臺灣博碩士論文加值系統

目的：本研究有別於一般統計法，先根據文獻，將影響精神分
裂復發的因素作為研究變項，利用存活分析探討精神分裂症的復發受
哪些因子的影響，並找出在病歷中，最能預測復發的危險因子。
方法：研究對象為台灣南部某區域教學醫院、經專業精神科醫
師診斷為精神分裂症（診斷代碼：295.0-295.9）之94 個案。所有個
案條件均符合發病後首次住院，在觀測期的五年內（2001-2005），因
復發而再入院的52 人（55.32％）為復發組；未復發的42 人（44.68
％）為未復發組，並根據文獻參照病歷將個案的預後、護理診斷、社
工評估以及COTE 量表各項總分紀錄於調查問卷成變項，再利用Cox
比例危害模式的存活分析，找出可顯著預測精神分裂症患者復發的危
險因子，並以風險危害比（hazard ratio,HR），以及HR 之95％ CI
分別表示其危害程度。
結果：經Cox 比例危害模式的存活分析，結果發現，在所有危
害因子當中，家中排行老大的個案以及與家人有衝突之個案，有顯著
的復發危害比。與家人有衝突的個案，復發危害比是與家人沒有衝突
個案的約4.8 倍（p＝0.004）， HR 之95％ CI 危害程度為
0.071-0.613；家中排行老大的個案，復發危害比是排行其它的2.95
倍（p＝0.049），HR 之95％ CI 危害程度為0.116-0.995。在社工評
估中，與父親的關係越差，其復發率越高（p＝0.027）。
結論：與家人有衝突、在家中排行老大及與父親關係差，為精
神分裂症復發的危險因子。研究結果可進一步提供醫療團隊，除了僅
針對病患身體疾病的醫療模式外，也應著重於對家庭取向之介入作為
處遇之參考。

Objective：The aim of this study was to use the method of the survival analysis of cox proportional hazards models to explore the risk factors of relapse in schizophrenia, according to several articles about this issues , the risk factors associated with the relapse in schizophrenia were investigated from the anamnesis.
Methods：Cases consisted of 94 patients who were diagnosed as schizophrenia （295.0-295.9）by psychiatrists from one of the teaching hospital in southern Taiwan. All of these patients
were required to have the condition of first hospitalization
after the onset. During the five years of observation
（2001-2005）, 52（55.32％）patients who were hospitalized once
more due to the illness relapse belonged to the group of
relapse；the remainders of 42 patients（44.68％）belonged to
the group of not being relapsed. According to the literatures,
patient＇s anamnesis of prognosis, nursing records, assessment of social workers and the measurements of COTE were turned into
variables. Then, the survival analysis of COX proportional risk
model was used to find out the hazard factors in predicting
relapse in schizophrenia. Moreover, hazard ratio（HR）and 95
％ Cl for HR would indicate the degree of relapse.
Results：The results showed that if the first child or usually
conflicts with the family was 4.8 times higher than the patients
who never involves in a conflict（p＝0.004）；95％ Cl for HR
would be 0.071-0.613；if the patient who is the first child of
the family was 2.95 times higher to be illness relapse than
other siblings（p＝0.049）. The relapse rate of patient who
conflicted with family members was 4.8 times higher than whom
didn＇t（p＝0.004）. 95％ Cl for HR was 0.071-0.613; the first child was 2.95 times higher than the other ranking children
（p＝0.049）, and the 95％ Cl for HR would be 0.116-0.995.The
social work assessment showed that the worse relationship with the father would result higher illness relapse （p＝0.027）.
Conclusion：If the patient who is the first child and usually conflicts with family or if the patient has worse
relationship with the father are the hazardous factors to cause illnss relapse in schizophrenia. The results can be a helpful reference for planning intervention and prevention programs for the prevention of relapse in schizophrenia.

第一章 緒 論
第一節 研究背景…………………………………... 1
第二節 研究動機…………………………………... 5
第三節 研究目的…………………………………... 6
第二章 文獻探討
第一節 精神分裂症的復發………………………... 7
第二節 復發的相關因子…………………………... 10
第三節 精神分裂症的預後………………………... 15
第四節 職能治療綜合評量表……………………... 18
第五節 存活分析…………………………………... 19
第三章 研究材料與方法
第一節 研究方法…………………………………... 22
第二節 研究架構…………………………………... 25
第三節 研究假設…………………………………... 28
第四節 研究對象…………………………………... 29
第五節 研究工具…………………………………... 31
第六節 分析方法…………………………………... 34
第四章 研究結果
第一節 樣本分析…………………………………... 36
第二期 人口學特性與各變項的關係……………... 39
第三節 預後對於復發的危害比…………………... 42
第四節 護理診斷對於復發的危害比……………... 43
第五節 社工評估對於復發的危害比……………... 44
第六節 COTE 量各向總分與危害比……………… 47
第七節 所有變項之危害模式分析
逐步淘汰之結果…………………………... 48
第五章 討論
第一節 研究結果與文獻比較……………………... 49
第二期 研究限制…………………………………... 53
第六章 結論與建議
第一節 結論………………………………………... 57
第二期 建議………………………………………... 56
第七章 參考文獻……………………………………….. 58
附錄
附錄一 人體試驗委員會記錄………………………. 69
附錄二 研究調查問卷……………………………... 70
附錄三 職能治療綜合評估量表…………………... 74

圖表目錄
圖目錄
圖1.1 疾病別當年（2004）再住院比值…………………. 3
圖3.1 觀測示意圖…………………………………………. 23
圖3.2 研究架構……………………………………………. 25
圖3.3 研究工具結構圖……………………………………. 31
圖4.1 樣本人口年度分佈圖………………………………. 36
表目錄
表1.1 民國八十八年之台灣地區YLDs 排名……………… 4
表2.1 Definition of Relpase………………………………8
表2.2 精神分裂症的預後指摽……………………………. 15
表2.3 過去文獻經陳記載之預後…………………………. 16
表3.1 存活分析模式引用之解釋變數與變數定義………. 32
表4.1 兩組人口年度分佈表………………………………. 36
表4.2 診斷別之描述性統計………………………………. 37
表4.3 個案之人口學及變項之描述………………………. 39
表4.4 預後對於精神分裂症患者
Cox 比例危害模式之存活分析 ………………….. 42
表4.5 護理診斷對於精神分裂症患者
Cox 比例危害模式之存活分析………………….. 43
表4.6 社工評估對於精神分裂症患者
Cox 比例危害模式之存活分析………………….. 44
表4.7 社工評估逐步淘汰分析之結果……………………. 45
表4.8 COTE 量表對於精神分裂症患者
Cox 比例危害模式之存活分析………………….. 47
表4.9 所有變項逐步淘汰之分析結果…………………… 47

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