「心智理論」(theory of mind) 是指個體察覺和推論他人想法或感受的能力。心智理論缺損已被證實為思覺失調症 (schizophrenia) 患者的疾病特徵之一、受疾病狀態影響，並引起社交互動問題。因此，有必要使用心智理論評估工具來量測思覺失調症患者之心智理論能力以發展對應之心理社會介入。為深入了解現存評估思覺失調症患者心智理論的評估工具，本論文第一部分為系統性回顧，以歸納與評析這些評估工具之特性。此系統性回顧的結果提供實務應用之原則並顯示現存之心智理論評估工具至少有以下其一問題：量測單一心智理論概念、涵蓋非心智理論之概念、非為思覺失調症患者量身設計的、理解故事情境所需的認知負擔大，或心理計量特性不理想。為了解決現存心智理論評估工具之限制，有必要發展適用於思覺失調症患者的心智理論評估工具。因此，本論文之第二部分為發展適用於思覺失調症患者之心智理論評估工具：「思覺失調症患者心智理論評估工具」 (Assessment of Theory of Mind for adults with Schizophrenia, AToMS)，並驗證此工具之心理計量特性。
在「發展期」，根據甫形成的心智理論之理論架構，建構AToMS以量測八個心智理論概念之認知推論或情意推論。以標準化嚴格的過程修改題目，並於25名思覺失調症成人患者進行個別認知訪談，以發掘題目可能的問題並盡可能減少題目之認知要求。在「驗證心理計量特性期」，共59名思覺失調症患者（年齡介於20至64歲）接受基準評估。受試者接受AToMS、社交能力與下肢肌力之評估，以分別檢驗題目難度、題目區辨力、內在一致性，以及會聚和發散效度。另評估受試者之精神症狀程度與神經認知功能，以提供受試樣本之臨床特徵作為臨床上使用AToMS之參考。四至六星期之後，22名患者再次接受AToMS施測，以檢驗再測信度。
研究結果顯示AToMS可量測多向度的心智理論構面，係採用含真實生活情境之動畫施測，可為思覺失調症成人患者所理解且認知負擔適中。AToMS未有地板或天花板效應 (0%, 15.3%)，具良好之內容效度 (內容效度指標 = 0.80–0.93)、良好之題目區辨力 (區辨相關係數 = 0.974–0.786) 且大部分題目難度適中 (0.339–0.966)；具良好之內在一致性 (Cronbach’s alpha = 0.85, 校正項目總分相關係數 = 0.341–0.707)，以及優良之再測信度 (組內相關係數 = 0.901)。
新發展以動畫呈現之AToMS，認知需求適中並具良好之心理計量特性，可正確與精確描繪思覺失調症成人患者之心智理論剖面。AToMS可被用來確認思覺失調症患者之心智理論缺損，以進行個別化之心理社會介入。AToMS可能可被應用於患有其它嚴重心理疾病之患者。未來研究有必要檢驗AToMS在其它臨床族群之適用性，並驗證AToMS之其它心理計量特性。

Theory of mind (ToM) refers to the ability to perceive and reason about other people’s thoughts or feelings, and it influences one’s social functioning. ToM deficit is a proven state-mediated trait marker of schizophrenia. Evidence has also revealed that ToM impairment in adults with schizophrenia subsequently causes their problems in social interaction. Therefore, it is important for practitioners to apply a ToM assessment to measure the ToM abilities of individuals with schizophrenia to develop corresponding psychosocial interventions. To provide a comprehensive and deep understanding of the current ToM measures in schizophrenia, the first part of the present dissertation performed a systematic review to summarize and evaluate the characteristics of the existing ToM tasks for people with schizophrenia. The results of this systematic review provided principles for application of these tasks in practice. Several problems in the existing ToM tasks were thus revealed. The problems include measuring a single ToM concept, containing non-ToM concepts, not originally designed for people with schizophrenia, cognitive overload in people with schizophrenia due to the task scenarios, or unsatisfactory psychometric properties. To overcome the limitations in existing ToM tasks, it is warranted to develop a new ToM measure specifically for people with schizophrenia. Accordingly, the second part of the present dissertation was to develop a comprehensible ToM measure, the Assessment of Theory of Mind for adults with Schizophrenia (AToMS), and to investigate its psychometric properties.
In the development phase, the AToMS was constructed to measure eight ToM concepts in multiple dimensions based on an updated theoretical ToM structure. The items were modified by rigorous procedures. Individual cognitive interviews were performed on twenty-five adults with schizophrenia (aged 20 to 64) to solve any problems in the items and to minimize the neurocognitive demands on the target population. In the psychometric evaluation phase, fifty-nine adults with schizophrenia (aged 20–64 years) were included in the baseline assessment. Participants were assessed with the AToMS, and the measures of social competence and leg strength, to respectively evaluate the item difficulty, item discrimination, internal consistency, and convergent and divergent validity. Psychotic symptoms and neurocognition were assessed to provide a clinical feature of the sample for generalization of the AToMS in practice. Four to six weeks later, twenty-two participants were selected to complete the AToMS again for evaluation of the test–retest reliability.
The results showed that the AToMS measures important ToM concepts in the multi-dimensional ToM construct in real-life contextual animation. The AToMS is comprehensible and neurocognitively affordable for adults with schizophrenia. The AToMS has no serious floor or ceiling effects (0%, 15.3%), and it has good content validity (content validity index = 0.80–0.93), good item discrimination (discrimination coefficients = 0.974–0.786), a majority of items of moderate difficulty (0.339–0.965), good internal consistency (Cronbach’s alpha = 0.85, corrected item–total correlation = 0.341–0.707), and excellent test–retest reliability (intraclass correlation coefficient = 0.901).
The newly developed animated AToMS, with adequate neurocognitive demands and good psychometric properties, can accurately and precisely describe the ToM profiles of adults with schizophrenia. The AToMS can be used to identify the areas of ToM deficits in individuals with schizophrenia. Subsequently, personalized psychosocial interventions can be designed. Although the AToMS has the potential to be applied to people with other severe mental disorders, future studies are needed to examine the feasibility and psychometric properties of the AToMS in other clinical populations.

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