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研究生: 林宇駿
Lin, Yu-Chun
論文名稱: 提升執行功能之生態化神經心理治療:以穩定期思覺失調患者為例
Using Ecological Neuropsychotherapy to Improve Executive Function of Stable Schizophrenics
指導教授: 郭乃文
Guo, Nai-Wen
共同指導教授: 楊延光
Yang, Yen-Kuang
學位類別: 碩士
Master
系所名稱: 醫學院 - 行為醫學研究所
Institute of Behavioral Medicine
論文出版年: 2017
畢業學年度: 105
語文別: 中文
論文頁數: 123
中文關鍵詞: 生態化神經心理治療穩定期思覺失調症執行功能
外文關鍵詞: Ecological Neuropsychotherapy, Stable Schizophrenics, Executive function
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  • 目的:思覺失調症患者有執行功能的缺損(American Psychiatric Association, 2013),Reichenberg與Harvey(2007)的後設分析指出思覺失調症患者中,在執行功能部件之計畫、彈性,以及自我覺察功能達顯著缺損。本研究針對此三部件,以神經心理取向建構出針對穩定期思覺失調症患者失執行功能的生態化神經心理治療方案。
    方法:本研究於南部某教學醫院精神科附設的日間照護中心和社區復健中心招募穩定期思覺失調症病患共15名,治療方案為每週1小時的個別課程及2小時的團體課程,為期8週,針對執行功能的計畫、彈性,以及自我覺察進行介入。研究者先擬定探索介入方案,經「治療方案探索組」7名個案之介入後進行療效分析與修正,並於「神經心理治療方案組」8名個案進行介入並分析療效。本研究以自陳式問卷及神經心理測驗為兩層次療效指標進行治療方案驗證,自陳式問卷層級採日常生活執行功能行為量表及時間管理量表,神經心理測驗層級採威斯康辛卡片分類測驗、倫敦塔、Knox’s方塊仿效測驗、數字廣度測驗、彩色路徑描繪測驗,並於前測、後測、治療完成2個月後追蹤測三個時間點進行療效驗證。
    結果:神經心理治療方案於自陳式問卷層級的動機控制及情緒監控兩項因素於三個時間點有顯著差異;神經心理測驗層級,威斯康辛卡片分類測驗的總錯誤率、執續反應率、執續錯誤率,彩色路徑描繪測驗第二版分數於三個時間點有顯著差異;顯示治療方案對穩定期思覺失調症病的「彈性」和「自我覺察」指標有所影響。
    討論:本研究依據神經心理學理論所設計之治療方案,對於穩定期思覺失調症病人之「彈性」及「自我覺察」測驗指標有所影響。未來研究可增加樣本數並改善治療方案之模組,藉以提升穩定期思覺失調症之精神照護。

    Introduction: Patients with schizophrenia have executive dysfunction (American Psychiatric Association, 2013).
    Reichenberg and Harvey(2007) integrated that the executive function of schizophrenia patients have sinificant impairment in planing, flexibility and self-awareness by meta-analysis.The present study aims to construct a treatment program of neuropsychotherapy for schizophrenic patients with executive dysfunction in stabilization phase.
    Method:15 patients with schizophrenia in stabilization phase joined the training for 1 hour individual course and 2 hours group course a week, over 8 weeks. The investigators prepared a treatment program and analyzed the efficacy of the 7 patients in the "Treatment Program Exploration Group",then revised the program and conducted in 8 patients of the "Neuropsychotherapy Treatment Group ".This study used indexes from two level evidences to discuss the curative effects, including neuropsychological assessments and test.Both groups were evaluated with Wechsler Adult Intelligence Scale (Chinese version) Third Edition for intelligence;Wisconsin Card Sorting Test(WCST), Tower of London (TOL), Color Trial Test(CTT), Knox Cube Test , Digit Span Task, and Executive Function Scale before and after intervention, and also in two month afterwards for follow-up.
    Result:The training showed sinificant improvement in flexibility and self-awareness, but not in planing.
    Discussion:This study showed the treatment program of neuropsychotherapy improved the “flexibility" and "self-awareness" of patients with schizophrenia in stabilization phase. Future studies should increase the sample size and improve the treatment program to enhance the mental health of patients with schizophrenia in stabilization phase.

    第壹章 緒論 1 第一節、思覺失調症的執行功能缺損 1 一、執行功能與前額葉的關係 1 二、執行功能的衡鑑 4 三、常見之失執行功能 6 四、思覺失調症的執行功能 7 第二節、穩定期思覺失調症 9 一、穩定期思覺失調症 9 二、慢性思覺失調症精神復健 11 第三節 神經心理治療 12 一、神經心理治療的定義 12 二、神經心理治療於團體情境之療效 14 三、生態化訓練素材 17 第四節 研究動機與問題假設 18 一、研究動機 18 二、研究假設 19 第貳章 研究方法 19 第一節、研究流程與架構 19 第二節、研究對象 21 一、納入標準 21 二、排除標準 21 第三節、研究工具 21 一、基本資料與人口學變項 21 二、自陳式問卷 22 三、神經心理測驗 23 第四節、治療結構規劃 28 第五節、資料處理與統計分析 28 第參章 研究結果 29 第一節、人口學與前測變項 29 第二節、治療方案探索組療效探討 32 一、治療方案探索組療效分析 32 二、治療方案探索組療效探討與修正 34 三、神經心理治療治療方案 38 第三節、神經心理治療方案組療效探討 40 一、神經心理治療方案療效分析 40 第四節、神經心理治療方案個別療效探討 43 一、A病人療效分析 43 二、B病人療效分析 50 三、C病人療效分析 57 四、D病人療效分析 64 五、E病人療效分析 71 六、F病人療效分析 78 七、G病人療效分析 85 八、H病人療效分析 92 九、個別療效探討統整 99 第肆章 討論 106 第一節、神經心理治療方案療效分析 106 第二節、研究限制與建議 108 第三節、研究貢獻與未來展望 108 參考文獻 109

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