Intervention to Improve Functional Outcome & Persistent Symptoms in Schizophrenia

描述(申请人提供)：精神分裂症的康复过程包括解决持续的症状和改善功能结果。我们的研究小组已经证明，在一种名为认知适应训练(CAT)的治疗中，利用患者家中的环境支持绕过认知功能缺陷，可以改善精神分裂症患者对药物的依从性和功能结果，认知行为疗法(CBT)可以减少症状和持续症状对患有这种疾病的个人的负面影响。数据表明，这些治疗方法具有特定的模式效应。在患者家中提供的多模式认知治疗中，针对功能结果和持续的阳性症状，可能会对精神分裂症患者的功能结果、持续症状和这些症状造成的痛苦产生最强烈的影响。我们建议将200名服用抗精神病药物的精神分裂症患者随机分为四种心理社会治疗之一，为期9个月：1)CAT，2)CBT，3)多模式认知治疗(Mcog；一种兼具CAT和CBT特点的综合治疗)，以及4)标准照常治疗(TAU)。治疗结束后将对患者进行6个月的随访。结果将在基线和每3个月进行一次评估。主要结果变量包括症状学和功能结果的测量。我们假设，以CBT为组成部分的治疗(CBT和MCoG)的患者在症状学指标上的改善程度将比随机接受非CBT治疗的患者(CAT或TAU)的改善程度更大，MCoG的患者将比单模式CBT的患者改善更大的程度。此外，我们假设，以CAT为成分的治疗(CAT和MCoG)的患者在症状学指标上的改善程度将比那些随机接受非CAT治疗(CBT或TAU)的患者改善更大，MCoG的患者将比单模式CAT的患者改善更大程度。通过多模式治疗促进精神分裂症康复的潜在公共卫生影响是深远的。通过整合有效的治疗方法，可以评估协同改善的潜力。家访的费用可能会很高。通过在同一次家访中提供多种模式的治疗，最大限度地提高患者的利益，可能会以最小的额外成本改善更广泛的结果。 许多精神分裂症患者继续听到声音，有错误的信念，注意力、记忆计划和日常功能方面的问题，即使接受药物治疗也是如此。精神分裂症的康复过程包括对整个人的治疗。本研究将测试一种新的多模式认知治疗(MCoG)。MCOG通过使用家庭中的支持，如符号、核对表和警报来解决注意力、记忆力和计划方面的问题，以改善日常功能。MCOG还帮助患者检查其信仰的证据，并处理无法通过药物完全解决的声音等症状。我们将比较4种治疗方法，以确定这种联合方法是否能改善精神分裂症患者的症状和功能。

DESCRIPTION (provided by applicant): The process of recovery in schizophrenia involves resolving persistent symptoms and improving functional outcomes. Our research groups have demonstrated that using environmental supports in the patient's home to bypass deficits in cognitive functioning in a treatment called Cognitive Adaptation Training (CAT) improves adherence to medications and functional outcomes in schizophrenia and that Cognitive Behavior Therapy (CBT) decreases symptomatology and the negative effect of persisting symptoms upon individuals with this disorder. Data suggest these treatments have modality specific effects. Targeting both functional outcomes and persistent positive symptoms in a multimodal cognitive treatment provided in the patient's home is likely to have the most robust effects on functional outcomes, persistent symptoms and the distress caused by these symptoms for individuals with schizophrenia. We propose to randomize 200 individuals with schizophrenia taking antipsychotic medications to one of four psychosocial treatments for a period of 9 months: 1) CAT, 2) CBT, 3) Multimodal Cognitive Treatment (Mcog; an integrated treatment featuring aspects of both CAT and CBT), and 4) standard treatment as usual (TAU). Patients will be followed for 6 months after treatment is completed. Outcomes will be assessed at baseline and every 3 months. Primary outcome variables with include measures of symptomatology and functional outcome. We hypothesize that patients in treatments with CBT as a component (CBT and Mcog) will improve to a greater extent on measures of symptomatology than those randomized to non-CBT treatments (CAT or TAU) and that patients in Mcog will improve to a greater extent than those in single modality CBT. Moreover, we hypothesize that patients in treatments with CAT as a component (CAT and Mcog) will improve to a greater extent on measures of symptomatology than those randomized to non-CAT treatments (CBT or TAU) and that patients in Mcog will improve to a greater extent than those in single modality CAT. The potential public health implications of promoting recovery in schizophrenia through multi-modal treatments are profound. By integrating effective treatments the potential for synergistic improvements can be assessed. Home visits can be costly. Maximizing the benefits to patients by providing multi-modal treatment on the same home visit is likely to improve a broader range of outcomes with minimal additional cost. Many individuals with schizophrenia continue to hear voices, have false beliefs, and problems with attention, memory planning and everyday functioning even with medication treatment. The process of recovery in schizophrenia involves treating the whole person. This study will test a new Multimodal Cognitive Treatment (Mcog). Mcog works around problems in attention, memory and planning by using supports in the home such as signs, checklists, and alarms to improve everyday functioning. Mcog also helps the individual to examine the evidence for their beliefs and to deal with symptoms like voices that are not completely resolved with medications. We will compare 4 treatments to determine if this combined approach improves both symptoms and functioning for individuals with schizophrenia.