서 론 연구대상및방법 1. 연구대상 연구도구및방법 1) 집단인지행동치료프로그램 368 Korean J Psychopharmacol 2003;14(4):

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1 KISEP Original Articles 공황장애환자에서인지행동치료의약물감량효과 최영희 김경미 박기환 윤혜영 인제대학교의과대학서울백병원신경정신과학교실 ABSTRACT The Effects of Cognitive Behavioral Therapy for Discontinuation of Medication in Panic Disorder Young Hee Choi, MD, PhD, Gyung Mee Kim, MD, Kee Hwan Park, PhD and Hye Young Yoon, MS Department of Neuropsychiatry, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea Objective:The purpose of this study is to determine whether CBT is effective in tapering or discontinuing medication regardless of the type of medication and its maintenance effects after long-term follow up. Method: 224 patients meet DSM-IV criteria for panic disorder with or without agoraphobia completed 12 weekly sessions of Panic Control Therapy (PCT;Barlow et al.). 80 patients who were using benzodiazepines alone and 144 patients who were using benzodiazepines and Antidepressants were measured with several screening scales at the pre- and post-treatment. The scales were Beck Depression Inventory (BDI), Spielberg State Anxiety Inventory (STAI-State), Spielberg Trait Anxiety Inventory (STAI-Trait), Body Sensation Questionnaire (BSQ), Agoraphobic Cognition Questionnaire (ACQ), Anxiety Sensitivity Index (ASI), Panic Belief Questionnaire (PBQ). These patients were assessed at 3 months, 6 months, 12 months of follow up and they were also assessed for their medications, panic frequency, and End-State Functioning. Results:After the completion of PCP, both benzodiazepines alone group and benzodiazepines and antidepressants combination group showed significant improvement (p<0.001) in all the results of 7-self reported questionnaires. 54% of patients discontinued their medication and 90.9% of patients were in HES at post-treatment. 70 % of patients were in HES at 3 month, 6 month, and 12 month follow up. The patients who could not discontinue medication also tapered their medication afterwards. The rate of discontinuing medication was significantly higher for the patients using benzodiazepines alone (86.3%) than patients using combination of benzodiazepines and antidepressants (56.3%). Conclusion:These findings support cognitive behavioral therapy can replace medication and these effects seem to last long. (Korean J Psychopharmacol 2003;14(4): ) KEY WORDS:Panic disorder Cognitive behavioral therapy Discontinuation of medication End State Functioning. 교신저자 367

2 서 론 연구대상및방법 1. 연구대상 연구도구및방법 1) 집단인지행동치료프로그램 368 Korean J Psychopharmacol 2003;14(4):

3 - 2) 평가도구및방법 369

4 사회인구학적특징 결 2. 인지행동치료이전복용약물종류에따른특성비교 과 Korean J Psychopharmacol 2003;14(4):

5 Table 1. Demographic data Sex Total n224 n80 BZs ADs n144 Male % % 40.50% Female % % 40.50% % Age yrsd a Education yrsd a Onset age yrsd a Duration of illness monsd a Marital status 0.40 a Married % % % Unmarried % % % Divorced % % % Occupation 9.58 a Office workers % % % Housewives % % % Business owners % % % Experts % % % Students % % % Labors % % % Unemployed % % % Others % % % aχ 2, BZsbenzodiazepines, ADsantidepressants Table 2. Pre-treatment scores of scales between BZs and BZsADs group Total n224 n80 BZs ADs n144 Panic attack pre 1mon * Panic attack pre 6mon BDI STAI-S STAI-T BSQ ** ACQ ** ASI PBQ p.05, p.001. BDIBeck Depression Inventory, STAI-SSpielberger State Anxiety Inventory, STAI-TSpielberger Trait Anxiety Inventory, BSQBody Sensation Questionnaire, ACQAgoraphobic Cognition Questionnaire, ASI Anxiety Sensitivity Index, PBQPanic Belief Questionnaire t 0.36 a t 3. 복용약물에따른인지행동치료의효과비교 - 371

6 Table 3. Comparison of treatment results between BZs and BZsADs group Total n224 n80 BZs ADs n144 pre post t pre post t pre post t BDI * * * STAI-S * * * STAI-T * * * BSQ * * * ACQ * * * ASI * * * PBQ * * * p.001. Table 4. Status of medication and end-state functioning at post-treatment, 3 month, 6 month, and 12 month follow up Post-treatment n224 3 month f/u n211 6 month f/u n month f/u n201 Medication Medication Medication Medication Medication Medication Medication Medication discontinuation continuation discontinuation continuation discontinuation continuation discontinuation continuation HES % % % % % % % % LES % % % % % % % % Total 121/ % 103/ % 140/ % 71/ % 139/ % 64/ % 136/ % * 25.92* 20.71* 15.63* p.001. HESHigh End-State Functioning, LESLow End-State Funtioning 65/ % 4. 치료후및추적조사시약물복용여부와최종상태기능평가 5. 치료후및추적조사시복용약물군에따른약물복용중단여부의차이비교 372 Korean J Psychopharmacol 2003;14(4):

7 Table 5. Status of medication at post-treatment, 3 month, 6 month, and 12 month follow up Post-treatment n224 n80 BZsADs n144 n76 3 month f/u n211 BZsADs n135 n75 6 month f/u n203 BZsADs n month f/u n201 n73 BZsADs n128 D % % % % % % % % C % % % % % % % % ** 10.30** 7.32* 18.20** p.01, p.001. DMedication discontinuation, CMedication continuation Table 6. Status of medication during 12 months of follow up after CBT BZs alone n73 BZsADs n128 2 Medication discontinuation % % 19.46* Medication continuation % % Re-medication % % Total % % p.001. Table 7. Status of medication and End-State Functioning during 12 months of follow up Medication discontinuation n135 Medication continuation n45 Re-medication n20 12 mon f/u HES % % % 15.86* end-state LES % % % p 개월추적조사동안각환자의복용약물에따른약물용량변화의차이비교 고찰 373

8 374 요 목적 : 방법 : Korean J Psychopharmacol 2003;14(4): 약

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1. 연구대상 연구방법 2. 측정도구 3. 명상법소개및연구절차 492

1. 연구대상 연구방법 2. 측정도구 3. 명상법소개및연구절차 492 KISEP Original Articles 38 3 1999 J Korean Neuropsychiatr Assoc Vol 38, No 3 명상이정서상태에미치는효과 * 이정호 ** 김영미 ** 최영민 ** The Effect of Meditation on Depression and Anxiety* Jung-Ho Lee, M.D.,** Young-Mee Kim,