Effects of Integrated Psychological Therapy for Schizophrenic Patients / 신경정신의학

OBJECTIVES: This study, as a preliminary one attempting to develop the Korean version of Integrated Therapy for the rehabilitation of schizophrenic patients, was designed to investigate the results of Integrated Psychological Therapy(IPT) and review the problems during the program application. METHODS: Cognitive Differentiation Scale, Problem-Solving Scale, and PANSS(Positive And Negative Syndrome Scale) were administered to schizophrenic inpatients before and after IPT incorporating cognitive differentiation, social perception, verbal communication, social skill and interpersonal problem-solving skill subprograms. The therapy groups were offered activities three times per week during the 12-week program. The control groups were attention-placebo groups for control ling factors such as group interaction and social attention, and were offered psychoeducation. RESULTS: The 12-week IPT groups, compared with the control groups, demonstrated significant improvements in the general psychopathology and the total symptoms of PANSS, but did not in cognitive functions and problem-solving skill. Significant improvements in cognitive functions were found only after cognitive differentiation subprogram and social skill subprogram had limited effects on social skills. But within 12-week IPT groups significant improvements in the positive symptoms, negative symptoms and general psychopathology were found. CONCLUSION: These findings support some effectiveness of IPT, but do not address the unique contribution by cognitive components. Applied to schizophrenic patients in this country, this modality had the problems such as differences in sociocultural and lingual background, duration of treatment, homogeneity in the level of the functioning among group members, management of emotions in activities, and the therapists' skill in the training of cognitive components. So the modification of this modality will be required.

Development of the Social Perception Scale for Cognitive Rehabilitation in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: This research was performed in order to develop the social perception scale which could detect the deficits of the social perception, composed of visual perception and contextual perception, in the patients with schizophrenia and might have the desirable reliability and discriminating power between the patients with schizophrenia and the normal controls, and so as to be appropriate to the schizophrenics' cognitive rehabilitation strategy of Brenner, et al. METHODS: We selected 10 photographs among 30 photographs which could show the variable social situations according to the consensus of the staff members of the Integrated Psychological Therapy. Then we developed the questions, composed of visual perception subscale and contextual perception subscale, which we called preliminary social perception scale. We tested the above scale to the 20 patients with schizophrenia in the chronic mental hospital. Then we tested the above scale to both the 20 patients meeting DSM-IV criteria for schizophrenia in the closed ward of the university psychiatric hospital and the 20 normal controls. We developed the final social perception scale to exclude the items of inadequate reliability. We compared the item difficulties of social perception scale between the patients in the chronic mental hospital and those in the university psychiatric hospital. finally, we compared the scores of social perception scale between the patients with schizophrenia and the normal controls. RESULTS: The final 6 items were selected to become the social perception scale according to the values of the item-total correlation, test-retest reliability, and interrater reliability. The final social perception scale showed similar rank of item difficulties between two groups with schizophrenia. The patient group differed significantly fiom the normal control group on the scores of contextual perception subscale(t=-3.09, p<.01) and the total scores of social perception scale(t= -3.33, p<.01). CONCLUSION: This study suggests that the above social perception scale which has excellent internal consistency, test-retest reliability, interrater reliability and the discriminating power. This scale can be applied to both the cognitive rehabilitation strategy in the patients with schizophrenia and the evaluation of the effectiveness of the cognitive rehabilitation.