Neurocognitive enhancement therapy with work therapy -: Effects on neuropsychological test performance
Neurocognitive enhancement therapy with work therapy -: Effects on neuropsychological test performance
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DOI：
10.1001/archpsyc.58.8.763
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发表时间：
2001-08-01
影响因子：
--
通讯作者：
Wexler, BE
中科院分区：
文献类型：
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作者：
Bell, M;Bryson, G;Wexler, BE
背景：认知缺陷是精神分裂症患者社会和职业功能障碍的主要决定因素。在这项研究中，我们确定了神经认知增强疗法（NET）与工作疗法（WT）相结合是否会改善与训练任务相关但不同的神经心理测试的表现。方法：65例精神分裂症或分裂情感性障碍患者随机分为NET加WT组或单独WT组。神经认知增强疗法包括基于计算机的注意力、记忆力和执行功能任务训练；信息处理组；以及对工作场所认知表现的反馈。工作治疗包括在医疗中心（如收发室、庭院、图书馆）实习的带薪工作活动，并提供相关支持。在入院时和5个月后分别进行神经心理测试。结果：入组前，两组在神经心理测试中均表现较差。接受NET+WT治疗的患者在执行功能、工作记忆和情感识别的前测后测试变量上有较大的改善。NET+WT组中多达60%的人在某些方面有所改善，并且有4到5倍的可能性显示出较大的效应量改善。NET+WT组正常工作记忆表现的患者数量显著增加，从45%增加到77%，而接受WT组则从56%减少到45%。结论：精神分裂症患者认知功能障碍的计算机训练可以推广到独立的结果测量中。效果可能来自NET和WT之间的协同作用，NET鼓励心理活动，而WT允许心理活动的自然环境得到锻炼、推广和加强。
Background: Cognitive deficits are a major determinant of social and occupational dysfunction in schizophrenia. In this study, we determined whether neurocognitive enhancement therapy (NET) in combination with work therapy (WT) would improve performance on neuropsychological tests related to but different from the training tasks.Methods: Sixty-five patients with schizophrenia or schizoaffective disorder were randomly assigned to NET plus WT or WT alone. Neurocognitive enhancement therapy included computer-based training on attention, memory, and executive function tasks; an information processing group; and feedback on cognitive performance in the workplace. Work therapy included paid work activity in job placements at the medical center (eg, mail room, grounds, library) with accompanying supports. Neuropsychological testing was performed at intake and 5 months later.Results: Prior to enrollment, both groups did poorly on neuropsychological testing. Patients receiving NET+WT showed greater improvements on pretest-post test variables of executive function, working memory, and affect recognition. As many as 60% in the NET+WT group improved on some measures and were 4 to 5 times more likely to show large effect-size improvements. The number of patients with normal working memory performance increased significantly with NET+WT, from 45% to 77%, compared with a decrease from 56% to 45% for those receiving WT.Conclusions: Computer training for cognitive dysfunction in patients with schizophrenia can have benefits that generalize to independent outcome measures. Efficacy may result from a synergy between NET, which encourages mental activity, and WT, which allows a natural context for mental activity to be exercised, generalized, and reinforced.