Effect Of Metacognitive Training On Cognitive Function In Patients With Schizophrenia And Resting-state Functional Magnetic Resonance Study

BackgroundSchizophrenia is a severe psychiatric disorder that has not yet been identified and has chronic persistence.In recent years,studies have found that even if the clinical were application of atypical antipsychotics.However,some patients still have recurrent illness.Because they can not insist on the whole course of antipsychotic drug treatment.Studies have shown that psychotherapy can add a small to medium-sized effect on the basis of medical treatment.Metacognitive training is a new group psychotherapy plan developed for schizophrenia patients.Metacognitive training(MCT)is to improve the understanding of psychotic symptoms in patients with schizophrenia under the premise of improving their delusional beliefs,improving the patient's clinical recovery and prognosis.Moritz et al.reported on the feasibility,safety,and efficacy of MCT.Therefore,this study used resting state functional magnetic resonance imaging(rs-fMRI)to explore brain regions that could predict the efficacy of MCT.Objectives1.To investigate the impact of metacognitive training combined with olanzapine treatment on clinical symptoms and cognitive function in schizophrenia patients.To explore the relationship between the improvement of clinical symptoms,cognitive function and brain area changes in schizophrenia.2.To explore brain markers that can predict the efficacy of MCT by using blood oxygenation level dependent(BOLD)of resting-state functional magnetic resonance imaging(rs-fMRI).3.To explore the differences in brain regions between patients with schizophrenia and healthy people by using blood oxygenation level dependent(BOLD)of resting-state functional magnetic resonance imaging(rs-fMRI).Methods1.The case-control study was used to collect 20 healthy people.Sixty schizophrenic patients who met the diagnostic criteria of schizophrenia according to the international classification of diseases(ICD-10).Finally,thirty-nine schizophrenia successfully completed this study.Patients were randomly assigned to metacognitive training combined with olanzapine treatment(n = 19)as consolidation group and olanzapine treatment(n = 20)as drug group.The study group received olanzapine tablets combined with metacognitive training,and the control group received olanzapine tablets combined with supportive psychotherapy for 8 weeks.The general information of all subjects were collected.2.At baseline and after 8 weeks of treatment,positive and negative syndrome scale(PANSS)and MATRICS cognitive function tests consisted of trail making test A,symbol coding,hopkins verbal learning test-revised(HVLT-R),wechsler memory scale spatial span(WMS-SS),neuropsychological assessment battery-mazes(NAB-M)mayer-alovey caruso emotional intelligence test(MSCEIT),brief visual spatial memory test-revised(BVMT-R),continuous performance test-idential pairs(CPT-IP),category fluency-animal naming fluency(CF-ANF)assessment was performed;and resting state functional magnetic resonance imaging.MATRICS battery for cognitive function tests and functional magnetic resonance scans were performed in 20 normal subjects.Results1.At baseline,there was no significant difference in the scores of complete MATRICS cognitive scales and PANSS scores,negative symptoms scores,general pathological symptoms scores,and delusional symptoms scores in the PANSS scale(P>0.05).After 8 weeks of treatment,there was a significant difference between the experimental group and the control group in PANSS total score,positive symptoms,general pathological symptoms,delusion of PANSS scale,symbol coding,and CF-ANF score(P<0.05).2.After 8 weeks of treatment,the PANSS total score,positive symptoms,general pathological symptoms,P1(delusions),symbol coding,HVLT-R,WMS-SS,and CF-ANF scores were compared with baseline differences between the research group and the control group.The difference was statistically significant(P<0.05).3.Compared with healthy person,schizophrenia had increasing activity in left cerebellar VIII,cerebellar vermis IV,V and left cerebellar III,left medial prefrontal cortex,left inferior frontal gyrus,and right central posterior gyrus decreased.The SVM classification was found to have an accuracy rate more than 75 ? to distinguish schizophrenia with schizoprenia.4.There was a negative correlation between the increased activity of the left medial prefrontal cortex and mental symptoms(r=-0.580,P=0.007).There was a positive correlation between decreased activity of the right tongue and psychiatric symptoms(r=0.522,P=0.022).Left lingual gyrus decreaed activity was negatively correlated with cognitive impairment(r =-0.563,P = 0.012).5.This study found that the increased activity of the left fusiform gyrus(monte-neurological institute coordinates x =-36,y =-60,z =-12,P<0.05)was highly correlated with the effect of MCT treatment.Using SVR analysis,it was found that abnormalities of left lingual gyrus and right lingual gyrus can be used to predict the efficacy of MCT in schizophrenia.Conclusions1.Metacognitive training can improve the cognitive function and clinical symptoms of schizophrenia patients.The brain regions of schizophrenia were abnormal.2.An abnormal brain region in schizophrenic patients can be used as a potential imaging imaging biomarker to distinguish between schizophrenia and normal people.This has certain practical significance for the auxiliary diagnosis of schizophrenia.3.Abnormal brain regions in schizophrenias can be used as potential imaging imaging biomarkers to predict the efficacy of MCT treatment.Abnormal brain regions in patients with schizophrenia are related to clinical symptoms and cognitive function.