Randomized Trial to Evaluate the Efficacy of Cognitive Therapy for Low-Functioning Patients With Schizophrenia
Randomized Trial to Evaluate the Efficacy of Cognitive Therapy for Low-Functioning Patients With Schizophrenia
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DOI：
10.1001/archgenpsychiatry.2011.129
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发表时间：
2012-02-01
影响因子：
--
通讯作者：
Beck, Aaron T.
中科院分区：
文献类型：
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作者：
Grant, Paul M.;Huh, Gloria A.;Beck, Aaron T.
背景：功能低下的慢性精神分裂症患者的直接治疗费用很高，由于失去就业和生产力而产生间接费用，并且生活质量低；抗精神病药物和心理社会干预措施在促进改善功能结果方面效果有限。目的：确定为期 18 个月的恢复导向认知治疗计划对改善低功能精神分裂症患者的心理社会功能和阴性症状（无意志-冷漠、快感缺乏-社交性）的疗效。设计、环境和参与者：一项单中心、18 个月、随机、单盲、平行组试验，入组了 60 名患者功能低下、神经认知受损的精神分裂症患者（平均年龄，38.4 岁；33.3% 女性；65.0% 非裔美国人）。干预措施：认知治疗加标准治疗与单独标准治疗比较。主要结果指标：主要结果指标是随机化后 18 个月时的总体评估量表评分。次要结局是随机分组后 18 个月时阴性症状评估量表和阳性症状评估量表的得分。结果：接受认知治疗的患者从基线到 18 个月的整体功能显示出临床显着的平均改善，大于标准治疗的改善（组内 Cohen d 分别为 1.36 和 0.06；调整后平均值 [SE]，58.3 [3.30]分别为 47.9 [3.60]；组间 d=0.56）。与接受标准治疗的患者相比，接受认知治疗的患者也显示出无意愿冷漠的平均减少幅度更大（调整平均值[SE]分别为1.66 [0.31] vs 2.81 [0.34]；P=.01；组间d=-0.66）和阳性症状（幻觉、妄想、混乱）（调整平均值[SE]为9.4 [3.3] vs 18.2） 18 个月时分别为 [3.8]；组间 d=-0.46。分析中控制了年龄，基线抗精神病药物（类别或剂量）或试验过程中药物变化不存在有意义的组间差异。结论：认知治疗可以成功地促进患有显着认知障碍的低功能患者的功能结果、动机和阳性症状的临床有意义的改善。
Context: Low-functioning patients with chronic schizophrenia have high direct treatment costs and indirect costs incurred due to lost employment and productivity and have a low quality of life; antipsychotic medications and psychosocial interventions have shown limited efficacy to promote improved functional outcomes.Objective: To determine the efficacy of an 18-month recovery-oriented cognitive therapy program to improve psychosocial functioning and negative symptoms (avolition-apathy, anhedonia-asociality) in low-functioning patients with schizophrenia.Design, Setting, and Participants: A single-center, 18-month, randomized, single-blind, parallel group trial enrolled 60 low-functioning, neurocognitively impaired patients with schizophrenia (mean age, 38.4 years; 33.3% female; 65.0% African American).Interventions: Cognitive therapy plus standard treatment vs standard treatment alone.Main Outcome Measures: The primary outcome measure was the Global Assessment Scale score at 18 months after randomization. The secondary outcomes were scores on the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms at 18 months after randomization.Results: Patients treated with cognitive therapy showed a clinically significant mean improvement in global functioning from baseline to 18 months that was greater than the improvement seen with standard treatment (within-group Cohen d, 1.36 vs 0.06, respectively; adjusted mean [SE], 58.3 [3.30] vs 47.9 [3.60], respectively; P=.03; between-group d=0.56). Patients receiving cognitive therapy as compared with those receiving standard treatment also showed a greater mean reduction in avolition-apathy (adjusted mean [SE], 1.66 [0.31] vs 2.81 [0.34], respectively; P=.01; between-group d=-0.66) and positive symptoms (hallucinations, delusions, disorganization) (adjusted mean [SE], 9.4 [3.3] vs 18.2 [3.8], respectively; P=.04; between-group d=-0.46) at 18 months. Age was controlled in the analyses, and there were no meaningful group differences in baseline antipsychotic medications (class or dosage) or in medication changes during the course of the trial.Conclusion: Cognitive therapy can be successful in promoting clinically meaningful improvements in functional outcome, motivation, and positive symptoms in low-functioning patients with significant cognitive impairment.