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題名:強迫症門診患者的臨床特徵與聯合治療模式效果之分析研究
作者:黃政昌 引用關係
作者(外文):Cheng-Chang Huang
校院名稱:國立臺灣師範大學
系所名稱:教育心理與輔導研究所
指導教授:林家興
學位類別:博士
出版日期:2003
主題關鍵詞:強迫症臨床特徵聯合治療模式認知行為治療藥物治療治療效果改變歷程改變機制obsessive-compulsive disorderclinical featuresthe combination treatment modelcognitive-behavior therapy (CBT)drug treatments (SSRIs)treatment effectschange processchange mechanism
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本研究以台灣地區的強迫症臨床樣本為研究對象,進行臨床特徵與聯合治療模式效果的分析研究。整個研究包括三個子研究,研究一目的在於描述強迫症患者的臨床特徵,包括人口學變項、求助經驗、臨床症狀與適應能力、病後人格等特徵與相互關係;研究二目的在驗證二種聯合治療模式的效果,進一步確認單一治療中,認知行為治療的效果是否優於藥物治療,而合併治療中,認知行為治療是否較可以助長藥物治療的效果,而藥物治療較不能助長認知行為治療改變;研究三目的則是針對強迫症患者進行訪談分析,以瞭解治療改變的歷程與改變的機制,並找出助長療效因子與抑制療效因子。
此三個研究分別使用不同的研究方法進行。研究一乃是針對北區某精神科專科醫院的強迫症的門診患者130位,以「門診患者基本資料表」、「高登人格量表(甲種)」、「耶魯布朗強迫症狀檢核表」、「耶魯布朗強迫症嚴重量表」、「簡式國際神經精神會談量表」、「生活品質量表」等六項工具,進行調查研究。研究二則邀請8位強迫症診患者為實驗對象,再將此8位受試者分成二組,每組4位分別進行不同治療順序的「跨受試延宕多基準線設計」之單一受試實驗,並以「耶魯布朗強迫症嚴重量表」來評估強迫症各種治療方式的效果改變。研究三則以參加完研究二的8位實驗對象繼續為受訪者,配合半結構式的訪談指引,進行質性方法的深度訪談。研究結果與發現如下:
1.男性在「性」和「精確」強迫思考上的人數百分比都顯著的高於女性。未婚者在「性」強迫思考的人數百分比顯著的高於已婚者;年齡愈低者愈容易出現「性」強迫思考。無職業者在「清洗」強迫行為上的人數百分比顯著的高於有職業者。教育程度愈低者,愈容易出現「清洗」的強迫行為;教育程度愈高者愈容易出現「計算」的強迫行為;「強迫症數量和共病數目」可以有效預測強迫症嚴重度、生活品質與病後人格。
2.第1類聯合治療模式與第2類聯合治療模式均有顯著治療效果。且單一治療時:認知行為治療的效果優於藥物治療;合併治療時,認知行為治療對藥物治療增進效果,較藥物治療對認知行為治療的增進效果明顯。
3.改變較明顯組的助長療效因子與改變較不明顯組的抑制療效因子,主要反應在症狀因素、個人因素、家庭因素、社會因素、藥物治療效果、認知行為治療效果等五方面的「程度」上差異,其中,積極參與認知行為治療的程度、個人配合相關治療的能力,以及家庭因素對個案支持與接納程度,是改變機制發生的核心因素。
根據研究結果與討論,研究者提出未來研究、臨床實務、心理衛教等三方面的建議。本研究一方面可充實國內強迫症文獻的基礎,二方面亦可作為日後臨床實務上治療強迫症的參考資料。
The overall purpose of this project was to survey clinical features and to analyze the effectiveness of two combination treatment models for outpatients with obsessive-compulsive disorders(OCD). Three studies under this project had been carried out. The aim of the first study was to survey clinical features, including demographic variables, clinical symptoms, help-seeking experience, adaptive abilities, and personality after onset. The aim of the second study was to examine the differential therapeutic effects of two combination treatment models. Specifically, the investigator intended to further confirm previous research finding whether cognitive-behavior therapy(CBT) was more effective than drug treatments(SSRIs) in the single treatment of OCD, and whether the effects of CBT were more powerful to facilitate the effects of the SSRIs than the effects of SSRIs do to the effects of CBT in the combination treatments of OCD. The purpose of the third study was to explore the change process, the facilitating factors, and the inhibiting factors in the change mechanisms.
A total of 130 OCD outpatients participated in study one. In order obtain the information on clinical features, all participant were invited to complete a set of inventories, including Gordon Personal Profile, Yale-Brown Obsessive-Compulsive Scale(symptom checklist), Yale-Brown Obsessive-Compulsive Scale(symptom severity), Mini International Neuropsychiatric Interview(MINI), and the Quality of Life Assessment(WHOQOL). A delayed multiple baseline across individuals design was adopted in conducting study two. There were 8 OCD outpatients were recruited as subjects in this study. A group of four were assigned to one of the two systematic combination treatment models. Subjects’ treatment responses measured by the Yale-Brown Obsessive-Compulsive Scale (symptom severity)” were collected each week throughout the course of treatment. The same 8 participants in study two were recruited as the subjects in study three. They were invited to participate in an in-depth interview after the course of their combination treatments.
The results of the research were as follows:
1.Among the research participants, men, compared to women, appeared more sexual and symmetry/exactness obsessions. Single, compared to married, appeared more sexual obsessions. Younger OCD outpatients appeared more sexual obsessions than those of elder. Unemployed, compared to employed status, appeared more washing compulsions. OCD outpatients with higher level of educational background appeared more counting compulsions than those with lower level of educational background. Symptom numbers and comorbidity numbers were the most effective factors in predicting obsessive-compulsive severity, quality of life, and personality after onset.
2.There were significant effects were found in both of the two combination treatment models. Further findings verified that cognitive-behavior therapy (CBT) was more effective than drug treatments (SSRIs) in single treatment of OCD, and the effects of CBT were more powerful to facilitate the effects of SSRIs than the effects of SSRIs to facilitate the effects of CBT in combination treatments of OCD.
3.The treatment outcome facilitating factors found between the most gained treatment group and the least gained treatment group were: personal factors, family factors, social factors, drug treatment, and CBT treatment. The three core facilitating factors found in this study were: active CBT participation, personal motivation and ability, and family acceptance and support.
In addition, the research and treatment implications of the findings and suggestions for future research and clinical practice were also discussed in this study.
中文資料
王文科(1994)。教育研究法(三版)。台北市、五南圖書公司。new window
江漢光、黃政嘉、馮榕(1992)。弱勢並受忽視的疾病強迫症和相關之神經病變。臺灣醫界,35(3),54-57。
何志培(2000)。如何走出強迫症的陰霾。諮商與輔導,172,15-18。
李文貴、劉文健、江漢光(1993)。強迫症神經學障礙研究之進展。國防醫學,17(4),363-367。
林式穀(1992)。精神藥物手冊。台北市:藝軒圖書出版社。
林信男(1997)。精神科物理及藥物治療。台北市:水牛出版社。
姚開屏等(2001)。台灣版世界衛生組織生活品質問卷之發展及使用手冊。世界衛生組織生活品質問卷台灣版問卷發展小組。
洪雅琴(1997)。單女同性戀者性取向認同發展歷程個案研究。未出版碩士論文,國立台灣師範大學教育心理與輔導學研究所,台北市。
胡幼慧(1996)。質性分析與寫成。載於胡幼慧(主編),質性研究:理論、方法及本土女性研究實例(93-122頁)。台北市:巨流圖書公司。
孫藝文、陳俊欽編譯(2001)。精神藥物治療手冊。台北市:和記書局。
孫讚福、林博彥、吳景寬(2001)。Risperidone Augmentation of Specific Serotonin Reuptake Inhibitors in the Treatment of Refractory Obsessive-Compulsive Disorder: Report of Two Cases(理思必妥輔助血清素再吸收抑制劑對頑抗型強迫症的治療:二例報告)。長庚醫學,24(9),587-592。
秦麗花(2001)。單一受試研究效果直分析。測驗統計簡訊,39,15-26。
袁樂民、馮煥光(1993)。強迫症。臨床醫學,31(2),122-127。
高淑清(2000)。現象學方法及其在教育研究上應用。載於中正大學教育所(主編),質的研究方法(93-122頁)。台北市:麗文文化。
商志雍、林信男(2002)。精神疾病藥物治療病案討論(15)--強迫症之藥物治療策略。當代醫學,29(3),194-195。
張信男、郭清祿(1998)。強迫症:欲罷不能,力不從心的焦慮疾患。臺北市藥師公會會刊,16(3),7-14。
陳心怡(2000)。貝克憂鬱量表第二版指導手冊。台北市:中國行為科學社。
陳文杏(2002)。強迫之心-強迫性精神官能症患者對強迫思考與行為發展歷程之生命敘說。未出版碩士論文,私立台北醫學院醫學研究所,台北市。
陳艷紅(1997)。台灣原住民青年發展歷程及其影響因素之分析研究--以四位新竹縣泰雅族男性青年的生命故事為例。未出版碩士論文,國立台灣師範大學教育心理與輔導研究所,台北市。
彭如瑩(2000)。台北市國中學生家長預防子女藥物濫用措施及藥物教育需求之研究。未出版碩士論文,國立台灣師範大學衛生教育研究所,台北市。new window
湯華盛(1988)。強迫症病人的腦部神經生化學研究。載於台北市立療養院(主編),台北市立療養院民國八十七年年報暨三十週年特刊。台北市:台北市立療養院。
湯華盛(2002)。強迫症認知行為團體心理治療手冊。未出版。
黃軍義(2000)。強姦行為之心理歷程的動態分析。未出版博士論文,國立台灣大學心理學研究所,台北市。new window
楊美慧(1991)。單身女性之婚姻關─現象學方法的研究。未出版碩士論文,國立台灣師範大學教育心理與輔導學研究所,台北市。
路君約(1976)。高登人格量表甲種指導手冊。台北市:中國行為科學社。
蔡欣玲(1998)。精神分裂症者對幻聽之主觀經驗。未出版碩士論文,私立長庚大學護理學研究所,台北市。
鄭瑞隆(2001)。實地工作。載於黃光雄(主編),質性教育研究理論與方法(105-115頁)。台北市:濤石文化事業公司。
譚利光(1998)。強迫症--心理治療案例。諮商與輔導,152,17-19。
蘇聖棻、湯華盛、蔡長哲、藍先元、陳喬琪、胡維恆(1999)。以Risperidone增強Fluvoxamine對難治型強迫症的治療效果:一例報告(Risperidone Augmentation of Fluvoxamine Efficacy in Obsessive-compulsive Disorder: A Case Report)。臺灣精神醫學,13(4),87-93。new window
Sheehan, J. J., (2001)。MINI國際神經精神會談量表(李宇宙等譯)。台灣精神醫學會(原作出版年:1997)
Strauss A. & Corbin, J. (1997)。質性研究概論(徐宗國譯)。台北市:巨流圖書公司。(原作出版年:1990)
Strauss, A., & Corbin, J. (1997)。質性研究概論(徐宗國譯)。台北市:巨流圖書公司。(原作出版年:1990)
Tawney, J. W., & Gast, D. L. (1994)。單一受試研究法(杜正治譯)。台北市:心理出版社。(原作出版年:1984)
Turner, S. M., & Beidel, D. C.(1991)。治療強迫症(李吉元譯)。台北市:出版處不詳。(原作出版年:1988)
西文資料
American Psychiatric Association(1994). Diagnostic and Statistical Manual of Mental Disorders. (4th ed.). Washington, DC: American Psychiatric Association.
Antony, M. M., Downie, F., & Swinson, R. P. (1997). Age of onset for individuals with obsessive-compulsive disorder. Unpublished data.
Antony, M. M., Downie, F., & Swinson, R. P. (1998). Diagnostic issues and epidemiology in obsessive-compulsive disorder. In R. P. Swinson, M. M. Antony, S. Rachman, & M. A. Richter (Eds), Obsessive-compulsive disorders: Theory, research and treatment(pp. 3-32). New York: Guilford.
Antony, M. M., Downie, F., Swinson, R. P., Huta, V., & Devins, G. M. (1998). (1998). Illness intrusiveness in individuals with panic disorder, obsessive compulsive disorder, or social phobia. Journal of Nervous and Mental Disease, 186, 193-197.
Baer, L. & Minichiello, W. E. (1998). Behavior therapy for obsessive-compulsive disorder. In M. A. Jenike, L. Baer, & W. E. Minichiello (Eds), Obsessive-compulsive Disorders: Practical management(ch. 17). St louis, MO: Mosby.
Baer, L. (2000). Getting control: Overcoming your obsessions and compulsions. (2rd ed.). NY: Plume.
Castle, D. J., Deale, A., & Marks, I. M. (1995). Gender difference in obsessive compulsive disorder. Australian and New Zealand Journal of Psychiatry, 29, 114-117.
Cohen, J. (1977). Statistical power analysis for the behavioral sciences(2nd eds). NY: Academic Press.
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155-159.
Corey, G. (1991). Theory and practice of counseling and psychology. (4th ed.). CF: Brooks/Cole.
Cottraux, J., Mollard, E., Bouvard, M., Marks, I., Sluys, M., Nury, A. M., Douge, R., & Ciadella, P. (1990). A controlled study of fluvoxamine and exposure in obsessive-compulsive disorder. International Clinical Psychopharmacology, 5, 17-30.
Davidson, G. C. & Neale, J. M. (2000). Abnormal Psychology(8th Ed.). NY: John Wiley & Sons,Inc.
Demal, U., Lenz, G, G., Mayrhofer, A., Zapotoczky, H. —G., & Zitterl, W. (1993). Obsessive-compulsive disorder and depression: A retrospective study on course and interaction. Psychopathology, 26, 145-150.
Foa, E. B., kozak, M. J., Steketee, G. S., & McCarthy, P. R. (1992). Treatment of depressive and obsessive-compulsive symptoms in OCD by imipramine and behavior therapy. British Journal of Clinical Psychology, 31, 279-292.
Goodman, W. K. & Price, L. H. (1998). Rating scales for obsessive-compulsive disorder. In M. A. Jenike, L. Baer, & W. E. Minichiello (Eds), Obsessive-compulsive Disorders: Practical management(ch. 17). St louis, MO: Mosby.
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Delgado, P., Heninger, G. R., & Charney, D. S. (1989b). The Yale-Brown Obsessive-Compulsive Disorder Scale: Ⅱ. validity. Archives of General Psychiatry, 46, 1012-1016.
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleishmann, R. L., Hill, C. L., Heninger, G. R., & Charney, D. S. (1989a). The Yale-Brown Obsessive-Compulsive Disorder Scale: Ⅰ. Development, use, and reliability. Archives of General Psychiatry, 46, 1006-1011.
Goodman, W. K., Rudorfer, M.V., & Maser, J. D. (Eds.). (1999). Obsessive-Compulsive Disorder: Contemporary Issues in Treatment (Personality and Clinical Psychology Series). Mahwah, NJ: Lawrence Erlbaum Associates.
Hanna, G. L. (1995). Demographic and clinical features of obsessive-compulsive disorder. in children and adolescents. Journal of the American Academy of child and Adolescent Psychiatry, 34, 19-27.
Higgins, N. C., Pollard, C. A., & Merkel, W. T. (1992). Relationship between religion related factors and obsessive-compulsive disorders. Current Psychology: Research and Reviews, 11, 79-85.
Hyman, B. M., & Pedrick, C. (1999). The OCD workbook: your guide to breaking free from obsessive-compulsive disorder. Oakland, CA: New Harbinger Publications.
Ingram, I. M. (1960). Obsessional illness in mental hospital patients. Journal of Medical Science, 107, 382-402.
Jenike, M. A. (1998). Drug treatment of obsessive-compulsive disorder. In M. A. Jenike, L. Baer, & W. E. Minichiello (Eds), Obsessive-compulsive Disorders: Practical management(ch. 22). St louis, MO: Mosby.
Jenike, M. A. (1998). Theories of etiology. In M. A. Jenike, L. Baer, & W. E. Minichiello (Eds), Obsessive-compulsive Disorders: Practical management(ch. 22). St louis, MO: Mosby.
Jenike, M. A., Baer, L., & Minichiello, W. E. (Eds.). (2000). Obsessive-compulsive disorders: Contemporary issues in treating. St louis, MO: Mosby.
Kaplan, H. I. & & Sadock, B. J. (1998). Kaplan and Sadock’s synopsis of psychiatry: Behavior science, clinical psychiatry. (8th ed.). Baltimore, ML: Williams & Wilkins.
Karno, M., & Golding, J. M. (1991). Obsessive compulsive disorder. In L. N. Robins & D. A. Regier(Eds), Psychiatric disorders in American: The Epidemiologic Catchment Area Study(p. 204-219). NY: Free Press.
Khanna, S., & Mukherjee, D. (1992). Checkers and washers; Valid subtypes of obsessive compulsive disorder. Psychopathology, 25, 283-288.
Kolada, J. L., Bland, R. C., & Newman, S. C. (1994). Obsessive compulsive disorder. Acta Psychiatrica Acandinavica(Suppl. 376), 24-35.
Koran, L. M., Thienemann, M. L. & Davenport, R. (1996). Quality of life for patients with obsessive-compulsive disorder. American Journal of Psychiatry, 153, 783-788.
Krno, M., Golding, J. M., Sorenson, S. B., & Burnam, A. (1988). The epidemiology of obsessive-compulsive disorder in five US communities. Archives of General Psychiatry, 45, 1094-1099.
Leckman, J. F., Grice, D. E., Boardman, J., Zhang, H., Vitale, A., Bondi, C., Alsobrook, J., Peterson, B. S., Cohen, D. J., Rasmussen, S. A.., Goodman, W. K., McDougle, C. J., & Pauls, B. S. (1997). Symptoms of of obsessive-compulsive disorder. American Journal of Psychiatry, 154, 911-917.
Lensi, P., Cassano, G. B., Correddu, G., Ravagli, S., Kunovac, J. L., & Akiskal, H. S. (1996). Familial-developmental history, symptomatology, comorbidity, and course with special reference to gender-related differences. British Journal of Psychiatry, 169, 101-107.
Lincoln, Y. (1995). Emerging criteria for quality in qualitative and interpretive research. Qualitative Inquiry, 1(3), 275-289.
March, J S. & Mulle, K. (1998). OCD in children and adolescents: A cognitive-behavioral treatment manual. New York: Guilford.
Marks, I. M., Lelliott, P., Basoglu, M., Noshirvani, H., Monteiro, W., Cohen, D., & Kasvikis, Y. (1988). Clomipramine, self-exposure and therapist-aided exposure for obsessive-compulsive rituals. British Journal of Psychiatry, 152, 522-534.
Neziroglu, F., Anemone, R., & Yaryura-Tobias, J. A. (1992). Onset of obsessive-compulsive disorder in pregnancy. American Journal of Psychiatry, 149, 947-950.
Noshirvani, H. F., Kasvikis, Y., Marks, I. M., Tsakiris, F., & Monteiro, W. O. (1991). Gender-divergent aetiolgical factors in obsessive-compulsive disorder. British Journal of Psychiatry, 158, 260-263.
Pollard, C. A., Henderson, J. G., Frank, M., & Margolis, R. B. (1989). Help-seeking paterns of anxiety-disordered individuals in the general populations. Behavior Research and Therapy, 16, 233-248.
Rachman, S., Cobb, J., Grey, S., McDonald, B., Mawson, D., Sartory, G., & Stern, R. (1979). The behavioral treatment of obsessional-compulsive disorders with and without clomipramine. Behavior research and therapy, 23, 571-583.
Raphael, F. J., Rani, S., Bale, R., & Drummond, L. M. (1996). Religion, ethnicity, and obsessive-compulsive disorder. International Journal of Social Psychiatry, 42, 38-44.
Rasmussen, S. A. & Eisen, J. L. (1998). The epidemiology and clinical features of obsessive-compulsive disorder. In M. A. Jenike, L. Baer, & W. E. Minichiello (Eds), Obsessive-compulsive Disorders: Practical management(ch. 2). St louis, MO: Mosby.
Rasmussen, S. A. & Tsuang, M. T. (1986). Clinical characteristics and family history in DSM-Ⅲ obsessive-compulsive disorder: American Journal of Psychiatry, 143, 317-322.
Rettew, D. C., Swedo, S. E., Leonard, H. L., Lenane, M. C., & Rapoport, J. L. (1992). Obsessive and compulsions across time in 79 children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 1050-1056.
Riessman, C. K. (1993). Narrative Analysis. Newsburry Park, CA: Sage.
Steketee, G. & Pigott, T. (1999). Obsessive compulsive disorder : The latest assessment and treatment strategies. Kansas City, MO: Compact Clinicals.
Steketee, G. & Pruyn, N. A. (1998). Families of individuals with obsessive-compulsive disorder. In R. P. Swinson, M. M. Antony, S. Rachman, & M. A. Richter (Eds), Obsessive-compulsive disorders: Theory, research and treatment(pp. 120-140). New York: Guilford.
Steketee, G., Grayson, J. B., & Foa, E. B. (1985). Obsessive-compulsive disorder: Differences between washers and checkers. Behavior Research and Therapy, 23, 197-201.
Steketee, G., Grayson, J. B., & Foa, E. B. (1987). A comparison of characteristics of obsessive-compulsive disorder and other anxiety disorders. Journal of Anxiety Disorders, 1, 325-335.
Steketee, G., Quay, S. & White, K. (1991). Religion and guilt in OCD patients. Journal of Anxiety Disorders, 5, 359-367.
Summerfeldt, L., Antony, M. M., Dowine, F., Richter, M. A., & Swinson, R. P. (1997). Prevalence of particular obsessions and compulsions in a clinic sample. Unpublished manuscript.
Swinson, R. P., Antony, M. M. , Rachman, S. , & Richter, M. A. (Eds.). (1998). Obsessive-compulsive Disorders: Theory, research and treatment. New York: Guilford.
Tayler, S. (1998). Assessment of obsessive-compulsive disorder. In R. P. Swinson, M. M. Antony, S. Rachman, & M. A. Richter (Eds), Obsessive-compulsive disorders: Theory, research and treatment(pp. 229-257). New York: Guilford.
Thompson, P. H. (1995). Obsessive-compulsive disorder in children and adolescents: Predictors in children and adolescent for long-term phenomenological course. Acta Psychiatrica Scandinavica, 92, 255-259.
Turner, S. M., & Beidel, D. C. (1988). Treating obsessive-compulsive disorder. New York: Pergamon.
Van Balkom, A. J. L. M., & van Dyck, R. (1998). Comnination treatment for obsessive-compulsive disorder. In R. P. Swinson, M. M. Antony, S. Rachman, & M. A. Richter (Eds), Obsessive-compulsive disorders: Theory, research and treatment(pp. 349-366). New York: Guilford.
Van Balkom, A. J. L. M., de Haan, E., van Oppen, P., Spinhoven, Ph., Hoogduin, C. A. L., & van Dyck, R. (in press). Cognitive-behavioral therapy versus the combination with fluvoxamine in the treatment of obsessive-compulsive disorder. Journal of neurous and Mental Disease.
Van Balkom, A. J. L. M., van Oppen, P., Vermeulen, A. W. A., van Dyck, R., Nauta, M. C. E., & Vorst, H. C. M. (1994). A meta-analysis on the treatment of obsessive-compulsive disorder. Clinical Psychology Review, 14, 359-381.
Weissman, M. M., Bland, R. C., Canino, G. J., Greenwald, S., Hwu, H. -G., Lee, C. -K., Newman, S. C., Oakley-Brown, M. A., Rubio-Stipec, M., Wickramaratne, P. J., Wittchen, H. —U. & Yeh, E. —K. (1994). The cross national epidemiology of obsessive compulsive disorder. Journal of Clinical Psychiatry, 55(Suppl.), 5-10.
 
 
 
 
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