Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
Schizophr Bull. 2022 Jan 21;48(1):262-272. doi: 10.1093/schbul/sbab102.
Cognitive impairment in schizophrenia predicts functional outcomes and is largely unresponsive to pharmacology or psychotherapy; it is thus a critical unmet treatment need. This article presents the impact of remotely completed, intensive, targeted auditory training (AT) vs control condition computer games (CG) in a double-blind randomized trial in young adults with recent-onset schizophrenia.
Participants (N = 147) were assessed for cognition, symptoms, and functioning at baseline, post-intervention, and at 6-month follow-up. All participants were provided with laptop computers and were instructed to complete 40 hours remotely of training or computer games. An intent-to-treat analysis (N = 145) was performed using linear mixed models with time modeled as a continuous variable. Planned contrasts tested the change from baseline to post-training, baseline to 6-month follow-up, and post-training to 6-month follow-up.
Global Cognition, which had improved in the AT group relative to the CG group at post-training, showed durable gains at 6-month follow-up in an omnibus group-by-time interaction test (F(1,179) = 4.80, P = .030), as did Problem-Solving (F(1,179) = 5.13, P = .025), and Speed of Processing improved at trend level significance (F(1,170) = 3.80, P = .053). Furthermore, the AT group showed significantly greater improvement than the CG group in positive symptoms (F(1,179) = 4.06, P = .045).
These results provide the first evidence of durable cognitive gains and symptom improvement at follow-up of cognitive training (CT) in early schizophrenia completed independently and remotely. While functioning did not show significant improvement, these findings suggest that intensive targeted CT of auditory processing is a promising component of early intervention to promote recovery from psychosis.
精神分裂症患者的认知障碍可预测其功能结局，且对药理学或心理治疗的反应不佳；因此，这是一个亟待满足的治疗需求。本文介绍了一项针对近期发病的精神分裂症年轻患者的双盲随机试验中，远程完成的强化靶向听觉训练（AT）与对照条件下的电脑游戏（CG）的影响。
参与者（N=147）在基线、干预后和 6 个月随访时进行认知、症状和功能评估。所有参与者都提供了笔记本电脑，并被指示远程完成 40 小时的训练或电脑游戏。采用线性混合模型对意向治疗分析（N=145）进行分析，将时间建模为连续变量。计划的对比测试了从基线到训练后的变化、从基线到 6 个月随访的变化以及从训练到 6 个月随访的变化。
在 AT 组相对于 CG 组，在训练后的总体认知得到了改善，在综合组间时间交互测试中，6 个月随访时仍保持了持久的改善（F（1，179）=4.80，P=0.030），解决问题的能力也得到了改善（F（1，179）=5.13，P=0.025），而处理速度的改善则呈趋势性显著（F（1，170）=3.80，P=0.053）。此外，AT 组的阳性症状改善明显优于 CG 组（F（1，179）=4.06，P=0.045）。
这些结果首次提供了在早期精神分裂症中完成的独立和远程认知训练（CT）的认知和症状改善在随访中具有持久性的证据。虽然功能没有显著改善，但这些发现表明，强化靶向听觉处理的 CT 是促进精神病康复的早期干预的一个有前途的组成部分。
