精神分裂症患者的知感能力研究

研究背景：精神分裂症患者對自己認知功能缺損的覺察明顯影響其認知復健的成效。過去對於此覺察之研究多以自陳式問卷評估。然自陳式問卷易受反應偏向和遺忘的影響而減低其信; 效度。知感是記憶監控功能之一，其概念近似認知功能的自我覺察。利用知感派典測量患者對自己記憶的覺察，可避免自陳式問卷的缺點。然過去對精神分裂症患者的知感研究稀少，僅有之研究樣本數偏少; 缺乏考量患者異質性，且所採用的知感正確性指標亦較不穩定。有鑒於此，改善過去研究缺點，重新檢視患者之知感能力有其必要。目的：本研究欲重新檢視並延伸過去研究之發現，主要目標為：一; 探討精神分裂症患者是否有知感功能缺損；二; 探討知感能力在患者中的個別差異；三; 探討和知感判斷有關的神經認知功能。實驗設計：病例對照研究法。研究場所：台大醫院精神部門診。參與者：40位精神分裂或情感性精神分裂症患者及40位年齡和性別相配之健康受試者。主要結果變項：利用「回憶─判斷─再認」派典測量受試者知感。以知感判斷和實際再認表現之關聯係數Hamann值作為知感能力指標。並以智力和神經心理測驗評估患者的神經認知功能。結果：患者知感正確性顯著較正常控制組低，且患者較低估自己未來的記憶表現。進一步分析顯示知感能力在患者中的變異性相當大，其中約4成患者Hamann值顯著低於猜測水準。在正常控制組中知感正確性和概念形成以及視覺再認記憶有關；但病患組未有此相關存在。結論：精神分裂症患者確有知感的缺損，但其缺損程度在該族群中相當異質。前額葉病理致使患者難以有效監控內在表徵，以及利用心智策略，可能是知感缺損的原因。由於對己認知功能的覺察對各種治療和復健的合作性以及自陳報告的信效度，具有相當程度的影響，臨床上，患者的神經心理衡鑑納入知感的評估有其必要。

關鍵字

精神分裂症；知感；監控記憶；監控認知；病識感；自我覺察；神經認知

並列摘要

Context: Cognitive insight in patients with schizophrenia is crucial for clinical management of cognitive deficits. Traditionally, self-reported inventories have been used to assess cognitive insight. However, their validity and reliability are vulnerable to various factors. One experimental paradigm, the Feeling-of-Knowing (FOK) procedure, measures metamemory, might overcome this vulnerability. However, only a few studies have employed FOK paradigm to examine this issue and their results was ambiguous. The present study is thus to explores this issue. Objective: To examine the following issues: (1) Do schizophrenia patients as a group evidence the FOK deficit? (2) Is the FOK change in schizophrenia homogeneous in nature? (3) What neurocognitive mechanism might account for the FOK deficit? Design: Case-control study. Setting: Outpatient clinic of the Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan. Participants: Forty patients with schizophrenia and 40 demographically matched normal healthy controls were recruited in the study. Main Outcome Measures: FOK accuracy was assessed by recall-judgment-recognition task, and the performance was expressed by the Hamann coefficient. Neurocognitive function was assessed, including general IQ, executive function, and memory tests. Results: On the group level, patients with schizophrenia had impaired FOK ability and evidenced a disposition to underestimate their memory performnce. However, the FOK ability among patients was variable, and 42.5% of patients exhibited a below chance level performance. There were marked relationships between FOK and set formation and visual recognition abilities in healthy controls, while such feature was not evident in the patient group. Conclusions: Based on the present results, we suggested that our patient’s FOK deficit might be due to prefrontal related dysfunction of intra-psychic monitoring and the utilization of mental resources. Since metamemory plays an important role in daily living and cognitive rehabilitation, we suggest that this function measure should be included in regular neuropsychological assessments of schizophrenia patients.

並列關鍵字

schizophrenia ； feeling-of-knowing ； metamemory ； metacognition ； insight ； self-awareness ； neurocognition

參考文獻

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精神分裂症患者的知感能力研究

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