臺灣博碩士論文加值系統

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。

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.

摘要
ABSTRACT
致謝
目錄
圖目次
表目次

第一章 前言

第二章 文獻探討
2.1 思覺失調症
2.2 幻聽特性
2.3 來源監控
2.3.1 來源監控理論與架構
2.3.2 幻聽與來源監控的關係
2.3.3 幻聽與來源監控的實徵研究
2.3.4 情緒性訊息對於來源監控的影響
2.3.5 綜合
2.4 研究設計與問題

第三章 內在－外在來源監控作業（實驗一）
3.1 研究問題一
3.1.1 研究假設一
3.2 研究問題二
3.2.1 研究假設二
3.3 研究設計
3.4 研究對象
3.4.1 幻聽組 思覺失調症患者26人
3.4.2 非幻聽組 思覺失調症患者24人
3.4.3 控制組 一般健康成人22人
3.5 研究工具
3.5.1 活性與負性症狀量表
3.5.2 中文魏氏成人智力量表簡版
3.5.3 中文版貝克憂鬱量表第二版
3.5.4 中文版貝克焦慮量表
3.6 內在-外在來源監控作業
3.6.1 實驗設計
3.6.2 實驗材料
3.6.3 實驗工具
3.7 研究流程
3.8 資料分析
3.9 研究結果
3.9.1 基本人口變項
3.9.2 中文版正性與負性症狀量表
3.9.3 憂鬱及焦慮分析
3.9.4 相關分析
3.9.5 記憶再認表現
3.9.6 來源監控作業表現

第四章 外在-外在來源監控作業 (實驗二)
4.1 研究問題三
4.1.1 研究假設三
4.2 研究問題四
4.2.1研究假設四
4.3 研究設計
4.4 研究對象
4.4.1 幻聽組 思覺失調症患者21人
4.4.2 非幻聽組 思覺失調症患者22人
4.4.3 控制組 一般健康成人22人
4.5 研究工具
4.6 外在-外在來源監控作業
4.6.1實驗設計
4.6.2 實驗材料
4.7 研究流程
4.8 資料分析
4.9 研究結果
4.9.1 基本人口變項
4.9.2 中文版活性與負性症狀量表
4.9.3 憂鬱及焦慮分析
4.9.4 相關分析
4.9.5 記憶再認表現
4.9.6 來源監控作業表現

第五章 總結與討論
5.1 研究結果總結
5.1.1 實驗一
5.1.2 實驗二
5.2 研究結果討論
5.2.1 內在-外在來源監控
5.2.2 情緒性訊息對於來源監控的影響
5.2.3 內歸因偏誤
5.2.4 外在-外在來源監控：圖片歸因與文字歸因偏誤
5.2.5 綜合之想法
5.3 研究貢獻
5.4 研究限制與未來方向

參考文獻
附件一 三軍總醫院人體試驗計畫審查同意函
附件二 中文版活性與負性症狀量表使用同意書
附件三 情緒標準刺激與反應常模基礎研究使用合約
附件四 267個常見中文雙字詞的情緒評量與自由聯想常模使用同意文
附件五　內在－外在來源監控作業 (實驗一) 字詞清單
附件六　外在－外在來源監控作業 (實驗二) 字詞清單

圖目次
圖1 實驗一受試者篩選流程
圖2 實驗一研究流程圖
圖3 實驗一來源監控作業錯誤率計算
圖4 實驗一幻聽組、非幻聽組與控制組在來源監控作業上之外歸因錯誤率
圖5 實驗一幻聽組、非幻聽組與控制組在組內情緒性字詞上之外歸因錯誤率
圖6 實驗一幻聽組、非幻聽組與控制組在來源監控作業上之內歸因錯誤率
圖7 實驗一幻聽組、非幻聽組與控制組在組內情緒性字詞上之內歸因錯誤率
圖8 實驗二受試者篩選流程
圖9 實驗二研究流程圖
圖10 實驗二來源監控作業錯誤率計算
圖11 實驗二幻聽組、非幻聽組與控制組在來源監控作業上之圖片歸因錯誤率
圖12 實驗二幻聽組、非幻聽組與控制組在組內情緒性字詞上之圖片歸因錯誤率
圖13 實驗二幻聽組、非幻聽組與控制組在來源監控作業上之文字歸因錯誤率
圖14 實驗二幻聽組、非幻聽組與控制組在組內情緒性字詞上之文字歸因錯誤率


表目次
表1 來源監控的實徵研究整理
表2 實驗一 字詞個數
表3 實驗一 基本人口變項
表4 實驗一 幻聽組與非幻聽組於PANSS上P3指標分數
表5 實驗一 幻聽組、非幻聽組及控制組於BDI及BAI分數
表6 實驗一 性別與各變項之變異數分析摘要表
表7 實驗一 相關分析
表8 實驗一 幻聽組、非幻聽組與控制組之記憶再認表現
表9 實驗一 幻聽組、非幻聽組與控制組在來源監控作業上之外歸因錯誤率
表10 實驗一 幻聽組、非幻聽組與控制組在外歸因錯誤率變異數分析摘要表
表11 實驗一 幻聽組、非幻聽組與控制組在來源監控作業上之內歸因錯誤率
表12 實驗一 幻聽組、非幻聽組與控制組在內歸因錯誤率變異數分析摘要表
表13 實驗二 字詞與圖片個數
表14 實驗二 詞彙的詞頻、筆畫、情緒價性的平均數與標準差
表15 實驗二 基本人口變項
表16 實驗二 幻聽組與非幻聽組於PANSS上P3指標分數
表17 實驗二 幻聽組、非幻聽組及控制組於BDI及BAI分數
表18 實驗二 性別與各變項之變異數分析摘要表
表19 實驗二 相關分析
表20 實驗二 幻聽組、非幻聽組與控制組之記憶再認表現
表21 實驗二 幻聽組、非幻聽組與控制組在來源監控作業上之圖片歸因錯誤率
表22 實驗二 幻聽組、非幻聽組與控制組的圖片歸因錯誤率變異數分析摘要表
表23 實驗二 幻聽組、非幻聽組與控制組在來源監控作業上之文字歸因錯誤率
表24 實驗二 幻聽組、非幻聽組與控制組在文字歸因錯誤率變異數分析摘要表

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