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초발 정신증 삽화 환자에서 미치료 기간과 인지저하 및 음성증상과의 연관성에 관한 연구

Study on the Association of Duration of Untreated Period with Cognitive Impairment and Negative Symptoms in 1st Episode Psychosis

김수인|이유진|성유미|연규월|임원정
대한생물치료정신의학회 (Korean Society Of Biological Therapies In Psychiatry)|2011.12|생물치료정신의학 (Journal of the Korean Society of Biological Therapies in Psychiatry)|제17권 제2호|pp. 211-220

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참고문헌

키워드

초발 정신증·인지기능·음성증상·전구증상First-episode psychosis · Cognitive function · Negative symptom · Prodrome
주제분류정신과학

초록

본 연구는 치료되지 않은 정신증 기간(DUP)뿐만 아니라 치료되지 않은 전구기 기간(DUI) 역시 초발 정신증 환자의 인지기능 손상과 연관되어 있음을 보여주고 있다. 한편, DUI는 임상적 변인 중 GAF highest 점수(음의 상관관계) 및 음성증상의 심각도 점수(양의 상관관계)와 강한 연관성을 나타내었다. 본 연구는 국내에서 DUP/DUI와 관련하여 초발 정신증 환자의 인지손상과의 연관성을 보여주는 첫 번째 연구라는 점에서 큰 의미를 가진다. 또한, 정신증 환자들의 인지기능과 관련하여 정신증이 완전히 활성화되기 이전의 전구기에 임상적 관심을 기울여야 한다는 것을 시사해주고 있다. 추후, 대규모의 대조군을 포함한 전향적인 장기 추적연구가 필요할 것으로 생각되며, DUP와 DUI의 정확한 정의나 의미에 대해서도 심도깊은 논의를 통해 임상의 및 연구자들 간에 합의점을 형성해야 할 것이다.

Abstract

Objectives：There were prior studies which suggested that duration of untreated psychosis(DUP) could be related to cognitive impairment and more negative symptom in psychotic subjects. We assessed the relationship between DUP or Duration of untreated illness(DUI), which adds duration of prodrome to DUP, and cognitive impairment as well as symptom profile and functioning impairment in 1st episode psychosis. Methods：Forty subjects with 1st episode psychosis who were diagnosed as schizophrenia, schizoaffective disorder, bipolar I disorder with psychotic feature or delusional disorder by DSM-IV-TR, varying from 18 to 50 years of age(average : 31.4 years, 21 female patients), were assessed for DUP and DUI. All subjects completed Positive and Negative Syndrome Scale(PANSS), Clinical Global Impression(CGI) scale, General Assessment of Functioning(GAF) scale, neuropsychological battery, including Korean Wechsler Adult Intelligence Scale(K-WAIS), Rey-Kim Memory Test, and K-FENT(Kims Frontal-Executive function Neuropsychological Test). Results：After controlling for age, sex, education level, marital status, IQ, PANSS general psychopathology subscale score and CGI-severity score, DUP showed significant negative correlation with the K-WAIS vocabulary subtest(r=-0479, p=0.006), Korean auditory verbal learning test(K-AVLT)(r=-0.405, p=0.024), memory quotient(r=-0.364, p=0.044), delayed recall(r=-0.512, p=0.003), retrieval efficiency index(r=-0.518, p=0.003). DUI showed significant negative correlations with K-WAIS vocabulary subtest(r=-0.402, p=0.025), K-AVLT(r=-0.425, p=0.017), delayed recall(r=-0.446, p=0.012), retrieval efficiency recall(r=-0.504, p=0.004). PANSS Negative subscale score and GAF past 1year highest score were correlated only with DUI(r=.508, p=.001; r=-.709, p=.000), not DUP. In the regression model, longer DUI predicted significantly more negative symptoms and lower GAF score of past 1 year highest(p=0.026, p＜0.001). Conclusion：Current results suggested that not only duration of untreated psychotic symptom but also duration of untreated prodrome might be associated with cognitive decline in terms of memory and frontal executive functions in 1st episode psychosis. Because the patients with a more negative symptom profile may have poorer treatment response, clinical attentions are warranted to the onset of prodrome before the full blown symptoms.

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