양극성 장애의 인지적 병식 및 역기능적 태도와 증상 간의 관계
The Relations of Cognitive Insight and Dysfunctional Attitudes to Symptoms of Illness in Bipolar Disorder
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본 연구는 양극성 장애 환자들의 인지적인 특성과 기분 증상의 관련성을 확인하기 위해 시행 되었다. 임상가가 평가한 객관적인 기분 증상 평가와 환자가 주관적으로 평가한 기분 증상 평가에서 부적 상관이 나타났는데 임상가가 평가한 기분 증상이 심각할수록 주관적으로는 자신의 증상에 대해 축소 보고하는 경향을 보였다. 또한 객관적 조증 증상이 현저하고 주관적인 증상 보고가 적을수록 인지적 병식이 낮은 것으로 나타났다. 이는 기분 증상과 인지적 병식 간에 관련성이 있음을 의미한다. 아울러, 역기능적 태도와 기분 증상과 관련성은관찰되지 않았으나 정상 집단에 비해 양극성 장애 환자들의 역기능적인 인지적 태도의 평균이 높았고, 특히평가/완벽주의 경향이 컸다. 이러한 결과는 기분 증상과독립적으로, 양극성 장애 환자의 역기능적 태도가 향후기분 삽화의 경과에 상당한 영향을 줄 수 있는 위험 요소로서 기능한다는 최근 연구 결과와 일관되는 것이며양극성 장애와 관련 있거나, 발병을 예측하는 특정한 인지적 취약성을 확인한 것으로서 의미를 지닌다.
Abstract
Objectives：There are several reports that patients with bipolar disorder have the negative cognitive style such as depressive disorder and it affect the course of illness. The insight of his or her own illness is also contribute to the course of it. In this research, We would like to investigate the relationship between symptoms, cognitive insight and dysfunctional attitudes of bipolar disorder. Methods：A total of 29 Bipolar patients and matched normal controls were recruited. All subjects completed the following questionnaires：Korean version of mood disorder questionnaire(K-MDQ), Korean version of Dysfunctional Attitude Style(K-DAS), and Korean version of Beck cognitive insight scale(K-BCIS), Korean version of Young Mania Rating Scales(K-YMRS) and Korean version of Hamilton Depression Rating Scale(K-HDRS) were administered to all patient by clinicians. Results：Compared with normal controls, patients with bipolar disorder showed significantly higher cognitive dysfunctional attitude scores. In subscales, scores of evaluation and perfection were significant differences. K-YMRS scores were negatively correlated with K-MDQ scores and K-BCIS scores. K-YMRS scores and K-MDQ scores had no correlation with scores of the dysfunctional attitudes. But K-YMRS scores were positively correlated with the self-esteem subscale of the dysfunctional attitude. Conclusion： Our results suggest that mood symptoms in bipolar disorder may affect subjective experience and cognitive insight of illness, but may not correlate with dysfunctional attitudes. The cognitive insight also do not correlate with dysfuctioanl attitudes. But compared with normal control, patient with bipolar disorder showed higher cognitive dysfunctional attitudes, especially evaluation and perfection.
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