esteem scale (SES-K), Korean version of beck depression inventory (BDI-K), and Korean version of interpersonal relationships (IR-K). Results: The only statistically significant difference between the experimental and control group was for interpersonal relationships. For the experimental group, there were statistically significant differences in self-esteem and interpersonal relationships. Conclusion: The results indicate that this type of program has a positive effect on self-esteem and interpersonal relationships and can be a feasible type of intervention program for community dwelling patients with chronic schizophrenia.