Department of Psychology, Institute of Psychiatry, King's College London, London, UK.
Schizophr Res. 2009 Dec;115(2-3):146-55. doi: 10.1016/j.schres.2009.08.007. Epub 2009 Sep 5.
Responsiveness to cognitive behaviour therapy (CBT) in psychosis may have a neurological basis. This study aimed to determine whether improvement in symptoms following CBT for psychosis (CBTp) in people with schizophrenia is positively associated with pre-therapy grey matter volume in brain regions involved in cognitive processing.
Sixty outpatients stable on medication with at least one distressing symptom of schizophrenia and willing to receive CBTp in addition to their standard care (SC), and 25 healthy participants underwent magnetic resonance imaging. Subsequently, 30 patients received CBTp (CBTp+SC; 25 completers) for 6-8 months and 30 continued with their standard care (SC; 19 completers). Symptoms in all patients were assessed (blindly) at entry and follow-up.
The CBTp+SC and SC groups did not differ clinically at baseline, and only the CBTp+SC group showed improved symptoms at follow-up. Severity of baseline symptoms was not associated with CBTp responsiveness. Reduction with CBTp in positive symptoms was associated with greater right cerebellum (lobule VII) grey matter volume, in negative symptoms with left precentral gyrus and right inferior parietal lobule grey matter volumes, and in general psychopathology with greater right superior temporal gyrus, cuneus and cerebellum (Crus I) grey matter volumes. Grey matter volume in these brain areas did not correlate with the severity of baseline symptoms.
Grey matter volume of the frontal, temporal, parietal and cerebellar areas that are known to be involved in the co-ordination of mental activity, cognitive flexibility, and verbal learning and memory predict responsiveness to CBTp in patients with psychosis.
精神分裂症患者对认知行为疗法（CBT）的反应可能有其神经学基础。本研究旨在确定精神分裂症患者接受认知行为治疗（CBTp）后症状改善是否与认知加工相关脑区的治疗前灰质体积呈正相关。
60 名接受药物治疗且至少有一种痛苦症状的精神分裂症门诊患者愿意在标准护理（SC）之外接受 CBTp，25 名健康参与者接受了磁共振成像检查。随后，30 名患者接受了 6-8 个月的 CBTp（CBTp+SC；25 名完成者），30 名患者继续接受标准护理（SC；19 名完成者）。所有患者在入组和随访时均进行了症状评估（盲法）。
CBTp+SC 和 SC 组在基线时无临床差异，仅 CBTp+SC 组在随访时症状改善。基线症状严重程度与 CBTp 反应无关。CBTp 对阳性症状的减轻与右侧小脑（VII 叶）灰质体积增加有关，对阴性症状的减轻与左侧中央前回和右侧下顶叶灰质体积减少有关，对一般精神病学症状的减轻与右侧颞上回、楔前叶和小脑（Crus I）灰质体积增加有关。这些脑区的灰质体积与基线症状的严重程度无关。
已知与精神活动协调、认知灵活性以及言语学习和记忆有关的额、颞、顶和小脑区域的灰质体积，可预测精神病患者对 CBTp 的反应。
