統合失調症に対する短期認知リハビリテーション介入の実現可能性と有効性：ランダム化アクティブコントロール試験

Schizophrenia is a severe mental disorder; those affected have a high prevalence of functional impairment and disability. Although cognitive remediation interventions for schizophrenia are effective, the feasibility of short interventions for patients requiring hospitalization remains unclear. The current study aims to investigate the impact of short interventions (i.e., four sessions) for patients hospitalized with acute (and sub-acute) episodes of schizophrenia.

The intervention consisted of one of three cognitive remediation programs: CogPack (CGP), Integrated Psychological Therapy (IPT), and Integrated Neurocognitive Therapy (INT). Outcomes were feasibility and efficacy. Feasibility was measured by treatment participation/, completion rate. Efficacy was measured by symptom load, psychosocial functioning, and cognitive performance.

83 inpatients with schizophrenia participated in the study. Patients in the INT group had higher adherence and engagement rates than those in the IPT and CGP groups. Participants who completed INT showed a greater improvement in psychopathology (PANSS), psychosocial functioning (mini-ICF-APP) and neurocognition (MCCB). Additionally, a reduction in the need for care was demonstrated (HoNOS).

Based on our findings, short courses of complex cognitive remediation interventions, such as INT, are both practical and feasible in acute stages of the disorder requiring hospitalization. Those in the INT group demonstrated superior adherence and engagement rates and more robust effects. Training and continuity of therapeutic teams appear to have a major influence on the extent of the effects (as the comparison of INT and IPT demonstrated). Consequently, INT, originally designed for outpatients, could be a standard therapy for schizophrenia, including for inpatients, in all stages of the disorder.