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  • 學位論文

家庭心理教育處置對精神分裂症患者及其照顧者的介入成效研究

The effectiveness of psychoeducational intervention for schizophrenic patients and their care-givers

指導教授 : 譚偉象

摘要


背景:精神分裂症患者為一慢性化疾患。在去機構化的政策下,照顧患者的責任成為家屬的負擔。家屬承受著家庭氣氛變動而產生壓力、負向感受的同時,亦須擔任患者的照顧者。若其尚未準備好又缺乏相關的疾病知識,容易使得整個家庭生活陷入被患者症狀主導的情況。嚴重影響著照顧者的身心健康及患者的病情。約30年來的研究顯示,歐美、中國及日本等無數國家皆證實家庭心理教育處置可有效提昇家庭對疾病的因應、患者配合治療的程度及降低患者的再住院率和照顧者的負荷。而過去此領域關於照顧者的介入,多著重於照顧者負荷的本質及如何 降低負荷感的議題。但以此角度,照顧患者將成為一種負向及令人無力並且拒絕任何正向或回饋的觀點,所以本研究加入測量正向心理及生理健康的評估量表。目的:本研究假設在參與9次的多家庭型心理教育處置後,可提昇照顧者的生活品質、對疾病的知識與患者的藥物遵從性,並降低照顧者的負荷及患者的住院率。方法:樣本為台北市某醫院的門診患者9位及其照顧者8位(1位照顧者於後測時退出,故將此筆資料刪除),經過分派後,5位患者及其照顧者參與實驗組,其他4位患者及其中的3位照顧者則列於等待組。統計分析顯著程度設定為α= 0.10。結果:研究結果顯示除了實驗組患者的藥物遵從性的提昇程度小幅度地高於等待組外(p=.08),其他本研究的結果皆無法支持本研究的假設。參與團體後的照顧者的心理、環境及社會關係生活品質向度有部份提昇(其p值分別為.07、.06及.07),等待組患者的症狀惡化程度亦顯著高於實驗組(p=.03)。討論:本研究縱使有許多方法上的不足限制了心理教育療效的呈現,但不會也不應該折損此處置方式在過去30幾年來累積的療效證據。基於提昇患者及其照顧者身心健康狀態、降低醫療成本的理由,建議當患者初發住院時即導入此取向的介入。專業人員提供的問題解決、情緒支持及降低隔離的支持系統確實足以協助家庭面對困難。未來的研究可致力於提昇照顧者生活品質的療效因素。

並列摘要


Objective: Deinstitionalization of patients with schizophrenia has shifted responsibility of care into family, and caregivers often experience high levels of distress and burden. The illness is unfamiliar to the family, and the lack of knowledge of illness will be harmful to family functioning due to the nature of the patient’s symptoms. This situation greatly influences the family and patient’s health. Psychoeducational interventions offered to family members of patients with schizophrenia have been proved to be effective over the past 30 years. However, caregivers’ problem is usually conceptualized as caring burden, and this conception seems to reject the positive aspect of experience of the caregivers, which might be damaging. The present study used the psychological instrument of positive psychology, and tried to explore the undiscovered experience of the caregivers after participating in a 9-session psychoeducational intervention program. Method: Nine pairs of caregivers and patients diagnosed with schizophrenia or schizoaffective disorder were randomly assigned to the psychoeducational intervention group or the waiting list group, which resulted in having 5 pairs in the experimental group and 4 pairs in the waiting list group. One caregiver dropped out at follow-up. Outcome measures were administered 12 weeks after the final session of the intervention. The statistical significance level was set at α= 0.10. Results: Comparing to the waiting list group, there were significant effects in the changes of patients’ drug attitude (p=.08) and patients’ symptoms (p=.03). The psychoeducatonal intervention was effective in caregivers with improvements in the psychological, environmental and social relationship domains of quality of life (p=.07, .06 and .07, respectively). Discussion: Due to the positive effects of psychoeducation, it is suggested that family psychoeducation should be implemented early in the course of the illness to achieve both caregivers’ and patients’ better health outcomes.

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