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Cognitive Adaptation Training: Effectiveness in real-world settings and Mechanisms of Action (CAT-EM)

认知适应训练：现实环境中的有效性和行动机制（CAT-EM）

基本信息

批准号：
10405566
负责人：
Dawn Irene Velligan
金额：
$ 41.81万
依托单位：
UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10405566
关键词：
Acute Adaptive Behaviors Adherence Ambulatory Care Attention Awareness Behavior Bypass Caring Cognition Cognitive Communities Community Mental Health Centers Conscious Country Diagnosis Direct Costs Economic Burden Educational Background Effectiveness Electronics Goals Habits Health Home Home environment Impaired cognition Impairment Individual Intention Intervention Lead Maintenance Measures Mediating Memory Motivation Occupational Outcome Outpatients Participant Persons Pharmaceutical Preparations Population Process Public Health Randomized Recovery Schizophrenia Series Services Symptoms Technology Theoretical model Time Training Training Support Visit Work base cognitive function cost cost effectiveness effectiveness study effectiveness testing effectiveness trial efficacy study functional disability functional outcomes hospital readmission improved improved functioning improved outcome medication compliance pill professional atmosphere psychosocial randomized effectiveness trial readmission rates response social theories treatment duration trial comparing

项目摘要

Abstract Schizophrenia remains one of the most disabling conditions world-wide with an economic burden that exceeded $155 billion dollars in fiscal year 2013 alone. Despite existing medication and community treatment, many individuals with this diagnosis continue to have poor outcomes and struggle toward recovery. CAT is a psychosocial treatment using environmental supports such as signs, alarms, pill containers, checklists, technology and the organization of belongings established in a person's home or work environment to bypass the cognitive and motivational difficulties associated with schizophrenia, and support habits for functional behavior to promote recovery. In a series of efficacy studies, CAT improved social and occupational functioning, symptoms, and adherence to medication, and reduced rates of readmission. We propose a cluster randomized effectiveness trial comparing Cognitive Adaptation Training (CAT) to existing community treatment (CT) for individuals with schizophrenia in 8 community mental health centers across multiple states including 400 participants. This would be the first large-scale effectiveness study of CAT for improving functional outcomes for those with schizophrenia seen in community mental health centers (CMHCs) where the majority of those with schizophrenia are followed for outpatient care and to study the purported mechanisms of action based on an integrated theoretical model. Participants will be assessed at baseline and 6 and 12 months on measures of functional and community outcome, medication adherence, symptoms, habit formation and automaticity, cognition and motivation. CAT treatment will be weekly for 6 months, biweekly for 3 months and monthly for the remainder of the trial. Purported mechanisms of action for CAT including bypassing impairments in cognitive function to improve functional outcome and bypassing motivational impairments to create automatic habits to improve functional outcome will be examined.

抽象的精神分裂症仍然是全世界最严重的疾病之一，其经济负担仅 2013 财年就超过 1,550 亿美元。尽管有现有的药物治疗和社区治疗，许多患有这种诊断的人的治疗效果仍然不佳，并且难以康复。猫是一个使用环境支持进行心理治疗，例如标志、警报、药丸容器、检查表、在一个人的家庭或工作环境中建立的技术和财产组织可以绕过与精神分裂症相关的认知和动机困难，以及功能性支持习惯促进康复的行为。在一系列功效研究中，CAT 改善了社会和职业功能、症状和药物依从性，并降低再入院率。我们提出一个集群比较认知适应训练 (CAT) 与现有社区治疗的随机有效性试验 (CT) 为多个州的 8 个社区精神卫生中心的精神分裂症患者提供检查，包括 400 名参与者。这将是 CAT 在改善功能方面的首次大规模有效性研究。社区精神卫生中心 (CMHC) 中大多数精神分裂症患者的结果对精神分裂症患者进行门诊护理并研究其所谓的作用机制基于综合理论模型。参与者将在基线以及 6 个月和 12 个月后接受评估功能和社区结果、药物依从性、症状、习惯形成和自动性、认知和动机。 CAT 治疗将持续 6 个月每周一次，持续 3 个月每两周一次，试验剩余时间每月一次。 CAT 的据称作用机制，包括绕过认知功能障碍以改善功能结果并绕过动机障碍将检查创建自动习惯以改善功能结果。