Mental Illness Research, Education and Clinical Center, VISN 5, VA Medical Center, Suite 6A (BT/MIRECC), 10 North Greene St., Baltimore, MD 21201, USA.
Am J Psychiatry. 2010 Feb;167(2):170-80. doi: 10.1176/appi.ajp.2009.09020264. Epub 2009 Dec 15.
There is considerable interest in cognitive remediation for schizophrenia, but its essential components are still unclear. The goal of the current study was to develop a broadly targeted computer-assisted cognitive remediation program and conduct a rigorous clinical trial in a large group of schizophrenia patients.
Sixty-nine people with schizophrenia or schizoaffective disorder were randomly assigned to 36 sessions of computer-assisted cognitive remediation or an active control condition. Remediation broadly targeted cognitive and everyday performance by providing supportive, graduated training and practice in selecting, executing, and monitoring cognitive operations. It used engaging computer-based cognitive exercises and one-on-one training. A total of 61 individuals (34 in remediation group, 27 in control group) engaged in treatment, completed posttreatment assessments, and were included in intent-to-treat analyses. Primary outcomes were remediation exercise metrics, neuropsychological composites (episodic memory, working memory, attention, executive functioning, and processing speed), and proxy measures of community functioning.
Regression modeling indicated that performance on eight of 10 exercise metrics improved significantly more in the remediation condition than in the control condition. The mean effect size, favoring the remediation condition, was 0.53 across all 10 metrics. However, there were no significant benefits of cognitive remediation on any neuropsychological or functional outcome measure, either immediately after treatment or at the 3-month follow-up.
Cognitive remediation for people with schizophrenia was effective in improving performance on computer exercises, but the benefits of training did not generalize to broader neuropsychological or functional outcome measures. The evidence for this treatment approach remains mixed.
认知矫正对精神分裂症有很大的兴趣，但它的基本组成部分仍不清楚。本研究的目的是开发一种广泛针对的计算机辅助认知矫正程序，并在大量精神分裂症患者中进行严格的临床试验。
69 名精神分裂症或分裂情感障碍患者被随机分配到 36 次计算机辅助认知矫正或主动对照组。矫正通过提供支持性、渐进性的训练和实践来广泛针对认知和日常表现，选择、执行和监测认知操作。它使用了吸引人的基于计算机的认知练习和一对一的培训。共有 61 人（矫正组 34 人，对照组 27 人）参与了治疗，完成了治疗后评估，并纳入了意向治疗分析。主要结果是矫正练习指标、神经心理学综合指标（情景记忆、工作记忆、注意力、执行功能和处理速度）以及社区功能的代理指标。
回归模型表明，在矫正条件下，10 项练习指标中的 8 项的表现明显优于对照组。在所有 10 项指标中，有利于矫正条件的平均效应大小为 0.53。然而，无论是在治疗后还是在 3 个月的随访中，认知矫正对任何神经心理学或功能结果测量都没有显著益处。
对精神分裂症患者进行认知矫正可以有效地提高计算机练习的表现，但训练的益处并没有推广到更广泛的神经心理学或功能结果测量上。这种治疗方法的证据仍然存在分歧。
