인지행동재활치료가 정신분열병 환자들의 인지 기능에 미치는 영향

이원혜(Won-Hye Lee),황태연(Tae-Yeon Hwang),이우경(Woo-Kyung Lee) 대한사회정신의학회 2001 사회정신의학 Vol.6 No.2

목 적: 본 연구는 만성 정신분열병 환자들을 대상으로 실시한 인지행동재활치료(CBRT)의 효과를 검증하고자 하였다. 연구방법: 만성 정신분열병으로 진단 받아 입원 중인 환자 12명을 대상으로 매주 1회(매회 50분간)씩 18주 동안 지남력, 주의집중력 훈련, 기억력 훈련, 변별력 및 조직화 훈련 등 4단계로 구성된 인지행동재활치료(CBRT)를 실시하였다. 대조군으로는 동일한 기간동안 일반적인 정신사회재활치료를 실시한 집단(n=9명)과, 일반적인 입원 치료만을 받은 집단(n=9명)을 두었다. 세 집단 모두 치료 전과 치료 후 신경심리 검사를 실시하여 그 변화를 비교하였다. 치료 전과 치료 후 인지 기능의 변화를 알아보기 위해 세 집단 모두, KWIS(Korean Wechsler Adult Intelligence Scale)의 WARD7 단축형, DS-CPT(Degraded Stimulus Continuous Performance Test), SPAN(SPAN of Apprehension Program), Word Fluency Test, Word Memory Test를 실시하였다. 결 과: 세 집단의 치료 전, 후 인지 기능 변화의 주효과 및 상호작용 효과를 살펴보기 위한 MANOVA 분석 결과, KWIS의 숫자, 상식, 토막짜기, 빠진곳 찾기에서 집단간 주효과(p<.05)가 발견되었는데, CBRT 집단이 다른 두 집단에 비해 토막짜기, 빠진곳 찾기의 수행이 유의하게 상승하였다. 또한, 산수와 SPAN에서는 치료 전, 후의 상호작용 효과도 관찰되었는데(p<.05), CBRT 집단은 치료 후 SPAN의 12matix에서 유의한 상승을 보인 반면, 일반적인 입원 치료만 받은 집단은 수행 수준이 오히려 감소하였다. 집단 내 변화를 알아보기 위해 세 집단 각각에 대해 paired-t test를 시행한 결과, CBRT 집단은 KWIS의 전체 지능, 동작성지능, 토막짜기, 빠진곳 찾기와 SPAN의 12matrix, 언어적 유창성에서 치료 후 수행이 유의하게 증가하였으나(p<.05). 정신사회재활치료 집단은 KWIS의 동작성 지능에서만 유의한 변화가 있었으며(p<.05), 일반적인 입원 치료만 받은 집단은 신경심리 검사의 어떤 변인에 대해서도 유의한 변화가 나타나지 않았다. 결 론: 만성 정신분열병 환자들을 대상으로 한 CBRT는 전반적인 인지 기능 향상에 효과적이었으며, 특히 시각적 기민성과 변별 능력, 지각적 분석 및 통합 능력, 적극적이고 융통성 있는 사고 활동에 긍정적인 영향을 미치면서 행동적 수준의 변화로 이어지고 있음을 시사한다. 이러한 신경심리 검사에서의 수행 향상이 치료 후에도 지속될 수 있는지에 대한 추후 연구(follow-up)가 필요할 것이다. 또한, 기초인지 기능의 향상이 일상생활의 적응이나 대인 관계 기술, 직업 수행 등 전반적인 기능의 호전으로 일반화 될 수 있을 지에 대해서도 후속 연구가 필요할 것이다. Objectives:This study was designed to investigate the outcomes of the Cognitive Behavioral Rehabilitation Therapy (CBRT) for chronic schizophrenic patients. Methods:The subjects were 30 chronic chronic schizophrenic inpatients. CBRT group(N=12) was given orientation training, visual discrimination and organization training, attention and concetration training, and memory function training. Compared groups were given psychosocial rehabilitation(N=9) and general inpatient care(N=9). Korean Wechsler Intelligence Scale(KWIS), Continuous Performance Test(CPT), Span of Apprehension(SPAN), Verbal memory test and Verbal fluency test were performed before and after the interventions. Results:CBRT group were significantly improved in full IQ, performance IQ, picture complete, block design, Span 12matrix, verbal fluency. But psychosocial rehabilitation group was only improved in performance IQ and general inpatient group showed no significant effects in all outcomes variables. Conclusion:Our findings suggest that CBRT for chronic schizophrenic patient was effective on improving general cognitive function. Especially, it increased psychomotor activity and entailed improvement of visual alertness, vigilance, perceptual organization and mental flexibility. In the future studies, follow-up study of effectiveness must be performed and generalization of cognitive functional improvement from CBRT into other psychosocial functions should be reviewed.

동독과 서독의 중심 거리에서 나타나는 환경 색채 특성에 관한 연구

이원혜(Lee, Won Hye),박영순(Park, young soon),이현수(Lee, Hyun Soo),송정화(Song, Jung Hwa) 한국색채학회 2004 한국색채학회 학술대회 Vol.2004 No.6

시설 거주 노인 우울증의 인지기능저하

이정식(Jung Sik Lee),이원혜(Won Hye Lee),이우경(Woo Kyeong Lee),오홍석(Hong Seok Oh) 대한노인정신의학회 2006 노인정신의학 Vol.10 No.1

Objectives : There is a wide spectrum of cognitive dysfunction in geriatric depression due to heterogeneity. The Authors tried to investigate cognitive dysfunction in the elderly with depression and the association between geriatric depression and demographic variables such as sex, age, and education. Methods : Total 101 non-demented participants living in the asylum for the aged had completed frontal lobe function test (executive function and conceptualization) and CERAD-K (the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease) to evaluate neuropsychological function. Symptoms of depression were evaluated by SGDS-K (Short Geriatric Depression Scale of Korean version). We divided the elderly into two groups (depressed, non-depressed group) to evaluate the differences in cognitive function. Results : 30 (29.7%) of the subjects suffered depression and 50 (49.5%) had cognitive decline. Geriatric depression is not associated with age, sex, and education. Depressed older adults had lower executive function score in total group and cognitive decline group than non-depressed. Within cognitive decline group, subject with geriatric depression had lower scores in word fluency and word delayed recall than non-depressed. There was significant correlation between SGDS-K score and executive function. Conclusion : Subjects with geriatric depression had significant executive dysfunction. Executive dysfunction in depressed older adults may provide the basis for further investigation of mechanisms of geriatric depression. Timely identification of executive dysfunction fundamental to daily activities of depressed older adults may lead to coping strategies that will improve the prognosis of geriatric depression.

국내 우울증 평가도구 타당화 연구의 체계적 고찰-진단적 타당성을 중점으로 : 한국형 우울 선별 도구 개발을 위한 예비 연구

정수연,김신향,박기호,제갈은주,이원혜,최윤영,이승환,최기홍,Jung, Sooyun,Kim, Shin-Hyang,Park, Kiho,Jaekal, Eunju,Lee, Won-Hye,Choi, Younyoung,Lee, Seung-Hwan,Choi, Kee-Hong 대한불안의학회 2017 대한불안의학회지 Vol.13 No.2

Reliable and valid diagnostic screening tools in the primary care setting enable accurate estimation of depression in individuals at risk or in need of treatment, and provide patients with an opportunity to receive optimal treatments. Although there have been extensive studies on screening tools for depression used in domestic mental health settings, there is little consideration and lack of a thorough review of the diagnostic validity of screening tools. In the current review, we selected 13 representative screening tools for depression which were evaluated in a total of 19 validation studies conducted in Korea. We summarized DSM-5 target domains, diagnostic indices, sensitivity, specificity, cut-off scores, and diagnostic validity information for each tool. Finally, the depression measurement expert group was constituted to evaluate the current status of screening tools for depression, and their recommendations for a new screening tool were summarized. This study was conducted as part of the Mental Health Technology Development project to develop the Korean screening tool for depression (K-DEP).

시설 거주 노인 우울증의 인지기능변화

이정식(Jung Sik Lee),박은미(Eun Mi Park),장순우(Soon Woo Chang),이주호(Joo Ho Lee),이원혜(Won Hye Lee) 대한노인정신의학회 2007 노인정신의학 Vol.11 No.2

Objectives : Cognitive impairment often occurs with geriatric depression, and may persist despite remission of depression. The authors investigated change of cognitive functions in geriatric depression according to time interval to identify whether cognitive impairment may persist or not. Methods : At baseline and 1 year follow-up, total 88 non-demented participants living in the asylum for the aged had a clinical examination that included depression assessment (SGDS-K : Short Geriatric Depression Scale of Korean version) and neuropsychological test (frontal lobe function test and CERAD-K : the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease). We divided the elderly into two groups (depressed : 27, non-depressed : 61) and evaluated the differences in change of cognitive functions. Results : Depressed group had lower scores on the word delayed recall test and construction recall test than non-depressed group at one-year follow-up. Except executive function, there was no significant difference in cognitive change between two groups according to time interval. Conclusion : These results support previous observations that cognitive impairment in geriatric depression may persist, especially in the executive function. Timely identification of executive function of depressed older adults may lead to coping strategies that will improve the prognosis of geriatric depression.

비임상군을 대상으로 한 온라인 기반 인지기능 향상 프로그램 개관

서지원(Seo, Ji-won),남예은(Nam, Ye-eun),이윤형(Lee, Yoon-hyoung),이원혜(Lee, Won-hye) 영남대학교 인문과학연구소 2022 人文硏究 Vol.- No.98

본 논문에서는 국내외에서 지난 10년 간 정상적인 인지기능을 가진 사람들(비임상군)을 대상으로 진행된 온라인 인지기능 향상 프로그램에 대해 훈련 목표로 삼은 인지기능, 효과 평가 도구 등을 중심으로 20편의 문헌을 개괄하였다. 또한 온라인 환경에서 다양한 연령대의 비임상군을 대상으로 프로그램을 진행할 때, 각 집단의 특성에 따라 구조나 내용에 어떠한 차별점이 있는지를 구체적으로 살펴보았다. 마지막으로 온라인 인지 향상 프로그램의 효과성을 검증하는데 있어서 중요한 비교 집단인 활성 대조군의 역할에 대해 확인하고, 온라인 인지 향상 프로그램이 실제 인지기능 향상으로 이어졌는지 그 효과에 대해 살펴보았다. 본 논문에서는 이렇게 검토한 내용을 바탕으로 온라인 및 웹 기반 인지 향상 프로그램의 활용 가능성과 프로그램 개발시 고려점 및 향후 연구 방향에 대해서 논의하였다. In this paper, we have reviewed 20 articles related with online cognitive enhancement programs for people with normal cognitive functions (non-clinical groups) over the past 10 years. We examined the focused cognitive functions of the training and tools for evaluating the effect of the training. In addition, the characteristics of each program were comprehensively reviewed in order to find out the important aspects for the on-line program for non-clinical groups of various ages. We also conformed the importance of the active control group for examining the effectiveness of the online cognitive enhancement program. We also examined whether the online cognitive enhancement programs actually led to meaningful improvement. Finally, we discussed the applicability of on-line cognitive enhancement programs, considerations for program development, and future research directions.

시설거주 노인들에서 주관적 기억장애 호소와 객관적 인지기능

이정식 ( Jung Sik Lee ),이우경 ( Woo Kyeong Lee ),박은미 ( Eun Mi Park ),이원혜 ( Won Hye Lee ),오홍석 ( Hong Seok Oh ),안은숙 ( Eun Soog An ),고영 ( Young Ko ) 한국정신병리진단분류학회 2006 精神病理學 Vol.15 No.1

Objectives: There are inconsistent results about relationships among the subjective memory complaints(SMC), objective memory functions, and depression. The Authors tried to examine the association of subjective memory complaints in the elderly with objective cognitive functions, depression and other demographic variables such as sex, age, and education. Methods: Total 175 participants living in the asylum for the aged had completed CERAD-K(the Korean version of the Consortium to Establish a Registry for Alzheimer`s Disease) to evaluate neuropsychological function. All of them were evaluated by four specific questions about everyday memory function. Symptoms of depression were evaluated by SGDS-K(Short Geriatric Depression Scale of Korean version). We divided the elderly into two groups(SMC+ group, SMC- group) to evaluate the differences in cognitive function and depression. Results: 109(62.3%) of the subject acknowledged having trouble with their memory. Memory decline and cognitive decline were associated with SMC. SMC+ group scored significantly lower on word delayed recall test than SMC- group, especially. Age, sex and education were significantly associated with SMC in total subject but not education in non-demented subject. Total score of SMC was explained partly by word delayed recall and depression variables in non-demented subject. Conclusion: This study suggested that association between SMC and objective memory function had clinical implication that SMC was a significant part of MCI criteria associated with early stage of Alzheimer`s Disease.

일상생활 수행능력 평가도구의 유효성 분석 연구

주채린(Chaelin Joo),김가영(Kayoung Kim),이원혜(Won Hye Lee),한주현(Joo Hyun Han),노은정(Eunjung Noh),임선진(Seon Jin Yim) 대한노인정신의학회 2023 노인정신의학 Vol.27 No.2

Objective: The study’s aim was to evaluate the validity of the Korean version of the University of California San Diego Performance- based Skills Assessment, Validation of Intermediate Measures (K-UPSA-2-VIM) in patients with dementia (D), mild cognitive impairment (MCI), and cognitive normal control group (CN). Methods: Study participants were 25 patients with D, 43 patients with MCI, and 111 controls with CN group, respectively. For cognitive assessment, Mini Mental State Examination, Consortium to Establish a Registry for Alzheimer’s Disease neuropsychological battery, and Clinical Dementia Rating were used. For functional assessment, Barthel-Activities of Daily Living, Instrumental Activities of Daily Living, Dementia Screening questionnaire, and K-UPSA-2-VIM were used. Results: Statistically significant differences were observed in all subdomains and total score of the K-UPSA-2-VIM among three cognitive groups. K-UPSA-2-VIM demonstrated 75.7% of sensitivity and 65.1% of specificity, with an area under the curve (AUC) of 0.731 (95% confidence interval [CI]: 0.641-0.821, p<0.001) in discriminating between CN and MCI groups. In discriminating between MCI and D groups, 76.7% of sensitivity and 64.0% of specificity, with an AUC of 0.706 (95% CI: 0.580-0.833, p=0.005) were demonstrated. Conclusion: The K-UPSA-2-VIM is useful to evaluate activities of daily living function in Korean patients with D and MCI.

청소년용 정신화 프로그램의 학생정신건강 증진효과 평가

문수진(Su Jin Moon),오소영(So Young Oh),이원혜(Won Hye Lee),홍민하(Min Ha Hong),민정원(Jung Won Min),김봉석(Bong Seog Kim),황준원(Jun Won Hwang),우이혁(Ieehyok Woo),반건호(Geon Ho Bahn) 대한소아청소년정신의학회 2012 소아청소년정신의학 Vol.23 No.3

Objectives:Understanding the emotions, thoughts, feelings and behaviors of others, as well as oneself, is part of the mentalizing function. We developed a new school-based community model for mental health, called the Mentalization Improvement Program for Adolescent-Community Model (MIPAdo-CM), based on the concept of mentalization. Methods:The MIPAdo-CM was composed of 12 sessions and was applied to 403 students in the 2nd grade of a middle school. Every session was conducted after the regular school hours for 6 weeks. After 6 weeks, we compared the endpoint changes of Adolescent Mental Problem Questionnaire-Revised (AMPQ-R), Emotional Empathy Test (EET), Peer Aggression Scale (PAS), Peer Bullying Scale (PBS), School Adjustment Scale (SAS), Test Anxiety Inventory (TAI) and Visual Analogue Scale between the subject and the control group. Results:There was no significant difference between two groups in AMPQ-R, EET, PAS, PBS, SAS, and TAI. On the Visual Analoge Scale, however, students in the trial classes reported more increase in understanding and respect for both others and themselves. Conclusion:The efficacy of MIPAdo-CM was subjective improvement of understanding and respect for both others and themselves, erence between two groups in AMPQ-R, Empathy test, To prove objective usefulness of this program, further studies with more structured design will be needed.

단축형 청소년용 정신화 프로그램의 학생정신건강 증진효과 평가

오소영(So Young Oh),문수진(Su Jin Moon),이원혜(Won Hye Lee),홍민하(Min Ha Hong),민정원(Jung Won Min),김봉석(Bong Seog Kim),황준원(Jun Won Hwang),우이혁(Ieehyok Woo),반건호(Geon Ho Bahn) 대한소아청소년정신의학회 2012 소아청소년정신의학 Vol.23 No.3

Objectives:We developed the short form of the Mentalization Improvement Program for Adolescent-Community Model (MIPAdo-CM-S), based on the concept of the mentalization. Methods:The MIPAdo-CM was composed of 6 sessions and was applied to 133 students in the 1st grade of a middle school for six weeks during their regular school hours. After 6 weeks, we compared the endpoint changes of Adolescent Mental Problem Questionnaire-Revised (AMPQ-R), Emotional Empathy Test, Peer Aggression Scale, Peer Bullying Scale, School Adjustment Scale, Test Anxiety Inventory and Visual Analogue Scale between the subject and the control group. Results:On the Visual Analoge Scale, students in the trial classes reported an increased understanding and respect for others, as well as themselves. Conclusion:The efficacy of MIPAdo-CM was subjective improvement of understanding and respect for both others and themselves. To prove objective usefulness of this program, further studies should be administered in the form of long-term, regular and structured courses.