研究限制及建議

第五章討論與建議

第五節研究限制及建議

壹、研究對象

本研究對象主要針對北部地區收案為主，收案人數為 35 人，

樣本數可能影響統計資料之分析之顯著。此次收案對象大部分為精神科日間照護中心之個案，可能受限於某類型的思覺失調症者，

若能在其他外縣市收案，其可能拓展研究對象所處地區性的廣度，

能使樣本更具代表性，未來可多針對社區或是門診之個案收案，

擴大樣本代表性。

此次收案未能針對思覺失調症者之發病年齡以及服藥狀況來作探討，而對於思覺失調症者來說，病程長短以及服藥狀況可能影響可能影響復健成效、功能以及生活品質，此亦為未來可再探討之部分。

貳、研究工具

據本研究所知，目前台灣仍未有研究探討 DSM-5 精神病症狀嚴重度臨床評分表在思覺失調症者之信效度，故本研究精神症狀之評估其信效度仍有考量。但此工具強調全面性的評估症狀，對於思覺失調症者之精神症狀嚴重度評估是重要的，故建議未來研究除發展工具信效度以外，仍頇強調全面性評估精神症狀嚴重度

的觀點。

WHODAS 2.0 與 WHOQOL-BREF 目前在思覺失調症者使用上皆有信效度之發展，顯示在思覺失調症者之應用是可行的，但此兩者皆為主觀性評估工具，建議未來之研究可再加入其他客觀性評估工具，如照顧者觀察或是臨床專業人員評估等。

參、研究變項

本研究此次人口學變項為控制變項，但在生活品質的文獻探討中，發現過去探討思覺失調症者生活品質之研究，對於性別、

教育程度、婚姻關係、居住狀況等人口學變項皆有琢磨，後續研究可再對此深入探討。

由於本研究目的為探討思覺失調症者精神症狀嚴重度、失能程度與生活品質的相關性，其因素之間是否有交互作用影響較難排除、控制，為此次研究較不足之地方。

整體來說，影響思覺失調症者之生活品質相關因素相當廣泛，

而生活品質又為個人主觀感受，若將生活品質視為復健後的重要指標，除了橫斷面的研究以外，縱貫面的後續追蹤研究可能為未來研究之重點。

肆、結語

根據此次文獻探討，此為第一篇以 FUNDES 7.1 和

WHOQOL-BREF 作為探討思覺失調症者失能程度和生活品質的研究，同時以 DSM-5 的精神病症狀嚴重度臨床評分表作為評估精神症狀嚴重度。

思覺失調症者之生活品質為重要的議題，而其影響因素十分廣泛，本研究以探討精神症狀與失能程度為主。思覺失調者由於疾病影響，造成各領域生活表現有不同的失能程度。故臨床專業人員在協助思覺失調症者的過程中，應該全面性評估精神症狀表現以及其失能程度，提供個別化的復健計劃，增進個人對於生活品質之滿意度，且亦可將之作為復健成效及指標。

參考文獻

廖華芳、嚴嘉楓、黃靄雯、劉燦宏、張本聖、吳亭芳、呂淑貞、紀彣宙、張光華

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of

Mental Disorders, 5th edition. Washington, DC: American Psychiatric

Association.

Alonso, J., Angermeyer, M. C., Bernert, S., Bruffaerts, R. Brugha, T. S., Bryson, H., …Vollebergh, W. A. M. (2004). Disability and quality of life impact of mental disorders in European study of the epidemiology of mental disorders (ESEMeD) project. Acta Psychiatrica Scandinavica, 109, 38-46.

Alpekin, K., Erkoç, Ş., Göğüş, A. K., Kültür, S., Mete, L., Ü çok, A., & Yazıcı, K. M.

(2005). Disability in schizophrenia: Clinical correlates and prediction over

10.1016/j.psychres.2004.05.027

Anderson, R. L., & Lewis, D. A. (2000). Quality of life of person with severe mental illness living in an intermediate care facility. Journal of Clinical Psychology,

56(4), 575-581.

Adegbaju, D. A., Olagunju, A. T., & Uwakwe, R. (2013). A comparative analysis of disability in individuals with bipolar affective disorder and schizophrenia in a sub-Saharan African mental health hospital: Towards evidence-guided rehabilitation intervention. Social Psychiatry and Psychiatric Epidemiology,

48(9), 1405-1415. doi: 10.1007/s00127-013-0654-6

Aki, H., Tomotake, M., Kaneda, Y., Iga, J., Kinouchi, S., Shibuya-Tayoshi, S., …Ohmori, T. (2008). Subjective and objectivequality of life, levels of life skills, and their clinical determinants in outpatients with schizophrenia.

Psychiatry Research, 158(1), 19-25. doi: 10. 1016/j.psychres.2006.05.017

Brissos, S., Balanza-Martinez, V., Dias, V. V., Carita, A. I., & Figueira, M. L.

(2011). Is personal and social functioning associated with subjective quality of life in schizophrenia patients in the community? European

Archives of Psychiatry and Clinical Neuroscience, 261(7), 509-517. doi:

10.1007/s00406-011-0200-z

Blanchard, J. J., Horan, W. P. & Collins, L. M. (2005). Examining the latent structure of negative symptoms: Is there a distinct subtype of negative symptom schizophrenia? Schizophrenia Research, 77, 151-165.

Bryson, G., Lysaker, P., & Bell, M. (2002). Quality of life benefits of paid work activity in schizophrenia. Schizophrenia Bulletin, 28(2), 249-257.

Brissos, S., Molodynski, A., Dias, V. V., & Figueire, M. L. (2011). The importance of measuring psychosocial functioning in schizophrenia. Ann Gen Psychiatry, 10,

Bowie, C. R., Reichenberg, A., Pattern, V. L., Heaton, R. K., & Harvey, P. D.(2006).

Determinants of real-world functional performance in schizophrenia subjects:

Correlations with cognition, functional capacity, symptoms. American Journal

of Psychiatry, 163(3), 418-425.

Chi, W. C., Chang, K. H., Escorpizo, R., Yen, C. F., Liao, H. F., Chang, F. H., …Liou, T. H. (2014). Measuring disability and its predicting factors in a large database in Taiwan using the World Health Organization Disability Assessment Schedule 2.0. International Journal of Environment Research and Public

Health, 11(12), 12148-12161. doi: 10.3390/ijerph111212148

Chopra, P. K., Couper, J. W., & Herrman, H. (2004). The assessment of patients with long-term psychotic disorders: application of the WHO Disability Assessment Schedule II. Australian and New Zealand Journal of Psychiatry, 38, 753-759.

Chang, K. H., Lin, Y. N., Laio, H. F., Yen, C. F., Escorpizo, R., Yen, T. H., & Liou, T.

H. (2014). Environmental effects on WHODAS 2.0 among patients with stoke with a focus on ICF category e120. Quality of Life Research, 23(6), 1823-1831.

doi: 10.1007/s11136-014-0624-9

Chugh, P. K., Rehan, H. S., Unni, K. E., & Sah, R. K. (2013). Predictive value of symptoms for quality of life in first-episode schizophrenia. Nordic Journal of

Psychiatry, 67(3), 153-158. doi: 10.3109/08039488.2012.687768

Dan, A., Kumar, S., Avasthi, A., & Grover, S. (2011). A comparative study on quality of life of patients of schizophrenia with and without depression. Psychiatry

Research, 189(2), 185-189. doi: 10.1016/j.psychres.2011.02.017

Endicott, J., Spitzer, R., Fleiss, J., & Cohen, J. (1976). The global assessment scale: A procedure for measuring overall severity of psychiatric disturbance. Archives

of General Psychiatry, 33, 766-771.

schizophrenia. Social Psychiatry and Psychiatric Epidemiology, 39(1), 73-77. doi: 10.1007/s00127-004-0697-9

Falvo, D. R. (2013). Schizophrenia and other psychiatric conductions.In medical and psychosocial aspects of chronic illness and disability (5th ed.), pp. 203-222.

Boston: Jones and Bartlett.

Fleury, M. J., Grenier, G., Bamvita, J. M., Tremblay, J., Schmitz, N., & Caron, J.

(2013). Predictors of quality of life in a longitudinal study of users with severe mental disorders. Human and Quality of Life Outcomes, 92(11), 1-12. doi:

10.1186/1477-7525-11-92

Ferrans, C., & Powers, M. (1992). Psychometric assessment of the Quality of Life Index. Research in Nursing and Health, 15, 29-38.

Fitzgerald, P. B., Williams, C. L., Corteling, N., Filla, S. L., Brewer, K., Adams, A., …Kulkarmi, J. (2001). Subject and observer-rated quality of life in schizophrenia. Acta Psychiatrica Scandinavica, 103(5), 387-392. doi:

10.1034/j.1600-0447.2001.00254.x

Guilera, G., Gómez-Benito, J., Pino, O., Rojo, J. E., Cuedta, M. J., Martínez-Arán, A., …Rejas, J.(2012). Utility of World Health Organization Disability Assessment Schedule II in schizophrenia. Schizophrenia Research, 138(2), 240-247. doi: 10.1016/j.schres.2012.03.031

Huang, R. R., Chen, Y. S., Chen, C. C., Chou, F. H., Su, S. F., Chen, M. C., . . . Chang, L. H. (2012). Quality of life and its associated factors among patients with two common types of chronic mental illness living in Kaohsiung City. Psychiatry

and Clinical Neurosciences, 66(6),

482-490.

doi:10.1111/j.1440-1819.2012.02380.x

Hsieh, C. J., Chang, C.C., Chen, S.C., & Shilh, Y. W. (2013). Needs and quality of life

of Psychiatry, 27(4), 283-294.

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 modeling analysis. Australian and New

Zealand Journal of Psychiatry, 44, 71-84.

Hsiao, C. Y., Hsieh, M. H., Tseng, C. J., Chien, S. H., & Chang, C. C. (2012). Quality of life of individuals with schizophrenia living in the community: Relationship to socio-demographic, clinical and psychosocial characteristics. Journal of

Clinical Nursing, 21(15), 2367-2376.doi: 10.1111/j.1365-2702.2012.04067.x

Huang, Y. M., Kao, C. Y., Hsu, J. H., & Yu, C. H.(2011).Analyses of the quality of life

among patients with schizophrenia. Taiwanese Journal of Psychiatry, 25(3), 158-166.

Harvey, P. D., Sabbag, S., Prestia, D., Durand, D., Twamley, E. W., & Patterson, T.L.

(2012). Functional milestones and clinician ratings of everyday functioning in people with schizophrenia: Overlap between milestones and specificity of ratings.

Journal of Psychiatric Research, 46,

1546-1552. doi:

10.1016/j.psychires.2012.08.018

Kurtz, M. M., Bronfeld, M., & Rose, J. (2012). Cognitive and social cognitive predictors of change in objective versus subjective quality-of-life in rehabilitation for schizophrenia. Psychiatry Research, 200(2), 102-107. doi:

10.1016/j.psychres.2012.06.025

Karadayı, G., Emiroğlu, B., & Üçok, A. (2011). Relationship of symptom remission with quality of life and functionality in patients with schizophrenia. Comprehensive Psychiatry, 52(6), 701-707. doi:

10.1016/j.comppsych.2010.11.012

and quality of life between genders in schizophrenia remission. Industrial

Psychiatry Journal, 19(1), 50-54. doi: 10.4103/0972-6748.77638

Kim, E. J., Song, D. H., Kim, S. J., Park, J. Y., Lee, E., Seok, J. H., …Cho, H. S.

(2010). Proxy and patients ratings on quality of life in patients with schizophrenia and bipolar disorder in Korea. Quality of Life Research, 19(4), 521-529. doi: 10.1007/s11136-010-9617-5

Lepage, M., Bodnar, M., & Bowie, C. R. (2014). Neurocognition: Clinical and functional outcomes in schizophrenia. The Canadian Journal of Psychiatry,

59(1), 5-12.

Landeen, J., Pawlick, J., Woodside, H., & Byrne, C. (2000). Hope, quality of life, and Symptom severity in individuals with schizophrenia.

Psychiatric Rehabilitation Journal, 23(4), 364-369.

Mubarak, A. R. (2005). Social functioning and quality of life of people with schizophrenia in the northern region of Malaysia. Australian e-Journal for the

Advancement of Mental Health, 4(3), 200-209.

Mubarak, A. R. (2006). Employment status, psychiatric disability and quality of life:

Comparison of men and women with schizophrenia in Malaysia. International

Journal of Social Welfare, 15(3),

240-246. doi:

10.1111/j.1468-2397.2006.00418.x

Meeberg, G. A. (1993). Quality of life: a concept analysis. Journal of Advanced

Nursing, 18(1), 32-38.

Mas-Expósito, L., Amador-Campos, J. A., Gómez-Benito, J., & Lalucat-Jo, L. (2011).

The World Health Organization Quality of Life Scale Brief Version: a validation study in patients with schizophrenia. Quality of Life Research, 20(7), 1079-1089. doi: 10.1007/s11136-011-9847-1

B. J. (1997). Work and nonvocational domains of functioning in persons with severe mental illness: A longitudinal analysis. The Journal of Nervous and

Mental Disease, 185(7), 419-426.

Maat, A., Fett, A. K., & Derks, E. (2012). Social cognition and quality of life in schizophrenia.

Schizophrenia Research, 137(1),

212-218. doi:

10.1016/j.schres.2012.02.017

Moreno-Küstner, B., Mayoral, F., Rivas, F., Angona, P., Requena, J., García-Herrera, J.

M., …Bellón, J. A. (2011). Factors associated with use of community mental health services by schizophrenia patients using multilevel analysis. BMC

Health Services Research, 11, 257. doi: 10.1186.1472-6963-11-257

Mckibbin, C., Patterson, T., & Jeste, D. V. (2004). Assessing disability in older patients with schizophrenia: Result from WHODAS-II. Journal of Nervous

and Mental Disease, 192(6),

405-413. doi:

10.1097/01.nmd.0000130133.32276.83

Norman, R. M. G., Malla, A. K., McLean, T., Voruganti, L. P. N., Cortese, L., Mcintosh, E., …Rickwood, A. (2000). The relationships of symptoms and level of functioning in schizophrenia to general wellbeing and the Quality of Life Scale. Acta Psychiatica Scandinavica, 102(4), 303-309. doi:

10,1034/j.1600-0447.2000.102004303.x

Priebe, S., & Fakhoury, W. K. H. (2008). Quality of life. In: Jeste, D. & Mueser, K.

(Eds.), The clinical handbook of schizophrenia (pp. 581–591). New York, NY:

Guilford Press.

Priebe, S., McCabe, R., Junghan, U., Kallert, T., Ruggerti, M., Slade, M., &

Reininghaus, U. (2011). Association between symptoms and quality of life in patients with schizophrenia: A pooled analysis of changes over time.

Ristner, M. S., Arbitman, M., Lisker, A., & Ponizovsky, A. M. (2012). Ten-year quality of life outcomes among patients with schizophrenia and schizoaffective disorder II. Predictive value of psychosocial factors. Quality of

Life Research, 21(6), 1075-1084. doi: 10.1007/s11136-011-0015-4

Rocca, P., Bellino, S., Calvarese, P., Marchiaro, L., Patria, L., Rasetti, R., & Bogetto, F. (2005). Depressive and negative symptoms in schizophrenia: different effects on clinical features. Comprehensive Psychiatry, 46(4), 304-310. doi:

10.1016/j.comppsych. 2004.09.001

Ritsner, M. S., Mar, M., Arbitman, M., & Grinshpoon. (2013). Symptom severity scale of the DSM5 for schizophrenia, and other psychotic disorder: Diagnostic validity and clinical feasibility. Psychiatric Research, 208, 1-8. doi:

10.1016/j.psychres.2013.02.029

Rajji, T. K., Miranda, D., & Mulsant, B. H. (2014). Cognition, Function, and disability in patients with schizophrenia: A review of longitudinal studies.

Canadian Journal of Psychiatry, 59(1), 13-17.

Rocca, P., Montemagni, C., Zappia, S., Piterà, R., Sigaudo, M., & Bogetto, F. (2014).

Negative symptom and everyday functioning in schizophrenia: A cross-sectional study in a real world-setting. Psychiatric Research, 218(3), 284-289. doi: 10.1016/j.psychres.2014.04.0180165-1781

Savilla, K., Kettler, L., & Galletly, C. (2008). Relationships between cognitive deficits, symptoms and quality of life in schizophrenia.Australian and New Zealand

Journal of Psychiatry, 42(6), 496-504.

Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., …Doubar, G. C. (1998). The Mini-International Neuropsychiatric Interview(M.I.N.I.): The development and validation of a structured diagnostic

59(20), 22-23.

Su, C. T., Ng, H. S., Yang, A. L., & Lin, C. Y. (2014). Psychometric evaluation of the Short Form 36 Health Survey (SF-36) and the World Organization Quality of Life Scale Brief Version (WHOQOL-BREF) for the patients with schizophrenia.

Psychological Assessment, 26(3),

980-989. doi:

10.1037/a0036764

Strejilevich, S. A., Palatnik, A., Avila, R., Bustin, J., Cassone, J., Figueroa, S., …de Erausqin, G. A. (2005). Lack of extrapyramidal side effects quality of life in outpatients treated with clozapine or with typical antipstchotics. Psychiatry

Research, 133(2), 227-280. doi: 10.1016/j.psychres.2004.10.009

Tarek, K. R., Dielle, M., & Benoit, H. (2014) Cognition, function, and disability in patients with schizophrenia: A review of longitudinal studies. Canadian

Journal of Psychiatry, 59(1), 13-17.

Tandon, R., Gaebel, W., Barch, D. M., Bustillo, J., Gur, R. E., Heckers, S., …Carpenter, W. (2013). Definition and description of schizophrenia in the DSM-5. Schizophrenia Research, 150, 3-10. doi:10.1016/j.schres.2013.05.028 Tomida, K., Takahashi, N., Saito, S., Maeno, N., Iwamoto, K., Yoshida, K., …Ozaki,

N. (2010). Relationship of psychopathological symptoms and cognitive function to subjective quality of life in patients with chronic schizophrenia.

Psychiatry and Clinical Neuroscience, 64(1),

62-69. doi:

10.1111/j.1440-1819.2009.02033.x

Ü stün, T. B., Chatterji, S., Kostanjsek, N., Rehm, J., Kennedy, C., Epping-Jordan, J., …Pull, C.(2010). Developing the World Health Organization Disability Assessment Schedule 2.0. Bulletin of the World Health Organization, 88, 815-823. doi: 10.2471/BLT.09.067231

with functionality and quality of life in patients with schizophrenia:

EGOFORS study.

European Psychiatry, 26(6),

422-425.

doi:10.1016/j.eurpsy.2011.01.014

Vandiver, V. L. (1998). Quality of life, gender and schizophrenia: a cross-national survey in Canada, Cube, and U.S.A. Community Mental Health Journal, 34(5), 501-511.

van der Plas, A. G. M., Hoek, H. W., van Hoeken, D., Valencia, E., & van Hemert, A.

M. (2011). Perceptions of quality of life and disability in homeless persons with schizophrenia living in non-institutional housing. International Journal of

Social Psychiatry, 58(6), 629-634. doi: 10.1177/0020764011419056

World Health Organization. (2011). World Report on Disability. Retrieved from http://

www.who.int/about/licensing/copyright_form/en/index.html

Wu, H. C.(2008). Predicting subjective quality of life in workers with severe psychiatric disabilities. Community Mental Health Journal, 44, 135-146. doi:

10.1007/s10597-007-9118-3

Wilson-d’Almeida, K., Karrow, A, Bralet, M. -C., Bazin, N., Hardy-Baylé, M. -C., &

Falissard, B. (2013). In patients with schizophrenia, symptoms improvement can be uncorrelated with quality of life improvement. European Psychiatry, 28, 185-189.doi: 10.1016/j.eurpsy.2011.10.002

Ware, J. E., & Sherbourene, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30(6), 473-483.

Wiersma, D., Wanderling, J., Dragomirecka, E., Ganev, K., Harrison, G, An Der Heiden, W, …Walsh, D. (2000). Social disability in schizophrenia: It’s development and prediction over 15 years in incidence cohorts in six European

Zhang, Z., Deng, H., Chen, Y., Li, S., Zhou, Q., Lai, H., …Shen, W. (2013).

Cross-sectional survey of the relationship of symptomatology, disability and family burden among patients with schizophrenia in Sichuan, China. Shanghai

Archives of Psychiatry, 26(1),

22-29. doi:

10.3969/j.issn.1002-0829.2014.01.004

附錄ㄧ精神病症狀嚴重度臨床評分表

VI 認知

附錄二台灣簡明版世界衛生組織生活品質問卷

第一部份生活品質問卷

問卷說明：

這份問卷詢問您對於自己的生活品質、健康、以及其他生活領域的感覺。請您回答所有的問題。如果您對某一問題的回答不確定，請選出五個答案中最適合的一個，通常會是您最早想的那個答案。

我們的問題所關心的是您最近兩星期內的生活情形，請您用自己的標準、希望、愉快、以及關注點來回答問題。請參考下面的例題：

例題一：整體來說，您滿意自己的健康嗎?

□極不滿意 □不滿意 □中等程度滿意 □滿意 □極滿意

請選出最適合您在最近兩星期內對自己健康的滿意程度，如果您很滿意自己的健康，就在「極滿意」前的□內打「√」。請仔細閱讀每個題目，並評估您自己的感覺，然後就每一個題目選出最適合您的答案。謝謝您的協助！

同意書

本人同意參加『思覺失調症者精神症狀、失能程度與生活品質之相關』研究計畫，

本人瞭解上述資料僅供學術研究，不作其他用途；且絕不會有本人或其他個人姓名出現在最後報告中。

受訪者簽名：

受訪日期：

1.

整體來說，您如何評價您的生活品質？

□極不好 □不好 □中等程度好 □好 □極好

2.

整體來說，您滿意自己的健康嗎？