Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.
Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Germany.
Neurosci Biobehav Rev. 2019 Dec;107:828-845. doi: 10.1016/j.neubiorev.2019.09.031. Epub 2019 Sep 23.
Cognitive remediation (CR) is nowadays mainly administered in a computerized fashion, yet frequently supplemented by human guidance. The effects of CR on cognitive, functional and clinical outcomes are consistently reported, yet the response is heterogeneous. In order to resolve this heterogeneity, we employed a multi-outcome meta-analytic approach, examined effects of CR on each outcome category separately and estimated directed effects between three outcome categories. We extracted treatment effects from 67 studies that trained patients with schizophrenia (total n = 4067) using either 1) computerized CR modality alone or 2) in combination with supplementary human guidance (SHG). All three outcome domains were significantly improved by CR with small to moderate effect sizes when assessing outcomes across all studies. The comparison between CR administered with SHG revealed largest effects on the cognitive subdomains of working and verbal memory. Structural equation modeling in the single-study data suggests that cognitive gains trigger restoration of psychosocial functioning which in turn facilitates improvement in clinical symptoms.
认知矫正（CR）目前主要以计算机化的方式进行，但经常辅以人工指导。CR 对认知、功能和临床结果的影响得到了一致的报道，但反应是异质的。为了解决这种异质性，我们采用了多结果荟萃分析方法，分别检查 CR 对每个结果类别的影响，并估计了三个结果类别的定向影响。我们从 67 项研究中提取了治疗效果，这些研究使用计算机化 CR 模式单独或与补充人工指导（SHG）相结合来训练精神分裂症患者（总 n=4067）。当评估所有研究的结果时，所有三个结果领域都因 CR 而得到显著改善，其效果从小到中等。在单独的研究数据中进行结构方程建模表明，认知收益引发心理社会功能的恢复，从而促进临床症状的改善。
