Compensating for Cognitive Deficits in Schizophrenia

许多精神分裂症门诊患者表现出明显的角色功能障碍、生活质量差和高再住院率。最近的研究表明，神经认知缺陷可以预测这些患者的社区结果。在一系列研究中，我们表明，认知适应训练(CAT)-一套手动驱动的补偿策略(体征、核对表、电子设备)，旨在绕过特定的神经认知缺陷-与对照条件相比，显著改善了精神分裂症患者的适应功能、生活质量和复发率。重要的问题仍然存在：CAT是否优于几乎所有患者都可以使用的最小范围的通用补偿策略(例如，药盒、日历)？CAT治疗的强度和成本能否大幅降低，同时保持在重要功能结果方面的进展？我们计划在为期两年的120名药物精神分裂症患者的样本中解决这些问题，这些患者被随机分配到三个治疗组中：1)CAT，2)最小环境支持，3)照常治疗。在最初的9个月的治疗之后，CAT的强度将在接下来的3个月里降低到经济上可行的水平，并在接下来的12个月里继续保持这种较低的强度。综合评估将在研究开始时以及3、6、9、18和24个月进行。主要结果变量将包括适应功能和生活质量的测量。以治疗前评分为协变量的重复测量协方差分析，将用于检查9个月、12个月和24个月时功能结果的组间差异。我们假设，在9个月结束时，接受CAT和最小支持的患者将比接受标准治疗的患者有更好的功能结果，当治疗在经济上可行的水平上提供适合于现有治疗提供系统时，CAT患者的功能和生活质量的提高将保持不变。

Many schizophrenia outpatients demonstrate significant impairment in role functioning, poor quality of life and high rates rehospitalization. Recent research has shown that neurocognitive deficits predict community outcomes for these patients. In a series of studies, we showed that Cognitive Adaptation Training (CAT) -a manual-driven set of compensatory strategies (signs, checklists, electronic devices) designed to bypass specific neurocognitive deficits -significantly improved adaptive functioning, quality of life, and rates of relapse in schizophrenia patients compared to control conditions. Significant questions remain: Is CAT superior to a minimal set of generalized compensatory strategies (e.g. pillboxes, calendars) that could be given to virtually all patients? Can the intensity and therefore the cost of CAT treatment be substantially reduced while maintaining gains in important functional outcomes? We plan to address these questions in a sample of 120 medicated schizophrenia patients randomly assigned for a period of two years to one of three treatment groups: 1) CAT, 2) Minimal Environmental Supports, 3) Treatment as usual. Following an initial 9 months of treatment, the intensity of CAT will be reduced to an economically viable level over the next 3 months and be continued at this lower intensity for the next 12 months. Comprehensive assessments will be obtained at study entrance and at 3, 6, 9, 18, and 24 months. Primary outcome variables will include measures of adaptive function and quality of life. Repeated measures analyses of covariance, with pretreatment scores used as covariates, will be utilized to examine group differences on functional outcomes at 9, 12, and 24 months. We hypothesize that at the end of 9 months, patients in CAT and minimal supports will have better functional outcomes than patients in standard treatment, and the gains in functionality and quality of life for patients in CAT will be maintained when the treatment is provided at an economically viable level that would be suitable for use in existing treatment delivery systems.