Cognitive Rehabilitation and Work Outcome in Schizophrenia

描述（由申请人提供）：精神分裂症以工作和社会功能缺陷为特征。工作功能方面的缺陷尤其发人深省。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。鉴于就业对重度精神分裂症患者的个人和临床健康的重要性，这些数字尤其令人沮丧。为了在这个问题上取得进展，可能有必要找到解决功能结果的关键决定因素的治疗方法。证据有力地表明，认知缺陷是精神分裂症患者功能结局的关键决定因素之一。这一发现强调了当前应用程序的基础。当前项目的主要目的是比较基于认知康复的两种培训干预措施，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。训练干预是：(a)无错误学习（一种补偿性方法）和(b)计算机化认知补救程序（一种认知增强方法）。选择这两种干预措施进行比较，因为它们代表了该领域在认知康复训练方面的最新进展和适应。这些干预措施的有效性将在支持就业的个人安置和支持模式的背景下进行检查，这是为重度精神障碍患者提供支持就业的主要循证方法。这项研究具有翻译意义，因为它将实验室基础的努力扩展到社区心理健康项目。这项研究将招募144名患有精神分裂症或分裂情感障碍的研究参与者，他们对竞争就业感兴趣。研究参与者将被随机分配到三个训练组中的一个：(a)无误学习加支持就业，(b)基于计算机的认知增强训练加支持就业，或(c)单独支持就业。在被安排到一个竞争激烈的社区工作后，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，然后随访12个月。后续评估将在初次就业后2、3、6、9和12个月进行，以检查短期和长期培训效果。初步分析将比较无误学习和基于计算机的认知训练与单独就业支持的效果。结果指标包括工作绩效、个人幸福感、工作任期和工作结果（如工资）。二级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，并检查其他潜在的关键决定因素（例如，药物依从性，酒精/物质使用，动机，生活事件）对工作功能的贡献。公共卫生相关性：从研究中获得的知识将使该领域了解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的优缺点。无论研究结果如何，其结果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，以更好地适应临床人群的需要。

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.