Cognitive Enhancement for Persistent Negative Symptoms in Schizophrenia

7.项目摘要/摘要 精神分裂症是所有精神疾病中致残率最高的疾病之一，并给人们带来沉重的负担 对经历这种障碍的个人，以及他们的家庭成员和社会。最新进展 药物治疗和心理社会干预大大减少了住院和 精神病症状，并为受影响的个人提供了更多融入社会的机会 社区的成员。尽管取得了这一重大进展，许多精神分裂症患者仍然 因持续的负面症状而明显残疾，包括缺乏动力、社交退缩、情绪化 直言不讳，口齿不清。这些阴性症状不能通过目前的药物治疗和 对现有的干预措施反应迟钝是出了名的，给患者和家属留下了很少甚至没有 治疗的选择。最近，人们越来越多地认识到认知和认知之间的重叠 精神分裂症的阴性症状和认知补救的心理社会研究已经开始显示 承诺通过利用计算机和小组练习来治疗阴性症状，以增强社会 和非社会认知。我们在三个不同的随机分析中初步观察到- 认知增强疗法(CET)--一种循证认知治疗的对照试验 治疗精神分裂症的方法，可以显著减少广泛的阴性症状领域。此外， 神经认知和社会认知的改善似乎是这些症状减轻的基础，并指出 认知增强是治疗阴性症状的最有前途的方法之一 精神分裂症。然而，到目前为止，经过充分设计的认知补救干预试验尚未 在有中重度和持续性阴性症状的患者中进行，以确认这些效果。 响应RFA-MH-18-707《非药物干预的确证疗效临床试验》 对于精神障碍，这个项目建议进行一项验证性疗效试验，以检查 CET用于治疗有明显和持续阴性症状的精神分裂症患者。总计 75例有中至重度持续性阴性症状的稳定型精神分裂症患者将 随机接受18个月的CET或积极的、丰富的支持性治疗对照。综合数据： 持续的阴性症状，社会和非社会认知，以及功能结果将被事先收集 每隔6个月进行一次治疗，以(1)证实CET对改善持久性的有效性 (2)证实认知目标参与对减轻负性症状的影响； 以及(3)检查CET对阴性症状和功能的短期持久性。结果是 该项目有望为治疗持续性阴性肿瘤开辟有希望的新途径 症状出现，并显著减轻个人和公共卫生负担 精神分裂症。

7. PROJECT SUMMARY/ABSTRACT Schizophrenia is one of the most disabling of all psychiatric conditions, and places significant burden on the individuals who experience the disorder, as well as their family members and society. Advances in pharmacotherapy and psychosocial interventions have led to significant reductions in hospitalization and psychotic symptoms, and have provided opportunities for affected individuals to become more integrated members of the community. Despite this significant progress, many individuals with schizophrenia remain markedly disabled by persistent negative symptoms, including lack of motivation, social withdrawal, emotional blunting, and poverty of speech. These negative symptoms are untreated by current pharmacotherapies and are notoriously unresponsive to existing interventions, leaving patients and family members with little to no options for treatment. Recently, there has been growing appreciation of the overlap between cognitive and negative symptoms in schizophrenia, and psychosocial studies of cognitive remediation have begun to show promise in treating negative symptoms by utilizing computer- and group-based exercises to enhance social and non-social cognition. We have preliminarily observed in post-hoc analyses of three separate randomized- controlled trials that Cognitive Enhancement Therapy (CET), an evidence-based cognitive remediation approach for schizophrenia, can result in significant reductions in broad negative symptom domains. Further, neurocognitive and social-cognitive improvement appear to underlie these symptom reductions, and point to the enhancement of cognition as one of the most promising approaches for treating negative symptoms in schizophrenia. To date, however, adequately designed trials of cognitive remediation interventions have yet to be conducted in patients with moderate-to-severe and persistent negative symptoms to confirm these effects. In response to RFA-MH-18-707, "Confirmatory Efficacy Clinical Trials of Non-Pharmacological Interventions for Mental Disorders", this project proposes to conduct a confirmatory efficacy trial to examine the efficacy of CET for the treatment of schizophrenia patients with significant and persistent negative symptoms. A total of 75 stabilized schizophrenia outpatients with moderate-to-severe persistent negative symptoms will be randomized to 18 months of CET or an active, enriched supportive therapy control. Comprehensive data on persistent negative symptoms, social and non-social cognition, and functional outcome will be collected prior to treatment and at frequent 6-month intervals to (1) confirm the efficacy of CET for improving persistent negative symptoms; (2) confirm the impact of cognitive target engagement on reduced negative symptoms; and (3) examine the short-term durability of CET effects on negative symptoms and functioning. The results of this project are expected to establish promising new avenues for the treatment of persistent negative symptoms in the condition, and to significantly reduce the personal and public health burden associated with schizophrenia.