Efficacy of a Cognitive Remediation Treatment Program for Bipolar Disorder

双相情感障碍认知矫正治疗方案的疗效

• 批准号: 8110347
• 负责人: KATHRYN Eve LEWANDOWSKI
• 金额: $ 14.99万
• 依托单位: MCLEAN HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-01 至 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8110347
• 关键词: Address; Adult; Age; Area; Award; Behavioral; Bipolar Disorder; Brain; Characteristics; Clinical; Clinical Trials; Cognition; Cognitive; Cognitive deficits; Cognitive remediation; Collaborations; Communities; Computers; Control Groups; Development; Diagnosis; Disease; Dose; Elements; Environment; Evaluation; Exhibits; Functional disorder; Funding; Future; Goals; Health; Hospitals; Hour; Image; Impaired cognition; Intervention; Intervention Studies; Investigation; K-Series Research Career Programs; Measures; Mediating; Mediator of activation protein; Mental Health; Mental disorders; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; National Institute of Mental Health; Neurobehavioral Manifestations; Neurocognition; Neurocognitive; Neurocognitive Deficit; Neurosciences; Onset of illness; Outcome; Outcome Study; Outpatients; Participant; Patients; Pharmaceutical Preparations; Pharmacotherapy; Phase; Phenotype; Populations at Risk; Positioning Attribute; Protocols documentation; Psychologist; Psychopathology; Psychotic Disorders; Public Health; Randomized; Recommendation; Recording of previous events; Recruitment Activity; Research; Research Personnel; Research Project Grants; Research Support; Review Literature; Sampling; Schizoaffective Disorders; Schizophrenia; Scientist; Secondary to; Secure; Site; Symptoms; Techniques; Time; Training; Training Programs; Treatment outcome; Work; base; career; cognitive change; cognitive enhancement; cognitive function; cognitive neuroscience; design; executive function; experience; fitness; functional improvement; functional outcomes; improved; insight; instructor; interest; knowledge base; medical schools; neuroimaging; novel; patient oriented research; processing speed; programs; psychosocial; skills; treatment program; visual memory

DESCRIPTION (provided by applicant): This is an application for a K23-Mentored Patient-Oriented Research Career Development Award entitled "Efficacy of a Cognitive Remediation Treatment Program for Bipolar Disorder". The candidate is an instructor and assistant research psychologist at McLean Hospital/Harvard Medical School with a background in neurocognitive and behavioral deficits in patients with psychosis and at risk populations. Clinically, the candidate has focused on treatment of adults with severe and persistent mental illness, including patients with schizophrenia (SZ), schizoaffective disorder (SZA), and bipolar disorder (BD). The candidate's work in cognitive phenotypes of psychotic illness and her clinical interests have converged on an interest in the implementation of novel treatment approaches to address cognitive dysfunction in psychosis. She now aims to apply her research and clinical experience to psychosocial clinical trials work specifically targeting neurocognitive dysfunction in patients with BD with psychosis and, ultimately, other psychotic illnesses. Cognitive dysfunction is increasingly recognized as a major feature of BD, present by illness onset, persistent into euthymia, and associated with functional outcome. Deficits are qualitatively similar to those seen in SZ, and may be quantitatively similar in some patient groups (50-55), e.g. in patients with a history of psychosis. Despite strong associations between cognitive impairment and functional outcomes in BD, treatment for these symptoms at present is inadequate. Pharmacotherapies do little to address cognitive symptoms, and may even worsen them. Psychosocial cognitive remediation (CR) treatments have been developed to target these symptoms and their functional correlates, and have shown early promise in patients with SZ in improving both neurocognition and community functioning. However, despite the overlap of neurocognitive deficits between patients with SZ and BD, no studies to date have extended neuroscience- based CR to patients with BD. The present proposal aims to assess the efficacy of CR treatment in patients with BD with a history of psychosis using a 70-hour CR paradigm compared to a dose- matched computer-based control. It is hypothesized that patients in the CR group will exhibit improvements in cognitive and community functioning compared to controls, which will persist during a 6-month durability phase. Additionally, putative mechanisms of functional change will be examined, including mediator effects of cognitive and clinical change on community functioning. 130 patients with BD with a history of psychosis recruited from the Psychotic Disorders Programs at McLean Hospital will be randomized into either the CR or computer control group. CR will be administered using the PositScience Brain Fitness and InSight programs, neuroscience-based training programs that have shown early promise in patients with SZ and are used actively by the Mentor (Dr. Keshavan) and an Advisor (Dr. Vinogradov) on this project. Participants will be assessed on measures of clinical, cognitive, and community functioning at baseline, following the 70-hour treatment or control phase, and again 6 months later. This project is in keeping with the NIH's stated strategic priorities for improving mental health outcomes in patients and strengthening the impact of NIMH-supported research on public health, with specific recommendations for broad implementation of effective psychosocial interventions. The candidate's research examining neurocognition across diagnoses and over time, and her pilot work examining CR in patients with psychosis indicate that a) patients with BD exhibit significant and persistent neurocognitive deficits, b) CR is well-tolerated in patients with BD with psychosis, c) the candidate has access to patients who are appropriate for the proposed study, and d) the candidate can develop and implement longitudinal and treatment-outcome studies of neurocognition in patients with psychotic illness. As an instructor and assistant research psychologist at McLean Hospital/Harvard Medical School, the candidate is well positioned to continue to develop her work toward a career as an independent investigator. She has gained extensive experience with patient oriented research, and now seeks additional training in clinical trials work, CR techniques, quantitative methods, and cognitive neuroscience techniques (including neuroimaging) in order to develop expertise in CR clinical trials and a knowledge base in cognitive neuroscience. Training in these areas is necessary for the development of her academic identity as a clinical scientist conducting independent investigations of CR in BD and other major psychotic illnesses. Additionally, in future work the candidate aims to develop collaborations with experts in cognitive neuroscience and imaging toward identifying mechanisms of cognitive change after CR treatment. The candidate has assembled a team of mentors and advisors for this project who are experts in CR (including the use of the CR programs selected for the present proposal), clinical trails, outcomes in bipolar disorder, quantitative methods in longitudinal research, and cognitive neuroscience and neuroimaging, and with whom she has demonstrated effective and productive collaborations. Additionally, a number of courses have been selected in key training areas, and are available to her through Harvard and its affiliates. Together with the rich training environment of McLean Hospital - Harvard's largest psychiatric training site - the above mentorship and didactics will allow the candidate to develop the skills and expertise necessary to transition to an independent research career, and, by the end of the award period, to develop next phase research projects and secure federal funding in order to undertake them.

描述（由申请人提供）：这是针对K23管理的患者研究职业发展奖的申请，标题为“对双相情感障碍的认知补救治疗计划的疗效”。该候选人是麦克莱恩医院/哈佛医学院的讲师和助理研究心理学家，具有神经认知和行为缺陷的背景，患有精神病患者和风险人群。在临床上，候选人专注于治疗严重和持续性精神疾病的成年人，包括精神分裂症患者（SZ），精神分裂症（SZA）和双相情感障碍（BD）。候选人在精神病的认知表型及其临床兴趣方面的工作对实施新型治疗方法的兴趣汇聚，以解决精神病中认知功能障碍。她现在的目标是将她的研究和临床经验应用于心理社会临床试验工作，专门针对患有精神病的BD患者，最终是其他精神病患者的神经认知功能障碍。 认知功能障碍越来越多地被认为是BD的主要特征，疾病发作，持续体内，与功能结果有关。缺陷在质量上与SZ中的缺陷相似，在某些患者组中可能在定量上相似（50-55），例如在有精神病史的患者中。尽管BD的认知障碍与功能结果之间存在密切的关联，但目前对这些症状的治疗不足。药物疗法对解决认知症状无济于事，甚至可能使它们恶化。已经开发出为针对这些症状及其功能相关性的社会心理认知补救（CR）治疗，并在改善神经认知和社区功能方面表现出了早期的希望。然而，尽管SZ和BD患者之间神经认知缺陷的重叠，但迄今为止，尚无研究对BD患者扩展基于神经科学的CR。本提案旨在评估CR治疗在BD患者患有精神病史的患者使用70小时CR范式与基于剂量匹配的计算机对照相比的功效。假设CR组的患者与对照组相比将表现出认知和社区功能的改善，这将在6个月的耐久性阶段持续存在。此外，将检查功能变化的推定机制，包括认知和临床变化对社区功能的介体影响。从麦克莱恩医院（McLean Hospital）招募的精神病患者的130例BD患者将被随机分为CR或计算机对照组。 CR将使用Positscience大脑健身和洞察力计划进行管理，基于神经科学的培训计划，这些计划已在SZ患者中表现出早期的承诺，并被导师（Keshavan博士）和顾问（Vinogradov博士）积极使用。参与者将在基线，70小时治疗或控制阶段以及6个月后的临床，认知和社区功能的措施中进行评估。该项目符合NIH的既改善患者心理健康成果并加强NIMH支持的公共卫生研究的影响，并具有针对广泛实施有效的社会心理干预措施的特定建议。 候选人的研究研究了跨诊断和随着时间的时间检查神经认知的研究，她的试点工作检查精神病患者的CR表明，a）患有BD的患者表现出严重且持久的神经认知缺陷，b）CR在患有精神病患者的BD患者中得到良好的耐受性，c cr可以访问候选者，并且可以访问候选者并实施候选者，并实施候选者，并实施了候选者，并且D）和D）进行了研究和D）。在精神病患者中。作为麦克莱恩医院/哈佛医学院的讲师和助理研究心理学家，该候选人有能力继续发展自己的工作，从事独立研究员的职业。她在以患者为导向的研究中获得了丰富的经验，现在寻求临床试验工作，CR技术，定量方法和认知神经科学技术（包括神经影像学）的额外培训，以发展CR临床试验的专业知识以及认知神经科学方面的知识基础。在这些领域的培训对于发展为临床科学家的学术身份是必要的，该临床科学家对BD和其他主要精神病疾病进行了独立研究。此外，在未来的工作中，候选人旨在与认知神经科学和成像专家建立合作，以识别CR治疗后认知变化的机制。该候选人已经为该项目组成了一组导师和顾问团队，他们是CR专家（包括使用为本提案选择的CR计划），临床跟踪，双相情感障碍的结果，纵向研究的定量方法以及认知神经科学和神经成像的定量方法，以及她与之有效和生产性和生产力和生产力。此外，在关键培训领域已选择了许多课程，并可以通过哈佛及其分支机构为她提供。与哈佛大学最大的精神病学培训站点麦克莱恩医院的丰富培训环境一起 - 上述指导和教学能力将使候选人能够发展过过渡到独立研究职业所必需的技能和专业知识，并在奖励期结束时，以开发下一阶段的研究项目，并确保联邦资金确保他们承担他们的资金。