慢性精神分裂病患者之執行功能與日常生活功能的關聯研究

目的：本研究欲了解慢性化精神分裂病患者的執行功能表現與日常生活的整體功能狀態，並探討和日常生活功能相關聯的執行功能部件，使未來能針對更特定的執行功能部件進行衡鑑與復健治療，以減低照顧者的負擔與社會成本的支出。方法：受試者由精神科日間病房或門診轉介且符合收案標準之慢性化精神分裂病患者共48名，其中男性28名，女性20名，平均年齡37.59歲。分別以簡短精神症狀量表和魏氏成人智力量表－第三版評估受試者的症狀嚴重度與智力程度；另評估其執行功能和日常生活功能，其中執行功能的測驗工具包含威斯康辛卡片分類測驗、Stroop叫色測驗、倫敦塔、路徑描繪測驗、郭氏語文記憶測驗的流暢度分測驗和記憶廣度測驗；日常生活功能的評估工具則包括個人和社會表現量表和照護需求層級量表。測得之執行功能部件包括：動作啟動和效能、認知流暢、自我監控效能、計劃、反應抑制和衝動控制、工作記憶。以逐步複迴歸分析人口學、疾病史和執行功能指標，與日常生活功能指標之間的關聯性。結果：慢性化精神分裂病患者在各執行功能部件和日常生活各領域之功能表現，多較一般人口運作困難。其中認知流暢、工作記憶和自我監控效能，是主要分別影響個人和社會整體功能、家務活動、和認知及情緒功能的執行功能部件，而家務活動同時亦受到動作啟動和效能、以及認知流暢所影響。結論：研究結果顯示慢性精神分裂病患者的不同日常生活功能領域，會受到不同的執行功能部件所影響，未來可針對欲了解的日常生活功能領域，選擇特定的執行功能衡鑑工具，並設計適當的認知復健計劃。

關鍵字

慢性精神分裂病；執行功能；日常生活功能

並列摘要

Background: For the course of schizophrenia tending to be chronic, patients with schizophrenia in Taiwan utilized a disproportionately high amount of health care services and reduced the productivity of the caregiver, which consumes enormous economic costs. One of the core symptoms of schizophrenia is diminishing executive function. Previous studies have found that impairment in executive function is associated with the inability to take care of themselves and live independently. Objective: This study intends to understand the impaired components of executive function among chronic schizophrenia and its association with daily living ability. Method: 48 patients with a diagnosis of schizophrenia according to DSM-IV-TR (28 men and 20 women, mean age 37.59) were recruited from outpatient services and day care center. Additionally, they must fulfill the definition of “chronic” in this study, meaning that “the patient’s course of illness is stabilized and is at least 10 years from onset. Their onset must be prior to 25 years old, respectively, and they have been on continuous medication in the past one year. Materials used includes: Brief Psychiatric Rating Scale (BSRS) for symptom severity; Wechsler Adult Intelligence Scale (Chinese version) - Third Edition for intelligence; Wisconsin Card Sorting Test (WCST), Stroop test, Tower of London (TOL), Trial Making Test (TMT), Verbal Memory Test and Digit Span Task for testing executive function; Personal and Social Performance Scale (PSP) and Hierarchy of the Care Required (HCR) for testing daily living ability. The executive function, tested by executive tasks, is comprised of 6 components: (1) motor initiation and efficiency, (2) cognitive fluency, (3) self-monitoring efficiency, (4) planning, (5) response inhibition and compulsion control, and (6) working memory. Stepwise regression was used to explore demography, medical history of schizophrenia, components of executive function associated with daily living ability. Results: Compared with normal individual in the previous study, participants in this study generally were worse on executive tasks. Furthermore, they also showed poor performances in daily living ability. Their cognitive fluency, working memory, self-monitoring efficiency correlated with personal and social performance, instrumental activity of daily living, cognitive and emotional function in turn. Beyond these, patient’s performance in instrumental activity of daily living also correlated with cognitive fluency and motor initiation and efficiency. Discussion: The chronic schizophrenia patient’s performances in different daily living abilities are associated with different components of executive function. This result suggests the need to choose adequate assessment tasks and cognitive rehabilitation program for specific daily living inability.