對於精神分裂症患者注意力歷程缺失現象的探討，過去大多集中在 對注意力歷程本身機制的探究；但在結果上一直找不到令人滿意的解釋． 然而在心理學的研究中發現， 個體在進入注意力歷程對刺激做進一步處 理之前，有一個前注意力歷程會先對視野中所現刺激做整體性的處理；之 後才能使個體經由選擇將注意力集中在所欲處理的訊息上，此即注意力歷 程二階段論． 本研究即以注意力歷程二階段論為起點，利用兩個以擬 似叫色作業進行的實驗去區辨精神分裂症患者在注意力表現的異常，究竟 導因於那一階段的運作失常．本研究的兩個實驗均是以伴隨分心項同時呈 現的 Stroop 色字為實驗刺激，藉由操弄目標項（ 即Stroop色字）刺激 類型及分心項與目標項間關係，觀察精神分裂症患者與正常在前注意力歷 程運作上有何差異，並期能據此瞭解精神分裂症患者注意力歷程缺失的可 能原因． 綜合兩實驗所得結果，精神分裂症患者在前注意力歷程的運 作上與正常人並無差別；但在進入注意力歷程對刺激做進一步處理時，抑 制機制的運作失常（運作不足或運作過度）為其注意力失常的可能原因之 一，但仍無法對本研究的結果作一完整的說明．此外，由研究結果中，也 可推測精神分裂症患者在對目標項進行細部分析時，其持續性的注意力也 有異於正常人；這部份仍有待進一步的研究． / There is a wealth of literature associating schizophrenia withdisorders of attention. This study bases on the two-stage approach of visual selective attention. The pre- attentiveparallel processcomputes how different each object is from each of the other objectswithin a particular stimulus dimension. Attention automatically drawto the location having the highest activation, implying that the subjects select location automatically and are irrespective of their intention. Two Stroop tasks used to differentiate schizophrenics and nornalic'sattentional processes, and try to figure out which stageis the caution of schizophrenic's dysfunctional attention. As the result, schizophrenic is not different with normalics on pre-attentiveprocess, but do have something problem onattentional process when theywhen they have to inhibit some information. It'sstill not a conclution,because the deficit of inhibition can not explain the results perfectly.

本文透過健保資料精神疾病歸人檔，擷取1997～2004年門診中之精神分裂症患者，針對其中701位精神科專科醫師對患者的精神分裂症一、二代藥物之處方行為進行研究。迴歸結果顯示醫師性別對處方選擇沒有特別的影響，同儕效果在相當程度上對醫師產生蠻大的改變。藥價調整前，教學醫院的醫師會受到周遭醫師開藥行為影響，其受影響程度大於非教學醫院。藥價調整後，教學醫院醫師幾乎不受同儕影響，相對的，非教學醫院比起藥價變動前，更易受到同僚行為而改變其行為。不過大體而言當周遭醫師容易開新藥（舊藥）時，醫師本身也會較容易開第二代（第一代）藥物。

本研究旨在探討「健康、性格、習慣量表(HPH)」的臨床效度。HPH最初是由柯永河教授(民84)編製，後來廣泛使用在國內臨床場域中。發展至今已有中上程度的信效度支持，但過去較缺乏臨床上區辨與構念效度的研究，因此本研究旨在探討HPH區辨不同疾患的能力，以及以臨床疾患為受試時量尺之構念效度。 本研究回顧國內外類似測驗─MMPI、KMHQ、MCMI─的發展軌跡，並參照前人作法來進行HPH的臨床區辨效度研究。初步以臨床場域中常見的精神分裂症、重鬱症、低落型情感疾患、焦慮疾患，共257名患者為受試。先以共變數分析(ANCOVA)探討控制人口與臨床變項後，不同疾患組別在HPH的A、B、D類量尺的影響。再進一步使用羅吉斯迴歸(logistic regression)探討哪些量尺及其組合可以區辨兩兩疾患間的差異。最後，本研究也進行HPH的探索性因素分析(exploratory factor analysis)，以檢驗其臨床上的因素結構。 本研究發現，精神分裂症(A1)、躁症傾向(A2)、憂鬱自殺類(A3、B4、A4)、心理功能與健康(D1、D3、D4、D5、D6)量尺在共變數分析上的差異情形與假設大致相符，後續討論分析也支持強迫症(B5)量尺效度。羅吉斯迴歸中，A1、A3、B4、B5能在兩兩疾患間區辨有顯著預測力。其中A1能在精神分裂症與其他三組疾患的兩兩區辨中預測，A3能在重鬱症與另外兩組(精神分裂症、焦慮症)的兩兩區辨中預測，B4能在低落型情感與精神分裂症的兩兩區辨中預測，B5能在強迫症與其他疾患間的兩兩區辨中預測。但是在重鬱症與低落型情感疾患間，以及低落型情感與焦慮疾患間，沒有量尺能在兩者的區辨中有顯著預測力。而各兩兩疾患間整體區辨效果有中至高度的關聯性，分類正確率也多有七成以上，顯示HPH量表在臨床上的區辨效度獲得支持。 構念效度部分，A、D類量尺因素結構與當初編製的每個量尺構念相近，B類量尺構念雖與原量尺略有不同，但仍不違背原量尺編製架構，因此構念效度亦獲得支持。不過各量尺仍有值得編修之處，討論一節中針對結果提出HPH後續編修之建議。 最後，本研究也將此結果之臨床實務應用於討論一節中詳述，以供後續研究與實務者參考。 / The purpose of this study is to examine the clinical validity of the Health, Personality, and Habit Test (HPH). The HPH was developed by Dr. Yung-Ho Ko in 1995, and has been widely used in clinical settings. The HPH has demonstrated appropriate reliability and validity, but little research has been done on its differential and construct validity in the clinical settings. Therefore, the aim of this study is to explore the HPH’s ability to differentiate between disorders and its construct validity in clinical context. This research reviewed the developments of similar tests, such as MMPI, KMHQ, and MCMI, and examined validity of the HPH with the same methods. Subjects were 257 patients who suffered from common disorders in clinical settings, including schizophrenia, major depression, dysthymia, and anxiety disorders. ANCOVA was first used to explore whether different disorders have an effect on category A, B, and D scales after controlling demographic and clinical variables. Next, logistic regression was used to clarify which scales and combinations can differentiate between two of four disorders. Finally, exploratory factor analysis was conducted to examine the structure of HPH in clinical setting. The results of ANCOVA showed that the differences of schizophrenia scale (A1), manic scale (A2), depression/suicide scales (A3, B4, & A4), obsessive-compulsive disorder (OCD) scale (B5), and psychological function and health scales (D1, D3, D4, D5, D6) were partly consistent with assumptions, supporting the differential validity of HPH. The results of logistic regression analysis also supported the validity of A1, A3, B4, and B5 scales. More specifically, A1 was able to differentiate schizophrenia from any other three disorders, A3 was able to differentiate MDD from schizophrenia and anxiety disorders, B4 was able to differentiate dysthymia from schizophrenia, and B5 was able to differentiate OCD from other disorders. However, none of the scales was able to differentiate MDD from dysthymia, nor were they able to differentiate dysthymia from anxiety disorders. Moreover, each of the logistic regression functions showed moderate to high correlations, and most of them achieved high overall hit rates (above 70%), providing support for the clinical differential validity of the HPH. As for construct validity, these factors in category A and D scales were essentially similar to original scales. Similarly, factors in category B scales were compatible to original scales though difference was found. In sum, these results lent support to the construct validity of the HPH in the clinical settings. However, refining of the scales is needed and suggestions are discussed. Finally, the practical uses of the findings were also discussed.