臺灣博碩士論文加值系統

第二型雙相情緒障礙症為一種嚴重的精神疾病，不僅造成個人、家屬痛苦，也導致沈重的社會負擔。而當患者與焦慮症共病時，其病程更形惡化；常見有更不穩定的情緒、較高的自殺企圖、社會職業失功能等。過去研究指出雙相情緒障礙症與憂鬱症患者在羅夏克測驗中有不同的表現。而相當比例的雙相情緒障礙者共病焦慮症，共病焦慮症對雙相情緒障礙者在羅夏克測驗中的影響的相關研究很少。隨著西元2011年新式的羅夏克施測系統「羅夏克測驗表現評估系統（Rorschach Performance Assessment System, R-PAS）」的問世，本研究欲使用新系統R-PAS來了解第二型雙相情緒障礙症是否合併焦慮症患者與健康受試者在羅夏克墨漬測驗上之差異。本研究於成大醫院精神科門診收取第二型雙相情緒障礙症患者25名、第二型雙相情緒障礙症合併焦慮症患者25名，並招募健康受試者23名，施以羅夏克墨漬測驗。結果顯示，R-PAS系統雖未能明顯用來區分第二型雙相情緒障礙症患者是否合併焦慮症，但在部分知覺與思考問題（perception and thinking problem）方面的指標（EII-3、TP-Comp、WSumCog、FQ-%、WD-%、FQo%），可以有效區分出第二型雙相情緒障礙症患者與健康受試者。目前已逐漸證實R-PAS系統的有效性，建議未來可將R-PAS系統納入臨床學習使用之衡鑑工具，以協助未來臨床診斷輔助與治療介入之參考。

Bipolar II disorder（BPII）, one kind of severe mental disorder, does not only cause the individuals’ suffering from disorder, but also leads to social and family burden. In addition, for the BPII patients comorbid with anxiety disorders, their disorder prognosis would be worse, such as unstable moods, high suicide attempts, and social professional disability etc. Previous study showed that BPII and depression patients havBipolar II disorder（BPII）, one kind of severe mental disorder, does not only cause the individuals’ suffering from disorder, but also leads to social and family burden. In addition, for the BPII patients comorbid with anxiety disorders, their disorder prognosis would be worse, such as unstable moods, high suicide attempts, and social professional disability etc. Previous study showed that BPII and depression patients have different performances in the Rorschach test. However, the high comorbidity rate with anxiety disorder in the BPII may confound this finding. So far, no studies have been conducted to consider this comorbidity issue in the Rorschach test. When the new Rorschach Performance Assessment System（R-PAS）had been published in 2011, this study intends to use R-PAS to understand whether BPII patients comorbid with anxiety disorder or not would show different performance in the Rorschach test compared to the healthy controls. In this study, all the patients were recruited from inpatient and outpatient clinics at National Cheng Kung University Hospital（25 BPII patients with anxiety disorder, BPII+AD and 25 BPII patients without anxiety disorder, BPII-AD）, and 23 health participants were compared. The results showed no significant differences were found between BPII+AD and BPII-AD using R-PAS, but some significant differences on the following indices, EII-3, TP-Comp, WSumCog, FQ-%, WD-% and FQo% were found while comparing BPII and HC groups. The R-PAS may be used as the diagnostic assessment in clinical application, more studies are needed to be done in the future.

目錄
中文摘要 i
英文摘要 ii
目錄 iii
表目次 iv
第一章 緒論 1
第一節 研究背景與動機 1
第二節 第二型雙相情緒障礙症 2
第三節 第二型雙相情緒障礙症合併焦慮症之探討 6
第四節 羅夏克墨漬測驗 9
第五節 研究目的與問題假設 26
第二章 研究方法 27
第一節 研究對象 27
第二節 研究工具 29
第三節 研究程序 33
第四節 統計分析 34
第三章 研究結果 35
第一節 人口學資料與臨床特性之統計分析 35
第二節 羅夏克測驗表現評估系統上的差異 38
第四章 討論與建議 50
第一節 人口學資料與臨床特性 50
第二節 羅夏克測驗表現評估系統的測驗表現 52
第三節 綜合討論、研究限制與建議 57
參考文獻 59
表目次
表1、羅夏克測驗各指標意義簡介 18
表2、三組受試者在人口學資料與臨床特性之比較 36
表3、第二型雙相情緒障礙症合併焦慮症之焦慮症臨床特徵 37
表4、羅夏克測驗訓練後檢驗評分者間信度之結果 39
表5、三組受試者在R-PAS SUMMARY SCORES AND PROFILES行為與觀察（ADMINISTRATION BEHAVIORS AND OBSERVATIONS）方面之比較 43
表6、三組受試者在R-PAS SUMMARY SCORES AND PROFILES - 認知投入與處理（ENGAGEMENT AND COGNITIVE PROCESSING）方面之比較 44
表7、三組受試者在R-PAS SUMMARY SCORES AND PROFILES - 知覺與思考問題（PERCEPTION AND THINKING PROBLEM）方面之比較 46
表8、三組受試者在R-PAS SUMMARY SCORES AND PROFILES - 壓力造成的困擾（STRESS AND DISTRESS）方面之比較 47
表9、三組受試者在R-PAS SUMMARY SCORES AND PROFILES - 自我與他人表徵（SELF AND OTHER REPRESENTATION）方面之比較 48

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