Intensive Brain Training in Early Onset Schizophrenia & Schizoaffective Disorder

描述(申请人提供)：这份R34试点方案名为“早发性精神分裂症和分裂情感障碍的强化大脑训练”，是为了响应RFA-MH-09-020神经发育障碍的新干预措施而提交的。这项试点研究的首要目标是确定旨在改善中枢听觉和视觉处理以及执行功能的密集计算机化干预是否改善了早发性精神分裂症和分裂情感障碍(EOSS)青年的神经认知和整体功能，根据18岁前的发病定义。与成人精神分裂症患者相比，患有EOSS的青少年有更明显的神经认知缺陷，通常预后更差。由于神经认知缺陷的严重程度与功能结果的联系比阳性精神病症状的严重程度更强，因此改善神经认知的干预措施在减少长期残疾方面可能特别有效。功能神经认知研究表明，精神分裂症患者处理信息的效率往往低于没有精神分裂症的人。发育神经学家已经证明，反复暴露在同步和有意义的刺激下可以导致大脑结构的变化，从而提高其处理效率。尽管这种可塑性变化即使在成年人身上也是可能的，但年轻人通常对这种环境训练的反应能力更强。这项试点研究将随机分配40名青少年(10-18岁)参加为期20周的90小时神经适应性计算机化认知强化培训计划(ICT组)，或花费相同时间参与商业电脑游戏(EOSS对照组)。在干预开始前、干预结束时(20周)以及基线后的8个月和12个月，将评估神经认知(主要结果衡量标准)、全球功能、精神症状和脑源性神经营养因子(BDNF)的变化。同样的评估将在同一时间点对20名年龄、性别和种族匹配的非精神疾病青年进行，以比较神经认知数据，并评估神经认知功能和BDNF水平随时间变化的典型程度。这项先导性研究的结果将有助于完善ICT计划，并为设计更明确的EOSS青少年神经认知干预测试提供信息。

DESCRIPTION (provided by applicant): This R34 pilot proposal, entitled "Intensive Brain Training in Early Onset Schizophrenia & Schizoaffective Disorder" is submitted in response to RFA-MH-09-020 Novel Interventions for Neurodevelopmental Disorders. The overarching goal of this pilot study is to determine whether an intensive computerized intervention targeted on improving central auditory and visual processing as well as executive functioning improves neurocognition and overall functioning in youth with Early Onset Schizophrenia and Schizoaffective Disorders (EOSS), defined by onset prior to 18 years. Youth with EOSS have more pronounced neurocognitive deficits and generally poorer prognosis than individuals with adult onset schizophrenia. Since severity of neurocognitive deficits have been more strongly linked to functional outcome than severity of positive psychotic symptoms, interventions that improve neurocognition may be especially potent in reducing long term disability. Functional neurocognitive studies have demonstrated that individuals with schizophrenia tend to process information less efficiently than those without schizophrenia. Developmental neuroscientists have demonstrated that repeated exposure to synchronized and meaningful stimuli can led to structural changes in the brain that improve its processing efficiency. Although such plastic changes are possible even in adults, younger individuals generally have greater capacity to respond to such environmental training. This pilot study will randomly assign 40 youth (ages 10-18 years) to participate in a 90 hour Intensive neuroadaptive computerized Cognitive Training program conducted over 20 weeks (ICT group) or to spend the same amount of time engaged in commercially available computer games (EOSS control group). Changes in neurocognition (primary outcome measure), global functioning, psychiatric symptoms and Brain Derived Neurotrophic Factor (BDNF) will be assessed prior to beginning the interventions, at completion of the intervention (20 weeks) and 8 and 12 months following baseline. The same assessments will be performed in a group of 20 nonpsychiatrically ill youth matched for age, gender and race at the same time points to allow comparison of neurocognitive data and assess the typical extent of variability over time in neurocognitive functioning and BDNF levels. The results of this pilot study will allow refinement of the ICT program and inform the design of a more definitive test of neurocognitive interventions for youth with EOSS.