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  • 學位論文

精神分裂症妄想症狀、心智理論能力和執行功能之相關探討

Paranoid Symptoms, Theory of Mind and Executive Function in Schizophrenia

指導教授 : 洪福建

摘要


研究背景與目的. 精神分裂症的病因研究至今仍難有一致的結論,主要與精神分裂症異質的症狀表現和難以控制的藥物影響或機構化因子有關,Frith (1992)認為研究精神分裂症的單一症狀也許能夠控制這些混淆因子的影響。Frith(1992)表示精神分裂症的被害妄想症狀可能與心智理論能力的關聯最大,即有妄想症狀的精神分裂症病人較無妄想症狀的精神分裂症病人在心智理論能力上有明顯缺陷。雖然過去研究已經都已普遍支持精神分裂症病人的確有明顯的心智理論缺陷。然而到目前為止,妄想症狀與心智理論能力此特定的關聯,在過去的研究中尚未得到一致的結果。因此本研究的目的在了解精神分裂症病人的妄想症狀與心智理論之間的關係。另外,有的學者認為心智理論能力並非一種獨立的認知系統,可能只是隸屬於執行功能的一支,且執行功能的高低可能會影響心智理論能力的表現。因此本研究的另一個目的在了解精神分裂症病人在心智理論能力表現是否會受到執行功能高低的影響。 研究方法. 本研究共選取31名精神分裂症患者,並將精神分裂症患者分為妄想組17人和非妄想組14人,另外選取20名社區居民作為對照控制組,比較三組在症狀嚴重度評估、智力水準、執行功能和心智理論能力表現。 研究結果. 精神分裂症病人只有在次級錯誤信念測驗的表現皆顯著較正常人差。症狀分組比較方面,妄想組病患在初級錯誤信念測驗和次級錯誤信念測驗上的表現皆顯著較非妄想組和正常控制組差,且在排除智力和執行功能的影響後,妄想組精神分裂症病人的初級和次級錯誤信念測驗表現仍較正常人和非妄想精神分裂症病人差。妄想症狀中,又以被害妄想嚴重度與心智理論缺陷的關聯最大。 討論. 本研究再次驗證精神分裂症病人在心智理論能力上的缺陷,且支持Frith的說法,即被害妄想症狀和心智理論能力有特定的關聯。另外,妄想精神分裂症病人的心智理論在排除智力和執行功能的影響後,仍顯現出明顯的缺陷,因此推估精神分裂症也許不只是執行功能的一支,可能是一組獨立的認知處理系統。本文最後提出其他可能影響心智理論能力表現的因素和未來的研究方向。

並列摘要


Background and purpose. The results of etiology researches in schizophrenia are inconsistent. It is mainly because of the heterogeneous symptoms of schizophrenia and the difficulties in control of medicine and institutionalization. Frith (1992) considered that focusing on single symptom in schizophrenic patients may be able to control these confounding factors. Frith (1992) proposed a theory concerning a specific relationship between impaired theory of mind (ToM) and paranoid delusions. There has been a substantial body of evidence supporting that schizophrenic patients do have impaired ToM. However, the specific relationship between impaired ToM and paranoid delusions has not been fully demonstrated yet. Therefore, the purpose of present research is to examine the relationship between paranoid delusions and ToM deficits in schizophrenic patients. In addition, some researchers believed that ToM is a branch of executive function system, instead of an independent cognitive module. Therefore, the other purpose of the study is to investigate if executive function would affect ToM. Method. A total of 31 patients with schizophrenia were recruited. Fourteen patients were classified as paranoid and 17 were classified as nonparanoid. Their IQ, executive function, and first and second order ToM performances were compared with 20 healthy controls. Results. Patients with schizophrenia performed significantly more poorly than healthy controls on second order ToM task, not on first order ToM task. However, the ToM deficit was only observed in those patients with severe paranoid symptoms, especially with persecutory delusions. Discussion. The study demonstrated the ToM deficits in patients with schizophrenia and Frith’s theory regarding the specific relationship between persecutory delusions and ToM deficits. Besides, after partial out the effects of IQ and executive function, the ToM deficit in schizophrenic patients was still significant, which supports the “ToM module” theory. Based on the result above, ToM was considered as an independent cognitive module, but not a branch of executive function. Other factors that influence ToM and future implications were discussed.

參考文獻


Abbruzzese, M., Ferri, S., Scarone, S. (1996). Performance on the Wisconsin Card Sorting Test in schizophrenia: Perseveration in clinical subtypes. Psychiatry Research, 30, 27-33.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders. (4th ed.). Washington D. C.: Author.
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