Orygen, Parkville, VIC, Australia.
Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
Aust N Z J Psychiatry. 2023 Oct;57(10):1308-1315. doi: 10.1177/00048674231160987. Epub 2023 Mar 25.
For people living with psychosis, cognitive impairment is common and can have significant impacts for functional recovery, impacting engagement with treatment and quality of life more broadly. There is now strong evidence for the effectiveness of cognition-focused treatments, such as cognitive remediation to improve clinical and functional outcomes for people with psychosis. However, engagement with treatment has been a long-standing issue in mental health care, including for people with psychosis, who often experience difficulties with motivation. While research on clinical effectiveness of cognition-focused treatment is growing, to date there has been little research focused on the implementation of such treatments and it is not clear how best to support uptake and engagement across diverse mental health settings. Implementation science is the study of methods and strategies to promote the adoption, application, and maintenance of evidence-based practices in routine care. To integrate cognition-focused treatments into routine practice, and improve engagement with treatment and the quality and effectiveness of care for people with psychosis, researchers need to embrace implementation science and research. This paper provides a succinct overview of the field of implementation science, current evidence for implementation of cognition-focused treatments for psychosis and practical guidance for using implementation science in clinical research. The future of psychosis research includes multidisciplinary teams of clinical researchers and implementation scientists, working together with providers and consumers to build the evidence that can improve the implementation of cognition-focused treatments.
对于患有精神病的人来说，认知障碍很常见，会对其功能恢复产生重大影响，从而更广泛地影响其对治疗的参与度和生活质量。目前有大量证据表明，以认知为重点的治疗方法（如认知矫正）可以改善精神病患者的临床和功能结果。然而，参与治疗一直是精神卫生保健中的一个长期问题，包括精神病患者，他们通常在动机方面存在困难。虽然针对以认知为重点的治疗的临床效果的研究不断增加，但迄今为止，针对此类治疗的实施情况的研究很少，也不清楚如何在不同的精神卫生环境中最好地支持其采用和参与。实施科学是研究促进循证实践在常规护理中采用、应用和维持的方法和策略的学科。为了将以认知为重点的治疗纳入常规实践，并改善精神病患者的治疗参与度以及护理的质量和效果，研究人员需要接受实施科学和研究。本文简要概述了实施科学领域、针对精神病的以认知为重点的治疗的实施现状以及在临床研究中使用实施科学的实用指南。精神病学研究的未来包括临床研究人员和实施科学家的多学科团队，与提供者和消费者共同努力，建立可以改善以认知为重点的治疗实施的证据。
