Durability of Effects of Cognitive Remediation on Cognition and Psychosocial Functioning in Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

认知矫正疗法 社会心理的 荟萃分析 精神分裂症(面向对象编程) 认知 随机对照试验 临床心理学 心理信息 认知技能 心理学 睡眠剥夺对认知功能的影响 韦氏成人智力量表 精神科 医学 梅德林 内科学 外科 政治学 法学
作者
Antonio Vita,Sergio Barlati,Anna Ceraso,Gabriele Nibbio,Francesca Durante,Michele Facchi,Giacomo Deste,Til Wykes
出处
期刊:American Journal of Psychiatry [American Psychiatric Association]
卷期号:181 (6): 520-531 被引量:15
标识
DOI:10.1176/appi.ajp.20230396
摘要

Objective: Cognitive remediation provides substantial improvements in cognitive performance and real-world functioning for people living with schizophrenia, but the durability of these benefits needs to be reassessed and better defined. The aims of this study were to provide a comprehensive assessment of the durability of the benefits of cognitive remediation for cognition and functioning in people living with schizophrenia and evaluating potential moderators of effects. Methods: A systematic search was conducted in PubMed, Scopus, and PsycINFO, and reference lists of included articles and Google Scholar were inspected. Eligible studies were randomized clinical trials of cognitive remediation in patients diagnosed with schizophrenia spectrum disorders in which follow-up assessments were included. Screening and data extraction were performed by at least two independent reviewers. Cohen's d was used to measure outcomes. Primary outcomes were changes in cognition and functioning from baseline to conclusion of follow-up. Moderators of the durability of effects were assessed. Results: Of 2,840 identified reports, 281 full texts were assessed and 130 reports on 67 studies with 5,334 participants were included. Cognitive remediation produced statistically significant positive effects that persisted at the end of follow-up in global cognition (d=0.23) and in global functioning (d=0.26). Smaller study samples and single-center studies were associated with better cognitive outcomes; longer treatment and follow-up duration, techniques for transferring cognitive gains to the real world, integration with psychiatric rehabilitation, group format of delivery, and more female participants in the sample were associated with better functional outcomes. Conclusions: Cognitive remediation provides durable improvements in cognition and functioning in schizophrenia. This finding corroborates the notion that cognitive remediation should be implemented more widely in clinical and rehabilitation practice.
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