統合失調症，発達障害，感情障害に対する認知リハビリテーション（NEAR：Neuropsychological and Educational Approach to cognitive Remediation）の効果に関する検討

Abstract

近年，様々な精神疾患において認知機能障害があることが分かってきており，それらは日常生活や社会生活に大きな影響を及ぼしている．投薬によって精神症状が改善しても，認知機能障害の影響で家庭生活や社会生活に支障を来し，病前と同様の生活に復帰できないことが多い．それらを改善する方法として注目されているのが認知リハビリテーションである．なかでもNEAR（Neuropsychological and Educational Approach to cognitive Remediation）は，学習理論と教育原理を背景に，パソコンソフトを使用するセッションと，生活における認知機能を話し合うセッションから成る，統制のとれたプログラムである．著者は平成23年からNEAR を実施してきた．NEAR は元々統合失調症における認知機能障害のトレーニングプログラムとして開発されたものであるが，同時に発達障害や感情障害に対してもNEAR を実施してきた．本研究での解析症例は，統合失調症群12例，発達障害群13例（広汎性発達障害，注意欠陥／多動性障害，特定不能の学習障害），感情障害群５例（うつ病性障害，双極性障害）である．NEAR の前後で測定した認知機能評価尺度（BACS: The Brief Assessment of Cognition in Schizophrenia）を解析したところ，統合失調症群における運動機能，感情障害群における遂行機能などを除き，ほとんどの項目で改善傾向を認めた．各疾患別にNEAR 前後のBACS 下位検査平均値を比較すると，運動機能において発達障害群が統合失調症群に比べ有意に改善し，遂行機能において統合失調症群が感情障害群に比べ有意に改善した．NEAR 前後のBACS 下位検査のプロフィールも疾患ごとに特徴的であった．NEAR は発達障害など統合失調症以外の精神疾患に対しても有効であり，疾患ごとに効果の現れ方が異なることが示唆された．Today, it is known that cognitive impairment accompanying various neuropsychiatric conditions deters success at work, school, and activities of daily living. Although symptoms may improve, it is difficult to recover to a fully functional life because they cannot stay at home independently, nor continue their occupation owing to cognitive impairment. Cognitive remediation is a rehabilitation program focused on improving cognitive impairment. NEAR (Neuropsychological and Educational Approach to cognitive Remediation) is a well-regulated program consisting of two types of sessions: one that employs computerassisted software and the other that discusses cognitive function in daily life with the learning theory and the principles of education as back ground. We have used the NEAR program for rehabilitation since 2011. Originally, NEAR is a program designed for schizophrenia, but we have also used it for developmental disorders and affective disorders. The subjects of this study were patients with schizophrenia (N=12), developmental disorder (pervasive developmental disorder, attention-deficit/ hyperactivity disorder, and learning disorder not otherwise specified, N=13), and affective disorder (depressive disorder and bipolar disorder, N=5). We found improvements in all aspects of cognition assessed by BACS (The Brief Assessment of Cognition in Schizophrenia) except motor function in schizophrenia and executive function in affective disorder, at baseline and follow-up. Motor function in the developmental disorder group improved significantly compared to the schizophrenia group, and executive function in the schizophrenia group improved significantly compared to the affective disorder group. The six assessment profiles, provided by BACS, were unique to each disorder at baseline and followup. We found that NEAR is an effective program for the improvement of cognitive function in other psychiatric disorders as well as schizophrenia, and represented effects differently in each disorder