臺灣博碩士論文加值系統

衝動性 (impulsivity)是一個複雜且多面向的概念，其定義往往會因學派的不同，而有極大的差異。其中行為學派以延宕滿足失能的角度來定義衝動性。例如，當個體同時面對兩個不同的選項時，若個體選擇價值較小，但延宕時間較短的酬賞物，則被認為是具有「衝動行為」。
Ho, Mobini, Chiang, Bradshaw & Szabadi（1999）提出一項乘積雙曲線典範 (multiplicative hyperbolic model [MHM])，以量化分析的方法闡述酬賞物大小、延宕增強（衝動性）與機率增強（冒險性）對動物選擇行為的作用。此典範在人類受試者上的適用性仍有待臨床研究的檢驗。過去的研究顯示，腦傷患者普遍有較高的衝動性，因此本研究即以腦傷患者為對象，用以檢驗MHM對衝動選擇行為的假設。
本研究除了由林口長庚醫院腦神經外科門診招募32名額葉損傷的患者外，另以廣告的方式招募33名健康受試者參與研究。所有受試者均接受一般智能、神經心理及衝動性之評估。由於本研究所招募之額葉損傷患者之受損部位及受傷範圍不盡相同，因此各項研究資料的分析，均先依其受損部位與範圍進行分組比較，之後再與控制組進行比較。
本研究結果顯示，所有額葉損傷者在一般智能和神經心理測驗的表現均顯著地比健康受試者差。同時，在部分神經心理功能方面，額葉損傷者也會因有無額葉以外區域損傷而出現顯著差異。再者，在一項改編自動物跨時選擇行為作業上，所有額葉損傷患者與健康受試者在此作業的選擇偏好會因酬賞物延宕時間的長短而有顯著差異。其中，額葉損傷患者的確顯現出較高的衝動選擇傾向，且此一傾向亦可藉由MHM所提出的量化典範予以描述。雖然，研究的結果同時也顯現出個體對酬賞物大小的敏感度亦可能因額葉損傷而產生改變，但此改變的程度僅趨近統計顯著的水準。
本研究再次凸顯出額葉損傷者除了在神經心理功能方面的確有受損的現象之外，也支持其衝動性較高的說法。同時，以選擇行為作業表現檢驗MHM的假設時也發現，額葉損傷患者在此作業的表現與眼窩前額葉受損的動物(Kheramin et al, 2002)有著極為類似的選擇傾向。

Impulsivity is a complex and multi-facet concept. People with different theoretical persuations define impulsivity differently. In the realm of behavioural approach, impulsivity is viewed as being unable to tolerate delayed gratification. For example, when being confronted with two choice alternatives, if the organism tends to choose the immediate and smaller reward in preference to the bigger and delayed reward, he/she will be regarded as being more impulsive.
Ho, Mobini, Chiang, Bradshaw & Szabadi (1999) proposed a multiplicative hyperbolic model (MHM) to quantitatively describe choice under such conditions based on animal research. The MHM assumes that choice is likely to be modulated by the interplay between reward size, its delays (impulsivity) and the odds against its occurrences (risk taking). Its applicability to clinical populations has not been confirmed. Patients with brain injuries tend to be more impulsive than healthy volunteers. Therefore, they may represent an ideal sample for testing some basic assumptions proposed by the MHM.
Thirty-two patients with frontal lobe injuries were recruited from the Department of Neurosurgery of Chang Gung Memorial Hospital (Lin-Kou). Another 33 healthy voltuneers were recruited by advertisement as the control group. All subjects underwent a series of intellectucal screening, neuropsychological assessment and impulsive behavioural tasks. As the sites of cerebral injuries were qualitatively different across many patients, the data obtained from all patients were further re-allocated based on their affected hemispheric and/or lobar sites before analyses.
The results showed that the performance of all patients on the general ability tests and most of the neuropsychological tests was significantly inferior to that of the healthy volunteers. The performance of patients with pure frontal damages differed significantly from that of the patients with additional damages to other regions on several neuropsychological tests. However, all the measures of impulsivity did no differ significantly between these two different patient groups. In the case of an inter-temporal behavioral task, there were significant differences in choice preference between all patients and volunteers when various sets of delays were employed. And, all the frontal-injured patients did show significantly stronger tendency for impulsive choice. This trend was further epitomized by using the null equations of MHM to quantify the choice preferences. Although there was also a trend for sensitivity to reward size being altered by the frontal lobe damages, the trend just fell short of statistical significane.
The study lends further support of the notion that the frontal lobe damages may result in specific neuropsychological deficits. In addition, when an behavioural task was employed, the frontal-injured patients’s choice preference is characteristically similar to that of orbital prefrontal lesioned animals (Kheramin et al, 2002).

目 錄
長庚大學碩士學位論文 指導教授推薦書……………………… i
長庚大學博(碩)士學位論文口試委員會審定書……………… ii
博碩士論文電子檔案上網授權書……………………………… iii
長庚大學博碩士紙本論文著作授權書……………………… iv
誌謝……………………………………………………………… v
摘要……………………………………………………………… vii
ABSTRACT………………………………………………………… ix
第一章 緒論………………………………………………………1
1.1. 前言………………………………………………………… 1
1.2. 研究背景…………………………………………………… 5
1.2.1 「衝動性」之概念與定義…………………………… 5
1.2.2. 人格理論……………………………………………… 5
1.2.3 行為取向……………………………………………… 9
1.2.4. 神經生理基礎………………………………………… 17
1.3. 研究目的…………………………………………………… 26
第二章 研究方法…………………………………………………… 28
2.1. 研究對象…………………………………………………… 28
2.2. 實驗器材或工具…………………………………………… 33
2.2.1 電腦設備及電子裝置………………………………… 33
2.2.2 基本能力評估………………………………………… 33
2.2.2.1中文年級認字量表………………………………… 33
2.2.2.2 瑞文氏標準圖形推理測驗……………………… 34
2.2.3 神經心理功能評估…………………………………… 35
2.2.3.1 簡式視空間記憶測驗修正版…………………… 35
2.2.3.2 魏氏邏輯記憶測驗……………………………… 36
2.2.3.3 加州詞彙學習測驗第二版……………………… 37
2.2.3.4 班頓3度空間建構能力測驗……………………… 38
2.2.3.5 直線方位判斷測驗……………………………… 39
2.2.3.6 普渡釘樁板測驗………………………………… 40
2.2.3.7 波士頓命名測驗─簡短版……………………… 41
2.2.3.9 威斯康辛卡片分類測驗………………………… 44
2.2.3.10 戴-蓋氏執行功能測驗系統…………………… 46
2.2.4 衝動性評估…………………………………………… 50
2.2.4.1 相似圖形配對測驗……………………………… 50
2.2.4.2 巴氏衝動量表第十一版………………………… 51
2.2.4.3 衝動性量表-第七版……………………………… 52
2.2.5 跨時選擇行為作業…………………………………… 52
2.3. 施測程序…………………………………………………… 54
2.4. 資料分析…………………………………………………… 55
2.4.1 基本資料……………………………………………… 56
2.4.2 基本能力測驗………………………………………… 56
2.4.3 神經心理測驗………………………………………… 57
2.4.4 衝動性測驗…………………………………………… 58
2.4.4.1 自陳式量表……………………………………… 58
2.4.4.2 行為抑制作業…………………………………… 59
2.4.4.3 衝動選擇作業（跨時選擇作業）……………… 59
第三章 研究結果………………………………………………… 60
3.1. 基本資料………………………………………………… 60
3.2. 基本能力………………………………………………… 62
3.3. 神經心理衡鑑…………………………………………… 64
3.3.1. 記憶功能…………………………………………… 64
3.3.2. 視空間知覺與建構能力…………………………… 67
3.3.3. 雙手靈活度………………………………………… 69
3.3.4. 命名能力…………………………………………… 69
3.3.5. 執行功能…………………………………………… 69
3.3.5.1. 史楚普色字干擾測驗………………………… 70
3.3.5.2. 威斯康辛卡片分類測驗……………………… 75
3.3.5.3. 戴-蓋氏執行功能測驗系統………………… 76
3.4. 衝動性評估……………………………………………… 79
3.4.1 相似圖形配對測驗………………………………… 79
3.4.2. 衝動自陳式量表…………………………………… 79
3.4.3. 跨時選擇行為作業………………………………… 81
3.4.3.1. 全體額葉損傷組vs.健康志願者…………… 81
3.4.3.2. 健康志願者組、PFI組、與PFI+組間之比較 85
第四章 討論…………………………………………………… 89
4.1. 腦傷患者的預後評估…………………………………… 89
4.2. 腦傷患者的基本能力…………………………………… 89
4.3. 腦傷患者之神經心理功能……………………………… 91
4.3.1 記憶功能…………………………………………… 91
4.3.2 視空間知覺與建構能力…………………………… 92
4.3.3 手部精細動作靈活度……………………………… 94
4.3.4 執行功能評估……………………………………… 94
4.3.4.1. 史楚普色字干擾測驗………………………… 95
4.3.4.2. WCST的表現…………………………………… 96
4.3.4.3. D-KEFS的表現………………………………… 97
4.3.4.4. 小結…………………………………………… 100
4.4. 腦傷患者的衝動性……………………………………… 101
4.4.1. 衝動抑制作業……………………………………… 101
4.4.2. 自陳式衝動性量表………………………………… 103
4.4.3. 衝動選擇作業……………………………………… 106
第五章 結論……………………………………………………… 114
參考文獻 ………………………………………………………… 118

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