Please use this identifier to cite or link to this item: https://ah.lib.nccu.edu.tw/handle/140.119/115757
題名: 思覺失調症青少年之生活適應 ─以一個復元觀點
The Life Adjustment of Adolescents With Schizophrenia:The Perspective of Recovery
作者: 洪培馨
Hung, Pei-Hsin
貢獻者: 宋麗玉
Song, Li-Yu
洪培馨
Hung, Pei-Hsin
關鍵詞: 思覺失調症
青少年
生活適應
復元
自我覺醒
Schizophrenia
Adolescent
Life adjustment
Recovery
Self- awareness
日期: 2018
上傳時間: 2-二月-2018
摘要: 本研究以復元觀點探討思覺失調症青少年的生活適應,將適應區分初發病、生病後及現況三階段,分析其(1)身、心、社會功能的轉變,以及與環境系統之互動情形;(2)影響生活適應之因素;(3)促進復元之因素;(4)復元結果。本研究採半結構訪談之方式,訪談十位思覺失調症青少年,研究結果如下:\n\n一、思覺失調症青少年之生活適應\n 疾病初發階段,就罹病青少年而言,疾病因應策略分為五種:「轉移注意力」、「問題解決」、「情緒導向」、「調適」與「無法處理」,並因疾病而從學校撤退,此外,青少年對發病原因傾向自我歸因與內省。家庭系統,在缺少疾病衛教的情形下,家屬與罹病青少年一同經歷混亂與無助,但仍展現出多重求助行為。醫院系統,醫生著重病理症狀控制,缺少疾病衛教與情緒支持,然而,住院經驗並非完全負向,亦具正向影響。\n 生病後,就罹病青少年而言,疾病對其身、心、社會功能的影響相當廣泛,但也帶給其覺醒與成長的契機。家庭系統,家屬對青少年的互動關係與教養方式會產生正向變化,但家屬之疾病態度與因應策略卻包含正、負向。學校系統,青少年與同儕交往的深淺,易受疾病汙名影響;老師對疾病的態度與因應方式亦可區分為正、負向。復健系統,參與復健可提供罹病青少年場域的轉換,協助其疾病穩定與調適。 \n 青少年與疾病共生的過程,會嘗試運用資源與優勢,與環境達到良好的適配;在疾病因應上發展出更多正向力量,學會使用「問題解決」策略,也從單一因應策略,發展到多重策略。此時青少年仍對未來充滿希望,並展現出他們渴望獨立自主,不讓家人擔心的成熟。\n\n二、影響生活適應之因素\n1.個人層面:人格特質與疾病因應策略。\n2.家庭及非正式網絡:家人言論、支持、態度與疾病因應策略,以及同\n 儕互動方式。\n3.正式網絡:老師關懷、給予彈性與連結輔導資源、醫護人員互動方式\n 與疾病衛教、精神復健機構之處遇模式、住院過程。\n4.社會汙名:經驗到來自雇主或同學的歧視,影響青少年的自我評價與\n 疾病接納度。\n\n三、促進復元之因素\n1.正式支持:經濟因素、處境改變、參與復健、專業人員協助、穩定就\n 業。\n2.非正式支持:網友支持、休閒娛樂。\n3.復元三大基石:症狀減緩、信念與態度、家庭支持。\n\n四、生活適應歷程中的復元\n 依據復元統合模式之復元指標達成的數量,本研究有五位思覺失調症青少年目前為完全復元型、四位半復元型和一位初學型,分別展現不同的內在力量,呈現出「優遊自在」、「學習與調適」與「挫折與探索」的人生,而激發其改變與成長的轉捩點為「自我覺醒」與「參與復健」。思覺失調症青少年具復元的可能性,不僅是為了克服障礙而發展因應策略,更是超越障礙與追求自主性的展現。\n\n 最後,研究者結合上述研究結果,嘗試繪製出思覺失調症青少年之復元統合模式,並提出本研究限制與建議,提供學校、心理衛生醫護人員、服務提供者、青少年病患之家屬與未來研究者參考。
This study aimed to use perspective of recovery to explore the life adjustment of adolescents with schizophrenia and distinguish the process of life adjustment into the initial, stable and current three stages, discussed (a) the respondents’ bio-psycho-social function changes and the interaction with the environment system;(b) the related factors of life adjustment;(c) the facilitating factors of recovery, and(d)the respondents’ result of recovery. This research adopted a semi-structured interview to interview ten adolescents with schizophrenia. The study results are as follows:\n\n一、The life adjustment of adolescents with schizophrenia\n In the initial stage, for the respondents, their illness coping strategies can be divided into five types:distraction, problem-focused, emotion-focused, accommodation and unable to handle, and they drop-out of school because of illness. Besides, respondents tend to self-attribution and introspection of the cause of the illness. In the family system, because of the lack of patient education situation, the family experience chaos and helplessness with the respondents either, but also show multiple help-seeking behavior. In the hospital system, doctors focus on the control of symptoms, lack of patient education and emotional support;however, the experience of hospitalization is not completely negative and it also has positive influence. \n\n In the stable stage, for the respondents, the illness has a wide range of effects on their bio-psycho-social function, but it also provided them an opportunity to awaken and grow. In the family system, the parenting style and relationship between respondents and their family have a positive change, but the attitudes toward illness and coping strategies of the family included positive and negative types.In the school system, the depth of relationship between respondents and peers are easily influenced by illness stigma, and teachers’ attitudes toward illness and coping strategies also include positive and negative types. Participate in rehabilitation can provide the respondents the conversion of the field to help them stabilize and accommodate illness. \n\n For respondents, it is a symbiotic process with illness, respondents will try to use resources and advantages to achieve a good fit with the environment and develop more strength to cope illness. They also learned to use " problem-focused " strategy and from using single strategy changed to use multi-strategies. At this moment, respondents are still hopeful for the future and long for independence, they are mature enough to not let their families worry.\n\n二、There are four types of factors that influenced the life adjustment:\n1.Personal factors:characteristics and illness coping \n strategies.\n2.Family and informal network:speech, support, attitude \n and illness coping strategies from family and peer \n interaction. \n3.Formal network:Teachers provide care, flexibility and \n connect counseling resources. Interaction with mental \n health practitioners and patient education. Treatment \n modes from psychiatric rehabilitation agencies. \n Hospitalization process/experience.\n4.Social stigma:Discrimination from employers or \n classmates influenced respondents’ self-evaluation and \n acceptance for illness.\n\n三、There are three types of factors that facilitate \n recovery:\n1.Formal support:financial issue, change for status, \n participate in rehabilitation, assistance from \n professionals, employment.\n2.Informal support:net-pals support and entertainment.\n3.Three cornerstones of recovery:symptom remission, \n faith /attitude and family support.\n\n四、The recovery from life adjustment of adolescents with \n schizophrenia\n According to the recovery target of the unity model of recovery which adolescents with schizophrenia achieved, they were divided into three recovery stages:five are full-recovery, four are semi-recovery, one is novitiate recovery, and they also show different mental strengths respectively which presented " comfort and leisure", "learning and accommodation" and "frustration and exploration" of life. Besides, the turning points which inspired respondents to change and grow are "self-awareness" and "participation in rehabilitation". Adolescents with schizophrenia have the potential for recovery, they not only developed coping strategies to overcome obstacles, but also presented how they transcended obstacles and pursued autonomy.\n\n Finally, according to the results, the investigator came up a recovery unity model suited for the adolescents with schizophrenia, and discussed the limitations of this study and the advices for school system, mental health practitioners, service providers, the family and future researchers.
參考文獻: 中文文獻\n王舒慧(2013)。疾病歷程:患者及家屬觀點之分析(未出版之碩士論文)。朝陽科技大學,臺中市。\n何昭葦(2010)。印尼雅加達慈濟大愛一村青少年生活適應研究(未出版之碩士論文)。慈濟大學,花蓮市。\n吳宗弘(2009)。高年級學童的家庭結構, 希望感與生活適應之分析研究(未出版之碩士論文)。國立花蓮教育大學,花蓮市。.\n吳惠媛(1994)。疾病的聲音:青年精神分裂病患的疾病經驗之詮釋學研究(未出版之碩士論文)。國立臺灣大學,臺北市。\n宋維村(1996)。靑少年精神醫學。臺北市:天馬。\n宋麗玉(2012)。社會支持網絡、壓力因應與社會網絡處遇。載於宋麗玉、曾華源、施教裕、鄭麗珍。社會工作理論-處遇模式與案例分析(331頁)。臺北:洪葉文化。\n宋麗玉(2015)。復元觀點模式與復元之成效。載於宋麗玉、施教裕、徐淑婷,優勢觀點與精神障礙者之復元:駱駝進帳與螺旋上升(21-25、48-50頁)。臺北市:洪葉文化。\n宋麗玉(2005)。精神障礙者之復健與復元—一個積極正向的觀點。中華心理衛生學刊,18(4),1-29。\n宋麗玉(2015)。復元觀點模式與復元之成效。載於宋麗玉、施教裕、徐淑婷,優勢觀點與精神障礙者之復元:駱駝進帳與螺旋上升(21-25、48-50頁)。臺北市:洪葉文化。\n李依蓁(2010)。父母協助生病子女發展完整病識感歷程─以精神分裂症為例。慈濟大學社會工作,花蓮市。\n林浥雰(2010)。青少年情緒智能,復原力與生活適應之相關研究(未出版之碩士論文)。臺灣師範大學,臺北市。\n林哲立、邱曉君、顏菲麗(譯)(2007)。人類行為與社會環境(原作者:Ashford, J. B., LeCroy, C. W., & Lortie, K. L)。臺北市:雙葉(原作出版年:2001)。\n林淑芬(1997)。精神分裂病患之社區適應、自我概念與社會支持\n(未出版之碩士論文)。高雄醫學大學,高雄市。\n林慧婷(2014)。精神分裂症患者家庭功能與復元之相關性研究(未出版之碩士論文)。國立臺北大學,臺北市。\n林鍾淑敏(2002)。走在荊棘路上-精神分裂症青少年病患的疾病經驗與適應歷程(未出版之碩士論文)。國立臺灣大學,臺北市。\n施教裕(2009)。復元的理念和模型。載於宋麗玉、施教裕,優勢觀點:社會工作理論與實務(101-119 頁)。臺北市:洪葉文化。\n洪貴真、劉嘉雯、任凱合(譯)(2012)。人類行為與社會環境─心理暨社會取向(原作者Elizabeth D. Hutchison)。臺北市:紅葉文化(原作出版年:2008)。\n胡幼慧與姚美華(1996)。質性研究 : 理論、方法及本土女性研究實例。 臺北市 : 巨流出版。\n范燕燕(2000)。精神病患者生活經驗與主體性之研究(未出版之碩士論文)。國立陽明大學,臺北市。\n徐淑婷(2015)。精神障礙者之特性與復元議題。載於宋麗玉、施教裕、徐淑婷,優勢觀點與精神障礙者之復元:駱駝進帳與螺旋上升(129-143頁)。臺北市:洪葉文化。\n高薰芳、林盈助、王向葵(譯)(2001)。質化研究設計 : 一種互動取向的方法(原作者:Joseph A. Maxwell)。臺北市 : 心理。\n高淑清(2008)。質性研究的18 堂課:首航初探之旅。臺北:麗文文化。\n張帥心(2015)。思覺失調症患者復元與失能程度之探討(未出版之碩士論文)。國立臺灣師範大學,臺北市。\n陳向明(2002)。社會科學質的研究。臺北市 : 五南。\n陳妙華(2013)。唇腭裂青少年自我概念、母親教養態度與生活適應之相關研究(未出版之碩士論文)。國立嘉義大學,嘉義市。\n陳依璇(2012)。不同背景國中學生的學校希望感及生活適應之相關研究(未出版之碩士論文)。國立臺灣師範大學,臺北市。\n陳金定。(2007)。青少年發展與適應問題:理論與實務。臺北市:心理。\n陸瑞玲、張阿雪、張曉雲、陳映雪(2005)。降低情緒障礙青少年日間留院特教班曠課率之分析。身心障礙研究季刊,3(3),169-181。\n陸麗香(2002)。青少年期精神病人主觀之同儕經驗探討(未出版之碩士論文)。慈濟大學,花蓮市。\n黃政昌(2001)。青少年精神病患出院後學校適應問題。師友月刊,404,33-35。\n黃瑞琦(2001)。社區精神分裂症病患之病識感,社會支持與生活適應(未出版之碩士論文)。高雄醫學大學,高雄市。\n黃德祥(2011)。青少年發展與輔導精要。臺北市:考用。\n黃雅琳(2014)。青少年精神病患於學校就學情境之探討─以主要照顧者之照顧經驗為例(未出版之碩士論文)。國立臺北護理健康大學,臺北市。\n廖思涵(2006)。高雄市國中生網路使用行為、網路沉迷與生活適應、學業成就之相關研究(未出版之碩士論文)。國立高雄師範大學,高雄市。\n劉玲君(2014)。以詮釋觀點探討精神障礙者的復元歷程(未出版之碩士論文)。國立臺北大學,臺北市。\n劉景宜(2012)。青少年精神疾患生命經驗敘事研究(未出版之碩士論文)。國立臺北教育大學,臺北市。\n劉燕萍(2006)。青少年精神障礙者於復健歷程中的自我決定(未出版之碩士論文)。輔仁大學,新北市。\n潘淑滿(2003)。質性研究 : 理論與應用。臺北市 : 心理。\n蔡佩芬(1998)。青少年精神分裂症病患壓力源、因應行為及生活適應之相關探討(未出版之碩士論文)。國立臺灣大學,臺北市。\n蔡明錤(2006)。精神病患主要照顧者求助經驗與求助抉擇之研究。東海大學,台中市。\n衛生福利部(2014)。2014年健保統計年報。取自http://dep.mohw.gov.tw/DOS/lp-1921-113.html\n鄧之華(2010)。青少年的情緒表達與生活適應:不同情境與社會關係之分析(未出版之碩士論文)。世新大學,臺北市。\n賴倩瑜(1995)。青少年精神分裂症病患生活適應與其主要照顧者教養方式之相關探討(未出版之碩士論文)。國立臺灣大學,臺北市。\n賴貞君(2006)。社區民眾的鄰里接觸經驗對精神疾病及患者態度之影響(未出版之碩士論文)。國立臺灣大學,臺北市。\n簡春安、鄒平儀(2004)。社會工作研究法。臺北市 : 巨流。\n闕漢中(譯)(1999)。兒童青少年社會工作(原作者:Paula Allen)。臺北市: 紅葉文化。\n蘇舜君(2013)。精神疾病患者復元經驗與歷程的探究(未出版之碩士論文)。國立國立臺灣師範大學,臺北市。\n鐘寶珠(1991)。精神分裂症青年病患和一般青年與其母親對「生活適應」態度之初步探討(未出版之碩士論文)。國立臺灣大學,臺北市。\n\n\n英文文獻\nAbraham, A., Silber, T. J., & Lyon, M.(1999). Psychosocial aspects of chronic illness in adolescence. Indian Journal of Pediatrics, 66(3), 447-453.\nAldersey, H. M. &Whitley, R.(2012). Family influence in recovery from severe mental illness. Community Mental Health Journal, 51(4),467-476.\nAndresen, R., Caputi, P., & Oades, L.(2006). Stages of recovery instrument: development of a measure of recovery from serious mental illness. Australian and New Zealand Journal of Psychiatry, 40(11-12), 972-980.\nArkoff, A.(1968). Adjustment and Mental Health(pp.18-21). New York: McGraw-Hill.\nBraehler, C., & Schwannauer, M.(2012). Recovering an emerging self: Exploring reflective function in recovery from adolescent‐onset psychosis. Psychology and Psychotherapy: Theory, Research and Practice, 85(1), 48-67.\nCadario, E., Stanton, J., Nicholls, P., Crengle, S., Wouldes, T., Gillard, M., & Merry, S. N.(2012). A qualitative investigation of first-episode psychosis in \nadolescents. Clinical Child Psychology and Psychiatry, 17(1), 81-102.\nCapp, G., Berkowitz, R., Sullivan, K., Astor, R. A., De Pedro, K., Gilreath, T. D., Benbenishty, R., & Rice, E.(2016). Adult relationships in multiple contexts and associations with adolescent mental health. Research on Social Work Practice, 26(6), 622-629.\nClinton, M., Lunney, P., Edwards, H., Weir, D., & Barr, J.(1998). Perceived social support and community adaptation in schizophrenia. Journal of Advanced Nursing, 27(5), 955-965.\nDepartment of Health and Human Services(2014).What Is Mental Health? Retrieved April 5, 2017 from https://www.mentalhealth.gov/basics/what-is-mental-health/\nDepartment of Health and Human Services(2017).Mental Health in AdolescentsRetrieved April 5, 2017 https://www.hhs.gov/ash/oah/adolescent-developmentfrom /mental-health/index.html\nde Wet, A., Swartz, L., & Chiliza, B.(2015). Hearing their voices: The lived experience of recovery from first-episode psychosis in schizophrenia in South \nAfrica. International Journal of Social Psychiatry, 61(1), 27-32.\nDickerson, F. B., Parente, F., & Ringel, N.(2000). The relationship among three measures of social functioning in outpatients with schizophrenia. Journal of Clinical Psychology, 56(12), 1509-1519.\nEstroff, S. E.(1989). Self, identity, and subjective experiences of schizophrenia: In search of the subject. Schizophrenia Bulletin, 15, 189-196.\nJessor, R.(1993). Successful adolescent development among youth in high-risk settings. American Psychological Association. 48(2), 117-126.\nJenkins, J. H., Strauss, M. E., Carpenter, E. A., Miller, D., Floersch, J., & Sajatovic,M.(2005). Subjective experience of recovery from schizophrenia-related \ndisorders and atypical antipsychotics. International Journal of Social \nPsychiatry, 51(3), 211-227.Kamptner, N. L.(1988). Identity development in late adolescence: Causal modeling \nof social and familial influences. Journal of Youth and Adolescence, 17(6), 493-514.\nLaithwaite, H., & Gumley, A.(2007). Sense of self, adaptation and recovery in patients with psychosis in a forensic NHS setting. Clinical Psychology and \nPsychotherapy, 14(4), 302-316.\nLally, S.J.(1989). Does being in here mean there is something wrong with me? Schizophrenia Bulletin , 15(2), 253-265. \nLecomte, Yves, and Céline Mercier.(2005)."The stress process perspective and adaptation of people with schizophrenia." Social Psychiatry and Psychiatric \nEpidemiology ,40(2), 139-148.\nLee, H., & Schepp, K. G.(2011). Ways of coping in adolescents with schizophrenia. Journal of Psychiatric and Mental Health Nursing, 18(2), 158-165.\nLower, R., Wilson, J., Medin, E., Corlett, E., Turner, R., Wheeler, K., & Fowler, D. (2015). Evaluating an early intervention in psychosis service for ‘high‐risk’ \nadolescents: symptomatic and social recovery outcomes. Early Intervention in Psychiatry, 9(3), 260-267.\nMyers, N. L.(2010). Culture, stress and recovery from schizophrenia: Lessons from the field for global mental health. Culture, Medicine, and Psychiatry, 34(3), \n500-528.\nO`Brien, M. P., Gordon, J. L., Bearden, C. E., Lopez, S. R., Kopelowicz, A., & Cannon, T. D.(2006). Positive family environment predicts improvement in symptoms and social functioning among adolescents at imminent risk for onset of psychosis. Schizophrenia Research, 81(2), 269-275.\nPaley, B., Conger, R. D., & Harold, G. T.(2000). Parents` affect, adolescent cognitive representations, and adolescent social development. Journal of Marriage and Family, 62(3), 761-776.\nResnick, S. G., Fontana, A., Lehman, A. F., & Rosenheck, R. A.(2005). An empirical conceptualization of the recovery orientation. Schizophrenia Research, 75(1), 119-128.\nRichard S. Lazarus(1976). Patterns of Adjustment(pp.3-5). New York: McGraw-Hill.\nRomney, D. M.(1995). Psychosocial functioning and subjective experience in schizophrenia: A reanalysis. Schizophrenia Bulletin, 21(3), 405-410.\nSadock, B. J., Sadock, V. A., & Ruiz, P.(2015). Kaplan & Sadock`s synopsis of Psychiatry:Behavioral sciences/clinical psychiatry(pp.301、317). \nSchiff, A. C.(2004). Recovery and mental illness: analysis and personal reflections. \nPsychiatric Rehabilitation Journal, 27(3), 212-218\nShaffer, L. F., & Shoben Jr, E. J.(1956). The psychology of adjustment(pp.9).Boston : Houghton Mifflin\nSteinberg, L., & Morris, A. S.(2001). Adolescent development. Annual Review of Psychology. 52(1), 83-110.\nSpaniol, L., Wewiorski, N. J., Gagne, C., & Anthony, W. A.(2002). The process of recovery from schizophrenia. International Review of Psychiatry, 14(4), 327-336.\nŚwiętochowski, W.(2011). Schizophrenia in adolescents and the family system. Polish Psychological Bulletin, 42(1), 5-10.\nTaylor, E.H.(1998). Advance in the diagnosis and treatment of children withserious mental illness. Child Welfare. 77(3), 311-332.\nVaughn, C., & Leff, J.(1976). The measurement of expressed emotion in the families of psychiatric patients. British Journal of Clinical Psychology. 15(2), 157-165.\nWells, K., Wyatt, E., & Hobfoll, S.(1991). Factors associated with adaptation of youths discharged from residential treatment. Children and Youth Services \nReview, 13(3), 199-216.\nWorld Health Organization(2014).Mental health: a state of well-being。Retrieved April 5, 2017 from http://www.who.int/features/factfiles/mental_health/en/
描述: 碩士
國立政治大學
社會工作研究所
104264005
資料來源: http://thesis.lib.nccu.edu.tw/record/#G0104264005
資料類型: thesis
Appears in Collections:學位論文

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