Deppen P, Sarrasin Bruchez P, Dukes R, Pellanda V, Vianin P
Département de psychiatrie-CHUV (DP-CHUV), section « E. Minkowski », consultation de Chauderon, 9, avenue d'Echallens, 1004 Lausanne, Suisse.
Encephale. 2011 Sep;37(4):314-21. doi: 10.1016/j.encep.2011.02.002. Epub 2011 Apr 9.
Nowadays, cognitive remediation is widely accepted as an effective treatment for patients with schizophrenia. In French-speaking countries, techniques used in cognitive remediation for patients with schizophrenia have been applied from those used for patients with cerebral injury. As cognitive impairment is a core feature of schizophrenia, the Département de psychiatrie du CHUV in Lausanne (DP-CHUV) intended to develop a cognitive remediation program for patients with a schizophrenia spectrum disease (Recos-Vianin, 2007). Numerous studies show that the specific cognitive deficits greatly differ from one patient to another. Consequently, Recos aims at providing individualized cognitive remediation therapy. In this feasibility trial, we measured the benefits of this individualized therapy for patients with schizophrenia. Before treatment, the patients were evaluated with a large battery of cognitive tests in order to determine which of the five specific training modules - Verbal memory, visuospatial memory and attention, working memory, selective attention, reasoning - could provide the best benefit depending on their deficit.
The study was designed to evaluate the benefits of the Recos program by comparing cognitive functioning before and after treatment.
Twenty-eight patients with schizophrenia spectrum disorders (schizophrenia [n=18], schizoaffective disorder [n=5], schizotypal disorder [n=4], schizophreniform disorder [n=1], DSM-IV-TR) participated in between one and three of the cognitive modules. The choice of the training module was based on the results of the cognitive tests obtained during the first evaluation. The patients participated in 20 training sessions per module (one session per week). At the end of the training period, the cognitive functioning of each patient was reevaluated by using the same neuropsychological battery.
The results showed a greater improvement in the cognitive functions, which were specifically trained, compared to the cognitive functions, which were not trained. However, an improvement was also observed in both types of cognitive functions, suggesting an indirect cognitive gain.
In our view, the great heterogeneity of the observed cognitive deficits in schizophrenia necessitates a detailed neuropsychological investigation as well as an individualized cognitive remediation therapy. These preliminary results need to be confirmed with a more extended sample of patients.
如今，认知康复被广泛认为是治疗精神分裂症患者的有效方法。在法语国家，用于精神分裂症患者认知康复的技术是从用于脑损伤患者的技术借鉴而来的。由于认知障碍是精神分裂症的核心特征，洛桑大学中心医院精神病科（DP-CHUV）打算为精神分裂症谱系疾病患者制定一个认知康复项目（Recos-Vianin，2007）。大量研究表明，不同患者的特定认知缺陷差异很大。因此，Recos旨在提供个性化的认知康复治疗。在这项可行性试验中，我们评估了这种个性化治疗对精神分裂症患者的益处。治疗前，对患者进行了大量认知测试，以确定五个特定训练模块（言语记忆、视觉空间记忆与注意力、工作记忆、选择性注意力、推理）中的哪一个根据其缺陷能提供最大益处。
本研究旨在通过比较治疗前后的认知功能来评估Recos项目的益处。
28名精神分裂症谱系障碍患者（精神分裂症[n = 18]、分裂情感性障碍[n = 5]、分裂型障碍[n = 4]、精神分裂症样障碍[n = 1]，DSM-IV-TR）参加了一至三个认知模块的训练。训练模块的选择基于首次评估时获得的认知测试结果。患者每个模块参加20次训练课程（每周一次）。在训练期结束时，使用相同的神经心理测试组合对每位患者的认知功能进行重新评估。
结果显示，与未训练的认知功能相比，接受特定训练的认知功能有更大改善。然而，两种类型的认知功能均有改善，表明存在间接认知获益。
我们认为，精神分裂症中观察到的认知缺陷的巨大异质性需要进行详细的神经心理学调查以及个性化的认知康复治疗。这些初步结果需要在更大规模的患者样本中得到证实。
