정신분열증 환자의 주관적 음성증상경험의 임상적 의의

Abstract

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 reports suggesting that patients suffer from the subjective experiences of their deficit symptoms, even though the objective positive and negative symtoms 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 objective positive and negative symptoms, depression, anxiety symptoms, and extrapyramidal symptoms. Method：All the 37 patients satisfied the diagnostic criteria of DSM-IV for schizophrenia . The subjective experiences of negative symptoms were evaluated using Scale for the Subjective Experience of Negative Symptoms, Korean version(K-SENS), 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 Symptom 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 psychopathology subscale score(γ=-0.08, p>0.05), respectively. There was no significant correlation between the 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 results revealed that the negative correlation between the subjective negative symptoms experienced as an uncomfortable ones and the objective positive 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 subjectively experienced negative symptoms, or that patients may not be aware of their negative symptoms because they are overwhelmed by their positive symtpoms. is suggested. These results also suggest that subjective experiences of negative symptoms are independent from depression, anxiety and extrapyramidal symptoms