fMRI of Cognitive Remediation Therapy in Schizophrenia

描述（由申请人提供）：认知功能障碍是精神分裂症和分裂情感性障碍（scz-sza）的主要和衰弱特征。即使在临床症状缓解后，持续的认知缺陷也会限制学习和工作表现以及对行为治疗的反应。这些功能障碍中一些最突出和最有问题的功能障碍，如工作记忆和某些类型的问题解决，被认为是额叶功能障碍的反映。由于额叶功能障碍是当前scz-sza病理生理模型的核心，认知缺陷与患者的生活质量和疾病的病理生理都相关。正因为如此，理解和治疗scz-sza的认知缺陷的新努力对于理解和治疗这种疾病都具有重要意义。目前大多数可用的治疗方法对scz-sza的认知缺陷的益处有限。一个可能的、有希望的例外是新的行为疗法，专门通过不同的指导、训练和练习组合来解决认知缺陷。我们在这些治疗方法的开发和评估方面一直处于领先地位，并为认知功能的实质性和持久改善提供了初步证据。在研究的早期阶段，关于观察到的认知功能的改善与潜在脑功能障碍的可能变化之间的关系存在几个重要问题。这些问题的答案对于理解治疗的本质、优化治疗的进一步发展以及评估治疗从根本上改变疾病进程的潜力非常重要。一项由r - 01资助的认知治疗的行为效果评估正在我们的实验室进行。R-21支持支持探索性和发展性fMRI研究，这些研究将提供与认知功能障碍行为治疗相关的区域脑激活变化的初步数据，并为这些变化的更全面研究开发方法。

DESCRIPTION (provided by applicant): Cognitive dysfunctions are major and debilitating features of schizophrenia and schizoaffective disorder (scz-sza). Even after clinical symptom remission, persistent cognitive deficits limit school and work performance and response to behavioral treatments. Some of the most prominent and problematic of these dysfunctions, those in working memory and certain types of problem solving, are thought to reflect frontal lobe dysfunction. Since frontal lobe dysfunction is central in current models of the pathophysiology of scz-sza, cognitive deficits are of relevance both to patient quality of life and to the pathophysiology of the illness. Because of this, new efforts to understand and treat the cognitive deficits of scz-sza are significant for both understanding and for treating the disorders. Most currently available treatments are of limited benefit for the cognitive deficits of scz-sza. One possible, promising exception are new behavioral treatments developed specifically to address the cognitive deficits with varying mixes of instructions and drill and practice. We have been leaders in the development and evaluation of these treatments, and have provided preliminary evidence of substantial and enduring improvements in cognitive function. At this early state in the research, there are several important questions about the relationship between the observed improvements in cognitive function and possible changes in underlying brain dysfunctions. Answers to these questions are important for understanding the nature of the treatments, optimizing further development of the treatments and assessing the potential of the treatments to fundamentally alter the course of illness. An R-0l funded evaluation of behavioral effects of cognitive treatment is ongoing in our laboratory. R-21 support is requested to support exploratory and developmental fMRI studies that will provide preliminary data on changes in regional brain activation associated with behavioral treatment of cognitive dysfunctions, and develop methods for fuller study of these changes.