A Culturally-Based Family Therapy for Schizophrenia

描述(申请人提供)：精神分裂症是一种严重的精神疾病，以认知、情感和社会职业功能障碍为特征，影响全球约1%的人口。虽然显然是生物引起的疾病，但现在越来越多的证据表明，这种疾病也对家庭的社会文化和情感氛围有很高的反应。现有的治疗方法显示，在以家庭为导向的干预措施后，症状有所改善。然而，美国的大多数课程只提供英语课程，并不了解文化。因此，现有的计划无法满足许多拉美裔美国人的需求，拉美裔美国人是美国增长最快、目前规模最大的少数族裔群体。本申请的目的是申请资金，以支持以家庭为中心的、文化知情的精神分裂症疗法(CIT-S)的开发、实施和评估，该疗法以英语和西班牙语进行。这种治疗将纳入在先前的精神疾病家庭治疗研究中被发现有效的元素，同时增加假设的新的文化成分以提高治疗效果。干预措施将包括15次会议，重点是：加强家庭团结感；教育亲属有关疾病的知识；帮助参与者利用文化、精神和/或存在主义信仰，帮助他们概念化和接受疾病；以及教授有效的沟通和解决问题的技能，以帮助创造一个稳定和治疗的家庭环境。将在治疗前、第15次治疗(终止)之后以及在6个月和12个月的随访点(从第一次治疗之日起)进行全面评估，以评估参与者的情绪和心理健康，并评估干预目标的信念、价值观和归因。每月还将进行住院/复发电话筛查和一般“登记”。为了保持治疗成果，在完成为期12个月的研究后，参与者将被邀请参加每周一次的多家庭支持小组，在那里，CIT-S的技能将得到加强。在研究的试点阶段(在本申请中描述)，将通过将CIT-S与常规治疗(TAU)对照条件进行比较来评估治疗效果。在接下来的几年里，PI将评估治疗的哪些方面与未经证实的患者和家庭功能最密切相关。然后，治疗将得到改进，保留有益的元素，修改或丢弃那些似乎不能提高参与者幸福感的元素。在随后的阶段，将进行一项全面的临床试验(通过RO1或类似的奖励提供资金)，将CIT-S与长度相匹配的传统家庭重点疗法进行比较。PI的长期目标是用西班牙语和英语开发有效的、了解文化知识的家庭干预措施，用于精神分裂症和相关疾病。

DESCRIPTION (provided by applicant): Schizophrenia, a serious mental disorder marked by cognitive, affective, and socio-occupational dysfunction, affects approximately one percent of the population worldwide. Although clearly a biologically induced disorder, mounting evidence now indicates that the illness is also highly responsive to the sociocultural and emotional atmosphere of the family. Existing therapies have shown an improvement in symptoms following family oriented interventions. However, most programs in the United States are offered only in English and are not culturally informed. Therefore, existing programs fail to meet the needs of many Hispanics, the fastest growing and now largest minority group in the United States. The purpose of this application is to request funds to support the development, implementation, and evaluation of a family-focused, Culturally Informed Therapy for Schizophrenia (CIT-S) conducted in both English and Spanish. This treatment will incorporate elements found to be effective in prior family treatment studies of mental illness, while adding new cultural components hypothesized to enhance treatment efficacy. The intervention will include 15 sessions with emphasis on: Fortifying a strong sense of family unity; educating relatives about the illness; helping participants tap into cultural, spiritual and/or existential beliefs that may aid them in conceptualizing and coming to terms with the illness; and teaching effective communication and problem solving skills to help create a stable and therapeutic home environment. Comprehensive assessments will be conducted prior to treatment, after the 15th session (termination), and at 6-month and 12-month follow-up points (from date of first treatment session) to evaluate participants' emotional and mental health and to assess beliefs, values, and attributions targeted by the intervention. Monthly hospitalization/relapse phone screenings and general "check-ins" will also be conducted. To maintain treatment gains, after completing the 12-month study, participants will be invited to attend weekly drop-in multifamily support groups, where CIT-S skills will be reinforced. In the pilot phase of the study (described in this application), treatment efficacy will be evaluated by comparing CIT-S with a Treatment as Usual (TAU) control condition. In subsequent years, the PI will assess which aspects of the treatment are most closely associated with unproved patient and family functioning. The treatment will then be refined, retaining beneficial elements, and revising or discarding those that do not appear to enhance participant well-being. In subsequent stages a full-scale clinical trial (funded through an RO1 or similar award) will be conducted comparing CIT-S to a traditional family focused therapy that is matched in length. The Pi's long term goal is to develop effective culturally informed family interventions for schizophrenia and related disorders, in Spanish and in English.