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系統識別號 U0026-0812200915385871
論文名稱(中文) 精神分裂症患者視覺和聽覺輸入路徑的記憶表現
論文名稱(英文) The memory of visual and auditory input in people with schizophrenia
校院名稱 成功大學
系所名稱(中) 職能治療學系碩博士班
系所名稱(英) Department of Occupational Therapy
學年度 97
學期 2
出版年 98
研究生(中文) 黃文儀
研究生(英文) Wen-yi Huang
電子信箱 t7695102@mail.ncku.edu.tw
學號 t7695102
學位類別 碩士
語文別 中文
論文頁數 72頁
口試委員 指導教授-施陳美津
口試委員-歐陽文貞
口試委員-蘇純瑩
口試委員-馬瀰嘉
中文關鍵字 中文版魏氏記憶力測驗-III  聽覺記憶力  視覺記憶力  精神分裂症 
英文關鍵字 schizophrenia  Wechsler Memory Scale-III  auditory verbal memory  Visual verbal memory 
學科別分類
中文摘要 背景和目的:認識精神分裂症患者經由何種適當感覺(聽覺或視覺)輸入路徑接受語言刺激,會使其記憶力功能表現更好,是職能治療師所關心的課題。過去大多數研究探討精神分裂症患者經由聽覺輸入路徑接受語言刺激的記憶力表現,較少探討視覺輸入路徑接受語文刺激的記憶力表現。故本研究目的是:1)探究精神分裂症患者經由聽覺路徑接受語言刺激的記憶力表現與正常人是否有差異,2)探究精神分裂症患者經由視覺路徑接受語文刺激的記憶力表現與正常人是否有差異,3)探究精神分裂症患者接受語言刺激時,經由視覺輸入路徑與聽覺輸入路徑的記憶力表現是否有差異。
方法:從南台灣地區某精神醫療中心,招募診斷為精神分裂症患者60位(精神分裂組),並在南台灣社區中招募沒有精神疾患和神經疾患的自願者60位(正常組),依據其年齡、教育程度和性別進行配對分組。精神分裂組與正常組均由抽籤方式決定接受聽覺輸入路徑接受語言記憶測驗或視覺輸入路徑接受語文記憶測驗。最後以成對樣本t考驗進行資料分析。
結果:研究顯示:1)精神分裂症患者經由聽覺輸入路徑接受語言刺激之記憶表現,在立即情節回憶、立即主題回憶、延宕情節回憶、延宕主題回憶、再認、學習斜率和保留等與正常人相較下均達顯著性差異(p≦.001)。2) 精神分裂症患者經由視覺輸入路徑接受語文刺激之記憶表現,除了學習斜率(t=.12, p=.9)外,精神分裂症患者在立即情節回憶、立即主題回憶、延宕情節回憶、延宕主題回憶、再認和保留等均達顯著性差異(p≦.011) 。3) 精神分裂症患者由聽覺與視覺輸入路徑接受語言(文)刺激的記憶表現未達到統計意義的差異,但精神分裂症患者視覺輸入路徑接受語文刺激的記憶力表現退化程度大於聽覺輸入路徑接受語文刺激的記憶力表現,尤其是延宕情節(t=-2.08, p=.04)和延宕主題(t=-2.33, p=.04)的記憶力表現達統計上顯著性差異。
結論:精神分裂症患者接受語言(文)刺激時,經由視覺輸入路徑和聽覺輸入路徑的的記憶力表現均出現損傷,兩者雖未達顯著性差異,但卻發現精神分裂症患者的視覺輸入路徑之記憶力表現退化程度大於聽覺輸入路徑之記憶力表現。日後臨床職能治療師進行活動時,當精神分裂症患者透過「聽覺」輸入路徑時接受語言訊息時,職能治療師講話速度應該放慢,每個字或詞的聲調清楚呈現,協助患者學習;當精神分裂症患者透過「視覺」輸入路徑時接受語文訊息時,提供寬裕時間給患者登錄訊息,或者教導患者深層登錄策略,促使患者有較好的記憶力表現。本研究的限制因尚未在國內尋獲評估視覺輸入路徑接受語文刺激記憶的評估工具,所以本研究依據中文版魏氏記憶力測驗-III中邏輯記憶測驗編制視覺輸入路徑接受語文刺激之記憶力測驗,所編制視覺輸入路徑接受語文刺激之記憶力測驗仍缺乏完善信效度和常模的建立,未來可進一步建立此測驗信效度。
英文摘要 Background and Purposes:It is an important issue for occupational therapists to find out the most preferable sensory input (auditory or visual) for people with schizophrenia in order to help them have better memory performance. In the past, most of studies have investigated verbal memory performances through auditory input; paucity of studies has investigated verbal memory performances through visual input in patients with schizophrenia. Therefore, the purposes of this study were:1) to investigate verbal memory performances through auditory input; 2) to investigate verbal memory performances through visual input; 3) to compare the memory performance differences between visual and auditory input in patients with schizophrenia and normal adult.

Methods: Sixty patients with schizophrenia and sixty volunteers with no psychiatric or neurological disorders (health group) were recruited from a psychiatric center and it adjacent community, located in south part of Taiwan. Health group was pair-matched with schizophrenia group according to their age, gender and years of education. Both auditory and visual inputs of verbal memory performance test were adapted from Logical Memory I and II of the Wechsler Memory Scale III. Half of schizophrenia and health groups were tested with auditory input verbal memory performance test and the other half of schizophrenia and health groups were tested with visual input verbal memory performance test.

Results:1) The schizophrenia group was statistically significantly worse than the healthy group in auditory input verbal memory performances; including immediate episodic recall, immediate topical recall, delay episodic recall, delay topical recall, recognition, learning slope and retention. 2) Except learning slope, the schizophrenia group was statistically significantly worse than the healthy group in visual input verbal memory performances; including immediate episodic recall, immediate topical recall, delay episodic recall, delay topical recall, recognition, and retention. 3) There was no significant difference between auditory and visual input verbal memory performances in the schizophrenia group. However, as compared auditory and visual input verbal memory performances of the schizophrenia group with those of the health group, the impairment of visual input verbal memory performance was significantly greater than that of the auditory input verbal memory performance in patients with schizophrenia, especially in delay episodic and delay topical recall memory performances.

Conclusion: Patients with schizophrenia had both auditory and visual input verbal memory impairments. The difference between auditory and visual input verbal memory performances was not significant. However, when compared with the healthy group the impairment of visual input verbal memory performance was significantly greater than that of auditory input verbal memory performance. The findings have their clinical implications. When we talk to the patients with schizophrenia we should speak as slowly and pronounce clearly. We should provide them enough time for them to read or teach them reading strategy. The Logical Memory I and II of Wechsler Memory Scale-III were originally designed for an auditory input memory tests. We had adapted them for visual input verbal memory tests without well established reliability, validity and norm might be the limitation of this study. In the future study, we suggest to develop a visual input verbal memory test with a well established reliability, validity and norm.
論文目次 目錄
中文摘要 i
英文摘要 iii
誌謝 vi
目錄 vii

表目錄 ix
圖目錄 x
附錄 xi
第一章 緒論
第一節 研究動機與重要性 1
第二節 研究目的 2
第三節 研究假設 2
第二章 文獻回顧
第一節 記憶力簡介 3
第二節 精神分裂症患者的大腦結構和感覺訊息對記憶力之影響 8
第三節 精神分裂症患者之記憶力表現 10
第四節 影響精神分裂症病患記憶力表現之臨床因子 14
第三章 研究方法
第一節 研究架構 20
第二節 研究設計 20
第三節 研究對象 21
第四節 研究工具 22
第五節 研究流程 27
第六節 資料分析 28
第四章 結果
第一節 樣本人口學與臨床基本資料 30
第二節 精神分裂症患者經由聽覺輸入路徑接受語言刺激之記憶表現 30
第三節 精神分裂症患者經由視覺輸入路徑接受語文刺激之記憶表現 30
第四節 比較精神分裂症患者聽覺與視覺輸入路徑接受語言(文)刺激之記憶表現 31
第五章 討論
第一節 精神分裂症患者經由聽覺輸入路徑接受語言刺激之記憶表現 32
第二節 精神分裂症患者經由視覺輸入路徑接受語文刺激之記憶表現 32
第三節 比較精神分裂症患者聽覺與視覺輸入路徑接受語言(文)刺激之記憶表現 34
第六章 結論與建議
第一節 臨床應用 36
第二節 研究限制和未來研究建議 36
參考文獻 38
自述 72

表目錄
表2-1 Chlorpromaine與 Benztropine 換算抗精神病藥劑之等價表 45
表4-1A 人口學與臨床基本資料表 46
表4-1B 精神分裂症組之憂鬱和幻聽干擾程度 47
表4-2 精神分裂症組和正常組聽覺輸入路徑接受語言刺激之記憶表現 48
表4-3 精神分裂症組和正常組視覺輸入路徑接受語文刺激之記憶表現 49
表4-4 精神分裂症組經由聽覺與視覺輸入路徑接受語言(文)刺激之記憶力表現 50
表5-1 精神分裂症組與正常組看故事時間 51
表5-2 精神分裂症組與正常組有無默念之記憶力表現 52
表5-3 正常組經由聽覺與視覺輸入路徑接受語言(文)刺激之記憶力表現 53
表5-4 精神分裂症患者視覺語文和聽覺語言記憶力退化程度 54

圖目錄
圖3-1 研究設計流程 55

附錄
附錄一:故事A 56
附錄二:故事B 57
附錄三:視覺語文– 邏輯記憶測驗(I)指導語 58
附錄四:視覺語文– 邏輯記憶測驗(II)指導語 60
附錄五:研究參與同意書 61
附錄六:120位受測者收案資料 62
附錄七:同意臨床試驗證明書 70
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