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시공간 재활훈련이 조현병 환자의 시공간 기능과 주의에 미치는 효과

The Effect of Visuospatial Rehabilitation on the Visuospatial Function and Attention in Patients with Schizophrenia

김지현|김명선
한국임상심리학회 (Korean Clinical Psychology Association)|2016.11|Korean Journal of Clinical Psychology|제35권 제4호|pp. 843-857|DOI 10.15842/kjcp.2016.35.4.012

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참고문헌

키워드

schizophreniaattention조현병인지재활시공간 기능주의조현병 증상cognitive rehabilitationvisuospatial functionnegative symptom
주제분류심리과학

초록

본 연구는 시공간 재활훈련이 조현병 환자들의 시공간 기능을 포함한 인지기능의 향상과 사회적 기능, 조현병 증상의 완화에 효과적인가를 알아보고자 하였다. 연구대상은 서울 소재 사회복귀시설에 거주하고 있는 조현병 환자 43명으로, 이들은 재활집단(n=14), 비교집단(n=14), 통제집단(n=15)으로 무선할당되었다. 재활집단은 주 3회 각 40분씩 6주에 걸쳐 총 18회기의 시공간 재활훈련을, 비교집단은 동일한 회기 동안 테트리스 게임을 실시하였고, 통제집단은 아무런 처지도 받지 않았다. 시공간 재활훈련 프로그램은 Bracy (1994)가 개발한 PSS CogReHab을 국내 상황에 맞게 수정하여 개발한 인지재활 프로그램을 사용하였다. 시공간 기능/시각기억, 주의, 언어기억, 작업기억, 집행기능을 평가하는 신경심리검사와 조현병 증상을 측정하는 Positive and Negative syndrome Scale (PANSS), 사회적 기능을 평가하는 한국판 정신사회적 기능-증상 평가척도(BASIS-32) 설문지를 재활훈련 전과 후에 실시하였다. 그 결과, 재활 후 실시한 신경심리검사에서 재활집단은 비교집단과 통제집단과 다르게 Rey 도형검사 모사단계, 숫자외우기 검사의 바로 따라외우기 조건, Stroop 검사의 단어-색채 조건의 수행이 유의하게 증가하였다. 그리고 재활집단에서 PANSS로 측정한 음성증상이 완화된 것이 관찰되었다. 이러한 결과는 시공간기능 재활이 조현병 환자의 시공간 기능 및 주의 기능 향상, 음성증상 완화에 효과적이라는 것을 의미하며, 조현병 환자의 치료에 시공간 기능을 포함하는 인지재활의 필요성을 시사한다.

Abstract

This study investigated the effect of visuospatial rehabilitation on the cognitive function in patients with schizophrenia. Fortythree patients with schizophrenia were randomly assigned into one of the three groups (rehabilitation, comparative, and control groups). The comprehensive neuropsychological tests including Rey-Osterreith Complex Figure Test (RCFT), Block Design, Puzzle, Korea-California Verbal Learning Test (K-CVLT), Stroop test, Digit Span, Spatial Span, and Wisconsin Card Sorting Test (WCST) were administered before and after rehabilitation for the three groups. In addition, schizophrenic symptoms and social function were measured by PANSS, and BASIS-32, respectively. Participants in the rehabilitation group received individual visuospatial rehabilitation three times a week for a 6 weeks durations, and the comparative group received the individual tetris game three times a week for a 6 weeks durations; the control group did not receive any treatment. The three groups did not differ on the performances of the neuropsychological tests, PANSS, and BASIS-32, which were administered before rehabilitation. However, the rehabilitation group showed significantly better performances on RCFT copy condition, Digit Span forward condition, color-word condition of the Stroop test, and PANSS negative symptom than the comparative and control groups after rehabilitation. These findings suggest that visuospatial rehabilitation is effective in improving visuospatial function, attention, and negative symptoms in patients with schizophrenia.

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