조현병의 급성 정신병적 삽화 치료에 따른 병식과 정신병리와의 관계

Abstract

Objectives Lack of insight has been regarded as the key feature of schizophrenia since the era of Kraepelin. The relationship between insight and psychopathology has been known to be statistically modest and non-linear. The aim of this study was to investigate psychopathological factors influencing insight achievement during treatment of acute psychotic episodes in schizophrenia, using the Korean version of the Scale to Assess Unawareness of Mental Disorder (SUMD-K) and the Positive and Negative Syndrome Scale (PANSS). Methods Information on demographic characteristics, SUMD-K, and PANSS were collected from the medical records of patients who were admitted to the psychiatric ward of Dongguk University International Hospital from March 1, 2009 to February 28 and were diagnosed as schizophrenia by the DSM-IV TR 2010. A total of 29 patients met the inclusion criteria. The scores of total and sub-items of SUMD-K for both current and past illnesses were assessed at five weeks after hospitalization and the scores of total and five factors of PANSS were assessed on hospitalization and at five weeks after hospitalization, respectively, and the changes in score between two time points were calculated. Statistical analysis of the relationships between the various items of the SUMD-K and the clinical characteristics, the total and sub-scores of PANSS was performed using the Pearson correlation test and multiple regression analysis with stepwise variable selection. Results Total score and five factor scores of PANSS for hospitalization and PANSS changes did not show statistical correlation with SUMD-K. The total score of general items and awareness of mental disorder of SUMD-K at five weeks after hospitalization showed significant associations with duration of education, depressed and cognitive factors for current illness of PANSS at five weeks after hospitalization, respectively. In addition, depressed factor and cognitive factor of PANSS showed a significant association with awareness of social consequences and awareness of the achieved affect of medication, respectively. Conclusion During treatment of acute psychotic episodes in patients with schizophrenia, various domains of psychopathology were differentially correlated with insight, which implied the multidimensional construct on a continuum. Conduct of further studies of neurobiological approaches underlying factors showing correlation with insight is needed.