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범불안장애의 진단과 심리학적 평가

Diagnosis and Psychological Assessment of Generalized Anxiety Disorder

김근향
대한신경정신의학회 (Korean Neuropsychiatric Association)|2012.01|신경정신의학 (JOURNAL OF THE KOREAN NEUROPSYCHIATRIC ASSOCIATION)|제51권 제1호|pp. 16-24

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참고문헌

키워드

범불안장애Generalized anxiety disorder측정도구진단DiagnosisPsychological assessment심리학적 평가Measures
주제분류정신과학

초록

GAD는 정신장애 분류의 진단적 위계, GAD 진단의 핵심인 과도한 불안과 걱정의 개념 및 정의, 동반되는 다른 질환과의 관계 문제 등으로 인해 임상장면에서 충분히 주의를 받아오지 못하다가 최근 관련된 이슈들이 다루어지고 GAD 진단과 관련된 문제들을 보완하고자 활발한 논의가 진행 중이며 최근 GAD에 대한 여러 약물치료의 효과 또한 입증되고있다. 국내에서도 GAD 약물치료 알고리듬을 개발하는 등관심이 확대되고 체계적인 연구가 시도되고 있다. 이에 발맞추어 본고에서는 GAD 진단과 이를 위한 심리학적 평가에서중점으로 다루어야 할 점들과 현재 국내에서 가용한 GAD 평가도구들을 개관하였다. 이와 같은 개관이 GAD 환자의 조기선별 및 진단적 평가 그리고 여러 가지 면에서 이질적인 증상과 특성들을 지닌 GAD 환자들을 다룰 때 치료적 초점을어디에 두어야 할 것인지에 대해서도 도움을 될 수 있을 것으로 생각된다. GAD의 정확한 진단과 면밀한 심리학적 평가를 기반으로 GAD에 대한 심도 있는 연구 또한 기대한다.

Abstract

Of the anxiety disorders which may be identified in a clinical setting, generalized anxiety disorder (GAD) has often been overlooked for several reasons : 1) its unremarkable place in the diagnostic hierarchy, 2) relationship to excessive anxiety and worry, and 3) comorbidity with other mental disorders which may take clinical precedence. However, clinicians should be attentive to the clinical signs leading to a diagnosis of GAD. This paper reviewed the availability of reliable assessment tools to help clinicians diagnose and assess GAD. First, diagnostic interview tools targeting GAD were introduced. Then, the tools for assessing worry (intensity/frequency/topic), factors associated with its maintenance (cognitive avoidance, intolerance of uncertainty), and tools for assessing generalized anxiety (severity/aspects), comorbid condition and differential diagnosis were reviewed. Lastly, cultural and developmental aspects related to GAD were addressed. The considerations included in this report were summarized in a flow chart and table that are practically useful in the diagnoses and assessment of GAD. Thus, this review provided guidelines for clinicians in the Korean psychiatric setting to enable appropriate diagnosis, assessment, and treatment of GAD.

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