Positive and Negative Symptoms and Decision-making Capacity for Research Participation among Patients with Schizophrenia Spectrum Disorders_

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題名：	Positive and Negative Symptoms and Decision-making Capacity for Research Participation among Patients with Schizophrenia Spectrum Disorders
書刊名：	Taiwanese Journal of Psychiatry
作者：	劉駿熒／吳百堅
作者(外文)：	Liou, Jiunn-ying／Wu, Bo-jian
出版日期：	2015
卷期：	29:3
頁次：	頁172-179+a7
主題關鍵詞：	麥氏臨床試驗知情同意決策能力評量表；思覺失調症；知情同意；MacArthur Competence Assessment Tool for Clinical Research；MacCAT-CR；Decision-making capacity；Schizophrenia；Informed consent
原始連結：	連回原系統網址
相關次數：	被引用次數:期刊(0) 博士論文(0) 專書(0) 專書論文(0) 排除自我引用:0 共同引用:0 點閱:5

背景：許多研究曾探討思覺失調症病人其正性或負性症狀，何者較顯著影響參與臨床試驗的知情同意決策能力，但結論並不一致。本研究運用迴歸方程模式探討此主題。方法：本研究納入177位思覺失調症或情感性思覺失調症住院病人，以「麥氏臨床試驗知情同意決策能力評量表（以下簡稱為MacCAT-CR）」、「正性及負性症狀量表」，以線性迴歸調整其他共變量，探討精神病症狀與MacCAT-CR分數的關係。結果：受試者平均年齡為51.4年，平均發病年數為27.9年，住院年數為15.1 年，68.9% 為男性。負性症狀總分與鑑別度分數（B=-0.06, t=-2.27, p＜0.05）及推論分數（B=-0.09, t=-2.65, p＜0.01）呈現明顯的負相關。男性（p＜0.05）、教育程度（p＜0.01）、認知功能（p＜0.01）與知情能力呈現明顯的正相關，而與住院年數（p＜0.05）呈現明顯的負相關。結論：本研究發現思覺失調症病人，負性症狀嚴重度與臨床試驗的知情同意決策能力呈現顯著負相關。臨床試驗主持人招募思覺失調症病人進行研究時，必須篩選出決策能力受損危險因子的個案，並須積極加強個案對於該臨床試驗內容的理解，以保障其權益。

以文找文

Objectives: Inconsistent results exist about which domain of psychopathology, i.e, positive or negative symptoms affects the decision-making capacity to consent to clinical research (DMC) most in patients with schizophrenia spectrum disorders (SSD). The current study was to explore this topic using a regression model controlling for related covariates. Methods: All 177 patients with schizophrenia or schizoaffective disorders were assessed with the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), the Positive and Negative Syndrome Scale, and other measures. We used a linear regression model to fi nd the association between psychotic symptoms and MacCAT-CR. Results: The mean age of subjects was 51.4 years. The majority of subjects were male (68.9%). The mean duration of schizophrenia and hospitalization were 27.9 years and 15.1 years, respectively. Negative symptoms were found to be signifi cantly to have negative association with appreciation (B=-0.06, t=-2.27, p＜0.05) and reasoning scores (B=-0.09, t=-2.65, p＜0.01). Some components of MacCAT-CR scores were signifi cantly to have positive association with educational years (p＜0.01), cognitive function (p＜0.01), male sex (p＜0.05), and negative association with the length of stay (p＜0.05). Conclusion: The most central fi nding of this study was that SSD patients with severe negative symptoms performed poorly on DMC. Beside, females, those with longer length of stay, lower educational level, and cognitive defi cit were associated with impaired DMC. Those fi ndings suggest that study investigators and institutional review boards should consider more intensive surveys for SSD patients with risk factors for impaired DMC and administer educational interventions to improve capacities to make decisions in the process of recruitment.

以文找文

期刊論文
1.	Crow, T. J.(1985)。The two-syndrome concept: origins and current status。Schizophr Bull，11，471-486。
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3.	Kovnick, J. A.、Appelbaum, P. S.、Hoge, S. K.(2003)。Competence to consent to research among long-stay inpatients with chronic schizophrenia。Psychiatr Serv，54，1247-1252。
4.	Cohen, B. J.、McGarvey, E. L.、Pinkerton, R. C.(2004)。Willingness and competence of depressed and schizophrenic inpatients to consent to research。Jam Acad Psychiatry Law，32，134-143。
5.	Appelbaum, P. S.(2006)。Decisional capacity of patients with schizophrenia to consent to research: taking stock。Schizophr Bull，32，22-25。
6.	Jeste, D. V.、Depp, C. A.、Palmer, B. W.(2006)。Magnitude of impairment in decisional capacity in people with schizophrenia compared to normal subjects: an overview。Schizophr Bull，32，121-128。
7.	Lan, T. H.、Wu, B. J.、Chen, H. K.(2013)。Validation of Chinese version of the MacArthur Competence Assessment Tool for Clinical Research (MacCATCR) in patients with schizophrenia spectrum disorders。Psychiatry Res，210，634-640。
8.	Moser, D. J.、Schultz, S. K.、Amdt, S.(2002)。Capacity to provide informed consent for participation in schizophrenia and HIV research。Am J Psychiatry，159，1201-1207。
9.	Stroup, S.、Appelbaum, P.、Swartz, M.(2005)。Decisionmaking capacity for research participation among individuals in the CATIE schizophrenia trial。Schizophr Res，80，1-8。
10.	Gandiiis, P. J.、Fletcher, K. E.、Geppert, C. M.(2008)。A direct comparison of research decision-making capacity: schizophrenia/schizoaffective? medically ill, and non-ill subjects。Schizophr Res，99，350-358。
11.	Gaipenter, W. T. Jr.、Gold, J. M.、Lahti, A. C.(2000)。Decisional capacity for informed consent in schizophrenia research。Arch Gen Psychiatry，57，533-538。
12.	Jeste, D. V.、Palmer, B. W.、Golshan, S.(2009)。Multimedia consent for research in people with schizophrenia and normal subjects: a randomized controlled trial。Schizophr Bull，35，719-729。
13.	Dunn, L. B.、Palmer, B. W.、Keehan, M.(2006)。Assessment of therapeutic misconception in older schizophrenia patients with a brief instrument。Am J Psychiatry，163，500-506。
14.	Dunn, L. B.、Palmer, B. W.、Appelbaum, P. S.(2001)。Prevalence and correlates of adequate performance on a measure of abilities related to decisional capacity: differences among three standards for the MacCAT-CR in patients with schizophrenia。Schizophr Res，89，110-118。
15.	Cheng, J. J.、Ho, H.、Chang, C. J.(1996)。Positive and Negative Syndrome Scale (PANSS): Establishment and reliability study of a Mandarin Chinese language version。Taiwan Journal of Psychiatry，10，251-258。
16.	Khan, A.、Lewis, C.、Lindenmayer, J. P.(2011)。Use of non-parametric item response theory to develop a shortened version of the Positive and Negative Syndrome Scale (PANSS)。BMC Psychiatry，11，178。
17.	Guo, N. W.、Liu, H. C.、Wong, P. F.(1988)。Chinese Version and Norms of the Mini-Mental State Examination。Journal of Rehabilitive Medical Association，16，52-59。
18.	Kay, Stanley R.、Fiszbein, Abraham、Opler, Lewis A.(1987)。The Positive and Negative Syndrome Scale (PANSS) for schizophrenia。Schizophrenia Bulletin，13(2)，261-276。
19.	O'Brien, R. M.(2007)。A Caution Regarding Rules of Thumb for Variance Inflation Factors。Quality & Quantity，41(5)，673-690。
20.	Folstein, Marshal F.、Folstein, Susan E.、McHugh, Paul R.(1975)。"Mini-mental state": A practical method for grading the cognitive state of patients for the clinician。Journal of Psychiatric Research，12(3)，189-198。

圖書
1.	Gelder, Michael、Gath, D.、Mayou, R.(1996)。Oxford Textbook of Psychiatry。New York：Oxford University Press。
2.	Appelbaum, P. S.、Grisso, T.(2001)。MacArthur Competence Assessment Tool for Clinical Research (MacCATCR)。Sarasota, Florida：Professional Resource Press。
3.	Tabachnick, Barbara G.、Fidell, Linda S.、Ullman, J. B.(2007)。Using Multivariate Statistics。Boston, Massachusetts：Pearson Education, Inc.。

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