Young D A, Freyslinger M G
Queen Street Mental Health Centre, Toronto, Ont., Canada.
Schizophr Res. 1995 Aug 15;16(3):199-207. doi: 10.1016/0920-9964(94)00074-i.
The purpose of this study was to explore the remediation of Wisconsin Card Sorting Test (WCST) deficits among highly chronic schizophrenic patients by employing an instructional technique known as scaffolding. The extent to which learning of the WCST generalized to a similar neuropsychological test, the Short Category Test (SCT) was examined. Forty-one chronic schizophrenic subjects drawn from in-patient and out-patient wards were given the WCST. Twenty-eight of the subjects who displayed the greatest impairment on the WCST were then administered the Brief Psychiatric Rating Scale (BPRS) and randomly assigned to groups that received three sessions of either scaffolded or didactic instruction. Post-testing with the WCST occurred an average of 1.9 (SD = 1.3) and again 31.4 (SD = 3.9) days after instruction. Subjects who received scaffolded instruction improved significantly in the number of categories achieved when compared to the didactic group. The improvement was sustained a month later. A strong trend favoring the scaffolded group on the SCT suggested that generalization of learning had occurred. Significant and durable improvement of WCST performance in severely disabled schizophrenics is clearly possible with the instructional method employed. The increment in abstract reasoning may generalize to other tasks. These findings have significant implications for psycho-social and cognitive rehabilitation.
本研究的目的是通过采用一种名为支架式教学的指导技术，探索高度慢性精神分裂症患者威斯康星卡片分类测验（WCST）缺陷的补救方法。研究考察了WCST学习在多大程度上能推广到类似的神经心理学测试——简短类别测验（SCT）。从住院部和门诊部抽取了41名慢性精神分裂症患者进行WCST测试。然后，对在WCST测试中表现出最大损伤的28名患者进行简明精神病评定量表（BPRS）测试，并随机分配到接受三次支架式教学或讲授式教学的组中。在教学后平均1.9天（标准差 = 1.3）和31.4天（标准差 = 3.9）再次用WCST进行后测。与讲授式教学组相比，接受支架式教学的患者在达到的类别数量上有显著改善。这种改善在一个月后仍然持续。在SCT上有利于支架式教学组的强烈趋势表明学习已经发生了推广。采用的教学方法显然可以使严重残疾的精神分裂症患者的WCST表现得到显著且持久的改善。抽象推理能力的提高可能会推广到其他任务中。这些发现对心理社会和认知康复具有重要意义。
