Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States.
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States.
Schizophr Res. 2019 Jan;203:24-31. doi: 10.1016/j.schres.2017.10.005. Epub 2017 Nov 9.
Meta-analyses have reported that the effects of cognitive remediation might go beyond improvement in cognition to include unexpected benefits for schizophrenia patients such as negative symptom reduction and improvements in functioning. In addition, some evidence indicated that these potentially beneficial effects are also present in the initial course of schizophrenia, but work in this area is still developing.
A RCT compared Cognitive Remediation (CR) to Healthy Behaviors Training (HBT) in 80 patients (78% male) with a mean age of 21.9years and mean education of 12.3years who had a first psychotic episode within two years of study entry. Participants were trained using CR programs or received HBT involving 50 sessions over 6months and then booster sessions over the next 6months. The SANS and BPRS were used to assess symptoms. The UCLA Social Attainment Survey assessed social functioning.
Using GLMM, improvements over 12months were found favoring CR for SANS Expressive Symptoms (p<0.01), which was composed of Affective Flattening (p<0.01) and Alogia (p=0.04), and for SANS Experiential Symptoms, composed of Avolition/Apathy (p=0.04) and Anhedonia/Asociality (p<0.01). CR was associated with improvements in social functioning (p=0.05) as compared to HBT.
We confirmed that the beneficial effects of CR appear to extend beyond cognition to improvements in negative symptoms and social functioning in early course schizophrenia patients. These results suggest that cognitive remediation might have an impact when the reduction of risk factors for chronicity is most critical for promoting recovery.
荟萃分析报告称，认知矫正的效果可能不仅限于改善认知，还包括对精神分裂症患者的意外益处，如减轻阴性症状和改善功能。此外，一些证据表明，这些潜在的有益效果也存在于精神分裂症的初始阶段，但该领域的工作仍在发展中。
一项 RCT 将认知矫正（CR）与健康行为训练（HBT）在 80 名（78%为男性）平均年龄为 21.9 岁，平均受教育程度为 12.3 岁的首次出现精神病发作的患者中进行了比较。研究开始后两年内，参与者接受了使用 CR 程序的训练或接受了 HBT，涉及 50 次疗程，为期 6 个月，然后在接下来的 6 个月内进行强化疗程。使用 SANS 和 BPRS 评估症状。UCLA 社会成就调查评估社会功能。
使用 GLMM，在 12 个月内发现 CR 对 SANS 表达症状（p<0.01）有改善，其中包括情感平淡（p<0.01）和言语减少（p=0.04），对 SANS 体验症状也有改善，包括意志减退/冷漠（p=0.04）和快感缺失/社交性减退（p<0.01）。与 HBT 相比，CR 与社会功能的改善相关（p=0.05）。
我们证实，CR 的有益效果似乎不仅限于认知，还包括改善早期精神分裂症患者的阴性症状和社会功能。这些结果表明，认知矫正可能会在降低慢性风险因素对促进康复最为关键时产生影响。
