정신분열병 환자의 통증 감지력 둔화와 압통 역치

Pain Insensitivity and Pressure Pain Thresholds in Patients with Schizophrenia

연구목적： 정신분열병 환자에서 통증자극에 따른 감지력이 저하되어 있는지를 압통역치를 이용하여 알아보고, 만일 통증감지력이 저하되어 있다면 이는 어떠한 정신증상과 관련되는지를 밝혀 보고자 하였다. 방 법： 정신분열병환자 21명(남자 8명, 여자 13명)과 건강대조군 23명(남자 9명, 여자14명)을 대상으로 하여, 환자군에게 양성 및 음성증상을 측정하고, 양군에서 압통측정기를 이용하여 압통역치를 측정하였다. 양군에 서 압통역치의 차이를 분석하고, 증상의 호전도에 따른 압통역치의 변화를 보았다. 결 과： 정신분열병환자가 정신증상이 심할 때 압통역치는 대조군에 비해 의미있게 높았으며, 증상이 호전되면 압 통역치는 정상대조군 수준으로 감소되었다. 정신증상 중에는 망상의 심도가 압통역치의 변화와 관계가 있었 으며, 투여된 항정신약물은 압통역치에 영향을 주지 않았다. 결 론： 정신분열병에서 보이는 통증감지력의 둔화현상은 지속적이라기 보다는 일시적인, 가역적인 뇌기능의 변화 에 따른 감각수용 장애나 집중력 저하와 관련되는 것으로 추정된다. 정신분열병에서 통증감지력의 둔화현상 을 조기에 발견하는 것은 치명적인 신체질환에 따른 위해(危害)를 막을 수 있다는 점에서 임상적으로 중요 한 부분이다.

Objectives：Decreased pain sensitivity to the external stimuli was sought by measuring the pressure pain thresholds in patients with schizophrenia. In the case of the pain insensitivity（PI) being confirmed, the relationship between psychiatric symptoms and PI was to evaluated. Methods：21 schizophrenic and 23 healthy controls were enrolled. Pressure pain thresholds(PPT) were measured by pressure algometer on initial and recovered phase, and positive and negative symptoms by PANSS(Positive and Negative Symptoms Scale)(Stanley et al. 1991) were obtained in patient group. The confounding factor induced by antipsychotics to the PPT was controlled for. Comparisons of PPT between two groups, and correlations of PPT and psychiatric symptoms in patient group were tested. Results： 1) Schizophrenic patients with active psychotic symptoms showed higher PPT compared to healthy controls. 2) When psychiatric symptoms were improved, PPT was decreased to the level of healthy controls. 3) Only the subscale of delusion in PANSS was closely correlated with PPT in patients with schizophrenia. 4) The dose of antipsychotics did not influence the PPT of the patient group. Conclusions：A part of patients with schizophrenia revealed they had higher pressure pain thresholds, which suggested PI in active symptom phase. However, PPT were restored almost to the level of normal controls when psychotic symptoms were improved. Thus, PI seemed to be a transient phenomenon rather than a persistent one. Changes of pain sensitivity to the external stimuli in schizophrenics would be associated with severity of delusion based upon reversible changes of brain function. Decreased attention due to delusion or lack of motivation seemed to be causal factors of PI. Clinicians should give attention to PI in schizophrenic patients to prevent physical illness and serious injuries in them.