published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Social Work / Master / Master of Social Work

腦癎症患者在心理和認知能力方面都承受著沉重的壓力。近年，腦癎症與心理狀態的互動關係得到廣泛重視。研究指出，心理治療能夠提升腦癎症患者的心理狀態及生活質素；部份結果更顯示能減少腦癎的發病次數。 / 本研究目的在於了解香港腦癇症患者當中，藥物難治性患者及藥物有效性患者的心理狀態與認知能力。另外，研究以隨機單盲對照的方式，探討靜觀治療小組及社交支援小組對藥物難治性患者在心理健康、生活質素、認知能力及腦癇病發模式的影響。最後，研究為腦外科手術對腦癎症患者心理狀態與認知能力的影響作探索性的研究。 / 研究共邀請186 名腦癇症患者參與。結果發現，在藥物難治性患者當中 (84 例)，39.3%和 29.8%有中度至嚴重的抑鬱症狀和焦慮症狀；相對地，在藥物有效性患者當中 (102 例)，只有15.7%和6.9%有相同程度的抑鬱和焦慮症狀。此外，認知功能損失在患者中十分普遍，尤以語言記憶、視覺專注力、聽覺專注力及工作記憶最為顯著。在藥物難治性患者當中，靜觀治療小組和社交支援小組均有效提升生活質素及減少發病次數(60 例)。比較而言，靜觀治療小組(30 例)比社交支援小組(30 例)更有效減低抑鬱及焦慮症狀，減少發病次數和提升延遲記憶功能。在14 個接受腦外科手術的組群中，於非語言優勢半球進行手術的患者和術後痊癒的患者於整體生活質素方面均有顯著提升。 / 整體結果顯示，在腦癎症患者當中，藥物難治性患者在心理健康、生活質素及認知能力方面，都明顯比藥物有效性患者承受著更大的壓力。另外，短期的心理小組治療有效提升藥物難治性患者的心理健康、生活質素、認知功能以及減低發作次數及減輕發作嚴重性。最後，腦外科手術的探索性研究結果，對術前進行輔導及對術後的預測有輔助的作用。 / 隨著對腦癎症治療的不斷發展，醫療配套方案中需要更具科學實證的心理治療作為輔助療法，以令患者達至身心健康。我們建議加強這範疇的研究工作。另外，研究亦應進一步探討心理治療為患者帶來進步的可持續性，使心理治療能更有效地在臨床上應用。 / Patients with epilepsy (PWEs) experience extensive psychological and cognitive disturbances. Increasing emphasis has been placed on the bidirectional interaction between seizure and psychological states, couples with accumulating evidences suggesting the potential effects of psycho-behavioural therapy on improving well-being and seizure control in PWEs. / This study has three levels of objectives. First, it aims to establish the neurocognitive and psychological profiles of PWEs with different drug-responsiveness in Hong Kong Chinese adults. Second, the effect of a mindfulness-based therapy (MBT) in people with drug-resistant epilepsy is examined against an attention-placebo control, social support (SS) groupusing a prospective assessor-blinded randomized controlled trial. Third, the neuropsychological effects of neurosurgery are explored. / A total of 186 PWEs were recruited. In the 84 patients with drug-resistant epilepsy, 39.3% and 29.8% reported moderate to severe level of anxiety and depression, respectively; versus 15.7% and 6.9% in patients with drug-responsive epilepsy (n = 102). Neurocognitive deficits were prevalent, particularlyin verbal recall memory, visual attention, auditory attention and working memory. The effects of the psycho-behavioural therapy were demonstrated. Specifically, patients received MBT (n = 30) showedsignificantly more improvement at post-intervention compared to the SS group (n=30) in terms of psychological well-being, seizure control and delayed memory function. For patients who underwent neurosurgery (n=14), those who received operation on their non-language dominant hemisphere and those who enjoyed post-operative seizure freedom reported significantly higher quality of life compared to their counterparts whose received operation on their language-dominant hemisphere and those whose seizure persisted. / Our findings established the neuropsychological and cognitive profiles of PWEs and revealed particular vulnerabilities in patients who were resistant to pharmacological treatment. We demonstrated the effects of short-term psycho-behavioural intervention in terms of improving psychological well-being, seizure control and neurocognitive function. Finally, our exploratory study on patients who underwent neurosurgery enhanced our understanding towards post-operative psycho-behavioural conditions on different types of patients, which was clinically important for pre-operative decision making. / Further research in local population focusing on neuro-psycho-behavioural aspects of epilepsy is crucial. The sustainability of the positive effects associated with the psycho-behavioural intervention should be carefully addressed in later study. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Tang, Yu Hing. / Thesis (Ph.D.) Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 131-158). / Abstracts also in Chinese; appendixes includes Chinese. / Tang, Yu Hing.