Cognitive Remediation of Schizophrenia in a Community Mental Health Setting

描述（由申请人提供）：本次竞争性更新的目的是：1）将我们对精神分裂症中基于神经可塑性的认知训练的研究从实验室转移到社区环境中; 2）证明其作为恢复认知和增强精神分裂症患者功能结局的方法的特定效用，该方法涉及基于社区的支持就业（SE）计划。 在我们基于神经科学的认知训练计划中，用户必须成功地进行数千次越来越困难的学习试验，以改善早期感觉、注意力和工作记忆功能中的信噪比处理。其目标是通过在受限和仔细控制的条件下利用大脑可塑性机制来促进关键神经认知功能的恢复，而不是促进补偿性认知或行为操作的发展。来自我们目前基于实验室的随机对照试验（RCT）的数据表明，经过50小时的训练和相对于积极控制，精神分裂症患者在处理速度，工作记忆和言语学习和记忆方面表现出显着改善（效应量为1.0）。培训后6个月的收益持续，并与社会和职业功能和动机的措施的改善显着相关。积极训练的受试者也显示出血清BDNF水平的显着增加。 为了使这种“恢复性”认知补救方法对精神分裂症患者的健康和康复产生有意义的影响，我们的下一阶段研究必须回答三个关键问题：基于神经可塑性的计算机化定向认知训练（TCT）能否在真实的临床环境中实施？它是否增强了患者对心理社会康复的反应（以SE的形式），显著改善了功能结局？在SE的背景下，它是否为患者提供了神经认知和功能方面的特定收益？ 为了回答这些问题，我们将对慢性精神分裂症受试者进行100小时基于神经可塑性的TCT与主动对照条件（100小时图形有趣的电脑游戏）的RCT，并结合SE。这项研究将在旧金山弗朗西斯科市中心的一个城市社区精神健康中心进行。两个受试者组在研究人员接触和计算机暴露量方面是相当的，不同之处仅在于他们是否接受了基于神经可塑性的主动认知训练方法。将在基线、6个月和12个月时评估受试者的神经认知主要结局指标。他们将在6个月、12个月、18个月和24个月时评估就业和生活质量的次要结果。 公共卫生相关性：本研究的目的是探讨神经科学指导的认知训练结合社区支持就业对精神分裂症患者的有效性。我们将研究将我们的基于神经可塑性的恢复性有针对性的认知训练的研究从实验室转移到社区环境的有效性;我们还将研究其在参与支持性就业的慢性精神病患者中增强功能结果的效用。

DESCRIPTION (provided by applicant): The purpose of this competitive renewal is: 1) To move our study of neuroplasticity-based cognitive training in schizophrenia out of the laboratory and into the community setting; 2) To demonstrate its specific utility as a method for restoring cognition and enhancing functional outcome in schizophrenia patients referred to a community-based supported employment (SE) program. In our neuroscience-based cognitive training program, the user must successfully perform thousands of progressively more difficult learning trials that improve signal-to-noise processing in early sensory, attention, and working memory functions. The goal is to foster the recovery of key neurocognitive functions by harnessing mechanisms of brain plasticity under constrained and carefully controlled conditions, rather than to promote the development of compensatory cognitive or behavioral operations. Data from our current laboratory-based randomized controlled trial (RCT) indicate that, after 50 hours of training and relative to an active control, individuals with schizophrenia show significant improvements in processing speed, working memory, and verbal learning and memory (effect size of 1.0). Gains endure 6 months after training and are significantly associated with improvement in measures of social and occupational functioning and motivation. Active training subjects also show significant increases in serum BDNF levels. In order for this "restorative" cognitive remediation approach to have a meaningful impact on the well- being and recovery of individuals with schizophrenia, our next phase of research must answer three critical questions: Can neuroplasticity-based computerized targeted cognitive training (TCT) be implemented in real- world clinical settings? Does it enhance patients' response to psychosocial rehabilitation (in the form of SE), significantly improving functional outcome? Does it offer patients specific gains in terms of neurocognition and functioning in the context of SE? To answer these questions, we will perform an RCT of 100 hours of neuroplasticity-based TCT vs. an active control condition (100 hours of graphically interesting computer games), when combined with SE for participants with chronic schizophrenia. The study will take place in an urban community mental health center in downtown San Francisco. Both subject groups will be comparable in terms of amount of research staff contact and computer exposure, and will differ only in whether or not they receive an active neuroplasticity- based cognitive training approach. Subjects will be assessed at baseline, and at 6 and 12 months on the primary outcome measures of neurocognition. They will be assessed at 6, 12, 18 and 24 months on secondary outcomes of employment and quality of life. PUBLIC HEALTH RELEVANCE: This purpose of this study is to investigate the usefulness of neuroscience-guided cognitive training combined with community-based supported employment for people with schizophrenia. We will examine the effectiveness of moving our study of neuroplasticity-based restorative targeted cognitive training out of the laboratory and into the community setting; and we will also investigate its utility in enhancing functional outcome in chronically mentally ill adults who are participating in supported employment.