Mueller Daniel R, Schmidt Stefanie J, Roder Volker
University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland;
University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Schizophr Bull. 2015 May;41(3):604-16. doi: 10.1093/schbul/sbu223. Epub 2015 Feb 22.
Cognitive remediation (CR) approaches have demonstrated to be effective in improving cognitive functions in schizophrenia. However, there is a lack of integrated CR approaches that target multiple neuro- and social-cognitive domains with a special focus on the generalization of therapy effects to functional outcome.
This 8-site randomized controlled trial evaluated the efficacy of a novel CR group therapy approach called integrated neurocognitive therapy (INT). INT includes well-defined exercises to improve all neuro- and social-cognitive domains as defined by the Measurement And Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative by compensation and restitution. One hundred and fifty-six outpatients with a diagnosis of schizophrenia or schizoaffective disorder according to DSM-IV-TR or ICD-10 were randomly assigned to receive 15 weeks of INT or treatment as usual (TAU). INT patients received 30 bi-weekly therapy sessions. Each session lasted 90min. Mixed models were applied to assess changes in neurocognition, social cognition, symptoms, and functional outcome at post-treatment and at 9-month follow-up.
In comparison to TAU, INT patients showed significant improvements in several neuro- and social-cognitive domains, negative symptoms, and functional outcome after therapy and at 9-month follow-up. Number-needed-to-treat analyses indicate that only 5 INT patients are necessary to produce durable and meaningful improvements in functional outcome.
Integrated interventions on neurocognition and social cognition have the potential to improve not only cognitive performance but also functional outcome. These findings are important as treatment guidelines for schizophrenia have criticized CR for its poor generalization effects.
认知矫正（CR）方法已被证明在改善精神分裂症患者的认知功能方面有效。然而，目前缺乏一种综合的CR方法，该方法能够针对多个神经认知和社会认知领域，特别关注治疗效果向功能结局的泛化。
这项8中心随机对照试验评估了一种名为综合神经认知疗法（INT）的新型CR团体治疗方法的疗效。INT包括明确的练习，以通过补偿和恢复来改善精神分裂症认知改善测量与治疗研究（MATRICS）计划所定义的所有神经认知和社会认知领域。156名根据《精神疾病诊断与统计手册》第四版修订版（DSM-IV-TR）或《国际疾病分类》第十版（ICD-10）诊断为精神分裂症或分裂情感性障碍的门诊患者被随机分配接受15周的INT治疗或常规治疗（TAU）。INT组患者接受30次每两周一次的治疗。每次治疗持续90分钟。采用混合模型评估治疗后及9个月随访时神经认知、社会认知、症状和功能结局的变化。
与TAU相比，INT组患者在治疗后及9个月随访时，在多个神经认知和社会认知领域、阴性症状及功能结局方面均有显著改善。需治疗人数分析表明，仅需5名INT组患者就能在功能结局方面产生持久且有意义的改善。
对神经认知和社会认知的综合干预不仅有可能改善认知表现，还能改善功能结局。这些发现很重要，因为精神分裂症治疗指南曾批评CR的泛化效果不佳。
