Targeting Processing Speed Deficits to Improve Social Functioning and Lower Psychosis Risk in Adolescents at Clinical High Risk for Psychosis

针对处理速度缺陷，改善临床精神病高风险青少年的社会功能并降低精神病风险

基本信息

批准号：
10402865
负责人：
BARBARA A. CORNBLATT
金额：
$ 53.66万
依托单位：
FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-05-15 至 2023-04-30
项目状态：
已结题

项目摘要

Project Summary Prevention of schizophrenia has primarily focused on adolescents and young adults who are considered to be at clinical high risk (CHR) for psychosis. These youngsters display subtle clinical symptoms that are similar to psychosis but not as intense, and therefore considered to still be amenable to early intervention. Initial prevention efforts used anti-psychotics as the primary preventive agents but these were shown to be largely ineffective. More recent approaches have focused on the remediation of the cognitive deficits that are readily apparent and predictive of future illness in CHR adolescents. However, while cognitive remediation has shown substantial promise for improving cognitive deficits and improving outcomes in patients with schizophrenia, it has not yet been markedly successful with CHR youth. The proposed study will test an innovative internet- based remotely-delivered Specific COgnitive REmediation plus Surround (or SCORES) intervention for CHR adolescents ages 14-20 years old that targets early processing speed deficits as measured at the neuropsychological level with the processing speed domain from the NIMH-Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) consensus cognitive battery. The proposed SCORES treatment package is grounded in a theoretical framework, supported by findings from our group and others, where processing speed deficits contribute to poor social functioning, which in turn leads to an increased risk for psychosis. We specifically selected cognitive remediation because it directly targets a core cognitive mechanism, processing speed, which is a rate limiting factor to higher order behaviors and clinical outcome in CHR adolescents. To overcome past difficulties in applying a cognitive remediation treatment to CHR teenagers, we have developed a platform to support our targeted processing speed training, which involves reducing the heterogeneity of the CHR study population (including a reduced age range, narrowed clinical criteria, and targeting individuals with pre-existing processing deficits). In addition, we have adding a novel support surround component which is expected to increase enjoyment and promote retention. In the single-arm R61 phase, a 2-year proof of concept study, 30 CHR individuals will receive SCORES for 10 weeks(4hrs per wk/40 hrs total) with a midpoint assessment at 20 hours (5 weeks) to demonstrate target engagement and identify the optimal dose of SCORES needed to engage the target. In the R33 phase, a 3 year pilot study, we will replicate target engagement in a new and larger sample of 54 CHR individuals randomized to SCORES (optimized dose)or to a Video GameControl condition to firmly establish the centrality of processing speed. In addition, the R33 phase will determine if changes in target engagement are associated with improved social functioning and decreasing attenuated positive symptoms.

项目摘要预防精神分裂症主要集中于被认为是的青少年和年轻人在临床高风险（CHR）的精神病下。这些年轻人表现出类似的微妙临床症状精神病，但不那么强烈，因此仍被认为仍然可以接受早期干预。最初的预防努力使用抗心理药作为主要的预防剂，但这些预防剂在很大程度上被证明是无效。最新的方法集中于对很容易的认知缺陷的补救明显并预测CHR青少年未来疾病。但是，尽管认知补救已显示改善认知缺陷和改善精神分裂症患者结局的实质性希望， CHR青年尚未明显成功。拟议的研究将测试创新的互联网 - 基于远程交付的特定认知补救措施以及CHR的环绕措施（或分数）干预措施 14-20岁的青少年针对早期加工速度缺陷，如在 NIMH测量和治疗的加工速度域的神经心理学水平改善精神分裂症认知（基质）共识认知电池的研究。提议分数治疗套件以理论框架为基础，由我们小组的发现和其他，加工速度赤字会导致社会功能不良，进而导致增加精神病的风险。我们专门选择了认知补救，因为它直接针对核心认知机制，加工速度，这是对高阶行为和临床行为的限制因素 CHR青少年的结果。为了克服过去在应用认知补救待遇上的困难 CHR青少年，我们已经开发了一个平台来支持我们的目标加工速度培训，这是涉及降低CHR研究人群的异质性（包括年龄范围缩小，缩小范围临床标准，并针对患有预先处理缺陷的个体）。此外，我们还添加了新颖的支持环绕成分，预计会增加享受并促进保留率。在单臂R61阶段，一项为期2年的概念验证研究，30个CHR个人将获得10分的分数在20小时（5周）的中点评估中，周（每周4个小时/40小时），以证明目标参与并确定参与目标所需的分数的最佳剂量。在R33阶段，一个3 年度试点研究，我们将在54个CHR个人的新样本中复制目标参与随机分数（优化剂量）或视频游戏对照条件以牢固确定中心性处理速度。此外，R33阶段将确定目标参与的变化是否关联随着社交功能的改善和减轻衰减的阳性症状。