精神病首次發作與疑似前精神病狀態之個體所知覺的親子關係

Abstract

目的：了解精神病不同風險之族群知覺親子關係之差異，以及親子關係知覺與精神病理表現的相關性。 方法：採橫斷面疾病對照法研究，藉由台灣早期精神分裂性障礙症的精神病理前瞻性研究計畫（a Study On Psychopathologic Progress of Early Schizophrenia-like Disorder; SOPRES）設立的知覺障礙特別門診招募、診斷及追蹤社區中精神病首次發作（First-Episode Psychosis, FEP）、疑似前精神病狀態族群，包括高度危險群（Ultra-High Risk Group, UHR）、中度危險群(Intermediate-Risk Group, IRG)、低度危險群（Marginal-Risk Group, MRG），與年齡性別相配的正常控制組(Normal Control Group, NC)，施測親子關係量表（Parental Bonding Instrument, PBI）分別了解個體與母親（PBI＿Mother）及與父親（PBI＿Father）關係之整體性評價，並以前驅症狀量表（Scale of Prodromal Symptoms, SOPS）評估個體精神病理表現及其與親子關係知覺之關連。 結果：本研究蒐集PBI＿Mother有效樣本325人，PBI＿Father有效樣本314人，經年齡性別控制後之多元迴歸分析顯示FEP、UHR、IRG、MRG知覺母親與父親關懷顯著低於NC，母親與父親保護顯著高於NC，IRG感受到低關懷高保護的親子關係最為明顯。除FEP以外，個體知覺與父母的關係一致性高，但母親關懷顯著高於父親關懷，母親保護亦顯著高於父親保護。個體知覺母親保護或過度保護與其負性症狀或一般精神病理呈現低度正相關。高度危險群轉變為精神病首次發作者與否在親子關係知覺無統計顯著差異，唯高度危險群中失聯者知覺父親關懷顯著低於有追蹤著。 結論：處於精神病風險族群所知覺親子關係相較於正常控制組呈現低關懷高保護之型態，精神病風險族群各組間之親子知覺無顯著差異，前驅症狀中之負性症狀與一般精神病理與個體知覺母親過度保護呈現微弱正相關。

Objective: To explore the parental bonding perceived by subjects at different risk of being psychosis, as well as the correlation between prodromal symptoms and the perception of maternal and paternal bonding. Methods: The study recruited at risk subjects in the comumnity from a special clinic of congitive and perceptual disturbance which is established by a Study On Psychopathologic Progress of Early Schizophrenia-like Disorder (SOPRES). By means of clinincal diagnosis assessments, different psychopathological stages inclued a First-Episode Psychosis group (FEP), a Putative Pre-Psychotic state group (PPP) including an Ultra-High-Risk group (UHR), an Intermediate-Risk Group（IRG）, and a Marginal-Risk group (MRG), as well as an age- and gender- matched Normal Control group (NC) were compared with maternal and paternal relationship of the Parental Bonding Instrument (PBI). Results: The effective sample of PBI_Mother is 325 and PBI_Father is 314. After controlling on sex and age variables, subjects of FEP, UHR, IRG and MRG described their mothers and fathers to be less care and more protection than NC. The most significant difference is between IRG and NC. Correlations between maternal overprotection and negative and general prodromal symptoms were significant but weak. Except FEP, subjects show high consistency of self-perceived relationship with their parents, but mother’s care and protection is significantly higher than the father's ones. In the period of 2 years follow up, the UHR converters and non-converters shows no statistically significant difference in perception of parental bonding, but UHR who lost follow up perceived their father to be less care. Conclusions: The study presents individual perceived high over-protection, and low care of parents has been presented at the clinical risk of becoming psychosis. Negative and general symptoms of prodromal stage of psychotic disorder may be an important factor that affect individuals perceived or received their mother to be low care and high protection.