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題名：住院精神分裂病患之自殺行為:個案對照研究
書刊名：臺灣精神醫學
作者：劉美蓉／張明永
作者(外文)：Liu, Mei-rong／Chong, Mian-yoon
出版日期：1997
卷期：11:4
頁次：頁46-59
主題關鍵詞：精神分裂病；自殺行為；自殺；憂鬱；Schizophrenia disorder；Suicidal behavior；Suicide；Depression
原始連結：連回原系統網址new window
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  • 被引用次數被引用次數:期刊(1) 博士論文(0) 專書(0) 專書論文(1)
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　　　　　目的︰精神疾患有高死亡率，特別是非自然死因，其中自殺、意外一直是主要的原因。本研究藉由一病例對照研究法，探討精神分裂病患者自殺行為之概況，進一步分析精神分裂病與自殺有關的危險因子，並嘗試解釋其行為。方法︰本研究以立意取樣方式，選取102位因自殺意念或自殺企圖之精神分裂病患者為病例組，配對相同性別、年齡而未曾有過自殺行為的同期精神分裂病住院患者102位為對照組。經由病歷回顧及出院後追蹤，收集社會人口學資料、生活史、相關的臨床病史及家族病史，及其指標住院時之主要問題與精神症狀。除探討比較個案之死亡率、自殺死亡率、及其相對危險性外，進一步以條件式對數迴歸分析來評估不同變數與自殺行為之關係。結果︰結果顯示，曾有自殺行為者之死亡危險性，是沒有自殺行為者之4.3倍。追蹤後發現，在病例組的死亡個案中有93.3%是死於非自然死因，且病例組個案之自殺死亡率遠高於對照組，過去曾有自殺企圖病史、出院後的初期、明顯憂鬱症狀及無業等狀況是其自殺成功危險因子。經由條件式對數迴歸分析之結果指出，憂鬱、罪惡感、激動、住院次數超過三次以上，是預測自殺行為最有效之變項，而憂鬱更是自殺行為最重要的先兆。結論︰本研究證明精神分裂病患具高非自然死因，而自殺是主要的原因。其自殺行為的社會特徵除與一般自殺者相似外，更受病程及精神病理之影響，持續性的治療以及對自殺危險因子之及早察覺與處置有利於精神分裂病患自殺的防止。
　　　　　Objective: Schizophrenia has a high mortality rate due to unnatural causes of death, particularly suicide and accidental death. This prospective case-controlled study investigated risk factors for suicidal behavior among schizophrenic inpatients. Methods: A purpose sample was selected from psychiatric inpatients of an academically-based medical center in south Taiwan. The case group contained 102 schizophrenic inpatients with problems of suicidal ideas or attempts. The controls were schizophrenic patients with no history of suicidal behavior who were matched with the case group for sex and age. The sociodemographic status, life history, clinical, social and family conditions of the study subjects were recorded. Subjects were followed up to determine their outcome. Results: There were 15 deaths from the case group and 4 from the controls. A significantly higher proportion (93.3%) of these deaths was from unnatural causes. The completed suicide rate in the case group was 4.3 times higher than that for controls. Subjects with a history of attempted suicide, in the early phase of post-hospitalization, suffered from depression or were jobless condition were at significant high risk for completed suicide. A conditional logistic regression analysis showed that depression, guilty feelings, agitation, and more than three admissions were all significantly related to suicidal behavior, and that depression was the most important prognostic factor for any suicidal behavior. Conclusion: These findings stress the importance of careful evaluation and assessment of the above suicidal risk factors in schizophrenic patients. Long-term follow-up is needed in order to reduce the risk of suicidal behavior.
期刊論文
1.林憲(19720200)。精神科住院病人自殺企圖之研究。臺灣醫學會雜誌，71(2)，89-96。  延伸查詢new window
2.Herrman, H. E.、Baldwin, J. A.、Christie, D.(1983)。A record-linkage study of mortality and general hospital discharge in-patients diagnosed as schizophrenic。Psychol Med，13，581-593。  new window
3.AUebeck, P.(1989)。Schizophrenia: a life-shortening disease。Schizophr Bull，15，81-89。  new window
4.Barraclough, B.、Bunch, J.、Nelson, B.、Sainsbury, P.(1974)。A hundred cases of suicide: clinical aspects。Br J Psychiatry，125，355-373。  new window
5.Clayton, P. J.(1985)。Suicide。Psychiatric Clin North Am，8，203-214。  new window
6.Diekstra, R. F. W.(1993)。The epidemiology of suicide and parasuicide。Acta Psychiatr Scand，71(suppl.)，9-20。  new window
7.AUebeck, P.、Allgulander, C.(1990)。Suicide among young men: psychiatric illness, deviant behaviour and substance abuse。Acta Psychiatr Scand，81，565-570。  new window
8.Cheng, T. A.(1995)。Mental illness and suicide: A case-control study in Taiwan。Arch Gen Psychiatry，52，594-603。  new window
9.Asnis, G. M.、Friedman, T. A.、Sanderson, W. C.、Kaplan, M. L.、Van Praag, H. M.、Harkavy-Friedman, J. M.(1993)。Suicidal behavior in adult psychiatric outpatients, I: Description and prevalence。Am J Psychiatry，150，108-112。  new window
10.Roy, A.(1982)。Suicide in chronic schizophrenia。Br J Psychiatry，141，171-177。  new window
11.Dassori, A. M.、Mezzich, J. E.、Keshavan, M.(1990)。Suicidal indicators in schizophrenia。Acta Psychiatr Scand，81，409-413。  new window
12.Addington, D. E.、Addington, J. M.(1992)。Attempted suicide and depression in schizophrenia。Acta Psychiatr Scand，84，288-291。  new window
13.Jones, J. S.、Stein, D. J.、Stanley, B.、Guido, J. R.、Winchel, R.、Stanley, M.(1994)。Negative and depressive symptoms in suicidal schizophrenics。Acta Psychiatr Scand，89，81-87。  new window
14.胡海國、葉英堃(1986)。出院精神疾病患者的兩年社區追蹤。中華民國神經精神醫學會會刊，12，71-81。  延伸查詢new window
15.Winokur, G.、Tsuang, M. T.(1975)。The Iowa 500: suicide in mania, depression and schizophrenia。Am J Psychiatry，132，650-651。  new window
16.Miles, C. P.(1977)。Conditions predisposing to suicide: a review。J Nerv Ment Dis，164，231-246。  new window
17.Cheng, K. K.、Leung, C. M.、Lo, W. H.、Lam, T. H.(1989)。Suicide among Chinese schizophrenics in Hong Kong。Br J Psychiatry，154，243-246。  new window
18.Waltzer, H.(1984)。Suicide risk in young schizophrenics。Gen Hosp Psychiatry，6，219-225。  new window
19.Breier, A.、Astrachan, B. M.(1984)。Characterization of schizophrenic patients who commit suicide。Am J Psychiatry，141，206-209。  new window
20.Mortensen, P. B.、Juel, K.(1990)。Mortality and causes of death in schizophrenic patients in Denmark。Acta Psychiatr Scand，81，372-377。  new window
21.Black, D. W.、Warrack, G.、Winokur, G.(1985)。Suicide in schizophrenia: The Iowa Record-linkage Study。J Clin Psychiatry，46，14-17。  new window
22.陳永興、葉英堃、胡維恆(1979)。精神科住院病人的自殺：疫北市立療養院一年的發生頻度。中華民國神經精神醫學會會刊，5，20-25。  延伸查詢new window
23.Sims, A.(1973)。Importance of a high tracing-rate in long-term medical follow-up studies。Lancet，2，433-435。  new window
24.Roy, A.(1986)。Depression, attempted suicide, and suicide in patients with chronic schizophrenia。Psychiatr Clin North Am，9，193-206。  new window
25.Black, D. W.、Warrack, G.、Winokur, G.(1985)。The Iowa Record-Linkage Study, III, Excess mortality among patients with 'functional' disorders。Arch Gen Psychiatry，42，82-88。  new window
26.Hu, W. H.、Sun, C. M.、Lee, C. T.、Peng, S. L.、Lin, S. K.、Shen, W. W.(1991)。A clinical study of schizophrenic studies: 42 cases in Taiwan。Schizophr Res，5，43-50。  new window
27.Cheng, K. K.、Leung, C. M.、Lo, W. H.、Lam, T. H.(1990)。Risk factors of suicide among schizophrenics。Acta Psychiatr Scand，81，220-224。  new window
28.Jeck, A. T.、Kovacs, M.、Weissman, A.(1975)。Hopelessness and suicidal behavior: an overview。Journal of the American Medical Association，234(11)，1146-1149。  new window
29.Yarden, P. E.(1974)。Observations on suicide in chronic schizophrenics。Compr Psychiatry，15，325-333。  new window
30.Beck, A.、Steer, R.、Kovacs, M.、Garrison, B.(1985)。Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation。Am J Psychiatry，142(5)，559-563。  new window
31.Drake, R. E.、Gates, C.、Cotton, P. G.、Whitaker, A.(1984)。Suicide amongschizophrenics-who is at risk?。J Nerv Ment Dis，172，613-617。  new window
32.胡維恆(19891200)。憂鬱症､精神分裂病與自殺。中華精神醫學，3(4)，197-204。  延伸查詢new window
圖書
1.Bleuler, E.、Zinkin, J.(1950)。Dementia Preacox or the Group of Schizophrenia。NY：International Press。  new window
2.Hawton, K.、Catalan, J.(1987)。Attempted Suicide: A Practical Guide to Its Nature and Management。Oxford：Oxford University Press。  new window
3.Bleuler, E.(1911)。Dementia Preacox or the Group of Schizophrenia。Leipzig, Deuticke：International Press。  new window
4.Bleuler, E.、Zinkin, J.(1950)。Dementia Preacox or the Group of Schizophrenia。N.Y.：International Press。  new window
5.Kaplan, H. I.(1994)。Synopsis of Psychiatry: Behavioral Sciences。Williams & Wilkins。  new window
6.Lester, D.(1988)。The Biochemical Basis of Suicide。Springfield：Charles C Thomas。  new window
7.Baechler, J.(1979)。Suicide。New York：Basic Books。  new window
8.Bleuler, E.(1911)。Dementia Preacox or the Group of Schizophrenia。Leipzig, Deuticke：International Press。  new window
圖書論文
1.Zubin, J.(1986)。Observations on nosological issues in the classification of suicidal behavior。The Prediction of Suicide。Philadelphia, Pennsylvania：The Charles Press。  new window
2.Roy, A.(1986)。Suicide in schizophrenia。Suicide。Baltimore, Maryland：Williams & Wilkins。  new window
3.Pokorny, A. D.(1986)。A scheme for classifying suicidal behaviors。The Prediction of Suicide。Philadelphia, Pennsylvania：The Charles Press。  new window
 
 
 
 
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