Measuring Cognitive Impairments Associated With Schizophrenia in Clinical Practice: Overview of Current Challenges and Future Opportunities.

IF 5.3 1区 医学 Q1 PSYCHIATRY
Keith H Nuechterlein, Henry Nasrallah, Dawn Velligan
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Abstract

Background: Cognitive impairment associated with schizophrenia (CIAS) negatively impacts daily functioning, quality of life, and recovery, yet effective pharmacotherapies and practical assessments for clinical practice are lacking. Despite the pivotal progress made with establishment of the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) for clinical research, implementation of the full MCCB is too time-consuming and cost-ineffective for most clinicians in clinical practice.

Study design: Here we discuss current assessments in relation to delivery format (interview-based and performance-based), validity, ease of use for clinicians and patients, reliability/reproducibility, cost-effectiveness, and suitability for clinical implementation. Key challenges and future opportunities for improving cognitive assessments are also presented.

Study results: Current assessments that require 30 min to complete would have value in clinical settings, but the associated staff training and time required might preclude their application in most clinical settings. Initial profiling of cognitive deficits may require about 30 min to assist in the selection of evidence-based treatments; follow-up monitoring with brief assessments (10-15 min in duration) to detect treatment-related effects on global cognition may complement this approach. Guidance on validated brief cognitive tests for the strategic monitoring of treatment effects on CIAS is necessary.

Conclusions: With increased advancements in technology-based and remote assessments, development of validated formats of remote and in-person assessment, and the necessary training models and infrastructure required for implementation, are likely to be of increasing clinical relevance for future clinical practice.

在临床实践中测量与精神分裂症相关的认知障碍:当前挑战与未来机遇概述》。
背景:与精神分裂症相关的认知障碍(CIAS)对患者的日常功能、生活质量和康复产生了负面影响,但临床实践中却缺乏有效的药物疗法和实用的评估方法。尽管用于临床研究的 "改善精神分裂症认知的测量和治疗研究"(MATRICS)共识认知电池(MCCB)的建立取得了关键性进展,但对于临床实践中的大多数临床医生来说,实施完整的MCCB过于耗时且成本效益不高:研究设计:在此,我们将讨论当前评估的实施形式(基于访谈和基于表现)、有效性、临床医生和患者的易用性、可靠性/可重复性、成本效益以及临床实施的适宜性。此外,还介绍了改进认知评估所面临的主要挑战和未来机遇:研究结果:目前需要 30 分钟才能完成的评估在临床环境中很有价值,但相关的人员培训和所需时间可能会阻碍其在大多数临床环境中的应用。对认知缺陷进行初步分析可能需要 30 分钟左右的时间,以帮助选择循证治疗方法;通过简短评估(持续时间为 10-15 分钟)进行后续监测,以检测治疗对整体认知的相关影响,可能会对这种方法起到补充作用。有必要为有效的简短认知测试提供指导,以便对 CIAS 的治疗效果进行战略性监测:结论:随着基于技术的远程评估技术的不断进步,开发有效的远程和面对面评估形式以及必要的培训模式和实施所需的基础设施,对未来的临床实践可能具有越来越重要的临床意义。
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来源期刊
Schizophrenia Bulletin
Schizophrenia Bulletin 医学-精神病学
CiteScore
11.40
自引率
6.10%
发文量
163
审稿时长
4-8 weeks
期刊介绍: Schizophrenia Bulletin seeks to review recent developments and empirically based hypotheses regarding the etiology and treatment of schizophrenia. We view the field as broad and deep, and will publish new knowledge ranging from the molecular basis to social and cultural factors. We will give new emphasis to translational reports which simultaneously highlight basic neurobiological mechanisms and clinical manifestations. Some of the Bulletin content is invited as special features or manuscripts organized as a theme by special guest editors. Most pages of the Bulletin are devoted to unsolicited manuscripts of high quality that report original data or where we can provide a special venue for a major study or workshop report. Supplement issues are sometimes provided for manuscripts reporting from a recent conference.
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