정신분열증 환자에서 주관적 음성증상경험의 임상적 의의

김지웅,김찬형,구민성,손석한,박진철,최문종,이은철,윤도준,이홍식 대한신경정신의학회 1999 신경정신의학 Vol.38 No.1

연구목적 : 현재까지 정신분열증의 음성증상평가는 주로 객관적인 평가에만 의존해왔기 때문에, 환자들이 주관적으로 직접 경험하는 음성증상의 평가는 경시된 경향이 있었다. 그러나 실제 많은 정신분열증 환자들은 음성증상을 자가하고 있다. 특히, 개관적인 양성 및 음성증상이 관찰되지 않는 경우에도 환자 본인은 음성증상으로 괴로워한다는 이전의 연구보고들이 있었다. 따라서 저자들은 주관적인 음성증상경험과 개관적인 양성증상 및 음성 증상, 우울증상, 불안증상, 추세외로증상과의 상관성을 알아봄으로써 정신분열증의 정신병리에 있어 주관적 음성증상의 존재를 규명하고, 정신분열증 정신병리의 발생기전을 유추해보며 이차적 음성증상과의 관계를 규명하고자 하였으며. 이러한 연구가 정신분열증 정신병리를 이해하는데 도움을 줄 수 있을 뿐 아니라 환자를 공감적으로 이해하는데 도움을 줄 수 있을 것으로 생각되어 본 연구를 시행하였다. 방 법 : DSM-Ⅳ 진단기준의 정신분열증 진단기준에 해당하는 환자를 대상으로 하였다. 주관적인 음성증상의 평가를 위해서 Scale for the Subjective Experience of Negative Symptoms : Korean version(KSENS)을 이용하였고, 개관적인 정신분열증 정신병리의 평가는 Positive and Negative Syndrome Scale(PNASS)를 이용하였다. 우울증상, 불안증상, 추세외로증상의 평가를 위해서 각각 Hamilton Rating Scale for Depression(HAM-D), Hamilton Rating Scale for Anxiety(HAM-A), Extrapyramidal Symptoms Rating Scale(ESRS)을 이용하였다. 각 정신병리척도 점수간의 상관성은 Spearman 상관계수를 이용하여 분석하였다. 결 과 : K-SENS 24항목 중에서 환자가 이를 불편한 것으로 경험하고 있는 항목의 비율과 PANSS 양성척도점수 사이에는 유의한 상관점이 있었으며 (r=-0.40, p〈0.05), 양성증상 중에서도 특히 과대성(r=-0.46, p〈0.05), 의심/피해(r=-0.34, p〈0.05), 적개심(r=-0.52, p〈0.05) 등의 증상과 유의한 상관관계를 보였다. K-SENS 24 항목 중에서 환자가 이를 불편한 것으로 경험하고 있는 항목의 비율과 PANSS 전체점수(r=-0.25, p〉0.05), PANSS 음성척도점수(r=-0.20, p〉0.05), PANSS 일반정신병리척도(r=-0.08, p〉0.05),와는 각각 유의한 상관성이 없었다. K-SENS 24항목 중에서 환자가 이를 불편한 것으로 경험하고 있는 항목의 비율과 HAM-D 점수(r=-0.01, p〉0.05), HAM-A 점수(r=-0.11, p〉0.05), ESRS 총점(r=0.34, p〉0.05)은 각각 유의한 상관성이 없었다. 결 론 : 본 연구결과에서, 정신분열증 환자들이 불편한 것으로 경험하는 주관적 음성증상과 과대성, 의심/피해, 적개심 같은 양성증상은 역상관관계가 있었으며, 이러한 결과를 바탕으로 양성증상이 주관적으로 불편하게 느끼는 음성증상에 대한 가능성과, 혹은 양성증상이 심할 경우, 이에 압도되어 음성증상을 주관적으로 느끼지 못할 수 있다는 가능성이 시사되었으며, 향후 종적인 연구를 통해 이를 규명해 볼 필요성이 제시되었다. 주관적인 음성증상경험과 우울증상, 불안증상, 추세외로 증상과는 상관성이 없는 것으로 나타나서 이들 증상과는 독립적인 증상임을 시사한다. Objective : Since the evaluation of negative symptoms has depended on the clinician's objective observation, the patients subjective experience of negative symptoms has been neglected. However, in fact, a lot of patients are aware of their negative symptoms. There are several reported suggesting that patients suffer from the subjective experiences of their deficit symptoms, even though the objective positive and negative symptoms cannot be observed. Under these circumstances, we have attempted this study with the idea that it would be helpful in understanding the psychopathology of schizophrenia. Also it would help clarifying the relationship between subjective experience of negative symptoms and objectives positive and negative symptoms, depression anxiety symptoms, and extrapyramidal symptoms. Method : All the 37 patients satisfied the diagnostic criteria of DSM-Ⅵ for schizophrenia. The subjective experiences of negative symptoms were evaluated using Scale for the Subjective Experience of Negative Symptoms : Korean version(KSENS), and for the depression, anxiety, extrapyramidal symptoms, we used Hamilton Rating Scale for Depression(HAM-D), Hamilton Rating Scale for Anxiety(HAM-A), and Extrapyramidal Symptoms Rating Scale(ESRS). The correlation between each psychopathology was tested by calculating Spearman correlation coefficient. Results : There was a significant correlation between the ratio of items experienced as uncomfortable symptoms among 24 items of K-SENS, and the score of PANSS positive subscale(γ=-0.40, p〈0.05), Among the positive symptoms, grandiosity(γ=-0.46, p〈0.05), suspiciousnes/persecution(γ=-0.34, p〈0.05), and hostility(γ=-0.52, p〈0.05) showed a significant correlation with the ratio of items experienced as uncomfortable symptoms among 24 items of K-SENS. There was no significant correlation between the ratio of items experienced as uncomfortable symptoms among 24 items of K-SENS, and PANSS total score(γ=-0.25, p〉0.05), or negative subscale score(γ=-0.20, p〉0.05), or general psychology subscale score(γ=-0.08, p〉0.05), respectively. There was no significant correlation between ratio of items experienced as uncomfortable symptoms among 24 items of K-SENS, and HAM-D(γ=-0.01, p〉0.05), or HAM-A(γ=-0.11, p〉0.05), ESRS(γ=0.34, p〉0.05), respectively. Conclusion : These revealed that the negative correlation between the subjective negative symptoms experienced as an uncomfortable ones and the objective symptoms such as grandiosity, suspiciousness/persecution, and hostility. From these results, the possibility that positive symptoms are used as a defense to hide from the negative symptoms because they are overwhelmed by their positive symptoms, is suggested. These results also suggest that subjective experiences of negative symptoms are independent from depression, anxiety and extrapyramidal symptoms.

조현병 환자에서 음성증상과 사회인지의 연관성

현지원(Jie Won Hyun),우정민(Jung Min Woo),정철호(Chul Ho Jung),김희철(Hee Cheol Kim),김양태(Yang Tae Kim) 대한생물치료정신의학회 2016 생물치료정신의학 Vol.22 No.2

Objectives:Although negative symptoms play important role in daily functioning of patients with schizophrenia, it remains unclear which symptoms clearly related to each other, and whether these symptoms develop sequentially or simultaneously. The current study examined negative and positive symptoms along with social cognition ability, to determine which symptoms are more strongly correlated. We also examined two subdomains of negative symptom, motivation/pleasure and expression, to investigate which subdomain has more strong correlation with social cognition. Methods:120 patients with schizophrenia were enrolled from three different hospitals. All patients were evaluated with Scale for the Assessment of Negative Symptoms(SANS), Positive And Negative Symptom Scale(PANSS), Clinical Assessment Interview for Negative Symptoms(CAINS), Korean Facial Expressions of Emotion(KOFEE) and Eyes task. Correlation analysis, structural equation modeling(SEM), and stepwise regression analysis were used to analyze data. Results:Social cognition was significantly correlated with negative symptoms rather than positive symptoms. Eyes task was negatively correlated with CAINS total score and both two subdomains. Although Eyes task was a significant predictor for both subscales of CAINS, it had more explanatory power for motivation/pleasure subdomain than expression subdomain. The results of SEM, model that KOFEE effects Eyes task and Eyes task effects each negative symptoms, motivation/pleasure, expression indicated most good fit. Conclusion:These findings confirmed the hypothesized relations that social cognition has more strong correlation with negative symptoms rather than positive symptoms. In addition these results provide empirical support for pathway which reduced social cognition ability impacts on developing negative symptoms.

만성 정신분열증 환자의 음성증상과 다른 증상과의 상호 관계에 관한 연구 : 음성증상과 우울증상, 추체외로증상과의 관계를 중심으로 Mainly on Relationship among Negative Symptoms, Depressive Symptoms, and Extrapyramidal Symptoms

김철규,이선화,이영호 大韓神經精神醫學會 1992 신경정신의학 Vol.31 No.3

For an approach to the pathophysiology of negative symptoms through their classification, the authors evaluated the relationship among negative symptoms, positive symptoms, depressive symptoms and extrapyramidal symptoms, and the change of each symptom. The subjects of study were 105 chronic schizophrenics who had been admitted to the Seoul National Mental Hospital from March, 1990 to December, 1990 and negative symptoms were measured by SANS, positive symptoms by SAPS, depressive symptoms by HDS' and extrapyramidal symptoms by EPSRS on admission and 4 weeks later. The results were as follow ; 1) There was no significant correlation between negative symptoms and previous course of illness(number of previous hospitalization, duration of previous hospitalization, age at onset and months since onset) on admission and 4 weeks later. 2) There was significant correlation between negative symptoms and depressive symptoms(P〈0.01), and between negative symptoms(P〈0.01) showed significant correlation only 4 weeks later. 3) Negative symptoms, positive symptoms and depressive symptoms were significantly improved after 4 weeks treatment(all P〈0.01), whereas extrapyramidal symptoms were not significantly changed. 4) For the correlation of subscales, working capacity and loss of interest of HDS, other items of HDS and rigidity of EPSRS were significantly correlated with all subscales of Sans on admission and 4 weeks later(P〈0.01, or P〈0.05). 5) For the change of each subscale after 4 weeks treatment, there was significant improvement in all subscales of SANS and SAPS(all P〈0.01), and in insomnia, working capacity and loss of interest, and other items of HDS(P〈0.01, P〈0.01, P〈0.05), whereas no in all subscales of EPSRS. These findings suggest that there are negative symptoms due to depressive symptoms and extrapyramidal symptoms, and that improvement of negative symptoms after 4 weeks treatment is more associated with that of depressive symptoms rather than that of extrapyramidal symptoms.

부적응적 완벽주의, 부정정서, 부정적 긴급성이 여자 대학생의 신경성 폭식증 증상에 미치는 영향

이수진,장혜인 한국임상심리학회 2017 Korean Journal of Clinical Psychology Vol.36 No.2

The purpose of this study was to examine the integrative effects of maladaptive perfectionism, negative affect, and negative urgency on bulimic symptoms in young women. Although negative affect and personality variables, such as maladaptive perfectionism and negative urgency have been studied as risk factors for bulimic symptoms, relatively little is known about underlying mechanisms by which these factors may conjointly lead to the development of bulimic symptoms. The current study therefore examined an integrative model of bulimic symptoms, including both personality and affect variables simultaneously. Specifically, maladaptive perfectionism was hypothesized as an antecedent of negative affect, and negative urgency was hypothesized as a mediator or a moderator between negative affect and bulimic symptoms. A total of 174 female college students completed a series of self-report inventories assessing maladaptive perfectionism, negative affect, negative urgency, and bulimic symptoms. The results indicated that negative affect and negative urgency sequentially mediated the effect of maladaptive perfectionism on bulimic symptoms. Additionally, negative urgency mediated the effect of maladaptive perfectionism on bulimic symptoms without its association with negative affect, and the direct effect of maladaptive perfectionism on bulimic symptoms was also significant. Based on these findings, the implications and limitations of this study were discussed.

정신분열병에서 특정 증산군에 따른 신경인지 기능의 차이

김철권,김상수,김명정 大韓神經精神醫學會 2003 신경정신의학 Vol.42 No.1

Objectives : This study investigated the validity of positive-negative dichotomy model by comparing the differences of neurocognitive function in the specific symptom subgroups of schizophrenia. Methods : Factor analysis was performed on 14 items of the Positive and Negative Syndrome Scale (PANSS) among 71 inpatients with schizophrenia. All patients were assigned to one of specific symptom subgroups based on a ratio score and compared the neurocognitive distinction of each subgroups with normal control grouP, which was composed of 60 healthy persons without psychiatric illness. Neurocognitive functions include sustained attention, sensory register, executive function, attention and concentration, and verbal memory and learning obtained using Degraded Stimulus Continuous Performance Test, Span Apprehension Task, Wisconsin Card Sorting Test, Digit Span, and Rey Auditory Verbal Learning Test respectively. Results : Three factors, Positive, negative and disorganized, were yielded from factor analysis on 14 items of the PANSS. Three symptom subgroups showed the differential neurocognitive profiles. Disorganized symptom subgroup showed significant deficits in the sustained attention, sensory register, executive function, attention and concentration, and verbal memory and learning compared with the normal controls. Negative symptom subgroup showed significant deficits in the sustained attention, sensory register, executive function, and verbal memory and learning, Positive symptom subgroup showed significant deficits only in the sustained attention and sensory register compared with the normal controls. No significant differences were noted in the sustained attention, sensory register, attention and concentration, and verbal memory and learning among three symptom subgroups. But the disorganized symptom subgroup showed a significant deficit in the executive function compared to the positive symptom subgroup. Conclusions : These results support that three symptom dimensions including disorganization may be more valid than the positive-negative symptom dichotomy in the dimensions of schizophrenic symptoms.

정신분열병에서 특정 증상군에 따른 신경인지 기능의 차이

김철권,김상수,김명정 대한신경정신의학회 2003 신경정신의학 Vol.42 No.1

Objectives:This study investigated the validity of positive-negative dichotomy model by comparing the differences of neurocognitive function in the specific symptom subgroups of schizophrenia. Methods:Factor analysis was performed on 14 items of the Positive and Negative Syndrome Scale (PANSS) among 71 inpatients with schizophrenia. All patients were assigned to one of specific symptom subgroups based on a ratio score and compared the neurocognitive distinction of each subgroups with normal control group, which was composed of 60 healthy persons without psychiatric illness. Neurocognitive functions include sustained attention, sensory register, executive function, attention and concentration, and verbal memory and learning obtained using Degraded Stimulus Continuous Performance Test, Span Apprehension Task, Wisconsin Card Sorting Test, Digit Span, and Rey Auditory Verbal Learning Test respectively. Results:Three factors, positive, negative and disorganized, were yielded from factor analysis on 14 items of the PANSS. Three symptom subgroups showed the differential neurocognitive profiles. Disorganized symptom subgroup showed significant deficits in the sustained attention, sensory register, executive function, attention and concentration, and verbal memory and learning compared with the normal controls. Negative symptom subgroup showed significant deficits in the sustained attention, sensory register, executive function, and verbal memory and learning. Positive symptom subgroup showed significant deficits only in the sustained attention and sensory register compared with the normal controls. No significant differences were noted in the sustained attention, sensory register, attention and concentration, and verbal memory and learning among three symptom subgroups. But the disorganized symptom subgroup showed a significant deficit in the executive function compared to the positive symptom subgroup. Conclusions:These results support that three symptom dimensions including disorganization may be more valid than the positive-negative symptom dichotomy in the dimensions of schizophrenic symptoms.

가정폭력 피해여성들의 외상 후 부정적 인지와 대처전략이 외상 후 스트레스증상과 정서증상에 미치는 효과

조용래 한국인지행동치료학회 2013 인지행동치료 Vol.13 No.3

본 연구는 가정폭력 피해여성들의 외상 후 스트레스증상, 불안과 우울증상에 대한 외상 후 부정적 인지와 대처전략들의 효과와 외상 후 부정적 인지의 여러 차원들의 상대적인 기여도를 검토하기 위하여 수행되었다. 쉼터에 거주하거나 상담기관을 방문한 가정폭력 피해여성 106명을 대상으로 그들의 인구통계학적 특징, 외상관련 특징, 외상 후 부정적 인지, 대처전략, 외상 후 스트레스증상, 불안과 우울증상에 관한 자료를 수집하였다. 위계적 중다회귀분석 결과, 다른 모든 관련 변인들의 영향을 통제한 후에도, 외상 후 부정적 인지는 외상 후 스트레스증상, 불안 및 우울증상 각각에 대하여 고유하게 기여하였다. 회피 대처의 경우, 인구통계학적 및 외상관련 특징들의 영향을 통제했을 때에는 외상 후 스트레스증상과 우울증상에 각각 유의하게 기여하였으나, 외상 후 부정적 인지의 영향을 추가로 통제한 후에는 고유효과가 유의하지 않았다. 적극적 행동 대처의 경우, 불안증상과 유의한 정적 상관을 보였으나, 인구통계학적 및 외상관련 특징들의 영향을 통제한 후에는 불안증상에 대한 효과가 유의하지 않았다. 다음으로, 동시적 회귀분석 결과, 외상 후 부정적 인지의 여러 차원들 중 외상반응관련 부정적 자기 차원만이 외상 후 스트레스증상과 불안증상에 각각 유의하게 기여하였으며, 미래/가치관련 부정적 자기 차원만이 우울증상에 유의하게 기여하였다. 이 결과들은 가정폭력 피해여성들의 외상 후 스트레스증상과 정서증상들을 이해하고, 예방 및 치료하는데 있어 그들의 외상 후 부정적 인지의 역할을 중요하게 고려해야 함을 시사한다. This study was conducted to examine the effects of post-traumatic negative cognitions and coping strategies on post-traumatic stress, anxiety, and depressive symptoms among female victims of domestic violence, as well as the relative contributions of the dimensions of post-traumatic negative cognition to their psychological symptoms. 106 residents in domestic violence-related shelters or visitors to domestic violence-related counseling centers completed the questionnaires measuring post-traumatic negative cognitions, coping strategies, post-traumatic stress, anxiety, and depressive symptoms, as well as questions about their demographic and trauma-related characteristics. Post-traumatic negative cognition was a significant predictor of post-traumatic stress, anxiety, and depressive symptoms, after controlling for the other relevant predictors. Avoidance coping was a significant predictor of post-traumatic stress and depressive symptoms above and beyond some demographic and trauma-related characteristics, but when additionally controlling for post-traumatic negative cognition, its unique effect was not significant. Active behavioral coping which significantly correlated with anxiety symptoms was not a significant predictor of anxiety symptoms above and beyond some demographic and trauma-related characteristics or post-traumatic negative cognition. Next, of the dimensions of post-traumatic negative cognition, only negative self-concept about traumatic reactions uniquely contributed to post-traumatic stress and anxiety symptoms, and only negative self-concept about future/values uniquely contributed to depressive symptoms. In conclusion, these findings suggest the importance of considering the role of post-traumatic negative cognitions in order to prevent and treat female assault victims' post-traumatic stress and emotional symptoms or disorders more effectively.

정신분열병의 음성 증상에 대한 Loxapine과 Cyproheptadine의 병합 효과

김형섭(Hyeong-Seob Kim),고영민(Young-Min Ko),최낙경(Nak-Kyung Choi),김수동(Soo-Dong Kim) 대한생물치료정신의학회 2000 생물치료정신의학 Vol.6 No.2

Objectives : Atypical antipsychotics are known for the improvement effect for negative symptoms by the characteristics of high 5-HT₂/D₂ receptor occupancy ratio. We attempted this study to see if the improvement effect for negative symptoms by the combination of loxapine and cyproheptadine is similar to atypical antipsychotics. Methods : The Subjects were 15(male 9, female 6) who were chronic schizophrenics and in-patient. Their mean age was 38.33±5.51 years old, mean onset age 19.60±3.87 years old, mean duration of illness 221.33±57.04 months. Thier mean dose of medication, just before study, was 1367±7.80 ㎎/day as a haldol equivalent dose. We combined loxapine 10㎎/day and cyproheptadine 6 ㎎/day for the purpose of producing occupancy of 5-HT₂(more than 80%) and D₂(about 40%) receptors. The combination of medication was sustained for 6 weeks and after then typical antipsychotics(haloperidol) were administered for 4 weeks. The PANSS and ESRS were applied for the evaluations of clinical effects and side effects (just before trial of the combination, 3rd weeks and 6th weeks from the start of the combination). ANOVA was used to testify the statistical treatment. Results : As a result of the combination, the negative symptom, the general psychopathologic symptom, the PANSS total scores were improved significantly at the 6th weeks from the start of the combination(P<0.05). The improvement rate was 46.7% for the negative symptom, 33.3% for the general psychopathologic symptom, and 40.0% for the PANSS total score. However, there were no changes for positive symptoms. The total ESRS score was improved during the combination, however, those were aggravated followed as typical antipsychotics administration. Conclusion : The results of this study showed that the combination of loxapine(10㎎/day) and cyproheptadine(6㎎ /day) got the possibility for the treatment of the negative symptoms in schizophrenics and also those partially reconfirmed that the mechanism of the the atypical antipsychotics in the improvements of the negative symptoms is caused by high 5-HT₂/D₂ receptor occupancy ratio.

Validation of the Korean-Version of the Clinical Assessment Interview for Negative Symptoms of Schizophrenia (CAINS)

정성일,우정민,김양태,곽상규 대한의학회 2016 Journal of Korean medical science Vol.31 No.7

The Clinical Assessment Interview for Negative Symptoms (CAINS) was developed to overcome the limitations of existing instruments and reflect the current view of negative symptoms. The aim of the present study was to evaluate the reliability and validity of the Korean version of the Clinical Assessment Interview for Negative Symptoms (K-CAINS). Inpatients (n = 49) and outpatients (n = 70) with schizophrenia were recruited from three institutions. The confirmative factor analysis, test-retest reliability, inter-rater reliability, convergent validity, and discriminant validity were assessed. The study group consisted of 71 males (59.7%) and 48 females (40.3%). Their mean age was 42.15 years (SD = 12.2). The K-CAINS was confirmed to be divided into two subscales of 9 items related to “motivation/pleasure” and 4 items related to “expression” in concordance with the original version of the CAINS. The results showed that the K-CAINS had a good inter-rater reliability (ICC = 0.84-0.94), test-retest reliability (r = 0.90, P < 0.001). Convergent validity was proven by demonstrating a significant correlation with the Positive and Negative Syndrome Scale (PANSS) negative subscale, and the Scale for the Assessment of Negative Symptoms (SANS). Discriminant validity was proven by the lack of a significant correlation with the PANSS positive subscale, the Korean version of the Beck depression inventory (BDI), the Korean version of the Calgary depression scale for schizophrenia (K-CDSS), and the Modified Simpson Angus scale (MSAS). The K-CAINS could be a reliable and valid tool to assess the negative symptoms of Korean schizophrenia patients.

남자 정신분열병 환자의 양성 및 음성 증상과 신경학적 검사소견

박영남,류동근 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.3

Objects:The purpose of this study is to evaluate the differential neurological abnormalities in the positive and negative subtypes of schizophrenia. Method: A neurological examination battery was administered to 41 male DSM-III-R schizophrenic patients hospitalized with acute symptoms. Results: In standard neurological examination, 27 of 41(65.9%) patients exhibited one or more abnormalities and patients with negative subtype had much severe degree of neurological abnormalities than those with positive subtype. Also integrative motor and sensory functions such as sequencing, opposing actions, alternating movement, go-no-go, mirror movement, adventitious overflow, audiovisual integration and finger tapping, were more impaired in negative subtype. Positive symptom scores had negative correlations with prefrontal signs and negative symptom scores had positive correlations with prefrontal signs and negative correlations with parietal signs. Conlusions: These results partially supports the hypothesis that negative symptoms of schizophrenia might be related to brain dysfunctions. However, a further work is in need to evaluate the clinical significances of these differential neurological findings in positive and negative subtypes of schizophrenia.