National Institute of Mental Health, 250 67 Klecany, Czech Republic.
Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic.
Int J Environ Res Public Health. 2021 Aug 28;18(17):9081. doi: 10.3390/ijerph18179081.
Standard approaches to cognitive remediation can suffer from limited skill transferability to patients' life. Complex virtual environments (VEs) enable us to create ecologically valid remediation scenarios while preserving laboratory conditions. Nevertheless, the feasibility and efficacy of these programs in psychiatric patients are still unknown. Our aim was to compare the feasibility and efficacy of a novel rehabilitation program, designed in complex VEs, with standard paper-pencil treatment in patients with schizophrenia and major depressive disorder. We recruited 35 participants to complete a VE rehabilitation program and standard treatment in a crossover pilot study. Twenty-eight participants completed at least one program, 22 were diagnosed with schizophrenia and 6 with major depressive disorder. Participant's performance in the representative VE training task significantly improved in terms of maximum achieved difficulty ( ≤ 0.001), speed ( < 0.001) and efficacy ( ≤ 0.001) but not in item performance measure. Neither the standard treatment nor the VE program led to improvement in standardized cognitive measures. Participants perceived both programs as enjoyable and beneficial. The refusal rate was higher in the VE program (8.6%) than in the standard treatment (0%). But in general, the VE program was well-accepted by the psychiatric patients and it required minimal involvement of the clinician due to automatic difficulty level adjustment and performance recording. However, the VE program did not prove to be effective in improving cognitive performance in the standardized measures.
标准的认知矫正方法可能在患者的日常生活中受到技能转移能力的限制。复杂的虚拟环境（VE）使我们能够在保留实验室条件的同时创建具有生态有效性的矫正场景。然而，这些程序在精神科患者中的可行性和疗效仍不清楚。我们的目的是比较复杂 VE 中设计的新型康复计划与标准纸笔治疗在精神分裂症和重度抑郁症患者中的可行性和疗效。我们招募了 35 名参与者完成了一项交叉先导研究中的 VE 康复计划和标准治疗。28 名参与者完成了至少一个方案，其中 22 名被诊断为精神分裂症，6 名被诊断为重度抑郁症。参与者在代表性 VE 训练任务中的表现，在最大达到难度（≤0.001）、速度（＜0.001）和效果（≤0.001）方面都有显著改善，但在项目表现测量方面没有改善。标准治疗和 VE 方案都没有导致标准化认知测量的改善。参与者认为这两种方案都很有趣且有益。VE 方案的拒绝率（8.6%）高于标准治疗（0%）。但总的来说，VE 方案被精神科患者很好地接受，由于自动难度水平调整和性能记录，它只需要临床医生的最小参与。然而，VE 方案在提高标准化测量中的认知表现方面并没有证明是有效的。
