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  

Effects of cognitive remediation therapy and computerized cognitive remediation therapy on cognitive deficits in patients with schizophrenia： a randomized controlled study

作　　者：谭淑平[1] 邹义壮[1] 王健[2] 杨甫德[1] 张广慧[2] 崔勇[3] 崔介峰[1] 陈楠[1] 范宏振[1] 韩标[1] 张丽霞[2] 宋崇升[1] 李钦云[2] 刘永昌[1] 屈威[1] 艾霞[1] 李东[1] 李晓玲[1] 周东丰[4] 王向群[4] 权文香[4] 李占江[5] 郭俊花[5] 

机构地区：[1]北京回龙观医院精神医学研究中心,100096 [2]北京回龙观医院科教办,100096 [3]北京回龙观医院康复科,100096 [4]北京大学第六医院 [5]北京安定医院

出　　处：《中华精神科杂志》2010年第3期140-145,共6页Chinese Journal of Psychiatry

基　　金：北京市科委2006年重大科研资助项目（D0906001000091）

摘　　要：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.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 symbo

关 键 词：精神分裂症 认知疗法 计算机 认知 

分 类 号：R749.3[医药卫生—神经病学与精神病学]