強迫症對修正版威斯康辛卡片分類測驗表現之影響

The Effect of Obsessire-compulsive Disorder on Performant of the Wisconsin Card sorting Test-Modified

鄭皓仁(Hao-Ren Cheng) ； 花茂棽(Mau-Sun Hua)

《臨床心理學刊》 2卷1期 (2005/06) Pp. 23-30

https://doi.org/10.6550/ACP.200506_2(1).0003

摘要

目的：先前研究發現強迫症患者在無轉換提示的威斯康辛卡片分類測驗表現上明顯出現固執性錯誤。本研究主要以修正版威斯康辛卡片分類測驗為工具，檢測提示轉換線索是否可改變強迫症患者之固執性錯誤，目的在進一步釐清強迫症患者之主要認知障礙，並期提供臨床工作者衡鑑與治療運用之參考。
方法：22位強迫症患者以及22位無精神疾病或神經疾病史之正常對照組個案，兩組以年齡、性別、教育程度變項加以配對。每位參與個案皆完成威斯康辛卡片分類測驗、語文智力測驗、以及症狀嚴重度與情緒量表評估。
結果：強迫症組與對照組變異數分析結果，在威斯康辛卡片分類測驗的固執性錯誤指標達顯著差異。疾病嚴重度與威斯康辛卡片分類測驗各項指標相關並無顯著相關。不同強迫症狀種類（檢查者與非檢查者）與人口學變項、情緒量表、症狀嚴重度量表以及神經心理測驗指標進行無母數變異數分析檢定，結果顯示僅在威斯康辛卡片分類測驗的獨特錯誤指標達顯著差異。
結論：即使修正版威斯康辛卡片分類測驗以提供轉換線索方式操作，強迫症患者仍然呈現較高的固執性錯誤，研究結果支持其心向設定轉換之障礙以及額葉功能不良之神經病理特徵。有鑑於強迫症患者心理運作缺乏彈性之認知特徵，在治療上建議不宜採用提示作為治療策略。同時，進一步建議臨床上針對強迫症之認知功能障礙進行神經心理衡鑑時，修正版威斯康辛卡片分類測驗為臨床衡鑑上便利使用且有效之工具。

關鍵字

強迫症 ； 修正版威斯康辛卡片分類測驗 ； 額葉 ； 神經心理衡鑑

並列摘要

Objective: The issue of whether patients with obsessive-compulsive disorder (OCD) have mental-shifting difficulty mainly reflected by significant perseverative errors on the Wisconsin Card Sorting Test has been controversial in the literature. Methodological problems might contribute to these discrepant findings. The present study re-examined this issue with a minimization of methodological defects, and further determined if patients who do have mental-shifting difficulty can benefit from an external cue for mental-shifting.
Method: Twenty-two OCD patients and 22 mentally and neurologically healthy controls were recruited, matched by age, sex and educational levels. All participants completed the Wisconsin card sorting test- Modified (WCST-M), the verbal intelligence subtests of the Wechsler Adult intelligent Scale-Revised [AC4], the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Beck Depression inventory (BDI) and the State-Trait Anxiety inventory (STAI).
Results: The data analysis showed that patients did not perform significantly different from their normal counterparts on the WCST-M with the exception of perseverative errors. There was no remarkable relationship between the severity of OCD and scoring indices of the WCST-M.
Conclusion: Our patients with OCD did evidence mental-shifting deficit reflected by remarkable perseverative errors on the WCST-M. Based on this result, we suggest that at least for some of the patients with OCD, the conventional psychotherapy with providing external cue might not be adequate.

並列關鍵字

Obsessive-Compulsive Disorder ； the Wisconsin Card Sorting Test-Modified ； Frontal Lobe ； Neuropsychological Assessment

參考文獻

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