Skills Training and Empowerment Program for Middle-Aged and Older Patients with P

项目概要/摘要 就直接治疗而言，精神分裂症是最严重、最昂贵的精神疾病之一 成本、生产力损失和公共援助支出，预计每年给社会造成的成本为 超过 620 亿美元。这些成本中近三分之二来自患者学习、工作、 自我照顾、人际关系和维持一般生活技能。在技能培训干预的同时 已开发用于解决该人群的技能缺陷，患者通常不会持续练习 他们在治疗中学到的技能；可能限制对这些重要技能的掌握，并最终限制 这些干预措施的有效性。我们之前比较过一个针对中老年人的技能培训项目 精神分裂症患者，发现患者不定期遵守家庭作业， 从而限制功能增益。我们开发了一种新的技能培训干预措施，称为“技能 培训和赋权计划”（STEP），其中结合了通信技术（即蜂窝 电话）以帮助最大限度地遵守家庭作业并提高技能对“现实世界”的概括 设置。本研究的主要目标是检验我们的 STEP 计划对于改善功能的有效性 中老年精神分裂症患者样本的结果。我们还将检查这是否 干预对于提高家庭作业依从性是成功的，我们认为这是联系家庭作业的关键机制 技能培训以提高功能结果。为了实现我们的目标，我们将招募240名中年和 患有精神分裂症的老年人，并随机分配他们接受为期 6 个月的新 STEP 干预 或为期 6 个月的原始技能培训干预，称为 FAST 计划。 STEP参与者 项目将参加 12 场小组干预课程（每场 120 分钟），重点培训 6 项 功能领域（例如沟通技巧、财务管理、药物管理）。参加者 还将收到手机，并将收到 24 次手机通话（每次 20 分钟），强调 家庭作业合规性和解决问题的合规性障碍。 FAST 参与者将收到 24 组- 基础会议（每次 120 分钟）强调相同的 6 个功能领域。两组均将获得 6 为期数月的强化课程，以强化功能增益。功能结果的群体差异将是 根据基线、基线后 6、12 和 18 个月的评估确定。

PROJECT SUMMARY/ABSTRACT Schizophrenia is among the most serious and most expensive mental disorders in terms of direct treatment costs, loss of productivity, and expenditures for public assistance, with an estimated annual cost to society of over $62 billion. Almost two thirds of these costs come from patients' diminished capacity for learning, working, self-care, interpersonal relationships, and maintaining general living skills. While skills training interventions have been developed to address skills deficits in this population, patients typically do not consistently practice the skills they learn in therapy; potentially limiting the mastery of these important skills and ultimately the efficacy of these interventions. We previously compared a skills-training program for middle-aged and older patients with schizophrenia and found that patients did not regularly comply with homework assignments, thereby limiting functional gains. We have developed a new skills-training intervention, called the "Skills Training and Empowerment Program" (STEP) that incorporates communication technology (i.e., cellular phones) to help maximize compliance with homework and to improve generalization of skills to "real-world" settings. The primary goal of this study is to examine the efficacy of our STEP program for improving functional outcome in a sample of middle-aged and older patients with schizophrenia. We will also examine whether this intervention is successful for increasing homework compliance, which we believe is a key mechanism linking skills training to increases in functional outcome. To accomplish our aims, we will enroll 240 middle-aged and older adults with schizophrenia and randomly assign them to receive 6-months of our new STEP intervention or 6-months of our original skills training intervention, known as the FAST program. Participants in the STEP program will attend 12 group-based intervention sessions (120 minutes each) emphasizing training in 6 functional domains (e.g., communication skills, financial management, medication management). Participants will also receive cellular phones and will receive 24 cell-phone sessions (20 minutes each) emphasizing homework compliance and problem-solving barriers to compliance. FAST participants will receive 24 group- based sessions (120 minutes each) emphasizing the same 6 functional domains. Both groups will receive 6 months of booster sessions to reinforce functional gains. Group differences in functional outcomes will be determined based upon assessments made at baseline, 6-, 12-, and 18-months post-baseline.