精神衛生護理對近代生物精神醫學發展之因應與省思

ၡāࢋĈϠۏჟৠᗁጯଂ˟˩͵ࡔ̚ཧᎸ੓Ăֹჟৠᗁጯ ࡁտ൏ᕇଂ͕ᖼொזཝĂࡊጯ׏ቑ˵Ϥ็௚۞ჟ ৠજ˧ጯሀёഈШ͕நϠநჟৠሀё۞׏ቑ൴ णĄଂ 1990 ѐ੓Ăჟৠ኎Ϡ᜕நצזჟৠϠۏ ᗁጯధк኏ᑝĂΒ߁Ĉ၁ᙋّჟৠ኎Ϡ᜕நᎸ ੓ăፋЪϠۏጯ៍ᕇ۞᜕ந၁ચ̍үצזࢦෛă Հฟٸ̈́ኳႷ۞໰᜕ၗޘᄃ͞ёăિ޺Հ޺ᜈᚑ ᖰ۞ࡁ੅ჟৠĄࢦෛϠۏჟৠᗁጯ̝ᅫĂჟৠ኎ Ϡ᜕நᑕТॡ࠷ޥĂтңਕೠ೪᜕ந۞ፋវ៍̈́ ΐૻ᜕நˠࣶ۞Բҿّޥ҂Ąჟৠ኎Ϡ᜕நᑕд ᜕நିֈă᜕ந၁ચ᜕̈́நࡁտ˯ΐૻϠۏჟৠ ᗁጯ̝࠹ᙯۢਕᄃྻϡĄ ᙯᔣෟĈϠۏჟৠᗁጯăჟৠ኎Ϡ᜕நăፋវ᜕ّநĄ

݈āā֏

˟˩͵ࡔ̚ཧĂຍγ൴ன̼ጯᘽۏ၆ჟৠ়ঽ۞ јड़Ăܳซ˞ჟৠᘽۏጯ۞൴णĂԯჟৠ়ঽঽЯ۞ ࡁտĂଂྵࠎԛё˯ᄃତܕࣰጯᅳા۞ჟৠ̶ژĂٛ ז၁ᅫ۞Ϡநᄃঽநត̼Ăซˢ׶̰γࡊ়ঽ˘ਠ۞ ၁ᙋࡁտĄჟৠᗁጯᅳાฟؕѣ˞எג۞ᖼតĂࡁտ ۞൏ᕇଂ͕ĞmindğזཝĞbrainğԼតĂԛјϠۏጯ ̚౵΄ˠຏזᎸ኷۞ᅳા̝˘Ąࡊጯ׏ቑ˵Ϥ็௚ ۞ჟৠજ˧ጯĞtraditional psychodynamicğሀёഈШ ͕நϠந۞ჟৠሀёĞpsychobiological perspectiveğ ĞCowan, Harter, & Kandel, 2000; McEnany, 1991;

Mc-Crone, 1996ğĄჟৠᗁጯ۞૞ຽ൴णଂĶዋᑕ̙։ķ ۞͕ந࿅඀ĂᖼͽĶᗁጯ়ঽķԼត۞ሀёࠎૄᖂ ĞMichels & Marzuk, 1993ağĄ

າ۞ჟৠᗁጯ͞ڱдࡁտඉர˯ଂಏ˘͞ڱĂ тĈͽপؠ۞ৠགྷ็ጱۏኳീณপؠ۞়ঽĂႊតј ჟৠᗁጯ۞ፋЪࡁտĂ҂ᇋ̶̄ă௟ࡪăৠགྷă׶ ҖࠎតีඈĞWolfe, 1994ğĂֹჟৠ়ঽ۞෧ᕝՀჟ ቁăΞያ̈́ѣड़Ą၆࣎វপؠ۞ჟৠᅪᘣĂͽૄЯ۞ ೡᘱĂ̼ጯăҺࠪጯă̶̰کጯᄃৠགྷϠநጯઇૄ ᖂĂᒢྋ଀ͽՀஎˢĂ၆পؠჟৠ়ঽ۞ڼᒚᄃᘽۏ ۞ֹϡĂ଀ͽՀฟ٤ĄТॡĂჟৠᗁጯ۞Ϡۏૄᖂ˵ ኏ᑝ͕நᒚڱĂฟؕயϠᓜԖ˯ր௚ّ۞၁ᙋࡁտĂ ͽ̈́ૻአ׎׍ѣຍཌྷඕڍ۞൴னĞMichels & Marzuk, 1993bğĄ Golden̈́ SawickiĞ1985ğ೩זĂࡊጯߏ౵௣Ξ ͽᒢྋ͕ം়ঽ۞ሕд৛૜Ą၆ٺϠۏጯ׶Ϡۏࡊ ԫ۞ጾ᜕۰҃֏ĂϠۏࡊԫ۞ซՎᑕϡдჟৠઉ૵ યᗟ̝఍ந˯Ă၆ჟৠঽଈயϠޝ̂۞჊ࡅĞClarke, 2000ğĄᔵ൒ჟৠᗁጯ۞ϠۏૄᖂͧͽـЇңॡ࣏۞ ൴णՀቿݎĂҭߏϫ݈۞ࡁտ˵͔൴Հкޞаඍᄃሏ ୻۞યᗟĄזغϫ݈Ϡۏჟৠᗁጯ൴ण۞ېڶтңĉ ׎၆ჟৠ኎Ϡ᜕நѣֱ̦ᆃ኏ᑝĉ᜕நᑕྍтңЯ ᑕĉͽ̈́ᑕྍѣֱ̦ᆃ࠷ޥĉჟৠ኎Ϡ᜕ந۞ႊซ׶ ჟৠᗁጯ۞ซणߏिि࠹ᙯ۞Ăώ͛ӈ੫၆Ϡۏჟৠ ᗁጯ൴णĂ̈́၆ჟৠ኎Ϡ᜕ந۞ᇆᜩઇ˘ໄ߁ೡࢗĂ ԓ୕ਕ͔൴Հк᜕நˠࣶ۞ᙯ̷Ą

Ϡۏჟৠᗁጯ

Ϡۏჟৠᗁጯߏ޽ჟৠᗁጯᅳાĂ౅࿅ৠགྷྋ࣠ ጯăৠགྷϠநጯ۞૞ຽۢᙊĂᆧΐ၆ཝ׶̶̰کҺࠪ ր௚۞ᒢྋĂซ҃ᒢྋჟৠ়ঽᄃϠۏّঽந፟ᖼ۞ ጯܝĄѩጯܝপҾૻአཝొΑਕ̈́׎дჟৠ়ঽٙ̚ Էႊ۞֎ҒĂ૟ܜഇͽֽԧࣇ၆͕ംĞmindğඕၹ׶ Αਕ۞ᒢྋĞΒ߁ώԧăҋԧᄃ෹ԧğĂᖼࠎ၆ཝొ Αਕ৿εٕΑਕᅪᘣ͞ࢬ۞ᒢྋĞBabich & Tolbert, 1992ğĄ

ჟৠ኎Ϡ᜕ந၆

ܕ΃Ϡۏჟৠᗁጯ൴ण̝Яᑕᄃ࠷ޥ

ᔁָटāᆒ୿ऍ

* ᄂΔᗁጯ̂ጯ᜕நጯրᓾरĂέ៉̂ጯ̳В኎Ϡጯੰ኎Ϡ߆ඉᄃგ நጯࡁտٙ౾࣏̀Ᏼˠ ᄂΔᗁጯ̂ጯ᜕நጯࡁտٙրି଱ * ఼ੈү۰гӬĈᆒ୿ऍāāέΔξӓᎸූ 250 ཱི ࿪āāྖĈĞ02ğ27361661 ů 6300

Ϡۏჟৠᗁጯᅳા඾ࢦд̣࣎ᆸࢬĂΒ߁Ĉ ჟ ৠঽநঽېᄃჟৠ়ঽᙷҾ̝ࠧؠć ჟৠঽநাې ٙ၆ᑕ̝ཝΑਕᅪᘣć Ч჌ჟৠ়ঽཝঽត̝ٙд ᄃ׎পّć ཝΑਕᅪᘣ̝࣒ϒᄃአዋĞӈϠۏጯ̝ ڼᒚğć ዋᑕཝΑਕᅪᘣٙᅮ̝Ϡ߿አዋĂΒӣ͕ நăछलăۤົّ۞ڼᒚᄃೇઉඈĄͽϠۏჟৠᗁጯ ̝நኢࠎ൴णჟৠᗁጯ̝ૄᖂĂΞͽ୻຾ࠧؠჟৠᗁ ጯ̝ࡊጯᅳાĂ֭୻຾ࠧؠૄٺᗁጯቑᘞ̝পّĂᄃ ׎΁͕நጯăۤົጯă̼͛ˠᙷጯඈጯܝѣ୻຾۞ડ ࿣ĞࡧăڒĂ 1995ğĄ

Ϡۏჟৠᗁጯ۞າซण

࿅Ν۞Η͵ࡔĂϠۏጯ̚౵ࢦࢋ۞൴னߏٺ̣˩ ѐ΃ޢഇ׶̱˩ѐ΃ܐഇৠགྷࡊጯ۞΍னĂ̶̄׶௟ ࡪϠۏጯ۞ԫఙдৠགྷր௚ࡁտ˯ѣᇃ̂гซणᄃᑕ ϡĄৠགྷࡊጯ၆ৠགྷ൴ਖ਼ܫཱི፟ט۞நྋᆧΐĂΒ߁ ৠ གྷ ۞ Α ਕ ൴ ण ă ཝ ͹ ࢋ ຏ ء ׶ ཝ ۞ ߿ જ ր ௚ ඈ ĞCowan et al., 2000ğĄ ˘ăཝొඕၹ ᖣϤ࿪ཝᕝᆸ̈́८ჃВॎౄᇆĂࡊጯछ൴னߙֱ ჟৠ̶ෘাঽଈཝొटณഴ͌Ă઎ཝވ̈́ௐˬཝވᕖ ̂Ă̂ཝϩኳăᗝཧă̈ཝ̈́ᙝቡր௚ĞপҾߏঔ੺ ਫ਼̈́Ճ̥८ğѣ෇ᒺன෪ĞMcCarely, 1996ğĄొ̶۞ ᗕໂّଐຏ়ଈ۞ঽଈĂཝވ˵ѣᕖ̂۞ன෪Ąᇎ៭ াଈ۰д८ჃВॎౄᇆ˭Ă൴ன̂ཝԍ८̈́ᗝཧӮྵ ၆໰௡ֽ଀̈Ăૻ࢝া۞ঽଈ˵ѣԍ८ᒺ̈۞ன෪Ă дڦຍ˧৿ε/࿅જ়ଈ۞࣎९֗˯ĂΞ֍݈ᗝཧٙ ͹Φ۞ޥ҂ăϫᇾጱШҖࠎă߿જࢍ൪۞Αਕѣᅪᘣ ĞZametkin et al., 1990ğĄϫ݈఺ֱཝొඕၹঽត۞ࡁ տĂ֭ܧٸኜαঔ࠰໤Ăٙͽإ̙ਕಶཝొඕၹពည ۞ᑭߤүࠎჟৠ়ঽ෧ᕝĄ ϫ݈Ăາ۞ჟ૜ᑭߤᆇጡĂтϒ̄೸डᕝᆸବႿ ĞPositron emission tomography, PETğ̈́Αਕّ८ჃВ ॎౄᇆĂΞͽ៍၅ཝొ̙Тડાд̙Тॡഇ˭۞΃ᔁ ېၗĄࡁտಡӘពϯĂჟৠ̶ෘাଈ۰۞ᗝཧ΃ᔁ߿ જྵमĂ҃ૄغ८۞΃ᔁ߿જ݋࠹၆೩੼ĞMcCarely, 1996ğĄ၆ٺᗕໂّଐຏ়ଈঽଈ۞ಡӘ݋޽΍Ă࣎ ९̂ཝϩኳ۞ҕ߹᛿ڦፋវഴ͌Ă׎̚ᗝཧҕ߹᛿ڦ ۞ഴ͌Հߏព඾ĞMann et al., 1996ğĄࡊጯछд൏ᇋা ଈ۰۞̂ཝϩኳĂ˵ѣֱপҾ۞൴னĄᔵ൒఺ֱ͞ࢬ ۞ࡁտإϏԆБؠኢĂҭΞቁؠ۞ߏჟৠ়ঽߏ˘჌ ̂ཝ۞়ঽĄࡊጯछ࠹ܫϏֽΞͽᖣϤঽիડા۞൴ னĂ੨Ъཝొৠགྷྋ࣠ጯ۞ໄهĂֽଯኢᓜԖাېᄃ ࠹ᙯ۞ཝొঽតĄ ˟ăϠۏ̼ጯ дϠۏ̼ጯ͞ࢬĂϫ݈ჟৠ̶ෘাజᄮࠎᄃк͐ ῔ր௚۞࿅ഭ߿᜙ѣᙯĞFarde et al., 1992ğĂ҃ᗕໂّ ଐຏ়ଈ݋׶ҕ୻৵ăϒඪ˯ཛྷ৵ăк͐῔ăəǕ῔ ૄ˚ᅕăጊധᅕៃĞGlutamateğᄃৠགྷ͡Ϡ ͉͡Ğneu-ropeptidesğ ඈ ৠ གྷ ็ ጱ ۏ ኳ ྵ ࠎ ᙯ ా Ğ Heninger, Charney, & Delgado, 1990; Rossen & Buschmann, 1995; Davidson et al., 2002ğĄధкࡁտᙋ၁ҕ୻৵дᇎ៭া ̚ҫѣࢦࢋ۞֎ҒĄҕ୻৵дཝొ۞ΑਕĂтĈԽ ᑝă൏ᇋă͕ംྻү߿જăࢴᇒăّҖࠎăჂ্/୻ ᏹăՏ͟ 24 ̈ॡ׶؞༼ఢޠăৠགྷ̶̰کΑਕă֗ វ໢ޘăᄮۢΑਕඈĂͽ̈́дূ൭ۢᛇٙ̚Էႊ۞ࢦ ࢋ֎ҒĂ఺ֱ࿅඀дᇎ៭াଈ۰֗˯ົѣள૱۞ྻү ĞCalarco & Krone, 1991; Davidson et al., 2002ğĄ҃ ൏ ᇋ া ଈ ۰ ੵ ˞ ˯ ࢗ ۏ ኳ γ Ă əǕ῔ ૄ ˚ ᅕ Ğ əǕ Aminobutyric acidğᄃ൏ᇋ۞ᙯܼ˵Яࠎᘽۏ۞ᒚड़ ҃జࢦෛĞMann et al., 1996ğĄࡊጯछ൴ன఺ֱৠགྷ็ ጱۏኳᄃჟৠ়ঽม۞ᙯܼĂ֭ܧ˘၆˘ĂϺӈ˘჌ ়ঽĂــົ஝ঘזрೀ჌ৠགྷ็ጱۏኳր௚۞ត ̼Ăд়ঽ൴ण۞̙ТॡഇĂৠགྷ็ጱۏኳ˵ົѣ̙ Т۞ត̼Ă׎̚۞ኑᗔ፟ᖼĂ̪ѣޞซ˘Վ၁រᄃࡁ տሏ୻̈́൴णĄ ˬăૄЯ͞ࢬ Ϥٺࡊԫ۞ࡎࢳ஠ซĂధкछ୉ăᅳዳ̈́ᗕࡪࡩ ۞ࡁտĂౌᙋځૄЯ۞᏷็Я৵ߏჟৠ̶ෘাăᗕໂ ّଐຏ়ଈăεംাඈೀ࣎ࢦࢋჟৠ়ঽ۞͹ࢋࣧ ЯĂּтĈ Crow நኢ೩זჟৠ̶ෘা۞ଈ۰Ăдૄ Яᖼᐂ࿅඀൴ϠࡎតĂᎮଈჟৠ̶ෘাߏߖҒវ̙၆ Ⴭ۞ඕڍĞCrow, 1990ğĄ Pulver ă Nestadt ̈́ Goldberg Ğ1994ğ੫၆ 100 ࣎ჟৠ̶ෘাଈ۰۞ࡁտ൴னĂଈ ۰Чѣ˘୧ߖҒវ۞ 22q11 ѣ৿ຫĂѩ৿ຫ૱૱ົЪ ׀ڦຍ˧৿εƝ࿅જ়ଈăᗕໂّଐຏ়ଈٕ׎΁ჟ ৠাĂЯѩѣֱጯ۰̏གྷ૟Ķ22q syndromeķ࠻јߏ ჟৠ̶ෘা۞Ѩ̶ᙷĞ߸Ă 1999ğĄன̫Ă၆ٺ૟ᇎ ៭াෛࠎົᇆᜩ̂ཝ׶֗វ۞к̮ր௚ᅪᘣ়ଈĂੵ ৠགྷᇆညдᗝ݈ϩኳăՃ̥८ăঔ੺ਫ਼ડા൴னள૱

ҕ߹ͅᑕĂдৠགྷ็ጱۏኳ۞አ༼Ϻѣள૱̙ఢ݋۞ ன෪ĞDavidson et al., 2002ğĂ൒҃Ă˯ࢗ۞൴னдᇎ ៭াᔵإϏజপளّϠۏᇾ੃Ğspecific biomarkerğ ٕ෧ᕝྏរٙቁᄮĂҭдϏֽϠۏჟৠᗁጯົᚶᜈـ ѩ͞Шଣ৶Ă֭೩ֻ၆ٺᇎ៭া۞ٽ਑ऴّវኳ۞ૄ Я Ϡ ۏ ᇾ ੃ ă ঽ ந Ϡ ந ፟ ᖼ ׶ Ξ ֻ ڼ ᒚ ۞ າ ᇾ ۞ ĞInsel & Charney, 2003ğĄ

઼̰έΔၷϔᓁᗁੰჟৠొ۞̶̄ࡁտވĂଂ 1999ѐ˟͡ฟؕତצछ୉ّεംাଈ۰ૄЯീྏĂᎡ ᑭଈ۰۞ APP ă PS1 ᄃ PS2 ૄЯĄϫ݈ѣ෸ֽ෸к۞ ᓜԖࡁտĂٕࠤҌགྷঽந˯۞෧ᕝࠎТኳ̼۞়ঽĂ జ൴னϤЧ჌ԆБ̙࠹̒۞ૄЯ৿ౝٙౄјĞ߸Ă 1999ğĄ̙˳۞ϏֽĂೀ࣎छल۞ჟৠ̶ෘাૄЯĂ ٕᗕໂّଐຏ়ଈૄЯϺΞਕײ̝୬΍Ă়ঽ࡭ঽ۞ ൴ன૟͟ৈᆧΐĄٙͽĂ̶̄Ϡۏԫఙ၆ჟৠᗁጯ۞ ᇆᜩĂΞଂѩ჌ԫఙ۞ኢ͛дჟৠᗁጯഇΏԣిјܜ ۞ன෪࠻΍ბࣔĂૄЯࡁտ۞ሕ˧ٙᇆᜩ۞ቑಛ่̙ ࢨٺ᏷็়ঽĂ͟ޢᔘΞਕՀჟቁ۞࿰ീ΍ߙֱᎮଈ ࢦঽ۞਑ऴវኳĂٕ၆ٺຏߖ໚̈́ᘽۏ۞ͅᑕඈĄ

Ϡۏჟৠᗁጯซण

၆ჟৠ኎Ϡ᜕ந۞኏ᑝ

ჟৠ኎Ϡ᜕ந۞ႊซ׶ჟৠᗁጯ۞ซणᙯܼ૜ ̷ĄϠۏჟৠᗁጯ۞ซणĂ၆ܕ΃ჟৠ኎Ϡ᜕ந˵ౄ јБࢬ۞ᇆᜩĄ఺ֱᇆᜩΞ̶ࠎೀ࣎͞ࢬĈ ˘ă၁ᙋّჟৠ኎Ϡ᜕ந۞Ꮈ੓ ࢬ၆͟ৈᆧΐ۞ჟৠϠۏᗁጯۢᙊ׶ঽଈᅮՐ۞ ԼតĂଂ 1990 ѐ੓ĂϠۏّ۞၁ᙋࡁտдჟৠ኎Ϡ ᜕நࠧᎸ੓Ă၆়ঽ׶ઉ૵̝ม۞ᙯܼ೩ֻ˘࣎፟ົ ᒢྋĞAbraham, Fox, & Cohen, 1992ğĄ᜕நˠࣶ၆ཝ ొΑਕѣՀ୻຾۞ᒢྋĂ၆ٺჟৠ়ঽ۞াېົѣ̙ Т۞Яᑕ͞ڱĂּтĈᒢྋᇎ៭াঽଈ۞Ⴢ্Ϡநݭ ၗĂ᜕நˠࣶಶՀΐਕିጱঽଈଳϡѣӄٺჂ্ܲઉ ۞͞ڱĄдჟৠᘽۏ͞ࢬĂ᜕நˠࣶਕםӄঽଈᒢྋ ᘽۏүϡ۞ͅᑕĂ̈́೩ֻઘүϡ۞ѣड़఍ந͞ڱĄ

઼࡚۞ჟৠঽଈᓑ༖ĞNational Alliance for the Mentally Ill, NAMIğ׶׎΁࣍ጱဥវ޽΍ĂϠۏჟৠ ᗁጯซणΞഴ͌˘ਠ̂ி၆ჟৠ়ঽ۞ѳЩ̼Ăឰϔ ிਕ̈́ѝ݌ٺಶᗁĂ̙҃ົਉᄱ়ঽ۞ڼᒚᄃ࿰ޢ ĞMcCrone, 1996ğĄϠۏ៍ᕇ၆ჟৠ়ঽ࡭ঽࣧЯ۞ྋ ᛖĂᄃؠཌྷჟৠ়ঽࠎཝొΑਕ۞ᅪᘣĂֹჟৠ়ঽ ࡭ঽ፟ᖼĂϤჟৠજ˧ጯ۞׏ቑᖼொז͕நϠۏ۞׏ ቑĂͷֹ̂ி၆ჟৠঽଈ۞ତצޘᆧΐĂଵϋЯ҃ഴ ͌ĞMcCrone, 1996ğĄ ˟ăࢦෛፋЪϠۏጯ៍ᕇ۞᜕ந၁ચ̍ү RoseĞ1998ğ޽΍дϫ݈᏷็ጯ׶ࡊԫԫఙ஽Җ ˭Ă൑ᇴ۞ጯఙഇΏд੅ኢৠགྷăཝă׶Җࠎ࠹ᙯ۞ ྖᗟĂ᜕நˠࣶᅮࢋᒢྋ͕ം࠹ᙯ۞ໄهĂт੃ጸă ၗޘăचُٕ൏ᇋඈĂѣ୧நгӔன΍͕ം۞ໄهඕ ڍĄ࿅ΝΪଂ࣎វགྷរ៍ᕇ੅ኢჟৠ়ঽ۞໰᜕̏ߏ ̙ૉ۞ĄϠۏࡊԫ൴ण۞኏ᑝĂ၆ᗁᒚ૞ຽ۞ᇆᜩـ ـ૲ֽՀк۞ႷೊĂּтĈͽϠۏࡊԫពϯ۞ள૱ன ෪Ăଯኢࠎள૱Җࠎ۞ྋᛖࣧЯĂ၆ჟৠ̶ෘা෧ᕝ ̚Ă׽ѣ۞˘ֱ̙ЪទᏭ઄న۞хႷĂٕߏ၆ٺ࣎វ д͕ந൭ࡴᑅ˧˭Ăপؠགྷរ֎Ғ۞֨᎔ͅᑕĂౌѣ ޞซ˘ՎᒢྋᄃଣտĞDawson & McCrone, 1996ğĄ ࡊጯ׶ԫఙ۞ࢭᎸĂ၆ٺ਑ऴ۞࣎९ٕ˘ਠ࣎វ۞ ໰᜕Ăٙࢬ၆۞߄ጼົՀΐᗁᒚ̼ᔌ๕ĞTrygstad, 1994ğĄ ˬă೩ֻՀฟٸኳႷ۞໰᜕ၗޘᄃ͞ё ᐌ඾າϠۏࡊԫ۞ซणĂჟৠ኎Ϡ᜕நˠࣶ۞໰ ᜕ၗޘᄃ͞ёצזᑭរĄͽᖞѣ۞໰ᜪ͞ёֽࢬ၆ࡊ ԫ۞າ൴னĂߏໂࠎދౕ۞үڱĂჟৠ኎Ϡ᜕நˠࣶ ତצৠགྷϠۏჟৠᗁጯ۞ඕڍĂ૟ͽՀฟٸኳႷ۞ၗ ޘٕ͞ё೩ֻ໰᜕ĄּтĈᇎ៭া۞ࣧЯజྋᛖࠎߏ ཝొঽត۞ඕڍǕĶᇎ៭াᄃ݈ᗝཧ׶ᙝቡր௚۞ཝ ొҕ߹߹જഴ͌ѣព඾ᙯܼķĂ఺ᇹ۞ᒢྋΞͽૻ̼ ঽଈ۞ĶϠঽ֎ҒķĂഴ͌࣎វ۞ཋೋຏ׶యЇĄ༊ ڼᒚ۰૟ཝొ۞࿪ཝବೡဦĂणனٺঽଈࢬ݈ॡĂΞ ͽࢫҲ΁ࣇ۞ҋయĂᛇ၅זϠঽ̙ߏĶ΁ࣇ࣎ˠ۞ય ᗟķĞMartin, 1999ğĄ൒҃఺ᇹ۞ྋᛖ˵͔൴າ۞Ϭ࠼ ᄃႷᇋĂ༊࣎९ೇࣧॡĂᅮࢋ͕ந˯۞ăჟৠ˯׶ۤ ົ˯۞ዋᑕĂಏ˘ϠۏЯ৵۞ྋᛖᄃڼᒚ̙֭ਕ྿ ז౵р۞૵ೇड़ڍĂЯѩϠۏࡊԫ۞ซणдჟৠ኎ Ϡ᜕நᅳાĂ႙ซг͔੓Հкۋ᜜ᄃ੅ኢĞClarke, 2000ğĄ αăિ޺Հ޺ᜈᚑᖰ۞ࡁ੅ჟৠ ৠགྷࡊጯछ޺ᜈгဘྏડᏰˠᙷཝ̚ϒ૱׶ள૱ ۞ͅᑕĂдˠᙷҖࠎܑன׶ৠགྷ۞ҕ߹߹જăᛸউณ

̝มԱזቁؠ۞࠹̢ᙯܼĂΞଓ΁ࣇ൑ڱᄲځࠎ̦ᆃ ѣֱҖࠎົజෛࠎͅ૱ٕள૱Ąனд۞ࡁտአߤ˵൑ ڱពϯĂள૱۞ཝొϠந߿જன෪׶ჟৠাې̝ม۞ ͅᑕĂͅߍ΍ள૱Җࠎ۞ྋᛖᄃ྽ᇇă̼͛̈́።Ϋ̝ มĂߏӎ׍ѣߙ჌࠹ᙯ۞ොᛖĄ׎၁Җࠎܑன׶ᒖ ဩăᄬ֏̢જă࿅Νགྷរăͽ̈́ۤົޙၹߏѣᙯా۞ (Dawson & McCrone, 1996)ĄЯѩࡊጯछિܫдϏֽ̪ ᅮѣր௚г޺ᜈᒢྋჟৠ়ଈ۞๸৪ ( Clarke, 2000 )Ą

ჟৠ኎Ϡ᜕ந၆

Ϡۏჟৠᗁጯซण۞࠷ޥᄃЯᑕ

Ϡۏჟৠᗁጯซण၆ჟৠ኎Ϡ᜕ந׽൒ѣ׎ϒࢬ ۞኏ᑝĂҭ˵ѣ׎࢑ࢬຍཌྷࣃ଀࠷ޥᄃЯᑕĄࡶਕѣ ड़۞൴೭׎ϒࢬ۞኏ᑝĂՆ඗࢑ࢬ۞ᇆᜩĂ݋ਕֹჟ ৠ኎Ϡ᜕நѣՀܜᅈࡎ৔ّ൴णĄ ࠷āޥ дჟৠᗁጯ۞ᅳાĂࡶෛϠۏ׏ቑĞbiological paradigmğࠎ׎ࢲሗॡĂೀͼົͽٙѣ۞ϠۏĞϠநğ ៍ᕇֽ࠻ޞ˘Ҝჟৠ়ঽ۞ଈ۰Ă҃ܧෛ׎ࠎԆፋ۞ ࣎វĞwhole personğĄҭˠߏ˘࣎Ϡநă͕ந׶ۤົ ۞ඕЪវĂ৿˘Я৵࠰ࠎ̙ΞĄჟৠ኎Ϡ᜕நˠࣶ֗ ఍Ϡۏჟৠᗁጯ۞ԣిซण̚ĂࢋᔖҺͽಏ˘ีޘ۞ ሀ ё Ğ one-dimensional modelğ ֽ ྋ ᛖ ̈́ ໰ ᜕ ঽ ଈ ĞDawson & McCrone, 1996ğĄ᜕நˠࣶੵ˞ᑕᆧΐৠ གྷࡊጯ׶ჟৠᗁጯ۞࠹ᙯໄهĞKeltner, 1996ğĂ̪ᑕ ᔖҺ่ϡϠۏጯ۞៍ᕇֽ࠻ঽଈ۞ҖࠎͅᑕĂͽҺ࿅ Њ৫̼ෛ౎Ă࿅ٺֹϡᖎಏ۞͞ڱֽྋᛖኑᗔ۞ன ෪ĄЯѩĂࢦෛ࣎វ۞Ϡநă͕நăۤົăីّ۞ፋ វ៍Ă૟Ϡۏጯ៍ᕇፋЪٺ᜕ந۞၁ચăࡁտ׶ିֈ ̚Ă඾ࢦፋវّ۞᜕ந໰ᜪĞRossen & Buschmann, 1995ğߏܧ૱ࢦࢋ۞Ą າ۞ϠۏჟৠᗁጯࡊԫĂ̙ਕΪߏϡ็௚͞ё็ ᅍາۢĂ҃ߏࢋ੊ቚ᜕நˠࣶԲҿّޥ҂۞ਕ˧Ąд ۢᙊགྷᑻ۞ॡ΃ĂтϠۏጯă͕நጯăۤົጯăˠᙷ ጯăࣰጯඈĂ᜕நˠࣶдྭጯܝ۞ᓜԖ၁ચᑕϡ˯Ӯ Էႊࢦࢋ֎ҒĂჟৠ኎Ϡ᜕நᅮࢋវរϠۏ៍ᕇдፋ វ᜕ந໰ᜪĞholistic careğ̚۞ຍཌྷĂ˵ᅮࢋᇃھă ᇅّăฟٸ۞਒ᘃঘᕷ׎΁ۢਕĂ̖ਕ൴೭ჟৠ኎Ϡ ᜕ந۞ૣ੼ᆊࣃᄃ፾পّĄ Яāᑕ д˟˩˘͵ࡔĂჟৠ኎Ϡ᜕நυืវᄮϠۏჟৠ ᗁጯ౵າซลۢᙊ۞ࢦࢋّĞMcCrone, 1996ğĄд̂ ጯٕࡁտٙ೩ֻჟৠϠۏᗁጯ۞࠹ᙯኝ඀Ă၆ٺཝొ ۞ৠགྷྋ࣠ጯăৠགྷϠநጯ۞ΑਕᄃүϡĂͽ̈́၆ٺ ჟৠᅪᘣ়ଈ̚Ăৠགྷጯă̶̰کጯăҺࠪጯѣՀк ௛၁۞ᄮᙊĂͷᅮซลጯ௫ѣᙯཝৠགྷᇆည۞ጯયĂ ᒢྋჟৠ়ঽٙᇆᜩ۞ཝొડા׶Լត۞ΑਕĂͽ̈́ யϠ۞࠹ᙯাېĞBabich & Tolbert, 1992ğĂᖣѩѣր ௚۞ޙၹጯϠ۞ϠۏჟৠᗁጯۢᙊĄ ૄᆸჟৠ኎Ϡ᜕நˠࣶࢋᄮᙊϒ૱۞ৠགྷྋ࣠ ጯăৠགྷϠநጯ׶ৠགྷҺࠪጯĂͽ̈́পؠჟৠᅪᘣ় ଈ۞ҺࠪͅᑕĂநྋѣड़۞ڼᒚ̬ˢ͞ڱ̈́׎дჟৠ ়ଈҖࠎԼච˯۞үϡĄ઼᜕࡚நםົٺ 1993 ѐĂ পҾΐૻჟৠ኎Ϡ᜕நˠࣶ၆౵າჟৠᘽநጯໄه۞ ᄮᙊĂ֭൴ण΍Б઼۞ჟৠᘽۏ኎ିඉரĞAmerican Nurses Association, 1994ğĄםົ޽΍ĂϤٺۢᙊ۞ԣ ి൴णᄃ௢᎕Ăѣֱᖞѣ়ঽᘽۏڼᒚ៍ه՛ೱԣ ిĂЯѩᅮࢋ޺ᜈซҖдᖚିֈĂͽᒔ଀ჟৠᘽۏ౵ າྤफ़Ąд໰ᜪঽˠ࿅඀̚Ă᜕நˠࣶᅮࢋ˞ྋঽଈ Ϡநېၗ׶ᘽۏүϡม۞ᙯܼĂᄮᙊᘽۏͅᑕ۞ෞ Ҥăઘүϡ۞఍ཉĂ͞ਕેҖՀซ˘Վ۞ᘽۏ኎ିᄃ ᏙྙĄ Ҍٺܧჟৠᘽۏ۞఍ཉ͞ڱĂּтĈˠᅫ̢જᄃ ତᛈăޙϲڼᒚّˠᅫᙯܼᄃ͕ந͚޺Ăߏ᜕நˠࣶ ޺ᜈ൴೭፾পّΑਕ۞ࢦࢋ͞ڱćΩγĂ᏷็Ꮩྙ೩ ֻྤੈ۞ڇચĂᄃᓜԖჟৠᗁर۞ЪүĂ၆छ୉ّჟ ৠ়ঽ۞̶̄෧ᕝᄃ఍ཉĂϺ႙ពࢦࢋĄ ჟৠ኎Ϡ᜕நˠࣶᑕϡჟৠᘽۏጯĂٕϠۏჟৠ ᗁጯۢᙊેҖ᜕ந߿જॡĂࢋਕ޺ᜈෞࣃड़ڍĂ޺ᜈ ซҖ੠ᖸአߤĂᒢྋ̈́ҿᕝѣड़۞᜕ந఍ཉඉரĂ఺ ֱ࿅඀Ӯᅮ౅࿅ࡁտֽםӄĄϏֽдޙϲෞҤϠந׶ ͕நീณ۞޽ᇾĂՀᅮࢋ׶׎΁ဥฤĂтĈჟৠࡊᗁ रă͕நᓜԖरăۤ̍रඈĂ൴णፋЪݭࡁտĂВТ

ଣ੅ჟৠঽଈ়ঽҖࠎ۞࠹ᙯЯ৵Ăഇਕ೩ֻՀࠎፋ វّ۞᜕ந໰ᜪĄ

ඕāāኢ

Ϡۏჟৠᗁጯଂ˟˩͵ࡔ̚ཧᎸ੓Ăֹჟৠᗁጯ ࡁտ൏ᕇଂ͕ᖼொזཝĂࡊጯ׏ቑ˵Ϥ็௚۞ჟৠજ ˧ጯሀёĂഈШ͕நϠநჟৠሀё۞׏ቑ൴णĄჟৠ ኎Ϡ᜕நଂ 1990 ѐ੓ĂצזჟৠϠۏᗁጯ۞኏ᑝĂ ࢬᓜኜкԼតĂΒ߁Ĉ၁ᙋّჟৠ኎Ϡ᜕நᎸ੓ăፋ ЪϠۏጯ៍ᕇ۞᜕ந၁ચ̍үצזࢦෛă׍Հฟٸ̈́ ኳႷ۞໰᜕ၗޘᄃ͞ёĂિ޺Հ޺ᜈᚑᖰ۞ࡁ੅ჟ ৠĄჟৠ኎Ϡ᜕நˠࣶੵ˞ᑕΐૻିֈă၁ચ̈́ࡁտ ˯၆Ϡۏჟৠᗁጯ࠹ᙯۢਕ̝ᒢྋᄃྻϡγĂՀᅮࢦ າ࠷ޥĂтңೠ೪᜕ந۞ፋវ៍̈́೩̿Բҿّޥ҂Ą

ણ҂͛ᚥ

߸јҌĞ1999ğĆ̶̄Ϡۏԫఙ၆ჟৠᗁጯ۞ᇆᜩĆ έ៉ჟৠᗁጯĂ 13Ğ2ğĂ 91 ů 104 Ą ࡧঔ઼ăڒܫշĞ1995ğĆϠۏჟৠᗁጯĆέΔĈ઼ ϲέ៉̂ጯᗁጯੰĄ

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Reflections on the Responses of

Psychiatric and Mental Health

Nursing to the Evolution of

Biological Psychiatry

Chia-Jung Hsiehʔ Shwu-Jiuan Liu*

ABSTRACT: Biological psychiatry was prospecting by scien-tist in the mid-20 century. This emphasis on the brain is a shift from the focus on the function of mind. The change has led to a paradigm shift in psychiatric thought away from traditional psy-chodynamic models towards a model influenced by a psychobio-logical perspective. The impacts of the evolution of biopsychobio-logical psychiatry on psychiatric health nursing include: focus on evi-dence-based psychiatric health nursing, emphasis on integrating biological knowledge into psychiatric health nursing, being open and critical in attitude and style of health care, and insisting on continuing research in psychiatric health nursing. Psychiatric health nurses should reflect the issues of holistic nursing and crit-ical thinking, and increase the coping strategies of knowledge and skill in nursing education, nursing practice, and nursing research.

Key words: biological psychiatry,

psychiatric health nursing, holistic care.

RN, MSN, Doctoral Candidate, Institute of Health Policy and Management, National Taiwan University. Instructor, College of Nursing, Taipei Medical University; *RN, PhD, Professor, College of Nursing, Taipei Medical University.

Address correspondence to: Shwu-Jiuan Liu, No. 250, Wu-Hsing St., Taipei 110, Taiwan, ROC.