Aim: To evaluate the efficacy of metacognitive group training in reducing psychotic symptoms and improving cognitive insight and functions in people with schizophrenia.
Design: Randomized controlled trial. It was carried out between July 2019 -February 2020.
Methods: Fifty-six patients with schizophrenia were enrolled and randomly assigned to either a control group (N = 29) or a metacognitive training group (N = 27). Blinded assessments were made at baseline, 1-week post-treatment and at follow-up 3 months after treatment. The primary outcome measure was psychotic symptoms based on the Psychotic Symptom Rating Scales (PSYRATS). Secondary outcomes were assessed by the Beck Cognitive Insight Scale (BCIS), the Personal and Social Performance (PSP) scale and the World Health Organization Disability Assessment Schedule (WHODAS).
Results: Completion at follow-up was high (92.86%). The intention-to-treat analyses demonstrated that patients in the metacognitive training group had significantly greater improvements of the Psychotic Symptom Rating Scales delusion score and total score and the Personal and Social Performance Scale, after 3 months, compared with the control group. The effect size was medium to large. The intention-to-treat analyses also demonstrated that patients in the metacognitive training group had significantly greater reductions of the Psychotic Symptom Rating Scales hallucination score and Beck Cognitive Insight Scale self-certainty score post-treatment, compared with the control group. The effect size was medium to large.
Conclusion: The metacognitive training administered by psychiatric and mental health nurses was effective in ameliorating delusions and social functioning over time and it immediately reduced hallucinations post-treatment.
Impact: Metacognitive training for treating psychosis in patients with schizophrenia is efficacious and administration is clinically feasible in the Portuguese context.
Trial registration number: ClinicalTrials.gov ID NCT03891186.
目的: 评价元认知团体训练在减少精神分裂症患者精神病性症状、提高其认知洞察力和认知功能方面的效果。 设计: 在2019年7月至2020年2月期间进行随机对照试验。 方法: 将56例精神分裂症患者随机分为对照组(N=29)和元认知训练组(N=27),并在其进行基线检查、治疗后的第1周和第3个月进行随访,随访时时进行盲法评估。根据精神病症状评定量表(PSYRATS),评估时的主要观察指标为精神病症状。并根据贝克认知洞察力量表(BCIS)、个人和社会表现量表(PSP)和世界卫生组织残疾评估表(WHODAS),对次要结果进行评估。 结果: 达成了较高的随访完成率(92.86%)。意向-治疗分析表明,与对照组相比,元认知训练组患者在经历3个月训练后,其精神病症状评定量表中的幻觉评分和总分以及个人和社会表现量表的得分情况有更显著的改善,效应值从中变为高。意向治疗分析还表明,与对照组相比,元认知训练组患者在接受治疗后,其精神病症状评定量表的幻觉评分和贝克认知洞察力量表的自我确定性评分显著降低,效应值从中变为高。 结论: 精神科护士和心理健康护士所实施的元认知训练能有效地改善病患的幻想症状、提高其社会功能,并能立即减少治疗后所产生的幻觉。 影响: 元认知训练治疗精神分裂症患者的精神病是有效的,且就葡萄牙的实施情况而言,该训练临床可行。 试验注册号 ClinicalTrials.gov ID NCT03891186.
Keywords: Beck Cognitive Insight Scale (BCIS); Personal and Social Performance (PSP) scale; Psychotic Symptom Rating Scales (PSYRATS); cognitive insight; mental health nursing; metacognitive training; psychiatric nursing; psychotic symptoms; randomized controlled trial; schizophrenia; social functioning.
© 2020 John Wiley & Sons Ltd.