Cognitive remediation for individuals with psychosis: efficacy and mechanisms of treatment effects
Cognitive remediation for individuals with psychosis: efficacy and mechanisms of treatment effects
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DOI：
10.1017/s0033291716001951
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发表时间：
2016-12-01
影响因子：
6.9
通讯作者：
Silverstein, S. M.
中科院分区：
文献类型：
--
作者：
Fiszdon, J. M.;Choi, K. H.;Silverstein, S. M.
背景。认知补救（CR）干预对精神病患者的普及部分是基于认知和功能之间建立的良好联系，以及通过针对认知，功能可以改善的假设。虽然许多试验报告了CR的疗效，但它仍然不被认为是一种循证治疗。重要的是，人们对其影响功能的机制知之甚少。在本研究中，我们评估了CR的近端和远端影响，并探讨了潜在的机制。共有75名精神障碍患者被随机分配到基于策略和演练-实践的CR或等候名单对照组，并在基线、2个月干预结束和2个月随访时对训练任务表现、神经认知、功能能力、症状和功能进行评估。与常规治疗相比，CR与训练后针对注意力、视觉空间记忆、语言学习和记忆的训练任务的显著改善有关，在2个月的随访中，组间差异持续存在。这些研究归纳为针对视觉空间记忆、言语学习和记忆、延迟言语记忆和言语工作记忆的神经心理学测量的重大改进。虽然在功能能力、症状或独立生活技能的自我报告测量方面没有与cr相关的改善，但在访谈者评定的功能测量（生活质量量表）方面有影响，这主要是由心理内基础子量表驱动的。最后，对于随机分配到CR组的受试者，训练任务改善、神经心理改善和功能测量之间存在显著的中等相关性。这表明CR与认知和功能变化之间存在复杂的多因素关系。
Background. The popularity of cognitive remediation (CR) interventions for individuals with psychosis is in part based on the well-established link between cognition and functioning and the assumption that by targeting cognition, function can improve. While numerous trials have reported CR's efficacy, it is still not considered an evidence-based treatment. Importantly, little is known about the mechanisms through which it may affect functioning.Method. In this study, we evaluated CR's proximal and distal effects, and examined potential mechanisms. A total of 75 individuals with psychotic disorders were randomized to a combination of strategy-based and drill-and-practice CR or wait-list control, with assessments of training task performance, neurocognition, functional capacity, symptoms and functioning conducted at baseline, end of the 2-month intervention, and 2-month follow-up.Results. Compared with treatment as usual, CR was associated with large post-training improvements on training tasks targeting attention, visuospatial memory, and verbal learning and memory, with persisting group differences at the 2-month follow-up. These generalized to mostly large improvements on neuropsychological measures targeting visuospatial memory, verbal learning and memory, delayed verbal memory and verbal working memory. While there were no CR-associated improvements on measures of functional capacity, symptoms, or a self-report measure of independent living skills, there was an effect on an interviewer-rated measure of functioning (Quality of Life Scale), which appeared primarily driven by the Intrapsychic Foundations subscale. Finally, for those randomized to CR, there were significant, medium-sized correlations between training task improvement, neuropsychological improvement and functioning measures.Conclusions. This suggests a complex, multifactorial relationship between CR, and cognitive and functional change.