认知矫正治疗慢性精神分裂症患者认知功能缺陷的随机对照研究
인지교정치료만성정신분렬증환자인지공능결함적수궤대조연구
Effects of cognitive remediation therapy and computerized cognitive remediation therapy on cognitive deficits in patients with schizophrenia: a randomized controlled study
  • 万方数据
    中华精神科杂志 중화정신과잡지
    CHINESE JOURNA OF PSYCHIATRY
    2010年 3期 140-145 ,共6页

    谭淑平%邹义壮%王健%杨甫德%张广慧%崔勇%崔介峰%陈楠%范宏振%韩标%张丽霞%宋崇升%李钦云%刘永昌%屈威%艾霞%李东%李晓玲%周东丰%王向群%权文香%李占江%郭俊花

    담숙평%추의장%왕건%양보덕%장엄혜%최용%최개봉%진남%범굉진%한표%장려하%송숭승%리흠운%류영창%굴위%애하%리동%리효령%주동봉%왕향군%권문향%리점강%곽준화

    精神分裂症%认知疗法%计算机%认知 精神分裂癥%認知療法%計算機%認知
    정신분렬증%인지요법%계산궤%인지
    Schizophrenia%Cognitive therapy%Computers%Cognition
    目的 探讨认知矫正治疗(CRT)和计算机认知矫正治疗(CCRT)对精神分裂症患者认知缺陷的疗效.方法 180例慢性期病情稳定的精神分裂症患者随机分成3组,CCRT组、CRT组和工娱治疗(WAT)组.CCRT组108例,治疗以自主开发的计算机认知矫正治疗系统为工具,每周4次,每次45 min,持续3个月;CRT组36例,以Ann Delahunty和Rodney Morice等制定的神经认知矫正手册(汉化)为治疗工具,在治疗师的指导下进行认知矫正治疗;WAT组36例,接受相同时间的工娱治疗.3组在治疗频度和治疗持续时间上完全一致.治疗前后及治疗结束后第3个月分别进行临床症状和认知功能评定,内容包括阳性和阴性症状量表(PANSS)、精神分裂症认知功能成套测验(MCCB)、威斯康星卡片分类测验(WCST).结果 治疗结束后及随访第3个月时,CCRT组和CRT组在改善WCST完成分类数、连线测验、空间广度方面显著优于WAT组(P均＜0.05);CCRT组在空间广度方面明显优于CRT组(P＜0.05),CRT组在符号编码方面则优于CCRT组(P＜0.05);3组的临床症状在治疗结束及随访阶段无明显变化.结论 CCRT和CRT均能显著改善慢性精神分裂症患者的认知功能,主要表现在记忆、执行功能、精神运动速度方面;CCRT在空间记忆方面较CRT有优势,CRT在精神运动方面较CCRT有优势,CCRT和CRT在执行功能、记忆、精神运动速度等方面的疗效能持续3个月.
    목적 탐토인지교정치료(CRT)화계산궤인지교정치료(CCRT)대정신분렬증환자인지결함적료효.방법 180례만성기병정은정적정신분렬증환자수궤분성3조,CCRT조、CRT조화공오치료(WAT)조.CCRT조108례,치료이자주개발적계산궤인지교정치료계통위공구,매주4차,매차45 min,지속3개월;CRT조36례,이Ann Delahunty화Rodney Morice등제정적신경인지교정수책(한화)위치료공구,재치료사적지도하진행인지교정치료;WAT조36례,접수상동시간적공오치료.3조재치료빈도화치료지속시간상완전일치.치료전후급치료결속후제3개월분별진행림상증상화인지공능평정,내용포괄양성화음성증상량표(PANSS)、정신분렬증인지공능성투측험(MCCB)、위사강성잡편분류측험(WCST).결과 치료결속후급수방제3개월시,CCRT조화CRT조재개선WCST완성분류수、련선측험、공간엄도방면현저우우WAT조(P균＜0.05);CCRT조재공간엄도방면명현우우CRT조(P＜0.05),CRT조재부호편마방면칙우우CCRT조(P＜0.05);3조적림상증상재치료결속급수방계단무명현변화.결론 CCRT화CRT균능현저개선만성정신분렬증환자적인지공능,주요표현재기억、집행공능、정신운동속도방면;CCRT재공간기억방면교CRT유우세,CRT재정신운동방면교CCRT유우세,CCRT화CRT재집행공능、기억、정신운동속도등방면적료효능지속3개월.
    Objective To explore the effects of cognitive remediation therapy (CRT) and computerized cognitive remediation therapy ( CCRT ) on cognitive deficits in patients with schizophrenia. Methods A total of 180 chronic inpatients with schizophrenia in stable clinical condition was randomized divided into three groups: CCRT, CRT and Work and Amusement Therapy (WAT). In addition to medication as usual, and under directions of therapists, patients in CCRT group received computerized cognitive remediation therapy (CCRT) which developed by this research team, CRT group received a Chinese version of manual cognitive remediation therapy derived from Neurocognitive Remediation Manual which revised by Til, Wykes, WAT group received operative musical therapy and dancing training. All of the three types of therapy lasted 3 months with 4 sessions per week, 45 minutes per session. A series of assessment were administrated pre-and post-treatment and 3-month follow up, including clinical symptoms using the PANSS scales and cognitive functions using a Chinese cognitive function test battery of schizophrenia and Wisconsin card sorting test ( WCST ). Results A total of 108 ones was recruited in CCRT group, 36 in CRT group, and 36 in WAT group. There were no significant difference among three groups in age ( 46.4 ±8.9,47.5 ±8. 1,45.8 ± 8.3) ,years of education(10. 0 ±2.5,10.4 ±2.7,10. 1 ±2.6),duration of disease (years) (22. 1 ±10. 2, 23.8 ± 10. 2, 20.9 ± 10.5) ,total score of PANSS (60. 4 ±12.5,61.3 ± 11.7, 62.8 ± 14. 1 ) or any index of cognitive measurement at baseline. After a three-month treatment, comparing with WAT group, significant improvements revealed in categories of WCST test (F=4. 16,P=0. 017),trail A (F=4.25,P = 0. 016), spatial span(F=5.40,P=0. 005),symbol coding ( F = 3.09, P = 0. 048 ) both in CCRT and CRT groups. A significant advantage ( P ＜ 0. 05 ) appeared in spatial span in CCRT group comparing to CRT. However, CRT had an advantage in symbol coding than CCRT(P ＜0.05). At a three-month follow up point, comparing with posttreatment, there was a nonsignificant(F = 1.69, P = 0. 15 )improvement of categories of WCST both in CCRT and CRT. However, a significant improvement of spatial span appeared in CCRT as comparing to CRT and WAT ( F = 2. 79,P = 0. 03 ). There was no significant change of clinical symptoms neither at posttreatment nor at follow up among three groups. Conclusion Both CCRT and CRT can significantly improve cognitive functions of patients with schizophrenia, especially in memory, execute function and psychomotor speed. In generally,the effects on cognitive improvement of CCRT and CRT are similar. However, CCRT have an advantage on spatial memory than CRT. And the effects on psychomotor speed improvement of CRT are superior to CCRT. The effects on execute function, memory, psychomotor speed of CCRT and CRT can maintain three months at least.
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