Compensatory cognitive training for psychosis: effects in a randomized controlled trial.
Compensatory cognitive training for psychosis: effects in a randomized controlled trial.
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DOI：
10.4088/jcp.12m07686
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发表时间：
2012-09
期刊：
影响因子：
--
通讯作者：
Jeste DV
中科院分区：
文献类型：
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作者：
Twamley EW;Vella L;Burton CZ;Heaton RK;Jeste DV
精神分裂症认知障碍的治疗迫在眉睫。我们开发并测试了为期12周的以小组为基础的、手工的、补偿性认知训练(CCT)干预，目标是前瞻记忆、注意力、学习/记忆和执行功能。干预的重点是补偿性策略，如日历使用、自我对话、做笔记和六步解决问题的方法，不需要计算机。在一项随机对照试验中，69名患有DSM-IV原发精神障碍的门诊患者被分配到单独接受标准药物治疗(SP)或CCT+SP治疗12周。在基线、治疗后和3个月的随访中进行神经心理表现和功能能力(主要结果)和精神症状严重程度、生活质量、社会技能表现、认知洞察力和自我报告的日常功能(次要结果)的评估。数据是在2003年9月至2009年8月期间收集的。多层次线性模型分析显示，持续认知测验对后续注意力(p=0.049)、治疗后和后续行动时的言语记忆(PS≤0.039)以及后续行动时的功能能力(加州大学伯克利分校基于绩效的技能评估)(p=0.004)有显著的影响。对照组在治疗后和随访时的阴性症状严重程度(PS≤0.025)和随访时的主观生活质量(P=0.002)也有不同程度的改善。补偿性认知训练是一种低技术、短暂的干预措施，不仅有可能改善精神病患者的认知表现，而且还有可能改善功能技能、消极症状和自我评估的生活质量。
Treatments for the cognitive impairments of schizophrenia are urgently needed. We developed and tested a 12-week, group-based, manualized, Compensatory Cognitive Training (CCT) intervention targeting prospective memory, attention, learning/memory, and executive functioning. The intervention focused on compensatory strategies such as calendar use, self-talk, note-taking, and a six-step problem-solving method, and did not require computers. In a randomized controlled trial, 69 outpatients with DSM-IV primary psychotic disorders were assigned to receive standard pharmacotherapy (SP) alone or CCT + SP for 12 weeks. Assessments of neuropsychological performance and functional capacity (primary outcomes) and psychiatric symptom severity, quality of life, social skills performance, cognitive insight, and self-reported everyday functioning (secondary outcomes) were administered at baseline, post-treatment, and 3-month follow-up. Data were collected between September 2003 and August 2009. Hierarchical linear modeling analyses demonstrated significant CCT-associated effects on attention at follow-up (p=0.049), verbal memory at post-treatment and follow-up (ps≤0.039), and functional capacity (UCSD Performance-based Skills Assessment) at follow-up (p=0.004). The CCT group also differentially improved in negative symptom severity at post-treatment and follow-up (ps≤0.025) and subjective quality of life at follow-up (p=0.002). Compensatory Cognitive Training, a low-tech, brief intervention, has the potential to improve not only cognitive performance, but also functional skills, negative symptoms, and self-rated quality of life in people with psychosis.