Kidd Sean A, Herman Yarissa, Virdee Gursharan, Bowie Christopher R, Velligan Dawn, Plagiannakos Christina, Voineskos Aristotle
University of Toronto Department of Psychiatry, Canada.
Toronto Centre for Addiction and Mental Health, CAMH, 1001 Queen St. W., Toronto, Ontario M6J1H1, Canada.
Schizophr Res Cogn. 2019 Jul 24;19:100157. doi: 10.1016/j.scog.2019.100157. eCollection 2020 Mar.
This randomized trial examined the relative effectiveness of primarily compensatory and primarily restorative cognitive interventions in an early psychosis population. A total of 56 patients were randomized to one of two treatments which were applied for four months with a five month follow up assessment. Comparisons were between (1) Cognitive Adaptation Training (CAT) - a treatment that uses environmental supports and weekly home visits to compensate for cognitive challenges and improve community functioning and (2) Action Based Cognitive Remediation (ABCR) - a treatment involving computerized cognitive drill and practice exercises, simulations, goal setting, and behavioral activation. Linear mixed effects models demonstrated significant effects on community functioning for both CAT and ABCR without a difference between conditions (n = 39), with an indication of greater gains at follow up in the ABCR group (n = 31). Improvements in symptomatology were less robust with mixed findings across neurocognition metrics. This study concluded that both CAT and ABCR hold promise as interventions for early intervention psychosis populations but more work is needed to identify illness severity, subtype and contextual considerations that might indicate an emphasis on more compensatory versus more restorative cognitive interventions.
这项随机试验研究了主要补偿性和主要恢复性认知干预措施在早期精神病患者群体中的相对有效性。共有56名患者被随机分配到两种治疗方法之一，这两种治疗方法实施四个月，并进行为期五个月的随访评估。比较的是：（1）认知适应训练（CAT）——一种利用环境支持和每周家访来应对认知挑战并改善社区功能的治疗方法；（2）基于行动的认知矫正（ABCR）——一种涉及计算机化认知训练和练习、模拟、目标设定及行为激活的治疗方法。线性混合效应模型显示，CAT和ABCR对社区功能均有显著影响，两种治疗方法之间无差异（n = 39），且有迹象表明ABCR组在随访时改善更大（n = 31）。症状学方面的改善不太显著，神经认知指标的结果不一。本研究得出结论，CAT和ABCR作为早期干预精神病患者群体的干预措施都有前景，但需要开展更多工作来确定疾病严重程度、亚型以及可能表明更侧重于补偿性而非恢复性认知干预的背景因素。
