Personalized and Scalable Cognitive Remediation Approaches

描述(由申请人提供)：现有的关于精神分裂症认知补救(CR)的文献是一种基于经验的干预措施，表明在各种治疗方法中，CR对神经认知和功能结果有适度的影响。然而，CR干预措施的反应有很大的个体差异，这表明需要改进干预策略，以更好地满足治疗参与者的特定神经认知和功能需求。神经认知和心理因素预测CR反应强烈的证据有可能使治疗过程个人化，从而将患者与适当的治疗相匹配。使用R34机制，我们将为一项研究奠定基础，该研究将测试在 社区门诊设置。拟议的研究分三个阶段进行。(1)在发展和适应阶段，我们将根据先前对认知障碍积极反应预测因素的研究，编制两套个性化的基于计算机的恢复性认知练习，以满足具有不同模式认知特征的人的学习需求。(2)在开放试验和改进期间，我们将在社区心理社会康复诊所的10名成年精神分裂症和分裂情感障碍患者中试行这两种认知干预措施。为期10次的公开试验将允许收集受试者的定性反馈和定量认知评估数据，以进一步完善评估和治疗参数。这一阶段的目标是提高CR干预措施的可接受性和可行性。(3)在试点可行性试验期间，我们将进行一项随机对照试验，看看基线认知特征是否预测对 不同的治疗方法。我们将重点研究招募、登记、随机、分层、保留和评估参与者成果的可行性。与R34机制的目的一致，这项先导性研究将产生R01，这将为个性化干预方法对精神分裂症认知和功能结果的影响提供更严格的测试。

DESCRIPTION (provided by applicant): The extant literature on Cognitive Remediation (CR) for schizophrenia, an empirically based intervention, indicates that across treatment methods, CR has moderate effects on neurocognition and functional outcomes. However, substantial individual differences in response to CR interventions indicate a need to refine intervention strategies to better meet the specific neurocognitive and functional needs of treatment participants. Evidence that neurocognitive and psychological factors predict a strong response to CR has the potential to enable a personalization of the treatment process and to thereby match patients to appropriate treatment. Using the R34 mechanism we will lay the groundwork for a study that tests the efficacy and feasibility of delivering scalable and personalized CR in a community outpatient clinic setting. There are three phases of the proposed study. (1) During Development and Adaptation, we will assemble two personalized packages of restorative computer-based cognitive exercises which, based on prior research about predictors of a positive response to CR, will address the learning needs of people with different modal cognitive profiles. (2) During Open Trial and Refinement, we will pilot test the two cognitive interventions in a sample of 10 adults with schizophrenia and schizoaffective disorder attending a community psychosocial rehabilitation clinic. A 10-session open trial will allow for the collection of qualitative feedback from the subjects and quantitative cognitive assessment data to further refine assessment and treatment parameters. The goal of this phase is to the increase acceptability and feasibility of the CR interventions. (3) During the Pilot Feasibility Trial, we wll conduct a randomized controlled trial to see if baseline cognitive profile predicts response to the different treatment approaches. We will focus on the feasibility of recruiting, enrolling, randomizing, stratifying, retaining, and assessing outcomes in the participants. Consistent with the purpose of the R34 mechanism, this pilot study will lead to a R01, which will provide a more rigorous test of the impact of personalized intervention methodologies on cognitive and functional outcomes in schizophrenia.