Community-Based Cognitive Training in Early Schizophrenia

早期精神分裂症的社区认知训练

• 批准号: 8889307
• 负责人: Rachel L. Loewy
• 金额: $ 67.68万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-19 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8889307
• 关键词: Address; Auditory; Behavioral; Caregivers; Client; Clinic; Clinical; Cognition; Cognitive; Cognitive remediation; Communities; Community Mental Health Centers; Computers; Control Groups; Data; Double-Blind Method; Early Intervention; European; Exercise; Functional disorder; Goals; Health; Impaired cognition; Individual; Intervention; Laboratories; Mental Health; Modeling; Neurosciences; Online Systems; Outcome; Patients; Problem Solving; Prognostic Marker; Provider; Psychosocial Assessment and Care; Psychotic Disorders; Randomized Controlled Trials; Rehabilitation therapy; Relative (related person); Research; Risk Factors; Schizophrenia; Services; Site; Symptoms; System; Training; Translating; Universities; base; cognitive disability; cognitive enhancement; cognitive function; cognitive reserve; cognitive training; community setting; computerized; design; executive function; experience; follow-up; functional disability; functional outcomes; improved; laptop; neuropsychological; neurotechnology; programs; psychosocial rehabilitation; relating to nervous system; service intervention; social

DESCRIPTION (provided by applicant): The purpose of this study is to perform a double-blind randomized controlled trial (RCT) in young patients with recent-onset (RO) schizophrenia to target improvement in cognitive functioning within real-world treatment settings. This multi-site study will be performed in 3 community mental health centers with specialized Early Intervention Services (EIS). We will compare the effects of web-based targeted cognitive training (TCT) vs. web-based general cognitive exercises (GCE), both delivered via portable laptop computers. We will investigate the behavioral and functional changes seen immediately after the intervention as well as at 6-month follow-up, compared to a no-training control group (NTC). This will be the first study to investigate cognitive enhancement for young RO schizophrenia patients in community mental health settings, using scalable interactive neurotechnology, and the first to compare two distinct cognitive training approaches. This study will generate high impact data on the potential for targeted pre-emption of the downward spiral of in cognitive and functional disability that often characterizes psychotic illness. It will also generate valuable daa on the relative effects of two distinct cognitive training approaches in schizophrenia, each derived from a very different theoretical rationale, providing much-needed information on the efficacy of a targeted "distributed neural system" training model derived from systems neuroscience vs. a "general cognitive stimulation" training model derived from neuropsychological rehabilitation approaches. The aims of this project are based on the current state of early psychosis research, as well as our own experience successfully applying neuroscience-informed cognitive training in schizophrenia. It is now abundantly clear that cognitive/neural system dysfunction represents a significant risk factor for schizophrenia as well as a poor prognostic indicator. Functional outcome in RO schizophrenia is predicted by level of cognitive impairment and baseline cognitive reserve, and recent findings suggest that specialized EIS programs focusing only on symptom reduction and psychosocial support may not robustly improve long-term outcomes- indicating that critical treatment targets are not being addressed at present in early psychosis interventions. Cognitive dysfunction and underlying neural system inefficiency should therefore be one of the primary targets for pre-emptive intervention in early psychosis. In this study, we will determine whether we can achieve this goal using cognitive training delivered via a portable computer, in order to improve functional outcome in young individuals with RO schizophrenia.

描述（由申请人提供）：本研究的目的是对新发（RO）精神分裂症年轻患者进行双盲随机对照试验（RCT），以改善现实世界治疗环境中的认知功能。这项多地点研究将在 3 个设有专门早期干预服务 (EIS) 的社区心理健康中心进行。我们将比较基于网络的针对性认知训练 (TCT) 与基于网络的一般认知练习 (GCE) 的效果，两者均通过便携式笔记本电脑进行。我们将调查干预后以及 6 个月随访时与未训练对照组 (NTC) 相比的行为和功能变化。这将是第一项利用可扩展的交互式神经技术研究社区心理健康环境中年轻 RO 精神分裂症患者认知增强的研究，也是第一项比较两种不同认知训练方法的研究。这项研究将产生高影响力的数据，说明有针对性地预防认知和功能障碍螺旋式下降的潜力，而认知和功能障碍通常是精神病的特征。它还将为精神分裂症中两种不同的认知训练方法的相对效果生成有价值的数据，每种方法都源于截然不同的理论原理，提供关于源自系统神经科学的有针对性的“分布式神经系统”训练模型的功效的急需信息与源自神经心理康复方法的“一般认知刺激”训练模型相比。该项目的目标基于早期精神病研究的现状，以及我们自己在精神分裂症中成功应用神经科学认知训练的经验。现在已经非常清楚，认知/神经系统功能障碍是精神分裂症的一个重要危险因素，也是一个不良的预后指标。 RO 精神分裂症的功能结果是通过认知障碍水平和基线认知储备来预测的，最近的研究结果表明，仅专注于症状减轻和社会心理支持的专门 EIS 计划可能无法显着改善长期结果 - 表明关键治疗目标没有得到落实目前在早期精神病干预中得到解决。因此，认知功能障碍和潜在的神经系统效率低下应该是早期精神病先发制人干预的主要目标之一。在这项研究中，我们将确定是否可以通过便携式计算机提供的认知训练来实现这一目标，以改善患有 RO 精神分裂症的年轻个体的功能结果。