精神病元认知训练（MCT）：对其有效性的系统元综述
Metacognitive training for psychosis (MCT): a systematic meta-review of its effectiveness.
作者信息
Meinhart Antonia, Sauvé Geneviève, Schmueser Annika, Penney Danielle, Berna Fabrice, Gawęda Łukasz, Lamarca Maria, Moritz Steffen, Ochoa Susana, König Caroline, Acuña Vanessa, Fischer Rabea
机构信息
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany.
Douglas Mental Health University Institute, Montréal, QC, Canada.
出版信息
Transl Psychiatry. 2025 Apr 22;15(1):156. doi: 10.1038/s41398-025-03344-0.
OBJECTIVE
Metacognitive training for psychosis (MCT) targets cognitive biases implicated in the pathogenesis of psychosis, e.g., jumping to conclusions, overconfidence in errors, and inflexibility. This systematic meta-review investigated the current meta-analytic evidence for the effectiveness of MCT with respect to core symptom features in schizophrenia (i.e., positive symptoms, delusions and hallucinations, negative symptoms, and overall psychotic symptoms).
DATA SOURCES
This meta-review was registered with PROSPERO (CRD42023447442) on July 28, 2023. Articles were searched across five electronic databases from January 1, 2007 to September 1, 2023.
STUDY SELECTION
Meta-analyses addressing metacognitive interventions targeting psychotic symptoms were eligible for meta-review.
DATA EXTRACTION AND SYNTHESIS
PRISMA guidelines were followed when applicable. Data extraction was done independently by two authors (AM, AS). A random-effects model was used to pool data within meta-analyses.
MAIN OUTCOMES AND MEASURES
Main outcomes were levels/severity of positive symptoms, delusions and hallucinations, negative symptoms, and overall psychotic symptoms after intervention.
RESULTS
Eight meta-analyses and two re-analyses were included for meta-review. A total of eight analyses provided sufficient data for analysis. Significant evidence was found in favor of MCT for positive symptoms (85.71%; N = 35, g = 0.473 [0.295, 0.651], I = 74.64), delusions (60%; N = 24, g = 0.639 [0.389, 0.889], I = 80.01), hallucinations (100%; N = 9, g = 0.265 [0.098, 0.432], I = 6.1), negative symptoms (100%; N = 17, g = 0.233 [0.1, 0.366], I = 34.78), and overall symptoms (50%; N = 37, g = 0.392 [0.245, 0.538], I = 65.73). None of the meta-analyses included a large enough sample size to meet the criteria for 'suggestive', 'convincing', or 'highly convincing' evidence according to metaumbrella.org guidelines (required sample size > 1000 cases). None of the meta-analyses scored 'moderate' or 'high' on methodological quality. Meta-analyses with significant results were more recent and/or considered more primary studies.
CONCLUSIONS AND RELEVANCE
There is consistent evidence that MCT ameliorates positive symptoms and delusions in schizophrenia.
目的
精神病元认知训练（MCT）针对与精神病发病机制相关的认知偏差，例如妄下结论、对错误过度自信和僵化思维。本系统综述调查了目前关于MCT对精神分裂症核心症状特征（即阳性症状、妄想和幻觉、阴性症状以及总体精神病性症状）有效性的元分析证据。
数据来源
本综述于2023年7月28日在国际系统评价前瞻性注册库（PROSPERO，注册号：CRD42023447442）登记。检索了5个电子数据库，时间跨度为2007年1月1日至2023年9月1日。
研究选择
针对精神病性症状的元认知干预的元分析符合纳入综述的标准。
数据提取与合成
适用时遵循系统评价和Meta分析的首选报告项目（PRISMA）指南。数据提取由两位作者（AM和AS）独立完成。采用随机效应模型合并各元分析中的数据。
主要结局指标
主要结局指标为干预后阳性症状、妄想和幻觉、阴性症状以及总体精神病性症状的水平/严重程度。
结果
纳入8项元分析和2项重新分析进行综述。共有8项分析提供了足够的数据用于分析。发现有显著证据支持MCT对阳性症状有效（85.71%；N = 35，g = 0.473 [0.295, 0.651]，I² = 74.64）、对妄想有效（60%；N = 24，g = 0.639 [0.389, 0.889]，I² = 80.01）、对幻觉有效（100%；N = 9，g = 0.265 [0.098, 0.432]，I² = 6.1）、对阴性症状有效（100%；N = 17，g = 0.233 [0.1, 0.366]，I² = 34.78）以及对总体症状有效（50%；N = 37，g = 0.392 [0.245, 0.538]，I² = 65.73）。根据metaumbrella.org指南，没有一项元分析的样本量足够大以满足“提示性”“令人信服”或“高度令人信服”证据的标准（所需样本量>1000例）。没有一项元分析在方法学质量上得“中等”或“高”分。有显著结果的元分析更新且/或纳入的原始研究更多。
结论与意义
有一致证据表明MCT可改善精神分裂症的阳性症状和妄想。
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