Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada.
Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Schizophr Res. 2022 Jan;239:160-167. doi: 10.1016/j.schres.2021.11.051. Epub 2021 Dec 9.
The objectives of this study are to test the efficacy of Cognitive-Behavioral Social Skills Training (CBSST) in enhancing social function in a sample of older patients with schizophrenia, and to assess whether baseline cognition moderates response to CBSST. To address these objectives, we conducted a randomized controlled trial of 63 participants, randomized 1:1 into CBSST or Treatment-As-Usual (TAU). The setting was a community-based geriatric mental health outpatient clinic in Toronto, Ontario, Canada. Data were collected at baseline, and week 18, 36 and 52, between June 2008 and May 2014. Participants were outpatients, aged 60 or older, with a diagnosis of schizophrenia or schizoaffective disorder and no evidence of dementia or other conditions associated with cognitive or functional impairment. The intervention was a weekly group CBSST for 36 weeks. Cognition, including executive function, was assessed at baseline. Modified total score on the Independent Living Skills Survey (ILSS) at 18, 36, and 52 weeks was the primary outcome measure. In a linear mixed model analysis, the ILSS trajectory was better in the CBSST group than the TAU group, with significantly better function at 36 (Cohen's d = 0.75) and 52 weeks (Cohen's d = 0.92). Baseline executive dysfunction moderated CBSST response, whereby participants with more severe executive dysfunction experienced the most improvement in ILSS. CBSST was efficacious in patients with late-life schizophrenia and prevented decline in social function over a one-year period. CBSST was most beneficial for patients with more severe executive dysfunction, i.e., those who needed skills training the most.
本研究旨在测试认知行为社会技能训练（CBSST）对提高老年精神分裂症患者社交功能的疗效，并评估基线认知是否调节对 CBSST 的反应。为了达到这些目标，我们进行了一项随机对照试验，共有 63 名参与者，按照 1:1 的比例随机分为 CBSST 或常规治疗（TAU）组。该研究地点是加拿大安大略省多伦多市的一个社区为基础的老年精神卫生门诊。数据收集于 2008 年 6 月至 2014 年 5 月之间的基线、第 18、36 和 52 周。参与者为门诊患者，年龄在 60 岁或以上，被诊断为精神分裂症或分裂情感障碍，且无痴呆或其他与认知或功能障碍相关的疾病的证据。干预措施是每周一次的 CBSST，共 36 周。基线时评估认知功能，包括执行功能。18、36 和 52 周时的独立生活技能调查（ILSS）的改良总分是主要的结局指标。在线性混合模型分析中，CBSST 组的 ILSS 轨迹优于 TAU 组，36 周（Cohen's d = 0.75）和 52 周（Cohen's d = 0.92）时功能明显更好。基线执行功能障碍调节了 CBSST 的反应，即执行功能障碍越严重的患者在 ILSS 中改善的幅度越大。CBSST 对老年精神分裂症患者有效，并在一年期间预防了社交功能的下降。CBSST 对执行功能障碍更严重的患者最有益，即最需要技能训练的患者。
