門診精神分裂病患者憂鬱之相關因素探討
Exploring the Related Factors With
Depression in Schizophrenic Outpatients
中文摘要 本研究目的在探討門診精神分裂病患者憂鬱之相關因素，包括個人因素、疾病因 素、自我照顧、社會支持等因素。採橫斷式之研究設計，以立意取樣，在台中市 某醫學中心精神科門診選取精神分裂病患者為研究對象，共計收案 143 名。研究 工具為結構式問卷，內容包括基本資料、社區精神病患症狀評量表、錐體外徑症 狀評量表、自我照顧量表及社會支持量表。由研究者親自訪談患者，所得資料以 描述性及推論性統計進行分析。 研究結果發現：（1）門診精神分裂病患者之活性症狀以「妄想」、「幻覺」較常見， 負性症狀以「活力低、沒有朝氣」、「不喜歡活動」較常見。整體精神症狀介於無 到輕度之間。（2）錐體外徑症狀以「四肢僵硬，動作緩慢不靈活」、「臉部表情少、 僵硬」較常見，整體錐體外徑症狀介於無到輕度之間。（3）患者自我照顧執行狀 況與獨立程度皆以「生理性自我照顧」較佳，其次是「健康性自我照顧」，「社會 性自我照顧」較差。（4）社會支持方面，患者主觀感受來自家人親戚及醫療人員 之支持程度為中等偏佳程度；來自同學朋友之支持程度則為中等偏差程度。（5） 49％患者有顯著憂鬱症狀，男性憂鬱比率高於女性，憂鬱症狀以「自我輕視」、「憂 鬱情緒」較常見。整體憂鬱症狀介於無到輕度之間。（6）患者憂鬱的高相關因素： 男性、與父母及兄弟姊妹同住、生活費主要來源為父母或兄弟姊妹、食慾改變（尤 其是食慾降低）、睡眠品質差、精神症狀及錐體外徑症狀嚴重、自我照顧執行狀 況差及獨立程度低、主觀感受之社會支持程度低者。（7）「負性症狀」、「活性症 狀」、「睡眠」、「同學朋友的社會支持」及「進食」等五項為憂鬱的顯著預測因子， 其解釋的總變異量為 39.5% ，其中以「負性症狀」及「活性症狀」之預測力較 佳，可以解釋 25.3%變異量。 本研究結果可協助精神科護理人員評估及了解門診精神分裂病患者之精神症 狀、錐體外徑症狀、自我照顧及社會支持與憂鬱的相關性，作為相關照護計畫之 參考，以協助患者減輕及避免憂鬱發生，並增加其對憂鬱的處置能力，進而提升 醫療的照護品質。 關鍵詞：精神分裂病、憂鬱、精神症狀、錐體外徑症狀、 自我照顧、社會支持。 英文摘要The purpose of this study was to explore the related factors with depression in
schizophrenic outpatients, including the personal demographic data, psychopathology, extrapyramidal symptoms, ability of self-care and social support. This study was a
cross-sectional design. One hundred and forty three schizophrenic outpatients from a medical center in Taichung city, were recruited in the study. A structured questionnaire with six components was used, including: (1) Personal Demographic questionnaires, (2) Psychotic Symptoms Scale, (3) extrapyramidal symptoms scale, (4) Self-care Questionnaire, (5) Social Support Questionnaire, (6) Calgary Depression Scale for Schizophrenia.
The results of this study showed that: (1) “Delusion” and “hallucination” were more common positive symptoms of schizophrenic outpatients, and “low vitality or no vigor” and “poor activity” were more common negative symptoms. The average grading of Psychotic Symptoms was between asymptomatic and mild. (2) “Rigidity of extremities, brady kinesia” and “mask face” were more common extrapyramidal symptoms. The average grading of extrapyramidal symptoms was between
asymptomatic and mild. (3) The performance and independence of subjects’ self-care were better expressed by physical self-care, followed by health self-care and social self-care. (4) The social support from families and health caregivers was rated higher than medium level. The social support from friends was rated lower than medium level. (5) Up to 49% of the subjects were symptomatically depressed, and the male were more depressed than the female. “Self-depreciation” and “depressive mood” were more common depressive symptoms. The average grading of depressive symptoms was between asymptomatic and mild. (6) The significant risk factors related to depression were male gender, living with original family, living expenses from original family, appetite change, sleep disturbance, severity of psychotic symptoms and extrapyramidal symptoms, poor self-care performance and
independence, poor social support from friends. (7) The significant predictors for depression in schizophrenia were “negative symptoms”, “positive symptoms”, “sleep”, “social support from friends” and “appetite”, which accounted for 39.5% of total variances. The “negative symptoms” and “positive symptoms” were more predictor, which accounted for 25.3% of total variances.
The results of the study highlighted the important relationship between psychotic symptoms, extrapyramidal symptoms, self-care, social support and depression. It provides important reference for psychiatric care plan, focusing on preventing and reducing the severity and incidence of depression in schizophrenic outpatients. Therefore, it enhances the quality of psychiatric nursing.
Key words: schizophrenia, depression, psychiatric symptoms, extrapyramidal symptoms, self-care, social support
