松德精神科診所 林耿立醫師的心情文章

為了讓忙碌上班族能方便就診
林耿立醫生特別於大安區宏恩醫院開設午間失眠門診

時段：每週二11:00~13:00
地址：宏恩醫院(北市仁愛路四段 61 號)
醫院位於捷運忠孝復興/忠孝敦化間

備註：宏恩醫院交通參考
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松德精神科診所/黃惠琪醫師
失智症自我檢測表
1. 我記不起來最近發生的事件… □很少□有時□經常
2. 我有困難找到正確的字眼來表達…□很少□有時□經常
3. 我有困難記得今天的日期以及是星期幾…
□很少□有時□經常
4. 我會忘記東西通常放在哪裡… □很少□有時□經常
5. 我很難去適應日常例行活動的變動…
□很少□有時□經常
6. 我很難了解雜誌、報紙上的文章，或是
跟上書本、電視上的故事… □很少□有時□經常
7. 和人說話時，我有困難跟上或是參與對
話，在團體中更明顯… □很少□有時□經常
8. 我無法處理財務，像銀行的事或是算錢找零…
□很少□有時□經常
9. 我對於其他日常事務感到困難，像是記得親友
上回來訪時間或是烹煮我以前拿手的菜…
□很少□有時□經常
10.我一向喜歡的活動，現在我失去興趣…
□很少□有時□經常
11.我有困難思考解決問題…
□很少□有時□經常
12.家人或是朋友曾說我記憶不好…
□很少□有時□經常

少3：含咖啡因飲料與巧克力

‧作用機制

有些爸比媽咪心想孩子的大腦活動力低，就給予咖啡因飲料來刺激大腦活動，提提神吧！錯！ 咖啡因與巧克力裡面所含的可可鹼、茶鹼均屬於甲基黃嘌呤類，能使中樞神經系統興奮，因此增加警醒度、降低疲勞與短時間提高注意力；但倘若長期攝取與過度使用，容易成癮與中毒，產生不良反應，如：神經過度敏感、易怒、焦慮、失眠與心悸、躁動、腹瀉、消化性潰瘍…等。

喝了含有咖啡因的飲品之後，孩子的情緒的確變得比較穩定且精神較容易集中，但時效短且長期下來容易成癮，而過度興奮也間接造成失眠與影響作息的問題。而一般的提神能量飲料含高量的咖啡因，長期飲用也容易造成依賴，甚至咖啡因中毒，而且神經過度敏感、警醒程度過高，反而難以處理眼前的資訊。

‧危險食物

早餐給孩子喝一杯奶茶就是爸比媽咪犯的最大錯誤！除了高糖，易使得血糖波動之外，茶類也含有咖啡因成分，容易讓孩子有過動的症狀出現！綠茶、烏龍茶、紅茶、花草茶，以及咖啡與巧克力都含有咖啡因。

‧建議攝取量

咖啡因與巧克力的建議攝取量是0，但在實際生活之中，卻很難完全避免接觸，不過，至少爸比媽咪瞭解這些危險食物，在挑選孩子的食物時，可以盡量減少提供。而茶類的咖啡因含量較低，但炎熱的夏日，早餐一杯奶茶、下午再一杯手搖飲品，咖啡因含量早就超標了！

如果孩子一天沒有飲用含有咖啡因的飲料，就出現白天嗜睡、沒精神的現象，那表示必需要減低孩子攝取的咖啡因了！或是有時候爸比媽咪發現已經12點了，孩子還不想睡，可能就是那一天喝了太多含咖啡因的飲品。

飲食限制 改善過動症狀

根據最新荷蘭2011年的研究指出，64％的過動孩子，在飲食限制方案介入之後，症狀有明顯改善，但是未受控制，則又再次復發。而飲食限制方案指的是只吃米飯、白肉、蔬菜和西洋梨、水的限制飲食；其他東西都不能吃，份量由營養師安排；一段時間之後，就恢復平時飲食，發現又恢復過動症狀。因此，林茂勳治療師指出，養成吃對東西的飲食習慣，就會自然吃對東西；只讓孩子吃適合的食物，就可以改善過動症狀。

Influence of interpersonal problems on the relationship between attachment styles and social skills in Borderline Personality disorder

Jin-Jia Pan1(潘金嘉), Geng-Li Lin2 M.D. (林耿立醫師)
Institute of Psychology, Heidelberg University, Germany1
Song De Psychiatry Clinic, Taipei2

Background:
The literature on the relationship between attachment style and patients with borderline personality disorder (BPD) has been the subject of controversy and few attempts have so far been made at exploring the role of interpersonal problems between the causality of attachment styles and social skills in patients with BPD. The objective of this research was to examine whether interpersonal problems mediated links between attachment styles and social skills in BPD. Furthermore, this research also was to explore if the bias of interpersonal problems in BPD could predict inadequate social skills.

Methods:
29 BPD outpatients (19female, 10male) and 65 control subjects completed Relationship Questionnaire, Structured Clinical Interview for DSM-IV Axis II Disorders, Symptom Checklist-90-Revised, Social Skills Inventory, and Inventory of Interpersonal Problems Circumplex Scales. Moreover, a total of 94 significant others (29 from outpatients, and 65 from healthy subjects) were also recruited in this study to assess subject’s interpersonal problems. Independent samples t-test was conducted to compare all variables in two groups and examine the difference between self-report and other-report interpersonal problems. Hierarchical multiple regression analysis was performed to test (a) the relationship between the difference of interpersonal problems and social skills, and (b) the mediation effect of interpersonal problems between attachment styles and social skills in BPD.

Results:
Three important findings were found in this study. Finding 1: The majority of control people had secure attachment styles, while many borderline patients ’attachment styles were insecure. Patients’ scores on social sensibility (SS) were significantly higher than controls and scores on emotional awareness and emotional expression (EAEE) were lower than controls. In terms of interpersonal problems, borderline people described themselves more domineering, vindictive, cold, exploitable, intrusive and nonassertive than normal people. Compared to other-report interpersonal problems in controls, significant others appraised borderline people more vindictive and more socially avoidant. Finding 2: The result of the relationship between the difference of interpersonal problems and social skills indicated that domineering, vindictive, and nonassertive as predictors could significantly negatively predict social awareness and social expression (SASE) respectively; moreover, exploitable as predictor significantly positively predicted SS. Finding3: (1)Preoccupied attachment style had significant predicting power over social sensibility in BPD. (2) Intrusive had full mediation effect between preoccupied attachment style and social sensibility in BPD.

Conclusions:
The results suggest evidence for potential interpersonal mechanism of development of BPD, which was meaningful for understanding the psychopathology of BPD and helpful for application of psychological intervention. Furthermore, several limitations have to be considered in interpreting results, for example, small sample size, borderline outpatients without considering the comorbidity of other personality disorders, the limit of cross sectional study, etc.

Key words: Borderline personality disorder, attachment styles, interpersonal problems, social skills

賀! !林耿立醫生獲聘【內政部警政署警察電訊所】心理輔導諮詢委員