初診精神分裂症患者及其家屬求助行為之初探

Abstract

本研究目的主要在瞭解台北市某教學醫院初診精神分裂症患者及其家屬求助行為，以質性研究，呈現精神分裂症患者疾病的症狀經驗以及因應策略，並且衍生出的求助行為。 研究發現，精神分裂症患者在經驗疾病症狀時，多呈現對於聽覺與視覺的症狀經驗，患者衍生出因應措施以及家屬缺乏對精神分裂症的認識，導致延遲就醫的發生；受訪者求助行為的型態包括精神醫療、中醫治療 (吃中藥、整脊)、民俗療法 (祭解、拜拜、收驚、求神問卜)與大眾醫療方式 (吃魚肝油補腦、運動)等多層面併用的複式求助型態；採取複式求助行為的決定因素為：宗教與對精神疾病的民俗信念、尋找任何可能痊癒的治療方式與受訪者的健康信念；受訪者在複式求助行為中選擇精神醫療的原因有：患者外顯行為的干擾程度、對精神分裂症疾病正確的認知與在另類療法體系受挫的求助經驗；而求助精神醫療的情境有：尋求答案與改變現況。 本研究之結果，使我們瞭解初診精神分裂症患者與家屬尋求複式求助行為與在精神醫療、民俗療法與中醫治療當中轉換的情境與原因，藉由對受訪者求助行為的瞭解，一方面可作為精神醫療專業人員全方位照護精神分裂症個案之參考，另一方面作為日後建立早期處置服務的參考方向。

The goal of this study focuses on the understanding of the help-seeking behaviors of the patients of schizophrenia and their families on their first visit to a teaching hospital in Taipei. The qualitative approach is adopted to firstly present the symptoms schizophrenia patients experience, the coping strategies they use, and then their help-seeking behaviors. In this study, it is found that schizophrenia patients experience aural and visual symptoms. Patients’ coping strategies and lack of knowledge concerning schizophrenia from their families result in the postponement of seeking professional medical help. Types of help-seeking behavior found from participants in this study include psychotic medical therapy, Chinese medicine therapy (taking herbal medicine or receiving chiropractic therapy), folk therapy (worship, divination), popular sector (nourishing brain by taking cod-liver oil, doing sports) and the pluralistic help-seeking type—the combination of two or more of the above types. Factors affecting the adoption of pluralistic help-seeking behaviors include religion and fold beliefs toward psychological disorders, seeking of any therapies for complete recovery and participants’ health beliefs. Reasons why participants choose psychotic medical therapy include degree of interruption of patients’ external behavior, their accurate knowledge in schizophrenia, and failure and frustration experienced when seeking help from alternative therapeutic systems. Contexts under which patients resort to psychotic medical therapy include answer-seeking and changing the status quo. The results of this study make it possible for us to know more in the process of pluralistic help-seeking behaviors in the part of the patients and their families; to realize the reasons why and the situations in which they transfer among psychotic, folk, and Chinese medicine therapies. Comprehension of the help-seeking behaviors of the participants can serve as a reference for professionals in psychotic medical therapy to take better care of the patients of schizophrenia, and on the other hand, to establish early intervention service in the future.