Cognitive remediation can improve negative symptoms and social functioning in first-episode schizophrenia: A randomized controlled trial.
Cognitive remediation can improve negative symptoms and social functioning in first-episode schizophrenia: A randomized controlled trial.
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DOI：
10.1016/j.schres.2017.10.005
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发表时间：
2019-01
影响因子：
4.5
通讯作者：
Nuechterlein KH
中科院分区：
文献类型：
--
作者：
Ventura J;Subotnik KL;Gretchen-Doorly D;Casaus L;Boucher M;Medalia A;Bell MD;Hellemann GS;Nuechterlein KH
荟萃分析报告称，认知补救的效果可能不仅仅是认知的改善，还包括对精神分裂症患者的意想不到的好处，如消极症状的减少和功能的改善。此外，一些证据表明，这些潜在的有益作用也存在于精神分裂症的初始病程中，但这一领域的工作仍在发展中。一项随机对照试验比较了80例患者（78%为男性）的认知补救（CR）和健康行为训练（HBT），这些患者平均年龄21.9岁，平均受教育12.3年，在研究开始的两年内首次出现精神病发作。参与者使用CR计划进行培训或接受HBT，包括在6个月内进行50次训练，然后在接下来的6个月内进行强化训练。使用SANS和BPRS评估症状。加州大学洛杉矶分校的社会成就调查评估了社会功能。使用GLMM， 12个月的改善有利于SANS表达症状的CR (p< 0.01)，其中包括情感扁平化（p< 0.01）和痛感（p= 0.04），以及SANS体验症状，包括逃避/冷漠（p= 0.04）和快感缺失/社会性（p< 0.01）。与HBT相比，CR与社会功能改善相关（p= 0.05）。我们证实，在早期精神分裂症患者中，CR的有益作用似乎超越了认知，还改善了阴性症状和社会功能。这些结果表明，当慢性风险因素的减少对促进康复至关重要时，认知补救可能会产生影响。
Meta-analyses have reported that the effects of cognitive remediation might go beyond improvement in cognition to include unexpected benefits for schizophrenia patients such as negative symptom reduction and improvements in functioning. In addition, some evidence indicated that these potentially beneficial effects are also present in the initial course of schizophrenia, but work in this area is still developing. A RCT compared Cognitive Remediation (CR) to Healthy Behaviors Training (HBT) in 80 patients (78% male) with a mean age of 21.9 years and mean education of 12.3 years who had a first psychotic episode within two years of study entry. Participants were trained using CR programs or received HBT involving 50 sessions over 6 months and then booster sessions over the next 6 months. The SANS and BPRS were used to assess symptoms. The UCLA Social Attainment Survey assessed social functioning. Using GLMM, improvements over 12 months were found favoring CR for SANS Expressive Symptoms (p<.01), which was composed of Affective Flattening (p<.01) and Alogia (p=.04), and for SANS Experiential Symptoms, composed of Avolition/Apathy (p=.04) and Anhedonia / Asociality (p<.01). CR was associated with improvements in social functioning (p=.05) as compared to HBT. We confirmed that the beneficial effects of CR appear to extend beyond cognition to improvements in negative symptoms and social functioning in early course schizophrenia patients. These results suggest that cognitive remediation might have an impact when the reduction of risk factors for chronicity is most critical for promoting recovery.
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