精神分裂症者疾病歷程：患者及家屬觀點之分析

Disease course in Schizophrenia：an analysis of patients and their families viewpoint

王舒慧(Shu-Hui Wang)

指導教授 ： 蕭文高

朝陽科技大學/人文暨社會學院/社會工作系/碩士(2013年)

摘要

精神分裂症屬於功能性的精神疾病，會因發病時間越久，患者症狀愈呈現慢性化，因而需要長期被照顧，家屬則成為主要照顧者的角色，易產生照顧負荷，另加上因疾病復發與再住院率高，家屬常以病況不穩定或擔心返家後照顧困難為由，而拖延出院。縱使患者順利返回社區生活，仍需面臨更多社區照顧需求，包括家屬照顧問題、服藥遵從性、社區資源等，另一個需面對的問題是輿論媒體以誇張的手法去報導精神疾病患者，也易導致社會大眾對於精神疾病患者產生誤解。因此，本研究目的有三：一、瞭解精神分裂症患者疾病歷程之經驗；二、瞭解精神分裂症患者家屬對於患者疾病歷程之經驗；三、歸納因應精神分裂症患者疾病歷程之助力與阻力因素。
本研究採質化的研究方法來進行，並以深度訪談法進行資料收集與分析，透過三位精神分裂症患者及三位照顧者的故事，來了解對疾病歷程的感受，並歸納因應精神分裂症患者疾病歷程之助力與阻力因素。
研究結果發現，在疾病前驅與發病期：研究參與者對於疾病症狀的解釋皆未提及症狀是因疾病因素所造成的，反而都有各自的解釋，多歸因為外在事件，也會因對疾病症狀的認知、求助的成效，他人的建議等，而採取不同因應症狀的方式；在疾病治療反覆期：當得知疾病診斷會出現否定、懷疑之心理狀態，也會藉由不斷重複就醫之行為，以獲得答案；對於門診或住院治療經驗，皆表示仍以症狀、藥物治療為主，出院後社區支持系統服務，也未持續落實執行；在服用藥物感受表示藥物的副作用，會影響服藥的規則性，但研究參與者知道藥物對於疾病症狀控制是有幫助的；在疾病穩定期：疾病歷程的助力包括專業的協助、重要他人支持及宗教團體，而導致疾病復元的阻力包括未參與社區復健機構、負向情境經驗及少與他人連結。最後從照顧者脈絡中發現，照顧責任仍多以家人為主，需承擔多重的責任，情緒也易受影響，但若具有社會福利資源的連結，照顧者的壓力可較為減輕，對於精神分裂症患者的未來生活安排感到擔心，若無力照顧時，會考慮將患者安排至長期照顧機構。
研究最後依據研究發現，提出幾點建議：一、患者及家屬可主動、積極參與，以取得相關資源；二、感同身受患者及家屬的處境；三、落實社區支持系統轉銜服務；四、減少精神疾病的烙印。

關鍵字

精神分裂症者 ； 疾病歷程

並列摘要

Schizophrenia is a functional disease. The longer time of the symptom onset, the syndrome of the patients appears more chronic characters and they need to have a long term nursing. Therefore, their families play a main role of nursing, which easily becomes a burden for family caregivers. Due to the high relapse and rehospitalization rates, their families often have a tendency to put off the time of discharging the patients from the hospital. Even after the patients are back to live in the community, they still have to face some problems, such as the lack of nursing, medication adherence, the accessibility of the community resource. The other problem is the misunderstanding of the society to the patients, as the media reports always describe the disease in an exaggerated way. Hence, the research focuses on the three dimensions:
1.To understand the schizophrenic patient’s illness history and experience.
2.To understand the schizophrenic patient’s families’ experience toward the
illness history of the patient.
3.To induce a conclusion of the obstacles and remedy aid for the schizophrenic
patient.
The research is based on the qualitative method, and conducts in-depth interviews for data collection and analyzation. Through the research of the three schizophrenic patients and family caregivers, the study induces the factors of resistance and remedy aid in the historical timeline for the schizophrenic patients.
The research results can be summarized as below:
1.Prodromal and active stage: The study focuses on how participants explained the symptoms, which are not referred to the symptoms are caused by the disease. They have their own understandings, and mostly they consider the causes are attributed to external events. Moreover, they adopt various ways to cope with the symptoms based on the understanding of the symptoms and suggestions by others.
2.Repeat treatment stage:The patients appear negative and doubtful mentality after they acquire the diagnosis. By repeatedly receiving medical treatments, they can also resolve their doubts. In regards to the experience of medical treatments in the hospital, they express the main treatments are medicines against the symptoms. The community support systems are not continually being conducted after they leave the hospital. The patients understand the medicines are helpful but the side effects affect their regular time of taking medicine.
3.Stable stage:The remedy aid in this stage include professional assistance, supports from significant others and religious groups; the obstacles which affect the recovery from their illness included not participating in the psychiatric community rehabilitation Institutions, negative experiences, and lack of connection with others. From the caregivers, the study discovers that the nursing responsibility mainly belongs to the patient’s families and their sentiment easily be affected by the care burden. If there is a connection with the social welfare resources, the pressure of the caregivers could be released. They can transfer the patients to the long term care institutions if they could not have a better arrangement for the patients.
Recommendations:
1.The patients and their families could be more active to obtain the related
resources.
2.People should be empathy with the experiences of the patients and their families.
3.To implement the transition service of the community support system.
4.To reduce the stereotypes of the mental diseases.

並列關鍵字

Schizophrenia ； Disease course

參考文獻

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