臺灣博碩士論文加值系統

目的：評估連續表現測驗（Continuous Performance Test, CPT）所測量之持續注意力與威斯康辛卡片分類測驗（Wisconsin Card Sorting Test, WCST）所測量之抽象理解能力與適應性轉變能力的缺失，是否各自為精神分裂症患者所特有。方法：臨床個案由訪員以遺傳研究診斷問卷（Diagnostic Interview for Genetic Studies, DIGS）直接訪談，再經由專家依DSM-IV之診斷標準確診後納入。共計有精神分裂症患者43位；無精神病性特質之重鬱症患者22位；無精神病性之雙極性患者24位；伴隨與心情一致之精神病性特質之雙極性患者32位，和伴隨與心情不一致之精神病性特質之雙極性患者16位。臨床個案並完成CPT與WCST兩種測驗 ; 其中部分住院個案（41位精神分裂症患者與13位雙極性患者）並在出院時重測這兩個測驗。CPT的健康對照組採用社區隨機選出之345位成人，而WCST之健康對照組則由醫院健檢病人加上少數民間機構人員組成，共有211人。結果：精神分裂症患者在CPT的表現和伴隨與心情不一致之精神病性特質之雙極性患者無異，皆顯著較無精神病性特質之重鬱症患者、無精神病性之雙極性患者和伴隨與心情一致之精神病性特質之雙極性患者來的差。而精神分裂症患者在WCST的表現和伴隨與心情一致之精神病性特質之雙極性患者無異，皆顯著較一般健康對照來的差。比較住院時與出院時之施測結果，精神分裂症患者在CPT與WCST二者都沒有改善；但雙極性患者在有遮蔽之CPT上有顯著改善，無遮蔽之CPT與WCST則一樣沒有改善。結論：CPT與WCST之施測結果，可能會受到精神病性症狀所影響；而症狀的改善可能會導致雙極性患者之部分CPT改善，精神分裂症患者則否。

Objectives: To evaluate whether the deficit on sustained attention as measured by the Continuous Performance Test (CPT) and deficits on abstraction ability and flexibility in thinking Wisconsin Card Sorting Test (WCST) are specific to schizophrenic patients. Methods: Participants included patients with bipolar disorder with mood-congruent psychotic features (N=32), bipolar disorder with mood-incongruent psychotic features (N=16), bipolar disorder without psychosis (N=24), major depression without psychotic features (N=22) and schizophrenia (N=43); all of them completed both CPT and WCST. Part of inpatients 41 schizophrenia patients and 13 bipolar patients were retested for the two tests at discharge. Patients were directly interviewed using the Diagnostic Interview for Genetic Studies and their diagnoses were made by experts, consensus according to DSM-IV. The normal controls were a community-based sample of 245 persons for the CPT and a hospital-based sample of 211persons for the WCST. Results: The CPT scores of patients with schizophrenia and bipolar disorder with mood-incongruent psychotic features were significantly worse then those of patients with bipolar disorder with mood-congruent psychotic features, bipolar disorder without psychotic features, major depression without psychotic features. The WCST scores of patients with schizophrenia and bipolar disorder with mood-congruent psychotic were significantly worse then normal controls. Comparing discharge with admission, patients with schizophrenia and bipolar disorder did not improve on the CPT and WCST scores except bipolar patients on the degraded CPT score. Conclusions: These findings suggest that performance on both the CPT and WCST may be affected by psychotic symptoms. When the psychotic symptoms improved, the degraded CPT of patients with bipolar disorder would improve, while schizophrenic patients would not.

中文摘要1
英文摘要2
第一章 前言3
第二章 文獻探討5
第一節 連續表現測驗5
壹、CPT工具之簡介與版本5
貳、精神分裂症患者與一般健康對照組在CPT表現的比較6
參、精神分裂症與高危險群對照之CPT分數8
第二節 威斯康辛卡片分類測驗9
壹、WCST工具之簡介與版本9
貳、精神分裂症患者與一般健康對照組在WCST表現的比較11
參、精神分裂症與高危險群對照之WCST分數13
第三節 研究目的14
第三章 材料與方法15
第一節 研究樣本15
第二節 研究工具17
壹、連續表現測驗17
貳、威斯康辛卡片分類測驗19
參、情感性疾患與相關疾病研究診斷問卷20
第三節 收案流程21
壹、健康對照組22
貳、臨床個案組22
第四節 資料整理與統計分析 25
第四章 結果27
第一節 收案情形與基本人口資料的描述27
壹、健康對照組27
貳、臨床個案組28
第二節 CPT測驗的表現情形30
壹、金山居民在CPT的表現30
貳、精神疾患之CPT表現與分析比較31
第三節 WCST測驗的表現36
壹、一般健康對照在WCST的表現36
貳、精神疾患在WCST的表現與分析比較37
第五章 討論70
第一節 CPT之探討70
第二節 WCST的探討73
第三節 樣本特性與限制75
第四節 未來研究展望76
參考文獻77
附表40
附圖62

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