Cognitive Rehabilitation and Work Outcome in Schizophrenia

精神分裂症的认知康复和工作成果

• 批准号: 7681017
• 负责人: Robert S Kern
• 金额: $ 28.35万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7681017
• 关键词: Absenteeism at work; Address; Alcohols; American Psychological Association; Attenuated; Belief; Clinical; Cognition; Cognitive; Cognitive deficits; Cognitive remediation; Communities; Computer software; Computers; Consult; Consultations; Development; Disabled Persons; Educational Intervention; Educational process of instructing; Effectiveness; Employment; Event; Evidence based practice; Funding; Future; Goals; Grant; Homelessness; Hour; Income; Independent Living; Individual; Intervention; Job Satisfaction; Knowledge; Laboratories; Lead; Learning; Life; Lifting; Measures; Mediator of activation protein; Memory; Mental Health; Methods; Modeling; Motivation; National Institute of Mental Health; Neurocognition; Occupations; Outcome; Outcome Measure; Participant; Patients; Performance at work; Personal Satisfaction; Persons; Pharmaceutical Preparations; Pharmacotherapy; Population; Poverty; Procedures; Prospective Studies; Psychiatric Social Work; Public Health; Randomized; Recording of previous events; Recovery; Recruitment Activity; Research; Research Design; Review Literature; Role; Schizoaffective Disorders; Schizophrenia; Site; Social Functioning; Social Security; Social Work; Socialization; Societies; Stigmata; Stress; Structure; Supported Employment; Symptoms; Testing; Time; Traction; Training; Training Programs; Translational Research; Treatment Efficacy; Treatment outcome; U-Series Cooperative Agreements; Unemployment; Vocational rehabilitation; Wages; Work; Workplace; base; cognitive rehabilitation; cognitive training; college; community living; computerized; cooking; cost; design; disability; drug discovery; emerging adult; empowerment; evidence base; experience; follow up assessment; follow-up; functional outcomes; improved; innovation; interest; intervention effect; medication compliance; mental health center; novel; novel strategies; prevent; programs; psychiatric disability; psychiatric rehabilitation; psychologic; psychosocial; public health relevance; research clinical testing; self esteem; severe mental illness; skills; sobriety; social skills; social stigma; success

DESCRIPTION (provided by applicant): Schizophrenia is characterized by deficits in work and social functioning. The deficits in work functioning are particularly sobering. Reviews of the literature indicate that approximately 65% to 90% of persons with severe mental illness (SMI) are chronically unemployed. These figures are particularly discouraging given the importance of employment to the personal and clinical well-being of persons with SMI. To gain traction on this problem, it will likely be necessary to find treatments that address the key determinants of functional outcome. Evidence strongly suggests that cognitive deficits are among the key determinants of functional outcome for persons with schizophrenia. This finding underscores the basis for the current application. The current project's primary aim is to compare two training interventions based on cognitive rehabilitation to examine their potential benefits in promoting work outcome for persons with schizophrenia. The training interventions are: (a) errorless learning (a compensatory approach), and (b) a computerized cognitive remediation program (a cognition-enhancing approach). These two interventions were selected for comparison because they are representative of the field's latest advances and adaptations in cognitive rehabilitation training. The efficacy of these interventions will be examined within the context of an Individual Placement and Support model of supported employment, the leading evidence-based approach to supported employment for persons with SMI. The study is translational in that it extends laboratory-based efforts to a community mental health program. The study will recruit 144 study participants with schizophrenia or schizoaffective disorder who are interested in competitive employment. Study participants will be randomly assigned to one of three training groups: (a) errorless learning plus supported employment, (b) computer-based cognition-enhancing training plus supported employment, or (c) supported employment alone. After being placed at a competitive job in the community, study participants will be administered baseline assessments of cognition, clinical symptoms, work performance, and personal well-being and then followed for 12 months. Follow-up assessments will be conducted at 2-, 3-, 6-, 9-, and 12-months after initial job placement to examine short-term and longer-term training effects. The primary analyses will compare the effects of errorless learning and computer-based cognitive training against supported employment alone. Outcome measures will include measures of work performance, personal well-being, job tenure, and work outcome (e.g., wages). Secondary analyses will compare the effects of the two cognitive rehabilitation training interventions against one another, examine group differences on cognition, and examine the contribution of other potential key determinants (e.g., medication adherence, alcohol/substance use, motivation, life events) on work functioning. PUBLIC HEALTH RELEVANCE: The knowledge gained from the study will inform the field about the strengths and weaknesses associated with the latest cognitive rehabilitation interventions aimed at promoting work functioning for persons with schizophrenia. Regardless of the study findings, the results will provide direction for future efforts. Training materials may need to be modified, obstacles within the workplace may need to be addressed, or cognitive training programs altered to better suit the needs of this clinical population.

描述（由申请人提供）：精神分裂症的特点是工作和社会功能缺陷。工作职能方面的缺陷尤其令人警醒。文献综述表明，大约 65% 至 90% 的严重精神疾病 (SMI) 患者长期失业。鉴于就业对于 SMI 患者的个人和临床健康的重要性，这些数字尤其令人沮丧。为了解决这个问题，可能有必要找到解决功能结果关键决定因素的治疗方法。有证据强烈表明，认知缺陷是精神分裂症患者功能结果的关键决定因素之一。这一发现强调了当前应用的基础。当前项目的主要目的是比较两种基于认知康复的培训干预措施，以检查它们在促进精神分裂症患者工作成果方面的潜在益处。培训干预措施是：(a) 无差错学习（一种补偿方法），以及 (b) 计算机化认知补救计划（一种认知增强方法）。选择这两种干预措施进行比较是因为它们代表了认知康复训练领域的最新进展和适应。这些干预措施的有效性将在支持性就业的个人安置和支持模式的背景下进行审查，该模式是为 SMI 患者提供支持性就业的领先循证方法。这项研究具有转化性，它将基于实验室的努力扩展到社区心理健康项目。该研究将招募 144 名患有精神分裂症或分裂情感障碍且对竞争性就业感兴趣的研究参与者。研究参与者将被随机分配到三个培训组之一：(a) 无误学习加支持性就业，(b) 基于计算机的认知增强培训加支持性就业，或 (c) 仅支持性就业。在社区中找到一份有竞争力的工作后，研究参与者将接受认知、临床症状、工作表现和个人幸福感的基线评估，然后进行为期 12 个月的跟踪调查。后续评估将在初次就业后2个月、3个月、6个月、9个月和12个月进行，以检查短期和长期培训效果。主要分析将比较无差错学习和基于计算机的认知训练与单独支持性就业的效果。结果衡量标准将包括工作绩效、个人福祉、工作任期和工作成果（例如工资）的衡量标准。二次分析将比较两种认知康复训练干预措施的效果，检查认知方面的群体差异，并检查其他潜在关键决定因素（例如药物依从性、酒精/药物使用、动机、生活事件）对工作的贡献发挥作用。公共卫生相关性：从研究中获得的知识将告知该领域与旨在促进精神分裂症患者工作功能的最新认知康复干预措施相关的优点和缺点。无论研究结果如何，结果都将为未来的努力提供方向。培训材料可能需要修改，工作场所内的障碍可能需要解决，或者认知培训计划需要改变，以更好地适应该临床人群的需求。