中文摘要
目的：時序記憶障礙，特別是順向干擾問題常見於額葉病變患者。強迫症患者神經病理相關之研究顯示額葉-紋狀體-視丘迴路(frontal–striatum–thalamus loop)之功能異常。然而針對強迫症患者之時序記憶功能，特別是順向干擾現象之研究卻相當匱乏。因此，本研究主要目的是檢視強迫症患者是否呈現順向干擾相關的問題。這些問題包括(一)強迫症患者是否較正常受試者有明顯的時序記憶問題?(二)強迫症患者是否較正常受試者有明顯的順向記憶干擾問題?(三)如果強迫症患者存在順向干擾問題，該問題只出現在語文材料刺激的記憶作業上，或非語文材料刺激的記憶作業上，或兩者皆出現？(四) 強迫症患者順向干擾問題是否依症狀類型而有差異?(五)若特定症狀類型的患者有較常人明顯的順向記憶干擾，該現象出現在語文或非語文素材?
方法：20位強迫症患者、20位恐慌症對照組以及20位無精神疾病或神經疾病史之正常對照組個案，三組以年齡，性別，教育程度變項加以配對。每位參與個案皆完成語文與非語文記憶干擾測驗、語文智力測驗、執行功能測驗以及症狀嚴重度與情緒量表評估.
結果：資料分析結果顯示無論在語文或非語文記憶干擾測驗的各項學習指標、自由回憶、物體再認以及記憶干擾指標(包括順向干擾指標以及時序指標)，強迫症患者的表現與恐慌症對照組以及正常對照組並無顯著差異。依症狀類型區分，檢查組與非檢查組在記憶測驗各項指標並未有顯著差異，但檢查組整體記憶功能有較差之傾向。
結論：本研究結果發現強迫症患者並沒有明顯順向干擾的問題，顯示患者具有正常的時序記憶功能，這個結果與國外文獻之報告並不一致。強迫症患者樣本的差異包括患者疾病異質性、症狀嚴重度、樣本數，以及時序記憶相關測量工具相異等問題似乎是造成結果不一致的主要原因。目前由於國內外在這方面相關文獻相當匱乏，因此有待後續之研究來加以釐清。

ABSTRACT

Objective: Temporal order memory deficit, especially abnormality of proactive interference, was frequently noted in patients with frontal lobe lesions. Neuropathological and neuroimaging studies revealed frontal-striatum-thalamus loop was dysfunctional in patients with obsessive-compulsive disorder (OCD). Since the problem of repetitive and intrusive thoughts is one of the core features in patients with OCD, it thus seems to be justified to hypothesize that abnormality of proactive interference might account for this clinical manifestation. However, few studies focused on the problems of proactive interference in patients with OCD. The aim of this study was to examine whether deviant proactive interference contributes to clinical symptoms in patients with OCD and to further explore whether proactive interference problem is material-specific in terms of memory function measures and can have a clinical implication for differentiating OCD patients with predominant checking symptoms from the patients with non-checking ones.

Method: Sixty patients, matched by age, sex and educational levels, participated in this study, including twenty patients with OCD, twenty patients with panic disorder, and twenty mentally and neurologically healthy controls. Each participant received a battery of neuropsychological tests, including temporal order memory, verbal intellectual function, and emotional status that consists of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Beck Depression Inventory (BDI), the State-Trait and Anxiety Inventory (STAI).

Results: The results revealed no significant differences among the patients with OCD, panic disorder and healthy controls concerning the performance of verbal learning, object recognition, and various proactive interference indices. Performance of OCD patients with checking symptoms was poorer than that of OCD patients with non-checking ones on the memory tasks.. However, the differences were not statistically significant.

Conclusion: Our patients with OCD did not evidence remarkable proactive interference deficit on both verbal and non-verbal temporal order memory tests. The present results seemed to be inconsistent with reports in literature. The heterogeneity of, and incompatible disease severity of OCD patients, as well as different temporal order memory measures might be responsible for the discrepancy. Moreover, because of our small sample of OCD patients, further study on a large scale to re-examine the issue is needed.

1.鍾思嘉 龍長風(民73年)。修訂情境與特質焦慮量表之研究。「測驗年刊」，卷31， 頁27-36。
2.李文貴、劉文健、江漢光(民82年)。強迫症神經學障礙研究之進展。「國防醫學」卷17，362-367。
3.袁樂民、馮煥光(民82年)。強迫症。「臨床醫學」，卷31，頁122-127。
4.陳心怡(民89年)。貝克憂鬱量表第二版指導手冊。中國行為科學社，台北市。
5.Altemus, M., Murphy, D. L., Greenberg, B.(1996). Intact codinf region of the serotonin transporter gene in OCD. American Journal of Medical Genetics, 67, 407-411.
6.Bebbington, P. E.(1998).Epidemiology of OCD. British Journal of Psychiatry, 173, 2-6.
7.Cabrera, A. R., McNally, R. J. & Savage, C. R.(2001).Missing the forest for the trees? Deficient memory for linguistic gist in obsessive-compulsive disorder. Psychological Medicine,31, 1089-1094.
8.Catalano, M., Sciuto, G..(1994). Lack of association between OCD and the D3 receptor gene: Some preliminary considerations. American Journal of Medical Genetics, 54, 253-255.
9.Chacko, R. C.(2000). Acquired OCD Associated With Basal Ganglia Lesions. J Neuropsychiatry Clinical Neuroscience , 2, 267-272.
10.Christensen, K. J., Kim, S. W., Dysken, M. W. & Hoover, K. M.(1992). Neuropsychological performance in obsessive-compulsive disorder. Biological Psychiatry,31, 4-18.
11.Clayton, I. C., Edwards, C. J. & Richards, J. C. (1999).Selective Attention In Obsessive-Compulsive Disorder, Jornal of Abnormal Psychology ,108: 171-175.
12.Cohen, L. J., Hollander, E., DeCaria, C. M. et.al.(1996). Specificity of Neuropsychological impairment in OCD: A Comparison with social phobic and normal control subjects. Journal of Neuropsychiatry, 8: 82-87.
13.Dolan, R. J. & Fletcher, P. C.(1997). Dissociating prefrontal and hippocampal function in episodic memory encoding. Nature, 388, 583-585.
14.Fletcher, P. C., Shallice, T., Dolan, R. J.(1998).The finctional roles of prefrontal cortex in episodic memory.Brain,121,1239-1248.
15.Fletcher, P. C.& Herson, R. N. A.(2001). Frontal lobes and human memory. Brain, 124, 849-881.
16.Freedman, M. & Cermak, L. S.(1986). Semantic encoding deficits in frontal lobe disease and amnesia. Brain and Cognition, 5, 108-114.
17.Goodman, W. K.(1989).The Yale-Brown Obsessive Compulsive Scale. Archives of General Psychiatry , 46, 1006-1011.
18.Greisberg, S., McKay, D.(2003). Neuropsychology of obsessive-compulsive disorder: a review and treatment implications. Clinical Psychology Review. 23 , 95-117.
19.Jurado, M. A., Junque, C., Vallejo, J., Salgado, P. & Grafman, J.(2002).Obsessive-compulsive Disorder(OCD) patient are impairment in remembering temporal order and in judging their own preference. Journal of Clinical and Experimental Neuropsychology, 24, 261-269.
20.Kim, M-S., Park, S-J., Shin, M. S. & Kwon, J. S.(2002).Neuropsychological profile in patients with obsessive-compulsive disorder over a period of 4-month treatment. Journal of Psychiatric Research, 36, 257-265.
21.Lacerda, A. L. T., Dalgalarrondo P., Caetano D., Hass G. L., Camargo E. E., Keshavan M.S.(2003). Neuropsychological performance and regional cerebral blood flow in obsessive-compulsive disorder. Progress in Neurological - Psychopharmacology & Biological Psychiatry. 27, 657-665.
22.Mataix, D., Junquem, C. Sanchez-Truet, M., Vallejo, J. & Barrios, M. (1999).Neuropsychological function in a subclinical obsessive-compulsive sample. Biological Psychiatry , 45, 898-904
23.Nalson Butters & Laird S.(1980) Carmark: Alcoholic Korsakoff’s Syndrome . Academic Press.
24.Okasha, A., Rafaat, M, Mahallawy, N., Ei, N. G., Seif, E. D. A., Sayed, M & Ei, K. S. (2000): Cognitive dysfunction in OCD. Acta Paychiatric Scandinavica , 101, 281-285.
25.Otto, M. W.(1992). Normal and abnormal information processing. Psychiatric Clinics of North America, 15, 825-847.
26.Poldrack, R. A. & Gabrieli, J. D. E.(1997).Functional anatomy of long-term memory. Journal of Neurophysiology, 14, 294-310.
27.Purcell, R., Maruff, P.& Kyrios, M.(1998). Cognitive deficits in OCD on tests of frontal-striatal function. Biological Psychiatry ,42, 348-357
28.Purcell, R., Maruff, P.& Kyrios, M. et al.(1998) Neuropsychological deficits in OCD. Arch psychiatry Scandinavica , 55, 415-423.
29.Sagar, H. J., Sullivan, E. V., Cooper, J. A. and Jordan, N.(1991). Normal release from proactive interference in untreated patients with parkinson’s disorder. Neuropsychologia, 28. 1033-1045.
30.Savage, C. R., Baer, L., Keuthen, N. J., Brown, H. D., Rauch, S. L. & Jenike, M.(1999) Organizational strategies mediate nonverbal memory impairment in OCD. Biological Psychiatry, 45, 905-916.
31.Savage, C. R., Deckersbach, T., Wilhelm, S., Rauch, S., Baer, L., Reid, T. & Jenike, M. A.(2000).Strategic processing and episodic memory impairment in obsessive compulsive disorder. Neuropsychology, 14,141-151.
32.Savage, C. R., Deckersbach, T., Hecker, S., Wagner, A. D., Schacter, D. L., Alpert, N. A., Fischman, A. J. & Rauch, S. L.(2001).prefrontal regions supporting spontaneous and directed application of verbal learning strategies evidence from PET.Brain,124,219-231.
33.Schnider, A., Daniken, C. V. & Gutbrod, K.(1996).The mechanism of spontaneous and provoked confabulation.Brain,119,1627-1632.
34.Schnider, A., Daniken, C. V. & Gutbrod, K.(1996).Disorientation in amnesia:a confusion of memory traces.Brain,119,1627-1632.
35.Schmidtke, K., Schorb, A., Winkelmann, G.. & Hohagen, F.(1998).Cognitive frontal lobe dysfunction in obsessive-compulsive disorder. Biological Psychiatry,43,666-673.
36.Sher, K. J., Frost, R. O. & Otto, R.(1983).Cognitive deficits in compulsive checkers: an exploratory study. Behaver Reasearch and Therapy,21,357-363.
37.Sher, K. J., Mann, B & Forst, R.(1984).Cognitive dysfunction in compulsive checkers: further explorations. Behaver Reasearch and Therapy,22,493-502.
38.Sher, K. J., Frost R. O., Kushner, M.(1989).Memory deficits in compulsive checkers: Replication and extension in a clinical sample. Behaver Reasearch and Therapy,27,65-69.
39.Shin, M. S., Park, S. J.,Kim, M. S., Lee, Y. H., Ha, T. H.,Kwon, J.S.(2004).Deficits of organizational Strategy and visual memory in obsessive-compulsive disorder.Neuropsychology,18,665-672.
40.Shimamura, A. P., Janowsky, J. S. & Squire, L. K.(1990). Memory for the temporal order of events in patients with frontal lobe lesions and amnesic patients.Neuropsychologia,28,803-813.
41.Shimamura A. P., Jurica P. J., Mangels J. A., Gershberg F. B.& Knight R. T.(1995).Susceptibility to memory interference effects following frontal lobe damage:finding from tests of paired-associate learning. Journal of Cognitive Neuroscience,7,144-152.
42.Summerfeldt, L. J., Endler, N. S.: Examining the Evidence for Anxiety-Related Cognitive Biases in Obsessive-Compulsive Disorder. Journal of Anxiety Disorder 1998; 12: 579-598
43.Tallis, F., Pratt. P. & Jamani N.(1999). OCD, checking, and non-verbal memory: a neuropsychological investigation. Behavior Research and Therapy , 37, 161-166.
44.Wilhelm, S., McNally, R. J., Baer, L. & Florin, I.(1996). Directed forgetting in OCD. Behavior Research and Therapy, 34, 633-641.
45.Wolff, M., et al.(2000). Genetic aspects of obsessive-compulsive disorder. The Psychiatric Clinics of North America, 23, 535-543
46.Wood, C. M., Venea, J. L., Chambless, D. L.& Bayen, U. J.(2002). Are compulsive checkers impaired in memory? a meta-analytic review. Clinical Psychology: Science & Practice,9,353-366.