Cognitive Rehabilitation and Work Outcome in Schizophrenia

描述（由申请人提供）：精神分裂症的特点是在工作和社会功能的缺陷。工作功能的缺陷尤其令人清醒。对文献的审查表明，大约65%至90%的严重精神疾病患者长期失业。鉴于就业对重度精神障碍患者的个人和临床健康的重要性，这些数字尤其令人沮丧。为了解决这个问题，可能需要找到解决功能结果关键决定因素的治疗方法。证据有力地表明，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。本项目的主要目的是比较两种基于认知康复的培训干预措施，以研究其在促进精神分裂症患者工作成果方面的潜在益处。培训干预措施包括：（a）无错学习（补偿方法），和（B）计算机化认知补救程序（认知增强方法）。选择这两种干预措施进行比较，因为它们代表了认知康复训练领域的最新进展和适应。这些干预措施的有效性将在支持性就业的个人安置和支持模式的背景下进行审查，这是对重度精神障碍患者支持性就业的主要循证方法。这项研究是翻译，因为它扩展了以实验室为基础的努力，以社区精神卫生计划。该研究将招募144名对竞争性就业感兴趣的精神分裂症或情感障碍患者。研究参与者将被随机分配到三个培训组中的一个：（a）无错学习加辅助就业，（B）基于计算机的认知增强培训加辅助就业，或（c）仅支持就业。在被安置在社区的竞争性工作后，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，然后随访12个月。在初次就业后的2、3、6、9和12个月，将进行跟踪评估，以检查短期和长期培训效果。初步分析将比较无错学习和基于计算机的认知培训与单独支持就业的效果。结果衡量标准将包括工作绩效、个人福祉、工作任期和工作成果的衡量标准（例如，工资）。二次分析将比较两种认知康复训练干预措施的效果，检查认知方面的组间差异，并检查其他潜在关键决定因素（例如，药物依从性、酒精/物质使用、动机、生活事件）对工作功能的影响。公共卫生相关性：从研究中获得的知识将告知该领域与最新的认知康复干预措施相关的优势和劣势，旨在促进精神分裂症患者的工作功能。无论研究结果如何，研究结果将为未来的工作提供方向。培训材料可能需要修改，工作场所内的障碍可能需要解决，或认知培训计划改变，以更好地适应这一临床人群的需求。

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.