Cognitive Training to Improve Work Outcomes in Severe Mental Illness

认知训练可改善严重精神疾病患者的工作成果

• 批准号: 8234175
• 负责人: Elizabeth W Twamley
• 金额: $ 28.53万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8234175
• 关键词: Address; Age; Alcohol or Other Drugs use; Area; Attention; Behavioral; Bipolar Disorder; Brain Diseases; Caring; Categories; Client; Cognition; Cognitive; Cognitive deficits; Communities; Community Integration; Comorbidity; Consensus; Data; Development; Diagnostic; Disease; Distal; Economic Burden; Education; Educational Intervention; Educational process of instructing; Effectiveness; Elderly; Employment; Evidence based practice; Failure; Family; Fostering; Freedom; Goals; Habits; Health Care Costs; Impaired cognition; Income; Individual; Inservice Training; Intervention; Job Satisfaction; Lead; Learning; Length; Life; Major Depressive Disorder; Mediating; Mediator of activation protein; Memory; Mental Health; Mental Health Services; Mental disorders; Meta-Analysis; Modeling; Motivation; National Institute of Mental Health; Neurocognitive; Occupational; Occupations; Outcome; Paper; Participant; Performance; Performance at work; Problem Solving; Productivity; Prospective Studies; Psychiatric therapeutic procedure; Public Health; Quality of life; Randomized Controlled Trials; Recovery; Recruitment Activity; Rehabilitation Research; Rehabilitation therapy; Research; Role; Sampling; Schizophrenia; Services; Severities; Short-Term Memory; Specialist; Supported Employment; Symptoms; Thinking; Time; Training Programs; Unemployment; Vocational rehabilitation; Wages; Work; base; cognitive training; community reintegration; community setting; cost; disability; evidence base; executive function; improved; meetings; middle age; processing speed; programs; psychiatric disability; psychiatric rehabilitation; severe mental illness; skills; success; trial comparing

DESCRIPTION (provided by applicant): Occupational disability is one of the most devastating and costly consequences of severe mental illness (SMI). Supported employment programs such as Individual Placement and Support (IPS) are the most effective way to help people with SMI obtain competitive employment (i.e., "regular jobs" in the community). However, many clients in supported employment either do not work at all or fail to keep their jobs. The cognitive impairments and everyday functioning skills deficits of psychiatric disorders contribute to poor work outcomes, but they are modifiable with Cognitive Training. Pilot data support the effectiveness of IPS and Cognitive Training for clients with SMI, including those who are middle-aged and older. The proposed research aims to evaluate the effectiveness of augmenting IPS supported employment services with a 3-month Cognitive Training program that aims to improve attention, learning, memory, and problem-solving abilities. The Cognitive Training approach is compensatory, in that it teaches strategies for overcoming cognitive deficits, and aims to help clients develop better thinking and memory habits that will last a lifetime. In the proposed 24- month randomized controlled trial, 152 participants with SMI will receive either IPS with Cognitive Training (IPS-CT) or IPS with enhanced support (IPS-ES). The IPS vocational specialist will deliver the Cognitive Training intervention in the client's community setting of choice, along with standard IPS services (job searching, job development, and follow-along job supports). IPS-ES will control for the additional time and attention provided in the IPS-CT condition during the first 3 months. All participants will be followed for 24 months, and employment data will be collected weekly. The primary aim of the study is to evaluate the hypothesis that compared to IPS-ES, IPS-CT will result in improved cognition, functional skills, work outcomes (e.g., number of weeks worked), and quality of life. Secondary aims are to investigate the mechanisms underlying such improvements and to identify predictors of employment outcomes. If Cognitive Training is found to improve outcomes in supported employment, the psychiatric rehabilitation field will be better prepared to help clients across the age spectrum meet their vocational and community reintegration goals.

描述（由申请人提供）：职业残疾是严重精神疾病（SMI）最具破坏性和昂贵的后果之一。支持的就业计划（例如个人安置和支持（IP））是帮助SMI获得竞争性就业（即社区中的“常规工作”）的最有效方法。但是，许多受支持的就业的客户根本无法工作，要么无法保留工作。精神疾病的认知障碍和日常功能的技能缺陷会导致不良的锻炼成果，但通过认知培训可以改变。试点数据支持IPS和认知培训的有效性，包括SMI的客户，包括中年和年龄较大的人。拟议的研究旨在通过3个月的认知培训计划评估增强IPS支持就业服务的有效性，旨在提高注意力，学习，记忆和解决问题的能力。认知训练方法是补偿性的，因为它教授克服认知缺陷的策略，并旨在帮助客户养成更好的思维和记忆习惯，从而持续一生。在拟议的24个月随机对照试验中，有152名SMI参与者将接受IPS认知培训（IPS-CT）或具有增强支持（IPS-ES）的IPS。 IPS职业专家将在客户的选择环境中提供认知培训干预措施，以及标准的IPS服务（求职，工作发展和跟进工作支持）。 IPS-ES将在头三个月内控制IPS-CT条件下提供的额外时间和注意力。所有参与者将被遵循24个月，并将每周收集就业数据。该研究的主要目的是评估与IPS-ES相比的假设，IPS-CT将改善认知，功能技能，工作成果（例如，工作数周的数量）和生活质量。次要目的是研究这种改进的基础机制，并确定就业结果的预测指标。如果发现认知培训可以改善支持就业的成果，那么精神科康复领域将做好更好的准备，以帮助整个年龄段的客户实现其职业和社区重新整合目标。

项目成果

Compensatory cognitive training for psychosis: effects in a randomized controlled trial.

• DOI: 10.4088/jcp.12m07686
• 发表时间: 2012-09
• 期刊: The Journal of clinical psychiatry
• 作者: Twamley EW;Vella L;Burton CZ;Heaton RK;Jeste DV
• 通讯作者: Jeste DV

A quantitative review of cognitive functioning in homeless adults.

• DOI: 10.1097/nmd.0000000000000248
• 发表时间: 2015-02
• 期刊: The Journal of nervous and mental disease
• 作者: Depp CA;Vella L;Orff HJ;Twamley EW
• 通讯作者: Twamley EW

Effect of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia: A randomized, 1-year study.

• DOI: 10.1001/archgenpsychiatry.2010.105
• 发表时间: 2010-09
• 期刊: ARCHIVES OF GENERAL PSYCHIATRY
• 作者: Guo, Xiaofeng;Zhai, Jinguo;Liu, Zhening;Fang, Maosheng;Wang, Bo;Wang, Chuanyue;Hu, Bin;Sun, Xueli;Lv, Luxian;Lu, Zheng;Ma, Cui;He, Xiaolin;Guo, Tiansheng;Xie, Shiping;Wu, Renrong;Xue, Zhimin;Chen, Jindong;Twamley, Elizabeth W.;Jin, Hua;Zhao, Jingping
• 通讯作者: Zhao, Jingping

Clinical and Cognitive Insight in a Compensatory Cognitive Training Intervention.

• DOI: 10.1080/15487768.2011.622159
• 发表时间: 2011-10-01
• 期刊: American journal of psychiatric rehabilitation
• 作者: Burton CZ;Vella L;Twamley EW
• 通讯作者: Twamley EW

The future of psychosocial interventions for older adults with severe mental illness.

对患有严重精神疾病的老年人进行心理社会干预的未来。

• DOI: 10.1016/j.jagp.2012.11.021
• 发表时间: 2013
• 期刊: The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
• 作者: Twamley,ElizabethW