Wykes Til, Newton Elizabeth, Landau Sabine, Rice Christopher, Thompson Neil, Frangou Sophia
Institute of Psychiatry, Kings College London, De Crespigny Park, London, SE5 8AF, UK.
Schizophr Res. 2007 Aug;94(1-3):221-30. doi: 10.1016/j.schres.2007.03.030. Epub 2007 May 23.
Schizophrenia with an onset in adolescence is known to be associated with a poorer outcome and cognitive difficulties. These impairments have an impact on quality of life and represent treatment targets. Cognitive remediation therapy (CRT) attempts to improve cognitive deficits by teaching information processing strategies through guided mental exercises. The objective of this study is to evaluate the efficacy of CRT in alleviating cognitive deficits compared to treatment as usual and explore the mediating and moderating effects of cognitive improvement.
Single-blind randomized controlled trial with two groups, one receiving CRT (N21) and the other standard care (N19) assessed at baseline, 3 months (post therapy) and follow-up (3 months post therapy). Participants were recruited from specialist inpatient and community mental health services and were young patients with recent onset schizophrenia (average age of 18) and evidence of cognitive and social behavioural difficulties. The intervention was individual cognitive remediation therapy delivered over a period of 3 months with at least three sessions per week. The main outcome measures were cognition (memory, cognitive flexibility and planning) and secondary outcomes (symptoms, social contacts and self-esteem).
Compared to standard care, CRT produced significant additional improvements in cognitive flexibility as measured by the Wisconsin Card Sort Test (WCST). Therapy moderated the effects of improved planning ability on symptoms such that improvements only had a beneficial effect when they were achieved in the context of CRT. Improvements in cognition in all domains had a direct effect on social functioning and improvements in WCST had a direct effect on overall symptom improvement.
Cognitive remediation therapy can contribute to the improvement in WCST even in adolescents. The changes in cognitive outcomes also contributed to improvements in functioning either directly or solely in the context of CRT. Evidence of the mediator and moderator effects of cognitive changes should lead to more effective therapy development.
已知青春期发病的精神分裂症与较差的预后及认知困难有关。这些损害会影响生活质量，也是治疗的目标。认知康复治疗（CRT）试图通过引导心理练习教授信息处理策略来改善认知缺陷。本研究的目的是评估与常规治疗相比，CRT在减轻认知缺陷方面的疗效，并探讨认知改善的中介和调节作用。
双组单盲随机对照试验，一组接受CRT（N = 21），另一组接受标准护理（N = 19），在基线、3个月（治疗后）和随访（治疗后3个月）进行评估。参与者从专科住院和社区心理健康服务机构招募，为近期发病的精神分裂症年轻患者（平均年龄18岁），有认知和社会行为困难的证据。干预为为期3个月的个体认知康复治疗，每周至少三次治疗。主要结局指标为认知（记忆、认知灵活性和计划能力），次要结局指标为症状、社交接触和自尊。
与标准护理相比，通过威斯康星卡片分类测验（WCST）测量，CRT在认知灵活性方面产生了显著的额外改善。治疗调节了计划能力改善对症状的影响，使得只有在CRT背景下实现的改善才具有有益效果。所有领域的认知改善对社会功能有直接影响，WCST的改善对总体症状改善有直接影响。
即使在青少年中，认知康复治疗也有助于改善WCST。认知结果的变化也直接或仅在CRT背景下有助于功能改善。认知变化的中介和调节作用的证据应能促进更有效的治疗发展。
