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和致残的精神健康状况，对患有这种疾病的个人，他们的家庭成员和社会造成相当大的负担。社会和非社会认知的损伤是精神分裂症残疾的主要因素，虽然这些缺陷目前未被抗精神病药物治疗，但有证据支持心理社会认知康复干预在治疗该障碍中的认知损伤中的疗效。这些治疗方法在患者发病后不久的早期应用，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，改变精神分裂症的长期轨迹。认知增强疗法（CET）是一种这样的认知康复方法，其独特地针对神经认知和社会认知功能的缺陷，并且已被证明导致社会和职业功能的显著改善，并且当在精神分裂症的早期应用时，对灰质损失发挥神经保护作用。尽管认知康复早期干预的承诺，没有证据表明其在慢性或早期病程精神分裂症患者中的长期持久性，因此认知康复治疗（如CET）改变疾病的神经生物学和功能轨迹的能力尚不清楚。本项目拟对参加CET治疗早期精神分裂症随机对照试验的58例患者进行10年随访研究，以提供证据证明早期干预与认知康复对该疾病的潜在长期益处。本试验的早期参与者随机接受CET或积极的强化支持治疗（EST），治疗长达两年，每年进行认知、功能结局和神经影像学评估。完成这项试验的个人现在已经接近10年了，许多人仍然留在匹兹堡地区，并与已知的治疗系统联系在一起，这为研究CET对这种疾病的长期影响提供了独特的机会。本研究将招募所有接受随机化并接受一定程度心理社会治疗的患者。将收集关于神经心理功能、社会认知、精神病理学和功能结局的全面认知和行为数据，以检查先前观察到的CET获益在该早期病程精神分裂症患者样本中的持久性。此外，结构 将进行神经成像评估以检查与活性治疗结束时发现的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认知能力的关键信息。 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