From the Department of Psychology, Queen's University, Kingston, Ontario (Best, Milanovic, Bowie); and the Department of Psychiatry, Queen's University, Kingston, Ontario (Iftene).
Am J Psychiatry. 2019 Apr 1;176(4):297-306. doi: 10.1176/appi.ajp.2018.18070849. Epub 2019 Mar 8.
Cognitive remediation is an efficacious treatment for schizophrenia. However, different theoretical approaches have developed without any studies to directly compare them. This is the first study to compare the two dominant approaches to cognitive remediation (training of executive skills and training of perceptual skills) and employed the broadest assessment battery in the literature to date.
Outpatients with schizophrenia spectrum disorders were randomly assigned to receive either executive training or perceptual training. Electrophysiological activity, neurocognition, functional competence, case manager-rated community functioning, clinical symptoms, and self-report measures were assessed at baseline, immediately after treatment, and at a 12-week posttreatment follow-up assessment.
Perceptual training improved the EEG mismatch negativity significantly more than executive training immediately after treatment, although the effect did not persist at the 12-week follow-up. At the follow-up, executive training improved theta power during an n-back task, neurocognition, functional competence, and case manager-rated community functioning to a greater extent than perceptual training. These effects were not observed immediately after treatment.
Both perceptual training and executive training improved neurophysiological mechanisms specific to their domains of intervention, although only executive training resulted in improvement in neurocognition and functioning. Improvements in favor of executive training did not appear immediately after treatment but emerged 12 weeks after the end of active treatment. Thus, short-term intervention targeting higher-order cognitive functions may prime further cognitive and functional improvement.
认知矫正对于精神分裂症是一种有效的治疗方法。然而，不同的理论方法已经发展起来，却没有任何研究直接对它们进行比较。这是第一项比较两种主要认知矫正方法（执行技能训练和感知技能训练）的研究，并采用了迄今为止文献中最广泛的评估工具包。
精神分裂症谱系障碍的门诊患者被随机分配接受执行技能训练或感知技能训练。在基线、治疗结束后和治疗后 12 周的随访评估时，评估电生理活动、神经认知、功能能力、个案经理评定的社区功能、临床症状和自我报告测量结果。
感知训练在治疗后即刻显著改善了 EEG 失匹配负波，尽管这种效果在 12 周的随访中没有持续。在随访中，与感知训练相比，执行训练在 n-back 任务中改善了θ功率、神经认知、功能能力和个案经理评定的社区功能。这些效果在治疗后即刻并未观察到。
感知训练和执行训练都改善了与各自干预领域相关的神经生理机制，尽管只有执行训练导致了神经认知和功能的改善。支持执行训练的改善并非在治疗结束后即刻出现，而是在积极治疗结束后 12 周才出现。因此，针对高阶认知功能的短期干预可能会促进进一步的认知和功能改善。
