Personalized and Scalable Cognitive Remediation Approaches

描述（由申请人提供）：精神分裂症认知补救（CR）的现有文献（一种基于经验的干预）表明，在所有治疗方法中，CR对神经认知和功能结局具有中度影响。然而，CR干预措施的个体差异表明需要完善干预策略，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对CR的强烈反应的证据有可能使治疗过程个性化，从而使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，该研究将测试在一个 社区门诊设置。拟议的研究分三个阶段进行。(1)在开发和适应过程中，我们将组装两个个性化的恢复性基于计算机的认知练习包，这些练习基于先前关于CR积极反应预测因素的研究，将满足具有不同模态认知特征的人的学习需求。(2)在开放试验和完善期间，我们将在参加社区心理社会康复诊所的10名精神分裂症和情感障碍成年人样本中对两种认知干预进行试点测试。一项为期10个疗程的开放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干预的可接受性和可行性。(3)在初步可行性试验期间，我们将进行一项随机对照试验，以观察基线认知特征是否能预测对 不同的治疗方法。我们将重点关注招募、登记、随机化、分层、保留和评估参与者结局的可行性。与R34机制的目的一致，这项试点研究将导致R01，这将提供更严格的测试个性化干预方法对精神分裂症认知和功能结局的影响。

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.