Understanding the Mechanisms of Cognitive Remediation on Recovery in People With Early Psychosis: A Mediation and Moderation Analysis.

IF 5.3 1区 医学 Q1 PSYCHIATRY
Rose Tinch-Taylor, Andrew Pickles, Dominic Stringer, Emese Csipke, Matteo Cella, Paul McCrone, Clare Reeder, Max Birchwood, David Fowler, Kathryn Greenwood, Sonia Johnson, Jesus Perez, Rosa Ritunnano, Andrew Thompson, Rachel Upthegrove, Jon Wilson, Alex Kenny, Iris Isok, Eileen M Joyce, Til Wykes
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Abstract

Background: To provide precision cognitive remediation therapy (CR) for schizophrenia, we need to understand whether the mechanism for improved functioning is via cognition improvements. This mechanism has not been rigorously tested for potential moderator effects.

Study design: We used data (n = 377) from a randomized controlled trial using CIRCuiTS, a therapist-supported CR, with participants from first-episode psychosis services. We applied structured equation modeling to test whether: (1) CR hours explain the goal attainment functional outcome (GAS) at posttreatment, (2) global cognitive improvement mediates GAS, and if (3) total symptoms moderate the CR hours to cognitive improvement pathway, and/or negative symptoms moderate the cognition to functioning pathway, testing moderator effects via the mediator or directly on CR hours to functioning path.

Study results: CR produced significant functioning benefit for each therapy hour (Coeff = 0.203, 95% CI 0.101-0.304, P < .001). The mediated path from CR hours to cognition and cognition to functioning was small and nonsignificant (Coeff = 0.014, 95% CI = -0.010, 0.037, P = .256). Total symptoms did not moderate the path to cognition (P = .211) or the direct path to outcome (P = .896). However, negative symptoms significantly moderated the effect of cognitive improvements on functioning (P = .015) with high negative symptoms reducing the functional gains of improved cognition.

Conclusions: Although cognitive improvements were correlated with functioning benefit, they did not fully explain the positive effect of increased therapy hours on functioning, suggesting additional CR factors also contribute to therapy benefit. Negative symptoms interfere with the translation of cognitive improvements into functional gains so need consideration.

了解认知矫正对早期精神病患者康复的影响机制:中介与调节分析
背景:为了对精神分裂症进行精确的认知矫正治疗(CR),我们需要了解功能改善的机制是否是通过认知改善。研究设计:研究设计:我们使用了一项随机对照试验的数据(n = 377),该试验使用了治疗师支持的 CR CIRCuiTS,参与者来自精神病首发服务机构。我们采用结构方程模型来检验:(1) CR 小时数是否能解释治疗后的目标实现功能结果(GAS);(2) 整体认知改善是否能调节 GAS;(3) 总症状是否能调节 CR 小时数到认知改善的路径,和/或阴性症状是否能调节认知到功能的路径,检验通过中介效应或直接通过 CR 小时数到功能路径的调节效应:研究结果:CR 对每一治疗小时的功能改善效果显著(Coeff = 0.203,95% CI 0.101-0.304,P):虽然认知能力的改善与功能受益相关,但它们并不能完全解释治疗时数增加对功能的积极影响,这表明 CR 的其他因素也有助于治疗受益。负面症状会干扰认知改善转化为功能改善,因此需要加以考虑。
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来源期刊
Schizophrenia Bulletin
Schizophrenia Bulletin 医学-精神病学
CiteScore
11.40
自引率
6.10%
发文量
163
审稿时长
4-8 weeks
期刊介绍: Schizophrenia Bulletin seeks to review recent developments and empirically based hypotheses regarding the etiology and treatment of schizophrenia. We view the field as broad and deep, and will publish new knowledge ranging from the molecular basis to social and cultural factors. We will give new emphasis to translational reports which simultaneously highlight basic neurobiological mechanisms and clinical manifestations. Some of the Bulletin content is invited as special features or manuscripts organized as a theme by special guest editors. Most pages of the Bulletin are devoted to unsolicited manuscripts of high quality that report original data or where we can provide a special venue for a major study or workshop report. Supplement issues are sometimes provided for manuscripts reporting from a recent conference.
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