臺灣博碩士論文加值系統

由於躁鬱症患病人口比例高，死亡機率高，加上患者本身在處於躁期時病識感較差，這些因素使得躁鬱症已逐年受到社會上的重視。如何針對躁鬱症患者進行有效介入，一直是醫療上的重要議題，若能在藥物治療之餘，輔以心理治療加以介入，對於躁鬱症患者的預後會更有幫助。心理治療的介入方向，是針對心理病理因素加以治療，故探求精神疾患的心理病理因素，實為改善病況最基礎的研究方式，此外，情緒也是影響躁鬱症病程的重要因素之一。因此本研究希望，藉由躁鬱症心理病理因素與情緒能力的探討，來搭配相關醫療介入，俾使心理治療能有效率地進行。
本研究透過比較40位躁鬱症患者、21位憂鬱患者與134位一般受試者其心理病理因素與情緒能力的表現，來評估三組之間的差異。結果顯示躁鬱組與一般組在對負向事件的永久性歸因、完美主義信念、自尊程度、增加正向情緒、失能調節、覺察負向情緒以及對負向情緒產生負向評價等七項因素上有所差異，除了對負向事件的永久性歸因與自尊程度外，其餘躁鬱組得分皆高於一般組；躁鬱組與憂鬱組則在增加正向情緒、覺察正向情緒、對正向情緒產生正向評價以及覺察負向情緒等四項因素上有所差異，躁鬱組在這四項因素的得分皆高於憂鬱組。

Bipolar disorder is being recognized gradually due to the high morbidity and mortality and poor insight during a manic episode of bipolar patients. In medical fields, it has been an important issue how to treat the bipolar patients effectively and efficiently. It would be better for prognosis of bipolar patients if we conduct psychological interventions combine with medication, hence, exploring the psychopathological factors which are the foundation to improve course and outcome. In addition, emotion also plays an important role to affect the course of bipolar disorder. Therefore, The aim of this study was to explore the psychopathological factors and emotional abilities of patients with bipolar disorder, and to combine medical treatment to enhance the efficiency of psychotherapy.Therefore, this study wished to enable the psychotherapy effectively by means of exploring the psychopathological factors and emotional abilities of bipolar disorder, and combining with medical treatment.
T his study evaluated variation between three groups by means of comparing with their performance of psychopathological factors and emotional abilities, three groups contain 40 bipolar patients, 21 depressive patients and 134 normal control participants. The result demonstrated that there were seven factors that have a significant difference between bipolar group and control group, and these factors contain : Permanent attribution of negative events, Perfectionism, Self-esteem, Increasing positive affections, Non-adaptable regulation, Awareness of negative affections, Negative appraisal of negative affections, in addition to Permanent attribution of negative events and Self-esteem, scores of other factors in bipolar group were significantly higher than control group. There were four factors that have a significant difference between bipolar group and depression group, and these factors contain : Increasing positive affections, Awareness of positive affections, Awareness of negative affections, Positive appraisal of positive affections, scores of four factors in bipolar group were significantly higher than depression group.
This study also use multiple regression analysis to predict the effect of psychopathological factors and emotional abilities on manic and depressive symptoms, and use structural equation modeling to assess the goodness-of-fit. The result indicated that factors affecting depressive symptoms contain: Permanent attribution of positive events、Perfectionism、Self-esteem、Circadian rhythms、Non-adaptable regulation；factors affecting manic symptoms contain: Self-esteem、Increasing positive affections、Positive appraisal of positive affections.
In conclusion, significant differences were indeed observed on psychopathological factors and emotional abilities between three groups, and psychopathological factors and emotional intelligence also affect manic and depressive symptoms significantly. Psychopathological factors and emotional abilities discovered in this study provide important guidance and direction for further research of pathology and treatment of bipolar disorder.

目錄

第一章 研究動機...…………………………………………………...................1
第二章 文獻回顧...…………………………………………………...................4
第一節 簡介躁鬱症………………………………………….......................4
一. 躁鬱症之定義…………..……………….…………......................4
二. 躁鬱症之症狀…………………………………….........................5
三. 躁鬱症之流行病學…………………………………....................6
四. 躁鬱症之發病機制……………………… ……….......................7
五. 躁鬱症之治療……..……………………………….......................8
第二節 躁鬱症心理病理因素….………………………….....................10
一. 歸因模式…………………...………………………......................11
二. 失功能態度…………………..……………………......................13
三. 自尊…………………………………………..................................15
四. 生活壓力事件…………….………………………......................18
五. 因素之間的交互作用……...……………………......................21
第三節 憂鬱症心理病理因素……………………………......................23
一. 歸因模式…………………...……………………….....................23
二. 失功能態度…………………..……………………......................24
三. 自尊……………………...…………………...................................24
四. 生活壓力事件…………….………………………......................25
第四節 情緒疾患與情緒能力……………………………......................27
一. 簡介情緒能力…….…....………………………........................27
二. 情緒覺察與躁鬱症……….…………….…….….....................29
三. 情緒調節與躁鬱症…….………………….….….....................31
第五節 文獻回顧總結…………...…………………………......................38
第三章 研究問題……………………….……………..…………......................41
第一節 研究問題與假設…..….….…………..……………......................41
第二節 研究架構………....…………..………..……………......................46
第四章 研究方法……………………….………..………………......................47
第一節 研究設計…………………..…………..……………......................47
第二節 研究程序…………………..………………..………......................48
第三節 研究樣本…………………..………………..………......................49
第四節 研究工具…………………..…………………..……......................53
第五節 資料分析方法…………..…...……………..……….....................58
第五章 研究結果……………………….………………..………......................60
第一節 一般組、憂鬱組、躁鬱組其心理病理因素與情緒能力差
異分析……………………………………………..……………....60
一. 一般組、憂鬱組、躁鬱組心理病理因素與情緒能力描
述性統計資料與變異數分析……....………..........................60
二. 三組心理病理因素與情緒能力事後比較分析..................66
三. 躁鬱組與一般組心理病理因素與情緒能力事後比較分
析……………………………………………………………….....68
四. 躁鬱組與憂鬱組心理病理因素與情緒能力事後比較分
析………………………………………………….........................71
第二節 研究模式之統計分析說明、心理病理因素與情緒能力之
相關分析………………………………………...........................74
一. 研究模式之統計分析說明…………………...........................74
二. 心理病理因素與情緒能力之相關分析…............................75
第三節 生活壓力事件、生活節律作息、心理病理因素、情緒能
能力、躁鬱症狀之迴歸分析…………..………......................80
一. 生活壓力事件影響生活節律作息之評估.........................81
二. 心理病理因素影響躁鬱症狀之評估.………......................82
三. 情緒能力影響躁鬱症狀之評估.…………............................85
第四節 逐步迴歸結果統整與結構方程模式…………....................88
一. 逐步迴歸結果統整….……...…..………….............................88
二. 結構方程模式與之適合度衡量與模式修正.....................92
第六章 結論與討論…………………….……………..………….....................98
第一節 結果摘要…………….……….………..…………........................98
第二節 討論……………..……….……………..…………......................110
第三節 結論……………..……….……………..…………......................116
第七章 研究限制與未來方向.….……………..…………...........................119
第一節 研究限制……..……...….……………..………….....................119
第二節 研究貢獻……..……...….……………..………….....................122
第三節 未來研究方向……...….……………..…………......................123
參考文獻.................................................................................................................125
附錄一、 施測同意書...………………………………………......................134
附錄二、 心理病理因素之相關分析表………………………................135
附錄三、 生活壓力量表……………………………………........................136

圖表目錄

圖3-2-1 心理病理因素與情緒能力影響躁鬱症狀模式圖.....................................46
圖5-3-1 心理病理因素與情緒能力影響躁鬱症狀之模式一.................................92
圖5-3-2 心理病理因素與情緒能力影響躁鬱症狀之模式二….............................94


表2-4-1 情緒調節策略分類表...............................................................................33
表2-5-1 躁鬱症患者與一般人其心理病理因素、生活壓力事件以及情緒能力表
現差異摘要表..........................................................................................38
表2-5-2 躁鬱症患者與憂鬱症患者其心理病理因素、生活壓力事件以及情緒能
力表現差異摘要表..................................................................................39
表4-3-1 三組成員之背景資料對照表...................................................................52
表5-1-1 三組在各項心理病理因素與情緒能力指標上的描述性統計資料摘要與變異數分析摘要表..............................................................................62
表5-1-2 三組在心理病理因素與情緒能力指標上的事後比較摘要表...............67
表5-1-3 躁鬱組與一般組在心理病理因素與情緒能力指標上的事後比較摘要表………………………………………………………………………..70
表5-1-4 躁鬱組與憂鬱組在心理病理因素與情緒能力指標上的事後比較摘要表………………………………………………………………………..72
表5-2-1 心理病理因素與情緒能力之相關分析表……………………………..79
表5-3-1 「心理病理因素」、「情緒能力」、「生活壓力事件」、「生活節律
作息」與「躁狂症狀」以及「憂鬱症狀」之皮爾森相關係數摘要表....80
表5-3-2 心理病理因素預測對憂鬱症狀解釋程度之迴歸分析………....……...84表5-3-3 情緒能力預測對躁狂症狀解釋程度程度之迴歸分析………………..87
表5-4-1 心理病理因素與情緒能力預測對憂鬱症狀解釋程度之迴歸分析…..89
表5-4-2 心理病理因素與情緒能力預測對躁狂症狀解釋程度之迴歸分析…..91
表5-4-3 心理病理因素與情緒能力預測對躁鬱症狀影響之模式比較………..95
表6-1-1 躁鬱組、一般組與憂鬱組心理病理因素與相關情緒能力之變異數分析整理表…………………………………………………………………..99
表6-1-2 心理病理因素與情緒能力之相關分析整理表………………………100
表6-1-3 心理病理因素與情緒能力影響躁鬱症狀之迴歸分析整理表….........102
表6-1-4 修正後心理病理因素與情緒能力影響躁鬱症狀之模式整理表.……103

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