精神分裂症认知障碍的补偿干预：系统评价和荟萃分析。
Compensatory Interventions for Cognitive Impairments in Psychosis: A Systematic Review and Meta-Analysis.
机构信息
Orygen, Parkville, Australia.
Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.
出版信息
Schizophr Bull. 2020 Jul 8;46(4):869-883. doi: 10.1093/schbul/sbz134.
OBJECTIVE
Cognitive compensatory interventions aim to alleviate psychosocial disability by targeting functioning directly using aids and strategies, thereby minimizing the impact of cognitive impairment. The aim was to conduct a systematic review and meta-analysis of cognitive compensatory interventions for psychosis by examining the effects on functioning and symptoms, and exploring whether intervention factors, study design, and age influenced effect sizes.
METHODS
Electronic databases (Ovid Medline, PsychINFO) were searched up to October 2018. Records obtained through electronic and manual searches were screened independently by two reviewers according to selection criteria. Data were extracted to calculate estimated effects (Hedge's g) of treatment on functioning and symptoms at post-intervention and follow-up. Study quality was assessed using Cochrane Collaboration's risk of bias tool.
RESULTS
Twenty-six studies, from 25 independent randomized controlled trials (RCTs) were included in the meta-analysis (1654 participants, mean age = 38.9 years, 64% male). Meta-analysis revealed a medium effect of compensatory interventions on functioning compared to control conditions (Hedge's g = 0.46, 95% CI = 0.33, 0.60, P < .001), with evidence of relative durability at follow-up (Hedge's g = 0.36, 95% CI = 0.19, 0.54, P < .001). Analysis also revealed small significant effects of cognitive compensatory treatment on negative, positive, and general psychiatric symptoms, but not depressive symptoms. Estimated effects did not significantly vary according to treatment factors (ie, compensatory approach, dosage), delivery method (ie, individual/group), age, or risk of bias. Longer treatment length was associated with larger effect sizes for functioning outcomes. No evidence of publication bias was identified.
CONCLUSION
Cognitive compensatory interventions are associated with robust, durable improvements in functioning in people with psychotic illnesses.
目的
认知补偿干预旨在通过使用辅助工具和策略直接针对功能进行干预，从而减轻心理社会残疾，从而最大程度地减少认知障碍的影响。本研究旨在通过考察认知补偿干预对精神病的作用，对认知补偿干预治疗精神病的效果进行系统评价和荟萃分析，包括对功能和症状的影响，并探讨干预因素、研究设计和年龄是否影响效应大小。
方法
检索电子数据库（Ovid Medline、PsychINFO），检索时间截至 2018 年 10 月。通过电子和手动搜索获得的记录由两名独立的评审员根据选择标准进行筛选。提取数据以计算治疗后和随访时功能和症状的治疗效果估计值（Hedge's g）。使用 Cochrane 协作风险偏倚工具评估研究质量。
结果
共纳入 26 项研究，来自 25 项独立的随机对照试验（RCTs）（共 1654 名参与者，平均年龄 38.9 岁，64%为男性）。荟萃分析显示，与对照组相比，补偿干预对功能有中等影响（Hedge's g=0.46，95%置信区间=0.33，0.60，P<0.001），在随访时具有相对持久的效果（Hedge's g=0.36，95%置信区间=0.19，0.54，P<0.001）。分析还显示，认知补偿治疗对阴性、阳性和一般精神病症状有较小的显著影响，但对抑郁症状没有影响。治疗效果估计值与治疗因素（补偿方法、剂量）、传递方法（个体/团体）、年龄或偏倚风险无显著差异。治疗时间的长短与功能结果的效应大小呈正相关。未发现发表偏倚的证据。
结论
认知补偿干预与精神病患者功能的显著和持久改善有关。
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