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

项目摘要/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疾病之一 成本、生产力损失和公共援助支出，估计每年对社会造成的费用为# 超过620亿美元。其中近三分之二的成本来自患者学习、工作和治疗能力的下降， 自我照顾、人际关系和维持一般生活技能。在技能培训干预期间 已经被开发来解决这一人群中的技能缺陷，患者通常不会始终如一地练习 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，最终限制了 这些干预措施的有效性。我们之前比较了中老年人的技能培训计划 精神分裂症患者发现，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训练干预方法，称为“技能” 培训和赋权方案“(STEP)，结合了通信技术(即蜂窝 手机)，以帮助最大限度地遵守家庭作业，并提高技能的普适性，以适应“现实世界” 设置。这项研究的主要目标是检查我们的STEP计划对改善功能的有效性 一组中老年精神分裂症患者的结果。我们还将研究这是否 干预成功地提高了家庭作业遵从性，我们认为这是一个关键的联系机制 技能训练，以增加功能结果。为了实现我们的目标，我们将招收240名中年和 老年精神分裂症患者，随机分配接受为期6个月的新步骤干预 或为期6个月的我们最初的技能培训干预，称为FAST计划。步骤中的参与者 该计划将参加12次小组干预会议(每次120分钟)，重点是6个月的培训 职能领域(例如，沟通技能、财务管理、药物管理)。参与者 还将收到手机，并将收到24次手机通话(每次20分钟)，强调 遵守作业和解决问题的障碍。快速参赛者将获得24组- 以会议为基础(每次120分钟)，强调相同的6个功能领域。两组都将获得6 几个月的助推器会议，以加强功能上的收获。两组在功能结果上的差异将是 根据基线、基线后6个月、12个月和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.