Compensatory Cognitive Training in Clinical High Risk Latino Youth

描述(申请人提供)：在开发精神病治疗方法方面，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。临床高危人群在1-2年内罹患精神病的比率在20%-40%之间，但无论他们是否发展为精神病，大多数人都有神经认知和功能缺陷。神经认知缺陷预示着后来的精神疾病，也预示着Follow的功能状态不佳 向上。通过在精神病病程早期进行干预，针对神经认知缺陷，可能会影响这种毁灭性疾病的功能结果。为响应RFA-MH-14-212-改善精神病临床高危人群护理的研究，拟议的R34应用程序将评估美国和墨西哥拉丁裔临床高危(CR)受试者的补偿性认知训练(CCT)和娱乐训练(RT)。尽管CCT在慢性精神疾病中已被广泛研究，显示出对神经认知领域和功能能力的中等到较大的影响，但在慢性精神疾病受试者中从未进行过研究。在为期12周的随机临床试验设计中，120名CHR拉丁裔受试者将被随机分为CCT组或RT组。受试者将在研究开始和结束时进行4次评估，中间每月一次。其具体目标是：1)比较CCT强化治疗与RT在初级神经认知(全球认知指数)和功能能力(UCSD Performance-Based Skills评估-UPSA)措施以及次级自我评估(特定功能水平)和临床症状(前驱症状量表-SOPS)措施上的差异；2)探索治疗反应的预测(调节因素)(例如，年龄、基线症状、神经认知)；以及3)探索治疗反应的中介因素(神经认知和功能的变化)。这项提案的另一个独特之处是将重点放在CHR针对精神病的拉丁裔对象上。拉美裔社区没有得到足够的服务，但占圣地亚哥县55%的学童。纳入墨西哥城的一个地点将有助于加速招募，因为他们可以接触到大量早期精神病受试者，通过包括大量拉丁裔受试者增加样本多样性和少数群体代表性，并帮助实施西班牙语版本的有条件现金转移。加州大学圣地亚哥分校的克里斯汀·卡登黑德医学博士和墨西哥城�a实验室的Camilo de la Fuente医学博士和墨西哥国家神经日志研究所�a y Neurocirug�a(INNN)的实验室有现有的合作关系，通过加州大学墨西哥和美国研究所(UC MEXUS)的赠款资助，这使得可以在不同地点建立早期精神病患者的可比性，并实施可靠性和质量控制方法来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.