慢性精神分裂症住院患者辅以认知矫正治疗的随机对照研究

Randomized controlled trial on adjunctive cognitive remediation therapy for chronically hospitalized patients with schizophrenia

背景认知矫正治疗（CognitiveReinediation Thet’apy，CRT）是一种很有希望的、新的非药物治疗方法，能够减少精神分裂症患者的认知缺损。但未在闲内得到充分的验证。目的探讨认知矫正治疗对慢性精神分裂症患者认知功能、社会功能及n知力的疗效。方法将126例病情相对稳定的慢性精神分裂症住院患者随机分成干预组和对照组。干预组接受行认知矫正治疗，对照组接受常规的工娱治疗，两组在治疗频度和治疗持续时间一致，均为每周5次，共3个月。于治疗前及治疗末分别采用威斯康星卡片分类测验（Wisconsin Card SortingTest，WCST）评估认知功能，采用住院慢性精神分裂症患者社会功能评定量表（ScaleofSocial Skillsofchronicschizophrenialnpatienls，SSSI）评估礼会功能以及采用自知力与治疗态度问卷（Insightand TreatmentAttitude,Questionnaire，ITAQ）评估自知力。结果研究过程中有4例患者脱落，干预组60例、对照组62例最终进入结果分析。治疗3个月后，两组的WCST测评结果均较治疗前显著改善，而干预组的WCST各指标的改善均比对照组明显。两组存3个月治疗后的SSSI总分均显著改善，但改善程度在丽组间无显著性差异；两组的ITAQ总分也均有提高．但干预组的改善程度比对照组更明显。结论在药物治疗的基础上，为期3个月的认知矫正治疗对改善慢性精神分裂症住院患者的认知功能及自知力比常规的工娱治疗更为有效。

Background： Cognitive remediation therapy （CRT） is one of the promising new non-drug approaches to reducing cognitive deficits of patients with schizophrenia that has not yet been fully evaluated in China. Aim： Assess the efficacy of CRT in improving the cognitive functioning, social functioning and insight of patients with chronic schizophrenia. Methods： 126 clinically stable inpatients with chronic schizophrenia were randomly allocated to an intervention group （with CRT） and a treatment as usual group （TAU） （which used standard occupational and recreational therapy methods）. The treatment frequency and duration were the same for the two groups： five times per week for three months. The Wisconsin Card Sorting Test （WCST） was used to evaluate before versus after changes in cognitive function, the Scale of Social Skills of chronic schizophrenia Inpatients （SSSI） was used to assess social functioning, and the Insight and Treatment Attitude Questionnaire （ITAO） was use to assess insight. Results： Four patients dropped out during the study leaving 60 in the CRT group and 62 in the TAU group in the final analysis. Both groups showed significant improvement in WCST measures over the three-month trial but the improvement in the CRT group was significantly greater than that for the TAU group on all of the WCST measures assessed. The total SSSI score improved significantly in both groups over the three months, but the improvement in the two groups was not significantly different. The total ITAO, score also showed significant improvement in both groups over the three months and the degree of improvement was significantly greater in the CRT group than in the TAU group. Conclusions： As an adjunctive treatment to antipsychotic medication, a three month course of CRT is more effective at improving the cognitive functioning and insight of hospitalized patients with chronic schizophrenia than routine occupational and recreational therapy.