運用認知行為治療於一位精神分裂症併酒精依賴患者之護理經驗

Cognitive Behavioral Therapy for a Patient with Schizophrenia and Alcohol Dependence

林秋蓮(Chu-Line Lin)

《馬偕護理雜誌》 5卷2期 (2011/07) Pp. 69-79

https://doi.org/10.29415/JMKN.201107_5(2).0007

摘要

本篇報告是運用認知行為治療於一位精神分裂症併酒精依賴患者的護理經驗。筆者於2009年3月10日至2009年4月6日照護期間，以觀察、面對面訪談、自我探索練習等方法，收集主、客觀資料並依身體、情緒、智能、社會、靈性等五大層面進行整體性護理評估。歸納個案主要健康問題為：一、感覺／知覺改變；二、個人調適能力失調；三、睡眠型態紊亂；四、低自尊等。透過個案、家屬、醫療團隊三方面之努力並於住院期間藉由認知行為治療之認知重建、壓力調適技巧，強化動機促使經驗成功，化被動為主動，個案能確認自我的想法並運用可協助的資源，從中接受自己的侷限，進而增進停止飲酒的自我控制及幻聽症狀發生時的處理技巧。出院後以電話追蹤方式及個案返診時家屬表達，個案出院後仍可持續運用於住院中學習的認知行為技巧，來面對幻聽症狀及遠離酒癮復發的高危險情境。

關鍵字

精神分裂症 ； 酒精依賴 ； 認知行為治療

並列摘要

From March 10 to April 6, 2009, the author provided cognitive behavioral therapy for a patient with both schizophrenia and alcohol dependence. Subjective and objective information was collected by observation, face-to-face interviewing, and self-exploration. By performing total evaluation based on five perspectives, the author identified the patient's major health problems as 1) sensory/perceptual abnormalities, 2) ineffective coping 3) sleep disturbance, and 4) low self-esteem. The patient, family, and medical team worked together using cognitive behavioral treatment, including cognitive restructuring, adaptation to pressure, strengthening motivation, and becoming active rather than passive. Through this treatment, the patient was assisted in affirming his self understanding, establishing self-confidence, reinforcing personal motivation to stop drinking, and developing techniques to cope with auditory hallucinations. After he was discharged, both the results of telephone follow-up and the family's positive response on clinic visits indicated that the patient continued to make progress with the cognitive behavioral treatment methods learned during hospitalization.

並列關鍵字

Schizophrenia ； alcoholic dependant ； cognitive behavioral therapy