Department of Psychiatry Trinity College Dublin, the University of Dublin, Dublin, Ireland.
The Central Mental Hospital, National Forensic Mental Health Service Ireland, Dublin, Ireland.
BMC Psychiatry. 2019 Jan 15;19(1):27. doi: 10.1186/s12888-019-2018-6.
Evidence is accumulating that Cognitive Remediation Training (CRT) is effective for ameliorating cognitive deficits experienced by patients with schizophrenia and accompanying functional impairment. There has been no randomized controlled trial of CRT using a nationally representative population of forensic patients, despite the significant cognitive deficits frequently present within this group.
Sixty-five patients with schizophrenia or schizoaffective disorder were enrolled in a single blind randomized controlled trial of CRT versus treatment as usual (TAU); representing 94% of those eligible within a national forensic cohort. The primary outcome measure was the composite score of the MATRICS Consensus Cognitive Battery (MCCB). Secondary outcome measures included neurocognitive and social cognitive domains, symptoms, and 'real world' functioning. Patient satisfaction was examined using an exit interview. Participants were reassessed at 8 months follow up. All data were analyzed using an intention to treat design (ITT).
For the primary outcome measure, the MCCB composite score, there were significant differences between those who participated in CRT and those receiving TAU at both end of treatment and 8 months follow up (Cohen's d = 0.34. Significant improvements were observed in visual and working memory. Mediation analysis found that those who cognitively benefited from CRT had corresponding improved functioning, and more net positive therapeutic moves i.e. moves to units with lower security within the hospital. Ninety-six percent believed their cognitive gains positively affected their daily lives.
CRT may be an acceptable and efficacious intervention for forensic patients with schizophrenia or schizoaffective disorder.
ClinicalTrials.gov Identifier: NCT02360813 . Trial registered Feb 4th 2015, last updated May 1st 2015.
越来越多的证据表明，认知矫正训练（CRT）对于改善精神分裂症患者的认知缺陷和伴随的功能障碍是有效的。尽管这一群体经常存在明显的认知缺陷，但尚未对使用全国代表性的法医患者进行 CRT 的随机对照试验进行评估。
65 名精神分裂症或分裂情感障碍患者参加了 CRT 与常规治疗（TAU）的单盲随机对照试验；这代表了全国法医队列中符合条件的 94%的患者。主要结局指标是 MATRICS 共识认知电池（MCCB）的综合评分。次要结局指标包括神经认知和社会认知领域、症状和“现实世界”功能。通过退出访谈来检查患者满意度。参与者在 8 个月的随访时进行重新评估。所有数据均采用意向治疗设计（ITT）进行分析。
对于主要结局指标，MCCB 综合评分，在治疗结束时和 8 个月随访时，接受 CRT 和接受 TAU 的患者之间存在显著差异（Cohen's d = 0.34）。在视觉和工作记忆方面观察到显著改善。中介分析发现，从 CRT 中受益的认知患者的功能相应改善，并且有更多的净积极治疗动作，即向医院内安全级别较低的单位转移。96%的人认为他们的认知收益对日常生活产生了积极影响。
CRT 可能是一种可接受且有效的治疗精神分裂症或分裂情感障碍法医患者的方法。
ClinicalTrials.gov 标识符：NCT02360813。试验于 2015 年 2 月 4 日注册，2015 年 5 月 1 日最后更新。
