본문 바로가기
KERD
논문KCI 등재

조현병 환자의 개인적, 사회적 기능상태의 예측인자

Factors Predicting Personal and Social Performance in Schizophrenia Patients

이문수|김승현|정현강|지수혁
대한조현병학회 (Korean Academy of Schizophrenia)|2016.10|대한조현병학회지 (Korean Journal of Schizophrenia Research)|제19권 제2호|pp. 47-59

1

조회

0

다운로드

4

인용

0

참고문헌

키워드

조현병Schizophrenia개인적 사회적 기능상태예측 인자Personal and social functioningPredicting factor
주제분류정신과학

초록

Objectives : Schizophrenia is a chronic psychiatric disorder characterized by its debilitating course. It leads to personal and social dysfunctions, burdening patients and guardians heavily. Enhancing functional outcome is a major treatment goal, but pharmacotherapy alone is usually not enough. Hence, it is important to reveal clinical factors that can predict personal and social performance in schizophrenia patients. Analyze factors influencing personal and social performance in schizophrenia patients. Methods : 66 schizophrenia patients from three University hospitals in Korea were enrolled, completing clinical scales between January 2008 and December 2009. 38 patients dropped out during follow up. 28 patients were included in the final study. Personal and social performance was measured using the Personal and Social Performance scale (PSP) since January 2015. Correlation and multiple regression analyses were performed to reveal associations between demographic and clinical factors and PSP. Results : Correlation analyses resulted in statistically significant correlations between CGI-S (r=-0.646, p＜0.01), PANSS (r= -0.419, p＜0.05), KISP (r=-0.523, r＜0.01), KmSWN (r=0.388, p＜0.05), Trail making B (r=0.608, p＜0.01), KDAI (r=0.608, p＜0.01), and PSP. Stepwise multiple regression analyses showed significant models with CGI-S (β=-0.485, p＜0.01), and KDAI (β=0.423, p＜0.01). Conclusion : Our results show that attitude toward drugs and symptom severity affect a patient’s personal and social performance most prominently. We advise to focus on patient education to reinforce attitude toward drugs, and to concentrate on reducing symptom severity to enhance personal and social performance in schizophrenia patients.

Abstract

Objectives : Schizophrenia is a chronic psychiatric disorder characterized by its debilitating course. It leads to personal and social dysfunctions, burdening patients and guardians heavily. Enhancing functional outcome is a major treatment goal, but pharmacotherapy alone is usually not enough. Hence, it is important to reveal clinical factors that can predict personal and social performance in schizophrenia patients. Analyze factors influencing personal and social performance in schizophrenia patients. Methods : 66 schizophrenia patients from three University hospitals in Korea were enrolled, completing clinical scales between January 2008 and December 2009. 38 patients dropped out during follow up. 28 patients were included in the final study. Personal and social performance was measured using the Personal and Social Performance scale (PSP) since January 2015. Correlation and multiple regression analyses were performed to reveal associations between demographic and clinical factors and PSP. Results : Correlation analyses resulted in statistically significant correlations between CGI-S (r=-0.646, p＜0.01), PANSS (r= -0.419, p＜0.05), KISP (r=-0.523, r＜0.01), KmSWN (r=0.388, p＜0.05), Trail making B (r=0.608, p＜0.01), KDAI (r=0.608, p＜0.01), and PSP. Stepwise multiple regression analyses showed significant models with CGI-S (β=-0.485, p＜0.01), and KDAI (β=0.423, p＜0.01). Conclusion : Our results show that attitude toward drugs and symptom severity affect a patient’s personal and social performance most prominently. We advise to focus on patient education to reinforce attitude toward drugs, and to concentrate on reducing symptom severity to enhance personal and social performance in schizophrenia patients.

참고문헌 (84)

  1. Tandon R, "Schizophrenia, “just the facts’ 4. Clinical features and conceptualization", Schizophrenia Research, 110, pp.1~23 (2009)
  2. Ritsner MS, "Quality of life impairment in schizophrenia, mood and anxiety disordersed", pp.173~226 (2007), Springer
  3. Eack SM, "Psychiatric symptoms and quality of life in Schizophrenia: A meta-analysis", Schizophrenia Bulletin, 33, pp.1225~1237 (2007)
  4. Meesters PD, "Social Functioning Among Older Community-Dwelling Patients With Schizophrenia: A Review", American Journal of Geriatric Psychiatry, 18, pp.862~878 (2010)
  5. Szoke A, "Longitudinal studies of cognition in schizophrenia: metaanalysis", British Journal of Psychiatry, 192, pp.248~257 (2008)
  6. Awad AG, "The burden of schizophrenia on caregivers", Pharmacoeconomics, 26, pp.149~162 (2008)
  7. Davies LM, "The economic burden of schizophrenia", Psychiatr Bull, 14, pp.522~525 (1990)
  8. Excellence NIfC, "Schizophrenia: core interventions in the treatment and management of schizophrenia in primary and secondary care" (2002), National Institute for Clinical Excellence
  9. Kinon BJ, "Early Response to Antipsychotic Drug Therapy as a Clinical Marker of Subsequent Response in the Treatment of Schizophrenia", Neuropsychopharmacology, 35, pp.581~590 (2010)
  10. Velligan DI, "The functional significance of symptomatology and cognitive function in schizophrenia", Schizophrenia research, 25, pp.21~31 (1997)
  11. Lysaker PH, "Social function in schizophrenia and schizoaffective disorder: associations with personality, symptoms and neurocognition", Health and quality of life outcomes, 2, pp.1~ (2004)
  12. Carbon M, "Thinking and acting beyond the positive:the role of the cognitive and negative symptoms in schizophrenia", Cns Spectrums, 19, pp.38~53 (2014)
  13. Arango C, "Pharmacological approaches to treating negative symptoms: A review of clinical trials", Schizophrenia Research, 150, pp.346~352 (2013)
  14. Elis O, "Psychosocial treatments for negative symptoms in schizophrenia: Current practices and future directions", Clinical Psychology Review, 33, pp.914~928 (2013)
  15. DeQuardo JR, "Review Do atypical antipsychotic medications favorably alter the long-term course of schizophrenia?", Journal of psychiatric research, 32, pp.229~242 (1998)
  16. Wyatt RJ, "Neuroleptics and the Natural Course of Schizophrenia", Schizophrenia Bulletin, 17, pp.325~351 (1991)
  17. Goodman AB, "Paranoid Schizophrenia-Prognosis under Dsm-Ii and Dsm-Iii-R", Comprehensive Psychiatry, 30, pp.259~266 (1989)
  18. Racenstein JM, "The relationship between positive symptoms and instrumental work functioning in schizophrenia: A 10 year follow-up study", Schizophrenia Research, 56, pp.95~103 (2002)
  19. Ventura J, "Symptoms as mediators of the relationship between neurocognition and functional outcome in schizophrenia: A meta-analysis", Schizophrenia Research, 113, pp.189~199 (2009)
  20. Evans JD, "The relationship of neuropsychological abilities to specific domains of functional capacity in older schizophrenia patients", Biological Psychiatry, 53, pp.422~430 (2003)
  21. Green MF, "What are the functional consequences of neurocognitive deficits in schizophrenia?", American Journal of Psychiatry, 153, pp.321~330 (1996)
  22. Nakagami E, "Intrinsic motivation, neurocognition and psychosocial functioning in schizophrenia: Testing mediator and moderator effects", Schizophrenia Research, 105, pp.95~104 (2008)
  23. Matheson SL, "How much do we know about schizophrenia and how well do we know it? Evidence from the Schizophrenia Library", Psychological Medicine, 44, pp.3387~3405 (2014)
  24. Brissos S, "The importance of measuring psychosocial functioning in schizophrenia", Annals of General Psychiatry, 10, pp.18~18 (2011)
  25. Priebe S, "Social outcomes in schizophrenia", The British Journal of Psychiatry, 191, pp.s15~s20 (2007)
  26. Leifker FR, "Validating measures of real-world outcome: the results of the VALERO expert survey and RAND panel", Schizophrenia Bulletin, 37, pp.334~343 (2011)
  27. Juckel G, "The new approach: psychosocial functioning as a necessary outcome criterion for therapeutic success in schizophrenia", Current Opinion in Psychiatry, 21, pp.630~639 (2008)
  28. Endicott J, "The Global Assessment Scale: a procedure for measuring overall severity of psychiatric disturbance", Archives of general psychiatry, 33, pp.766~ (1976)
  29. Hall RCW, "Global Assessment of Functioning-a Modified Scale", Psychosomatics, 36, pp.267~275 (1995)
  30. Goldman HH, "Revising axis V for DSM-IV:a review of measures of social functioning", Am J Psychiatry, 149, pp.1148~1156 (1992)
  31. Morosini PL, "Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS)to assess routine social funtioning", Acta Psychiatrica Scandinavica, 101, pp.323~329 (2000)
  32. 이정구, "한국판 Personal and Social Performance 척도 (K-PSP)의 표준화 연구", 대한정신약물학회지, 17(6), pp.497~506 (2006), 대한정신약물학회
  33. Guy W, "ECDEU Assessment Manual for Psychopharmacology:1976" (1976), National Institute of Mental Health
  34. Busner J, "The Clinical Global Impressions scale: errors in understanding and use", Comprehensive Psychiatry, 50, pp.257~262 (2009)
  35. Haro JM, "The Clinical Global Impression-Schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia", Acta Psychiatrica Scandinavica, 107, pp.16~23 (2003)
  36. Naber D, "Subjective well-being under neuroleptic treatment and its relevance for compliance", Acta Psychiatrica Scandinavica, 111, pp.29~34 (2005)
  37. 윤진상, "항정신병 약물치료하에서주관적 안녕감을 평가하는 한 국형 척도의 개발", 신경정신의학, pp.987~989 (2000)
  38. 윤보현, "한국판 약물태도 척도의 심리측정적 특성", 대한정신약물학회지, 16(6), pp.480~487 (2005), 대한정신약물학회
  39. Hogan TP, "A Self-Report Scale Predictive of Drug Compliance in Schizophrenics-Reliability and Discriminative Validity", Psychological Medicine, 13, pp.177~183 (1983)
  40. Day JC, "A Self-Rating Scale for Measuring Neuroleptic Side-Effects-Validation in a Group of Schizophrenic-Patients", British Journal of Psychiatry, 166, pp.650~653 (1995)
  41. Lambert TJR, "Measurement of antipsychotic-induced side effects: Support for the validity of a self-report (LUNSERS) versus structured interview (UKU) approach to measurement", Human Psychopharmacology-Clinical and Experimental, 18, pp.405~411 (2003)
  42. 정희연, "한국판 리버풀 항정신병약물 부작용 평가 척도(LUNSERS)의 표준화 연구 - 리버풀 항정신병약물 부작용 평가 척도 -", 신경정신의학, 41(1), pp.138~145 (2002), 대한신경정신의학회
  43. Markova IS, "The Assessment of Insight in Clinical-Psychiatry-a New Scale", Acta Psychiatrica Scandinavica, 86, pp.159~164 (1992)
  44. Markova IS, "Assessment of insight in psychosis: a re-standardization of a new scale", Psychiatry Research, 119, pp.81~88 (2003)
  45. Kim J, "Assessing the reliability and validity of the Korean version of the Revised Insight Scale for Psychosis (KISP)", Korean J Schizophr Res, 7, pp.15~22 (2004)
  46. Zimet GD, "The Multidimensional Scale of Perceived Social Support", Journal of Personality Assessment, 52, pp.30~41 (1988)
  47. Addington D, "A Depression Rating-Scale for Schizophrenics", Schizophrenia Research, 3, pp.247~251 (1990)
  48. 김용구, "한국어판 정신분열병의 캘거리 우울증 척도의 신뢰도 및 타당도 연구", 신경정신의학, 44(4), pp.446~455 (2005), 대한신경정신의학회
  49. Remington G, "The use of electronic monitoring (MEMS®) to evaluate antipsychotic compliance in outpatients with schizophrenia", Schizophrenia research, 90, pp.229~237 (2007)
  50. Wechsler D, "Wechsler adult intelligence scale-fourth" (2008), Pearson
  51. 황순택, "K-WAIS-IV 표준화-신뢰도와 타당도 (초)", 한국심리학회연차학술발표논 문집, pp.140~140 (2012)
  52. Crowe SF, "The differential contribution of mental tracking, cognitive flexibility, visual search, and motor speed to performance on Parts A and B of the Trail Making Test", Journal of Clinical Psychology, 54, pp.585~591 (1998)
  53. Seo EH, "A normative study of the Trail Making Test in Korean elders", International Journal of Geriatric Psychiatry, 21, pp.844~852 (2006)
  54. Kawata AK, "Psychometric properties of the Personal and Social Performance scale (PSP) among individuals with schizophrenia living in the community", Quality of Life Research, 17, pp.1247~1256 (2008)
  55. Brissos S, "The Portuguese version of the Personal and Social Performance Scale (PSP): reliability, validity, and relationship with cognitive measures in hospitalized and community schizophrenia patients", Social psychiatry and psychiatric epidemiology, 47, pp.1077~1086 (2012)
  56. Nasrallah H, "Reliability, validity and ability to detect change of the Personal and Social Performance scale in patients with stable schizophrenia", Psychiatry research, 161, pp.213~224 (2008)
  57. 문영선, "약물 교체가 필요한 조현병 환자에서 Paliperidone Extended Release로의 교체 후 유효성과 안전성에 관한 분석", 대한정신약물학회지, 23(3), pp.97~106 (2012), 대한정신약물학회[DOI]
  58. 조다함, "한국인 조현병 환자에서 흡연과 사회인구학적, 임상적 특성과의 관계", 신경정신의학, 51(5), pp.255~262 (2012), 대한신경정신의학회
  59. Karadayı G, "Relationship of symptomatic remission with quality of life and functionality in patients with schizophrenia", Comprehensive Psychiatry, 52, pp.701~707 (2011)
  60. Rocca P, "Negative symptoms and everyday functioning in schizophrenia: a cross-sectional study in a real world-setting", Psychiatry Research, 218, pp.284~289 (2014)
  61. Bowie CR, "Prediction of real-world functional disability in chronic mental disorders: a comparison of schizophrenia and bipolar disorder", American Journal of Psychiatry (2010)
  62. McGurk SR, "Cognitive and symptom predictors of work outcomes for clients with schizophrenia in supported employment", Psychiatric Services (2003)
  63. Rabinowitz J, "To what extent do the PANSS and CGI-S overlap?", Journal of Clinical Psychopharmacology, 26, pp.303~307 (2006)
  64. Norman RMG, "The relationship of symptoms and level of functioning in schizophrenia to general wellbeing and the Quality of Life Scale", Acta Psychiatrica Scandinavica, 102, pp.303~309 (2000)
  65. Woon PS, "Neurocognitive, clinical and functional correlates of subjective quality of life in Asian outpatients with schizophrenia", Progress in Neuro-Psychopharmacology and Biological Psychiatry, 34, pp.463~468 (2010)
  66. Hofer A, "Correlates of subjective and functional outcomes in outpatient clinic attendees with schizophrenia and schizoaffective disorder", European Archives of Psychiatry and Clinical Neuroscience, 256, pp.246~255 (2006)
  67. Lambert M, "Current issues in schizophrenia: Overview of patient acceptability, functioning capacity and quality of life", Cns Drugs, 18, pp.5~17 (2004)
  68. Yamauchi K, "Predictors of subjective and objective quality of life in outpatients with schizophrenia", Psychiatry and Clinical Neurosciences, 62, pp.404~411 (2008)
  69. Stefanopoulou E, "Insight, Global Functioning and Psychopathology Amongst In-patient Clients with Schizophrenia", Psychiatric Quarterly, 80, pp.155~165 (2009)
  70. Lysaker PH, "Toward understanding the insight paradox: Internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders", Schizophrenia Bulletin, 33, pp.192~199 (2007)
  71. Mohamed S, "Cross-sectional and Longitudinal Relationships Between Insight and Attitudes Toward Medication and Clinical Outcomes in Chronic Schizophrenia", Schizophrenia Bulletin, 35, pp.336~346 (2009)
  72. Buckley PF, "Insight and its relationship to violent behavior in patients with schizophrenia", American Journal of Psychiatry, 161, pp.1712~1714 (2004)
  73. Schwartz RC, "Does insight affect longterm inpatient treatment outcome in chronic schizophrenia?", Comprehensive Psychiatry, 38, pp.283~288 (1997)
  74. McCabe R, "Insight, global neuropsychological functioning, and symptomatology in chronic schizophrenia", Journal of Nervous and Mental Disease, 190, pp.519~525 (2002)
  75. Mahurin RK, "Trail making test errors and executive function in schizophrenia and depression", The Clinical Neuropsychologist, 20, pp.271~288 (2006)
  76. Perianez JA, "Trail Making Test in traumatic brain injury, schizophrenia, and normal ageing: Sample comparisons and normative data", Archives of Clinical Neuropsychology, 22, pp.433~447 (2007)
  77. Mahurin RK, "Trail making test errors and executive function in schizophrenia and depression", Clinical Neuropsychologist, 20, pp.271~288 (2006)
  78. Martinez-Aran A, "Executive function in patients with remitted bipolar disorder and schizophrenia and its relationship with functional outcome", Psychotherapy and Psychosomatics, 71, pp.39~46 (2002)
  79. Hutton SB, "Executive function in first-episode schizophrenia", Psychological Medicine, 28, pp.463~473 (1998)
  80. Wölwer W, "Impaired Trail-Making Test-B performance in patients with acute schizophrenia is related to inefficient sequencing of planning and acting", Journal of psychiatric research, 36, pp.407~416 (2002)
  81. Baloush-Kleinman V, "Adherence to antipsychotic drug treatment in early-episode schizophrenia: A six-month naturalistic follow-up study", Schizophrenia Research, 130, pp.176~181 (2011)
  82. Ascher-Svanum H, "Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care", Journal of Clinical Psychiatry, 67, pp.453~460 (2006)
  83. Malla AK, "Symptoms, cognition, treatment adherence and functional outcome in first-episode psychosis", Psychological Medicine, 32, pp.1109~1119 (2002)
  84. Novick D, "Predictors and clinical consequences of non-adherence with antipsychotic medication in the outpatient treatment of schizophrenia", Psychiatry Research, 176, pp.109~113 (2010)

관련 논문AI추천

조현병 환자의 인지기능 및 심리사회적 요인과 직업재활과의 연관성강제욱, 공보금, 김성진, 김현정, 문정준, 서영수, 전동욱, 정도운, 정성수, 하태민대한생물치료정신의학회 · 생물치료정신의학2014 · 제20권 제2호조현병 외래 환자의 개인적 회복 관련 요인김준기, 김철권대한조현병학회 · 대한조현병학회지2024 · 제27권 제2호5년 이상 외래 치료를 받고 있는 조현병 환자의 약물 순응도에 영향을 미치는 요인박현, 김상훈, 김정호, 임홍규, 하강수대한신경정신의학회 · 신경정신의학2016 · 제55권 제4호WHODAS 2.0으로 평가한 만성 조현병 환자의 기능 장애와 관련 요인김철응, 박경우, 유승형, 이동균, 이형래대한신경정신의학회 · 신경정신의학2019 · 제58권 제1호조현병 환자에서 심리사회적 요인, 인지 기능, 정신병리와 병식의 관계김승현, 백종우, 어다솜, 이문수, 한창수대한조현병학회 · 대한조현병학회지2015 · 제18권 제2호조현병 장애 등급 평가와 한국판 University of California San Diego 실행에 기초한 기술평가 척도의 유용성강제욱, 김성진, 김유나, 문정준, 박성용, 이윤호, 이충열, 전동욱, 정도운대한생물치료정신의학회 · 생물치료정신의학2018 · 제24권 제2호

이 간행물의 다른 논문 (4건)

항정신약물을 복용 중인 조현병 환자에서 성기능 장애의 유병률 조사윤해주, 정선화, 박동연, 박은경, 이종일, 강시현pp. 60-67일 대학병원 정신건강의학과 병동에서의 비정형 항정신병제 처방 경향 : 11년 관찰 연구김의태, 박성열, 신상호pp. 68-77Factors Affecting Quality of Life and Family Burden among the Families of Patients with Schizophrenia맹세리, 김현지, 이정섭, 김철응, 김원형, 배재남pp. 78-88조기정신증에서 정신병적 증상 발현 후에 약물반응도가 증가되어 관해된 사례김정훈, 박종익pp. 89-93
원문 보기