醫學生的精神科問題與適應障礙

情緒問題和適應障礙是影響醫學生學習與成長重要的關鍵之一，同時醫學敎育學程和環境引發的壓力也可能是某些醫學生個人精神健康的負面因素，國内醫學敎育過去很少關切該項課題。本報告為初步描述性研究，作者收集經轉介或自行求助於「醫學生生涯規劃暨諮商服務」計畫的醫學系學生共30名。由作者從事深度精神科面談，以求助或轉介的主要問題為導向，根據診斷準則作成精神科診斷；並且就其與學業、同儕關係、感情問題、或醫學生涯選擇等適應障礙的相互因果關係進行瞭解。30例中具精神科疾患之診斷共17例(56.7%)，僅達適應障礙者共13例(43.3%)。無論是否具精神科問題，其適應障礙均已嚴重影響學業，甚至必須中輟，有5例曾有自殺企圖。分析發现，不同學程階段可能有不同性質的壓力，成為精神科問題和適應障礙的誘因。因此，學校除原有醫學教育改革外，根據不同階段的需要設計學生輔導計畫，並且充實校園諮商輔導的資源，極為必要。

關鍵字

醫學生；精神科疾患；適應障礙

並列摘要

The impact of medical curriculum stress may be hazardous for the mental health of medical students. It has also been widely discussed that psychiatric problems and emotional disturbances influence the learning capacity and affect the developmental process of medical students. Unfortunately, this key issue has not been sufficiently addressed by medical schoolteachers in Taiwan. In this report we retrospectively collected thirty medical students of the Department of Medicine, National Taiwan University College of Medicine, who were self-referred or referred by their teachers to the Program of Counseling & Career Services for Medical Students from 1997 to 1999. 17 of 30 (56.7%) met the DSM-Ⅲ-R criteria of one formal psychiatric disorder including schizophrenia, depression and anxiety disorders. 13 of 30 (43.3%) were diagnosed as adjustment disorder characterized by their problems and their relations to the stress and events. Most of them had had academic difficulties, which was often revealed in the period shortly before final examination. The inquiry of the precipitating stress showed specific patterns associated with different curriculum stages. We described six cases in total, two cases at each stage. The present study shows that the psychiatric disorders and adjustment disorders found in the Taiwanese medical students are significantly different from those found in their counterparts in other countries. The difference is mainly a result of different educational systems.

並列關鍵字

medical student ； psychiatric disorder ； academic stress

國際替代計量

醫學生的精神科問題與適應障礙

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