Compensatory Cognitive Training in Clinical High Risk Latino Youth

临床高危拉丁裔青少年的补偿性认知训练

• 批准号: 8789627
• 负责人: KRISTIN S. CADENHEAD
• 金额: $ 21.68万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-12 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8789627
• 关键词: Activities of Daily Living; Adolescent and Young Adult; Affect; Age; Algorithms; Area; California; Caring; Child; Chronic; Chronic Schizophrenia; Cities; Clinical; Clinical Treatment; Clinical Trials Design; Cognition; Cognitive; Cognitive remediation; Collaborations; Communities; Community Outreach; Comorbidity; County; Coupled; Deterioration; Development; Disease; Doctor of Philosophy; Double-Blind Method; Early identification; Ethics; Evaluation; Family history of; Funding; Grant; Individual; Institutes; Intervention; Laboratories; Latino; Measures; Mediator of activation protein; Mental Health Services; Methodology; Mexican Americans; Mexico; Minority; Neurocognition; Neurocognitive; Neurocognitive Deficit; Outcome Measure; Patient Self-Report; Patients; Performance; Persons; Phase; Population; Preparation; Prevention; Psychotic Disorders; Public Health; Quality Control; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Rehabilitation therapy; Research; Risk; Sampling; Schizophrenia; Schools; Severities; Site; Special Equipment; Staging; Symptoms; Syndrome; Time; Training; Training Technics; Translating; Underserved Population; United States; Universities; Work; Youth; base; cognitive enhancement; cognitive training; disability; first episode psychosis; follow-up; functional outcomes; functional status; help-seeking behavior; high risk; improved; indexing; interest; meetings; neuroprotection; novel; prevent; primary outcome; programs; psychotic symptoms; public health relevance; response; secondary outcome; skills; therapy development; treatment response

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.

描述（由申请人提供）：对于精神疾病治疗的开发，尤其是在早期阶段，越来越重视认知增强、神经保护和认知矫正领域。临床高危 (CHR) 个体在 1-2 年内罹患精神病的几率在 20-40% 之间，但无论是否罹患精神病，大多数人都存在神经认知和功能缺陷。神经认知缺陷预示着后来的精神病以及随后的功能状态不佳 向上。通过在精神病病程的早期进行干预以针对神经认知缺陷，可能会影响这种破坏性疾病的功能结果。拟议的 R34 应用程序是为了响应 RFA-MH-14-212 - 改善精神障碍临床高危人群护理的研究，将评估美国和墨西哥拉丁裔临床高危 (CHR) 受试者的补偿性认知训练 (CCT) 与娱乐训练 (RT)。尽管 CCT 已在慢性精神病中进行了广泛研究，显示出对神经认知领域和功能能力的中等到大的影响，但从未在 CHR 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，120 名 CHR 拉丁裔受试者将被随机分为 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进行四次评估。具体目标是 1) 比较 CCT 增强与 RT 的主要神经认知（全球认知指数）和功能能力（UCSD 基于绩效的技能评估 - UPSA）测量以及次要自评功能（特定功能水平）和临床症状（前驱综合症量表 - SOPS）测量； 2) 探索治疗反应的预测因素（调节因素）（例如年龄、基线症状、神经认知），3) 探索治疗反应的调节因素（神经认知和功能的变化）。 该提案的另一个独特之处在于，CHR 重点关注拉丁裔精神病受试者。拉丁裔社区服务不足，但占圣地亚哥县学童的 55%。纳入墨西哥城站点将能够加速招募，因为他们可以接触大量早期精神病受试者，通过纳入大量拉丁裔受试者来增加样本多样性和少数族裔代表性，并协助实施西班牙语版本的 CCT。加州大学圣地亚哥分校 (UCSD) 的 Kristin Cadenhead 医学博士和来自墨西哥城国家神经病学和神经西鲁格研究所 (INNN) 实验室 Psiquiatr�a 实验实验室的 Camilo de la Fuente 医学博士、哲学博士实验室已建立合作关系，由加州大学墨西哥研究所提供资助， 美国（UC MEXUS），允许建立跨地点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。