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E-ISSN : 2733-4538
본 연구에서는 정신분열증과 정신증적 양극성장애 환자들 간의 신경인지 수행을 비교하였는데, 특히 정신분열증에 핵심적이라고 알려진 신경인지 영역에 속하는 소검사들을 채택하여 두 집단 간 어떠한 유사점과 차이점이 있는지 살펴보았다. 더불어 이들의 신경인지 결함과 정신증적 증상의 관련성에 대해서도 조사하였다. 구조화된 면접을 통해 진단이 확인된 44명의 안정적인 정신분열증 환자와 13명의 정신증적 양극성장애 환자들을 대상으로 정보처리속도, 주의/각성, 언어학습, 시각학습, 작업기억, 추론 및 문제해결의 6가지 신경인지 영역에 해당하는 9개의 신경인지 검사들을 실시하였으며, 지능검사와 임상증상 평가도구도 함께 실시하였다. 그 결과, 정신분열증 환자들은 정보처리속도, 주의/각성, 언어학습 영역의 신경인지 검사에서 정신증적 양극성장애 환자들보다 유의미하게 더 심각한 결함을 나타냈으며, 전체 신경인지 영역에 걸쳐 중간 수준의 효과크기가 발견되었다. 특히 정신증적 증상을 통제하고 난 후에는 두 장애 간 신경인지기능의 차이가 대부분 사라졌는데, 다변량분석 결과에서도 집단 효과는 유의미하지 않았으며 와해증상의 효과만이 유의미한 것으로 나타났다. 이는 정신증적 증상이 신경인지 결함에 대해 중요하고도 공통적인 기여를 한다는 사실을 알려주지만, 신경인지 수행과 정신증적 증상 간의 유의미한 상관 패턴은 두 집단에서 서로 다르게 나타나 정신증적 증상이 각 신경인지 영역에 영향을 미치는 기저 메커니즘은 다를 수 있음이 시사된다.
In the present study, we compared cognitive impairments in schizophrenic and psychotic bipolar disorder patients and also investigated the relationships between psychotic symptoms and cognitive impairments. Forty-four patients with chronic schizophrenia and 13 with psychotic bipolar disorder underwent a neurocognitive battery which measured performance on key cognitive domains for schizophrenia. Overall intelligence and clinical characteristics were also evaluated. The results revealed that schizophrenic patients performed significantly worse than patients with psychotic bipolar disorder with regard to processing speed, attention/vigilance, and verbal learning domains. Additionally, medium-sized effects were found across all cognitive measures between the two patient groups. However, these differences disappeared after controlling for the severity of psychotic symptoms. A subsequent multivariate analysis revealed that the main effect for group on cognitive performance was insignificant and that psychotic symptoms, especially disorganized symptoms, significantly contributed to cognitive impairment, even after controlling for group differences. This indicated that psychotic symptoms contribute to cognitive impairment in both schizophrenia and bipolar disorder. However, because the patterns of correlations between psychotic symptoms and cognitive performance varied with respect to schizophrenia and psychotic bipolar disorder, it is reasonable to suggest that the underlying mechanisms of these two psychiatric disorders may differ.
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