緒論
隨著國內人口老化，慢性思覺失調症住院病患亦呈現老化趨勢。本研究希望探討多數研究支持，可應用於失智症患者的認知復健活動，是否同樣適用於改善中老年慢性思覺失調症患者的認知、情緒與社交功能退化情形。
方法
本研究於台灣東部某精神科專科教學醫院進行。第一部分，分析該醫院中老年思覺失調患者的人口學變項在該醫院所占比例；第二部分，採用單盲，類實驗對照組研究設計，來收集認知與社交復健團體應用於該院中老年伴隨認知功能退化的慢性思覺失調症患者之介入成效，評估的研究變項包括患者的認知功能、情緒與行為症狀、生活功能、生活品質及社會性心智功能。本研究受試者共分三組，研究組篩選24位診斷為思覺失調症，且伴隨有認知退化者為研究對象（Case組，平均年齡61.8歲，教育程度8.83年），參加每週一次，為期3個月時間，共12次的認知與社交復健團體心理治療。另選取診斷、性別、年齡與教育程度上，大致可與研究組配對之控制組2組，控制組一24位（Control組，平均年齡61.2歲，教育程度8.08年），為與研究組同樣具有思覺失調合併認知退化症狀，但僅接受例行藥物與護理等照護治療；控制組二22位（Aging組，平均年齡59.5歲，教育程度10.73年），為不具有認知退化症狀，亦僅接受例行藥物與護理等照護之患者。所有受試者在團體介入前、介入後與團體結束後三個月追蹤，共接受三次研究變項的評估。（本研究主要分析研究組與控制組一的評估結果）
結果
第一部份，本研究發現該醫院罹患具思覺失調診斷的病患約占全院82.7%。全院50歲以上住民，已佔總人數82.5%，65歲含以上住民，佔總人數30.0 %，年齡結構確實呈現老化趨勢。第二部份，本研究發現，讓研究組持續參與10-12次，運用「認知與社交復健團體」治療，病患在簡短心智功能測驗（Mini Mental Status Examination, MMSE）的表現有明顯提升（F=4.43, p=0.041），團體介入的效果量可以達到中等程度（Cohen’s d= 0.67），尤其在定向感與語言兩項認知功能進步顯著。但是此成效在團體結束後三個月的追蹤顯示，研究組的MMSE得分又會回復到團體介入前的分數。本次研究結果也顯示在精神症狀，生活品質與日常生活功能、情緒與動機方面的評估，團體介入未達到統計顯著成效，但透過團體帶領者在團體歷程，與成員回饋中的質性資料，可以觀察到成員的正向改變。
結論
本研究的主要貢獻在於發現，認知與社交復健的團體心理治療對於長期住院的中老年慢性思覺失調症且伴隨有認知退化患者，在延緩部分認知功能的退化具有明顯成效，但此成效需要持續的團體介入才能得以維持其效果。希望本研究的發現能提供從事長期照護中老年且認知功能退化之精神病患的醫療人員參考，本研究的限制和建議亦一併呈現於內文中，提供後續有興趣的研究者參考。

Introduction
Aging is an important issue for chronic schizophrenia in Taiwan. Declined cognitive
performance is treated as one kind of characteristics in aging. The study was to investigate whether the cognitive rehabilitation for dementia can apply to improve middle-aged and elderly people with chronic schizophrenia.
Method
The research is studied in the psychiatric hospital in east Taiwan.In the first path, analyes the proportion of emographic variables of the patients in this hospital. Next, single blind study was conducted to examine the effectiveness of integrated cognitive rehabilitation group on chronic schizophrenia. Participants were grouped into three groups, including of intervention group, control group Ⅰ and control group Ⅱ. Twenty-four participants were assigned to received twelve sessions, weekly cognitive rehabilitation group (mean of age= 61.8 years; educational years =8.83 years). Twenty-four participants in Control group Ⅰ were accepted for routinely nursing care and medicine treatment (mean of age= 61.2 years; educational years =8.08 years). Residual of participants who did not showed cognitive decline were assigned to control group Ⅱ to receive routinely nursing care and medicine treatment (mean of age= 59.5 years; educational years =10.73 years). All of them were assessed by cognitive function, emotional status, psychotic symptoms, quality of life and functions of daily living at baseline, post-session and 3-month follow-up. (This study mainly analyzes the evaluation results of the cognitive rehabilitation group and the Control group Ⅰ)
Results
The prevalence of schizophrenia was 82.7% in mental hospital. 82.5% of dwellers were fifty years old above, and 30% of dwellers were sixty-five years old above. Compared with MMSE at baseline, the participants in cognitive rehabilitation group showed significant improvement after twelve-session intervention (F=4.43, p=0.041) with moderate effect size (Cohen’s d= 0.67), especially for orientation and language express. Unexpectedly, MMSE at 3-month follow-up in cognitive rehabilitation group could be not significantly improved compared with baseline. There was no significant differences of emotional status, psychotic symptoms, quality of life and functions of daily living between baseline and 3-month follow-up in cognitive rehabilitation. Furthermore, the results qualitative analysis for feedback from the participants in cognitive rehabilitation group supported the effectiveness of cognitive rehabilitation group on schizophrenia.
Conclusions
Our results preliminarily supported effectiveness of cognitive and social rehabilitation group on delaying the degradation of some cognitive functions in long-term hospitalization chronic schizophrenia. Importantly, the intervention should be routinely conducted in schizophrenia after twelve sessions. Hope to provide the results for the medical and health workers caring the middle-aged and elderly patients with chronic schizophrenia. The limits and suggestions of the research are in the content, and the following researchers interested about the topic can consult.

致謝 I
中文摘要 II
英文摘要 IV
目錄 VI
表次 VII
圖次 VIII
第一章 緒論 1
第二章 文獻探討 3
第一節 中老年慢性思覺失調症患者與認知退化 3
第二節 中老年慢性思覺失調症患者伴隨認知退化的治療 7
第三節 中老年慢性思覺失調患者與社會性心智功能 16
第三章 研究方法 17
第一節 研究架構與假設 17
第二節 研究樣本 19
第三節 研究工具 20
第四節 研究程序與資料分析 24
第四章 研究結果 27
第一節 研究場域人口結構現況 27
第二節 基本人口學資料 28
第三節 實驗處理前三組等組性 30
第四節 認知與社交復健團體的立即成效分析 38
第五節 認知與社交復健團體的追蹤成效分析 48
第五章 討論與建議 57
第一節 研究結果之討論 57
第二節 研究限制與建議 64
參考文獻 67
附錄 75

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