Drury V, Birchwood M, Cochrane R, Macmillan F
Archer Centre, All Saints Hospital, Birmingham.
Br J Psychiatry. 1996 Nov;169(5):593-601. doi: 10.1192/bjp.169.5.593.
The application of cognitive therapy (CT) to psychosis is currently being developed in the UK. This paper reports a trial of CT in acute psychosis with the objective of hastening the resolution of positive symptoms and reducing residual symptoms.
Of 117 patients with acute non-affective psychosis, 69 satisfied inclusion criteria and 40 proceeded to stratified randomisation. The experimental intervention involving individual and group CT was compared with a group receiving matched hours of therapist input providing structured activities and informal support; routine pharmacotherapy was provided by clinicians blind to group allocation. Patients were monitored weekly using self-report and mental state assessments during admission and over the subsequent nine months.
Both groups showed a decline in positive symptoms but this was more marked in the CT group (P < 0.001). At 9 months 5% of the CT group, v.56% of the control group, showed moderate or severe residual symptoms.
CT appears to be a potent adjunct to pharmacotherapy and standard care for acute psychosis. Issues concerning internal and external validity of the study and opportunities for further research are discussed.
认知疗法（CT）在精神病治疗中的应用目前正在英国开展。本文报告了一项针对急性精神病的认知疗法试验，目的是加速阳性症状的缓解并减少残留症状。
在117例急性非情感性精神病患者中，69例符合纳入标准，40例进行分层随机分组。将包含个体和团体认知疗法的实验性干预措施与接受相同时长治疗师指导（提供结构化活动和非正式支持）的对照组进行比较；常规药物治疗由对分组情况不知情的临床医生提供。在住院期间及随后的九个月里，每周通过自我报告和精神状态评估对患者进行监测。
两组的阳性症状均有所减轻，但认知疗法组更为明显（P < 0.001）。九个月时，认知疗法组有5%的患者出现中度或重度残留症状，而对照组这一比例为56%。
认知疗法似乎是急性精神病药物治疗和标准护理的有效辅助手段。文中讨论了该研究的内部和外部有效性问题以及进一步研究的机会。
