精神疾病與智能障礙：流行病學與醫療照護需求分析

Psychiatric Disorders and Intellectual Disability: Epidemiological and Healthcare Need Analysis

10.30072/JDR.200404.0003

蔡艷清(Im-Cheng Choi)；嚴嘉楓(Chia-Feng Yen)；林金定(Jin-Ding Lin)

智能障礙者 ； 精神疾病 ； 醫療照護需求 ； intellectual disability ； psychiatric disorders ； psychiatric health needs

身心障礙研究季刊

2卷2期（2004 / 04 / 01）

95 - 108

繁體中文

智能障礙者合併精神疾病的問題漸漸受到西方國家高度的重視，精神醫學也針對此一議題尋求深入研究與探討。國內智能障礙者的精神衛生問題正屬於萌芽階段，相關的研究較為缺乏，本篇論文以文獻回顧的方式探討智能障礙者精神疾病的盛行情形和影響因素，並分析智能障礙者精神疾病的醫療照護需求。文獻回顧結果顯示，智障者普遍遭受精神疾病和行為異常的困擾，且種類繁多複雜，兒童、青少年和成年智障者罹患的精神疾病種類不同。目前一般成年人精神疾病的診斷標準普遍運用於智能障礙者，然而目前精神疾病相關評估工具琳瑯滿目，智能障礙者精神疾病盛行率的測量因診斷標準不一致以及缺乏具代表性的樣本，致使各國對盛行率測量的結果不一；而在影響智能障礙者罹患精神疾病之影響因素的各種研究調查中，也顯示因診斷標準的差異致使各研究在結果上也有些差異存在。本研究亦發現隨著西方國家對智能障礙者的照護策略趨向於社區化後，智能障礙者精神疾病需求有降低的傾向，尤其反映在住院利用率上，一般的精神服務被認為無法反映出智能障礙者精神衛生照護的需求，而專業的智能障礙精神衛生服務為目前少數先進國家另一個醫療照護發展的方向。

Western countries have paid more attention to identify and respond to the issue of mental health and intellectual disability in recent decades. In Taiwan, very little has been done to this issue. This present paper aims to review the epidemiological characteristics and examines the healthcare needs toward intellectual disability and psychiatric disorders based on literature reviews. The reviews found that most studies have stated that people with intellectual disability are more often afflicted by psychiatric disorders than the general population. The studies of psychiatric disorders among this group reported huge variations in prevalence rates and associated risk factors, an important reason for the differences is the methodologist dissimilarity, particularly in assessment tools and the sampling methods used. As deinstitutionalization has been carried out in many western countries, healthcare needs of people with dual diagnosis decreased, particularly in inpatient care. Consequently, the development of specialist psychiatric care has been a new service strategy for this group in some advanced counties.

1. 蔡艷清、嚴嘉楓、林金定(2003)。啟智專業工作者之實務工作經驗分析。身心障礙研究，1，43-52。
   連結：
2. American Psychiatric Association(2000).Diagnostic and statistical manual of manual disorders.Washington D.C.:American Psychiatric Association.
3. Bouras N.,Cowley A.,Holt G.,Newton J.T.,Sturney P.(2003).Referral trends of people with intellectual disabilities and psychiatric disorders.Journal of Intellectual Disability Research,47,439-446.
4. Carvill S.,Marston G.(2002).People with intellectual disability, senory impairments behaviour disorder: a case series.Journal of Intellectual Disability Research,46,264-272.
5. Chaplin R.(2004).General psychiatric services for adults with intellectual disability and mental illness.Journal of Intellectual Disability Research,48,1-10.
6. Cooper S.A.(2003).The Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD) papers.Journal of Intellectual Disability Research,47,1-2.
7. Deb S. Thomas M.,Bright C.(2001).Mental disorder in adults with intellectual disability. 1: Prevalence of functional psychiatric illness among a community-based population aged between 16-64 years.Journal of Intellectual Disability Research,45,495-505.
8. Deb S.,Thomas M.,Bright C.(2001).Mental disorder in adults with intellectual disability. 2: The rate of behaviour disorders among a community-based population aged between 16-64 years.Journal of Intellectual Disability Research,45,506-514.
9. Duggan L.M.,Morris M.,Adams C.E.(1997).Prevalence study of the randomized controlled trials in the Journal of Intellectual Disability Research: 1957-1994.Journal of Intellectual Disability Research,41,232-237.
10. Einfeld S.L.,Toage B.J.(1996).Population prevalence of psychopathology in children and adolescents with intellectual disability: II epidemiological findings.Journal of Intellectual Disability Research,40,99-109.
11. Emerson E.(2003).Prevalence of psychiatric disorders in children and adolescents with and without intellectual disability.Journal of Intellectual Disability Research,47,51-58.
12. Guatafsson C.(1997).The prevalence of people with intellectual disability admitted to general hospital psychiatric units: level of handicap, psychiatric diagnosis and care utilization.Journal of Intellectual Disability Research,41,519-526.
13. Halt G.,Costello H.,Bouras N.,Diareme S.,Hillery J.,Moss S.,Rodriguez-Biazquez.,Salvador L.,Weber G.,Dimitrakaki C.(2000).BIOMED-MEROPE project: service for adults with intellectual disability: a European comparison.Journal of Intellectual Disability Research,44,685-696.
14. Holland A.J.(1999).Psychiatric and mental retardation.International Review of Psychiatry,11,76-82.
15. Hurley A.D.,Folstein M.,Lam N.(2003).Patients with and without intellectual disability seeking outpatient psychiatric services: diagnosis and prescribing pattern.Journal of Intellectual Disability Research,47,39-50.
16. Janicki M.P.,Davidson P.W.,Henderson C.M.,McCallion P.,Taets J.D.,Force L.T.,Sulkes S.B.,Frangenberg E.,Landrigan P.M.(2002).Health characteristics and health services utilization in older adults with intellectual disability living in community residences.Journal of Intellectual Disability Research,46,287-298.
17. Kerr A.M.,MeCulloch D.,Oliver K.,McLean B.,Coleman E.,Law T.,Beaton P.,Wallace S.,Newell E.,Ecetes T,Prescott R.J.(2003).Medical needs of people with intellectual disability require regular reassessment, and the provision of client- and care-held reports.Journal of Intellectual Disability Research,47,134-145.
18. Kishore M. T.,Nizamie A.,Nizamie S.H.,Jahan M.(2004).Psychiatric diagnosis in persons with intellectual disability in India.Journal of Intellectual Disability Research,48,19-24.
19. Lin J.D.,Lee P.N.,Yen C.F.,Wu J.L.(2003).The health status profile of persons with institutions in Taiwan.Journal of Medical Sciences,23,285-290.
20. Mansell J.,Ashman B.,Macdonald S.,Beadle-Brown J.(2002).Residential care in the community for adults with intellectual disability: needs, characteristics and services.Journal of Intellectual Disability Research,46,625-633.
21. Masi G.(1998).Psychiatric illness in mentally retarded adolescents: clinical features.Adolescence,33,425-434.
22. McGrother C.W.,Bhaumik S.,Thorp C.F.,Watson J.M.,Taub N.A.(2002).Prevalence, morbidity and service need among South Asian and white adults with intellectual disability in Leicestershire, UK.Journal of Intellectual Disability Research,46,299-309.
23. McGrother C.W.,Hauck A.,Bhaumik S.,Throp C.,Taub N.(1996).Community care for adults with learning disability and their carers: needs and outcomes from the Leicestershire register.Journal of Intellectual Disability Research,40,183-190.
24. Nøttestad J. A.,Linaker O.M.(1999).Psychiatric health needs and services before and after complete deinstitutionalization of people with intellectual disability.Journal of Intellectual Disability Research,43,523-530.
25. Reber M.,Batshaw M. L.,Perret Y. M.(1992).Children with disabilities-a medical primer.Paul H. Brookes Publishing Co., Inc.
26. Taylor J. L.,Hatton C.,Dixon L.,Douglas C.(2004).Screening for psychiatric symptoms: PAS-ADD Checklist norms for adults with intellectual disability.Journal of Intellectual Disability Research,48,37-41.
27. Van Schrojenstein Lantman-de Valk H.M.J.,Van den Akker M.,Maaskant M.A.,Haveman M.J.,Urlings H.FJ.,Kessels A.G.H.,Crebolder H.F.J.M.(1997).Prevalence and incidence of health problems in people with Intellectual Disability.Journal of Intellectual Disability Research,41,42-51.
28. World Health Organization,International Classification of Disease(translator)(1997).Translator ICD10 to ICD9.World Health Organization.
29. Xenitidis K.,Gratsa A.,Bouras N.,Hammond R.,Ditchfied H.,Holt G.,Martin J.,Brooks D.(2004).Psychiatric inpatient care for adults with intellectual disabilities: generic or specialist units?.Journal of Intellectual Disability Research,48,11-18.
30. 中華民國七十九年十二月七日華總（一）義字第七○○七號公布
31. 胡雅各、林千惠、徐享良(2002)。啟智教養機構內重度障礙院生問題行為及其相關因素之調查研究。台灣人文生態研究，4，119-152。
32. 莊美娥(2003)。對教養機構中住宿智障兒童精神疾患之探討。兒童福利期刊，5，145-156。
33. 中華精神科雜誌
34. 正道心理諮詢網

1. 蔣馨怡(Hsin-Yi Chiang);蔡景宏(Ching-Hong Tsai);陳彥錚(Yen-Cheng Chen);許兆瑋(Chao-Wei Hsu);劉欽蓮(Chin-Lien Liu);陳正宗(Cheng-Chung Chen)(2021)。台灣兒童青少年心智障礙者社區精神醫療服務現況與需求。台灣醫學。25(3)。307-315。 
2. 洪聖雯(2016)。智能障礙學生肥胖相關因素之探討。中山醫學大學護理學系學位論文。2016。1-62。
3. 曾盈薰(2017)。社區化精神照顧服務之下多重科別就醫現象之研究。長榮大學社會工作學系（所）學位論文。2017。1-93。