Compensatory Cognitive Training in Clinical High Risk Latino Youth

描述（由申请人提供）：在精神病治疗的发展中，特别是在早期阶段，越来越重视认知增强、神经保护和认知补救领域。临床高风险个体（Clinical High Risk，简称CRD）在1-2年内发展为精神病的比率在20-40%之间，但大多数人无论是否发展为精神病都有神经认知和功能缺陷。神经认知缺陷预示着以后的精神病和随访时的不良功能状态 起来通过在精神病的早期干预，以神经认知缺陷为目标，可能会影响这种毁灭性疾病的功能结局。为响应RFA-MH-14-212 -改善精神疾病临床高风险人群护理的研究，拟定的R34申请将评估美国和墨西哥拉丁裔临床高风险（ERD）受试者的补偿性认知训练（CCT）与卧床训练（RT）。虽然CCT已在慢性精神病中进行了广泛的研究，证明了对神经认知领域和功能能力的中等至大的影响大小，但从未在慢性精神病受试者中进行过研究。在一项为期12周的随机临床试验设计中，将120名拉丁美洲裔受试者按组随机分配至CCT或RT组。受试者将在研究开始和结束时以及中间每月一次接受4次评估。具体目的是：1）比较CCT增强与RT对原发性神经认知功能的影响（全球认知指数）和功能能力（UCSD基于表现的技能评估- UPSA）措施和二级自评功能（特定功能水平）和临床症状（前驱症状量表- SOPS）测量; 2）探索治疗反应的预测因子（调节因子）（例如，年龄、基线症状、神经认知）和3）探索治疗反应的介导因子（神经认知和功能的变化）。 这项提案的独特之处还在于，将重点放在精神病研究所的拉丁裔受试者身上。拉丁裔社区服务不足，但占圣地亚哥县学童的55%。纳入墨西哥城研究中心将加速招募，因为他们可以接触大量早期精神病受试者，通过纳入大量拉丁美洲受试者增加样本多样性和少数民族代表性，并协助实施西班牙语版CCT。加州圣地亚哥大学（UCSD）的Kristin Cadenhead医学博士和墨西哥城国家神经病学研究所（INNN）Psiquiatráa实验室的Camilo de la Fuente医学博士和博士的实验室之间存在合作关系，由加州大学墨西哥和美国研究所的赠款资助（UC MEXUS），允许建立跨站点的早期精神病人群的可比性，并实施可靠性和质量控制方法，为拟议的研究做准备。

DESCRIPTION (provided by applicant): An increasing emphasis in the development of treatments for psychotic illness, especially in early stages, has been in the area of cognitive enhancement, neuroprotection and cognitive remediation. Individuals at Clinical High Risk (CHR) develop a psychotic illness at rates between 20-40% over a 1-2 year period but the majority have neurocognitive and functional deficits whether they develop psychosis or not. Neurocognitive deficits predict a later psychotic illness and also poor functional status at follow up. By intervening early in the course of psychosis to target neurocognitive deficits, it might be possible to affect the functional outcome of this devastating disease. The proposed R34 Application, in response to RFA-MH-14-212 - Research to Improve the Care of Persons at Clinical High Risk for Psychotic Disorders, will assess Compensatory Cognitive Training (CCT) versus Recreational Training (RT) in Latino Clinical High Risk (CHR) subjects in the US and Mexico. Although CCT has been studied extensively in chronic psychotic illness, demonstrating moderate to large effect sizes on neurocognitive domains and functional capacity, it has never been studied in CHR subjects. In a 12 week randomized clinical trial design, 120 CHR Latino subjects will be randomized by groups into CCT or RT. Subjects will be assessed 4 times, at the beginning and end of the study, and at intermediary monthly intervals. The Specific Aims are to 1) Compare CCT augmentation versus RT on Primary Neurocognitive (Global Cognitive Index) and Functional Capacity (UCSD Performance-based Skill Assessment - UPSA) measures and Secondary Self-Rated Functioning (Specific Level of Functioning) and Clinical Symptom (Scale of Prodromal Syndromes - SOPS) measures; 2) Explore predictors (moderators) of treatment response (eg, age, baseline symptoms, neurocognition) and 3) explore mediators of treatment response (change in neurocognition and functioning). Also unique to this proposal will be the focus on Latino subjects at CHR for psychosis. The Latino community is underserved yet represents 55% of school children in San Diego county. The inclusion of a Mexico City site will enable an accelerated recruitment, given their access to large numbers of early psychosis subjects, increase sample diversity and minority representation by including large numbers of Latino subjects and assist in the implementation of a Spanish version of CCT. The laboratories of Kristin Cadenhead, MD, at University of California San Diego (UCSD) and Camilo de la Fuente MD, PhD, from the Laboratorio de Psiquiatr�a Experimental, Instituto Nacional de Neurolog�a y Neurocirug�a (INNN), Mexico City, have an existing collaborative relationship, funded by grants through the University of California Institute for Mexico and the United States (UC MEXUS), that allowed establishment of comparability of early psychosis populations across sites and implementation of reliability and quality control methodology in preparation for the proposed study.