華人臉部情緒辨識測驗工具(CFERD)之建立及其於精神分裂症之應用

Establishing the Chinese Facial Emotion Recognition Database (CFERD) and Its Application in Patients with Schizophrenia

黃隆正(Charles Lung-Cheng Huang)

指導教授 ： 洪純隆

高雄醫學大學/醫學院/醫學研究所/博士(2013年)

摘要

辨識他人的情緒是人類共通且基本的社會互動基石，也是屬於社會認知的一環。雖然證據支持「基本情緒」有跨文化的共通性，但在辨識的正確率及強度上仍然存在著某些文化差異性。這些不一致可能跟研究中所使用之不同臉部表情辨識刺激及工具有關。先前的研究發現精神分裂症有臉部情緒辨識的缺損。此缺損會影響其人際互動及社交技巧、生活品質、職業功能、獨立生活能力等，故在預測精神分裂症的臨床預後及社會功能的角色極為重要。精神分裂症的表情辨識缺損與某些臨床及人口學因素、症狀、臨床狀況或特性等有關。然而，精神分裂症的情緒辨識缺損的異質性還在爭論中，而且此種辨識缺損極可能和精神分裂症的不同臨床症狀或類型有關。
目前並無一個專為華人發展且經過驗證的完整臉部情緒辨識測驗工具。此外，對於精神分裂症臉部情緒辨識異質性的瞭解尚不足夠；這些缺損跟不同臨床症狀卅類型、神經認知功能特性和其社會功能等病理現象的關係至今仍然沒有定論。有鑑於此，本研究目的是發展一個適合本土文化使用的彩色電腦化華人臉部情緒資料庫：華人臉部情緒辨識測驗工具(Chinese Facial Emotion Recognition Database, CFERD)，以應用在相關的情緒行為研究。在建立CFERD之標準化常模之後，應用此一經過驗證的測驗工具，測試精神分裂症患者的臉部情緒辨識表現。
本研究計畫包含兩部分。研究一收集100個18-50歲正常個案，目的為：（1）發展一個適合本土文化使用的彩色電腦化華人臉部情緒資料庫－華人臉部情緒辨識測驗工具(CFERD)，（2）以健康受測者來驗證CFERD，（3）並建立其標準化常模。結果顯示，CFERD在各個情緒間可以有效區辨。情緒辨識的總體敏感指標 (Sensitivity index, d')為0.94，其中以快樂最易辨識，驚訝跟悲傷比較不易辨識。在經過此驗證及標準化常模的建立之後，CFERD將可以作為相關情緒科學研究的測驗工具，尤其可以應用在華人族群的相關研究。
研究二納入74個18-50歲精神分裂症個案，及由研究一所收集的80個正常個案，目的為：(1) 應用經過驗證的CFERD來測試華人精神分裂症患者的臉部情緒辨識，並闡明其為全面性的缺損或特異性的缺損，(2) 進一步釐清此臉部情緒辨識缺損異質性是否存在精神分裂症不同的類型間（比如妄想型及非妄想型），(3) 探究精神分裂症臉部情緒辨識功能是否與其人口學特徵、臨床症狀卅類型、神經認知功能和社會功能等病理現象有關，(4) 檢證情緒辨識缺損是否與其他臨床症狀與神經認知功能一樣，可以預測精神分裂症的社會功能表現。研究結果合乎本研究的研究假設：(1) 華人精神分裂症有全面性的臉部表情辨識缺損，而不是只有負向情緒，(2) 而且此缺損會在不同精神分裂症類型中（如妄想型/非妄想型）有差異性的表現，(3) 總體來說，妄想型精神分裂症的臉部表情辨識能力比非妄想型的好，(4) 精神分裂症患者臉部情緒辨識缺損與其人口學特徵、神經認知功能缺損和社會功能等病理現象皆有一定的關聯性，(5) 情緒辨識缺損跟神經認知功能缺損一樣，可以預測精神分裂症的社會功能。本研究對情緒辨識及認知科學建立新的研究工具，並應用在精神分裂症患者，驗證了其於臨床評估的可行性。

關鍵字

臉部情緒辨識 ； 精神分裂症 ； 神經認知功能 ； 社會功能 ； 華人臉部情緒辨識測驗工具(CFERD)

並列摘要

The recognition of emotions from others’ faces, one of the social cognitions, is a universal and fundamental skill for social interaction. Although evidence supports that universal basic emotions are universal across cultures, there is also subtle cultural variation in recognition accuracy and intensities. Nevertheless, previous studies of the facial affect recognition in mental disorders have provided conflicting results. These discrepancies may be partially explained by stimuli and instruments differences between studies. Impairment of facial emotion recognition has been evidenced in patients with schizophrenia. This facial emotion recognition deficit has been shown to be a crucial predictor of clinical outcome and adversely affects the interpersonal and social functioning of people with schizophrenia. Such impairment in schizophrenia has been found to be moderated by certain clinical and demographic factors. However, the heterogeneous characteristics and of such deficits in schizophrenia are still being debated, and these characteristics could relate to the clinical syndrome or types of schizophrenia.
There is no validated facial emotion recognition task developed for Chinese. In addition, the understanding concerning the heterogeneous characteristics of emotion recognition deficits in schizophrenia is not adequate. Therefore, the objective of current study is to develop the Chinese Facial Emotion Recognition Database (CFERD), a culturally suitable color image database of facial expressions of Chinese people that can be used as a refined measuring tool for studying of affect behavior and affective neurosciences. Furthermore, the validated CFERD will be applied in examining the ability to recognize the facial expressions of emotion in patients with schizophrenia.
This study project has two parts. Subproject No.1 enrolled 100 healthy participants with age 18-50 year-old, and aimed to: (1) develop a culturally suitable instrument, the Chinese Facial Emotion Recognition Database (CFERD), (2) validate the CFERD with non-clinical healthy participants, and (3) generate a normative data set of CFERD. Results showed that participants could differentiate and recognize the target emotion precisely with CFERD. The sensitivity index d' for all emotions was 0.94. The emotion was more readily detected in happiness, and less easily detected in surprise and sadness. The validated and standardized CFERD will be a useful tool for emotion recognition assessment in affective neurosciences research, especially for the Chinese.
Subproject No.2 recruited 74 schizophrenia patients with age 18-50 year-old, as well as 80 healthy controls from subproject No.1. It aims to: (1) clarify whether Chinese schizophrenia patients would show generalized or specific emotion recognition impairment using CFERD, (2) examine if this impairment heterogeneous would exist among different types of schizophrenia, (3) investigate the association of emotion recognition with demographic characteristics, clinical aspects, neurocognitive function, and social functioning of schizophrenia, and (4) verify if the emotion recognition deficits could predict social functioning, as neurocognitive function do. Results showed that (1) Chinese schizophrenia patients demonstrated generalized emotion recognition impairment rather than specific deficit, (2) this impairment heterogeneous existed among different types of schizophrenia, (3) in general, paranoid schizophrenia performed better than non-paranoid schizophrenia, (4) there were correlations among emotion recognition with demographic variables, clinical characteristics, neurocognitive function, and social functioning of schizophrenia, and (5) the emotion recognition deficits could predict social functioning, as neurocognitive function does. The current study established a new assessment tool for emotion recognition and cognitive science, and validated its application in clinical population by testing it in patients with schizophrenia.

並列關鍵字

facial emotion recognition ； schizophrenia ； neurocognitive function ； social functioning ； Chinese Facial Emotion Recognition Database (CFERD)

參考文獻

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