Cognitive Behavioral Skills Training for Schizophrenia

描述（由申请人提供）：精神分裂症影响了200多万美国人，并导致了严重的残疾。药物可以减轻阳性症状，但不能专门针对功能。功能结果显示与认知障碍和社交技能缺陷的关系比阳性症状更强。心理社会干预与药物治疗相结合可以改善认知和社会功能，但适当的认知目标和干预技术的最佳组合尚不清楚。需要进行对照良好的社会心理干预试验，通过减轻认知障碍和改善社区功能来扩大药物治疗。我们开发了认知行为社会技能训练（CBSST），并对其进行了操作和指导，该训练针对精神分裂症患者的认知和元认知障碍、社会技能缺陷和干扰功能的思想。建议的项目是一项比较CBSST和支持性接触（SC）的随机对照试验。精神分裂症患者（N=236）将被随机分配到这两种情况中的一种，治疗1年，治疗后随访1年。结果的多维评估将包括社会功能（主要结果）、神经心理功能、认知洞察力、精神症状和卫生服务利用。短期目标是检查CBSST对SC的有效性以及潜在的预测因素和变化机制。关键问题是：(1)在标准治疗中加入CBSST是否能改善精神分裂症患者相对于SC的康复结果？(2)基线时神经认知障碍的严重程度或治疗后神经认知障碍的改善是否对社会功能预后有差异？(3)认知洞察力的改善是否介导CBSST精神病症状的改善？如果CBSST继续产生增量效果，未来更大的有效性和推广试验将是合理的。

DESCRIPTION (provided by applicant): Schizophrenia affects more than 2 million Americans and leads to profound disability. Medications can reduce positive symptoms but do not specifically target functioning. Functional outcome shows stronger relationships with cognitive impairments and social skills deficits than with positive symptoms. Psychosocial interventions combined with pharmacotherapy can improve cognitive and social functioning, but the appropriate cognitive targets and optimal combination of intervention techniques are unclear. Well-controlled trials of psychosocial interventions that amplify pharmacotherapy by alleviating cognitive impairments and improving community functioning are needed. We developed, manualized and piloted cognitive-behavioral social skills training (CBSST), which targets cognitive and metacognitive impairments, social skills deficits, and thoughts that interfere with functioning in schizophrenia patients. The proposed project is a randomized controlled trial comparing CBSST with Supportive Contact (SC). Patients with schizophrenia (N=236) will be randomized to one of the 2 conditions, treated for 1 year and followed longitudinally for 1 year after treatment. A multi-dimensional evaluation of outcomes will include social functioning (primary outcome), neuropsychological functioning, cognitive insight, psychiatric symptoms, and health services utilization. The short-term objectives are to examine the effectiveness of CBSST over SC and potential predictors and mechanisms of change. Key questions are: (1) Does adding CBSST to standard care improve rehabilitation outcomes relative SC in schizophrenia patients? (2) Does severity of neurocognitive impairment at baseline or improvement in neurocognitive impairment in treatment differentially predict social functioning outcome? (3) Does improvement in cognitive insight mediate improvement in psychotic symptoms in CBSST? If CBSST continues to produce incremental effectiveness, future larger effectiveness and dissemination trials would be justified.