弦外之音測驗臺灣版於思覺失調症患者之心理計量特性驗證

鄭淇文

doi:10.6342/NTU201700306

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弦外之音测验台湾版於思觉失调症患者之心理计量特性验证

Validation of the Taiwanese version of the Strange Stories Test in patients with schizophrenia

郑淇文 , 硕士　　导师：薛漪平　　

繁体中文 DOI： 10.6342/NTU201700306

思觉失调症；心智推理；心理计量特性； schizophrenia ； theory of mind ； psychometric properties

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摘要 │ 参考文献 (118) │ 国际计量

摘要〈TOP〉

研究背景：心智推理 (theory of mind) 是个体推论自己或他人心智状态的能力。研究显示，心智推理障碍为思觉失调症患者的特徵之一，影响患者的社会功能与社区生活的独立甚剧。因此，有效评估患者心智推理能力对治疗计画拟定十分重要。Strange Stories Test是国外研究者常用来评估思觉失调症患者进阶心智推理能力的评估工具，目前台湾已发展中文版又名弦外之音测验，其简易、施测快速、适用台湾文化，且在正常人上具良好再测信度等优点，使其相较其他评估工具更具研究、临床上的使用潜力。然而，目前台湾版的弦外之音测验於思觉失调症患者的心理计量特性尚未被验证。
 
    研究目的：本研究欲验证弦外之音测验於思觉失调症患者的信度与效度，以了解此测验用於思觉失调症患者心智推理评估的适用性。

研究方法：本研究募集共34位台大医院日间病房的慢性思觉失调症患者参与研究，受试者共接受研究者2次施测，2次时间间隔为3周。每次的施测项目包括弦外之音测验与社会认知筛检问卷 (SCSQ)。此外於前测时，也会以蒙特利尔认知测验 (MoCA) 评估受试者的认知功能，且由医师以CGI-S评估其症状严重度。受试者於第一次弦外之音测验的回答在经其同意後，由研究者录音以供施测者间信度的验证。再测前，受试者先经CGI-S评分确认其症状稳定无变化才进行再测。研究者於收案期间由病历蒐集受试者的人口学资料，并向日间病房精神科医师收集受试者最近一次评估的个人与社会功能量表 (PSP) 与活性与负症状量表 (PANSS) 分数。本研究以弦外之音测验的前後测结果进行资料分析，分析指标包括再测信度、随机评估误差、最小可侦测变化值、练习效应、内部一致性、施测者间信度、天花板与地板效应；再分别以PSP、SCSQ作外在效标，验证弦外之音测验之生态效度与收敛效度。本研究另比较患者与过去研究中正常人族群的弦外之音测验分数差异，以检验测验的区辨效度。

研究结果：结果显示测验具有可接受的施测者间信度、内部一致性、收敛效度。另外，测验的再测一致性及生态效度不佳、随机评估误差与最小可侦测变化值较大，且具低至中度练习效应及明显的天花板效应；区辨效度的结果显示测验对患者与正常人的区辨效度不好。

研究结论：弦外之音测验的验证结果显示此测验使用在慢性思觉失调症患者上的心理计量特性不佳，使得测验的实用价值受限。未来，可能须改良此测验或发展更具信效度之心智推理测验以适用於思觉失调症患者。

并列摘要〈TOP〉

Background 
   The term theory of mind (ToM) refers to the ability to infer one’s own and other people’s mental states. A great deal of evidence shows that impaired ToM is a trait of schizophrenia which attributes to poor social function of patients. To address this problem, it is important for clinicians and researchers to use a good ToM test for  schizophrenia patients to assess their abilities in ToM. Among several ToM tests, the Taiwanese version of the Strange Stories Test is one with many advantages because it is brief, easy to administer, and reliable in a normal group. However, the psychometric properties of this test in schizophrenia patients remain unknown.

Objective 
The purpose of this study is to validate the reliability and validity of the Taiwanese version of the Strange Stories Test in patients with schizophrenia.

Methods
     Two measures including the Taiwanese version of the Strange Stories Test and the Social Cognition Screening Questionnaire (SCSQ) were tested twice on 34 schizophrenia patients from National Taiwan University Hospital by the researcher, with a 3-week interval between assessments. The Montreal Cognitive Assessment (MoCA) was also administered on the participants in the initial evaluation to assess the cognitive function of the participants. After giving their consent, the participants’ verbal responses of the Strange Stories Test in the initial evaluation were recorded to examine inter-rater reliability. The researcher used scores of the Clinical Global Impression scale (CGI) to confirm that the clinical states of the participants remained stable before retest. In addition, participants’ scores of Personal and Social Performance Scale (PSP) and Positive and Negative Syndrome Scale (PANSS) were collected from two psychiatrists, and the demographic information of participants was collected from medical charts. The test-retest reliability, random measurement error, minimal detectable change (MDC), practice effect, internal consistency, inter-rater reliability and ceiling and floor effect were examined by analyzing the test and retest scores of the Strange Stories Test. The ecological and convergent validity were examined by analyzing the correlation between the scores of the Strange Stories Test and PSP and the scores of the Strange Stories Test and SCSQ respectively. The discriminative validity was analyzed by comparing the difference between the scores of the patients and the scores of the normal group in a previous study.

Results  
     This measure had generally acceptable inter-rater agreement, internal consistency and convergent validity. The test-retest agreement was poor with non- negligible random measurement error and the MDC% of this measure exceeded the acceptable standard. This measure also showed a notable ceiling effect and small to moderate practice effects. Finally, the ecological validity and the discriminative validity were unsatisfactory.

Conclusions
     Our results revealed that the Taiwanese version of the Strange Stories Test had insufficient reliability and validity. Therefore, we might consider a further revision of this test. It is also a useful way to develop a new ToM measure with both clinical usefulness and scientific soundness.

参考文献 ( 118 ) 〈TOP〉

Ahmed, F. S., & Miller, L. S. (2013). Relationship between theory of mind and functional independence is mediated by executive function. Psychology and Aging, 28(2), 293-303. doi:10.1037/a0031365
连结：
Ahmed, F. S., & Stephen Miller, L. (2011). Executive function mechanisms of theory of mind. Journal of Autism and Developmental Disorders, 41(5), 667-678. doi:10.1007/s10803-010-1087-7
连结：
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
连结：
Arnall, F. A., Koumantakis, G. A., Oldham, J. A., & Cooper, R. G. (2002). Between-days reliability of electromyographic measures of paraspinal muscle fatigue at 40, 50 and 60% levels of maximal voluntary contractile force. Clinical Rehabilitation, 16(7), 761-771.
连结：
Atkinson, G., & Nevill, A. M. (1998). Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Sports Medicine, 26(4), 217-238.
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