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Seishin Igaku Volume 51, Issue 10 （October 2009）

精神医学 51巻10号（2009年10月発行）

Japanese English

研究と報告

統合失調症の認知機能障害に対する認知矯正療法の効果に関する予備的検討 Explorative Study on the Effect of the Implementation of the Neuropsychological Educational Approach to Cognitive Remediation on Cognitive Dysfunction of Japanese Patients with Schizophrenia 池澤聰 ^1,4 , 朴盛弘 ¹ , 三木志保 ¹ , 加藤正人 ¹ , 玉城国哉 ¹ , 岩崎彰 ³ , 佐藤いづみ ³ , 片山征爾 ^1,3 , 梅林麻紀 ⁴ , 栗村真由美 ⁴ , 速水淑子 ⁴ , 小松千昭 ⁴ , 仙田雪菜 ⁴ , 山田香子 ⁴ , 廣江ゆう ⁴ , 長田泉美 ^1,4 , 大宮啓徳 ⁵ , 佐々木淳也 ⁵ , 加藤明孝 ⁵ , 吉澤丸子 ⁶ , 松村健司 ⁶ , 岡純子 ⁶ , 木村一朗 ⁶ , 兼子幸一 ¹ , 最上多美子 ² , 中込和幸 ¹ , 黒沢洋一 ⁷ Satoru IKEZAWA ^1,4 , Shenghong PU ¹ , Shiho MIKI ¹ , Masato KATO ¹ , Kuniya TAMASHIRO ¹ , Akira IWASAKI ³ , Izumi SATO ³ , Seiji KATAYAMA ^1,3 , Maki UMEBAYASHI ⁴ , Mayumi KURIMURA ⁴ , Yoshiko HAYAMI ⁴ , Chiaki KOMATSU ⁴ , Yukina SENDA ⁴ , Kouko YAMADA ⁴ , Yu HIROE ⁴ , Izumi NAGATA ^1,4 , Hironori OHMIYA ⁵ , Junya SASAKI ⁵ , Toshinori KATO ⁵ , Maroko YOSHIZAWA ⁶ , Kenji MATSUMURA ⁶ , Junko OKA ⁶ , Ichiro KIMURA ⁶ , Koichi KANEKO ¹ , Tamiko MOGAMI ² , Kazuyuki NAKAGOME ¹ , Youichi KUROZAWA ⁷ ¹鳥取大学医学部医学科精神行動医学分野 ²鳥取大学大学院医学系研究科臨床心理学 ³安来第一病院 ⁴養和病院 ⁵米子病院 ⁶渡辺病院 ⁷鳥取大学医学部医学科健康政策医学分野 ¹Division of Neuropsychiatry, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan ²Division of Clinical Psychology, Graduate School of Medical Sciences, Tottori University Faculty of Medicine ³Yasugi Daiichi Hospital ⁴Yowa Hospital ⁵Yonago Hospital ⁶Meiwakai-Medical and Welfare Center Watanabe Hospital ⁷Division of Health Administration and Promotion, School of Medicine, Tottori University Faculty of Medicine キーワード： Schizophrenia , Cognitive dysfunction , Cognitive remediation , NEAR , neuropsychological educational approach to cognitive remediation , BACS-J , Japanese version of brief assessment of cognition in schizophrenia Keyword: Schizophrenia , Cognitive dysfunction , Cognitive remediation , NEAR , neuropsychological educational approach to cognitive remediation , BACS-J , Japanese version of brief assessment of cognition in schizophrenia pp.999-1008

発行日 2009年10月15日 Published Date 2009/10/15

DOI https://doi.org/10.11477/mf.1405101509

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抄録

　近年，統合失調症の社会的転帰の改善を目指して，海外では，認知矯正療法が注目されている。

　筆者らは，コンピューターソフトを用いて行う認知矯正療法の1つであるNeuropsychological Educational Approach to Cognitive Remediation（NEAR）を2007年より統合失調症の治療に導入した。

　その結果，言語記憶・作業記憶・語流暢性・遂行機能など比較的広範囲な認知機能において有意な改善を認めた。今後，認知機能の改善を日常生活場面に般化させるために，包括的な心理社会的リハビリテーションプログラムと組み合わせていくことが有用であると考えられた。

　It is widely accepted that cognitive dysfunction in schizophrenia plays a major role in determining the social outcome of patient. Cognitive remediation therapy was used for Japan with the aim of alleviating the many difficulties that these patients encounter in their social lives. After participating in the 1-week training program in America for clinicians on Neuropsychological Educational Approach to Cognitive Remediation (NEAR), we introduced the approach in Japan. The main aim of this study is to verify the efficacy of 1 year of NEAR sessions on the improvement of cognitive and social functions of patients in Japan.

　Twelve patients with schizophrenia participated in the program which consisted of 2 one-hour sessions a week. Treatment efficacy was assessed in subjects who had completed approximately 6 months of NEAR sessions. In each session, subjects engaged in computer tasks that involved cognitive processing according to the subjects’ cognitive dysfunction profiles. In addition, a group meeting that aimed at promoting motivation and generalization of cognitive skills to daily life was held once a week.

　We measured efficacy by comparing it with the following 3 scales: (a) The Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS-J) as a cognitive function scale, (b) The Life Assessment Scale for Mental Illness (LASMI) as a social function scale.

　The findings of the present study can be summarized as follows; (a) patients showed significant improvement in cognitive function;however, such improvement was not seen in social function, (b) age of onset of illness was positively correlated with the improvement in attention, (c) NEAR attendance rate correlated positively with the improvement in skills required for activities of daily living, (d) baseline attention performance exhibited negative correlation with the improvement in interpersonal skills, (e) the improvement in executive function positively correlated with the improvement in skills required for daily life activites.

　Although the sample size in the present study was small, our findings indicate that the application of NEAR was moderately effective in improving cognition in the case of Japanese patients, and some potential predictors of its efficacy were identified.