Long Term Impact of Early Cognitive Enhancement in Schizophrenia

 描述(由申请人提供)：精神分裂症是一种严重的致残精神健康状况，给精神障碍患者、他们的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精神分裂症患者残疾的主要贡献者，虽然这些缺陷目前没有得到抗精神病药物的治疗，但有证据表明，心理社会认知康复干预在治疗精神分裂症认知障碍方面是有效的。在患者发病后不久早期应用这些治疗方法，已经显示出特别有希望产生认知和功能改善，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轨迹。认知增强疗法(CET)是一种针对神经认知和社会认知功能缺陷的认知康复方法，已被证明能够显著改善社会和职业功能，并在精神分裂症早期应用时对灰质丢失起到神经保护作用。尽管有希望通过认知康复进行早期干预，但没有证据表明其对慢性或早期精神分裂症患者的效果是否长期持久，因此，认知康复治疗(如CET)改变疾病神经生物学和功能轨迹的能力尚不清楚。该项目建议对参加CET治疗早期精神分裂症的58名患者进行为期10年的随访研究，以提供证据表明早期干预对认知康复的潜在长期益处。这项试验中的早期课程参与者被随机分配到CET或积极强化支持疗法(EST)，并接受长达两年的治疗，每年进行认知、功能结果和神经成像评估。在完成这项试验后，个人现在已经接近10年，许多人仍然留在匹兹堡地区，并与已知的治疗系统相连，这为研究CET对这种疾病的长期影响提供了独特的机会。所有被随机分配并接受一定程度心理社会治疗的患者将被招募回来进行这项研究。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综合认知和行为数据，以检验CET在这一早期病程精神分裂症患者样本中先前观察到的益处的持久性。此外，结构性的 将进行神经成像评估，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保持不变。总之，这个项目将提供精神分裂症早期认知康复长期持久性的第一个全面证据，并将产生关于精神分裂症患者能力的关键信息 CET改变了疾病的长期残疾轨迹，这可能会产生深远的影响 对精神分裂症患者和社会的影响。

 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.