Watson Andrew J, Stringer Dominic, Pickles Andrew, McCrone Paul, Reeder Clare, Birchwood Max, Fowler David, Greenwood Kathryn, Johnson Sonia, Perez Jesus, Thompson Andrew, Upthegrove Rachel, Wilson Jon, Kenny Alex, Isok Iris, Suseendrabose Balaji, Joyce Eileen M, Wykes Til, Cella Matteo
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
South London and Maudsley NHS Foundation Trust, London, UK.
Psychol Med. 2025 Mar 3;55:e66. doi: 10.1017/S0033291725000212.
Although cognitive remediation (CR) improves cognition and functioning, the key features that promote or inhibit its effectiveness, especially between cognitive domains, remain unknown. Discovering these key features will help to develop CR for more impact.
To identify interrelations between cognition, symptoms, and functioning, using a novel network analysis approach and how CR affects these recovery outcomes.
A secondary analysis of randomized controlled trial data (N = 165) of CR in early psychosis. Regularized partial correlation networks were estimated, including symptoms, cognition, and functioning, for pre-, post-treatment, and change over time. Pre- and post-CR networks were compared on global strength, structure, edge invariance, and centrality invariance.
Cognition, negative, and positive symptoms were separable constructs, with symptoms showing independent relationships with cognition. Negative symptoms were central to the CR networks and most strongly associated with change in functioning. Verbal and visual learning improvement showed independent relationships to improved social functioning and negative symptoms. Only visual learning improvement was positively associated with personal goal achievement. Pre- and post-CR networks did not differ in structure (M = 0.20, p = 0.45) but differed in global strength, reflecting greater overall connectivity in the post-CR network (S = 0.91, p = 0.03).
Negative symptoms influenced network changes following therapy, and their reduction was linked to improvement in verbal and visual learning following CR. Independent relationships between visual and verbal learning and functioning suggest that they may be key intervention targets to enhance social and occupational functioning.
尽管认知康复（CR）可改善认知和功能，但促进或抑制其有效性的关键特征，尤其是认知领域之间的关键特征，仍不明确。发现这些关键特征将有助于开发更具影响力的CR。
使用一种新颖的网络分析方法确定认知、症状和功能之间的相互关系，以及CR如何影响这些康复结果。
对早期精神病患者CR的随机对照试验数据（N = 165）进行二次分析。估计了正则化偏相关网络，包括治疗前、治疗后以及随时间变化的症状、认知和功能。比较了CR前后网络在全局强度、结构、边不变性和中心性不变性方面的差异。
认知、阴性和阳性症状是可分离的结构，症状与认知表现出独立关系。阴性症状是CR网络的核心，与功能变化的关联最为紧密。言语和视觉学习能力的改善与社交功能改善和阴性症状表现出独立关系。只有视觉学习能力的改善与个人目标达成呈正相关。CR前后的网络在结构上没有差异（M = 0.20，p = 0.45），但在全局强度上存在差异，这反映出CR后网络的整体连通性更高（S = 0.91，p = 0.03）。
阴性症状影响治疗后的网络变化，其减轻与CR后言语和视觉学习能力的改善相关。视觉和言语学习与功能之间的独立关系表明，它们可能是增强社交和职业功能的关键干预靶点。
