SKILLS TRAINING FOR SCHIZOPHRENIA:ENHANCING OUTCOMES

精神分裂症技能培训：改善成果

• 批准号: 6640292
• 负责人: THOMAS E SMITH
• 金额: $ 23.66万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-03-01 至 2005-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6640292
• 关键词: adult human (21+); antipsychotic agents; behavioral /social science research tag; clinical research; cognition; combination therapy; functional ability; group therapy; human subject; human therapy evaluation; interview; longitudinal human study; medical rehabilitation related tag; mental disorder chemotherapy; neuropsychological tests; outcomes research; psychopharmacology; psychosocial rehabilitation; quality of life; questionnaires; risperidone; schizophrenia; serotonin inhibitor; short term memory; social behavior; training

Social and symptom management skills training approaches are widely available for use in the care of individuals with schizophrenia. Controlled studies have demonstrated efficacy, but questions persist regarding generalizability and overall effectiveness of skills training in outpatient settings. It is important to establish whether there are subgroups of individuals who are more likely to benefit from intensive rehabilitation efforts, so that treatments can be appropriately matched and rehabilitation efforts made more efficient. Preliminary studies by our group and others suggest that individuals with good verbal memory capacity are more likely to acquire new skills and use them in real world settings. However, there are no prospective studies of skills training for outpatients with schizophrenia that control for the effects of neurocognitive deficits. Also, there are no studies of the effectiveness of skills training for individuals taking atypical antipsychotic medications. This is important in that atypical antipsychotics are now first-line treatments for schizophrenia, and also because these agents may improve verbal memory function in a way that increases the chances of good rehabilitation outcomes. This study tests the effectiveness of a standard skills training approach and the mediating effects of verbal memory deficits in a cohort of outpatients with chronic psychotic disorders taking atypical antipsychotic medications. Subjects taking stable doses of risperidone, olanzapine, or quetiapine will receive either intensive symptom management and social skills training or a comparison group therapy for 12 months. Medication assignment will not be controlled, but separate randomization streams will be used for subjects taking each of the atypical agents. In addition, a stratified randomization procedure will be used to control for good vs. poor neurocognitive functioning using identified cutoff values on a verbal memory test. The primary aims of the study are to: a) document the degree of skill acquisition seen following training; b) identify the degree of generalization of learned skills to other settings; and c) document the mediating effects of neurocognitive deficits on treatment response and functional capacity. This study will generate new information that can guide treatment planning and maximize the chances for recovery in individuals with schizophrenia.

社会和症状管理技能培训方法广泛用于精神分裂症患者的护理。对照研究已经证明了有效性，但关于技能培训在门诊设置的普遍性和整体有效性的问题仍然存在。重要的是要确定是否存在更有可能从强化康复工作中受益的个体亚群，以便适当地匹配治疗并使康复工作更有效。我们小组和其他人的初步研究表明，拥有良好言语记忆能力的人更有可能获得新技能，并在现实世界中使用它们。然而，目前还没有对精神分裂症门诊患者进行技能培训的前瞻性研究，以控制神经认知缺陷的影响。此外，对于服用非典型抗精神病药物的个体，也没有关于技能培训有效性的研究。这一点很重要，因为非典型抗精神病药物现在是精神分裂症的一线治疗方法，也因为这些药物可能在某种程度上改善言语记忆功能，增加良好康复结果的机会。本研究在一组服用非典型抗精神病药物的慢性精神病门诊患者中测试了标准技能训练方法的有效性和言语记忆缺陷的中介作用。服用稳定剂量利培酮、奥氮平或喹硫平的受试者将接受强化症状管理和社交技能培训或对照组治疗，为期12个月。药物分配将不受控制，但将为服用每种非典型药物的受试者使用单独的随机分配流。此外，分层随机化程序将用于控制良好和较差的神经认知功能，使用在言语记忆测试中确定的截止值。本研究的主要目的是：a)记录培训后技能习得的程度；B)确定所学技能在其他环境中的推广程度；c)记录神经认知缺陷对治疗反应和功能能力的中介作用。这项研究将产生新的信息，可以指导治疗计划，并最大限度地提高精神分裂症患者康复的机会。