认知康复对重度抑郁症患者的有效性：一项真实世界环境下的多中心随机对照研究。
Effectiveness of cognitive remediation in subjects with major depressive disorder: A multicenter randomized controlled study in a real-world setting.
作者信息
Barlati Stefano, Nibbio Gabriele, Bellomo Antonello, Carpiniello Bernardo, Colombo Cristina, De Giorgi Serafino, Deste Giacomo, Maina Giuseppe, Martinotti Giovanni, Tortorella Alfonso, Di Salvo Gabriele, Luciano Mario, Pinna Federica, Ventriglio Antonio, Fiorillo Andrea, Vita Antonio
机构信息
Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy.
Department of Clinical and Experimental Sciences, https://ror.org/02q2d2610University of Brescia, Brescia, Italy.
出版信息
Eur Psychiatry. 2025 Aug 4;68(1):e106. doi: 10.1192/j.eurpsy.2025.10073.
BACKGROUND
Cognitive impairment represents a central component of major depressive disorder (MDD), affecting a large proportion of people living with MDD and showing a consistent negative impact on social, interpersonal, and occupational functioning and subjective quality of life. Cognitive remediation (CR) is a training-based psychosocial intervention targeting cognitive performance and psychosocial functioning that has shown consistent evidence of effectiveness in individuals with schizophrenia and that could provide significant benefits also in people with MDD: this study aimed to assess the effects of a computerized CR intervention in adults living with MDD.
METHODS
Participants recruited in this single blind multicentric randomized controlled trial were allocated to receive a computerized CR intervention delivered by an active and trained therapist or to an active control condition (computer games - CG). Outcomes were measured with validated instruments by blind assessors and included cognitive performance, depressive symptoms, and psychosocial functioning. Outcomes were assessed using mixed models for repeated measures, considering baseline and end-of-treatment scores.
RESULTS
Hundred and one participants (CR=52 and CG=49) were included and 81 (CR=45 and CG=36) completed the study. CR produced superior results in clinician-rated depressive symptoms (=0.023, =042), global clinical severity (=0.025, =0.39), subjective depressive symptoms (=0.005, =0.45), working memory performance (=0.004, =0.34), executive functions/cognitive flexibility (=0.020, =0.43), and subjective cognitive impairment (=0.006, =0.48).
CONCLUSIONS
CR represents an effective intervention in MDD, improving clinical outcomes and cognitive performance in a clinician-rated and in a subjective manner, which should be more consistently implemented in clinical practice and included in MDD treatment recommendations.
背景
认知障碍是重度抑郁症（MDD）的核心组成部分，影响着很大一部分MDD患者，并对社交、人际和职业功能以及主观生活质量产生持续的负面影响。认知康复（CR）是一种基于训练的社会心理干预措施，旨在改善认知表现和社会心理功能。已有证据一致表明，该方法对精神分裂症患者有效，对MDD患者也可能有显著益处：本研究旨在评估计算机化CR干预对成年MDD患者的影响。
方法
在这项单盲多中心随机对照试验中招募的参与者被分配接受由积极且经过培训的治疗师提供的计算机化CR干预，或分配到积极对照条件组（电脑游戏 - CG）。由盲法评估者使用经过验证的工具测量结果，包括认知表现、抑郁症状和社会心理功能。使用重复测量的混合模型评估结果，同时考虑基线和治疗结束时的分数。
结果
共纳入101名参与者（CR组 = 52名，CG组 = 49名），81名（CR组 = 45名，CG组 = 36名）完成了研究。CR在临床医生评定的抑郁症状（P = 0.023，效应量 = 0.42）、整体临床严重程度（P = 0.025，效应量 = 0.39）、主观抑郁症状（P = 0.005，效应量 = 0.45）、工作记忆表现（P = 0.004，效应量 = 0.34）、执行功能/认知灵活性（P = 0.020，效应量 = 0.43）和主观认知障碍（P = 0.006，效应量 = 0.48）方面产生了更好的结果。
结论
CR是一种对MDD有效的干预措施，能够以临床医生评定和主观的方式改善临床结局和认知表现，应在临床实践中更持续地实施，并纳入MDD治疗建议中。
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