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研究生:江佩娟
研究生(外文):Peichuan Chiang
論文名稱:病患的精神分裂症症狀與其非精神病性家屬的分裂病性人格特質:家族研究
論文名稱(外文):Symptoms of schizophrenia and schizotypal features in their nonpsychotic relatives: A Family study
指導教授:陳為堅陳為堅引用關係
指導教授(外文):Chen Wei-Jen
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:流行病學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2002
畢業學年度:90
語文別:中文
中文關鍵詞:家族研究因素分析分裂病性人格特質
外文關鍵詞:family studyfactor analysisschizotypy / schizotypal personality
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中文摘要
背景與目標:藉用連續性精神病學症狀來偵測精神分裂症的易感受基因座(susceptibility loci),可能會比用類別式診斷獲得更高的統計檢力。但是文獻上關於精神分裂症症狀的面向與非精神病性個體的人格特質之間是否具有共享的病因學因素的探討非常有限。本研究試圖去釐清精神分裂症的症狀與他們的一等親之分裂病性人格因素間的可能關係。
方法:針對符合DSM-IV診斷的精神分裂症病患,於住院時(86名)的活性與負性症候群量表評估得分,與採用半結構式訪談所獲得的非精神病性一等親(227名)之分裂病性人格的評分進行因素分析。之後,我們採用迴歸分析檢驗病患的症狀預測其家屬分裂病性人格得分的能力,並調整家屬的年齡、性別、教育程度與親屬類別。我們總共檢驗病患於五個追蹤時間點的症狀資料,包括入院(86名)、出院(79名)、第三個月(53名)、第六個月(73名)、第一年(68名)的病患資料,與其所對應的家屬資料(204名、190名、128名、177名和170名)。
結果:精神分裂症病患在不同時間點之症狀皆可獲得活性、負性與解組三個因素,而無精神病性症狀之家屬人格特質則可獲得認知/情感症候、敏感焦慮、孤獨內向、活性分裂病性人格、怪異行為、與情感受限六個人格特質因素。在調整家屬的年齡、性別、教育程度與親屬類別的影響後,迴歸模式顯示入院病患的負性症狀可以預測家屬的敏感焦慮(β=0.395, p=0.037),活性症狀可以預測家屬的認知/情感症候(β=0.508, p=0.022),解組症狀可以預測家屬的活性分裂病性人格(β=0.568, p=0.009)與情感受限(β=0.295, p=0.039)。出院與第三個月時,病患的負性症狀可以預測家屬的內向孤獨(β=-0.165, p=0.035; β=0.328, p=0.035)。第六個月的分析則顯示,病患的負性症狀可以預測家屬的敏感焦慮(β=0.464, p=0.030)與怪異行為(β=0.308, p=0.015)。
結論:精神分裂症的負性症狀因素比活性症狀與解組症狀更能預測家屬的分裂病性人格特質因素,且病患的負性症狀最能一致地預測家屬的內向孤獨與敏感焦慮。這顯示:1 ) 負性症狀是比較好的家族性預測指標;2 ) 精神分裂症的負性症狀因素與負性分裂病性人格特質在病因學上可以視為連續性的變化。

Abstract
Objective: Continuous rather than categorical approach to psychopathology may be statistically more powerful to detect susceptibility loci for schizophrenia. There has been limited research into shared etiology factors between the dimensions of schizophrenic symptomatology and schizotypal features in nonpsychotic individuals. We therefore sought to examine the relationship between symptoms of schizophrenic probands and dimensions of schizotypy in their nonpsychotic first-degree relatives.
Methods: Factor analyses were performed on the Positive and Negative Syndrome Scale
ratings from 86 patients at admission with a DSM-IV diagnosis of schizophrneia and on
the Structure Interview for Schizotypy ratings from 227 of their nonpsychotic first-degree
relatives. We examined the ability of symptoms in probands to predict factors of
schizotypy in relatives using regression analyses, adjusted for relatives’ age, sex, education
and relationship to proband. In total, we examined the PANSS ratings from probands at
five different time-points: admission (n=86), discharge (n=79), the third month (n=53), the
sixth month (n=73), and the first-year (n=68) after index admission, and with their
nonpsychotic relatives where SIS were available (n=204, 190, 128, 177, and 170,
respectively).
Results: We obtained consistently three meaningful schizophrenic factors
(Positive, Negative, and Disorganization) similarly on the PANSS ratings from probands
assessed at five different time-points, respectively, and six schizotypal factors
(Cognitive/affect sign, Sensitivity/anxiety, Isolation/introversion, Positive schizotypy, Odd
behavior, and Constricted affect) on the SIS ratings from their relatives. For probands’
symptoms at admission, Negative factor in probands predicted Sensitivity/anxiety (β
=0.395, p=0.037) in relatives; Positive factor predicted Cognitive/affect sign (β=0.508,
p=0.022) ; and Disorganization factor predicted Positive schizotypy (β=0.568,
p=0.009) and Constricted affect (β=0.295, p=0.039). Negative factor in probands
assessed at remission and in the third month predicted Isolation/introversion (β=-0.165,
p=0.035; β=0.328, p=0.035) in relatives, while Negative factor in probands assessed in
the sixth month predicted Sensitivity/anxiety (β=0.464, p=0.030) and Odd behavior (β
=0.308, p=0.015) in relatives.
Conclusions: Negative factor in schizophrenia predicts more consistently specific
schizotypal factors, i.e., Isolation/introversion and Sensitivity/anxiety, in relatives than
either Positive or Disorganization factor. This indicates that (1) negative schizophrenic
symptom is a better predictor for familiality; and (2) negative schizophrenic symptom
factor occurs on an etiological continuum with its personality-based counterparts.

總目錄
授權書…………...……………………………………………………………I
致謝….………………………………………………………………………III
中文摘要……………………………………………………………………..V
英文摘要…………………………………………………………………...VII
目錄…………………………………………………………………………IX
表格目錄……….……………………………………………………….…XIII
附錄……………………………………………………………………...…XV
目錄
第一章 研究背景………………………………………………………....1
第一節 研究動機與目的………………………………………………1
第二節 分裂病性人格特質(schizotypal personality or schizotypy)的
歷史回顧………………………………………………….…..3
第三節 精神分裂症與分裂病性人格疾患的家族遺傳相關….....……6
第四節 分裂病性人格特質連續性(continuity)的理論基礎…….…7
第五節 分裂病性人格特質的多重面向(multidimensionality)……8
第六節 研究類型的進展與研究現況……...………………………..11
第二章 研究方法及材料……………………………………….……...16
第一節 研究設計……………..……………………………….……16
第二節 研究個案……………….…………………………….…….16
第三節 訪談工具與診斷步驟....……....…………………………...17
第四節 資料處理與分析……….…………..………………………19
壹、敘述性統計分析與單變項分析…………………………...19
貳、因素分析…………………………………………………..19
參、相關分析…………………………………………………...20
第三章 資料分析結果………………………………………………….22
第一節 精神分裂症患者之非精神病性一等親的人口學資料與
SIS得情形……………………………………………..22
壹、家屬樣本描述……………………………………………22
貳、家屬人口學特質分布……………………………………22
參、家屬的分裂病性人格症狀與症候的得分分布…………23
肆、家屬分裂病性人格症狀得分分布之集中情形與離散情形(SIS 裡19個總體評估項目)…………………………25
伍、精神分裂症患者之非精神病性一等親的年齡、性別與教育程度,及SIS裡19個分裂病性人格項目間的相關……25
第二節 精神分裂症病患的PANSS得分情形………………………26
壹、病患樣本說明……………………………………………...26
貳、病患PANSS得分情形……….……………………………26
第三節 家屬分裂病性人格特質與精神分裂症患者症狀的因素分析結果………………………………………………………….27
壹、家屬樣本分裂病性人格特質的因素分析結果………….27
貳、精神分裂症患者活性症狀與負性症狀之因素分析結果..30
第四節 精神分裂症病患的症狀因素與其非精神病性一等親之分裂
病性人格特質之相關情形…..……………………………...31
壹、皮爾森積差相關……...……………………………………31
貳、線性相關……………..……………………………………32
第四章 綜合討論...……………………….……………………………..33
壹、精神分裂症病患的三因素結構……………………….…..33
貳、病患的負性症狀是比較好的家族性預測指標…..……….33
參、負性症狀與負性人格特質有連續性關係…………..…….34
肆、解組症狀與情感受限的關係…………………………..…35
伍、其他結果…………………………………………………..36
陸、研究限制……………………………………………….…..37
參考文獻………………………………………………………………….…39
表格目錄
表一、非精神病性一等親(227名)的親屬類別與性別分布……………....53
表二、非精神病性一等親(227名)年齡與教育年數分布………………...54
表三、19題SIS評估的分裂病性人格症狀與症候的得分情形 (227名家
屬)…….…………………………………..…………………………55
表四、家屬分裂病性人格症狀得分分布之集中情形與離散情形(SIS裡19個總體評估項目)…………………………………………..……56
表五、變項間的相關矩陣……………………………………….…………57
表六、第一年追蹤內各次所評估的精神分裂症病患的PANSS得分平均值
與標準差………………………………………..………………..…59
表七、非精神病性一等親(227名),以SIS評估的十九個分裂病性人格症狀與症候,經由最大變異法因素分析所獲得的因素負荷量…60
表八、病患有完成PANSS之非精神病性一等親(204名),以SIS評估的
十九個分裂病性人格症狀與症候,經由最大變異法因素分析所獲
得的因素負荷量……………….………………………………..…62
表九、精神分裂症患者(86名),於入院時以PANSS所評估的十四項活性與負性量表題目,經由最大變異法之因素分析所獲得的因素負
荷量……………….…………………………………………………64
表十、精神分裂症患者(79名),於出院時以PANSS所評估的十四項活性與負性量表題目,經由最大變異法之因素分析所獲得的因素負荷量…………………………………………………………………65
表十一、精神分裂症患者(53名),於三個月追蹤時以PANSS所評估的十四項活性與負性量表題目,經由最大變異法之因素分析所獲得的因素負荷量…………………………………………………66
表十二、精神分裂症患者(73名),於六個月追蹤時以PANSS所評估的十四項活性與負性量表題目,經由最大變異法之因素分析所獲得的因素負荷量…………………………………………………67
表十三、精神分裂症患者(68名),於第一年追蹤時以PANSS所評估的十四項活性與負性量表題目,經由最大變異法之因素分析所獲得的因素負荷量…………………………………………………68
表十四、精神分裂症病患因素分析摘要表(因素負荷量大於0.5以上的題項)…………………………………………………………...……69
表十五、精神分裂症患者的症狀因素(入院、出院與第三個月)與其非精神病性一等親的分裂病性人格特質因素之皮爾森積差相關…………………………………………………………………70
表十六、精神分裂症患者的症狀因素(半年與第一年評估)與其非精神
病性一等親的分裂病性人格特質因素之皮爾森積差相關……71
表十七、精神分裂症患者的症狀因素(86名病患,入院時的評估)與其
非精神病性一等親的分裂病性人格特質因素(204名家屬)之線
性相關……………………………………………………………72
表十八、精神分裂症患者的症狀因素(79名病患,出院時的評估)與
其非精神病性一等親的分裂病性人格特質因素(190名家屬)
之線性相關……………………………………………………….73
表十九、精神分裂症患者的症狀因素(53名病患,三個月時的追蹤評估)與其非精神病性一等親的分裂病性人格特質因素(128名家屬之線性相關……………………………………………………….…74
表二十、精神分裂症患者的症狀因素(73名病患,六個月時的追蹤評估)
與其非精神病性一等親的分裂病性人格特質因素(177名家屬)
之線性相關………………………………………………..…….75
附錄
修正版準精神分裂症結構化問卷(SIS)……………………………………76

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中文文獻
陳英豪、吳裕益:測量與評量。復文圖書出版社,2001年。
陳順宇:多變量分析。華泰書局,2000年。
黃俊英:多變量分析〈第七版〉。台北中國經企研究所,2000年。
連盈如,精神分裂症患者親屬的準精神分裂性人格特徵:探索性與驗證性因素分析研究。台灣大學公共衛生學院流行病學研究所碩士論文
,1998年。

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