Cognitive Rehabilitation and Work Outcome in Schizophrenia

描述(申请人提供)：精神分裂症的特征是工作和社会功能缺陷。工作运作方面的缺陷尤其发人深省。对文献的回顾表明，大约65%到90%的严重精神疾病(SMI)患者长期失业。考虑到就业对SMI患者的个人和临床福祉的重要性，这些数字尤其令人沮丧。为了在这个问题上获得牵引力，很可能有必要找到解决功能结果关键决定因素的治疗方法。有强有力的证据表明，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的基础。目前项目的主要目的是比较两种基于认知康复的训练干预措施，以检查它们在促进精神分裂症患者的工作成果方面的潜在好处。培训干预措施是：(A)无错误学习(补偿性方法)，(B)计算机化的认知补救方案(增强认知的方法)。之所以选择这两种干预措施进行比较，是因为它们代表了认知康复训练领域的最新进展和适应情况。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审查，这是为重度精神障碍患者提供支持就业的领先的循证方法。这项研究是翻译性的，因为它将基于实验室的努力扩展到社区心理健康计划。这项研究将招募144名对竞争性就业感兴趣的精神分裂症或分裂情感障碍患者。研究参与者将被随机分配到三个训练组之一：(A)无错误学习+辅助就业，(B)基于计算机的认知增强培训+辅助就业，或(C)单独支持就业。在被安排到社区一份竞争激烈的工作后，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，然后进行为期12个月的跟踪调查。在初次就业后2个月、3个月、6个月、9个月和12个月将进行后续评估，以检查短期和长期培训效果。初步分析将比较无错误学习和基于计算机的认知培训与单独支持就业的效果。成果衡量标准将包括对工作绩效、个人幸福感、工作期限和工作成果(例如工资)的衡量。二次分析将比较两种认知康复训练干预措施的效果，检查群体在认知方面的差异，并检查其他潜在关键决定因素(例如，服药依从性、酒精/药物使用、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向该领域通报最新的认知康复干预措施的优缺点，这些干预措施旨在促进精神分裂症患者的工作功能。无论研究结果如何，结果都将为未来的努力提供方向。培训材料可能需要修改，工作场所内的障碍可能需要解决，或者认知培训计划可能需要改变，以更好地适应临床人群的需求。

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.