Alice Medalia, Alice M Saperstein, Melanie M Wall, Cale N Basaraba, Iruma Bello, Ilana Nossel, Lisa B Dixon
{"title":"在美国大型早期精神病协调专科护理系统中提供认知矫正的可行性和可接受性。","authors":"Alice Medalia, Alice M Saperstein, Melanie M Wall, Cale N Basaraba, Iruma Bello, Ilana Nossel, Lisa B Dixon","doi":"10.1111/eip.13624","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Multinational treatment guidelines support providing cognitive remediation to people recently diagnosed with schizophrenia, but the feasibility of implementing the treatment on a large scale is less well understood.</p><p><strong>Methods: </strong>This study took place between 2019 and 2023 at 14 clinics within a large network of programs providing early intervention services to people aged 16-30 experiencing nonaffective psychosis. Clinics were randomly assigned to deliver cognitive remediation as twice-weekly clinician-led groups (N = 5), cognitive remediation as once-weekly clinician-led groups with homework (N = 6), or treatment as usual (N = 3). All clinics screened for cognitive health need to guide treatment planning. Clinical teams (N = 11) received training to provide cognitive remediation. Program evaluation data were analysed for feasibility and acceptability.</p><p><strong>Results: </strong>Screening for cognitive health needs was completed on 77% of the 1193 participants enrolled at the 11 clinics offering cognitive remediation. Clinicians identified cognitive difficulties in 53.9% (n = 496) of screened participants and referred 27% (n = 134) of these participants to cognitive remediation. Of referred participants, 77.6% (n = 104) initiated treatment, and n = 41 completed the treatment. The rate of referral was nearly double, and treatment initiation was significantly higher at programs delivering once-weekly (84.3%) than twice-weekly (64.4%) treatment but the difference in the rate of treatment completion was statistically nonsignificant. Satisfaction among treatment completers was high.</p><p><strong>Conclusions: </strong>Referrals to cognitive remediation required systemic support of a feasible cognitive health screening process. About a quarter of people with clinician-identified cognitive health needs were referred to cognitive remediation. Feasibility data suggest a flexible model of treatment delivery may facilitate implementation in this service setting.</p>","PeriodicalId":11385,"journal":{"name":"Early Intervention in Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Feasibility and Acceptability of Providing Cognitive Remediation in a Large USA System of Coordinated Specialty Care for Early Psychosis.\",\"authors\":\"Alice Medalia, Alice M Saperstein, Melanie M Wall, Cale N Basaraba, Iruma Bello, Ilana Nossel, Lisa B Dixon\",\"doi\":\"10.1111/eip.13624\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Multinational treatment guidelines support providing cognitive remediation to people recently diagnosed with schizophrenia, but the feasibility of implementing the treatment on a large scale is less well understood.</p><p><strong>Methods: </strong>This study took place between 2019 and 2023 at 14 clinics within a large network of programs providing early intervention services to people aged 16-30 experiencing nonaffective psychosis. Clinics were randomly assigned to deliver cognitive remediation as twice-weekly clinician-led groups (N = 5), cognitive remediation as once-weekly clinician-led groups with homework (N = 6), or treatment as usual (N = 3). All clinics screened for cognitive health need to guide treatment planning. Clinical teams (N = 11) received training to provide cognitive remediation. Program evaluation data were analysed for feasibility and acceptability.</p><p><strong>Results: </strong>Screening for cognitive health needs was completed on 77% of the 1193 participants enrolled at the 11 clinics offering cognitive remediation. Clinicians identified cognitive difficulties in 53.9% (n = 496) of screened participants and referred 27% (n = 134) of these participants to cognitive remediation. Of referred participants, 77.6% (n = 104) initiated treatment, and n = 41 completed the treatment. The rate of referral was nearly double, and treatment initiation was significantly higher at programs delivering once-weekly (84.3%) than twice-weekly (64.4%) treatment but the difference in the rate of treatment completion was statistically nonsignificant. Satisfaction among treatment completers was high.</p><p><strong>Conclusions: </strong>Referrals to cognitive remediation required systemic support of a feasible cognitive health screening process. About a quarter of people with clinician-identified cognitive health needs were referred to cognitive remediation. 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Feasibility and Acceptability of Providing Cognitive Remediation in a Large USA System of Coordinated Specialty Care for Early Psychosis.
Introduction: Multinational treatment guidelines support providing cognitive remediation to people recently diagnosed with schizophrenia, but the feasibility of implementing the treatment on a large scale is less well understood.
Methods: This study took place between 2019 and 2023 at 14 clinics within a large network of programs providing early intervention services to people aged 16-30 experiencing nonaffective psychosis. Clinics were randomly assigned to deliver cognitive remediation as twice-weekly clinician-led groups (N = 5), cognitive remediation as once-weekly clinician-led groups with homework (N = 6), or treatment as usual (N = 3). All clinics screened for cognitive health need to guide treatment planning. Clinical teams (N = 11) received training to provide cognitive remediation. Program evaluation data were analysed for feasibility and acceptability.
Results: Screening for cognitive health needs was completed on 77% of the 1193 participants enrolled at the 11 clinics offering cognitive remediation. Clinicians identified cognitive difficulties in 53.9% (n = 496) of screened participants and referred 27% (n = 134) of these participants to cognitive remediation. Of referred participants, 77.6% (n = 104) initiated treatment, and n = 41 completed the treatment. The rate of referral was nearly double, and treatment initiation was significantly higher at programs delivering once-weekly (84.3%) than twice-weekly (64.4%) treatment but the difference in the rate of treatment completion was statistically nonsignificant. Satisfaction among treatment completers was high.
Conclusions: Referrals to cognitive remediation required systemic support of a feasible cognitive health screening process. About a quarter of people with clinician-identified cognitive health needs were referred to cognitive remediation. Feasibility data suggest a flexible model of treatment delivery may facilitate implementation in this service setting.
期刊介绍：
Early Intervention in Psychiatry publishes original research articles and reviews dealing with the early recognition, diagnosis and treatment across the full range of mental and substance use disorders, as well as the underlying epidemiological, biological, psychological and social mechanisms that influence the onset and early course of these disorders. The journal provides comprehensive coverage of early intervention for the full range of psychiatric disorders and mental health problems, including schizophrenia and other psychoses, mood and anxiety disorders, substance use disorders, eating disorders and personality disorders. Papers in any of the following fields are considered: diagnostic issues, psychopathology, clinical epidemiology, biological mechanisms, treatments and other forms of intervention, clinical trials, health services and economic research and mental health policy. Special features are also published, including hypotheses, controversies and snapshots of innovative service models.
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