绘画训练助力精神分裂症认知缺陷神经生理康复

Painting Training Facilitates Neurophysiological Rehabilitation of Cognitive Deficits in Schizophrenia

摘要: 研究背景：精神分裂症是一种严重的精神障碍，认知缺陷是其核心症状之一，严重影响患者的日常生活和社会功能。有效的认知缺陷康复对于精神分裂症患者的全面康复至关重要。然而，传统的康复方法在改善认知功能方面仍存在诸多不足。传统的康复方法，如娱乐疗法、职业治疗等，虽然在缓解症状、改善社交能力方面取得了一定效果，但在认知功能的提升上往往效果有限。这些方法缺乏针对性，难以系统地训练患者的认知功能，尤其是在记忆、注意力和执行功能等方面。基于以上背景，绘画康复作为一种新兴的康复手段逐渐被引入。绘画康复通过艺术创作的过程，能够激发患者的创造力和想象力，提供一种情感表达和自我认知的平台。在认知康复方面，绘画康复通过复杂的脑力活动，促进患者的注意力、记忆力和执行功能的改善。相比于传统的工娱疗法其对患者的稳定、视觉知觉组织训练、精细动作训练和大脑连接活化都可能有一定的积极作用。虽然目前国内外关于绘画训练对精神分裂症患者的康复研究取得了一定的进展，但其具体研究多停留于临床表现和量表得分等传统层面，关键的神经生理层面改善情况并没有一个好的结论，也没有使用合适的方法去在神经生理层面去进行评估。研究目的：本研究旨在从神经生理层面验证绘画治疗对精神分裂症患者认知功能缺陷的康复效果，验证一种神经电生理技术在这一领域的价值。研究方法：通过行为学(MoCA)和认知神经电生理(ERP)技术对其进行验证。本研究在通辽市精神卫生中心共招募了139名精神分裂症患者，均为非急性期，被试分为实验组和对照组，实验组接受12周的常规康复治疗结合绘画训练康复，对照组接受常规康复治疗，采用蒙特利尔认知评估(MoCA)和事件相关电位对患有精神分裂症的个体进行认知能力评估，从行为学和认知神经电生理这两个不同的层面去验证其认知功能缺陷的康复效用。研究结果：两组患者在经过12周的康复治疗后，认知能力都有所改善，绘画组的MoCA得分改善情况明显上升，但两组均有所改善，MoCA结果并不能有效的证明绘画训练的有效性；通过ERP技术的应用，研究发现绘画组的相位同步性(ITPC)具有显著的上升，而对照组则几乎没有显著变化；相较于ITPC这个指标而言，波幅和潜伏期的变化并不明显。研究结论：传统的MoCA虽然能在一定程度上反映认知的变化，但不能证明绘画训练相较于传统康复的有效性；事件相关电位从神经电生理层面充分证明绘画训练的有效性，代表了绘画训练能够从神经生理层面改善精神分裂症患者的认知功能；明确了事件相关电位技术用以评估绘画训练的极高价值。

Abstract: Background of the Study: Schizophrenia is a serious mental disorder, and cognitive deficit is one of its core symptoms, which seriously affects patients’ daily life and social functions. Effective rehabilitation of cognitive deficits is essential for the comprehensive rehabilitation of patients with schizophrenia. However, traditional rehabilitation methods still have many shortcomings in improving cognitive function. Although traditional rehabilitation methods, such as recreational therapy and occupational therapy, have achieved certain effects in relieving symptoms and improving social skills, they often have limited effects in improving cognitive function. These methods lack pertinence and are difficult to systematically train patients’ cognitive function, especially in memory, attention and executive function. Based on the above background, painting rehabilitation as a new means of rehabilitation has been gradually introduced. Through the process of artistic creation, painting rehabilitation can stimulate the creativity and imagination of patients, and provide a platform for emotional expression and self-cognition. In cognitive rehabilitation, painting rehabilitation promotes the improvement of patients’ attention, memory and executive function through complex mental activities. Compared with traditional public entertainment therapy, it may have a certain positive effect on patients’ emotional stability, visual perception organization training, fine motor training and brain connection activation. Although the research on the rehabilitation of schizophrenic patients by painting training at home and abroad has made some progress, its specific research mostly stays at the traditional level of clinical manifestations and scale scores. There is no good conclusion on the improvement of the key neurophysiological level, and there is no appropriate method to evaluate it at the neurophysiological level. Objectives: The purpose of this study is to verify the effect of painting treatment on the rehabilitation of cognitive deficits in patients with schizophrenia from the perspective of neurophysiology, and to verify the value of a neuroelectrophysiological technology in this field. Methods：It was validated by behavioral (MoCA) and cognitive neuroelectrophysiological techniques. A total of 139 schizophrenic patients were recruited in Tongliao Third People’s Hospital in this study. They were all in non-acute phase. The subjects were divided into experimental group and control group. The experimental group received 12 weeks of conventional rehabilitation therapy combined with painting training rehabilitation, and the control group received conventional rehabilitation therapy. Montessori cognitive assessment (MoCA) and event-related potential were used to evaluate the cognitive ability of individuals with schizophrenia. The rehabilitation utility of cognitive deficits was verified from two different levels of behavior and cognitive neuroelectrophysiology. Results: After 12 weeks of rehabilitation treatment, the cognitive abilities of the two groups were improved. The MOCA score of the painting group was significantly improved, but both groups were improved. The MOCA results could not effectively prove the effectiveness of painting training; Through the application of ERP technology, the study found that the phase synchronization (ITPC) of the painting group increased significantly, while the control group had little significant change; Compared with the index of ITPC, the changes of amplitude and latency are not obvious. Conclusion: Although traditional MOCA can reflect cognitive changes to a certain extent, it cannot prove the effectiveness of painting training compared with traditional rehabilitation; The event-related potential fully proves the effectiveness of painting training from the perspective of neurophysiology, which represents that painting training can improve the cognitive function of patients with schizophrenia from the perspective of neurophysiology; It is clear that the event-related potential technology is of great value in evaluating painting training.