研究生: |
張帥心 Chang, Shuai-Hsin |
---|---|
論文名稱: |
思覺失調症患者復元與失能程度之探討 Exploring Recovery and Disability of Schizophrenic Patients |
指導教授: |
吳亭芳
Wu, Ting-Fang |
學位類別: |
碩士 Master |
系所名稱: |
復健諮商研究所 Graduate Institute of Rehabilitation Counseling |
論文出版年: | 2015 |
畢業學年度: | 103 |
語文別: | 中文 |
論文頁數: | 96 |
中文關鍵詞: | 思覺失調症 、復元 、失能程度 |
英文關鍵詞: | patients with schizophrenia, recovery, functional severity |
論文種類: | 學術論文 |
相關次數: | 點閱:207 下載:44 |
分享至: |
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報 |
(一)研究背景與目的︰
隨著精神障礙者復元運動的興起與發展,思覺失調症者擺脫難以痊癒的刻板印象,達到復元或大幅改善。然而,對於多數的亞洲國家而言,精神障礙者復元的概念仍在萌生階段,臺灣相關的研究亦不多。本研究探討思覺失調症的復元狀況與失能程度,進而運用在思覺失調症者復元導向的服務上。
(二)方法︰
本研究共有35名思覺失調症者參與,皆來自北部地區某醫學中心之精神科日間病房及門診。研究者以復元階段量表檢視思覺失調症者的復元程度,並利用身心障礙鑑定功能量表7.1成人版評估其失能程度。資料以SPSS 22.0統計套裝軟體進行分析。
(三)結果︰
思覺失調症者在復元階段量表總分、復元過程分數與身心障礙鑑定功能量表的失能總分無顯著相關。但復元結果分數與失能表現總分 (γ=- 33) 及生活情境下能力總分 (γ=- 34) 達顯著負相關。此外,身心障礙鑑定功能量表中社區參與的表現 (γ=- 39) 與生活情境下能力 (γ=- 41) 和復元結果亦有所相關。
(四)結論︰
本研究結果顯示思覺失調症者的復元結果與失能程度有關,而社會參與也與復元結果相關。相信運用各種方法改善思覺失調症的失能情形,以及提供社會參與機會,將對其復元有所裨益。
Objective:
With the rapid development of the recovery movement, patients with schizophrenia have gotten rid of the prejudice of being recoverably challenged and achieve the state of recovery or remission. However, the concept of recovery is in its infanct in most of Asian countries. In addition, there are few researches related to recovery in Taiwan presently. The current study investigated the relevance of recovery situation and functional disability of patients with schizophrenia, in order to provide recovery-oriented services to patients with schizophrenia.
Method:
35 participants diagnosed as schizophrenia were recruited from day care ward and outpatient department of a medical center in northern Taiwan. Investigators used the ‘Stage of Recovery Scale’ to identify the recoverable state and the ‘Functioning Scale of the Disability Evaluation System 7.1-Adult version’ to explore the functional severity of schizophrenia. Data were analyzed by Statistical Product and Service Solutions (SPSS) 22.0 statistical software.
Results:
The scores of overall recovery and process of recovery were not significantly related to the total score of FUNDES7.1-Adult version in people with schizophrenia. However, the score of recoverable outcome is negatively related to the performance (γ=- 33) and capability (γ=- 34) of the total score in FUNDES7.1-Adult version. Besides, it is vivid that performance (γ=- 39) and capability (γ=- 41) of community participation were significantly related to the score of recoverable outcome.
Conclusions:
The current study demonstrated that the recoverable outcome was related to disability severity and social participation of people with schizophrenia. Therefore, applying a variety of approaches to improve disability severity and providing opportunities with social participation may benefit the recovery of patients with schizophrenia.
(一) 中文書目
1.孔繁鐘、孔繁錦 (2007) 。精神疾病診斷手冊DSM-IV-TR。美國精神
醫學學會出版。新北市:合記。
2.內政部統計處 (2015)。104年第3週內政統計通報 (103年底人口結構
分析) 。取自http://sowf.moi.gov.tw/stat/week/list.htm
3.內政部衛生福利部統計總處 (2014)。身心障礙者人數。取自
http://www.dgbas.gov.tw/ct.aspxItem=15445&CtNode=4640&mp=1
4.行政院勞工委員會職業訓練局 (2003)。 精神障礙者就業服務工作手
冊。臺北市:行政院勞動署。
5.行政院勞工委員會職業訓練局 (2009)。98年身心障礙者勞動狀況勞動
調查報告。
6.成冠緯、陳正宗、徐淑婷、林帥廷、吳明宜 (2013)。精神分裂症患者
之工作自我效能與功能性生活技能對於就業狀況的影響。職能治療學會
雜誌,31 (1),53-72
7.李明濱 (2011)。實用精神醫學第三版。臺北市:國立臺灣大學醫學
院。
8.李雅敏、林宏熾 (2008)。成年就業思覺失調症者康復經驗之研究。社
團法人台灣職業重建專業協會復健諮商,2,49-76。
9.宋麗玉 (2001)。精神病患社會功能量表之發展與驗證-以實務應用為
取向。中華心理衛生學刊,14(3),49-76。
10.宋麗玉 (2005)。精神障礙者之復健與復元-一個正向積極的觀點。
中華心理衛生學刊,18,1-29 。
11.宋麗玉、徐淑婷 (2009)。精神障礙者復元統合模式之驗證-復元階
段量表發展與優勢觀點 (I)。取自中央研究院人文社會科學研究中心
調查研究專題中心學術調查資料庫 https://srda.sinica.edu.tw
12.宋麗玉、徐淑婷 (2011)。精神障礙者復元統合模式之驗證-復元階
段量表發展與優勢觀點 (III) 。取自中央研究院人文社會科學研究
中心調查研究專題中心學術調查資庫 https://srda.sinica.edu.tw
13.宋麗玉、施教裕 (2009)。優勢觀點:社會工作理論與實務。臺北:
洪葉文化。
14.社團法人台灣社區精神復健發展協會 (2014)。102年社區復健機構
奇夢子復元敘說發表會。取自http://tscprd.org/recovery.htm
15.身心障礙者權益保護法 (2007年7月11日)。
16.林美伶、熊秉荃、林淑蓉、胡海國 (2002)。精神分裂症患者之烙印
處境。慈濟醫學雜誌,14(6) ,381 - 388。
17.林素珠 (2005) 。日常生活團體訓練對慢性精神分裂症病患自我照顧
能力之成效探討。慈濟大學,花蓮市。
18.邱南英 (2007)。思覺失調症:問題導向。新北:合記。
19.胡海國 (2002)。精神分裂症之社區流行病學。當代醫學,34(7),
717-727。
20.紀彣宙 (2015)。從身心障礙資料庫看台灣失能者的分佈。第四次
TREATS學會暨第五次TSICF學會聯合學術研討暨論文發表大會大會
手冊。
21.高雄市政府勞工局 (2009)。高雄市慢性精神障礙者就業狀況與需求
調查計畫研究報告。高雄市:高雄市政府勞工局。
22.徐淑婷 (2013)。精神障礙者復元研究之發展。復健諮商三所學術研
討聯誼,高雄師範大學。
23.張珏、張鳳航、鄭雅文 (2011)。雇主對精神障礙者就業之看法與聘
用意願:現況、問題與政策因應。台灣衛誌,30(1),5-18。
24.黃曼聰、陳威勝、陳芝萍 (2007)。精神健康職能治療—理論與實務。
臺北:五南。
25.復元與優勢觀點發展中心 (2014)。中心宗旨。取自 http://socialwork2009.nccu.edu.tw/crsp/a/index.html
26.褚增輝、謝清麟 (2004)。精神病人日常生活功能評量表第三版之信
度與效度初探。職能治療學會雜誌,22,1-14。
27.曾秋蓉、邱政元、顏文娟、蘇惠珍、蕭秋月(2012)。社區復健中心之
精神分裂症患者其污名感受、污名因應與生活品質相關因素之探討。
護理雜誌,59(4),62-70。
28.陽明大學整合性照顧研究中心 (2015) 。中文化之評估內容。取自 http://www.ym.edu.tw/interrai/assessment.html
29.臺灣ICF研究學會 (2012)。新制身心障礙鑑定簡介。臺北市:行政
院衛生署。
30.臺灣ICF研究學會 (2014)。身心障礙鑑定功能量表7.1操作手冊。
臺北:行政院衛生署。
31.臺灣精神醫學會 (2014) 。 Schizophrenia中文譯名由「精神分裂
症」更名為「思覺失調症」的歷史軌跡。取http://www.sop.org.
tw/Official/official_15.asp
32.廖華芳、嚴嘉楓、劉燦宏、張本聖、吳亭芳、呂淑貞、紀彣宙、張光
華(2013)。身心障礙鑑定功能量表之簡介與運用。臺灣醫學,
17(3),317-331。
33.歐陽文貞 (2011)。DSM-5「思覺失調症及精神病」診斷概念改變的
簡介。台灣精神醫學會DSM-5通訊,1(3) ,12-16。
34.劉震鐘 (2014)。不只是怪,可能是病了:認識日常生活中的精神
病。臺北:心靈工坊。
35.劉素芬 (2011)。社會功能與社區慢性精神病人復元之相關性研究-以
社區復健中心與康復之家為例。臺大社工學刊,23,137-180。
36.韓德彥、陳淑惠 (2008)。精神疾病污名感受量表及其短版之心理計
量特性。中華心理衛生學刊,21(3),279-290。
37.蕭真真、林維芬、楊稜璟 (2010)。「疾病管理與復元方案」對精神
障礙者復元成效之研究。中華團體心理治療,16(2),11-53。
38.蕭淑貞、陳賢佳、葉櫻媛、陳杏佳、邱淑貞 (1997)。 精神病患居家
自我照顧。中華公共衛生雜誌,16(6),478-487。
39.羅麗敏、李麗花、葉宜靜 (2011)。社交技巧訓練對住院精神分裂病
患表達與溝通成效之探討。護理暨健康照顧研究,7(1),65-72。
(二) 英文書目
Aldersey, H. M. &Whitley, R. (2014). Family influence in
recovery from severe mental illness, Community Mental
Health Journal, 51(4), 467-476.
American Psychiatric Association.(2013). Diagnostic and
Statistical Manual of Mental Disorders (DSM-5®).
American Psychiatric publishing.
Anthony, W. A. (2000). A recovery-oriented service
system: Setting some system level standards.
Psychiatric Rehabilitation Journal, 24(2),159-168.
Belio, C., Prouteau, A., Koleck, M., Saada, Y., Merceron
, K., Dayre,E., ... & Mazaux, J. M.(2014).
Participation restrictions in patients with
psychiatric and/or cognitive disabilities:Preliminary
results for an ICF-derived assessment tool. Annals of
Physical and Rehabilitation Medicine, 57(2), 114-137.
Bellack, A. S. (2006). Scientific and consumer models of
recovery in schizophrenia : concordance, contrasts,
and implication. Schizophrenia Bulletin, 32(3),
432-442.
Corrigan, P. W., Giffort, D., Rashid, F., Leary, M., &
Okeke, I. (1999).Recovery as a psychologica
construct. Community Mental Health Journal, 35(3),
231-239.
Creek, L., & Lougher, L. (2008). Occupational Therapy and
Mental Health. UK: Elsevier Health Sciences.
Dunn, E. C., Wewiorski, N. J., & Rogers, E. S. (2008).
The meaning and importance of employment to
people in recovery from serious mentalillness:
Results of a qualitative study. Psychiatric
Rehabilitation Journal, 32 (1) , 59-62.
Dunn, E. C., Wewiorski, N. J., & Rogers, E. S. (2010). A
qualitative investigationof individual and contextual
factors associated with vocational recovery among
people with serious mental illness.
American Journal of Orthopsychiatry, 80 (2), 185-94.
Farkas, M., Gagne, C., Anthony, W., & Chamberlin, J. (2005).
Implementing recovery oriented evidence based programs: Identifying the critical dimensions. Community Mental Health Journal, 41(2),141-58.
Hamidreza, K., Mehdi, R., & Maryam, R. (2011). The effects of nursing discharge plan (post-discharge education and follow-up on self-care ability in patients with chronic schizophrenia hospitalized in Razi
psychiatric Center. Iranian Journal of Nursing and Midwifery Research, 16(2), 162-168.
Harding, C. M., Brooks, G. W., Ashikage, T., Strauss, J. S., & Breier, A.(1987). The vermont longitudinal study of persons with severe mental illness II: Long-term outcomes of subjects who retrospectively met DSM-III criteria for schizophrenia. American Journal of Psychiatry, 144(6), 727-735.
Harrow, M., Grossman, L.,Jobe, T. H., & Herbener, E. S.( 2005). Dopatients with schizophrenia ever show periods of recovery? A 15-yearmulti-follow-up study. Schizophrenia Bulletin, 31, 723-34.
Harvey, P. D. (2009). Functional recovery in schizophrenia: raising the bar for outcomes in people with schizophrenia. Schizophrenia Bulletin, 35(2) , 299.
Harvey, P. D., Heaton, R. K., Carpenter W. T., Green M. F., Gold, J. M., & Schoenbaum, M. (2012). Functional impairment in people with schizophrenia: Focus on employability and eligibility for disability
compensation. Schizophrenia Research, 140, 1-8.
Hector, W. H. T., Ada, Y. L., Raymond, C. K. C., Morris, B., & Cheung,W. M. (2010). Review on vocational predictors: A systematicreview of predictors of vocational outcomes among individuals with
schizophrenia: An update since 1998. Australian and New Zealand Journal of Psychiatry, 44, 495-504.
Ho, W. N., Chiu, Y. L., Lo, T. L., & Yiu, G. C. (2010). Recovery components as determinants of the health-related quality of life among patients with schizophrenia: structural equation modelling analysis. Australian and New Zealand Journal of Psychiatry, 44(1), 71-84.
Kaewprom, C., Curtis, J., & Deane, F. P. (2011). Factors involved in recovery from schizophrenia:A qualitative study of Thai mental health nursesnhs. Nursing and Health Sciences, 13, 323-327.
Kuo, J. & Lin, S. K. (2010). Functional recovery in schizophrenia.Taiwanese Journal of Psychiatry, 24(2), 87-98.
Liberman, R., Kopelowicz, A., Ventura, J., & Gutkind, D. (2002).Operational criteria and factors related to recovery from schizophrenia. International Review of Psychiatry, 4, 256-272.
Liberman, R., & Kopelowicz, A. (2005). Recovery from schizophrenia: A concept in search of research. Psychiatric Services, 56, 735-742.
McGurk, S. R., & Meltzerb, H. Y. (2000) . The role of cognition in vocational functioning in schizophrenia. Schizophrenia Research,45(3), 175-184.
McGurk, S. R., Mueser, K. T., DeRosa, T. J., & Wolfe, R. (2009). Work, recovery, and comorbidity in schizophrenia: a randomized controlled trail of cognitive remediation. Schizophrenia Bulletin, 35(2), 319-335.
Mesholam-Gately, R.I., Giuliano, A.J., Goff, K.P., Faraone,S.V.,& Seidman,L.J. (2009). Neurocognition in first-episode schizophrenia: A meta-analytic review. Neuropsycholog, 23(3), 315-336.
Mountain,D., & Shah, P. J. (2008). Recovery and the medical model.Advances in Psychiatric Treatment, 14, 241-244.
National Institute For Mental Health in England. (2004). Emerging Best Practice in Mental Health Recovery, 取自http:// www.2gether.
nhs.uk/files/EmergingBestPracticeInRecovery.pdf
Pachoud, B., Plagnol, A., & Leplege, A. (2010). Outcome, recovery and return to work in severe mental illnesses. Disability and Rehabilitation, 32(12), 1043-1050.
Roe, D., Mashiach-Eizenberg, M., & Lysaker, P. H. (2011). The relation between objective and subjective domains of recovery among persons with schizophrenia-related disorders. Schizophrenia Research, 131(1), 133-138.
Schennach, R., Riedel, M., Obermeier, M., Jäger,M., Schmauss,M.,Laux,G.,... & Mo¨ller, H-J. (2012). Remission and recovery and their predictors in schizophrenia spectrum disorder:Results from a 1-year follow-up naturalistic trial. Psychiatr Quarterly, 83, 187-207.
Schieff, A. C. (2004). Recovery and mental illness: Analysis and personalreflections. Psychiatric Rehabilitation Journal, 27 (3) , 212-218.
Schwartz, C., & Gronemann, O. C. (2009). The contribution of self-efficacy, social support and participation in the community to predicting loneliness among persons with schizophrenia living in supported residences. Israel Journal of Psychiatry and Related Sciences, 46(2), 120-129.
Scotti, P. (2009). Recovery as Discovery. Schizophrenia Bulletin, 35 (5) ,844-846.
Silverstein , S. M. & Bellack, A. S. (2008). A scientific agenda for theconcept of recovery as it applies to schizophrenia. Clinical Psychology Revie, 28, 1108-1124.
Song, L.Y. & Shin, C.Y. (2009). Factors, process and outcomes of recovery from psychiatric disability: the unity model. International Jornal of Social Psychiatry, 55 (4), 348-360.
Stuart , J. L. (2004). Environmental influences in schizophrenia: the known and the unknown. Advances in Psychiatric Treatment, 10, 323-330.
Świtaj, P., Anczewska, M., Chrostek, A., Sabariego, C., Cieza, J., Bickenbach, J.,&Chatter, S. (2012). Disability and schizophrenia: a systematic review of experienced psychosocial difficulties. BMC Psychiatry, 12 (1), 193.
Tenorio-Martínez, R., Carmen Lara-Muñoz, M., & Medina-Mora, M. E. (2009). Measurement of problems in activities and participation in patients with anxiety, depression and schizophrenia using the ICF checklist. Social Psychiatry and Psychiatric Epidemiology, 44 (5),377-384.
Terry, K. (2004). Employment, Recovery, and Schizophrenia: Integrating Health and Disorder at Work. Psychiatric Rehabilitation Journal, 28 (1), 8-15.
Tse, S., Siu, B. W. M., & Kan, A. (2013). Can recovery-oriented mental health services be created in Hong Kong? Struggles and strategies. Administration and Policy Mental Health, 40, 155-158.
Vanwel, T.F., & Landsheer J.A.(2012). Societal participation: examining the impact of a rehabilitation approach for young people with schizophrenia. Journal of Psychiatric & Mental Health Nursing, 19, 792-798.
Viertio, S., Tuulio-Henriksson, A., Perala, J., Saarni, S. I., Koskinen, S.,Sihvonen, M., . . . Suvisaari, J. (2011). Activities of daily living, social functioning and their determinants in persons with psychotic disorder. European psychiatry, 27(6), 409-415.
Wexler, B. E., & Morris, D. B. (2005). Cognitive remediation and vocational rehabilitation for schizophrenia. Schizophrenia Bulletin,31(4),931-941.
Whitley, R. (2014). Introducing recovery. Canadian Journal of Psychiatry , 59(5), 233.
Wilson, E. H. (2014). Evaluating the ICF framework as a predictor of recovery among adults with serious mental illness. USA: University of Wisconsin-Madison.
Woodside, H., Schell, L., &Allison-Hedges, J.(2006). Listening for recovery: The vocational success of people living with mental illness.Canadian Journal of Occupational Therapy, 73(1), 36-43.
World Health Organition (2002). Towards a common language for functioning disability and health. Geneva: World Health Organition.
Yilmaz, M. Josephsson,S., Danermark, M. & Ivarsson, A. B. (2008).Participation by doing: Social interaction in everyday activities among persons with schizophrenia. Scandinavian Journal of Occupational Therapy, 15, 162-172.