Feasibility and tolerability of a cognitive remediation clinical service in first episode coordinated specialty care.
Feasibility and tolerability of a cognitive remediation clinical service in first episode coordinated specialty care.
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DOI：
10.1111/eip.12978
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发表时间：
2021-04
影响因子：
2
通讯作者：
Lewandowski KE
中科院分区：
文献类型：
--
作者：
Lewandowski KE
认知补救是一种循证干预，针对精神病患者常见和致残的认知缺陷。疗效研究和荟萃分析的结果表明，认知补救对慢性和首次发作患者的认知产生中等至大的影响。然而，这种治疗方法的临床可用性仍然很少，反映了科学与实践之间的重大差距。在这里，我们描述了发展的认知补救计划，在门诊首次发作精神病的临床服务，以及初步的可行性和可接受的结果。根据疗效试验和临床评估的证据，我们开发了一个CR计划，其中包括基于互联网的计算机培训练习和每周一次的面对面治疗组。根据三个连续12周的组系列的数据评估结果。可行性结果包括采用、填充、成本和利用;耐受性结果基于用户调查和焦点小组反馈。我们发现了可行性的证据，包括良好的采用，填充，利用率和成本。根据用户调查和焦点小组的反馈，我们还发现了良好的耐受性和满意度，超过80%的受访者对该计划以及主观认知和功能改善的总体满意度很高。本报告提供的初步证据表明，认知补救可以转化为真实的世界临床实践的首发精神病。需要对认知补救的实施和传播进行系统评估，并有可能改善精神病患者获得认知健康干预措施的机会。
Cognitive remediation is an evidence-based intervention targeting the common and disabling cognitive deficits in people with psychosis. Findings from efficacy studies and meta-analyses show that cognitive remediation produces medium to large effects on cognition in both chronic and first episode patients. However, clinical availability of this treatment remains scarce, reflecting a major gap between science and practice. Here we describe the development of a cognitive remediation programme in an outpatient first episode psychosis clinical service, and preliminary feasibility and acceptability outcomes. Based on evidence from efficacy trials and assessment within the clinic of perceived benefits and barriers, we developed a CR programme that involved both internet-based computer training exercises and a weekly in-person therapy group. Outcomes were assessed based on data from three consecutive 12-week group series. Feasibility outcomes included adoption, fill, cost, and utilization; tolerability outcomes were based on user survey and focus group feedback. We found evidence of feasibility including good adoption, fill, utilization, and cost. We also found good tolerability and satisfaction based on feedback from a user survey and focus groups, with more than 80% of respondents reporting high overall satisfaction with the programme and subjective cognitive and functional improvements. The present report provides preliminary evidence that cognitive remediation can be translated into real world clinical practice for first episode psychosis. Systematic evaluation of implementation and dissemination of cognitive remediation is needed, and has the potential to improve access to cognitive health interventions for people with psychosis.
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