健康与遗传心理学研究室知识库

精神分裂症是一种发病机制不明的长期慢性精神疾病，在人群中的患病率约为1 %。前瞻记忆是指记住未来要去做某事的一种能力。大量研究表明，精神分裂症患者及精神分裂症高危人群均存在前瞻记忆缺损。而前瞻记忆能力的缺损与精神分裂症患者药物管理能力变差，日常生活能力降低密切相关。而这又会阻碍病情的康复、降低患者的生活质量、给照顾者和社会带来负担，因而改善精神分裂症患者的前瞻记忆具有非常重大的现实意义。
执行意向是一种促进目标达成的编码方式，其形式为“如果Y出现，那么我就去做Z"。己有研究表明这一策略能很好促进精神分裂症患者前瞻记忆的提升。尽管如此，目前采用执行意向对精神分裂症的前瞻记忆进行干预的研究仍存在诸多不足，有些问题函待探讨和澄清:C1)目前，研究只采用了持续不超过_5分钟的短期执行意向策略来促进精神分裂症的前瞻记忆表现，这种效应可能不能迁移至其他任务或情境;C2)尽管有研究提示精神分裂症的前瞻记忆缺损与药物管理能力和社会功能呈负相关，但目前尚无研究表明通过前瞻记忆进行干预可以有效提升其药物管理能力和社会功能;(3)执行意向干预对精神分裂症的前瞻记忆的效果能否持续，以及前瞻记忆干预对药物管理能力、社会功能的促进效应能否持续还不清楚。
为探讨上述问题，本研究共招募了42名社区精神分裂症患者，在完成基线测量后被随机分配至执行意向组和对照组，每组21人。两组患者在人口学变量等方面均无显著差异。执行意向组除接受常规药物治疗外，采用小组干预方式，每组6-8人，共接受10次执行意向干预训练，每周2次，每次约90分钟，训练持续_5周。在训练中，主要让精神分裂症患者能独立在日常生活中使用言语一视觉想象组合型执行意向技术。整个干预项目共包含_5个模块:(1)模块1主要针对前瞻记忆及前瞻记忆困难给患者做心理一社会教育，并引出执行意向策略;(2)模块2主要训练执行意向的言语成分;(3)模块3主要训练执行意向的视觉想象成分;(4)模块4训练在模拟情景中使用言语一视觉想象组合型执行意向;(5)模块_5训练在日常生活场景中使用言语一视觉想象组合型执行意向。对照组仅接受常规药物治疗。两组接受前后测，以及3个月后的跟踪测量。主要采用电脑前瞻记忆任务、改编版前瞻记忆筛选任务、打电话任务、前瞻与回溯性记忆问卷等对前瞻记忆进行测查;采用药物管理能力评估任务、操作性功能评估测试、个体和社会功能量表、精神分裂症病人生活质量量表对社会功能进行评估;采用持续性注意测试任务、字符数字广度测试、韦氏记忆测验中的逻辑记忆和视觉再现评估认知功能;以及采用生活满意度问卷、贝克抑郁问卷、状态一特质焦虑问卷对
相关心理状态进行评估。
结果表明，执行意向组和对照组相比，在基于事件、基于时间的电脑前瞻记忆任务和回电话任务表现上都有显著改善，且干预效应可以持续到3个月后。此外，相比于对照组，执行意向组干预后在社会功能测验中的工作能力、社会功能总分及延迟逻辑记忆上均有显著提升;但在前瞻记忆筛选任务中的显著提升仅出现在3个月后。结果还发现对于那些受教育程度低、智力低、认知功能差、社会功能差的患者，通过干预能在前瞻记忆表现上获得更大程度的提升。
综上，我们的干预项目能较好的提升精神分裂症患者的前瞻记忆水平，且能维持至3个月。同时对患者的社会功能也有短期的提升作用。对于基线功能水平较差的患者能通过干预在前瞻记忆能力上获得更大的提升。再结合其结构化、低成本、低脱落率的优点，该干预方法具有在临床上推广的潜在价值。

Schizophrenia, a type of chronic disabling mental illness, is associated with sever cognitive deficits. Prospective memory refers to the ability to remember to carry out intended actions in the future. Numerous studies showed that schizophrenia patients and individuals at high risk for schizophrenia manifested deficits in prospective memory. Moreover, the prospective memory difficulty among schizophrenia patients concurred with their poor medication management and social function. Those deficient functions may prevent schizophrenia patients from recovery and independent living, which cause burdens to care-givers and the society. Thus, it become urgently needed to intervene prospective memory in schizophrenia patients.
Implementation intentions, an encoding strategy to facilitate behaviors in the typical form of "if I encounter丫then I will do Z", has manifested robust effect in prospective memory. Notwithstanding, some issues still needed to be clarified. Firstly,previous studies adopting implementation intentions manipulation to improve prospective memory in schizophrenia patients typically just require patients to encode the instructions in less than _5 minutes before the experiments. However, the brief instruction manipulation and ignoring training participants to apply the techniques actively in daily fife may result in weak transfer effects as well as lasting effects. In addition, although some studies showed that prospective memory was correlated with medication management and social function among schizophrenia patients, no study examined whether the intervention for prospective memory in schizophrenia patients can improve medication management ability and social function. Moreover, it was unknown whether the implementation intention training can improve prospective memory, medication management ability and social function with lasting effects.
To answer the above questions, a total of 42 outpatients were recruited and randomly assigned to the implementation intentions (n=21)and the treatment as usual (n=21)group. The two groups showed no difference in any measurements at baseline.The implementation intentions group received implementation intentions training as well as regular medication treatment. The 10-session intervention program was conducted twice a week, and the participants attended the 1.5-hour session in groups of 6一8 participants. The patients were instructed to flexibly apply the combination of verbal and imagery encoding strategy in daily life. The current implementation intentions program consisted of 5 modules:l)psycho-education introduction of prospective memory and the prospective memory difficulties in daily life; 2) training the verbal component; 3) training the visual imagery component; 4) simulated application of implementation intentions; 5) generalized exercises in daily life.Treatment as usual group mainly received regular medication treatment. The two groups received a series of measures on prospective memory, medication management,social function, neurocognition, and psychological state at baseline, post-treatment and 3-month follow-up. Prospective memory was assessed by computer-based prospective memory task, adapted Memory for Intentions Screening Test (MIST),phone call task, Prospective and Retrospective Memory Questionnaire (PRMQ).Medication management was measured by Medication Management Ability Assessment (MMAA). Social function was measured by Beijing Performance-based Functional Ecological Test (BJ-PERFECT), Personal and Social Performance scale (PSP) and Schizophrenia Quality of Life Scale (SQLS). Cognition was assessed by Sustained Attention to Response Task (SART), Chinese version of Letter-Number Span Test, logical memory and visual reproduction subscales of the Wechsler Memory Scale一Revised. Psychological state was measured by Satisfaction With Life Scale (SWLS), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI).
The results showed training一associated improvements on computer-based prospective memory and phone call task at post-treatment and 3-month follow-up assessments. In addition, implementation intentions training improved working ability subdomain and total score of BJ-PERFECT and logical memory delayed recall at post-treatment but elevated MIST performance at 3-month follow-up. The results also showed that less education, lower IQ, weaker cognition and psychosocial function predicted more improvements in prospective memory performance.
To summarize, our intervention program showed good effect and durability for prospective memory in schizophrenia patients. Besides, the program demonstrated short-term effects in social function and benefited more for patients with lower baseline functions. Thus, the low-cost, low-dropping rate training program has the potential to be widely used in community settings.