Department of Psychiatry, Columbia University College of Physicians and Surgeons, 180 Fort Washington Avenue HP234, NY 10021, USA.
Psychiatry Res. 2012 Oct 30;199(3):164-8. doi: 10.1016/j.psychres.2012.04.042. Epub 2012 May 29.
People with schizophrenia have neuro-cognitive deficits that are associated with poor functional outcome, yet their awareness of their cognitive deficiencies is variable. As new treatments for cognition are developed, it will be important that patients are receptive to the need for more therapy. Since insight into symptoms has been associated with treatment compliance, it may be of value to provide psycho-education to improve understanding about cognition in schizophrenia. We report a randomized controlled trial that enrolled 80 subjects in either a brief psycho-education intervention about cognition, or a control condition. Subjects in the two conditions did not differ at baseline in insight or receptiveness to treatment, or on demographic, cognitive, or psychiatric variables. Current cognitive impairment of subjects was evidenced by the indice of working memory, attention and executive functioning abilities, (X=77.45 intervention group; 82.50 control condition), that was significantly below both the normative mean and estimated average premorbid IQs (X=101.3 intervention group; X=104.57 control condition). Multivariate repeated measures ANOVAs indicated that subjects who received the psycho-education did not improve insight into their cognitive deficits or willingness to engage in treatment for cognitive dysfunction. While the failure to find a significant impact of this intervention on awareness of cognitive deficit and receptiveness to cognitive treatment raises questions about the malleability of insight into neuro-cognitive deficits, the intervention was briefer than most reported psycho-education programs and multi-session formats may prove to be more effective.
精神分裂症患者存在神经认知缺陷,这与较差的功能预后相关,但他们对自身认知缺陷的意识存在差异。随着认知治疗新方法的不断发展,患者对更多治疗的接受程度将变得非常重要。由于对症状的认识与治疗依从性相关,因此提供认知方面的心理教育以提高对精神分裂症认知的理解可能具有价值。我们报告了一项随机对照试验,该试验招募了 80 名受试者,分别接受关于认知的简短心理教育干预或对照组。两组受试者在基线时的洞察力或对治疗的接受程度、人口统计学、认知或精神病变量方面没有差异。受试者当前的认知障碍表现为工作记忆、注意力和执行功能能力的指数,(干预组 X=77.45;对照组 X=82.50),明显低于正常平均值和估计的平均发病前智商(干预组 X=101.3;对照组 X=104.57)。多变量重复测量方差分析表明,接受心理教育的受试者并没有提高对自身认知缺陷的洞察力或对认知功能障碍治疗的意愿。虽然该干预措施对认知缺陷意识和对认知治疗的接受程度没有显著影响,但这引发了对神经认知缺陷洞察力可变性的质疑,因为干预措施比大多数报告的心理教育项目更简短,多疗程格式可能更有效。