Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
South London and Maudsley NHS Foundation Trust, London, UK.
Schizophr Bull. 2023 May 3;49(3):614-625. doi: 10.1093/schbul/sbac214.
Cognitive remediation (CR) benefits cognition and functioning in psychosis but we do not know the optimal level of therapist contact, so we evaluated the potential benefits of different CR modes.
A multi-arm, multi-center, single-blinded, adaptive trial of therapist-supported CR. Participants from 11 NHS early intervention psychosis services were independently randomized to Independent, Group, One-to-One, or Treatment-as-usual (TAU). The primary outcome was functional recovery (Goal Attainment Scale [GAS]) at 15-weeks post randomization. Independent and TAU arms were closed after an interim analysis, and three informative contrasts tested (Group vs One-to-One, Independent vs TAU, Group + One-to-One vs TAU). Health economic analyses considered the cost per Quality Adjusted Life Year (QALY). All analyses used intention-to-treat principles.
We analyzed 377 participants (65 Independent, 134 Group, 112 One-to-One, 66 TAU). GAS did not differ for Group vs One-to-One: Cohen's d: 0.07, -0.25 to 0.40 95% CI, P = .655; Independent vs TAU: Cohen's d: 0.07, -0.41 to 0.55 95% CI, P = .777. GAS and the cognitive score improved for Group + One-to-One vs TAU favoring CR (GAS: Cohen's d: 0.57, 0.19-0.96 95% CI, P = .003; Cognitive score: Cohens d: 0.28, 0.07-0.48 95% CI, P = .008). The QALY costs were £4306 for Group vs TAU and £3170 for One-to-One vs TAU. Adverse events did not differ between treatment methods and no serious adverse events were related to treatment.
Both active therapist methods provided cost-effective treatment benefiting functional recovery in early psychosis and should be adopted within services. Some individuals benefited more than others so needs further investigation.
ISRCTN14678860 https://doi.org/10.1186/ISRCTN14678860Now closed.
认知矫正（CR）有益于精神分裂症患者的认知和功能，但我们并不知道治疗师接触的最佳水平，因此我们评估了不同 CR 模式的潜在益处。
一项多臂、多中心、单盲、适应性的治疗师支持的 CR 试验。来自 11 个 NHS 早期干预精神病服务的参与者被独立随机分配到独立、小组、一对一或常规治疗（TAU）。主要结局是随机分组后 15 周的功能恢复（目标实现量表[GAS]）。独立和 TAU 臂在中期分析后关闭，测试了三个信息性对比（小组对一对一，独立对 TAU，小组+一对一对 TAU）。健康经济学分析考虑了每质量调整生命年（QALY）的成本。所有分析均采用意向治疗原则。
我们分析了 377 名参与者（65 名独立，134 名小组，112 名一对一，66 名 TAU）。小组与一对一之间的 GAS 没有差异：Cohen's d：0.07，-0.25 至 0.40 95%CI，P=0.655；独立与 TAU 之间：Cohen's d：0.07，-0.41 至 0.55 95%CI，P=0.777。小组+一对一的 GAS 和认知评分均较 TAU 有所提高，有利于 CR（GAS：Cohen's d：0.57，0.19-0.96 95%CI，P=0.003；认知评分：Cohen's d：0.28，0.07-0.48 95%CI，P=0.008）。小组对 TAU 的 QALY 成本为 4306 英镑，一对一对 TAU 的成本为 3170 英镑。治疗方法之间的不良事件没有差异，没有与治疗相关的严重不良事件。
两种积极的治疗师方法都提供了具有成本效益的治疗，有益于早期精神病患者的功能恢复，应在服务中采用。一些人比其他人受益更多，因此需要进一步研究。
ISRCTN14678860 https://doi.org/10.1186/ISRCTN14678860 现已关闭。
