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정신분열병 심리사회적 치료의 역사와 성과

The History and Achievement of Psychosocial Treatment for Patients with Schizophrenia

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대한신경정신의학회 (Korean Neuropsychiatric Association)|2009.12|신경정신의학 (JOURNAL OF THE KOREAN NEUROPSYCHIATRIC ASSOCIATION)|제48권 제6호|pp. 411-421

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정신분열병·심리사회적 치료·가족치료·사회기술훈련·인지교정치료·직업재활치료
주제분류정신과학

초록

지난 30년 동안 정신분열병 환자의 심리사회적 치료는 가족치료, 사회기술훈련, 인지교정치료, 직업재활치료를 중심으로 많은 발전과 성과를 거두었다. 가족치료는 환자의 증상 재발 방지에 효과가 있으며 비교적 2년 이상의 지속 효과가 있는 것으로 나타났다. 사회기술훈련은 훈련시킨 특정한 기술의 획득은 가능하나 증상의 호전 및 재발 방지에는 효과가 적은 것으로 나타났다. 그러나 1년 이상의 훈련이 지속될 때 그 효과가 다른 사회기능 영역으로 일반화될 가능성이 있는 것으로 보인다. 신경인지 기능의 반복적 훈련은 사회 기능 영역에서 작은 효과 크기를 보이며, 환자의 사회인지나 사회기술훈련, 사회적 맥락 파악과 같은 높은 차원의 사회적 기능에 대한 부가적이고 포괄적인 치료는 환자의 사회 기능에 중간 정도의 효과 크기를 보인다. 환자의 직업 적응의 성공에 관련이 있는 인자는 병전기능, 음성증상, 인지기능 등이 있으며, 직업재활훈련 및 작업장에서 전문가에 의한 지지는 환자의 직업 적응 및 유지에 직접적으로 많은 도움을 준다. 최근 정신분열병 심리사회적 치료는 사회인지 왜곡에 대한 교정이나 여러 치료 방법의 결합, 또는 새로운 방식의 치료적 접근을 통해 효율적인 방식으로 환자의 성공적인 사회 적응을 돕기 위한 노력을 지속하고 있다.

Abstract

Objectives: Psychosocial treatment combined with pharmacological treatment has been established as one of the most important interventions for schizophrenia. However, it still does not show Editor’s note：I was not certain whether you intended the highlighted text to convey “psychosocial treatment + pharmacological treatment is an important treatment” or “psychosocial treatment is an important treatment, and pharmacological treatment is also an important treatment.” My edit reflects the former. If you actually intended the latter meaning, please change this sentence to read, “Psychosocial treatment has been established alongside pharmacological treatment as one of the most important interventions for schizophrenia.” satisfactory results with regard to patients’ social adjustment and independent living abilities. For this study, we reviewed the psychosocial treatment of schizophrenia: its therapeutic concepts, methods, effects of clinical application, and therapeutic limitations. Methods: We searched four areas of the English website Pubmed：family therapy, social skills training, cognitive remediation, and vocational rehabilitation, which are the main psychosocial treatment areas for schizophrenia. Results: Family therapy can reduce the relapse rate through psychoeducation, stress management, and behavioral intervention for family members when the therapy lasts longer than 9 months. This effect seems to last longer than 2 years. Social skills training allows patients to acquire specific skills but shows a relatively small effect on symptom improvement and relapse prevention. However, it is possible that social skills training has a lasting or generalized effect on the obtained skills if practiced long term (longer than 1 year). Basic neurocognitive function training shows a relatively small effect on social functioning, while additive and comprehensive social interventions, such as social cognition, social skill training, and context appraisal show a moderate effect on patients' social functioning. The success of vocational adjustment is related to premorbid functioning, negative symptoms, and cognitive functioning, and direct expert support can help patients’ vocational functioning in the workplace. Conclusion: The psychosocial treatment of schizophrenia has many important achievements during the past 30 years. However, several limitations of each type of psychosocial therapy have been ascertained during this same period. Researchers in the field of psychosocial treatment for schizophrenia have recently been trying to find more efficient treatments, by correcting distortions of social cognition, combining various treatment modules, and attempting new therapeutic approaches to psychosocial treatment.

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