探討精神疾病高風險個案於症狀影響下之正面因應經驗

背景：精神疾病是一種慢性且需長期醫療照護的疾病，其在疾病發病前經常出現一段已經影響功能表現的前驅症狀。此精神高風險症狀因個人、背景、文化有所不同，但對個案的學習、人際、生活、認知與情緒功能具有巨大負面影響。然仍有個案在家庭、學校與醫療間獲得協助度過危機，這些個案所採取的較為正向的態度與經驗，文獻中仍較少見。目的：本研究目的為了解台灣精神高風險個案，面對症狀干擾時仍存在的內在力量，以了解個案在症狀影響下之正面因應經驗。方法:本研究是採描述性質性研究法，於中部某醫學中心主動求診於精神科門診之18名精神高風險個案，以一對一面對面深入訪談收集資料，經過每2-3個月之會談追蹤，再納入一年內未被確認診斷為思覺失調症、雙極性情感疾患、與重度憂鬱症之12位個案訪談內容進入分析。以質性內容分析法，歸納精神高風險個案面臨症狀干擾時，所呈現之正向經驗與態度。結果：研究分析共40次訪談資料，男性3位、女性9位。結果發現個案受到精神高風險症狀干擾的影響，沉浸認知、情緒、與人際負面感受，但仍可發現個案具有正向處置之經驗。可歸納出3個主軸:「全心守住僅存力量增進自控」、「覺察關愛友善環境之慰藉支持」、「接受自我增進對疾病的接納」及相對應14個次主軸。從描述中發現，個案雖常出現負向感受，但約1/3的個案於疾病發作前，仍具有自我覺察力，可主動發現身心的改變，努力保留自我判斷能力，適時地去澄清所經歷的症狀變化，減少症狀對生活功能的影響。應用：本研究結果顯示，精神高風險症狀若能早期預防早期治療，是能改善其當下疾病困擾的難題，亦有效幫助降低惡化程度。不論家庭或是學校，若增加首善的社會環境，可以在適當時提供個案支持，以維持情緒與心靈上的穩定。本研究結果提供正面臨相同類似經歷的青年與青少年，一個可供參考的依據來面對疾病的恐懼。

關鍵字

精神高風險；症狀經驗；正向態度；前驅期

並列摘要

Background: Mental illness is a chronic disease that requires long-term care and often exhibits prodromal signs that affect functioning before the onset of the disorder. These at-risk mental state symptoms, which vary among individuals from different backgrounds and cultures, have a significant negative impact on an individual's learning, interpersonal relationships, daily living, cognitive functioning, and emotional state. In spite of this, some of the individuals receive support from their families, schools and healthcare professionals to help them cope with these difficulties. However, there is limited exploring the positive attitudes and experiences in literature. Objective: The purpose of this research was to understand the inner strengths that persist in individuals with at-risk mental states in Taiwan. The goal was to explore the positive coping experiences of individuals who suffering from those prodromal symptoms. Method: The descriptive qualitative research design with 18 individuals with at-risk mental states from psychiatric clinics at a medical center in central Taiwan by convenient sampling was used in the study. Data were collected through in-depth individual face-to-face interviews every 2-3 months. The analysis only included 12 participants who didn’t have diagnosis of schizophrenia, bipolar disorder, or major depression in one year after enrolling in the study. The qualitative content analysis was to explore the positive experiences and attitudes of individuals with at-risk mental facing the suffering from the prodromal symptoms. Result: A total of 40 interview were involved in the analysis, including 3 male and 9 female participants. The results indicated that individuals affected by high risk mental symptoms experienced negative effects on their cognition, emotions, and relationships with others. Nonetheless, it was also noted that these individuals demonstrated positive coping experiences. Consequently, three major themes and related 14 subthemes emerged from the research: "Preserving remaining strength to enhance self-control," "Awareness comfort and support from the environment," and "Embracing personal growth for acceptance of the illness." The outcomes showed that while individuals often experienced negative emotions, approximately one-third of them displayed self-awareness even prior to the onset of the illness. They actively acknowledged changes in their mental and physical states, made efforts to maintain their ability to assess themselves accurately, and promptly addressed alterations in their symptoms to minimize the impact on their daily functioning. Clinical implication: The results of this study indicated that early prevention and treatment of high-risk mental symptoms can have a substantial impact on addressing the difficulties associated with the illness and effectively slowing down its advancement. Whether within the family or at school, fostering a supportive social environment can offer timely assistance to individuals, maintaining emotional and mental stability. The findings of this research could provide guidance for teenagers and young adults facing similar experiences, offering a positive perspective to confront the fear of mental illness.

並列關鍵字

At-risk mental state ； Symptom experiences ； Positive attitudes ； Prodromal phase

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