조현병 입원 환자에서의 갑상샘 기능이상과 증상 심각도, 치료 반응과의 관계

Association between Thyroid Dysfunction and Severity, Treatment Response in Schizophrenic Inpatients

  • 정미줄 (국립춘천병원 정신건강의학과) ;
  • 황현국 (국립춘천병원 임상심리학과) ;
  • 서영은 (국립춘천병원 정신건강의학과) ;
  • 최종혁 (국립춘천병원 정신건강의학과)
  • Jung, Mee-Jool (Department of Psychiatry, Chuncheon National Hospital) ;
  • Hwang, Hyun-Kuk (Departments of Clinical Psychology, Chuncheon National Hospital) ;
  • Seo, Yung-Eun (Department of Psychiatry, Chuncheon National Hospital) ;
  • Choi, Jong-Hyuk (Department of Psychiatry, Chuncheon National Hospital)
  • 투고 : 2018.12.07
  • 심사 : 2019.04.01
  • 발행 : 2019.04.30

초록

Objectives Thyroid hormone deficiency during the neurodevelopmental period can impair brain development and induce psychiatric symptoms. This study examined the association between thyroid dysfunction and the severity of symptoms in schizophrenia patients, and the treatment response of patients with schizophrenia. Methods Three hundred thirty-eight schizophrenia patients, with no prior history of thyroid disease or taking medication associated with it, were studied. We assessed the blood thyroid hormone level, the Brief Psychiatric Rating Scale (BPRS) scores on the day of admission and discharge, admission period, dose of administered antipsychotics, and the number of antipsychotic combinations. The collected data were subsequently analyzed using the Kruskal-Wallis test and Pearson's chi-square test. Results The percentage of schizophrenia patients who presented with abnormal thyroid hormone level was 24.6%. High total triiodothyronine (TT3) (p = 0.003), low TT3 (p = 0.001), and high free thyroxine (fT4) (p < 0.001) groups showed a higher BPRS score on admission than did the normal thyroid hormone group, while thyroid stimulating hormone (TSH) levels were not significantly correlated with the severity of symptoms. Furthermore, thyroid hormone was not associated with the treatment response assessed by the rate of BPRS score reduction, admission days, use of clozapine, and dose of antipsychotics. Conclusions The TT3 and fT4 hormone levels were significantly associated with the severity of symptoms in schizophrenia patients. These relations suggested that thyroid dysfunction may be associated with the severity of schizophrenia. And hence, further analysis of the results of the thyroid function test, which is commonly used in cases of psychiatric admission, is required.

키워드

참고문헌

  1. John JP. Fronto-temporal dysfunction in schizophrenia: a selective review. Indian J Psychiatry 2009;51:180-190. https://doi.org/10.4103/0019-5545.55084
  2. Heinrich TW, Grahm G. Hypothyroidism presenting as psychosis: myxedema madness revisited. Prim Care Companion J Clin Psychiatry 2003;5:260-266. https://doi.org/10.4088/PCC.v05n0603
  3. Phillips DI. Programming of the stress response: a fundamental mechanism underlying the long-term effects of the fetal environment? J Intern Med 2007;261:453-460. https://doi.org/10.1111/j.1365-2796.2007.01801.x
  4. Santos NC, Costa P, Ruano D, Macedo A, Soares MJ, Valente J, et al. Revisiting thyroid hormones in schizophrenia. J Thyroid Res 2012;2012:569147. https://doi.org/10.1155/2012/569147
  5. Duval F, Mokrani MC, Ortiz JA, Schulz P, Champeval C, Macher JP. Neuroendocrine predictors of the evolution of depression. Dialogues Clin Neurosci 2005;7:273-282. https://doi.org/10.31887/DCNS.2005.7.3/fduval
  6. Sim K, Chong SA, Chan YH, Lum WM. Thyroid dysfunction in chronic schizophrenia within a state psychiatric hospital. Ann Acad Med Singapore 2002;31:641-644.
  7. Yazici K, Yazici AE, Taneli B. Different neuroendocrine profiles of remitted and nonremitted schizophrenic patients. Prog Neuropsychopharmacol Biol Psychiatry 2002;26:579-584. https://doi.org/10.1016/S0278-5846(01)00311-6
  8. Bunevicius R, Steibliene V, Prange AJ Jr. Thyroid axis function after in-patient treatment of acute psychosis with antipsychotics: a naturalistic study. BMC Psychiatry 2014;14:279. https://doi.org/10.1186/s12888-014-0279-7
  9. Dickerman AL, Barnhill JW. Abnormal thyroid function tests in psychiatric patients: a red herring? Am J Psychiatry 2012;169:127-133. https://doi.org/10.1176/appi.ajp.2011.11040631
  10. Humber NHS Foundation Trust. Guidelines for antipsychotic medication switches. March, 2012 [cited 2018 May 17]. Available from: https://www.humber.nhs.uk/Downloads/Services/Pharmacy/Guidelines/Antipsychotic%20medication%20switches%20guidelines.pdf.
  11. Inada T, Inagaki A. Psychotropic dose equivalence in Japan. Psychiatry Clin Neurosci 2015;69:440-447. https://doi.org/10.1111/pcn.12275
  12. Leucht S, Samara M, Heres S, Davis JM. Dose equivalents for antipsychotic drugs: the DDD method. Schizophr Bull 2016;42 Suppl 1:S90-S94. https://doi.org/10.1093/schbul/sbv167
  13. Baskin HJ, Cobin RH, Duick DS, Gharib H, Guttler RB, Kaplan MM, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract 2002;8:457-469. https://doi.org/10.4158/1934-2403-8.6.457
  14. Melmed S, Polonsky K, Larsen PR, Kronenberg H. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier;2015. p.359.
  15. Leucht S, Busch R, Kissling W, Kane JM. Early prediction of antipsychotic nonresponse among patients with schizophrenia. J Clin Psychiatry 2007;68:352-360. https://doi.org/10.4088/JCP.v68n0301
  16. Kelly DL, Conley RR. Thyroid function in treatment-resistant schizophrenia patients treated with quetiapine, risperidone, or fluphenazine. J Clin Psychiatry 2005;66:80-84. https://doi.org/10.4088/JCP.v66n0111
  17. Telo S, Bilgic S, Karabulut N. Thyroid hormone levels in chronic schizophrenic patients: association with psychopathology. West Indian Med J 2016;65:312-315.
  18. Baumgartner A, Pietzcker A, Gaebel W. The hypothalamic-pituitarythyroid axis in patients with schizophrenia. Schizophr Res 2000;44:233-243. https://doi.org/10.1016/S0920-9964(99)00187-5
  19. Gesing A. The thyroid gland and the process of aging. Thyroid Res 2015;8:A8. https://doi.org/10.1186/1756-6614-8-S1-A8
  20. Aggarwal N, Razvi S. Thyroid and aging or the aging thyroid? An evidence-based analysis of the literature. J Thyroid Res 2013;2013:481287. https://doi.org/10.1155/2013/481287
  21. Bremner AP, Feddema P, Leedman PJ, Brown SJ, Beilby JP, Lim EM, et al. Age-related changes in thyroid function: a longitudinal study of a community-based cohort. J Clin Endocrinol Metab 2012;97:1554-1562. https://doi.org/10.1210/jc.2011-3020
  22. Jeong JH, Hong SC, Bahk WM. Neurohormonal dysregulations in schizophrenia. The Korean journal of psychopharmacology 2006;17:415-422.
  23. Crocker AD, Overstreet DH, Crocker JM. Hypothyroidism leads to increased dopamine receptor sensitivity and concentration. Pharmacol Biochem Behav 1986;24:1593-1597. https://doi.org/10.1016/0091-3057(86)90491-0
  24. Bauer M, Glenn T, Pilhatsch M, Pfennig A, Whybrow PC. Gender differences in thyroid system function: relevance to bipolar disorder and its treatment. Bipolar Disord 2014;16:58-71. https://doi.org/10.1111/bdi.12150
  25. Breier A, Schreiber JL, Dyer J, Pickar D. National Institute of Mental Health longitudinal study of chronic schizophrenia. Prognosis and predictors of outcome. Arch Gen Psychiatry 1991;48:239-246. https://doi.org/10.1001/archpsyc.1991.01810270051007