Optimizing Cognitive Remediation Outcomes in Schizophrenia

描述(申请人提供)：这项研究的目的是明确和积极地推动精神分裂症患者对基于神经可塑性的认知治疗的最佳反应，以便最大限度地提高治疗反应。我们将调查在基于计算机的认知矫正计划中通常被忽视的因素-那些与社会认知相关的因素-并将描绘它们与动机、功能结果以及奖励预期和情绪处理的神经基础的关系。目前的研究表明，除非我们充分了解和利用这些因素，否则我们不会在精神分裂症患者的治疗方面取得有意义的进展。我们的具体目标是：1.进行随机对照试验，将100名精神分裂症受试者分配到60小时的基于神经可塑性的计算机化定向认知训练(TCT)中，该训练完全集中在“冷认知”(一种训练早期感觉处理、注意力、工作记忆和听觉和视觉领域的认知控制的计划)，或者60小时的训练，将TCT计划与每天20分钟的适应性计算机化社会认知训练(SCT)练习相结合。2.比较两组受试者在神经认知、社会认知、动机和功能结果方面的结果。3.在干预后6个月对受试者进行评估，以确定训练效果的持久性。4.确定TCT单独与TCT+SCT在关键神经区域的大脑激活模式的变化：在奖赏预期和情绪识别期间。这一方法的及时性得到了最近的证据的支持，这些证据表明，传统的认知治疗方法与精神分裂症的功能结果之间只有微弱的联系，但社会认知和功能结果之间存在着强烈的、直接的关系。因此，我们现在必须检查一个精心设计的最先进的认知训练计划的临床、功能和神经影响，该计划将神经认知与社会认知训练结合起来。公共卫生相关声明(叙述)这项研究与公共卫生相关，因为它将：1)确定在基于神经可塑性的听觉和视觉处理认知训练中增加社会认知训练是否会改善精神分裂症患者的预后；2)帮助确定针对精神分裂症的基于神经可塑性的认知治疗策略，从而在帮助患者在动机以及社会和职业功能方面实现有意义的改善方面提供最大的好处。

DESCRIPTION (provided by applicant): The purpose of this study is to explicitly and aggressively drive an optimal response to neuroplasticity- based cognitive remediation in schizophrenia in order to maximize treatment response. We will investigate factors that have generally been ignored in computer-based cognitive remediation programs-those related to social cognition-- and will delineate their relationship to motivation, functional outcome, and the neural substrates of reward anticipation and emotion processing. Current research indicates that, unless we fully understand and harness these factors, we will not achieve meaningful treatment gains for individuals with schizophrenia. Our specific aims are: 1. To perform an RCT in which 100 schizophrenia subjects are assigned to either 60 hours of neuroplasticity- based computerized targeted cognitive training (TCT) that focuses exclusively on "cold cognition" (a program which trains early sensory processing, attention, working memory and cognitive control in auditory and visual domains), or to 60 hours of training that combines the TCT program with 20 minutes per day of adaptive computerized social cognition training (SCT) exercises. 2. To compare the outcomes of these two groups of subjects on measures of neurocognition, social cognition, motivation, and functional outcome. 3. To assess subjects six months after the intervention to determine the durability of training effects. 4. To identify changes in brain activation patterns in key neural regions as a result of TCT alone vs. TCT+SCT: during reward anticipation, and during emotion recognition. The timeliness of this approach is supported by recent evidence demonstrating only weak associations between traditional cognitive remediation approaches and functional outcome in schizophrenia, but a strong, direct relationship between social cognition and functional outcome. Thus we must now examine the clinical, functional, and neural effects of a well-designed state-of-the-art cognitive training program that combines neurocognition with social cognition training. Public Health Relevance Statement (Narrative) This research is relevant to public health in that it will: 1) determine whether the addition of social cognition training exercises to neuroplasticity-based cognitive training of auditory and visual processing improves outcome for people with schizophrenia; 2) help to identify neuroplasticity-based cognitive remediation strategies for schizophrenia that provide the maximal benefit in terms of helping patients to achieve meaningful improvements in motivation and social and occupational functioning.