Targeting Processing Speed Deficits to Improve Social Functioning and Lower Psychosis Risk in Adolescents at Clinical High Risk for Psychosis

项目摘要 精神分裂症的预防主要集中在被认为是精神分裂症的青少年和年轻人身上。 精神病临床高危人群。这些年轻人表现出微妙的临床症状， 精神病，但不那么严重，因此认为仍然适合早期干预。初始 预防工作使用抗精神病药物作为主要预防药物，但这些药物在很大程度上 无效。最近的方法集中在补救容易被忽视的认知缺陷上。 对青少年未来的疾病有明显的预测作用。然而，虽然认知补救已经表明， 对于改善精神分裂症患者的认知缺陷和改善预后， 在年轻人中还没有取得明显的成功。这项拟议中的研究将测试一种创新的互联网- 基于远程递送的特异性COgestival REmediation + Surround（或SCORES）干预治疗 青少年年龄14-20岁，目标是早期处理速度缺陷， 神经心理学水平与来自NIMH测量和治疗的处理速度域 精神分裂症认知改善研究（MATRICS）共识认知组合。拟议 SCORES治疗方案以理论框架为基础，得到我们小组研究结果的支持， 另一些人，处理速度不足导致社会功能低下，这反过来又导致 增加患精神病的风险。我们特别选择了认知补救，因为它直接针对一个核心， 认知机制，处理速度，这是一个速率限制因素，以更高的秩序行为和临床 在青少年中的结果。为了克服过去在应用认知补救治疗时遇到的困难， 为了帮助青少年，我们开发了一个平台来支持我们有针对性的处理速度训练， 包括减少研究人群的异质性（包括减少年龄范围，缩小 临床标准，并针对预先存在处理缺陷的个体）。此外，我们还增加了一个 本发明提供了一种新型的支撑环绕部件，该支撑环绕部件预期增加乐趣并促进保持力。在 单臂R61阶段，为期2年的概念验证研究，30名受试者将获得10分 周（每周4小时/共40小时），在20小时（5周）进行中点评估，以证明目标 参与并确定参与目标所需的SCORES的最佳剂量。在R33阶段， 在为期一年的试点研究中，我们将在一个新的、更大的样本中复制目标参与度，该样本包括54名参与者 随机分配至评分（优化剂量）或视频游戏控制条件，以牢固确立中心性 处理速度。此外，R33阶段将确定目标接合的变化是否与 社会功能得到改善，阳性症状减少。

Project Summary Prevention of schizophrenia has primarily focused on adolescents and young adults who are considered to be at clinical high risk (CHR) for psychosis. These youngsters display subtle clinical symptoms that are similar to psychosis but not as intense, and therefore considered to still be amenable to early intervention. Initial prevention efforts used anti-psychotics as the primary preventive agents but these were shown to be largely ineffective. More recent approaches have focused on the remediation of the cognitive deficits that are readily apparent and predictive of future illness in CHR adolescents. However, while cognitive remediation has shown substantial promise for improving cognitive deficits and improving outcomes in patients with schizophrenia, it has not yet been markedly successful with CHR youth. The proposed study will test an innovative internet- based remotely-delivered Specific COgnitive REmediation plus Surround (or SCORES) intervention for CHR adolescents ages 14-20 years old that targets early processing speed deficits as measured at the neuropsychological level with the processing speed domain from the NIMH-Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) consensus cognitive battery. The proposed SCORES treatment package is grounded in a theoretical framework, supported by findings from our group and others, where processing speed deficits contribute to poor social functioning, which in turn leads to an increased risk for psychosis. We specifically selected cognitive remediation because it directly targets a core cognitive mechanism, processing speed, which is a rate limiting factor to higher order behaviors and clinical outcome in CHR adolescents. To overcome past difficulties in applying a cognitive remediation treatment to CHR teenagers, we have developed a platform to support our targeted processing speed training, which involves reducing the heterogeneity of the CHR study population (including a reduced age range, narrowed clinical criteria, and targeting individuals with pre-existing processing deficits). In addition, we have adding a novel support surround component which is expected to increase enjoyment and promote retention. In the single-arm R61 phase, a 2-year proof of concept study, 30 CHR individuals will receive SCORES for 10 weeks(4hrs per wk/40 hrs total) with a midpoint assessment at 20 hours (5 weeks) to demonstrate target engagement and identify the optimal dose of SCORES needed to engage the target. In the R33 phase, a 3 year pilot study, we will replicate target engagement in a new and larger sample of 54 CHR individuals randomized to SCORES (optimized dose)or to a Video GameControl condition to firmly establish the centrality of processing speed. In addition, the R33 phase will determine if changes in target engagement are associated with improved social functioning and decreasing attenuated positive symptoms.