Seccomandi Benedetta, Agbedjro Deborah, Bell Morris, Keefe Richard S E, Keshavan Matcheri, Galderisi Silvana, Fiszdon Joanna, Mucci Armida, Cavallaro Roberto, Bechi Margherita, Ojeda Natalia, Peña Javier, Wykes Til, Cella Matteo
Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK.
J Psychiatr Res. 2021 Jan;133:38-45. doi: 10.1016/j.jpsychires.2020.12.013. Epub 2020 Dec 4.
IQ and IQ decline are considered risk factors for poor prognosis in people with a diagnosis of schizophrenia. However, it is still not clear if, at least in part, IQ and IQ decline influence long-term outcomes via a negative effect on interventions.
To identify whether current IQ, estimated premorbid IQ, or IQ decline moderate the response to cognitive remediation (CR).
Individual participant data from twelve randomised controlled trials of CR were considered. Hierarchical and k-means analyses were carried out to identify different IQ clusters. The moderating effect of estimated premorbid IQ, current IQ, and different IQ clusters (preserved, deteriorated and compromised trajectories) on cognitive outcomes at post-therapy and follow-up were evaluated using multiple linear regression.
Data from 984 participants (CR = 544, control = 440) with schizophrenia and schizoaffective disorders were considered. The sample had a mean current IQ of 84.16 (SD 15.61) and estimated premorbid IQ of 95.82 (SD 10.63). Current IQ moderated working memory outcomes: people with higher IQ had larger working memory gains after therapy compared to those with a lower IQ. Those with a preserved IQ had better cognitive outcomes compared to either the deteriorated or compromised IQ groups, and those with a deteriorated IQ had better outcomes compared to those in the compromised IQ group.
Current IQ is a significant moderator of cognitive gains after CR. These findings highlight the need to evaluate whether therapy adaptations (e.g. offering more sessions) can attenuate this effect so that those with lower IQ may derive benefit similar to those with higher IQ.
智商及智商下降被认为是精神分裂症患者预后不良的风险因素。然而，智商及智商下降是否至少部分地通过对干预措施产生负面影响来影响长期预后仍不清楚。
确定当前智商、预估病前智商或智商下降是否会调节对认知康复（CR）的反应。
纳入了12项CR随机对照试验的个体参与者数据。进行了分层分析和k均值分析以识别不同的智商集群。使用多元线性回归评估预估病前智商、当前智商以及不同智商集群（保持、下降和受损轨迹）对治疗后及随访时认知结果的调节作用。
纳入了984例精神分裂症和分裂情感性障碍患者的数据（CR组=544例，对照组=440例）。样本的当前平均智商为84.16（标准差15.61），预估病前智商为95.82（标准差10.63）。当前智商调节了工作记忆结果：智商较高者在治疗后工作记忆的改善幅度大于智商较低者。智商保持者的认知结果优于智商下降或受损组，智商下降者的结果优于智商受损组。
当前智商是CR后认知改善的显著调节因素。这些发现凸显了评估治疗调整（如增加疗程）是否可以减弱这种效应的必要性，以便智商较低者能获得与智商较高者相似的益处。
