KISEP Original Articles 14 4 2003 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):367-376) KEY WORDS:Panic disorder Cognitive behavioral therapy Discontinuation of medication End State Functioning. 교신저자 367
서 론 연구대상및방법 1. 연구대상 - - - 2. 연구도구및방법 1) 집단인지행동치료프로그램 368 Korean J Psychopharmacol 2003;14(4):367-376
- 2) 평가도구및방법 369
- - - 370 1. 사회인구학적특징 결 2. 인지행동치료이전복용약물종류에따른특성비교 과 Korean J Psychopharmacol 2003;14(4):367-376
Table 1. Demographic data Sex Total n224 n80 BZs ADs n144 Male % 106 47.3% 40.50% 066 45.8 Female % 118 52.7% 40.50% 078 54.2% Age yrsd 036.38 08.48 36.80 07.75 036.15 08.87 0.57 a Education yrsd 014.51 02.45 14.55 02.18 014.49 02.60 0.17 a Onset age yrsd 031.89 08.57 31.59 08.67 032.06 08.54 0.38 a Duration of illness monsd 051.33 54.06 60.78 62.94 045.87 47.61 1.95 a Marital status 0.40 a Married 171. 76.3% 63 78.8% 108 75.0% Unmarried 050. 22.3% 16 20.0% 034 23.6% Divorced 003 01.3% 01 01.3% 002 01.4% Occupation 9.58 a Office workers 071 31.7% 30 37.5% 04128.5% Housewives 066 29.5% 20 25.0% 046 31.9% Business owners 022 09.8% 12 15.0% 010 06.9% Experts 029 12.9% 09 11.3% 020 13.9% Students 009 04.0% 02 02.5% 007 04.9% Labors 005 02.2% 00 00.0% 005 03.5% Unemployed 018 08.0% 06 07.5% 012 08.3% Others 004 01.8% 01 01.3% 003 02.1% 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 003.47 06.89 002.36 04.40 004.10 07.93 2.05* Panic attack pre 6mon 012.54 30.30 007.98 12.32 014.54 35.30 1.76 BDI 018.67 10.10 017.25 10.30 019.47 09.94 1.58 STAI-S 055.42 14.65 053.87 15.66 056.27 14.04 1.17 STAI-T 056.28 11.97 057.70 11.73 055.71 12.06 0.99 BSQ 037.83 25.03 030.13 26.80 042.05 23.04 3.33** ACQ 028.91 19.90 022.25 20.59 032.54 18.61 3.67** ASI 033.66 12.72 035.29 13.09 033.29 12.58 0.88 PBQ 156.67 34.62 159.58 33.86 155.18 35.02 0.98 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
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 018.67 10.10 09.93 07.51 12.87* 017.25 10.30 10.25 08.15 05.76* 019.47 09.94 09.48 07.11 12.03* STAI-S 055.42 14.65 41.68 09.52 13.06* 053.87 15.66 42.05 09.43 06.79* 056.27 14.04 41.48 09.60 11.24* STAI-T 056.28 11.97 44.72 09.13 12.18* 057.70 11.73 46.13 09.64 07.08* 055.71 12.06 44.16 08.91 09.96* BSQ 037.83 25.03 26.36 17.40 12.68* 030.13 26.80 21.97 18.03 06.83* 042.05 23.04 26.67 16.67 10.71* ACQ 028.91 19.90 19.48 13.40 12.21* 022.25 20.59 16.84 14.61 05.71* 032.54 18.61 20.85 12.57 11.03* ASI 033.66 12.72 14.38 10.00 16.29* 035.29 13.09 16.31 11.78 08.51* 033.29 12.58 13.61 09.15 13.83* PBQ 156.67 34.62 91.31 30.02 23.97* 159.58 33.86 93.62 34.45 12.68* 155.1835.02 90.22 27.77 20.35* 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 n203 12 month f/u n201 Medication Medication Medication Medication Medication Medication Medication Medication discontinuation continuation discontinuation continuation discontinuation continuation discontinuation continuation HES 110 90.9% 74 71.8% 102 72.9% 26 36.6% 95 68.3% 22 34.4% 96 70.6% 27 41.5% LES 011 09.1% 29 28.2% 038 27.1% 45 63.4% 44 31.7% 42 65.6% 40 29.4% 38 58.5% Total 121/224 54.0% 103/224 46.0% 140/211 66.4% 71/211 33.6% 139/203 68.5% 64/203 31.5% 136/201 67.7% 2 13.79* 25.92* 20.71* 15.63* p.001. HESHigh End-State Functioning, LESLow End-State Funtioning 65/201 32.3% 4. 치료후및추적조사시약물복용여부와최종상태기능평가 5. 치료후및추적조사시복용약물군에따른약물복용중단여부의차이비교 372 Korean J Psychopharmacol 2003;14(4):367-376
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 n128 12 month f/u n201 n73 BZsADs n128 D 55 68.8% 66 45.8% 61 80.2% 79 58.5% 60 80.0% 79 61.7% 63 86.3% 73 57.0% C 25 31.3% 78 54.2% 15 19.7% 56 41.5% 15 20.0% 49 38.3% 10 13.7% 55 43.0% 2 10.87** 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 63 86.3% 073 57.0% 19.46* Medication continuation 08 11.0% 037 28.9% Re-medication 02 02.7% 018 14.1% Total 73 100% 128 100% 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 95 70.4% 17 37.8% 10 50.0% 15.86* end-state LES 40 29.6% 28 62.2% 10 50.0% p.001. 2 6. 12개월추적조사동안각환자의복용약물에따른약물용량변화의차이비교 고찰 373
374 요 목적 : 방법 : Korean J Psychopharmacol 2003;14(4):367-376 약
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