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。发病时通常 发生在年轻的成年期，精神分裂症患者往往难以建立和维持社会关系， 在社区中的工作角色。认识到精神分裂症的严重残疾， 退伍军人健康管理局优先向患有严重精神疾病的成年人提供精神卫生保健服务。 和持续的精神疾病总统的新自由委员会呼吁发展 精神卫生保健服务，重点是“提高消费者成功科普生活的能力 这些问题包括：如何应对挑战、如何促进复苏和如何建设复原力。“拟议的干预研究旨在 增强患者的认知和心理社会功能。认知功能障碍与 精神分裂症被发现是病人在社区表现如何的最强预测因素之一。 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。这种干预已成功地适用于以下患者： 精神分裂症拟议的治疗研究借鉴了最近的研究结果，这些研究结果表明， 工作记忆是一个关键的，潜在的性能限制，认知缺陷的精神分裂症， 干预后，该领域可能发生临床显著变化。拟议研究的主要目的 是为了测试一种新的认知补救干预措施的有效性， 功能协调发展的为了实现这一目标，将招募80名精神分裂症志愿者患者，并随机分配至 以工作记忆为目标的认知补救条件或计算机技能训练干预 教计算机应用的学校在这两种情况下，参与者将接受三次计算机培训， 一周4个月。我们假设接受认知补救干预的患者将 在工作记忆和执行记忆的神经心理学测量上显示出显著更大的变化， 接受计算机技能课程的患者的能力。另外，我们假设干预- 诱发的认知变化将与功能能力的同时改善相关， 在社区中的社会心理功能。第二个研究目标是检查干预的稳定性- 引起认知的变化。认知和心理社会功能将在术后4个月和8个月重新评估 治疗终止，以检查治疗效果的稳定性，并评估强度较低的 维护培训（每周一次）为参与者提供任何额外的好处。最后，本研究 将以探索性方式检查治疗反应是否存在个体差异。的 COMT基因Val 158 Met多态性与工作记忆相关， 前额叶功能障碍这项研究将测试COMT多态性是否是 预测对认知修复的反应。

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.