額葉及顳葉型癲癇患者情緒辨識、心智理論與社會功能之關係探討

研究背景：「情緒辨識」意指個體透過視覺或聽覺知覺特徵去推斷他人情緒狀態的能力，而「心智理論」則是指個體推論他人心中想法、意圖、信念與感受的能力，兩者皆是社會認知功能的核心要素。在社會情境中，情緒辨識以及心智理論都是在人與人互動過程中不可或缺的能力，唯有適切地覺知與推論他人內在狀態，才能讓我們維持一來一往的人際交流。過去研究雖已證實，額葉型癲癇患者與顳葉型癲癇患者有情緒辨識與心智理論的缺損，但卻鮮少研究探討上述障礙對患者日常生活功能的影響。　　本研究目的有：(1) 探討癲癇相關風險因子與情緒辨識、心智理論、社會功能之間的關係；(2) 探討癲癇患者及健康成年人神經心理測驗表現及其與情緒辨識、心智理論、社會功能之間的關係；(3) 探討癲癇患者情緒辨識、心智理論、社會功能表現之間的關係；(4) 探討癲癇患者與健康成年人在情緒辨識表現之差異，及在不同表達強度下情緒辨識表現之差異；(5) 探討癲癇患者與健康成年人在心智理論表現之差異，及進一步分析兩組在認知心智理論與情感心智理論表現之差異。研究方法：本研究經神經專科醫師轉介，共招募額或顳葉型癲癇患者26名，另根據教育程度、年齡、性別等變項配對，共募得30位健康成年人，每位受試者皆逐一接受情緒辨識、心智理論、社會功能、執行功能、智力及精神症狀的評估，並根據智力及精神症狀評估結果進行收案篩選，以排除智能不足或嚴重精神症狀兩項因素的干擾。研究結果與結論：研究結果發現(1)相較健康成年人，癲癇患者在害怕臉孔情緒辨識表現顯著較差，在悲傷、厭惡臉孔情緒辨識平均正確得分上，兩組差異雖未達顯著，但癲癇患者得分有偏低趨勢，有待未來增加樣本數，做進一步確認；(2)不論健康成年人或癲癇患者，隨著情緒強度增加，其情緒辨識正確率皆有明顯提升；(3)癲癇患者在心智理論表現（尤其是情感層面心智理論表現）顯著較健康成年人差，同時心智理論與情緒辨識表現間存在正相關；(4)癲癇患者在心智理論與社會功能的人際溝通向度表現存在正相關；(5)癲癇患者的社會功能表現與精神症狀困擾、癲癇發作頻率、服用藥物種類呈現負相關。

關鍵字

臉孔情緒辨識；情緒表達強度；心智理論；社會功能

並列摘要

Background: “Emotion recognition” refers to the capacity to infer the emotional state of others through the characteristics of visual or auditory perception. The term “Theory of Mind” refers to the ability to understand other people's thoughts, intentions, beliefs, and feelings. Both of them are critical components of social cognition and essential abilities in social interaction. Understanding the affective states of others can guide our behavioral responses to maintain interpersonal communication. Researches confirmed that patients with frontal lobe epilepsy and temporal lobe epilepsy impaired in emotion recognition and mental theory; however, the impact of dysfunctions on daily life remains to be further explored. Research purpose: To investigate (1) the relationship between seizure-related risk factors and facial emotion recognition, the theory of mind, as well as social function ; (2) the neuropsychological features of patients with epilepsy and healthy controls and its relationship with emotion recognition, theory of mind, and social functioning; (3) the relationship among emotion recognition, the theory of mind, and social function in patients with epilepsy; (4) the differences of emotion recognition between patients with epilepsy and healthy controls, and the differences of emotion recognition under variant expression intensity; (5) the differences in theory of mind between patients with epilepsy and the healthy controls, and to further analyze the differences between the two groups in cognitive and affective theory of mind. Method: Twenty-six patients with frontal or temporal lobe epilepsy who were referred by a neurologist and 30 matched controls were included. All participants completed a facial emotion recognition test, the Theory of Mind test, the Color Trails Test, selected subtests of the Mandarin version of the Wechsler Adult Intelligence Scale-III, the Social and Occupational Functioning Scale for Epilepsy, and the Symptom Checklist-90-Revised. Participants with mental retardation or severe psychiatric symptoms were excluded. Results and conclusion: The results showed that (1) compared with healthy controls, patients with epilepsy showed significantly worse performance in recognition of emotions on feared faces. Although there was no significant difference in the average correct score of sad and disgusted facial emotion recognition between the two groups, but the score of patients with epilepsy tended to be lower, which needs to be further examined by increasing the number of samples in the future; (2) with the increase of emotion intensity, the correct rate of emotion recognition was significantly improved in both healthy adults and patients with epilepsy; (3) patients with epilepsy performed significantly worse in theory of mind (especially in affective one) than healthy controls. Furthermore, impaired theory of mind was significantly associated with poor facial emotion recognition; (4) there was a positive correlation between the interpersonal communication score (of the social functioning scale) and theory of mind in patients with epilepsy; (5) impaired social functioning in patients with epilepsy was significantly associated with psychiatric disturbances, seizure frequency, and number of antiepileptic drugs used.