Predictors of Response to Cognitive Remediation in Service Recipients With Severe Mental Illness
Predictors of Response to Cognitive Remediation in Service Recipients With Severe Mental Illness
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DOI：
10.1037/prj0000252
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发表时间：
2017-03-01
影响因子：
1.9
通讯作者：
McGurk, Susan R.
中科院分区：
文献类型：
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作者：
Lindenmayer, Jean-Pierre;Ozog, Veronica Anna;McGurk, Susan R.
目的：认知障碍是精神分裂症患者的显著特征，损害其职业、社会和经济功能。这些挑战预示着社会和工作的结果。认知补救已被证明对改善认知功能和社会功能都是有效的。然而，认知补救并不是在所有参与者中都产生改善。我们对患有严重精神疾病的服务对象进行认知补救干预后与改善相关的人口学、神经认知和精神病理学预测因素进行了调查。方法：根据《精神疾病诊断与统计手册》（第4版，文本修订版），137名被诊断为精神分裂症、分裂情感性障碍或双相情感障碍的成年参与者参加了为期12周的认知补救计划。对人口统计学和疾病变量进行评估，并对精神病理学（阳性和阴性综合征量表[PANSS]）、神经认知（改善精神分裂症认知的测量和治疗研究[matrix]共识认知电池[MCBB]）和社会功能（个人和社会绩效量表[PSP]）进行基线和终点评估。使用可靠变化指数计算认知领域的变化。采用Logistic回归分析评估干预后认知改善的预测因素。结果：62%的参与者在MCCB的至少一个领域有所改善。较高的基线处理速度、注意力或警觉性和工作记忆预示着对认知补救的积极反应。年龄较小、受教育程度较高、停留时间较短、PANSS水平较低是其他预测因素。结论和实践意义：我们的研究结果表明认知修复的临床有效性，并确定了对干预反应良好的临床和认知预测模式。临床医生对这些预测因素的识别可能会提高结果，并有助于制定个性化的康复认知修复治疗计划。
Objective: Cognitive challenges are prominent features of individuals diagnosed with schizophrenia, impairing occupational, social, and economic functioning. These challenges are predictive of social and work outcomes. Cognitive remediation has been shown to be effective in improving both cognitive and social functions. However, cognitive remediation does not produce improvement in all participants. We investigated demographic, neurocognitive, and psychopathological predictors associated with improvement following cognitive remediation interventions in service recipients with severe mental illnesses. Method: One hundred thirty-seven adult participants with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) were enrolled in 12-week cognitive remediation programs. Assessments of demographic and illness variables, together with baseline and end point assessment of psychopathology (Positive and Negative Syndrome Scale [PANSS]), neurocognition (Measurement and Treatment Research to Improve Cognition in Schizophrenia [MATRICS] Consensus Cognitive Battery [MCBB]), and social functions (Personal and Social Performance Scale [PSP]) were conducted. Change in cognitive domains was calculated using the reliable change index. Logistic regression analysis was used to assess predictors of cognitive improvement after the intervention. Results: Sixty-two percent of participants improved on at least 1 of the MCCB domains. Higher baseline speed of processing, attention or vigilance, and working memory predicted a positive response to cognitive remediation. Younger age, higher education level, shorter length of stay, and lower PANSS Negative and Disorganized factors were additional predictors. Conclusions and Implications for Practice: Our results indicate the clinical usefulness of cognitive remediation and identified a pattern of clinical and cognitive predictors of good response to the intervention. Identification of these predictive factors by clinicians may enhance the outcome and aid in the development of individualized rehabilitative cognitive remediation treatment plans.