Briki Malick, Monnin Julie, Haffen Emmanuel, Sechter Daniel, Favrod Jérôme, Netillard Christian, Cheraitia Elisabeth, Marin Karine, Govyadovskaya Svetlana, Tio Grégory, Bonin Bernard, Chauvet-Gelinier Jean-Christophe, Leclerc Stéphanie, Hodé Yann, Vidailhet Pierre, Berna Fabrice, Bertschy Anna Zinetti, Vandel Pierre
Clinical Psychiatry Department, Dijon University Hospital, 21000 Dijon, France; EA 481 "Neurosciences Laboratory", Franche-Comté University, 1 place du Maréchal Leclerc, 25030 Besançon Cedex, France.
Clinical Psychiatry Department, Besançon University Hospital, 25030 Besançon Cedex, France; INSERM Technological Innovation Clinical Investigation Centre (INSERM CIC-IT 808), Besançon University Hospital, 25030 Besançon Cedex, France.
Schizophr Res. 2014 Aug;157(1-3):99-106. doi: 10.1016/j.schres.2014.06.005. Epub 2014 Jun 24.
A psychotherapeutic approach for schizophrenia is now recommended as an adjuvant for psychopharmacology, since antipsychotic medications only have a partial impact especially as regards positive symptoms and insight. In addition, cognitive distortions and the lack of metacognitive skills might increase positive symptoms leading to poor social functioning. This underlines the need for specific approaches which target cognitive processes relevant for insight, and abilities in metacognition. Metacognitive training (MCT) is a structured group intervention, which enhances a patient's reflection on cognitive biases and improves problem-solving. The aim of our study was to assess MCTs' short term impact on insight, symptoms and quality of life. Fifty patients with schizophrenia or schizoaffective disorders and persistent positive symptoms (delusions or hallucinations) were enrolled in the study. After baseline assessment participants were randomised either to supportive therapy or MCT. Both groups used the same design (1h-session twice a week during 8weeks) although the basic knowledge given to participants was different between interventions. Participants were assessed at eight weeks based on the Scale to Assess Unawareness of Mental Disorder, Positive and Negative Syndrome Scale (PANSS), Psychotic Symptom Rating Scales, the Calgary Depression Scale for Schizophrenia and the Quality of Life Scale. Between-group differences were significant in favour of MCT on the PANSS positive scale. Between-group differences in post- and pre-test values showed a trend in favour of MCT for insight on hallucinations. Results of our study indicate that the MCT has an effect on reducing positive symptomatology, and a trend impact on insight and social functioning.
目前推荐一种针对精神分裂症的心理治疗方法作为精神药理学的辅助手段，因为抗精神病药物的作用有限，尤其是在阳性症状和自知力方面。此外，认知扭曲和元认知技能的缺乏可能会加重阳性症状，导致社会功能不佳。这凸显了针对与自知力相关的认知过程和元认知能力采取特定方法的必要性。元认知训练（MCT）是一种结构化的团体干预，可增强患者对认知偏差的反思并提高解决问题的能力。我们研究的目的是评估元认知训练对自知力、症状和生活质量的短期影响。五十名患有精神分裂症或分裂情感性障碍且存在持续性阳性症状（妄想或幻觉）的患者参与了该研究。在基线评估后，参与者被随机分为支持性治疗组或元认知训练组。两组采用相同的设计（每周两次，每次1小时，共8周），尽管不同干预措施给予参与者的基础知识有所不同。在八周时，根据精神障碍自知力评估量表、阳性和阴性症状量表（PANSS）、精神病症状评定量表、卡尔加里精神分裂症抑郁量表和生活质量量表对参与者进行评估。在PANSS阳性量表上，组间差异显著，元认知训练组更具优势。前后测值的组间差异显示出元认知训练组在幻觉自知力方面更具优势的趋势。我们的研究结果表明，元认知训练对减轻阳性症状有效果，对自知力和社会功能有一定的影响趋势。
