약물저항성 조현병 환자에서 인지행동치료의 효과
The Effect of Cognitive Behavioral Therapy in Drug-Resistant Patients with Schizophrenia
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Objectives Cognitive behavioral therapy of schizophrenia has been developed as a psychological therapy for drug resistant patients with schizophrenia. However, there are some controversial issues regarding the size and mode of the therapeutic effect. The aim of this study is to compare the effect of cognitive behavioral therapy with supportive therapy after treatment. Methods Patients with drug resistant schizophrenia were randomly allocated, and stratified according to two mental health institutes to two different therapy groups. We used four assessment scales to evaluate residual symptoms of patients in detail. Patients were assessed twice by a blind rater, at baseline and after treatment. Results No significant differences in the change of PANSS (Positive and Negative Syndrome Scale) scores were observed between the cognitive behavioral therapy and supportive therapy groups at one month after treatment. There was no significant difference in change of K-PSYRATS (Korean-Psychotic Symptom Rating Scale)-Delusion score, however, a trend toward significance in K-PSYRATS - Hallucination was observed between the two groups. In the aspect of insight, a significant difference in the change of SDMD-K (The Scale to assessment Unawareness of Mental Disorder-Korean version) score was observed between the two groups after treatment. Conclusion Despite remarkable development of pharmacotherapy for schizophrenia, many patients still suffer from residual symptoms. Findings of this study showed that cognitive behavioral therapy can improve the insight of patients and reduce the severity of residual positive symptoms, especially hallucination. Cognitive behavioral therapy should be practiced effectively in the psychiatric clinic and community mental health system.
Abstract
Objectives Cognitive behavioral therapy of schizophrenia has been developed as a psychological therapy for drug resistant patients with schizophrenia. However, there are some controversial issues regarding the size and mode of the therapeutic effect. The aim of this study is to compare the effect of cognitive behavioral therapy with supportive therapy after treatment. Methods Patients with drug resistant schizophrenia were randomly allocated, and stratified according to two mental health institutes to two different therapy groups. We used four assessment scales to evaluate residual symptoms of patients in detail. Patients were assessed twice by a blind rater, at baseline and after treatment. Results No significant differences in the change of PANSS (Positive and Negative Syndrome Scale) scores were observed between the cognitive behavioral therapy and supportive therapy groups at one month after treatment. There was no significant difference in change of K-PSYRATS (Korean-Psychotic Symptom Rating Scale)-Delusion score, however, a trend toward significance in K-PSYRATS - Hallucination was observed between the two groups. In the aspect of insight, a significant difference in the change of SDMD-K (The Scale to assessment Unawareness of Mental Disorder-Korean version) score was observed between the two groups after treatment. Conclusion Despite remarkable development of pharmacotherapy for schizophrenia, many patients still suffer from residual symptoms. Findings of this study showed that cognitive behavioral therapy can improve the insight of patients and reduce the severity of residual positive symptoms, especially hallucination. Cognitive behavioral therapy should be practiced effectively in the psychiatric clinic and community mental health system.
참고문헌 (16)
- McGlashan TH, "Psychotherapeutic models and the treatment of schizophrenia: the records of three successive psychotherapists with one patient at Chestnut Lodge for 18 years", Psychiatry, 51, pp.340~362 (1988)
- Gunderson JG, "Effects of psychotherapy in schizophrenia: II. Comparative outcome of two forms of treatment", Schizophr Bull, 10, pp.564~598 (1984)
- Tarrier N, "Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia", BMJ, 317, pp.303~307 (1998)
- Sensky T, "A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication", Arch Gen Psychiatry, 57, pp.165~172 (2000)
- Lewis S, "Randomised controlled trial of cognitive-behavioural therapy in early schizophrenia: acute-phase outcomes", Br J Psychiatry Suppl, 43, pp.91~97 (2002)
- National Institute for Clinical Excellence, "Clinical Guideline 1: Schizophrenia - Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care", pp.257~274 (2010), National Institute for Clinical Excellence
- Lynch D, "Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials", Psychol Med, 40, pp.9~24 (2010)
- Kim KR, "Clinical efficacy of individual cognitive therapy in reducing psychiatric symptoms in people at ultra-high risk for psychosis", Early Interv Psychiatry, 5, pp.174~178 (2011)
- 정영철, "정신분열병 환자의 망상에 대한 인지행동치료의 효과", 신경정신의학, 40(1), pp.63~71 (2001), 대한신경정신의학회
- Haddock G, "Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS)", Psychol Med, 29, pp.879~889 (1999)
- Amador XF, "Assessment of insight in psychosis", Am J Psychiatry, 150, pp.873~879 (1993)
- 송지영, "병식 평가 척도-한국판(SUMD-K)의 신뢰도와 타당도 검증", 신경정신의학, 45(4), pp.307~315 (2006), 대한신경정신의학회
- Sadock BJ, "Synopsis of Psychiatry. 10th ed", pp.1091~1098 (2007), Lippincott Williams & Wilkins
- Wiersma D, "Natural course of schizophrenic disorders: a 15-year followup of a Dutch incidence cohort", Schizophr Bull, 24, pp.75~85 (1998)
- Samarasekera N, "Befriending patients with medication-resistant schizophrenia: can psychotic symptoms predict treatment response?", Psychol Psychother, 80(Pt 1), pp.97~106 (2007)
- Mortimer AM, "Symptom rating scales and outcome in schizophrenia", Br J Psychiatry Suppl, 50, pp.7~14 (2007)