國外研究顯示精神分裂症病患在臨床症狀和認知性心智功能缺損具有異質性，在國內已有研究者針對門診或急性住院的精神分裂症病患進行相關研究並已獲致相當的研究成果，但是筆者發現國內目前對於病患人數更多的住院慢性精神分裂症病患的臨床症狀的異質性、心智功能缺損特性和其社會功能等病理現象的瞭解尚不足夠，因此有必要針對上述病理現象進行完整的瞭解。在本論文中筆者設計八個個別但相關的系列研究來瞭解"不同臨床症狀剖面下的慢性精神分裂症病患的心智功能缺損特性與社會功能的關係"。這八個研究的的關係是研究一到研究四為論文的主要研究，研究三的四個預備研究是論文的次要研究，它們各別的研究目的分述如下：研究一主要目的是瞭解「慢性精神分裂症病患的臨床症狀面向和剖面」。研究二主要目的是瞭解「不同臨床症狀剖面下慢性精神分裂症病患的『認知性心智功能』的缺損特性」。3、研究三主要目的是瞭解「不同臨床症狀剖面下慢性精神分裂症病患的『社會性心智功能』的缺損特性」。為了驗證研究者所選取用來評估「社會性心智功能」的評估工具的適用性，研究者在本章做了四個預備研究，它們的研究目的分述如下：（1）預備研究一的主要目的是檢驗「國際情緒圖片系統」（International Affective Picture System, IAPS）在國內及本論文的適用性，在本研究中用以評估個案的情緒處理能力。（2）預備研究二的主要目的是編制適合國內及本研究使用的「台灣版人際反應性指標量表」（Taiwan version of International Reactivity Index, T-IRI），在本研究中用以評估個案的同理能力。（3）預備研究三的主要目的是瞭解「台灣版冷漠評估量表」（Taiwan version of Apathy Evaluation Scale, T-AES）在慢性精神分裂症病患使用的心理計量特性，在本研究中用以評估個案的動機。（4）預備研究四的主要目的是檢驗「日本人和白種人臉部表情測驗」（Japanese and Caucasian Facial Expression of Emotion, JACFEE）在國內及本論文的適用性，在本研究中用以評估個案的表情辨識能力。4、研究四主要目的是「瞭解不同臨床症狀剖面下慢性精神分裂症病患的『社會功能』影響因素」。筆者在研究一發現國內慢性精神分裂症病患的臨床症狀為五因素結構，而且以這五個臨床症狀面向可以將慢性精神分裂症病患分為明顯廣泛症狀、明顯正負性混合症狀和明顯社交退縮三種不同的症狀剖面；此外研究一也發現PANSS原量表中的負性症狀具有異質性，可以區分為兩個相互獨立的成份。筆者在研究二發現慢性精神分裂症病患的認知性心智功能缺損具有異質性，可以被區分為正常認知表現型、執行功能缺損型、記憶功能缺損型、執行與記憶功能缺損型、廣泛認知功能缺損型等五種缺損類型。同時也彌補了Kremen等人〔2004〕未能評估精神分裂症病患的視覺空間記憶的遺憾。此外，研究二支持國外研究發現精神分裂症與多種認知功能缺損有關，特別是注意力、記憶力和執行功能的看法，尤其是在不同的症狀剖面下，可以更細緻的發現明顯廣泛症狀組在處理速度和智商上也存在缺損。其次，研究二發現精神分裂症病患的持續性注意力可能伴隨其生病年數的增加逐漸變差。最後，研究二證明研究一所區分出的明顯廣泛症狀、明顯正負性混合症狀和明顯負性症狀三個臨床症狀剖面，由其認知性心智功能缺損的量和質來檢驗具有外在效度。筆者在研究三的預備研究一證明IAPS在台灣的適用性並初步建立了台灣成人常模；並且發展出能完整代表台灣常模情感空間的六類IAPS照片的評估工具。在研究三的預備研究二證明T-IRI在台灣的適用性並初步建立了台灣成人常模。在研究三的預備研究三証明TAES-S在慢性精神分裂症病患的適用性並初步建立了慢性精神分裂症病患常模。在研究三的預備研究四証明JACFEE可以適用於國內成人受試者；並且發現國內成人受試者對於害怕和生氣兩種臉部表情的判斷可能受到文化因素和群組內優勢效應的共同影響。在研究三發現筆者在本論文中建構的「社會性心智功能」具有建構效度與區辨效度；也驗證IAPS、T-IRI、TAES-S和JACFEE在慢性精神分裂症病患具有適用性；此外也發現慢性精神分裂症病患在「社會性心智功能」的缺損可能與其額葉和顳葉間的神經迴路功能失調有密切關係；最後筆者發現冷漠現象、同理關心能力和害怕表情辨識能力在精神分裂症的早期偵測上可能具有應用性以及活性症狀會干擾病患對臉部表情的辨識。筆者在研究四發現對於不同臨床症狀剖面的慢性精神分裂症病患的社會功能的影響因素並不完全相同；也發現對於慢性精神分裂症病患社會功能次向度的不同影響因素；此外筆者也發現認知性心智功能、社會性心智功能、臨床症狀和人口學變項對慢性精神分裂症病患整體社會功能的影響比重；最後筆者認為研究四可以視為以神經心理評估和認知復健做為慢性精神分裂症病患心理社會介入模式的實徵支持證據。

Many studies showed schizophrenics were heterogeneous in their clinical symptoms and cognitive mental dysfunction features. In Taiwan, some researchers had studied on these pathological phenomena in outpatient or acute onset schizophrenia patients. However, for chronic inpatient schizophrenics, these pathological phenomena including clinical symptoms, mental dysfunction features, and social function are still unclear. It is necessary to do a comprehensive and serial studies understanding these pathological phenomena. In this dissertation, author designed eight serial studies for understanding mental dysfunction features and their relations to social function in chronic schizophrenics with heterogeneous clinical symptoms profiles. From Study 1 to study 4 are main studies. In study 3, author designed four preparatory studies. Their aims are as the following. 1. The aim of study 1 is for understanding symptom dimensions and their profiles in chronic schizophrenics. 2. The aim of study 2 is for understanding cognitive mental dysfunction features in chronic schizophrenics with different clinical symptom profiles. 3. The aim of study 3 is for understanding social mental dysfunction features in chronic schizophrenics with different clinical symptom profiles. For assessing social mental function, there are 4 preparatory studies which aims are as following. （1） The aim of preparatory study 1 is to testify the appropriateness of International Affective Picture System （IAPS） in adult sample of Taiwan. The IAPS is designed to assess subject’s emotion processing ability in social context. （2） The aim of preparatory study 2 is to compile and to revise the Taiwan version of International Reactivity Index （T-IRI） in adult sample of Taiwan. The T-IRI is designed to assess subject’s empathetic ability. （3） The aim of preparatory study 3 is to testify the appropriateness of Taiwan version of Apathy Evaluation Scale （T-AES） in chronic schizophrenics of Taiwan. The T-AES is designed to assess subject’s motive. （4） The aim of preparatory study 4 is to testify the appropriateness of Japanese and Caucasian Facial Expression of Emotion （JACFEE） in adult sample of Taiwan. The JACFEE is designed to assess subject’s facial recognition ability. 4. The aim of study 4 is for understanding influential factors on social function in chronic schizophrenics with different clinical symptom profiles. The results in study 1 showed there were 5 symptom dimensions in chronic schizophrenics. According these dimensions, chronic schizophrenics could be differentiated as 3 profiles including significant mixed positive and negative symptom, significant widespread symptom, and significant social withdrawal. Besides above results, study 1 found negative symptom in PANSS existing two mutually independent components. The results in study 2 showed there were heterogeneous in cognitive mental dysfunction features in chronic schizophrenics. According to these features, chronic schizophrenics could be differentiated as within normal cognitive range, executive function deficits, memory function deficits, executive with memory function deficits, and widespread cognitive deficits 5 subtypes. Meanwhile, study 2 had made up for Kremen, Seidman, Faraone, Toomey, and Tsuang（2004） study’s limitation. In addition, study 2 supported chronic schizophrenics exited impairments in multiple domains, especially in attention, memory and executive function. For significant widespread symptom group, processing speed and intellectual function also exited significant impairments. In study 3, preparatory study 1 testified the appropriateness of IAPS in adult sample of Taiwan, preparatory study 2 compiled and revised T-IRI in adult sample of Taiwan, preparatory study 3 testified the appropriateness of T-AES in chronic schizophrenics of Taiwan, preparatory study 4 testified the appropriateness of JACFEE in adult sample of Taiwan. Besides above results, preparatory study 4 found cultural factors and in-group advantage effect may influence judgment correct rate on fear and angry. In formal study, study 3 proved social mental function to have constructive and differential validity. Results showed chronic schizophrenics have deficits on their social mental function compared to normal control and these deficits may result from dysfunction on their frontal-temporal circuits. Other findings included apathy, empathetic concern and fear facial expression recognition probably having potential on early detection, and positive symptoms having negative influence on facial recognition. Finally, the results in study 4 showed there were different influential factors on social function and its subdimensions in chronic schizophrenics with different clinical symptom profiles. In addition, cognitive mental function, social mental function, clinical symptoms, and demographic variables have different weights on predictive power on social function of chronic schizophrenics. Overall, study 4 could be regarded as an empirical evidences to use neuropsychological assessment and cognitive rehabilitation as a psychosocial intervention approach in chronic schizophrenics in future.

目 次
口試委員會審定書………………………………………………… i
誌謝………………………………………………………………… iii
中文摘要…………………………………………………………… v
英文摘要…………………………………………………………… iv
第壹章
緒論………………………………………………………………… 1
一、前言…………………………………………………………… 1
二、研究動機……………………………………………………… 3
三、研究目的……………………………………………………… 6
第貳章
慢性精神分裂症病患的臨床症狀面向和剖面研究……………… 9
一、前言…………………………………………………………… 9
二、研究對象和方法……………………………………………… 12
三、結果…………………………………………………………… 14
四、討論…………………………………………………………… 19
第參章
不同臨床症狀剖面下慢性精神分裂症病患的認知性心智功能的
缺損特性研究……………………………………………………… 25
一、前言…………………………………………………………… 25
二、研究對象和方法……………………………………………… 42
三、結果…………………………………………………………… 47
四、討論…………………………………………………………… 59
第肆章
不同臨床症狀剖面下慢性精神分裂症病患的社會性心智功能的
缺損特性研究……………………………………………………… 71
一、前言…………………………………………………………… 71
二、預備研究一：國際情緒圖片系統在台灣的適用性研究…… 75
三、預備研究二：台灣版人際反應性指標量表的編制………… 86
四、預備研究三：台灣版冷漠評估量表在慢性精神分裂症病患
使用的心理計量特性………………………… 96
五、預備研究四：日本人和白種人臉部表情測驗在台灣的適用
性……………………………………………… 105
六、正式研究對象和方法……………………………………… 117
七、正式研究結果………………………………………………… 119
八、正式研究討論………………………………………………… 134
第伍章
不同臨床症狀剖面下慢性精神分裂症病患的社會功能影響因素
研究………………………………………………………………… 149
一、前言…………………………………………………………… 149
二、研究對象和方法……………………………………………… 154
三、結果…………………………………………………………… 155
四、討論…………………………………………………………… 164
五、綜合討論……………………………………………………… 172
參考文獻…………………………………………………………… 191
附錄…………………………………………………………… 233

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