臺灣博碩士論文加值系統

研究背景：
過去研究發現第一型、第二型雙極症患者在臨床表徵及病程表現上有所差異。在認知功能的研究方面，發現相較於第二型雙極症患者，第一型雙極症患者的神經心理功能表現較差。持續性注意力是認知處理的基本能力，而雙極症患者常出現持續性注意力缺損的問題，並且先前研究發現，即使是症狀緩解期的雙極症患者，仍有持續性注意力缺損的問題，因此認為持續性注意力缺損是雙極症患者認知能力上的特質。Continuous performance test (CPT) 常被使用在測量持續性注意力和認知衝動性，且先前研究顯示，症狀緩解期的雙極症患者在CPT表現上會出現對於目標刺激偵測度下降的情形。
由於第一型、第二型雙極症有相當不同的臨床表徵及病程，且持續性注意力缺損是雙極症患者共有的問題，因此探討兩型雙極症患者在CPT表現上的差異將有助於了解兩型雙極症患者之持續性注意力的表現情形，並作為未來提供不同治療處遇的指引。

研究目的：
本研究欲探討兩型雙極症患者在CPT表現的差異，藉以了解兩型雙極症患者在持續性注意力及認知衝動性是否有所差異。
並根據先前針對兩型雙極症患者認知功能方面的研究結果，本研究假設與第二型雙極症患者相比，第一型雙極症患者有明顯較差的持續性注意力。

研究方法：
經人體實驗委員會同意後，目前分別自精神科門診收集22例第一型雙極症病患、29例第二型雙極症病患，並另收取20例健康控制組。在取得個案同意後，經精神科醫師的初步晤談，再由訓練良好的臨床心理師以修正版的中文化終生精神疾病之診斷結構晤談版Schedule for Affective and Schizophrenia-Lifetime Chinese version (SADS-L) 以確定診斷，且使用CPT作為測量持續性注意力及認知衝動性之工具。統計分析使用多變量共變數分析，在考量反應時間、年齡、教育年數、情緒症狀嚴重度的情況下，比較第一型、第二型雙極症患者的持續性注意力是否有所差異。

研究結果：
兩型雙極症患者在人口學變項上沒有明顯的差異，然而在症狀嚴重度上，第二型雙極症患者有明顯較嚴重的症狀表現。在控制症狀嚴重度、年齡、教育年數與反應時間後，發現相較於第二型雙極症患者，第一型雙極症患者出現較多的誤授反應 (commission errors) 、較長的反應時間、較大的正確反應時間變異量、較差之刺激偵測度 (d’)，但在誤漏反應 (omission errors) 部分，兩型雙極症患者沒有明顯的差異。
本研究結果支持，相較於第二型雙極症患者，第一型雙極症患者有較差之持續性注意力表現。

未來研究方向：
未來研究可從以下方向作改進：(1) 縱貫研究可幫助了解兩型雙極症患者之持續性注意力缺損是病前既有之問題或是隨著病程發展每況愈下的結果。(2) 增加樣本數以進行更嚴謹的統計分析。(3) 對患者的用藥情形進行控制或採用統計方法加以控制。(4) 針對完全緩解期之兩型雙極症患者進行CPT表現的比較，以確保症狀嚴重度不會干擾患者的CPT表現。

Background: Sustained attention deficit was the most commonly reported impairments in bipolar disorder. The goal of this study was to compare the sustained attention of inter-episode patients with BP I to those with BP II disorder.
Methods: 51 patients with bipolar disorder (22 BP I and 29 BP II) and 20 healthy controls participated in this study and were tested with Conners' Continuous Performance Test-II (CPT). Psychiatric symptoms were assessed with the 17-item Hamilton depression rating scale and Young Mania Rating Scale.
Results: A significant and negative relation was shown merely between years of education and omission errors in patients with BP I and BP II (r=-0.320, p＜0.01). Patients with BP I had a significantly longer response latency (F(2,68)=7.648, p=0.001) (reaction time, RT), RT standard error (F(2,68)=5.252, p=0.008), worse d’ (F(2,68)=6.313, p=0.003) and more commission errors (F(2,68)=6.182, p=0.004) than those with BP II and healthy controls. No significant difference was found among these three groups on omission errors and no significant correlations were observed between CPT performance and clinical characteristics in these three groups.
Limitations: A longitudinal follow-up study design and larger sample size might provide more information on whether sustained attention deficit in BP patients is a premorbid issue or not and might have illustrated clearer differences between the three groups.
Conclusions: These findings suggested that impairments in sustained attention might be more representative of BP I than BP II, even after controlling for the severity of symptoms, age, years of education and reaction time.

中文摘要……………………………………………………………………… Ⅱ
英文摘要……………………………………………………………………… Ⅴ
致謝…………………………………………………………………………… Ⅶ
目錄…………………………………………………………………………… Ⅸ
表目錄…………………………………………………………………………
ⅩⅠ


第壹章 緒論………………………………………………………………… 1
第一節 雙極症之探討…………………………………………………… 1
一、雙極症之診斷分類………………………………………………… 1
二、雙極症之盛行率…………………………………………………… 2
三、研究雙極症之重要性……………………………………………… 3
四、區分第一型、第二型雙極症之重要性…………………………… 4
第二節 兩型雙極症患者之認知功能/持續性注意力功能之探討 …… 6
一、兩型雙極症患者認知功能差異…………………………………… 6
二、注意力理論/持續性注意力與認知處理歷程之角色與關係 …… 7
(一) 認知神經心理學觀點之注意力理論………………………… 7
(二) 持續性注意力與認知處理歷程之角色與關係……………… 11
三、 第一型雙極症患者之持續性注意力功能表現 ………………… 12
四、 兩型雙極症患者之持續性注意力功能表現差異 ……………… 13
五、 持續性注意力之評估 …………………………………………… 14
第三節 研究目的與問題假設 ………………………………………… 16
第貳章 研究方法…………………………………………………………… 17
第一節 研究對象………………………………………………………… 17
第二節 研究工具………………………………………………………… 19
一、Continuous Performance Test (CPT)…………………………… 19
二、診斷晤談工具- 終生精神疾病之診斷結構晤談版……………… 21
三、中文版漢氏憂鬱症量表…………………………………………… 21
四、中文版楊氏躁症量表……………………………………………… 22
第三節 研究流程………………………………………………………… 23
第四節 統計分析………………………………………………………… 24
第參章 研究結果…………………………………………………………… 25
第一節 臨床及人口學變項……………………………………………… 25
第二節 CPT 變項……………………………………………………… 26
第肆章 討論………………………………………………………………… 28
第一節 本研究之主要發現與解釋……………………………………… 28
一、第一型、第二型雙極症患者在持續性注意力之差異…………… 28
二、第一型、第二型雙極症患者在認知衝動性之差異……………… 29
三、症狀表現、患病時間與CPT表現之間的關係…………………… 30
四、人口學變項與CPT表現的關係…………………………………… 31
五、右側前額葉 (Right PFC) 與CPT所測得之持續性注意力的係………………………………………………………………… 32
六、認知功能缺損與心理社會功能之關係…………………………… 32
第二節 研究限制………………………………………………………… 33
第三節 研究貢獻………………………………………………………… 34
第伍章 結論………………………………………………………………… 35
參考文獻……………………………………………………………………… 36

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