认知康复综合训练改善苯丙胺类依赖者认知功能的随机对照试验

摘要

目的：评估认知康复综合训练对改善苯丙胺类兴奋剂（ATS ）依赖者认知功能障碍的疗效。方法：在强制戒毒机构招募符合精神障碍诊断与统计手册第4版（DSM-IV）苯丙胺类兴奋剂依赖者，随机分为干预组（30例）和对照组（26例）。对照组仅接受常规教育，干预组除接受常规教育外还接受24周的认知康复综合训练，主要包括心理康复与躯体康复。采用中文版CogState量表（CSB ）在干预前（基线）及干预24周末评估两组受试者的认知功能。结果：两组干预前的CSB 各维度得分无统计学差异。在24周末干预结束时，干预组在单卡学习任务[（0.06±0.12）vs.（－0.03±0.14），P＜0.05]、Two-Back任务[（0.12±0.15）vs.（0.01±0.19），P＜0.05]、连续配对学习任务[（－0.46±0.35）vs.（－0.15±0.49），P＜0.05]三个维度得分改善优于对照组。两组其余5个维度得分变化即检出任务、识别任务、国际购物清单任务、Groton迷宫任务、社会情绪识别任务无统计学差异（均P＞0.05）。结论：认知康复综合训练可以改善苯丙胺类依赖者的视觉学习记忆、工作记忆和空间工作记忆，而对其他方面认知功能无明显改善。%Objective:To assess the effect of combined cognitive rehabilitation training on improving cogni-tive dysfunction in amphetamine-type stimulant dependent patients.Methods:Subjects who met the clinical diagno-sis of ATS dependence by DSM-IV in compulsory isolation detoxification institute were randomly assigned into in-tervention group (n =30 )and control group (n =26 ).Control group received a regular education.Intervention group also received a combined cognitive rehabilitation training besides regular education,including psychological and physical rehabilitation for 24 weeks.The Chinese version of CogState Battery (CSB)was used to assess cogni-tive function at baseline and 24 weeks after the intervention.Results:No significant difference was found on all sub-scales scores of CogState Battery between two groups at baseline.At 24 weeks after the intervention,compared to control group,the intervention group had more improvements in three sub-scale scores,i.e.,One Card LearningTask [(0.06 ±0.12)vs. (-0.03 ±0.14),P<0.05],Two-back Task [(0.12 ±0.15)vs. (0.01 ±0.19),P<0.05]and Continuous Paired Association Learning Task [(-0.46 ±0.35)vs. (-0.15 ±0.49),P<0.05].No difference was found on improvements in the rest 5 sub-scale scores,i.e.,Detection Task,Identification Task,Inter-national Shopping List Task,Groton Maze Learning Task and Social Emotional Cognition Task (P >0.05 ).Conclusion:The combined cognitive rehabilitation training could improve amphetamine-type stimulant dependent patients'visual learning and memory,working memory and spatial working memory,while have no significant im-provement on other cognitive functions.