臺灣博碩士論文加值系統

本研究目的在翻譯Scale to assess Unawareness of Mental Disorder，建立中文版「精神分裂症病識感評量表」的信、效度，並探討中文版「精神分裂症病識感評量表」的得分，與連續表現測驗得分之相關。
本研究採立意取樣，樣本來自北部某醫學中心的精神科急性、復健病房，以半結構式訪談：針對31名精神分裂症患者，進行評量表之再測信度與評分者間一致性的信度檢定；在評量表之效度檢定方面，除採用專家鑑定內容效度外，並收案49名，以中文版「活性與負性症狀評量表」（Positive And Negative Syndrome Scale）中的G12.判斷力及病識感障礙題項的得分，進行幅和效度（convergent validity）的檢定；同時並針對44名個案、進行無遮蔽連續表現測驗，23名個案、進行25％遮蔽連續表現測驗。
研究結果顯示：（一）本研究翻譯建立的中文版「精神分裂症病識感評量表」，係針對精神分裂症患者為對象的一個多層面評估病識感之評量表。評量個案是否具有：1.罹患精神疾病的覺知，2. 藥物治療效果的覺知，3.精神疾病造成之社會影響的覺知，4.對於精神症狀的覺知，5.對其精神症狀做正確歸因。（二）中文版「精神分裂症病識感評量表」其再測信度及評分者間一致性，係以內在等級相關檢定，結果顯示本評量表具有相當的穩定度及高度的評分者間一致性。（三） 將中文版「精神分裂症病識感評量表」的得分，與中文版「活性與負性症狀評量表」中的G12.得分做相關，進行幅和效度（convergent validity）的檢定，結果具有高度的相關。（四）中文版「精神分裂症病識感評量表」的得分，與連續表現測驗之相關，以Pearson積差相關（Pearson’s Product-Moment Correlation）進行分析，結果並無統計上意義。
本評量表的研究與臨床施測所得的結果，證明此一多層面評估病識感之評量表將可提供臨床相關領域的參考與運用。

The purpose of this study was to examine Chinese version of “Scale to assess Unawareness of Mental Disorder” as an effective instrument for clinical workers. In addition to establish the validity and reliability of the Chinese version of thie scale, we also intend to find the relationship between the score of “Scale to assess Unawareness of Mental Disorder” and the Continuous Performance Test in schizophrenic patients.
The study subjects included schizophrenic patients who were admitted to the acute psychiatric ward and rehabilitation ward of a teaching hospital in Taipei. The data were collected by semi-structured interviews with patients: 31 patients were interviewed to confirm inter-rater and test-retest reliability. To verify convergent validity, we have interviewed 49 patients while G12 item of PANSS（Positive And Negative Syndrome Scale）” Lack of judgement and insight” and the score of “Scale to assess Unawareness of Mental Disorder” were compared. Furthermore, we also investigated the performance of our samples on two sessions of the Continuous Performance Test 1-9( undegraded and 25% degraded).
The results showed that the Chinese version of “Scale to assess Unawareness of Mental Disorder” was a effective instrument in evaluating Taiwanese schizophrenic patients’ lack of awareness of the deficits, social consequences of the disorder, and effect of medication. The scales also effectively evaluated the awareness and the attribution of his (her) psychotic symptoms. The test-retest reliability and inter-rater reliability of this Chinese version was rather good. In addition, G12 item in PANSS and subscales in the “Scale to assess Unawareness of Mental Disorder” showed rather high correlations. However, we could not find any statistical relationship between the subscales and the Adjusted z score of d’ & lnβ in Continuous Performance Test.
The results of this study suggest that the Chinese version of the scale was a rather excellent scales for the evaluation of multiple aspects of insight in schizophrenia.

目 錄
誌謝I
論文摘要III
AbstractV
目錄VII
圖表目錄X
第一章 緒論1
第一節 研究動機1
第二節 研究目的4
第二章 文獻查證5
第一節 病識感的定義與測量5
第二節 病識感對精神分裂症病患的重要性14
第三節 精神分裂症16
第四節 影響精神分裂症病患病識感的假說與臨床研究探討21
第五節 精神分裂症與連續表現測驗之相關27
第六節 評量表的信度與效度29
第三章 研究過程與方法35
第一節 研究過程35
第二節 研究對象39
第三節 研究工具40
第四節 收案與評量表評量過程48
第五節 資料整理與分析51
第六節 倫理考量53
第四章 研究結果54
第一節 研究對象基本屬性54
第二節 中文版「精神分裂症病識感評量表」之專家內容效度57
第三節 中文版「精神分裂症病識感評量表」的信度60
第四節 中文版「精神分裂症病識感評量表」的效度65
第五節 中文版「精神分裂症病識感評量表」之得分67
第六節 中文版「精神分裂症病識感評量表」得分與研究對象基本屬性之相關69
第七節 評量表的得分與連續表現測驗得分的相關71
第五章 討論75
第一節 中文版「精神分裂症病識感評量表」的內容制定75
第二節 中文版「精神分裂症病識感評量表」的信度79
第三節 中文版「精神分裂症病識感評量表」的效度82
第四節 中文版「精神分裂症病識感評量表」的得分84
第五節 中文版「精神分裂症病識感評量表」的得分與研究對象基本屬性之相關85
第六節 中文版「精神分裂症病識感評量表」的得分與連續表現測驗得分的相關86
第六章 結論與建議88
第一節 結論88
第二節 應用與建議92
第三節 研究限制與相關建議94
參考資料97
附錄一 研究工具使用同意函105
附錄二 問卷內容效度之專家名單106
附錄三 個案基本資料107
附錄四 精神疾病患者病識感評量表108
附錄五 中文版SUMD探詢句指引118
附錄六SUMD症狀次量表與其相對應之症狀評量表分項123
附錄七需請臨床醫師進行評估之SAPS、SANS部分評量表124

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