Kuokkanen Riitta, Lappalainen Raimo, Repo-Tiihonen Eila, Tiihonen Jari
Niuvanniemi Hospital, Kuopio, Finland; Department of Psychology, University of Jyväskylä, Finland.
Crim Behav Ment Health. 2014 Dec;24(5):345-57. doi: 10.1002/cbm.1905. Epub 2014 Mar 11.
In schizophrenia, the presence of certain cognitive biases has been established. Informed by this, metacognitive training (MCT) has been developed for schizophrenia. There is increasing evidence of its effectiveness with some patients, but its applicability to dangerous patients has not yet been demonstrated.
Our aim was to test the feasibility of a randomised controlled trial (RCT) of MCT for patients in a high-security hospital setting.
Twenty of 33 eligible and selected male in-patients with schizophrenia and a history of violence were randomised pairwise to eight sessions of MCT or treatment as usual. Symptom severity and reasoning, according to the jumping to conclusions paradigm, were measured before, immediately after treatment, and 3 and 6 months later.
Men in both groups completed the trial, and those in the MCT arm, almost all of the group sessions. The MCT arm had a significant advantage in improvement of 'suspiciousness', greatest at 3 months, but then declining. No significant improvement in reasoning ability was achieved.
Metacognitive training showed sufficient promise in this group for a full trial to be worthwhile, and the feasibility of an RCT methodology, even in a secure hospital, was established. The fact that the improvements faded during follow-up suggests that a useful modification to the treatment would be lengthening the protocol, repeating it, or both.
在精神分裂症中，某些认知偏差的存在已得到证实。基于此，已为精神分裂症患者开发了元认知训练（MCT）。越来越多的证据表明其对一些患者有效，但尚未证明其对危险患者的适用性。
我们的目的是测试在高度戒备医院环境中对患者进行MCT随机对照试验（RCT）的可行性。
33名符合条件且被选中的有暴力史的男性精神分裂症住院患者中，20人被成对随机分配接受八次MCT治疗或常规治疗。根据“急于下结论”范式，在治疗前、治疗后即刻以及治疗后3个月和6个月测量症状严重程度和推理能力。
两组男性均完成了试验，MCT组的患者几乎完成了所有小组治疗。MCT组在改善“猜疑”方面具有显著优势，在3个月时最为明显，但随后下降。推理能力未取得显著改善。
元认知训练在该组中显示出足够的前景，值得进行全面试验，并且确立了RCT方法的可行性，即使是在戒备森严的医院。随访期间改善效果逐渐消失这一事实表明，对治疗进行有益的改进可能是延长治疗方案、重复治疗方案或两者兼而有之。
