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青少年和年轻人身上，他们被认为是 处于精神病的临床高风险(CHR)。这些年轻人表现出类似于 精神错乱，但没有那么严重，因此被认为仍然可以接受早期干预。首字母 预防工作使用抗精神病药物作为主要预防药物，但这些药物被证明在很大程度上是 效果不佳。更新的方法集中在弥补认知缺陷上，这些缺陷很容易 慢性阻塞性肺疾病青少年的明显和对未来疾病的预测。然而，尽管认知补救方法已经表明 它为改善精神分裂症患者的认知障碍和改善预后带来了巨大的希望 还没有在CHR年轻人身上取得明显的成功。这项拟议的研究将测试一种创新的互联网- 基于远程提供的特定认知补救加上周围(或评分)干预 以早期加工速度缺陷为目标的14-20岁青少年 NIMH加工速度域的神经心理水平--测量与治疗 精神分裂症(Matrics)共识认知成套测验改善认知功能的研究建议数 Score治疗方案以理论框架为基础，得到了我们小组和 另一些情况下，处理速度不足会导致社交功能不佳，进而导致 患精神病的风险增加。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，加工速度，这是高阶行为和临床的一个速度限制因素 慢性阻塞性肺疾病青少年的结局。克服过去在应用认知补救治疗方面的困难 CHR青少年，我们开发了一个平台来支持我们的定向处理速度训练，其中 涉及减少CHR研究人群的异质性(包括缩小年龄范围、缩小 临床标准，以及针对有预先存在的加工缺陷的个人)。此外，我们还添加了一个 新颖的支撑环绕组件，预计将增加乐趣和促进保持。在 单臂R61阶段，为期两年的概念验证研究，30名CHR个人将获得10分 每周(每周4小时/总共40小时)，中点评估为20小时(5周)，以演示目标 并确定与目标接触所需的最佳分数剂量。在R33阶段，3 在一年的试点研究中，我们将在一个新的、更大的54个CHR个人样本中复制目标参与 随机到分数(优化剂量)或到视频游戏控制条件，以牢固地建立中心性 处理速度。此外，R33阶段将确定目标参与度中的更改是否关联 随着社会功能的改善和减轻阳性症状的减少。

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.