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

项目总结/摘要 就直接治疗而言，精神分裂症是最严重和最昂贵的精神障碍之一 成本，生产力损失和公共援助支出，估计每年社会成本为 超过620亿美元其中近三分之二的费用来自患者学习、工作、 自我照顾、人际关系和维持一般生活技能。虽然技能培训干预措施 已经开发了解决这一人群中的技能缺陷，患者通常不坚持实践 他们在治疗中学到的技能;潜在地限制了对这些重要技能的掌握， 这些干预措施的有效性。我们之前比较了一个针对中年和老年人的技能培训计划， 精神分裂症患者，并发现患者没有定期遵守家庭作业， 从而限制了功能增益。我们开发了一种新的技能培训干预措施，称为“技能 培训和赋权方案”（STEP），其中包括通信技术（即，蜂窝 电话），以帮助最大限度地遵守家庭作业，并提高技能的泛化到“现实世界” 设置.本研究的主要目的是检查我们的STEP程序改善功能的有效性 结果在一个样本的中年和老年精神分裂症患者。我们还将研究这是否 干预是成功的，增加家庭作业的遵守，我们认为这是一个关键的机制， 技能培训，以增加功能的结果。为了实现我们的目标，我们将招收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6个月的STEP干预 或6个月的原始技能培训干预，称为FAST计划。STEP的参与者 该计划将参加12个基于小组的干预会议（每个120分钟），强调在6 功能域（例如，沟通技巧、财务管理、药物管理）。参与者 还将收到手机，并将收到24个手机会议（每次20分钟），强调 家庭作业的遵守和解决问题的遵守障碍。参与者将获得24个小组- 基于会议（每次120分钟），强调相同的6个功能域。两组将获得6 几个月的强化训练来强化功能功能结局的组间差异将 根据基线、基线后6个月、12个月和18个月进行的评估确定。

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.