研究生: |
陸怡芬 Lu, I-Fen |
---|---|
論文名稱: |
思覺失調症青年重返校園之學校適應歷程 The School Adjustment Process of Adolescents with Schizophrenia |
指導教授: | 張千惠 |
學位類別: |
碩士 Master |
系所名稱: |
特殊教育學系 Department of Special Education |
論文出版年: | 2020 |
畢業學年度: | 109 |
語文別: | 中文 |
論文頁數: | 179 |
中文關鍵詞: | 青年 、重返校園 、思覺失調症 、復元 、學校適應 |
英文關鍵詞: | adolescent, recovery, return to school, schizophrenia, school adjustment |
DOI URL: | http://doi.org/10.6345/NTNU202000936 |
論文種類: | 學術論文 |
相關次數: | 點閱:434 下載:41 |
分享至: |
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報 |
本研究採敘事探究,旨在了解思覺失調症青年罹患疾病後的學校適應情形。邀請四位在中學時期罹患思覺失調症的青年擔任研究參與者,以半結構訪談大綱蒐集其生命經驗,針對研究發現提出以下結論。
首先,青年罹患思覺失調症後,因自身及家人缺乏精神醫療概念,治療配合度不佳,生活飽受疾病干擾。同時,學校適應出現許多困難,難以參與課堂活動及遵從規範,無法勝任學習任務,人際關係以負向經驗為主。當其住院治療後,配合藥物治療,情緒症狀改善,精神症狀獲得良好控制,讓其能夠重新開始學習,學習動機及能力皆有所提升。出院重返校園後,持續接受治療,緩解的精神症狀,能因應學校環境與要求,但學業學習是主要壓力,如採取問題解決或自我調適的方式,得以勝任學習任務,而其常規適應普遍良好,人際關係以正向經驗為主。
再者,從思覺失調症青年重返校園情形發現,良好疾病控制及正向心理特質是學校適應的關鍵,如採用問題解決或自我調適的因應方式,能促進其學校適應狀況。另外,社會支持是學校適應的助力,家庭支持則是重要基石,家人支持治療的態度,有助其疾病獲得控制。而重返校園前的日間病房醫療教育復健模式,能為其重返校園預作準備,有利出院後的學校適應。
最後,從思覺失調症青年重返校園經驗發現,滿意的學校適應經驗,有助其改善內在心理狀態,重新獲得希望感,教育在復健過程扮演重要角色,有助各項社會功能提升。思覺失調症青年在治療後症狀能獲得控制,但治療並非治癒,其會發展出疾病因應方式,學習與疾病共處。
基於研究結果,本研究針對思覺失調症青年、思覺失調症青年的家人、學校系統及醫療系統等給予不同建議,期盼思覺失調症青年的需求及復元發展能獲得更多關注。此外,根據本研究限制,亦對未來研究提出相關建議。
This research adopted narrative study of qualitative research. The aim of this research analyzed the school adjustment of the adolescents with schi-zophrenia. Four adolescents who suffered from schizophrenia in high school were invited to be research participants. This research collected their life ex-periences with a semi-structured interview. After analyzing the data, the re-sults were as follow:
Firstly, the adolescents with schizophrenia received the psychiatric treatment poorly, due to the lack of mental medical concepts. Their life was greatly disturbed by the disease, and they adjusted school hardly. They could’t participate in class and followed the school rules. They were unable to perform learning tasks and had negative experiences with their teachers and classmates. When they received day hospitals care, they received medication steadily. Their emotional symptoms were improved and their mental symptoms were well controlled. They could learn again, and their motivation and abilities of learning were improved. When they returned to school, they still received psychiatric treatment to relieve the mental symptoms. They can deal with the school environments and requirements, but the academic learn-ing was their main pressure. If they choose problem-solving or self-adjustment methods, they will be able to perform learning tasks. They can follow the school rules, and have positive experience with teachers and classmates.
Furthermore, according to their experiences of returning to school, this research is found that good disease control and positive psychological traits are the main factors of their school adjustment. If they choose prob-lem-solving or self-adjustment methods, they will promote their school ad-justment. Moreover, social support can critically aid to their school adjust-ment, especially their family support. If their family supports psychiatric treatment, they will get better disease control. Before they return to school, the rehabilitation in the day hospitals helps them to prepare skills to go back to school. It can aid them to adjust school after discharge.
Finally, according to the experiences of the adolescents with schizoph-renia, it is found that their good school adjustment can help themselves im-prove their psychological situations and find hope again. Education plays an important role in their rehabilitation process and can help improve their func-tions. After psychiatric treatment, the disease is controlled but not healed. The adolescents with schizophrenia develop their own way to deal with the disease and learn to coexist with the disease.
According to the results of this research, the researcher makes different sugges-tions to the adolescents with schizophrenia, their families, schools, and med-ical systems. The researcher hopes that the needs and recovery of the adoles-cents with schizophrenia will receive more attention. Besides, the researcher makes some suggestions for future research based on the limitations of this research.
王文伶、丁政本、鄧若瑩(2016):輕度障礙、資優以及一般國中學生因應普通班學習活動的適應現況與其影響因素。特殊教育學報,44,1-36。
王瓊珠(2017):學習障礙大學生學校生活適應研究。特殊教育學報,45,1-24。
丘彥南、宋維村(2011):兒童精神疾病的治療。載於李明濱主編:實用精神醫學(第三版)(361-371頁)。臺北市:洪葉。
江漢光(1996):罹患精神疾病青少年之個案輔導。教師天地,80,38-47。
石樹慧(2001):療養院嚴重情緒障礙班學員的生活經驗(未出版之碩士論文)。國立臺灣師範大學,臺北市。
台灣精神醫學會(2014):Schizophrenia中文譯名由「精神分裂症」更名為「思覺失調症」的歷史軌跡。取自http://www.sop.org.tw/news/l_info.asp?/13.html
李姿瑩、陳佩玉、羅湘敏、黃裕惠、吳怡慧、楊梅芝、蔡明富(譯)(2013):兒童與青少年情緒及行為障礙(原作者J. M. Kauffman & T. J. Landrum)。臺北市,華騰。(原著出版年:2013)
李雅敏、林宏熾(2008):成年就業精神分裂症患者康復經驗之研究。復健諮商,2,49-75。
宋維村(1996):青少年精神醫學。臺北市:天馬。
李靜怡、劉明松(2011):高雄市國中學習障礙學生自我概念與學校適應。東臺灣特殊教育學報,100(13),99-126。
李鳳美(2007):探討青少年精神病患主要照顧者生活壓力、社會支持對照顧負荷之影響(未出版之碩士論文)。國立台北護理學院,臺北市。
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。
宋麗玉(2018):精神障礙者邁向復元之路:優勢管點之運用。載於宋麗玉(主編),優勢觀點與社會工作實務─邁向復元之路(第一版)(51-77頁)。臺北市:洪葉。
林坤燦、羅清水、邱瀞宜(2008):台灣地區大專校院身心障礙學生休退學現況調查研究。東台灣特殊教育學報,10,1-19。
林家興(2010):心理疾病的認識與治療。臺北市:心理。
余婉菁(2018):思覺失調症青少年面對疾病經驗之敘事研究(未出版之碩士論文)。國立暨南國際大學,南投縣。
林鍾淑敏(2002):走在荊棘路上-精神分裂症青少年疾患的疾病經驗與適應歷程(未出版之碩士論文)。國立台灣大學,臺北市。
胡海國(2002):精神分裂症之社區流行病學。當代醫學,29(9),26-36。
洪培馨(2018):思覺失調症青少年之生活適應─以一個復元觀點(未出版之碩士論文)。國立政治大學,臺北市。
衛生福利部(2016):2025衛生政策白皮書。取自https://oliviawu.gitbooks.io/2025-whbook/content/di_yi_jie_kai_chuang_xin_li_jian_kang_ji_yuan.html。
衛生福利部統計處(2019):精神疾病患者門、住診人數統計。取自https://dep.mohw.gov.tw/DOS/cp-1720-7337-113.html。
徐淑婷(2015):精神障礙者之特性與復元議題。載於宋麗玉(主編),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。
徐翊健、高廉程、張杰、葉大全、黃郁絜、黃鈺蘋、…劉佑閿(譯)(2018):DSM-5精神疾病診斷與統計(原作者American Psychiatric Association)。新北市:合記。(原著出版年:2013)
唐榮昌、李淑惠(2008):析論精神分裂症之介入方式。雲嘉特教,7,8-13。
許天威、蕭金土、吳訓生、林和姻、陳亭予(2002):大專校院身障礙學生學校適應狀況之研究。特殊教育學報,16,159-198。
國立臺灣大學醫學院附設醫院精神醫學部(2015):認識思覺失調症。臺北市:衛生福利部。
陳志平、周台傑、孟瑛如(2011):國民中小學情緒行為障礙學生多元介入調查研究。特殊教育學報,34,3-34。
梁宜安(2004):由生態系統探討精神分裂症之嚴重情緒障礙學生學習的需求(未出版之碩士論文)。國立台北師範學院,臺北市。
張芬芬(2010):質性資料分析的五步驟:在抽象階梯上爬升。初等教育學刊,35,87-120。
陳俊欽(2003):幫他走過精神障礙。臺北市:張老師文化。
張春興(1994):教育心理學:三化取向的理論與實踐。臺北市:東華。
張春興(2006):張氏心理學辭典。臺北市:東華。
郭峰志(譯)(2001):現代社區精神醫療:整合式心理衛生服務體系(原作者William T. Breakey)臺北市:心理。(原著出版年:1996)
國家發展委員會:人口推估查詢系統【詳細資料查詢】。取自https://pop-proj.ndc.gov.tw/dataSearch6.aspx?uid=3109&pid=59
張聖莉、王文科、張昇鵬(2008):台東縣高中職接受融合教育身心障礙學生學校適應之研究。台東特教,28,1-6。
鈕文英(2014):質性研究方法與論文寫作修訂版。臺北市:雙葉。
曾文星、徐靜(1998):現代精神醫學。臺北市:水牛。
黃正昌(2001):青少年精神病患出院後學校適應問題。師友月刊,404,33-35。
黃宗正、劉智民、劉震鐘、謝明憲、簡意玲、胡海國(2011):精神分裂症的臨床與精神病理。台灣醫學,15(4),365-374。
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。
詹文宏、周台傑(2006):高中職學習障礙學生和一般學生學校適應模式之研究。特殊教育學報,24,113-134。
楊延光(1999):杜鵑窩的春天:精神疾病照顧手冊。臺北市:張老師文化。
楊國明、張聖莉(2003):兒童期精神分裂病─花蓮地區8個案例分析。慈濟醫學雜誌,15(4),275-280。
溫惠君(2001):融合教育指標及其特殊教育績效之探討─以智障學生為例(未出版之碩士論文)。國立臺灣師範大學,臺北市。
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相關探討(未出版之碩士論文)。國立臺灣大學,臺北市。
蔡明富(2011):特殊教育中有無伴隨品行疾患之注意力缺陷過動症學生的學校與家庭適應研究。應用心理研究,49,31-63。
鄭津妃、張正芬(2014):融合教育的績效:SNELS 資料庫國中障礙學生的學校適應與滿意。特殊教育研究學刊,39(3),81-109。
盧台華、林燕玲(2006):社會適應表現檢核表之信效度及其相關因素之研究。特殊教育研究學刊,30,1-25。
劉景宜(2013):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。
謝碧玲、張雅惠、李培壅、顏正芳、張明永、黃俊仁(2009):妄想型精神分裂症病患之認知治療教育團體:學習成效之評估。高雄行為科學學刊,1,40-48。
劉燕萍(2004):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)。私立輔仁大學,新北市。
蘇建文、林美珍、程小危、林惠雅、幸曼玲、陳李綢、吳敏而、柯華葳、陳淑美(1991):發展心理學。臺北市:心理。
Andresen, A., Oades, L., & Caputi, P. (2003). The experience of recovery from schizoph-renia: towards an empirically validated stage model. Australian and New Zealand Journal of Psychiatry, 37, 586-594.
Anthony, W. A. (2004). The recovery effect. Psychiatry Rehabilitation Journal, 27, 303-304.
Anthony, W. A., Cohen, M. R., Farkas, M. D., & Bachrach, L. L. (2002). Psychiatric Re-habilitation. Boston, MA: Boston University Press.
Abraham, A., Silber, T. J., & Lyon, M. (1999). Psychosocial aspects of chronic illness in adolescence. Indian Journal of Pediatrics, 66(3), 447-453.
Beels, C. C. (1981). Social support and schizophrenia. Schizophrenia Bulletin, 7(1), 58-72.
Bronfenbrenner, U. (1988). Interacting systems in human development. Research para-digms: Present and future. In N. Bolger, A. Caspi, G. Downey, & M. Moorhouse (Eds.), Persons in context: Developmental processes (pp. 25-49). Cambridge, English: Cambridge University Press.
Buchanan, J. (1995). Social support and schizophrenia: a review of the literature. Archives of Psychiatric Nursing, 9(20), 68-76.
Chiba, R., Miyamoto, Y., & Kawakami, N. (2010). Reliability and validity of the Japanese version of the recovery assessment scale (RAS) for people with chronic mental illness: Scale development. International Journal of Nursing Studies, 47(3), 314-322.
Clarke, S. P., Oades, L. G., Crowe, T. P., Caputi, P., & Deane, F. P. (2009). The role of symptom distress and goal attainment in promoting aspects of psychological recovery for consumers with enduring mental illness. Journal of Mental Health, 18(5), 389-397.
Clinton, M., Lunney, P., Edwards, H., Weir, D., & Barr, J. (1998). Perceived social sup-port and community adaptation in schizophrenia. Journal of Advanced Nursing, 27, 955-965.
Cohen, C. I., & Sokolvsky, J. (1978). Schizophrenia and social networks: ex patients in the inner city. Schizophrenia Bulletin, 4(3), 546-560.
Cresswell, C., Kuipers, L., & Power, M. (1992). Social network and support in long-term psychiatric patient. Psychological Medicine, 22(4), 1019-1026.
Davidson, M., Reichenberg, A., Rebinowitz, J., Weiser, M., Kaplan, Z., & Mark M. (1999). Behavioral and intellectual markers for schizophrenia in apparently healthy male adolescents. American Journal of Psychiatry, 156(9), 1328-1335.
Davidson, L., & Roe, D. (2007). Recovery from versus recovery in serious mental llness: One strategy for lessening confusion plaguing recovery. Journal of Mental Health,August, 16(4), 459-470.
Deegan, P. E. (1988). Recovery: The lived experience of rehabilitation. Psychosocial Re-habilitation Journal, 11(4), 11-19.
Eggers, C., Bunk, D., & Krause, D. (2000). Schizophrenia with Onset before the Age of Eleven: Clinical Characteristics of Onset and Course. Journal of Autism and Deve-lopmental Disorders, 30(1), 29-38.
Faccincani, C., Mignolli, G., & Platt, S. (1990). Service utilization, social support and psychiatric status in a cohort of patients with schizophrenic psychoses: A 7 year fol-low-up study. Schizophrenia Research, 3(2), 139-146.
Florenzano, R. U. (1991). Chronic Mental Illness in Adolescence: A Global Overview. Pediatrician, 18, 142-149.
Granö, N., Karjalainen, M., Edlund, V., Saari, E., Itkonen, A., Anto, J., & Roine, M.(2012). Adolescents at risk of psychosis have higher level of hopelessness than adolescents not at risk of psychosis. Nordic Journal of Psychiatry, 67, 258-264.
Hopper, K. (2007). Rethinking social recovery in schizophrenia: What a capabilities ap-proach might offer. Social Science & Medicine, 65(5), 868–879.
Jacobson, N. & Greenley, D. (2001). What is recovery? A conceptual model and explica-tion. Psychiatric Service. 52(4), 482-485.
Jessor, R. (1993). Successful adolescent development among youth in high-risk settings. American Psychological Association, 48(2), 117-126.
Kaiser, S. L., Snyder, J., Corcoran, R., & Drake, R. J. (2006). The relationships among insight, social support, and depression in psychosis. Journal of Nervous & Mental Disease, 194, 905-908.
Kelly, M. & Gamble, C. (2005). Exploring the concept of recovery in schizophrenia. Journal of Psychiatric and Mental Health Nursing, 12, 245-251.
Lally, S. (1989). Does being in here mean there is something wrong with me? Schizophre-nia Bulletin, 15(2), 253-266.
Lay, B., Blanz, B., Hartmann, M., & Schmidt, M. H. (2000). The Psychosocial Outcome of Adolescent Onset Schizophrenia: A 12-Year Follow-up. Schizophrenia Bulletin, 26(4), 801-816.
Lecomte, Y., & Mercier, C. (2005). The stress process perspective and adaptation of people with schizophrenia. Social Psychiatry and Psychiatric Epidemiology , 40(2), 139-148.
Leamy, M., Bird, V., Boutillier, C. L., Williams, J., & Slade, M. (2011). Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. The British Journal of Psychiatry, 199(6), 445-452.
Lee, P. W., Lieh-Mak, F., Yu, K. K., & Spinks, J. A. (1993). Coping strategies of schi-zophrenia patients and their relationship to outcome. British Journal Psychiatry, 163, 177-182.
Leff, J., Satorius, N., Jablensky, A., Korten, A., & Ernberg, G. (1992). The International Pilot Study of Schizophrenia: five-year follow-up findings. Psychological Medicine, 22, 131-145.
Liberman, R., Kopelowicz, A., Ventura, J., & Gutkind, D. (2002).Operational criteria and factors related to recovery from schizophrenia. International Review of Psychiatry, 4, 256-272.
Lim, M. W., Remington, G., & Lee, J. (2017). Personal recovery in serious mental illness: Making sense of the concept. Annals of the Academy of Medicine, Singapore, 46(1), 29-31.
Lower, R., Wilson, J., Medin, E., Corlett, E., Turner, R., Wheeler, K., & Fowler, D. (2015). Evaluating an early intervention in psychosis service for ‘high‐risk’ adolescents: symptomatic and social recovery outcomes. Early Intervention in Psychiatry, 9(3), 260-267.
Marwaha, S. & Johnson, S. (2004). Schizophrenia and employment. Social Psychiatry and Psychiatric Epidemiology, 39, 337-349.
Mountain, D. & Shah, P. J. (2008). Recovery and the medical model. Advances in Psy-chiatric Treatment, 14, 241-244.
Norman, M. G., Malla, A. K., Manchanda, R., Harricharan, R., Takhar, J., & Northcott, S. (2005). Social support and three-year symptom and admission outcomes for first ep-isode psychosis. Schizophrenia Research, 80, 227- 234
O' Carroll, R. (2000). Cognitive impairment in schizophrenia. Advances in Psychiatric Treatment, 6(3), 161-168.
Provencher, H. L., Gregg, R., Mead, S., & Muesser, K. T. (2002). The role of work in the recovery of persons with psychiatric disabilities. Psychiatric Rehabilitation Journal, 26(2), 132-144.
Rauf, U. & Ali, U. (2017). Association between Social Support and Self-esteem in People with Schizophrenia. Pakistan Journal of Psychology, 48(1), 23-37.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock's synopsis of Psychiatry: Behavioral sciences clinical psychiatry. Philadelphia, PA: Wolters Kluwer Press.
Sanders, K. S. & DuBois, D. L. (1996). Individual and Socio-Environmental Predictors of Adjustment to College Among Students with Disabilities. Journal of Postsecondary Education and Disability, 12(2), 28-43.
Schiff, A. C. (2004). Recovery and mental illness: Analysis and personal reflections. Psy-chiatric Rehabilitation Journal, 27(3), 212-218.
Scivoletto, S., Boarati, M. A., & Turkiewicz, C. (2011). Psychiatric emergencies in child-hood and adolescence. Revista Brasileira de Psiquiatria, 32(2), 112-120.
Slade, M. (2002). What outcomes to measure in routine mental health services, and how to assess them: A systematic review. Australian and New Zealand Journal of Psychiatry, 36(6), 743-753.
Song, L.Y. & Shin, C. Y. (2009). Factors, process and outcomes of recovery from psychia-tric disability: The unity model. International Journal of Social Psychiatry, 55(4), 348-360.
Spaniol, L., Wewiorski, N., Gagne, C., & Anthony, W. (2002). The process of recovery from schizophrenia. International Review of Psychiatry, 14(4), 327-336.
Taylor, E. H. (1998). Advance in the diagnosis and treatment of children with serious mental illness. Child Welfare, 77(3), 311-332.
Thompson, E. H. & Doll, W. (1982). The burden of families coping with the mentally ill: an invisible crisis. Family Relations, 31, 371-388.
Torrey, W. C., Mueser, K. T., McHugo, G. H., & Drake, R. E. (2000). Self-esteem as an outcome measure in studies of vocational rehabilitation for adults with severe mental illness. Psychiatric Service, 51(2), 229-233.
Watt, N. F., Grubb, T. W. & Kimling, L. E. (1982). Social emotional, and intellectual be-havior at school among children at high risk for schizophrenia. Journal of Consulting and Clinical Psychology, 50(2), 171-181.
Wells, K., Wyatt, E., & Hobfoll, S. (1991). Factors associated with adaptation of youths discharged from residential treatment. Child and Youth Services Review, 13, 199-216.
Wilder-Willis, K. E., Shear, P. K., Steffen, J. J., & Borkin, J. (2002). The relationship be-tween cognitive dysfunction and coping abilities in schizophrenia. Schizophrenia Research, 55, 259-267.
Woodside, H., Schell, L., & Allison-Hedges, J. (2006). Listening for recovery: The voca-tional success of people living with mental illness. Canadian Journal of Occupation-al Therapy, 73(1), 36-43.
Young, S. L. & Ensing, D. S. (1999). Exploring recovery from the perspective of people with psychiatric disabilities. Psychiatric rehabilitation journal, 22(3), 219.