Compensating for Cognitive Deficits in Schizophrenia

许多精神分裂症门诊患者表现出明显的功能障碍，生活质量差，再住院率高。 最近的研究表明，神经认知缺陷预测这些患者的社区结果。 在一系列研究中，我们发现，与对照组相比，认知适应训练（CAT）--一套旨在绕过特定神经认知缺陷的手动驱动的补偿策略（体征、检查表、电子设备）--显著改善了精神分裂症患者的适应功能、生活质量和复发率。重要问题仍然存在：CAT是否上级几乎所有患者都可以使用的最小限度的广义补偿策略（例如，药盒、日历）？ CAT治疗的强度和成本是否可以大幅降低，同时保持重要功能结果的收益？ 我们计划在120名药物治疗的精神分裂症患者中解决这些问题，这些患者被随机分配到三个治疗组之一，为期两年：1）CAT，2）最小环境支持，3）照常治疗。 在最初9个月的治疗后，在接下来的3个月内，CAT的强度将降低到经济上可行的水平，并在接下来的12个月内继续以这种较低的强度进行治疗。将在研究入组时以及3、6、9、18和24个月时进行综合评估。 主要结果变量将包括适应功能和生活质量的测量。将使用重复测量协方差分析（治疗前评分作为协变量）检查9、12和24个月时功能结局的组间差异。 我们假设，在9个月结束时，CAT和最小支持的患者将比标准治疗的患者具有更好的功能结局，并且当以经济上可行的水平提供治疗时，CAT患者的功能和生活质量的改善将保持在适用于现有治疗输送系统的水平。

Many schizophrenia outpatients demonstrate significant impairment in role functioning, poor quality of life and high rates rehospitalization. Recent research has shown that neurocognitive deficits predict community outcomes for these patients. In a series of studies, we showed that Cognitive Adaptation Training (CAT) -a manual-driven set of compensatory strategies (signs, checklists, electronic devices) designed to bypass specific neurocognitive deficits -significantly improved adaptive functioning, quality of life, and rates of relapse in schizophrenia patients compared to control conditions. Significant questions remain: Is CAT superior to a minimal set of generalized compensatory strategies (e.g. pillboxes, calendars) that could be given to virtually all patients? Can the intensity and therefore the cost of CAT treatment be substantially reduced while maintaining gains in important functional outcomes? We plan to address these questions in a sample of 120 medicated schizophrenia patients randomly assigned for a period of two years to one of three treatment groups: 1) CAT, 2) Minimal Environmental Supports, 3) Treatment as usual. Following an initial 9 months of treatment, the intensity of CAT will be reduced to an economically viable level over the next 3 months and be continued at this lower intensity for the next 12 months. Comprehensive assessments will be obtained at study entrance and at 3, 6, 9, 18, and 24 months. Primary outcome variables will include measures of adaptive function and quality of life. Repeated measures analyses of covariance, with pretreatment scores used as covariates, will be utilized to examine group differences on functional outcomes at 9, 12, and 24 months. We hypothesize that at the end of 9 months, patients in CAT and minimal supports will have better functional outcomes than patients in standard treatment, and the gains in functionality and quality of life for patients in CAT will be maintained when the treatment is provided at an economically viable level that would be suitable for use in existing treatment delivery systems.