精神分裂症患者的症狀與認知、情感心智理論能力缺陷之關連性研究

The Relationship between the Symptoms of Schizophrenia and Cognitive and Affective of Component of Theory of Mind Defect

謝文菁(Wen-Ching Hsieh)

指導教授 ： 洪福建

中原大學/理學院/心理學研究所/碩士(2012年)

https://doi.org/10.6840/cycu201200230

摘要

研究動機及目的. 近二十年來，精神分裂症病患的心智理論能力缺失逐漸受到許多研究者的關注，並聚焦探討該能力缺失與病患的症狀表現、社會人際互動或認知功能障礙之間的相關。研究結果一致的指出精神分裂症病患有心智理論能力缺失的現象，但對於該能力缺失與其症狀表現之間的關連性，眾多研究者的觀點卻始終未能達成共識。然而，在十多年前，開始有研究者提出心智理論能力並非為單一的能力，而是包含數個次要成份(Tager-Flusberga & Sullivan, 2000；Shamay-Tsoory et al., 2005)，而此想法也漸漸獲得其他研究者的共鳴，並應用於探討帕金森氏症與厭食症的病患，但以精神分裂症病患為探討對象的研究仍為少數，因此本研究嘗試探討精神分裂症病患的認知、情感心智理論能力缺失，並進一步檢驗不同向度的心智理論能力缺失與症狀特徵之間的關連性，期望能對精神分裂症病患的心智理論能力缺失有更深入的瞭解。

研究方法. 本研究分為兩階段進行：第一個階段為試驗性研究階段，於宜蘭縣某國民中學隨機選取60名國中二年級學生進行小米作業、次級錯誤信念作業及眼部辨識作業的施測，目的在於檢驗三項心智理論作業的信度，以便刪除不合適的題目。第二階段為正式研究階段，由30位精神分裂症病患與30位一般社區民眾參與研究進行，兩組受試者在性別與年齡變項上相互配對，而病患會依據其在正性與負性症狀量表(PANSS)的分數差異區分為正性症狀組與負性症狀組。接著使用修正後的小米作業、次級錯誤信念作業及眼部辨識作業進行認知、情感心智理論能力評估，以比較正性症狀組病患、負性症狀組病患及一般社區民眾在三項心智理論作業的表現情形。最後則進行相關分析，以檢驗各症狀組群與認知、情感心智理論作業之間的相關。

研究結果. 研究結果顯示小米作業中的次級認知心智理論狀況與次級錯誤信念作業具有顯著相關，但初級、次級情感心智理論狀況與眼部辨識作業之間則缺乏關連性。其次，不論使用何種型式的心智理論作業，精神分裂症病患的表現均較一般社區民眾差，只是不同症狀表現的病患，在三項心智理論作業的表現則略有差異，即小米作業顯示出現正性症狀的病患在認知與情感心智理論狀況的表現均不佳，而出現負性症狀的病患僅在認知心智理論狀況的表現不佳，但次級錯誤信念作業及眼部辨識作業卻顯示出現正性症狀或負性症狀均會影響其作業表現。最後，研究結果顯示正性症狀傾向與認知心智理論能力缺失有關，而其他的症狀特徵與認知、情感心智理論能力缺失之間的相關則不顯著。

結論. 研究結果初步證實小米作業中的次級認知心智理論狀況與次級錯誤信念作業一樣，可測量到相同難度的認知心智理論能力，但在評估情感心智理論能力方面，仍須後續研究的投入，以設計出更合適的情感心智理論作業。其次，精神分裂症病患確實有心智理論能力缺失的問題，但此能力缺失僅表現在次級階段，也就是說病患有困難站在第二人的角度去推測第三人的想法。至於在認知、情感心智理論能力缺失的方面，研究結果傾向支持精神分裂症病患的認知、情感心智理論能力皆有受損，且認知心智理論能力的缺失特別與被害或怪異的妄想症狀有關，而其他症狀特徵與心智理論能力缺失之間的相關，仍需更多的研究繼續探討。

關鍵字

正性與負性症狀量表之五因素模型 ； 正性與負性症狀量表(PANSS) ； 精神分裂症 ； 心智理論

並列摘要

Background and purpose. In the past two decades, more and more researchers have interested in theory of mind (ToM) deficits in schizophrenia, and focused on the association of theory of mind deficits with symptoms of schizophrenia, interpersonal relationship, and cognitive impairment. All researchers agreed that patients with schizophrenia showed impaired theory of mind, but this issue that the relationship between theory of mind deficits and symptoms of schizophrenia has not had a consistent conclusion. However, more than 10 years ago, some researchers proposed the definition of theory of mind is broad, perhaps reflecting the fact that it is probably not a unitary function, it could be consisted of some subcomponents(Tager-Flusberga & Sullivan, 2000；Shamay-Tsoory et al., 2005). A number of studies have examined the subcomponents of theory of mind in patients with Parkinson’s disease and anorexia nervosa, but there are few studies have examined the patients with schizophrenia. Therefore, the purpose of this study was to investigate the cognitive and affective of component of theory of mind in patients with schizophrenia, and examine the relationship between the subcomponents of theory of mind deficits and schizophrenic symptoms, hope to understand the nature of theory of mind deficits in schizophrenia.

Method. This study was divided into two phases. In the first phase of this research, the author conducted three theory of mind tasks by inviting 60 students of junior high school to participate in the study on reliability. The second phase of this research, 30 patients with schizophrenia and 30 healthy subjects were recruited. Within both groups, subjects were matched by gender and age. In the schizophrenic patients group, patients were divided into positive symptom group and negative symptom group by PANSS scales. Subjects were assessed on the revised of Yoni task, second order false believe task and eyes test in order to compare the performance of theory of mind tasks of three groups, and examine the correlation between the symptoms of schizophrenia and cognitive and affective of component of theory of mind deficits.

Results. The results revealed that there was a significant association of cognitive ToM condition of Yoni task with the second-order false believe task, but the first–order and second-order affective ToM condition of Yoni task was not related to eyes test. Second, patients with schizophrenia made more errors on three theory of mind tasks as compared to healthy controls. However, the patients with positive symptom made the most errors on cognitive and affective ToM condition of Yoni task, but the patients with negative symptom made more errors only on cognitive ToM condition of Yoni task. Nevertheless, the difference between positive and negative symptom group was not significant on second-order false believe task and eyes test. Third, there was a significant association of cognitive theory of mind deficits with the positive symptom. Contrary to expectations, the associations of other symptoms with cognitive and affective of component of theory of mind deficits were absent.

Conclusion. The finding confirmed that the second-order cognitive ToM condition of Yoni task was similar to the traditional second-order false believe task, which indeed measured the cognitive component of theory of mind, but the assessment of affective component of theory of mind was needed more researches in order to design applicable affective theory of mind task. Second, patients suffering from schizophrenia showed impaired theory of mind, but these deficits only manifested in advanced theory of mind abilities, it meant that patients with schizophrenia cannot stand in the second person’s point of view to infer the third person’s belief. As to the cognitive and affective of component of theory of mind deficits, the result suggested that patients with schizophrenia were impaired in both cognitive and affective of component of theory of mind, and the cognitive component of theory of mind deficits were especially observed in those patients with unusual thought or persecutory delusion. The relationship between the theory of mind deficits and other symptoms is needed more researches to explore in future.

並列關鍵字

Theory of Mind ； Schizophrenia ； Positive and Negative Syndrome Scale(PANSS) ； Five-factor model of the Positive and Negative Syndrome Scale

參考文獻

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