Stiekema Annemarie P M, van Dam Michelle T, Bruggeman Richard, Redmeijer Jeroen E, Swart Marte, Dethmers Marian, Rietberg Kees, Wekking Ellie M, Velligan Dawn I, Timmerman Marieke E, Aleman André, Castelein Stynke, van Weeghel Jaap, Pijnenborg Gerdina M H, van der Meer Lisette
Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, the Netherlands.
School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands.
Schizophr Bull. 2020 Sep 21;46(5):1259-1268. doi: 10.1093/schbul/sbz135.
Feasible and effective interventions to improve daily functioning in people with a severe mental illness (SMI), such as schizophrenia, in need of longer-term rehabilitation are scarce.
We assessed the effectiveness of Cognitive Adaptation Training (CAT), a compensatory intervention to improve daily functioning, modified into a nursing intervention.
In this cluster randomized controlled trial, 12 nursing teams were randomized to CAT in addition to treatment as usual (CAT; n = 42) or TAU (n = 47). Daily functioning (primary outcome) was assessed every 3 months for 1 year. Additional follow-up assessments were performed for the CAT group in the second year. Secondary outcomes were assessed every 6 months. Data were analyzed using multilevel modeling.
CAT participants improved significantly on daily functioning, executive functioning, and visual attention after 12 months compared to TAU. Improvements were maintained after 24 months. Improved executive functioning was related to improved daily functioning. Other secondary outcomes (quality of life, empowerment, negative symptoms) showed no significant effects.
As a nursing intervention, CAT leads to maintained improvements in daily functioning, and may improve executive functioning and visual attention in people with SMI in need of longer-term intensive psychiatric care. Given the paucity of evidence-based interventions in this population, CAT can become a valuable addition to recovery-oriented care.
对于需要长期康复治疗的严重精神疾病（如精神分裂症）患者，改善其日常功能的可行且有效的干预措施很少。
我们评估了认知适应训练（CAT）作为一种改善日常功能的补偿性干预措施，并将其改编为护理干预措施后的有效性。
在这项整群随机对照试验中，12个护理团队被随机分为除常规治疗外还接受CAT干预的组（CAT组；n = 42）或仅接受常规治疗的组（TAU组；n = 47）。对日常功能（主要结局）进行为期1年、每3个月一次的评估。在第二年对CAT组进行额外的随访评估。次要结局每6个月评估一次。使用多水平模型分析数据。
与TAU组相比，CAT组参与者在12个月后日常功能、执行功能和视觉注意力方面有显著改善。24个月后这些改善得以维持。执行功能的改善与日常功能的改善相关。其他次要结局（生活质量、赋权、阴性症状）未显示出显著影响。
作为一种护理干预措施，CAT能使日常功能持续改善，并可能改善需要长期强化精神科护理的严重精神疾病患者的执行功能和视觉注意力。鉴于该人群中基于证据的干预措施匮乏，CAT可成为以康复为导向的护理的一项有价值的补充。
