具聽幻覺思覺失調症患者之情緒性訊息的來源監控

The source monitoring for emotional information in schizophrenia with auditory hallucination

陳舒玫(Shu-Mei Chen)

指導教授 ： 洪福建

中原大學/理學院/心理學研究所/碩士(2016年)

https://doi.org/10.6840/cycu201600256

摘要

研究背景與目的：過去Frith 主張思覺失調症患者的聽幻覺症狀是由於內在自我產生的事件，將它外歸因的緣故。本研究試圖延伸過往對於聽幻覺思覺失調症在來源監控上缺損的結論，並加入不同情緒向度的訊息，提出患者對於內在自我產生的負向詞彙更容易錯誤歸類於外在來源的假設。除此之外，Brébion 等人的研究另外發現幻覺者比起其他患者，更容易將口語項目報告為圖片項目，在區辨想像圖片以及真實圖片上產生困難，與Frith現實監控有關的說法相符，因此以此納入兩種不同類型的來源監控作業。

研究方法：實驗一總計幻聽組受試者26名、非幻聽組24名，ㄧ般健康成人控制組22名。內在-外在來源監控作業中，受試者與實驗者需以口頭方式分別輪流產出15個雙字詞 (包含正性/中性/負性詞)，並於再認階段由實驗者念出30個由受試者與實驗者產出的舊詞，以及30個未曾出現的新詞，要求受試者區分字詞的新舊(出現過/沒出現過)以及來源(自己說的/實驗者說的)。 實驗二含幻聽組21名、非幻聽組22名，ㄧ般健康成人控制組22名，外在-外在來源監控作業中電腦輪流產出30個文字項目以及圖片項目刺激，並於再認階段時由實驗者念出各內容名稱，並加入30個新字詞，同樣使受試者區分新舊與類型(圖片項目/文字項目)。

研究結果：思覺失調症幻聽組於情緒困擾上憂鬱與焦慮程度皆顯著高於思覺失調症非幻聽組與ㄧ般健康成人控制組，然而於兩種來源監控作業當中，幻聽組、非幻聽組與控制組的整體記憶表現以及歸因錯誤率上皆無顯著差異，即使加入了情緒性字詞後，並無發現顯著將負向訊息外歸因或圖片歸因的現象。

結論：過去研究結果指向聽幻覺思覺失調症患者於來源監控上的表現較ㄧ般控制組差，然而本研究結果並未發現具有幻聽的思覺失調症患者擁有來源記憶的缺損。研究者推論其他症狀可能影響患者於來源監控上的表現 (如，妄想)，未來研究中可嘗試釐清妄想症狀在幻聽與無幻聽的思覺失調症患者身上對於歸因偏誤的影響。

關鍵字

思覺失調症 ； 幻聽 ； 來源監控

並列摘要

Background and purpose. Frith has claimed that auditory hallucinations are due to the misattribution of one’s internal cognitive operations to external events. The present study attempted to extend previous research on source monitoring deficits in schizophrenia patients with hallucination. We hypothesized that patients would show a bias to attribute self-generated words to an external source, especially when the stimulus can trigger negative emotions. Furthermore, Brébion et al also found that schizophrenia patients with hallucinations were more prone to report that spoken items had been presented as pictures, compared with those without hallucination. This result is consistent with Frith’s theory and suggest that hallucinations are associated with confusion between imagined and perceived pictures.

Methods. Twenty-six schizophrenia patients with auditory hallucination (AHs), Twenty-four schizophrenia patients without auditory hallucination (NAHs), and Twenty-two healthy subjects participated in Experiment 1. Participants completed internal-external task, in which participants and experimenter were instructed to verbally provide 15 semantic words (including positive/neutral/negative words). Then, the experimenter read aloud a word list containing 30 words the experimenter and participants had generated and 30 new words. The participants was required to distinguish each item from old or new, and identify the source as self-generated or experimenter generated. Twenty-one AHs, Twenty-two NAHs, and Twenty-two healthy subjects participated in Experiment 2. Participants completed an external-external source-monitoring task. Thirty items were produced by the computer, either presented as pictures, or as visual words. After that, the experimenter read aloud a word list including the former 30 produced target items and 30 new ones. The participants were required to distinguish each item from old or new, and identify the source as pictures items or sematic items.

Results. The AHs reported significant higher emotional distress (i.e. depression and anxiety) than the other two groups. However, in the two kinds of the source memory task, there were no differences between the AHs, NAHs and the healthy groups in regard to memory accuracy and attributional bias. Even if adding the emotional terms to the tasks we did not discover the significantly increased number of source attributional bias.

Discussion. The previous research has consistently shown that schizophrenia patients with auditory hallucination performed poorly on source memory task, compared with healthy ones. However, the present study did not observe source monitoring deficit in schizophrenia patients with AHs. The present study suggests that other symptoms (e.g., delusions) may also influence patients’ source monitoring performance. The further research could clarify that whether delusions have impact on attributional bias in schizophrenia patients with and without AHs.

並列關鍵字

Schizophrenia ； Hallucinations ； Source monitoring

參考文獻

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