주요우울장애 환자의 증상 심각도에 따른 신경인지적 특성
Neurocognitive Characteristics According to Depression Severity in Patients with Major Depressive Disorder
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초록
주요우울삽화는 뇌에 신경독성(neurotoxicity)으로 작용하는 일종의 외상 사건(traumatic event)이므로 우울삽화의경험은 인지기능 저하를 수반할 수 있으며, 삽화가 반복될수록 인지기능 저하가 더 심각할 수 있다.1)2) 인지기능의 결함이개인의 일상생활에서의 기능 및 삶의 질에 부정적 영향을 미치기 때문에 환자가 가지는 인지기능의 결함을 정확하게 이해하는 것은 중요하다.3) 주요우울장애(major depressive disorder, 이하 MDD) 환자의 인지기능을 조사한 선행 연구들은 MDD 환자들이 인지기능의 결함, 특히 기억, 주의력, 집행기능 및 정신운동속도의 결함을 가지고 있음을 비교적 일관되게 보고하였다.4)5) 우울삽화가 재발한 환자의 인지기능을 조사한 연구에서도정상통제군에 비해 재발성 우울 집단이 반응 억제, 문제해결능력, 작업기억 등과 같은 집행기능 검사와 주의력 검사에서수행 저하를 보였다.6) 그러나 우울증의 만성적 경과와 인지기능의 관계에 대해 회의적인 입장의 연구 결과도 보고되고있다. 예를 들어, Grant 등1)은 우울증이 있는 젊은 성인 환자들에게 전산화 인지기능 배터리를 실시한 결과 주요우울삽화의 횟수와 인지기능 검사 수행 간 유의한 상관을 관찰하지못하였고, Biringer 등7)도 우울증의 경과와 인지기능 사이의유의한 관련성을 관찰하지 못하였다.
Abstract
Objectives : This study investigated associations between symptom severity and neurocognitive functions in patients with major depressive disorder using comprehensive neuropsychological tests. Methods : Ten patients with low depression (LD) and 22 patients with high depression (HD) participated. Symptom severity was determined by both the Beck Depression Inventory and the Hamilton Depression Rating Scale. Additionally, anxiety was measured by the Korean version of the State-Trait Anxiety Inventory (STAI-KYZ). Ten subtests of the Korean-Wechsler Adult Intelligence scale (K-WAIS), Stroop test, the word/design fluency tests were administered to assess cognition. Results : The LD and HD groups did not differ in any of cognitive measures but anxiety level. Namely, the HD group obtained significantly higher scores on the state (U = 29.50, p ＜ 0.01) and trait (U = 28.50, p ＜ 0.001) anxiety scales than the LD group. A significant interaction effect between trait anxiety and depression severity was observed on the picture arrangement subtest of the K-WAIS [F (1, 27) = 5.09, p ＜ 0.05]. Conclusions : Cognitive deficits observed in patients with major depressive disorder may be related to other factors rather than current symptom severity. Trait anxiety possibly moderates the effect of current symptom severity on social judgment in these patients.
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