Augmenting Social Cognitive Intervention for Veterans with Schizophrenia

描述(由申请人提供)： 患有精神分裂症和分裂情感障碍的退伍军人残疾程度高，社区结果差，这些糟糕的功能结果构成了一个主要的公共卫生问题。精神分裂症谱系障碍的治疗已经从根本上从注重减轻症状转向注重康复和改善功能方面。仅仅通过更好地控制临床症状，这些疾病患者的社区结果所需的改善将不会发生。相反，有必要找到新的治疗方法，解决导致不良功能结局的关键决定因素，包括社会认知。基础(非社会)认知和社会认知都被认为是精神分裂症和分裂情感障碍功能结局的关键决定因素。基本认知包括：学习和记忆、警觉/注意、处理速度、推理和解决问题以及工作记忆等领域。社会认知一般是指构成社会互动基础的心理操作，包括对社会相关刺激的感知、解释、管理和产生反应，包括他人的意图和行为。作为我们之前的奖励金的一部分，我们已经开发了一个社会认知培训计划，并正在进行验证。初步结果表明，该计划改善了社会认知和功能能力的衡量标准。在这项研究中，我们将评估在当前的社会认知干预中增加一个活体成分(发生在社区中的训练活动)是否有助于将训练效果推广到社区结果和主观满意度。在为期12周的培训计划中，将检查社会认知和功能能力的结果衡量标准，并将在3个月的随访中评估受益的持久性。将在培训结束和3个月的随访中评估对社区功能和主观满意度的概括性。在研究的5年中，我们将105名患者随机分配到训练组(社会认知干预加活体锻炼，社会认知干预不进行活体锻炼和对照)。受试者将在基线、6周(中点)、完成培训(12周)和3个月的随访时接受评估。要改善精神分裂症和分裂情感障碍的功能结果，有意义的步骤需要了解如何提高训练计划的普适性。这项研究计划的最终目标是通过解决功能结果的决定因素来改善患有精神障碍的退伍军人的社区结果。 公共卫生相关性： 社会认知障碍是精神分裂症患者社区功能的决定因素，越来越多地被视为干预的目标。当前提案的首要目标是评估增加基于社区的活体训练部分是否可以增强社会认知训练计划对社区成果的普适性。该项目的长期目标是开发针对社会认知缺陷的有效治疗方法，以帮助精神分裂症患者在日常生活中更好地发挥作用。

DESCRIPTION (provided by applicant): Veterans with schizophrenia and schizoaffective disorder experience high levels of disability and poor community outcome, and these poor functional outcomes constitute a major public health concern. The treatment of schizophrenia spectrum disorders has shifted fundamentally from a focus on symptom reduction to a focus on recovery and improving aspects of functioning. Needed improvements in community outcome for patients with these disorders will not occur simply through better control of clinical symptoms. Instead, it is necessary to find new treatments that address the key determinants of poor functional outcome, including social cognition. Both basic (non-social) cognition and social cognition are considered key determinants of functional outcome for schizophrenia and schizoaffective disorder. Basic cognition includes the domains of: learning and memory, vigilance / attention, speed of processing, reasoning and problem solving, and working memory. Social cognition generally refers to mental operations that underlie social interactions, including perceiving, interpreting, managing, and generating responses to socially relevant stimuli, including the intentions and behaviors of others. As part of our previous Merit grant, we have developed a training program for social cognition and are in the process of validating it. Initial results suggest that the program improves performance on measures of social cognition and functional capacity. In this study, we will evaluate whether adding an in vivo component (training activities that occur in the community) to the current social cognition intervention facilitates generalization of training effects to community outcome and subjective satisfaction. Outcome measures of social cognition and functional capacity will be examined during the 12 week training program, and durability of benefits will be assessed at a 3-month follow up. Generalization to community functioning and subjective satisfaction will be assessed at the end of training and at the 3-month follow up. We will enroll 105 patients across the 5 years of the study with random assignment to training group (social cognition intervention with in vivo exercises, social cognition intervention without in vivo exercises and control). Subjects will receive assessments at baseline, 6 weeks (mid-point), completion of training (12 weeks), and the 3-month follow up. Meaningful steps toward achieving improved functional outcome in schizophrenia and schizoaffective disorder require understanding how generalization of training programs can be enhanced. The ultimate goal of this research program is to improve community outcome for veterans with psychotic disorders by addressing the determinants of functional outcome. PUBLIC HEALTH RELEVANCE: Social cognitive impairments are determinants of community functioning in schizophrenia and are increasingly viewed as targets for intervention. The overarching goal of the current proposal is to evaluate whether adding a community-based in vivo training component can enhance the generalization of a social cognitive training program to community outcomes. The long-term goal of this project is to develop effective treatments for social cognitive deficits to help individuals with schizophrenia function better in their daily lives.