臺灣博碩士論文加值系統

如何正確的偵測偽病者是臨床神經心理學與司法醫學中一項重要的議題。近年來，一項利用反應時間表現曲線法的偵測技巧，已被證明在偵測偽裝認知障礙者上極具功效。但此作業的表現是否也和其他測驗一般，容易受到不同反應型態及其他因素的干擾，尚屬未知。
本研究利用兩個實驗分別觀察不同反應型態與與情緒因素對此表現曲線策略可能產生的影響。在實驗一中，選取32位年齡為18-25歲的大學生參與實驗，並以配對控制的方式將其隨機分派至以字母或圖形為刺激的表現曲線作業中，藉由不同指導語的操弄要求所有參與者以四種反應型態作答。在實驗二中，共有43名健康的志願者及39位符合DSM-IV中憂鬱症診斷的患者參與實驗。
結果發現，在實驗一中，不同的反應型態的確會產生不同的作業表現，但本作業所使用的各種量化指標均足以區分不同的反應策略。在實驗二中，和控制組比較之下，憂鬱症患者在此作業的表現曲線上，則呈現出斜率較陡、但錯誤率較低的情況。
造成這些不同表現結果可能的機轉，將在本文中一一個別討論。

How to accurately detect malingerer is an important issue in clinical neuropsychology and medico-legal settings. Recently, a performance curve method based on choice reaction times has been proved to be very effective and sensitive in detecting the simulators of cognitive impairment. However, it is not known whether the performance on this task is also liable to be affected by different response styles or other factors.
The present study entails two experiments investigating the effects of different response styles and depression on the performance on this task, respectively. In Experiment 1, 32 university students matched with sex were recruited and randomly assigned to two different versions of the task, which consist of either letter or visual stimuli. All participants had to undergo four experimental conditions based on different testing instructions in order to elicit various response styles. In Experiment 2, there were 43 healthy volunteers and 39 patients fulfilled DSM-IV diagnostic criteria of major depressive disorder were recruited.
The results of Experiment 1 showed that different response styles tend to affect the performance on this task differently, but all these response styles can be easily dissociated by the quantitative indices of the task. In Experiment 2, compared to the control group, the performance of depressed patients on this task revealed steeper slopes of reaction time functions, but with lower error rates.
The possible mechanisms of the effects produced by different factors on the performance of this task will be discussed.

第一章 序論.............................................. 1
1.1何謂「偽病」(malingering)? ............................. 1
1.1.1定義與歷史發展................................... 1
1.1.2發生率............................................5
1.2偵測「偽裝認知障礙者」之技術與策略.................... 7
1.2.1發展偵測「偽裝認知障礙者」技術的重要性............. 7
1.2.2 偵測技術與策略的種類............................. 8
1.2.3偵測策略在應用上的限制.......................... 14
1.3表現曲線策略的應用.................................. 18
1. 3.1四分類法........................................ 18
1. 3.2. 反應時間表現曲線策略........................... 22
1.3.2.1反應時間與認知功能........................... 22
1.3.2.2選擇反應時間在偵測偽裝認知障礙的應用......... 25
1.3.2.3應用與發展................................... 27
1.4研究目的............................................ 29
第二章 實驗一........................................... 33
2.1前言................................................ 33
2.2 研究方法........................................... 34
2.2.1 參與者.......................................... 34
2.2.2工具............................................ 34
2.2.2.1基本心智評估................................. 34
2.2.2.2表現曲線作業................................. 36
2.2.3實驗設計........................................ 37
2.2.4實驗程序........................................ 38
2.2.5資料分析........................................ 39
2.3結果................................................ 41
2.3.1基本心智功能.................................... 41
2.3.2表現曲線作業.................................... 41
2.4討論................................................ 51
第三章 實驗二............................................ 62
3.1前言................................................ 62
3.2研究方法............................................ 64
3.2.1參與者........................................... 64
3.2.2工具............................................ 65
3.2.2.1情緒狀態評估................................. 65
3.2.2.2基本心智評估................................. 66
3.2.2.3臨床神經心理評估............................. 66
3.2.2.4偵測偽裝記憶力缺損測驗....................... 74
3.2.2.5表現曲線作業................................. 75
3.2.3實驗步驟........................................ 75
3.2.4資料分析........................................ 76
3.3結果................................................ 77
3.3.1基本資料、基本心智功能與情緒狀態 ............... 77
3.3.2臨床神經心理評估................................ 78
3.3.3偵測偽裝記憶力缺損測驗.......................... 81
3.3.4表現曲線作業.................................... 82
3.4討論................................................ 88
第四章 綜合討論......................................... 97
4.1反應型態與表現曲線作業.............................. 98
4.2 憂鬱症與表現曲線作業...............................101
第五章 結論............................................104
參考文獻................................................107

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