住院慢性思覺失調症病患臨床症狀因素結構和其剖面的探索性研究

An Exploratory Study of Clinical Symptom Factors and Profiles for Chronic Inpatient Schizophrenics

目的：本研究有兩個目的，第一是釐清國內住院慢性思覺失調症病患的臨床症狀因素結構。第二則是依據臨床症狀因素結構，探索住院慢性思覺失調症病患是否存在不同的症狀剖面。方法：本研究的受試者為196位台北榮民總醫院玉里分院住院慢性思覺失調症病患，其中115位為男性，81位為女性，平均年齡為51.57歲，平均教育年數為10.04年，受試者的臨床症狀由六位精神科醫師使用中文版活性與負性量表負責進行評估，評估結果以廣義相關圖和探索性因素分析進行分析，所有受試者評估時皆接受抗精神病藥物的治療。結果：本研究發現以廣義相關圖分析住院慢性思覺失調症病患的臨床症狀包括認知缺損、活性症狀、情感遲滯、憂鬱焦慮和社交退縮等五因素結構，而且以這五個臨床症狀因素可以將慢性思覺失調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；此外本研究也發現活性與負性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分。結論：本研究透過實徵研究異法同證了住院慢性思覺失調症病患的臨床症狀為五因素結構，也發現認知缺損和情感遲滯與個案的年齡和教育年數無關，有做為早期偵測思覺失調症的潛力。但是受限於受試者的來源和特性，建議要將本研究的發現應用於其他思覺失調症病患群體前謹慎小心。

Aims: There were two aims in this study. The first was to clarify clinical symptom factors in chronic inpatient schizophrenics. The second was to explore whether there were different symptom profiles based on patients' clinical symptom factor structure. Method: One hundred and ninety-six subjects, who met the diagnostic criteria of schizophrenia in DSM-IV, were included in this study. There were 115 male and 81 female participants and their mean age and education level (here referred to in terms of years of education experience) were 51.57 years and 10.04 years respectively. All subjects had a routine antipsychotics therapy session and participated in a Chinese version of a PANSS interview facilitated by one of six psychiatrists. The results from the PANSS interviews were analyzed using GAP and EFA. Results: The results from the GAP analysis showed that there were five symptom factors; these factors were impaired cognition, positive symptoms, emotional retardation, depression/anxiety, and social withdrawal. According to these factors, chronic inpatient schizophrenics could be categorized into 3 profiles groups: 1. a significant mixed positive and negative symptom group, 2. a significant widespread symptom group, and 3. a significant social withdrawal group. This study also found that there were two mutually independent components of negative symptom factors in the original PANSS. Conclusion: This study identified five factor-based structure profiles for clinical symptoms in chronic inpatient schizophrenics. In addition, based on findings there are no any correlation among patient’ age, educational level, impaired cognition and emotional retardation, these two factors may be potential markers for early detection of schizophrenia. However, there were some limitations in this study.