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전산화 집행 기능 재활이 조현병 환자의 인지 기능 향상에 미치는 효과

The effect of computerized executive function rehabilitation on the improvement of cognitive functions in patients with schizophrenia

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초록

본 연구는 전산화 집행 기능 재활이 조현병 환자의 인지 기능의 향상과 조현병 증상의 완화 및 삶의 질 향상에 효과적인가를 알아보고자 하였다. 연구 대상은 조현병 환자 30명이었으며, 이들을 각각 재활군(n = 15)과 통제군(n = 15)에 무선할당 하였다. 재활군은 주 3회 각 45분씩 6주에 걸쳐 총 18회의 집행 기능 재활을 받았고, 통제군은 어떠한 처치도 받지 않았다. 집행 기능의 재활에는 Bracy(1995)가 개발한 PSS CogReHab를 국내 상황에 맞게 수정하여 개발한 한국형 전산화 인지 재활 프로그램이 사용되었다. 재활 후 환자들의 인지 기능 변화를 알아보기 위하여 집행 기능, 주의, 작업 기억, 비언어 기억과 언어 기억을 평가하는 신경심리검사를 재활 전과 후에 실시하였고, 이와 더불어 조현병 증상을 평가하는 양성-음성 증상 척도(The Positive and Negative Syndrome Scale: PANSS)와 조현병 환자의 삶의 질 척도(Schizophrenia Quality of Life Scale: SQLS)를 재활 전과 후에 실시하였다. 그 결과, 재활 전 실시한 신경심리검사, PANSS 및 SQLS에서 재활군과 통제군 간의 유의한 차이가 관찰되지 않았으나 재활 후 실시한 신경심리검사에서 재활군은 재활 전에 비해 위스콘신 카드분류 검사에서 유의하게 감소된 오반응수와 보속 오반응수와 유의하게 향상된 숫자 외우기 검사의 수행을 보인 반면 통제군에서는 이러한 수행 향상이 관찰되지 않았다. 이러한 결과는 집행 기능의 재활이 조현병 환자의 집행 기능 및 작업 기억의 향상에 효과적이라는 것과 조현병의 치료에 집행 기능을 포함하는 인지 재활의 필요성을 시사한다.

Abstract

This study investigated the effect of executive rehabilitation on improvement of cognitive function in patients with schizophrenia. Thirty schizophrenia patients were randomly assigned to one of two groups, rehabilitation and control groups. Comprehensive neuropsychological tests including Wisconsin Card Sorting Test (WCST), Stroop test, Trail Making Test, Digit Span, Rey-Osterreith Complex Figure Test and Korea-California Verbal Learning Test were administered before and after rehabilitation for the two groups. In addition, schizophrenia symptoms and quality of life were measured using PANSS and SQLS, respectively. Participants in the rehabilitation group received executive rehabilitation three times a week for 6 weeks individually, whereas the control group did not receive rehabilitation. The two groups did not differ on the performances of any of the neuropsychological tests, PANSS and SQLS scores administered prior to rehabilitation training. The rehabilitation group showed significantly improved performances on the WCST (reduced total numbers of error and perseverative error) and Digit Span administered after the training. However, the control group did not show these improvements. These findings suggest that executive rehabilitation is effective for improvement of executive function and working memory in patients with schizophrenia.

참고문헌 (102)

  1. 김정기, "K-CVLT : 신경심리학적 기억검사(성인용)" (1999), 도서출판 특수교육
  2. 김진훈, "한국어판 정신분열병 삶의 질 척도의 개발과 PANSS와의 관련성", 신경정신의학, 45(5), pp.401~410 (2006), 대한신경정신의학회
  3. 박윤정, "주의력 재활 훈련이 정신분열병 환자의 인지 기능에 미치는 효과", Korean Journal of Clinical Psychology, 24(4), pp.721~737 (2005), 한국임상심리학회
  4. 안석균, "만성 정신분열병 환자에서 전산화 인지재활 프로그램을 이용한 주의력 훈련의 효과", 신경정신의학, 36(1), pp.72~79 (1997)
  5. 염태호, "K-WAIS 실시요강" (1992), 한국 가이던스
  6. 유민호, "게임을 이용한 인지 장애 치료 방법 및 그 기록 매체, 게임을 이용한 인지 장애 치료 장치", 국내 특허 출원, 2007
  7. 이중서, "한국판 양성 및 음성증후군 척도(Positive and Negative Syndrome Scale)의 신뢰도와 타당도", 신경정신의학, 40(6), pp.1090~1105 (2001), 대한신경정신의학회
  8. 장희진, "전산화 주의 재활 훈련이 정신분열병 환자의 인지 기능에 미치는 효과", Korean Journal of Clinical Psychology, 30(3), pp.803~823 (2011), 한국임상심리학회
  9. 정월영, "주의력향상 훈련이 정신분열병 환자의 인지기능향상에 미치는 효과", Korean Journal of Clinical Psychology, 25(4), pp.919~934 (2006), 한국임상심리학회
  10. 조수진, "정신분열병 환자에 대한 인지재활 훈련이 신경인지기능과 사회적 기능에 미치는 효과", Korean Journal of Clinical Psychology, 23(3), pp.559~576 (2004), 한국임상심리학회
  11. Addington, J., "Neurocognitive and social functioning in schizophrenia", Schizophrenia Bulletin, 25(1), pp.173~182 (1999)
  12. Baddeley, A. D., "Working memory", Science, 255(5044), pp.556~559 (1992)
  13. Bark, N., "The impact of cognitive remediation on psychiatric symptoms of schizophrenia", Schizophrenia Research, 63(3), pp.229~235 (2003)
  14. Bell, M. D., "Neurocognitive enhancement therapy with work therapy : effects on neurocognitive test performance", Archives of General Psychiatry, 58(8), pp.763~768 (2001)
  15. Bell, M. D., "Neurocognitive enhancement therapy with work therapy; productivity outcomes at 6-month and 12-month follow-up", Journal of Rehabilitation and Development, 42(6), pp.829~838 (2005)
  16. Bell, M. D., "Effects of neurocognitive enhancement therapy in schizophrenia : normalization of memory performance", Cognitive Neuropsychiatry, 9(3), pp.199~211 (2004)
  17. Bellucci, D. M., "Computer-assisted cognitive rehabilitation reduces negative symptoms in the severely mentally ill", Schizophrenia Research, 59(2-3), pp.225~232 (2003)
  18. Bozikas, V. P., "Neuropsychological profile of cognitively impaired patients with schizophrenia", Comprehensive Psychiatry, 47(2), pp.136~143 (2006)
  19. Bracy, O. L., "Computer-based cognitive rehabilitation", Cognitive Rehabilitation, 1(1), pp.7~8 (1983)
  20. Bracy, O. L., "PSS CogReHab, version 95", Psychological Software Services, Inc, ~ (1995)
  21. Burda, P. C., "Computer administered treatment of psychiatric inpatients", Computer and Human Behavior, 7(1-2), pp.1~5 (1991)
  22. Burda, P. C., "Computer-assisted cognitive rehabilitation of chronic psychiatric inpatients", Computers in Human Behavior, 10(3), pp.359~368 (1994)
  23. Cicerone, K. D., "Evidence-based cognitive rehabilitation : recommendations for clinical practice", Archives of Physical Medicine and Rehabilitation, 81(12), pp.1596~1615 (2000)
  24. Crawford, J. R., "Frontal lobe impairment in schizophrenia : relationship to intellectual functioning", Psychological Medicine, 23(3), pp.787~790 (1993)
  25. d'Amato, T., "A randomized, controlled trial of computer-assisted cognitive remediation for schizophrenia", Schizophrenia Research, 125(2), pp.284~290 (2011)
  26. Davalos, D. B., "Enhancement of executive functioning skills : an additional tier in the treatment of schizophrenia", Community Mental Health Journal, 38(5), pp.403~412 (2002)
  27. Dawson, P., "Executive functions in children and adolescents: A practical guide to assessment and intervention" (2004), Guilford Press
  28. Diforio, D., "Executive function in adolescents with schizotypal personality disorder", Schizophrenia Research, 42(2), pp.125~134 (2000)
  29. Dollfus, S., "Executive", attentional cognitive functions in schizophrenic patients and their parents: a preliminary study, 2002, pp.53(1-2), 93~99
  30. Eling, P., "On the historical and conceptual background of the wisconsin card sorting test", Brain and Cognition, 67(3), pp.247~253 (2008)
  31. Everett, J., "Performance of patients with schizophrenia on the Wisconsin Card Sorting Test(WCST)", Journal of Psychiatry & Neuroscience, 26(2), pp.123~130 (2001)
  32. Fey, E., "The performance of young schizophrenics on the Wisconsin Card Sorting Test", Journal of Consulting Psychology, 15(4), pp.311~319 (1951)
  33. Fiszdon, J. M., "Durability of cognitive remediation training in schizophrenia : performance on two memory task at 6-month and 12-month follow-up", Psychiatry Research, 125(1), pp.1~7 (2004)
  34. Fitzgerald, D., "Cognitive functioning in young people with first episode psychosis : relationship to diagnosis and clinical characteristics", The Australian and New Zealand Journal of Psychiatry, 38(7), pp.501~510 (2004)
  35. Goldberg, T. E., "Intellectual impairment in adolescent psychosis : a controlled psychometric study", Schizophrenia Research, 1(4), pp.261~266 (1988)
  36. Golden, C. J., "Stroop color and word test : a manual for clinical and experimental uses" (2002), Stoelting Co
  37. Green, M. F., "What are the functional consequences of neurocognitive deficits in schizophrenia", American Journal of Psychiatry, 153(3), pp.321~330 (1996)
  38. Green, M. F., "Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the ‘right stuff’?", Schizophrenia Bulletin, 26(1), pp.119~136 (2000)
  39. Greig, T., "Improved cognitive function in schizophrenia after one year of cognitive training and vocational services", Schizophrenia Research, 96(1-3), pp.156~161 (2007)
  40. Groeger, J. A., "Measuring memory span", International Journal of Psychology, 34(5-6), pp.359~363 (1999)
  41. Harvey, P. D., "Cognitive functioning in schizophrenia : a consensus statement on its role in the definition and evaluation of effective treatments for the illness", Journal of Clinical Psychiatry, 65(3), pp.361~372 (2004)
  42. Heaton, R. K., "Wisconsin card sorting test manual" (1981), Psychological Assessment Cooperation Press
  43. Heaton, R. K., "Wisocnsin card sorting test(WCST)" (1993), Psychological Assessment Resources Inc
  44. Heinrichs, R. W., "Neurocognitive deficit in schizophrenia : a quantitative review of the evidence", Neuropsychology, 12(3), pp.426~445 (1998)
  45. Horgaty, G. E., "Cognitive enhancement therapy for schizophrenia : effect of a 2-year randomized trial on cognition and behavior", Archives of General Psychiatry, 61(9), pp.866~876 (2004)
  46. Hughes, C., "Longitudinal study of symptoms and cognitive function in chronic schizophrenia", Schizophrenia Research, 59(2-3), pp.137~146 (2003)
  47. Kay, S. R., "The Positive and negative syndrome scale(PANSS)for schizophrenia", Schizophrenia Bulletin, 13(2), pp.261~276 (1987)
  48. Kay, S. R., "Pyramidical model of schizophrenia", Schizophrenia Bulletin, 16(3), pp.537~545 (1990)
  49. Kim, M. S., "Neuropsychological correlates of P300 abnormalities in patients with schizophrenia and obsessive-compulsive disorder", Psychiatry Research : Neuroimaging, 123(2), pp.109~123 (2003)
  50. Kim, M. S., "Neuropsychologic profile of college students with schizotypal traits", Comprehensive Psychiatry, 52(5), pp.511~516 (2011)
  51. Kluwe-Schiavon, B., "Executive functions rehabilitation for schizophrenia : A critical systematic review", Journal of Psychiatric Research, 47(1), pp.91~104 (2013)
  52. Kongs, S. K., "Wisconsin Card Sorting Test-64 Card Version Professional Manual" (2000), Lutz, Psychological Assessment Resources, INC
  53. Kremen, W. S., "Intelligence quotient and neuropsychological profiles in patients with schizophrenia and in normal volunteers", Biological Psychiatry, 50(6), pp.453~462 (2001)
  54. Kurtz, M. M., "Computer-assisted cognitive remediation in schizophrenia: What in the active ingredient?", Schizophrenia Research, 89(1-3), pp.251~260 (2007)
  55. Lee, J., "Working memory impairments in schizophrenia : a meta-analysis", Journal of Abnormal Psychology, 144(4), pp.599~611 (2005)
  56. Levin, S., "Contributions of clinical neuropsychology to the study of schizophrenia", Journal of Abnormal Psychology, 98(4), pp.341~356 (1989)
  57. Lezak, M. D., "Neuropsychologicla assessment" (1995), Oxford University Press
  58. Lezak, M. D., "Neuropsychological assessment" (2004), Oxford University Press
  59. Ma, X., "Neurocognitive deficits in first-episode schizophrenic patients and their first-degree relatives", American Journal of Medical Genetics Part B(Neuropsychiatric Genetics, 144B(4), pp.407~416 (2007)
  60. Marder, S. R., "Initiatives to promote the discovery of drugs to improve cognitive function in severe mental illness", Journal of Clinical Psychiatry, 67(7), pp.31~35 (2006)
  61. McGurk, S. R., "Cognitive and symptom predictors of work outcomes for clients with schizophrenia in supported employment", Psychiatric Services, 54(8), pp.1129~1135 (2003)
  62. Medalia, A., "Treating problem-solving deficits on an acute care psychiatric inpatient unit", Psychiatry Research, 97(1), pp.79~88 (2000)
  63. Medalia, A., "The remediation of problem-solving skills in schizophrenia", Schizophrenia Bulletin, 27(2), pp.259~267 (2001)
  64. Medalia, A., "Remediation of problem-solving skills in schizophrenia: evidence of a persistent effect", Schizophrenia Research, 57(2-3), pp.165~171 (2002)
  65. Meyers, J., "Rey Complex Figure and Recognition Trail: Professional manual" (1995), Psychological Assessment Resources
  66. Morice, R., "Cognitive inflexibility and pre-frontal dysfunction in schizophrenia and mania", The British Journal of Psychiatry, 157(1), pp.50~54 (1990)
  67. Oliver-Souza, R. D., "Trail making and cognitive set-shifting", Arquivos de Neuro-psiquiatria, 60(4), pp.900~905 (2002)
  68. Penadés, R., "Cognitive remediation therapy for outpatients with chronic schizophrenia: A controlled and randomized study", Schizophrenia Research, 87(1-3), pp.323~331 (2006)
  69. Penadés, R., "Executive function needs to be targeted to improve social functioning with cognitive remediation therapy(CRT) in schizophrenia", Psychiatry Research, 177(1-2), pp.41~45 (2010)
  70. Polgár, P., "Executive function in deficit schizophrenia: What do the dimension of the Wisconsin Card Sorting Test tell us?", Schizophrenia Research, 122(1-3), pp.85~93 (2010)
  71. Puig, O., "Processing speed and executive functions predict real-world everyday living skills in adolescents with early-onset schizophrenia", European Child & Adolescent Psychiatry, 21(6), pp.315~326 (2012)
  72. Reeder, C., "Which executive skill should we target to affect social functioning and symptom change? a study of a cognitive remediation therapy program", Schizophrenia Bulletin, 30(1), pp.87~100 (2004)
  73. Reitan, R. M., "Validity of the Trail Making Test as an indicator of organic brain damage", Perceptual and Motor Skills, 8(3), pp.271~276 (1958)
  74. Reitan, R. M., "Trail Making Test : Manual for administration and scoring" (1992), Reitan Neuropsychology Laboratory
  75. Ritsner, M., "Predicting quality of life impairment in chronic schizophrenia from cognitive variables", Quality of Life Research, 16(6), pp.929~937 (2007)
  76. Ritter, I. M., "Neurocognitive measures of prefrontal cortical dysfunction in schizophrenia", Schizophrenia Research, 68(1), pp.65~73 (2004)
  77. Rodewald, K., "Planning and problem-solving training for patients with schizophrenia : a randomized controlled trial", BMC Psychiatry, 11, pp.1~11 (2011)
  78. Rossi, A., "Cognitive function in euthymic bipolar patients, stabilized schizophrenic patient, and healthy controls", Journal of Psychiatric Research, 34(4-5), pp.333~339 (2000)
  79. Rudel, R. G., "Relation of forward and backward digit repetition to neurological impairment in children with learning disabilities", Neuropsychologia, 12(1), pp.109~118 (1974)
  80. Scala, S., "Neurocognitive profile and its association with psychopathology in first-degree relatives of patients with schizophrenia: A case-control study", Psychiatry Research, 200(2-3), pp.137~143 (2012)
  81. Seacrest, L., "A comparison of the allen cognitive level test and the wisconsin card sorting test in adults with schizophrenia", American Journal of Occupational Therapy, 54(2), pp.129~133 (2000)
  82. Seidman, L. J., "Intellectual decline in schizophrenia : evidence from a prospective birth cohort 28 year follow-up study", Journal of Clinical and Experimental Neuropsychology, 28(2), pp.225~242 (2006)
  83. Seidman, L. J., "Clinical Syndromes in Adult Neuropsychology: The practitioner's Handbook", pp.381~449 (1992), Elsevier
  84. Semkovska, M., "Assessment of executive dysfunction during activities of daily living in schizophrenia", Schizophrenia Research, 69(2-3), pp.289~300 (2004)
  85. Shorr, J. S., "Memory for the Rey-Osterrieth figure : perceptual clustering, encoding and storage", Neuropsychologia, 6(1), pp.43~50 (1992)
  86. Silver, H., "Working memory deficit as a core neuropsychological dysfunction in schizophrenia", The American Journal of Psychiatry, 160(10), pp.1809~1816 (2003)
  87. Silverstein, A. B, "Agreement between a short-form and full scale as a function of the correlation between them", Journal of Clinical Psychology, 45(6), pp.929~931 (1989)
  88. Spaulding, W. D., "Effects of cognitive treatment in psychiatric rehabilitation", Schizophrenia Bulletin, 25(4), pp.657~676 (1999)
  89. Sponheim, S. R., "Cognitive deficits in recent-onset and chronic schizophrenia", Journal of Psychiatric Research, 44(7), pp.421~428 (2010)
  90. Spreen, O., "A compendium of neuropsychological tests: Administration, norms, and commentary" (1998), Oxford University Press
  91. Stroop, J. R., "Studies of inference in serial verbal reactions", Journal of Experimental Psychology, 18(6), pp.643~662 (1935)
  92. Tomida, K., "Relationship of psychopathological symptoms and cognitive function to subjective quality of life in patients with chronic schizophrenia", Psychiatry and Clinical Neurosciences, 64(1), pp.62~69 (2010)
  93. Tyson, P, J., "Attention and executive function in people with schizophrenia : relationship with social skills and quality of life", International Jounal of Psychiatry in Clinical Practice, 12(2), pp.112~119 (2007)
  94. Van der Does, A. J. W., "What determines Wisconsin card sorting performance in schizophrenia?", Clinical Psychology Review, 12(6), pp.567~583 (1992)
  95. Weickert, T. W., "Cognitive impairment in patients with schizophrenia displaying preserved and compromised intellect", Archives of General Psychiatry, 57(9), pp.907~913 (2000)
  96. Wexler, B. E., "Cognitive remediation and vocational rehabilitation for schizophrenia", Schizophrenia Bulletin, 31(4), pp.931~941 (2005)
  97. Wilkinson, G., "Self-report quality of life measure for people with schizophrenia : the SQLS", The British Journal of Psychiatry, 177(1), pp.42~46 (2000)
  98. Wilson, B. A., "Methodological of Frontal and Executive Function", pp.239~250 (1997), Psychology Press
  99. Wobrock, T., "Cognitive impairment of executive function as a core symptom of schizophrenia", The World Journal of Biological Psychiatry, 10(4), pp.442~451 (2009)
  100. Wolf, L. E., "Wisconsin card sorting deficits in the offspring of schizophrenics in the New York high-risk project", Schizophrenia Research, 57(2-3), pp.173~ (2002)
  101. Wykes, T., "The effects of neurocognitive remediation on executive processing in patients with schizophrenia", Schizophrenia Bulletin, 25(2), pp.291~307 (1999)
  102. Wykes, T., "Cognitive remediation therapy(CRT) for young early onset patients with schizophrenia: An exploratory randomized controlled trial", Schizophrenia Research, 94(1-3), pp.221~230 (2007)

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