Cognitive Remediation of Schizophrenia in a Community Mental Health Setting

社区心理健康环境中精神分裂症的认知治疗

• 批准号: 8196725
• 负责人: Sophia Vinogradov
• 金额: $ 46.36万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-05-12 至 2014-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8196725
• 关键词: Acetylcholine; Adult; Attention; Behavioral; Brain; Brain-Derived Neurotrophic Factor; Chronic Schizophrenia; Clinical; Cognition; Cognitive; Cognitive remediation; Communities; Community Mental Health Centers; Computer Assisted; Computers; Control Groups; Coping Skills; Data; Development; Dopamine; Dose; Effectiveness; Employment; Event; Exercise; Feasibility Studies; Fostering; Goals; Hippocampus (Brain); Hour; Individual; Instruction; Intervention; Laboratories; Learning; Measures; Memory; Mental Health; Mentally Ill Persons; Methods; Motivation; Neurocognition; Neurocognitive; Neuronal Plasticity; Neurons; Neurosciences; Neurosciences Research; Noise; Norepinephrine; Occupational; Outcome; Outcome Measure; Participant; Patients; Personal Satisfaction; Phase; Process; Quality of life; Randomized Controlled Trials; Recovery; Relative (related person); Research; Rewards; San Francisco; Schedule; Schizoaffective Disorders; Schizophrenia; Sensory; Serum; Short-Term Memory; Signal Transduction; Social Functioning; Supported Employment; Testing; Training; Training Programs; Verbal Learning; Work; Workplace; active control; base; cognitive training; community setting; computerized; evidence base; functional outcomes; improved; interest; operation; primary outcome; processing speed; programs; psychosocial; psychosocial rehabilitation; public health relevance; response; secondary outcome; social; translational neuroscience

DESCRIPTION (provided by applicant): The purpose of this competitive renewal is: 1) To move our study of neuroplasticity-based cognitive training in schizophrenia out of the laboratory and into the community setting; 2) To demonstrate its specific utility as a method for restoring cognition and enhancing functional outcome in schizophrenia patients referred to a community-based supported employment (SE) program. In our neuroscience-based cognitive training program, the user must successfully perform thousands of progressively more difficult learning trials that improve signal-to-noise processing in early sensory, attention, and working memory functions. The goal is to foster the recovery of key neurocognitive functions by harnessing mechanisms of brain plasticity under constrained and carefully controlled conditions, rather than to promote the development of compensatory cognitive or behavioral operations. Data from our current laboratory-based randomized controlled trial (RCT) indicate that, after 50 hours of training and relative to an active control, individuals with schizophrenia show significant improvements in processing speed, working memory, and verbal learning and memory (effect size of 1.0). Gains endure 6 months after training and are significantly associated with improvement in measures of social and occupational functioning and motivation. Active training subjects also show significant increases in serum BDNF levels. In order for this "restorative" cognitive remediation approach to have a meaningful impact on the well- being and recovery of individuals with schizophrenia, our next phase of research must answer three critical questions: Can neuroplasticity-based computerized targeted cognitive training (TCT) be implemented in real- world clinical settings? Does it enhance patients' response to psychosocial rehabilitation (in the form of SE), significantly improving functional outcome? Does it offer patients specific gains in terms of neurocognition and functioning in the context of SE? To answer these questions, we will perform an RCT of 100 hours of neuroplasticity-based TCT vs. an active control condition (100 hours of graphically interesting computer games), when combined with SE for participants with chronic schizophrenia. The study will take place in an urban community mental health center in downtown San Francisco. Both subject groups will be comparable in terms of amount of research staff contact and computer exposure, and will differ only in whether or not they receive an active neuroplasticity- based cognitive training approach. Subjects will be assessed at baseline, and at 6 and 12 months on the primary outcome measures of neurocognition. They will be assessed at 6, 12, 18 and 24 months on secondary outcomes of employment and quality of life. PUBLIC HEALTH RELEVANCE: This purpose of this study is to investigate the usefulness of neuroscience-guided cognitive training combined with community-based supported employment for people with schizophrenia. We will examine the effectiveness of moving our study of neuroplasticity-based restorative targeted cognitive training out of the laboratory and into the community setting; and we will also investigate its utility in enhancing functional outcome in chronically mentally ill adults who are participating in supported employment.

描述（由申请人提供）：本次竞争性更新的目的是：1）将我们对精神分裂症基于神经可塑性的认知训练的研究从实验室转移到社区环境中； 2) 为了证明其作为一种恢复认知和增强精神分裂症患者功能结果的方法的具体效用，参考基于社区的支持性就业 (SE) 计划。 在我们基于神经科学的认知训练计划中，用户必须成功地执行数千次难度逐渐加大的学习试验，以改善早期感觉、注意力和工作记忆功能的信噪处理。目标是通过在受限和仔细控制的条件下利用大脑可塑性机制来促进关键神经认知功能的恢复，而不是促进补偿性认知或行为操作的发展。我们目前基于实验室的随机对照试验 (RCT) 的数据表明，经过 50 小时的训练，相对于主动对照组，精神分裂症患者在处理速度、工作记忆以及言语学习和记忆方面表现出显着改善（效应大小为 1.0）。培训后的收益可持续 6 个月，并且与社会和职业功能和动机指标的改善显着相关。主动训练对象的血清 BDNF 水平也显着增加。 为了使这种“恢复性”认知矫正方法对精神分裂症患者的健康和康复产生有意义的影响，我们下一阶段的研究必须回答三个关键问题：基于神经可塑性的计算机化有针对性的认知训练（TCT）能否在现实世界的临床环境中实施？它是否能增强患者对社会心理康复（以 SE 的形式）的反应，从而显着改善功能结果？它是否为 SE 背景下的患者提供神经认知和功能方面的特定收益？ 为了回答这些问题，我们将对慢性精神分裂症参与者进行 100 小时基于神经可塑性的 TCT 与主动控制条件（100 小时图形有趣的电脑游戏）的随机对照试验，并与 SE 相结合。该研究将在旧金山市中心的一个城市社区心理健康中心进行。两个科目组在研究人员接触和计算机接触的数量方面具有可比性，仅在他们是否接受基于神经可塑性的主动认知训练方法方面有所不同。受试者将在基线、6 个月和 12 个月时接受神经认知主要结局指标的评估。他们将在 6、12、18 和 24 个月时接受关于就业和生活质量的次要结果的评估。 公共卫生相关性：本研究的目的是调查神经科学指导的认知训练与基于社区的支持性就业相结合对精神分裂症患者的有用性。我们将研究将基于神经可塑性的恢复性定向认知训练研究从实验室转移到社区环境中的有效性；我们还将研究其在增强参与支持性就业的慢性精神疾病成年人的功能结果方面的效用。