精神分裂症風險青少年之自我感探討

Sense of Self in Adolescents at Risk of Schizophrenia

劉于涵(Yu-han Liu)

指導教授 ： 陳淑惠

國立臺灣大學/理學院/心理學研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.01573

摘要

自我的崩解、毀壞是精神分裂症的核心基礎，並且在疾病的前驅期即會出現一些因自我感改變所造成的異常自我經驗。本研究之目的在探索自我感困擾在不同罹病風險程度族群中的差別，及個體於疾病演進歷程中自我感的變化趨勢，以擴充對精神分裂症自我感困擾的認識。此外，本研究試圖了解風險族群中，自我感困擾對於日後精神分裂症是否發病的預測力，以期能提昇早期篩檢之精確度以利早期介入，進而降低精神分裂症對個體造成的影響。本研究藉由學校、醫院轉介系統以及大眾傳播媒體募集324位較具罹患精神分裂症風險之參與者。藉由臨床專業評估，依其風險程度分為：極高風險組（52人）、中度風險組（41人）與邊緣風險組（44人）；亦包48位精神分裂症初次發病患者，以及139位健康正常參與者，以玆對照。使用工具為自填式問卷，包括：基本資料、前驅症狀量表、自我感量表以及身材外貌及自信評估。本研究採前瞻式研究方法，除了基礎線期的測量外，初次發病組及極高風險組每半年追蹤一次，其餘風險組及正常對照組則一年追蹤一次，追蹤為期兩年。研究結果顯示自我感困擾與正負性及解構症狀之相關未達顯著，然而與部分一般症狀達顯著相關（如睡眠障礙、不悅情緒）。不同風險組間的自我感困擾無顯著差異；然而風險組及初次發病組的自我感困擾則均與正常對照組有顯著差異，顯示自我感困擾可區辨正常組及臨床組。自我感困擾嚴重度有隨著精神分裂症風險程度的升高而升高的趨勢。然而發病之後，其自我感困擾卻明顯下降。「自我認同遲鈍不確定」及「身材外貌現在相對於過去的差異」對於個體是否會轉變發病為精神分裂症最具預測力。本研究據以進行理論及臨床應用上之討論。

關鍵字

精神分裂症 ； 自我感困擾 ； 異常自我經驗 ； 極高風險

並列摘要

Self-disturbance is a disturbance caused by the alteration of the basic sense of self. It may be the core feature of schizophrenia and its prodrome. The purpose of the study was to explore the details of self-disturbance in individuals of different risk levels of schizophrenia, and to examine whether self-disturbance can be predictive to psychosis. A prospective study was designed on participants recruited by referrals from a community-based population. Through clinical interviews by experienced psychiatrists, three pre-psychotic risk groups were established: an ultra-high risk group (UHR; n = 52), an intermediate-risk group (IRG; n = 41), and a marginal-risk group (MRG; n = 44). Also 48 participants with first-episode psychosis (FEP) and 139 healthy controls (NC group) were recruited as comparison. All participants were examine with Sense of Self Scale (SOS) to assess the severity of their self-disturbance, and the scale of appraisal of appearance and self-confidence to assess their subjective appraisal of the past, present and ideal appearance and self-confidence. In the two-year follow-up, the FEP and UHR were followed twice a year, and the rest once a year. Results revealed that self-disturbance could discriminate the healthy control and clinical groups (i.e. risk groups and first-episode group). And no matter observed within or between groups, the trend of alteration in self-disturbance existed as that its severity increased as risk level increased; however, when participants converted to psychosis, the severity of self-disturbance decreased. Besides, one subscale of sense of self and discrepancy between appraisal of present and past appearance were predictive to the full-blown of psychosis.

並列關鍵字

prodrome ； schizophrenia ； self-disturbance ； anomalous self-experience ； ultra-high risk

參考文獻

胡海國 (1997)。精神分裂症之症狀學：疾病分類與文化的關連性。「台灣精神 醫學」，11，211-228。

龔卓軍。(2006)。身體感：胡塞爾對身體的形構分析。「應用心理研究」，29，157-181

Yung, A.R., Phillips, L.J., McGorry, P.D., McFarlane, C.A., Francey, S., Harrigan,S.,　... Jackson, H.J.(1998).Prediction of psychosis. A step towards indicated prevention of schizophrenia. British Journal of Psychiatry., Suppl. 172, 14–20.

Asai, T., & Tanno, Y. (2008). Highly schizotypal students have a weaker sense of self-agency. Psychiatry and Clinical Neurosciences, 62(1), 115-119.

American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC：Author.