认知矫正对稳定期双相障碍患者的临床疗效  

Functional remediation for euthymic patients with bipolar disorder

作　　者：张勇 王文辰[2] 席园园 汪娜 李大志 孙霞 张健[2] 李申[3] Zhang Yong;Wang Wenchen;Xi Yuanyuan;Wang Na;Li Dazhi;Sun Xia;Zhang Jian;Li Shen(Henan Key Laboratory of Neurorestoratology,the First Affiliated Hospital of Xinxiang Medical University,Xinxiang 453100,China;Unit of Bipolar Disorder,Tianjin Anding Hospital,Tianjin 300222,China;Department of Psychiatry,Tianjin Medical University,Tianjin 300070,China)

机构地区：[1]新乡医学院第一附属医院/河南省神经修复重点实验室,453100 [2]天津市安定医院心境障碍科,300222 [3]天津医科大学基础学院精神卫生学系,300070

出　　处：《中华精神科杂志》2020年第6期486-492,共7页Chinese Journal of Psychiatry

基　　金：河南省神经修复重点实验室开放课题资助项目(HNSJXF-2018-011)。

摘　　要：目的:探讨认知矫正(functional remediation)对稳定期双相障碍患者的疗效。方法:利用计算机随机分组法,将双相障碍患者按照1∶1比例分为认知矫正组(n=39)和常规治疗组(n=42),并给予12周干预,观察认知矫正组和常规治疗组患者情绪识别、社会和认知功能的疗效差异;分别采用汉密尔顿抑郁量表(Hamilton Depression Rating Scale-17,HDRS 17)、杨氏躁狂量表(Young Mania Rating Scale,YMRS)、Bell-Lysaker情绪识别任务(Bell-Lysaker Emotion Recognition Task,BLERT)、功能测验简版(Functioning Assessment Short Test,FAST)、精神分裂症认知功能评估成套测验[Measurement and Treatment Research to Improve Cognition in Schizophrenia(MATRICS)Consensus Cognitive Battery,MCCB]评估患者的情绪和社会及认知功能,采用重复测量方差分析方法比较2组相关变量指标的差异性和交互作用。结果:(1)2组基线人口学变量和临床变量差异无统计学意义;(2)认知矫正组BLERT负性情绪正确数干预前后变化值显著高于常规治疗组(F=4.53,P<0.05);(3)认知矫正组FAST总分、职业功能、认知功能得分干预前后变化值显著高于常规治疗组(F=8.15、7.94、10.93,均P<0.05);(4)认知矫正组连线测验-A[(41.2±10.2/50.4±6.0)分比(39.9±9.8/44.2±3.6)分]、符号编码[(41.8±5.6/52.5±7.4)分比(40.5±10.4/46.2±4.2)分]、词语学习[(41.2±4.2/51.7±4.2)分比(40.0±5.9/46.0±3.2)分]和持续操作测验[(41.7±11.1/51.4±5.8)分比(43.2±8.3/45.7±2.5)分]干预前后变化值显著高于常规治疗组(F=5.35、4.94、8.77、10.56,均P<0.05)。结论:认知矫正改善稳定期双相障碍患者负性情绪识别能力、职业功能、词语记忆、注意和信息处理速度。Objective To explore the efficacy of functional remediation(FR)on clinical symptoms,emotional recognition and functioning in euthymic patients with bipolar disorder.Methods The study subjects were randomized into the FR group(n=39)and the treatment as usual group(TAU,n=42)at the 1∶1 ratio.They were given a 12-week treatment and the emotional recognition,social and cognitive function were assessed at both baseline and the endpoint by Hamilton Depression Rating Scale-17(HDRS17),Young Mania Rating Scale(YMRS),Bell-Lysaker Emotion Recognition Task(BLERT),Functioning Assessment Short Test(FAST)and The Measurement and Treatment Research to Improve Cognition in Schizophrenia(MATRICS)Consensus Cognitive Battery(MCCB).A chi-square test and independent samples t-test were used to compare the demographic variables and clinical variables between FR group and TAU group,repeated-measures analyses of variances were conducted to compare the impact of two different interventions on clinical symptoms,BLERT emotional recognition,the FAST total scores and six domains,and all domains in MCCB.Results(1)No differences on baseline demographic variables and clinical variables were found between FR group and TAU group(all P>0.05);(2)The repeated-measures analyses revealed that FR group had greater improvement in the correct numbers of BLERT-negative emotional recognition compared to TAU group(F=4.53,P<0.05);(3)FR group showed greater improvements in the FAST total scores including occupational functioning and cognitive functioning compared to TAU group(F=8.15,7.94,10.93,all P<0.05);(4)FR group showed greater improvements in the T-scores for TMT-A(Trail Making Test-A),BACS-SC(Brief Assessment of Cognition in Schizophrenia:Symbol Coding subtest),HVLT-R(Hopkins Verbal Learning Test-Revised)and CPT(Continuous Performance Test)compared to TAU group[(41.2±10.2/50.4±6.0)vs.(39.9±9.8/44.2±3.6),(41.8±5.6/52.5±7.4)vs.(40.5±10.4/46.2±4.2),(41.2±4.2/51.7±4.2)vs.(40.0±5.9/46.0±3.2),(41.7±11.1/51.4±5.8)vs.(43.2±8.3/45.7±2.5),F=5.35,4.

关 键 词：双相情感障碍 认知 社会功能 认知矫正 情绪识别 

分 类 号：R749.4[医药卫生—神经病学与精神病学]