정신분열병 환자의 전두엽-관리기능 = Frontal-executive functions in schizophrenic patients.

다국어 초록 (Multilingual Abstract)

The present study investigated frontal-executive functions in 45 schizophrenic patients and 27 normal control subjects. All subjects were administered Executive Intelligence Test (EXIT), K-Wechsler Adult Intelligence Scale (K-WAIS) and Rey-Kim Memory Test (RKMT). The major findings were as follows. Firstly, the difference between the schizophrenia group and the control group was most pronounced in executive intelligence quotient (EIQ) compared with the difference in verbal comprehension index (VCI), perceptual organization index (POI), freedom-from-distractibility index (FDI), and memory quotient (MQ). Secondly, the 4 difference scores of the EXIT are relatively pure measures of executive functions. The schizophrenic group was significantly lower than the control group in each difference score. Thirdly, of the schizophrenic group, 25 showed a clinically defective performance (i.e., ≤79) in at least one of the three summary measures--EIQ, MQ, and full-scale intelligence quotient (FIQ). Of these 25, 24 (96%) showed a defective performance in EIQ. These results suggest that frontal-executive function is one of the most defective cognitive functions in schizophrenia.

국문 초록 (Abstract)

본 연구는 45명의 정신분열병 환자와 27명의 정상인을 대상으로 전두엽-관리기능을 비교하였다. 측정 도구로는 EXIT(Executive Intelligence Test)를 사용하였으며, 비교를 위하여 지능검사(K-WAIS)와 기억검사(Rey-Kim 기억검사)도 함께 실시하였다. 주요 결과는 다음과 같았다. 첫째, 정신분열병군은 시공간지수, 주의력지수, 기억지수, 관리지능지수 각각에서 통제군 보다 유의미하게 낮았다. 그러나 양 집단의 차이는 관리지능지수에서 가장 현저하였다. 둘째, EXIT에서 산출되는 4개의 ‘차이 점수’(difference score)는 기존의 점수들에 비해 보다 순수한 관리기능지표로 해석할 수 있다. 이 4개의 차이 점수 각각에서 정신분열병군은 통제군에 비해 유의미하게 낮았다. 셋째, 정신분열병군에서 지능지수, 기억지수, 관리지능지수 중 어느 하나라도 경계선이하(즉 79이하)인 환자는 25명이었다. 이 중 24명(96%)이 관리지능지수에서 결손을 보였다. 그러므로 관리지능지수의 결손이 없는 상태에서 지능지수나 기억지수의 단독적 결손을 보이는 정신분열병 환자는 극히 드물었다. 이상의 결과는 정신분열병군이 다수의 인지 영역에서 결손이 있지만 그 중에서도 관리기능의 결손이 가장 심함을 제시한다.

참고문헌 (Reference)

1 "지능검사와 신경심리검사는 무엇이 다른가?" 22 : 141-158, 2003

2 리광철, "정신분열증 환자의 인지 결함" 21 : 377-389, 2002

3 "정신분열병의 급성기 및 관해기에서의 신경인지 결손에 관한 연구" 40 : 936-954, 2001

4 "정신분열병 환자의 신경심리학적 특성 기억능력과 실행능력을 중심으로" 5 : 101-114, 1996

5 "전두엽-증후군의 임상평가 Kims 전두엽-관리기능 신경심리검사를 중심으로" 8 : 173-190, 2001a

6 "외상성 뇌손상 환자와 정신분열증 환자의 위스콘신 카드 분류 검사상에 나타난 인지적 특성 비교" 19 : 351-363, 2000

7 "신경심리 검사에 나타난 남자 정신분열병 환자와 조증 환자의 전두엽 기능 장애" 35 (35): 39-49, 1996

8 "숫자 바로 따라 외우기와 거꾸로 따라 외우기의 차이에 관한 규준 연구" 22 : 599-613, 2003

9 "and temporal lobes as sites for schizophrenia" 379-389, 1990

10 "What are the functional consequences of neurocognitive deficits in schizophrenia?" 153 : 321-330, 1996

11 "Verbal fluency in schizophrenia: relationship with executive function, semantic memory and clinical alogia" 26 : 39-49, 1996

12 "The problem of assessing executive functions" 17 : 281-297, 1982

13 "The neuropsychological signature of schizophrenia generalized or differential deficit? American Journal of Psychiatry" 40-48, 1994

14 "The neuropathology of schizophrenia:a critical review of the data and their interpretation" 122 : 593-624, 1999

15 "The measurement of differential deficit" 14 : 303-311, 1973

16 "The generalized pattern of neuropsychological deficits in outpatients with chronic schizophrenia with heterogeneous Wisconsin card sorting test results Archives of General Psychiatry" 891-898, 1991

17 "The central executive:a concept and some misconceptions" 4 : 523-526, 1998

18 "The central executive does not exist" 4 : 518-522, 1998

19 "The case for frontostriatal dysfunction in schizophrenia" 16 : 391-402, 1990

20 "Statistical analysis in psychology and education" McGraw- Hill 1981

21 "Schizophrenia－a brain disease?: a critical review of structural and functional cerebral abnormality in the disorder." 166 : 563-582, 1995

22 "Rey-Kim 기억검사를 이용한 기억장애 평가" 8 : 29-48, 2001c

23 "Rey-Kim 기억검사: 해설서." 도서출판 신경심리 1999

24 "Remodeling old models of intelligence Handbook of intelligence" 267-300, 1985

25 "Recall memory deficit in schizophrenia a possible manifestation of prefrontal dysfunction" 251-257, 1989

26 "Pre-frontal committee for perception, working memory, attention, long-term memory, motor-control, and thinking: a tutorial review" 12 : 83-139, 2003

27 "Performance on tests of frontal lobe function reflect general intellectual ability" 40 : 970-977, 2002

28 "Performance of schizophrenic patients on tests sensitive to left or right frontal or parietal function in neurological patients The Journal of Nervous and Mental Disease" 435-443, 1983

29 "Neuropsychological impairments in deficit vs nondeficit forms of schizophrenia Archives of General Psychiatry" 804-811, 1994

30 "Neuropsychological functioning of first-episode schizophreniform patients American Journal of Psychiatry" 898-903, 1992

31 "Neuropsychological functioning in first-episode psychosis－evidence of specific deficits" 43 : 47-55, 2000

32 "Neuropsychological assessm" Oxford University Press 1995

33 "Neurocognitive deficit in schizophrenia:a quantitative review of evidence" 12 : 426-445, 1998

34 "Moderator variables of executive functioning in schizophrenia:meta-analytic findings" 27 : 305-316, 2001

35 "Memory impairment in schizophrenia its’ relationship to executive function" 21 : 85-96, 1996

36 "Memory and executive function impairments in deficit syndrome schizophrenia" 102 : 29-37, 2001

37 "Long-term memory deficits in schizophrenia primary or secondary dysfunction?" 17 : 539-547, 2003

38 "Kims 전두엽-관리기능 신경심리검사: 해설서" 도서출판 신경심리 2001b

39 "K-WAIS의 3요인 해석을 위한 규준 연구" 21 : 631-645, 2002

40 "Is it possible to be schizophrenic yet neuropsychologically normal?" 11 : 437-446, 1997

41 "Intelligence in schizophrenia meta-analysis of the research" 430-459, 1984

42 "INS Dictionary of Neuropsychology" Oxford University Press 1999

43 "Hypofrontality in schizophrenia:RIP" 345 : 1383-1384, 1995

44 "How specific are the memory and other cognitive deficits caused by frontal lobe lesions?" Psychology Press 155-175, 1997

45 "Generalized cognitive deficits in schizophrenia a study of first- episode patients" 56 : 749-754, 1999

46 "Frontal/executive impairments in schizophrenia" 22 : 125-137, 1996

47 "Frontal-subcortical circuits and human behavior" 50 : 873-880, 1993

48 "Frontal- subcortical circuits and neuropsychiatric disorders" 6 : 358-370, 1994

49 "Frontal lobe impairment in schizophrenia relationship to intellectual functioning" 787-790, 1993

50 "Frontal and non-frontal lobe neuropsychological test performance and clinical symptomatology in schizophrenia" 353-359, 1992

51 "Executive functions and developmental psychopathology" 37 : 51-87, 1996

52 "Executive function in first-episode schizophrenia" 28 : 463-473, 1998

53 "Executive dysfunction in schizophrenia Cognition in schizophrenia" Oxford University Press 51-72, 2000

54 "Do "frontal tests" measure executive function? Issues of assessment and evidence from fluency tests." Psychology Press 191-213, 1997191-213

55 "Differential behavioral effects in frontal lobe disease" 6 : 53-60, 1968

56 "Diagnostic and statistical manual of mental disorders" 1994

57 "Cognitive assessment for clinicians" Oxford University Press 1994

58 "Assessment of the dysexecutive syndrome in schizophrenia" 27 : 635-646, 1997

59 "A selective and critical review of neuropsychological deficits and the frontal lobes" 4 : 161-198, 1994

60 "A comparison of clustering solutions for cognitive heterogeneity in schizophrenia." 4 : 353-362, 1998