Lopez-Morinigo Javier-David, Martínez Adela Sánchez-Escribano, Barrigón María Luisa, Escobedo-Aedo Paula-Jhoana, Ruiz-Ruano Verónica González, Sánchez-Alonso Sergio, Mata-Iturralde Laura, Muñoz-Lorenzo Laura, Cuadras Daniel, Ochoa Susana, Baca-García Enrique, David Anthony S
Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain.
Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain.
Schizophrenia (Heidelb). 2023 Jan 30;9(1):7. doi: 10.1038/s41537-022-00316-x.
Poor insight in schizophrenia spectrum disorders (SSD) is linked with negative outcomes. This single-centre, assessor-blind, parallel-group 1-year follow-up randomised controlled trial (RCT) tested whether metacognitive training (MCT) (compared to psychoeducation) may improve insight and outcomes in outpatients with SSD assessed: at baseline (T0); after treatment (T1) and at 1-year follow-up (T2). Insight (primary outcome) was measured with (i) the Schedule for Assessment of Insight-Expanded version- (SAI-E), including illness recognition (IR), symptom relabelling (SR), treatment compliance (TC) and total insight scores (TIS); and (ii) the Beck Cognitive Insight Scale (BCIS). Between-group comparisons were nonsignificant, while within the MCT group (but not within controls) there was a significant medium effect size for improved TIS at T2 (d = 0.67, P = 0.02). Secondary outcomes included cognitive measures: Jumping to Conclusions (JTC), Theory of Mind (ToM), plus symptom severity and functioning. Compared to psychoeducation, MCT improved the PANSS excitement (d = 1.21, P = 0.01) and depressed (d = 0.76, P = 0.05) factors at T2; and a JTC task both at T1 (P = 0.016) and at T2 (P = 0.031). Participants in this RCT receiving MCT showed improved insight at 1-year follow-up, which was associated with better mood and reduced JTC cognitive bias. In this pilot study, no significant benefits on insight of MCT over psychoeducation were detected, which may have been due to insufficient power.
精神分裂症谱系障碍（SSD）患者的自知力缺乏与不良预后相关。这项单中心、评估者盲法、平行组1年随访随机对照试验（RCT）检验了元认知训练（MCT）（与心理教育相比）是否能改善SSD门诊患者的自知力及预后，评估时间点为：基线期（T0）、治疗后（T1）和1年随访期（T2）。自知力（主要结局）通过以下方式测量：（i）自知力扩展版评估量表（SAI-E），包括疾病认知（IR）、症状重新归因（SR）、治疗依从性（TC）和自知力总分（TIS）；以及（ii）贝克认知自知力量表（BCIS）。组间比较无显著差异，而在MCT组（而非对照组）中，T2时TIS改善有显著的中等效应量（d = 0.67，P = 0.02）。次要结局包括认知指标：妄下结论（JTC）、心理理论（ToM），以及症状严重程度和功能。与心理教育相比，MCT在T2时改善了阳性和阴性症状量表（PANSS）的兴奋（d = 1.21，P = 0.01）和抑郁（d = 0.76，P = 0.05）因子；在T1（P = 0.016）和T2（P = 0.031）时均改善了一项JTC任务。这项RCT中接受MCT的参与者在1年随访时自知力有所改善，这与更好的情绪和减少的JTC认知偏差相关。在这项初步研究中，未检测到MCT在自知力方面比心理教育有显著益处，这可能是由于检验效能不足。
