國際間已有多篇研究發現思覺失調症患者在不同認知功能領域具廣泛性缺損且異質性大，思覺失調症患者能夠透過不同神經認知功能表現加以區分出不同亞型。本研究主要延續先前蔣世光等人（2016）對於漢族思覺失調症患者之研究架構，以神經心理測驗表現為判斷依據，將其區分為認知正常範圍組（Cognitively Normal Range, CNR; N=52）和低於正常範圍組（Below Normal Range, BNR; N=50），目的在於比較兩種認知功能亞型的慢性思覺失調症患者在不同社會認知功能表現是否有所差異。本研究的方法如下：參與者來源為台灣東部某醫院內被診斷為思覺失調症之長期住院患者，實際參與者共60位，兼採用過去資料庫之研究數據共42筆，最終共收錄102人次之有效研究數據。男性66名，女性36名，全體參與者平均年齡為46.78歲，平均受教育年數為10.39年，首次發病年齡為20.66歲，平均生病年數達24.75年。研究的社會認知領域包括：動機、臉部表情辨識能力、社會情境下情緒刺激的評價與感知能力，以及同理能力等。使用的評估工具分別為：台灣版冷漠評估量表、國際情緒圖片系統、日本人和白種人臉部表情辨識測驗和中文版人際反應性指標量表。統計方法採用描述性統計、獨立樣本t檢定及皮爾森積差相關，輔以階層迴歸分析對資料進行處理。主要研究結果為：（1）BNR組在基本動機較CNR組更為冷漠，組間達顯著差異。（2）國際情緒圖片系統中，CNR組面對負性情緒照片，被喚起的情緒反應較BNR組明顯。（3）日本人和白種人臉部表情辨識測驗則發現兩組對六項基本情緒的判斷正確率並無組間差異，但仍有相同反應傾向。（4）惟中文版人際反應性指標量表結果發現CNR組在各項同理能力表現皆低於BNR組。結論：研究結果初步支持社會認知功能仍受神經認知功能缺損程度影響而有差異，僅第（4）項研究結果與原研究假設相左，推論可能與認知功能相對較佳的參與者長期受汙名化或憂鬱情緒影響有關，有待後續研究再進一步釐清。

There have been many international studies on the cognitive impairment of patients with schizophrenia. Because these patients have significant differences in different cognitive impairments, subsequent studies have distinguished these impairments into secondary types. Chiang et al. (2016) applied this model to understand schizophrenic patients of the Han nationality. This study adopts part of Chiang’s research framework to analyze different participants. Based on the performance of neuropsychological tests, two types of chronic patients are divided, including Cognitively Normal Range (CNR; n=52) and Below Normal Range (BNR; n=50), to compare their different performances in several social cognitive functions.

One hundred two participants, 66 males, and 36 females, in this study are long-term hospitalized patients diagnosed with schizophrenia in a hospital in eastern Taiwan. They are 60 actual patients, and 42 used research data from the past database. The average age of them was 46.78. The average year of education was 10.39. In addition, the age of the first onset was 20.66, and the average year of illness was 24.75. The areas of social cognition embrace motivation, facial expression recognition, evaluation and perception of emotional stimuli in social contexts, and empathy. The evaluation instruments used to test the subjects are the Taiwanese version of the Apathy Evaluation Scale (T-AES), International Affective Picture System (IAPS), the Japanese and Caucasian Facial Expression of Emotion (JACFEE), and the Chinese version of the Interpersonal Reactivity Index (C-IRI). The statistical methods use descriptive statistics, independent sample t-test, and Pearson correlation coefficient, and hierarchical regression analysis to process the data.

After the two groups, CNR and BNR, completed the four scale tests, the Chinese version of the Interpersonal Reactivity Index is significantly different from the hypothesis. However, the results of the other three tests are in line with expectations. The results indicate that social cognitive functions are still affected by neurocognitive function impairment. Only one test result is contrary to the outcome of previous research (Chiang, 2009). The reason might be related to the CNR group who have suffered from a long-term stigma and depression, which needs to be further clarified by follow-up research.

致謝 Ⅰ
中文摘要 Ⅲ
英文摘要 Ⅴ
目錄 Ⅶ
表次 Ⅸ
圖次 XI
第一章 緒 論 1
第二章 文獻探討 4
第一節 思覺失調症與其神經認知功能缺損 4
第二節 病理研究派典和認知功能亞型相關論點 8
第三節 思覺失調症患者的社會認知功能 11
第三章 研究方法 15
第一節 研究對象 15
第二節 研究工具 18
第三節 研究程序與資料分析 26
第四章 研究結果 29
第一節 神經認知功能亞型區分 29
第二節 兩認知功能亞型之於台灣版冷漠評估量表 35
第三節 兩認知功能亞型之於國際情緒圖片系統 38
第四節 兩認知功能亞型之於日本人和白種人臉部表情辨識測驗 43
第五節 兩認知功能亞型之於中文版人際反應性指標量表 47
第六節 社會認知功能與社會認知功能之間的關聯性 55
第七節 社會認知功能與神經認知功能之間的關聯性 58
第五章 研究討論與建議 61
第一節 關於兩認知功能亞型患者的冷漠現象 61
第二節 關於兩認知功能亞型患者的情緒向度差異 63
第三節 關於兩認知功能亞型患者的臉部表情辨識能力 65
第四節 關於兩認知功能亞型患者的同理能力 67
第五節 研究貢獻與限制 70
第六節 研究結論與建議 72
參考文獻 74
附錄 80

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