Comparing Cognitive Remediation Approaches for Schizophrenia

摘要 过去30年的证据表明，70-80%的精神分裂症患者表现出 在注意力、学习和记忆、解决问题的能力方面存在明显的神经认知缺陷， 语言和感觉运动技能（例如，赖兴贝格和哈维，2007年）。特别重要的是， 由于这些缺陷的严重程度与社区功能受损、社会 问题解决和心理社会康复计划的进展（绿色等人，2000;绿色等人， 2015年）。认知补救（CR）是一种行为干预，解决认知缺陷， 精神分裂症通过恢复失去的认知技能或提供通过任务绕过缺陷的策略 实践荟萃分析（Wykes等人，2011; McGurk等人，（2007）发现，认知 补救是改善精神分裂症认知功能的有效方法，然而， 关于干预的积极因素的精确性使其建议无法作为一个 该疾病的标准治疗（狄克逊等人，2010年）。本三年期提案旨在确定 最有效改善精神分裂症认知功能的认知训练机制 通过比较两种不同侧重点的CR系统程序：演练练习与 补偿策略这两个方案都有很强的初步经验支持。了一百 35名被诊断为精神分裂症或情感障碍的患者将被随机分配到 三个小组之一：一个基于神经可塑性的，计算机辅助认知的训练和实践项目 旨在恢复失去的认知能力的训练练习; 绕过认知缺陷或电脑游戏控制条件。研究措施，有组织 根据实验治疗方法，将目标与结果区分开来， 评估任何观察到的训练效果的泛化。

Abstract Evidence over the past 30 years has revealed that 70-80% of individuals with schizophrenia exhibit marked neurocognitive deficits on measures of attention, learning and memory, problem-solving, language and sensory-motor skill (e.g., Reichenberg & Harvey, 2007). Particular significance has been attached to these deficits as their severity has been linked to impaired community function, social problem-solving and progress in psychosocial rehabilitation programs (Green et al., 2000; Green et al., 2015). Cognitive remediation (CR) is a type of behavioral intervention that addresses cognitive deficits in schizophrenia by restoring lost cognitive skills or providing strategies for bypassing deficits through task practice. Meta-analyses (Wykes et al., 2011; McGurk et al., 2007) have revealed that cognitive remediation is a validated approach to improving cognitive function in schizophrenia, however a lack of precision regarding the active elements of the intervention have prevented its recommendation as a standard treatment for the illness (Dixon et al., 2010). The present three-year proposal seeks to identify cognitive training mechanisms that are most effective at improving cognitive function in schizophrenia by comparing two different systematic programs of CR with different foci: drill-and-practice exercises vs. compensatory strategies. Both programs have strong preliminary empirical support. One-hundred and thirty-five clients diagnosed with schizophrenia or schizoaffective disorder will be randomly assigned to one of three groups: a neuroplasticity-based, drill-and-practice program of computer-assisted cognitive training exercises designed to restore lost cognitive capacity; a manualized strategy training method for bypassing deficits in cognition, or a computer games control condition. Study measures, organized according to an experimental therapeutics approach, with targets distinguished from outcomes, will assess generalization of any observed training effects.