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조현병에서 인지행동치료의 적용

The Application of the Cognitive Behavioral Therapy in Schizophrenia

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대한신경정신의학회 (Korean Neuropsychiatric Association)|2012.11|신경정신의학 (JOURNAL OF THE KOREAN NEUROPSYCHIATRIC ASSOCIATION)|제51권 제6호|pp. 359-366

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키워드

인지행동치료조현병Schizophrenia집단 인지행동치료Cognitive behavioral therapy약물저항성 환자급성 정신병적 증상. 전구기 정신증Drug resistant patientAcute psychotic stateEarly psychosisGroup cognitive behavioral therapy
주제분류정신과학

초록

조현병의 인지행동치료는 약물치료와 더불어 정신병적증상을 효과적으로 다룰 수 있는 가장 체계적인 심리학적 치료 방법이다. 조현병의 인지행동치료를 통하여 전구기 정신증 환자부터 약물저항성 만성 환자까지 망상과 환청과 같은정신병적 증상에 일정 부분 호전을 가져올 수 있으며 사회적기능 회복에도 도움이 될 수 있다. 인지행동치료의 효과는 약1년 정도 지속되는 것으로 보이며 이후에는 부가적인 치료가필요하다. 집단 인지행동치료의 정신병적 증상에 대한 효과는 명확하지 않지만 비교적 동질적인 증상 집단을 대상으로치료를 시도하였을 때, 사회적 기능 회복에 대한 효과는 있는것으로 보인다. 조현병의 인지행동치료는 국내의 임상과 지역사회에서 활발하게 적용되어야 할 것이다.

Abstract

Objectives Cognitive behavioral therapy for treatment of schizophrenia was designed as a psychological therapy for treatment of drug resistant patients with schizophrenia. This therapy is currently being widely applied from early psychosis to chronic condition. The aim of this article is to review the main results of research articles on cognitive behavioral therapy of schizophrenia and prompt practicing the therapy in Korean mental health services. Methods The important original and review articles were referred in order to understand the main results of research from published international books, and the English website Pubmed was searched in order to update recent findings. This article reviewed the results of four areas of different phases and types of cognitive behavioral therapy for treatment of schizophrenia: drug resistant chronic patients, acute psychotic state, prodromal phase, and group cognitive behavioral therapy. Results Cognitive behavioral therapy for treatment of drug resistant patients with schizophrenia can attenuate the positive and general symptoms more than that for patients who receive supportive psychotherapy or treatment as usual. However, the effect appears to be less than previously expected, small to moderate. Cognitive behavioral therapy for patients of acute psychotic state can reduce the time of recovery from acute psychotic symptoms by approximately 25%. The result of cognitive behavioral therapy for patients of prodromal phase shows that the therapy can reduce the rate of transition to schizophrenia by up to one third. Group behavioral therapy has recently been tested. Group therapists have suggested that the therapy should be applied through the way of groups with relatively homogenous symptoms. However, whether the therapy can reduce the severity of hallucination in the voice hearer group is inconclusive. Conclusion Alongside pharmacotherapy for treatment of schizophrenia, cognitive behavioral therapy is a distinct psychological therapy for attenuation of psychotic symptoms. The effect of cognitive behavioral therapy appears to last for one year and requires additional therapeutic sessions after one year. The effect is not still clear in group cognitive behavioral therapy for treatment of schizophrenia. Cognitive behavioral therapy for treatment of schizophrenia should be practiced widely in the Korean mental health system.

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