| Objective:Schizophrenia is a chronic, severe, and disabling brain disorder with unknown etiology. The onset age is young or middle-age, with disturbances and dyssynchrony of sensation, perception, thinking, emotion, behavior and so on. With the deteriorating process of schizophrenia, cognitive impairments are always accompanied. Cognitive impairment have a long lasting influence to the patient with schizophrenia, and cognitive deficits resulted patients can not learn new skills and return to society. Antipsychotic medication is the main treatment method of schizophrenia, but drug therapy can not improve the social function, professional ability and cognitive function of patients. Effective psychotherapy at the basis of drug maintenance treatment may be an effective way to improve the prognosis of patients with schizophrenia. In this study, the discontiguous naikan cognitive therapy was conducted to patients with paranoid schizophrenia in order to evaluate the effects on cognitive improvement of this psychotherapy. A fitting psychotherapy to patients in rehabilitative period was explored.Methods:From Sept.1st,2009to Mar.31st2010,100patients with paranoid schizophrenia in rehabilitative period were recruied. They all met the diagnostic criteria in International Classification of Diseases, Tenth Edition (ICD-10). They were16to40years old, middle or high school educatied; voluntarily participated in this study, and the consent of the guardian’s and informed consent were made. Antipsychotic drug dosage was stable; no adjustment on the dosage and kind of antipsychotics would be made in short time. The clinically effective criteria were the followed items:reduction rate of the PANSS total score≥50%or the PANSS total score≤60; PANSS G12score scale of≤3。 Patients were divided into study group with discontiguous Naikan cognitive therapy and control group randomly. The study group taken the prescribed drug previously, and was given the discontiguous Naikan cognitive therapy (DNCT) for4weeks simultaneously. Control group was given only the prescribed drug medication. After12weeks follow-up study, evaluation to two groups of patients by some assessment tools were performed, including Raven test (SPM), Wechsler Adult Intelligence Scale(WAIS), Wisconsin Card Sorting Test (WSCT),Number cancellation test(CT).Results:In the total of100patients,40patients accepted the discontiguous Naikan cognitive therapy,49patients accepted previously prescribed antipsychotic drugs only,and11patients drew off from the study.Before study,all the scores of the assessments showed no significant differences between the two groups.After12weeks follow up,there are some improvements were found as following:①Number cancellation test scores:net points and error rate scores were significantly different(t=2.522,P=0.013;t=-3.499,P=0.001;t=3.186,P=0.002)between two groups. In the study group,there are significantly improvement were found compared to baseline,and no difference in the control group.(t=-3.116,p=0.003;t=-4.811,p=0.000;t=4.670,p=0.000),After12weeks follow-up,gross points,net points,factor scores and error rate were significantly different compared to baseline(t=-2.270,p=0.029;t=-3.948,p=0.000;t=3.932,p.0.000);and no significant difference was found compared to that after treatment.②Wechsler intelligence scale:the scores of the study group were improved significantly in the factor of arithmetic and digital symbol than before,(t=-2.275,p=0.028;t=-2.096,p=0.043).At the end of12weeks follow up,the factor score of digital symbol was significantly improved than before,(t=-2.296,p=0.027);but no significantly difference than after treatment.③Wisconsin Card Sorting Test:significantly differences were found in the factors of Cc,(t=-2.585,P=0.011)but other factors showed no significantly difference.DNCT group showed significantly improvement in the factors of Cc,Rc,Re,Rpe,nRpe than before treatment(t=-2.562,P=0.014;t=-3.617,P=0.001;t=3.617,P=0.001;t=2.820,P=0.008;t=2.469,p=0.018).In the control group,the score of Rc,Re, nRpe were found statistically difference(t=-2.713,P=0.009;t=2.713,P=0.009;t=2.106,P=0.040)after treatment compared to the baseline.The follow-up results showed that:the control group score of Rc,Re,nRpe still statistically difference compared to baseline(t=2.545,p.0.014;t=2.717,p=0.009;t=2.356,p=0.023), and no statistical significance compared to that of after treatment.In the study group, the score of Cc,Rc,Re,Rpe,nRpe were found significantly difference compared to baseline(t=-2.082:p=0.044:t=-2.655,p=0.011:t=2.265,p=0.011;t=2.511,p=0.016;t=2.149,p=0.038);and the score of Cc factor was found significantly different compared to that of after treatment.④Raven’s Progressive Matrices:Compared with the control group,there were no significant differences in the study group about the scores of IQ pre and after treatment. After12weeks follow up, there were also no significant differences within the two groups. Compared with the baseline, the scores of IQ also no significant differences in the ended point of follow up.Conclusion:①Discontiguous Naikan cognitive therapy can significantly improve the executive function attention level in patients with paranoid schizophrenia, whereas there was no significant improvement in the intelligence;②Discontiguous Naikan cognitive therapy may be an effective psychotherapy to improve the cognitive function of schizophrenia, and it is helpful to the rehabilitation of schizophrenia. |
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