University of Brescia, School of Medicine, Brescia, Italy.
Schizophr Res. 2011 Dec;133(1-3):223-31. doi: 10.1016/j.schres.2011.08.010. Epub 2011 Sep 9.
The efficacy of cognitive remediation interventions in schizophrenia has been demonstrated in several experimental studies. However, the effectiveness of such treatments in the usual setting of care of schizophrenia and a direct comparison of different modalities of interventions have not been systematically analyzed. The aim of the study was to assess the effectiveness of the cognitive subprograms of Integrated Psychological Therapy (IPT-cog) and of a computer-assisted cognitive remediation (CACR) method on symptomatological, neuropsychological and functional outcome measures in schizophrenia.
Ninety patients with schizophrenia were assigned to IPT-cog, CACR or usual rehabilitative interventions (REHAB) in a naturalistic setting of care. Clinical, neuropsychological, and functional outcome variables were assessed at baseline and after 24 weeks of treatment.
Both the IPT-cog and CACR groups improved more than the comparison group with respect to all outcome variables. The more responsive cognitive domains were speed of processing and working memory. The effectiveness of the 2 remediation methods on the outcome dimensions considered was comparable. However, IPT-cog, but not CACR, was more effective than REHAB on speed of processing, and the CACR group had better outcome than both the REHAB and the IPT-cog groups when the Health of the Nation Outcome Scale was considered. Few correlations between neurocognitive and functional outcome changes were found.
The study demonstrates the effectiveness, although nongeneralized, of IPT-cog and CACR in schizophrenia when applied within a psychiatric and psychosocial treatment regimen representative of the usual setting and modality of care, with no evident superiority of any of the methods, and indicates that the changes in functional outcome during treatment are modestly mediated by improvement in specific cognitive domains.
认知矫正干预在精神分裂症中的疗效已在多项实验研究中得到证实。然而，这些治疗方法在精神分裂症常规治疗环境中的有效性以及不同干预模式的直接比较尚未得到系统分析。本研究旨在评估综合心理治疗（IPT-cog）的认知子程序和计算机辅助认知矫正（CACR）方法对精神分裂症患者症状、神经心理学和功能结局的疗效。
90 名精神分裂症患者在自然治疗环境中被分配到 IPT-cog、CACR 或常规康复干预（REHAB）组。在基线和 24 周治疗后评估临床、神经心理学和功能结局变量。
IPT-cog 和 CACR 组在所有结局变量上的改善均优于对照组。反应更快的认知领域是加工速度和工作记忆。两种矫正方法在考虑的结局维度上的有效性相当。然而，IPT-cog 比 REHAB 更能有效改善加工速度，而 CACR 组在考虑国家健康量表（Health of the Nation Outcome Scale）时的结局优于 REHAB 和 IPT-cog 组。神经认知和功能结局变化之间只有很少的相关性。
该研究表明，IPT-cog 和 CACR 在应用于代表常规治疗环境和模式的精神科和心理社会治疗方案中具有有效性，尽管不是普遍的，但没有任何方法具有明显的优势，并表明治疗过程中功能结局的变化在一定程度上是由特定认知领域的改善介导的。
