Effect of computerized cognitive remediation therapy in improvement of patients with schizophrenia
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摘要:目的
探讨计算机认知矫正治疗（CCRT）联合无抽搐电休克治疗（MECT）对精神分裂症患者认知功能的改善作用。
方法选取70例精神分裂症患者为研究对象，按随机数字表法随机分为对照组和观察组，每组35例。对照组予以药物联合MECT治疗，观察组予以药物联合MECT及CCRT治疗。比较2组临床疗效及治疗前后阳性与阴性症状量表（PANSS）、认知功能成套测验（MCCB）、总体功能评估量表（GAF）、生活质量量表（SQLS）评分。
结果观察组总有效率为91.43%，与对照组80.00%比较，差异无统计学意义（P>0.05）。2组治疗后PANSS中阴性症状、阳性症状、一般精神症状评分均较治疗前降低，差异有统计学意义（P<0.05），但2组间比较差异均无统计学意义（P>0.05）。治疗后，观察组MCCB中的连线测验（TMT）、空间广度测验（SS）、言语记忆测验（HVLT-R）、视觉记忆测验（BVMT-R）、迷宫测验（MAZES）评分均较治疗前提高，且观察组上述5种测试评分均高于对照组，差异有统计学意义（P<0.05）。与对照组比较，观察组GAF评分更高、SQLS评分更低，差异均有统计学意义（P<0.05）。
结论CCRT可有效改善经MECT治疗的精神分裂症患者的认知功能，并改善社会功能和生活质量。
Abstract:ObjectiveTo explore the effect of computerized cognitive remediation therapy (CCRT) combined with modified electroconvulsive therapy (MECT) in improving cognitive impairment of patients with schizophrenia.
MethodsA total of 70 patients with schizophrenia were selected and randomly divided into control group and observation group, with 35 cases in each group. The control group was treated with drugs and MECT, and the observation group was treated with drugs, MECT and CCRT. Clinical efficacy and scores of Positive and Negative Symptom Scale (PANSS), MATRICS Consensus Cognitive Battery (MCCB), Global Assessment Function (GAF) and Schizophrenic Quality of Life Scale (SQLS) before and after treatment were compared between the two groups.
ResultsThe total effective rate of the observation group was 91.43%, which showed no significant difference compared to 80.00% of the control group (P>0.05). After treatment, the scores of negative symptoms, positive symptoms and general mental symptoms in PANSS were significantly lower than those before treatment in both groups (P<0.05), but there were no significant differences between the two groups (P>0.05). After treatment, the scores of trail making test (TMT), spatial span test (SS), Hopkins verbal learning test (HVLT-R), brief visuospatial memory test revised (BVMT-R) and maze test (MAZES) in MCCB in the observation group increased significantly when compared to those before treatment, and were significantly higher than those in the control group (P<0.05). Compared with the control group, the GAF score was significantly higher and the SQLS score was significantly lower in the observation group (P<0.05).
ConclusionCCRT can effectively improve the cognitive function, social function and quality of life in schizophrenic patients treated with MECT.
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表 1 2组临床疗效比较[n(%)]
组别 临床控制 显效 有效 无效 总有效 对照组(n=35) 13(37.14) 11(31.43) 4(11.43) 7(20.00) 28(80.00) 观察组(n=35) 15(42.86) 10(28.57) 7(20.00) 3(8.57) 32(91.43) 
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表 2 2组PANSS评分比较(x±s)
分 组别 时点 阴性症状评分 阳性症状评分 一般精神症状评分 对照组(n=35) 治疗前 23.48±3.12 19.66±2.79 42.49±6.94 治疗后 14.63±2.96* 9.02±2.35* 24.86±5.34* 观察组(n=35) 治疗前 23.59±2.86 19.87±2.68 42.67±6.83 治疗后 13.56±2.54* 8.52±2.04* 23.75±4.68* PANSS: 阳性与阴性症状量表。与同组治疗前相比, * P<0.05。
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表 3 2组MCCB评分比较(x±s)
分 组别 时点 TMT评分 SS评分 HVLT-R评分 BVMT-R评分 MAZES评分 对照组(n=35) 治疗前 0.27±0.06 10.78±3.29 16.52±4.67 12.61±3.77 1.55±0.51 治疗后 0.29±0.05 11.42±3.87 16.13±4.05 11.97±3.64 1.51±0.46 观察组(n=35) 治疗前 0.26±0.07 10.59±3.34 16.42±4.41 12.56±3.85 1.54±0.48 治疗后 0.34±0.05*# 13.71±3.52*# 18.36±3.52*# 14.62±3.52*# 1.75±0.37*# MCCB: 认知功能成套测验; TMT: 连线测验; SS: 空间广度测验; HVLT-R: 言语记忆测验; BVMT-R: 视觉记忆测验; MAZES: 迷宫测验。与同组治疗前相比, * P<0.05; 与对照组治疗后比较, #P<0.05。
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表 4 2组GAF、SQLS评分比较(x±s)
分 组别 时点 GAF评分 SQLS评分 对照组(n=35) 治疗前 53.81±9.33 35.12±8.04 治疗后 60.36±7.98* 24.33±5.17* 观察组(n=35) 治疗前 53.47±8.94 34.89±7.26 治疗后 64.27±7.14*# 18.45±4.56*# GAF: 总体功能评估量表; SQLS: 生活质量量表。
与治疗前比较, * P<0.05; 与对照组比较, #P<0.05。
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