Remediation of Working Memory in Schizophrenia

精神分裂症是世界上成年人最致残的疾病之一。通常以发病为特征 精神分裂症患者发生在青年时期，通常难以建立和维持社会和 社区中的工作角色。为了认识到与精神分裂症有关的严重残疾， 退伍军人健康管理局优先为患有严重疾病的成年人提供精神卫生保健服务 以及持续性的精神疾病。总统的新自由委员会呼吁制定 以“提高消费者成功应对生活的能力”为重点的精神卫生保健服务 关于促进复苏和建立复原力的挑战。 增强患者的认知和心理社会功能。与认知功能障碍相关的 精神分裂症被发现是预测社区患者病情好坏的最有力指标之一。 认知补救是一种基于计算机的干预措施，旨在恢复认知功能 脑损伤患者。这种干预措施已经成功地用于患有 精神分裂症。拟议的治疗研究借鉴了最近的研究结果，这些结果表明 工作记忆是精神分裂症和精神分裂症患者的一种关键的、潜在的表现受限的认知缺陷 如果进行干预，在这一领域内可能会发生临床上的重大变化。拟议研究的主要目的 是为了测试一种针对工作记忆相关的新型认知补救干预的有效性 功能。为了实现这一目标，80名精神分裂症自愿患者将被纳入并随机分配到 要么是针对工作记忆的认知修复条件，要么是计算机技能培训干预 教授计算机应用的课程。在这两种情况下，参与者每年将接受三次计算机培训 每周4个月。我们假设接受认知矫正干预的患者将 在工作记忆和执行能力的神经心理测量上表现出显著的变化 比接受计算机技能课程的患者更有能力。此外，我们假设干预- 诱发的认知变化将与同时改善的功能能力和 社区中的心理社会功能。第二个研究目标是检查干预的稳定性-- 引起认知上的变化。认知和心理社会功能将在4个月和8个月后重新评估 终止治疗以检查治疗效果的稳定性，并评估是否强度较低 维护培训(每周一次)为参与者提供了任何额外的好处。最后，这项研究 将以探索性的方式检查治疗反应是否存在个体差异。这个 已发现COMT基因Val158Met多态与工作记忆和 精神分裂症患者的前额叶功能障碍。这项拟议的研究将测试COMT多态是否 对认知补救反应的预测。

Schizophrenia is among the most disabling illnesses of adults in the world. With illness onset typically occurring in young adulthood, individuals with schizophrenia often struggle to establish and maintain social and work roles in the community. In recognition of the profound disability associated with schizophrenia, the Veteran's Health Administration has prioritized provision of mental health care services to adults with severe and persistent mental illnesses. The President's New Freedom Commission called for the development of mental health care services that focus on "increasing consumer's ability to successfully cope with life challenges, on facilitating recovery, and on building resilience." The proposed intervention study is designed to enhance cognition and psychosocial functioning in patients. The cognitive dysfunction associated with schizophrenia has been found to be one of the strongest predictors of how well patients do in the community. Cognitive remediation is a computer-based intervention that was developed to restore cognitive functioning in patients with brain injury. This intervention has been adapted successfully for use with patients with schizophrenia. The proposed treatment study draws upon recent research findings which suggest both that working memory is a critical, potentially performance-limiting, cognitive deficit in schizophrenia and that with intervention, clinically significant change can occur within this domain. The primary aim of the proposed study is to test the efficacy of a novel cognitive remediation intervention that targets working memory-related functions. To accomplish this goal, 80 volunteer patients with schizophrenia will be enrolled and randomized to either a cognitive remediation condition that targets working memory or a computer skills training intervention that teaches computer applications. In both conditions participants will receive computer training three times a week for 4 months. We hypothesize that patients who receive the cognitive remediation intervention will demonstrate significantly greater change on neuropsychological measures of working memory and executive abilities than patients who receive the computer skills course. In addition, we hypothesize that the intervention- induced cognitive change will be associated with concurrent improvements in functional capacity and psychosocial functioning in the community. A second study goal is to examine the stability of the intervention- induced changes in cognition. Cognition and psychosocial functioning will be reassessed 4 and 8 months after treatment termination to examine the stability of treatment effects and to assess whether a less intense maintenance training (once a week sessions) provides any additional benefit to participants. Lastly, this study will examine in an exploratory manner whether there are individual differences in treatment response. The Val158Met polymorphism of the COMT gene has been found to be associated with working memory and prefrontal dysfunction in schizophrenia. The proposed study will test whether the COMT polymorphism is predictive of response to cognitive remediation.