Long Term Impact of Early Cognitive Enhancement in Schizophrenia

早期认知增强对精神分裂症的长期影响

• 批准号: 8890341
• 负责人: SHAUN M EACK
• 金额: $ 23.21万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8890341
• 关键词: Achievement; Address; Adult; Aftercare; Antipsychotic Agents; Area; Back; Behavioral; Biological Preservation; Brain; Chronic; Chronic Schizophrenia; Cognition; Cognitive; Collection; Computers; Data; Development; Disease; Early Intervention; Early treatment; Employment; Exposure to; Family; Family member; Functional disorder; Hospitalization; Impaired cognition; Impairment; Individual; Intervention; Lead; Life; Long-Term Effects; Longitudinal Studies; Magnetic Resonance Imaging; Measures; Mediating; Mental Health; National Institute of Mental Health; Neurocognition; Neurocognitive; Neuronal Plasticity; Outcome; Participant; Patients; Pharmaceutical Preparations; Psychopathology; Public Health; Randomized; Randomized Controlled Trials; Recovery of Function; Recruitment Activity; Resolution; Resources; Role; Sampling; Schizophrenia; Social Functioning; Societies; Structure; Supportive care; System; Task Performances; Training; Work; active method; base; biopsychosocial; cognitive enhancement; cognitive function; cognitive rehabilitation; design; disability; effective intervention; follow-up; functional disability; functional gain; functional improvement; functional outcomes; gray matter; information gathering; neuroimaging; neuromechanism; neuropsychological; prevent; psychosocial; public health relevance; randomized trial; relating to nervous system; remediation; social; social cognition

 DESCRIPTION (provided by applicant): Schizophrenia is a severe and disabling mental health condition that exacts considerable burden on the individuals who live with the disorder, their family members, and society. Impairments in social and non- social cognition are leading contributors to disability in schizophrenia, and while these deficits are currently untreated by antipsychotic medication, evidence has supported the efficacy of psychosocial cognitive rehabilitation interventions in treating cognitive impairments in the disorder. The early application of these treatments soon after individuals develop the illness has shown particular promise for producing cognitive and functional improvements that stand to alter the long-term trajectory of schizophrenia by preventing chronic disability and capitalizing on early neuroplasticity reserves. Cognitive Enhancement Therapy (CET) is one such approach to cognitive rehabilitation that uniquely targets deficits in neurocognitive and social-cognitive function, and has been shown to lead to considerable improvements in social and vocational functioning, and to exert a neuroprotective effect against gray matter loss, when applied early in schizophrenia. Despite the promise of early intervention with cognitive rehabilitation, no evidence is available on the long-term durability of its effects in either chronic or early course schizophrenia patients, and thus the ability of cognitive rehabilitation treatments, such as CET, to alter the neurobiologic and functional trajectory of the illness is not known. This project proposes to conduct a 10-year follow-up study of the 58 patients who participated in a randomized- controlled trial of CET for early course schizophrenia, in order to provide evidence on the potential long-term benefits of early intervention with cognitive rehabilitation in the disorder. Early course participants in this trial were randomized to CET or an active Enriched Supportive Therapy (EST) and treated for up to two years, with annual cognitive, functional outcome, and neuroimaging assessments. Individuals are now approaching 10- years since completing this trial, and many have remained in the Pittsburgh area and connected with known treatment systems, providing the unique opportunity to examine the long-term impact of CET on the disorder. All available patients who were randomized and received some exposure to their psychosocial treatment condition will be recruited back for this study. Comprehensive cognitive and behavioral data will be collected on neuropsychological function, social cognition, psychopathology, and functional outcome to examine the durability of the previously observed benefits of CET in this sample of early course patients with schizophrenia. In addition, structural neuroimaging assessments will be conducted to examine whether the neuroprotective effects of CET compared to EST found at the end of active treatment have been maintained. Together, this project will provide the first comprehensive evidence of the long-term durability of early cognitive rehabilitation in schizophrenia, and will generate critical information on the ability of CET to alter the long-term disability trajectory of the illness, which could have a profound impact on patients with schizophrenia and society.

 描述（由申请人提供）：精神分裂症是一种严重且致残的精神健康状况，给患者、其家庭成员和社会带来相当大的负担。社会和非社会认知障碍是导致精神分裂症残疾的主要原因，虽然这些缺陷目前无法通过抗精神病药物治疗，但有证据支持心理社会认知康复干预措施在治疗精神分裂症认知障碍方面的功效。在个体患病后不久早期应用这些治疗方法，显示出特别有希望改善认知和功能，通过预防慢性残疾和利用早期神经可塑性储备来改变精神分裂症的长期发展轨迹。认知增强疗法（CET）是一种认知康复方法，专门针对神经认知和社会认知功能缺陷，已被证明在精神分裂症早期应用时，可以显着改善社会和职业功能，并对灰质损失发挥神经保护作用。尽管认知康复的早期干预有希望，但没有证据表明其对慢性或早期病程精神分裂症患者的长期影响，因此认知康复治疗（例如 CET）改变疾病的神经生物学和功能轨迹的能力尚不清楚。该项目拟对参与早期精神分裂症 CET 随机对照试验的 58 名患者进行为期 10 年的随访研究，以提供早期干预认知康复的潜在长期益处证据。该试验的早期课程参与者被随机分配接受 CET 或积极的强化支持疗法 (EST)，并接受长达两年的治疗，每年进行认知、功能结果和神经影像学评估。自完成这项试验以来，个体现在已经接近 10 年了，许多人仍然留在匹兹堡地区并与已知的治疗系统保持联系，这提供了独特的机会来检查 CET 对这种疾病的长期影响。所有被随机分配并接受一定程度心理社会治疗条件的可用患者都将被招募回来参加这项研究。将收集有关神经心理功能、社会认知、精神病理学和功能结果的全面认知和行为数据，以检查先前观察到的 CET 在早期精神分裂症患者样本中的益处的持久性。此外，结构 将进行神经影像学评估，以检查与积极治疗结束时发现的 EST 相比，CET 的神经保护作用是否得到维持。总之，该项目将为精神分裂症早期认知康复的长期持久性提供第一个全面的证据，并将产生关于精神分裂症早期认知康复能力的关键信息。 CET 改变疾病的长期残疾轨迹，这可能会产生深远的影响 关于精神分裂症患者和社会。