Effectiveness of Psychosocial Treatment for Inpatients with Psychosis

心理社会治疗对住院精神病患者的有效性

• 批准号: 8696880
• 负责人: BRANDON A GAUDIANO
• 金额: $ 21.41万
• 依托单位: BUTLER HOSPITAL (PROVIDENCE, RI)
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-09 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8696880
• 关键词: Acute; Administrator; Behavioral; Caring; Chronic; Clinical Trials; Cognitive; Cognitive Therapy; Competence; Coping Skills; Development; Disease; Educational process of instructing; Effectiveness; Empirical Research; Environment; Fostering; Future; Goals; Health Benefit; Health Personnel; Health Services Research; Hospital Units; Hospitalization; Hospitals; Individual; Inpatients; Intervention; Length of Stay; Manuals; Measures; Mental disorders; Modeling; Modification; Outcome; Outpatients; Patients; Pharmacotherapy; Phase; Pilot Projects; Population; Population Intervention; Preparation; Prevalence; Provider; Psychiatric Hospitals; Psychosocial Assessment and Care; Psychotic Disorders; Public Health; Publishing; Randomized; Recovery; Relapse; Research; Research Project Grants; Risk Factors; Sampling; Speed; Suicide; Symptoms; Testing; Time; Training; Training Programs; base; community setting; coping; cost; design; disability; evidence base; follow-up; functional disability; high risk; improved; innovation; meetings; mindfulness; novel; psychosocial; public health relevance; randomized trial; severe mental illness; theories; treatment as usual; uptake

DESCRIPTION (provided by applicant): Effectiveness of Psychosocial Treatment for Inpatients with Psychosis Patients with psychotic disorders frequently require treatment at inpatient hospital settings during periods of acute illness for crisis management and stabilization. Although these patients often receive efficacious pharmacotherapy, there is a recognized lack of empirically-supported psychosocial interventions provided to patients in typical hospital settings. The provision of high quality psychosocial treatment during hospitalization is challenging due to short lengths of stay and a general lack of trained therapist employed on hospital units who can provide these evidence-based therapies. This unmet need for hospital psychosocial treatment represents a crucial missed opportunity to teach patients coping strategies that can speed time to recovery and impact post-discharge risk factors, including psychotic relapse, treatment nonadherence, suicidality, chronic functional impairment, and rehospitalization. Acceptance and Commitment Therapy (ACT) is a newer cognitive-behavioral approach that combines innovative mindfulness-based strategies for helping patients to cope more successfully with psychotic and other symptoms and implement values-consistent behavioral goals. ACT is the only specific therapy to date that has shown initial efficacy in randomized trials for improving acute and post-discharge outcomes in patients with psychosis when implemented in short-term psychiatric hospitals in the U.S. However, adaptations to the original ACT approach are urgently needed to foster widespread implementation in community settings. There is a need to modify the approach using a more feasible group delivery format that can be administered by routine hospital staff. The aim of the current R34 proposal is to adapt the only promising acute-care psychosocial treatment for psychosis to be implementable in an inpatient setting and pilot test its effectiveness. More specifically, we propose to further develop a comprehensive treatment manual for ACT for Inpatients (ACT-IN) by conducting an open trial (n = 20) in hospitalized patients with psychotic disorders. As part of the open trial, w will implement and evaluate treatment fidelity/competence measures and a therapist training program to evaluate the treatment's implementability among hospital staff. To prepare for a future large-scale clinical trial, we also will conduct a randomized controlled pilot study in a sample (n = 60) of patients hospitalized with psychotic disorders by comparing ACT- IN to treatment as usual to estimate relevant treatment parameters at hospital discharge and 4-month follow- up. In preparation for a future large-scale clinical trial, we will assess the feasibility nd acceptability of the intervention to multiple stakeholders, including consumers. We also will collect pilot effectiveness outcomes, including acute psychiatric symptoms, post-hospital functioning, and rehospitalization rates. This pilot study will lay the groundwork for a fully-powered clinical trial evaluating the effectiveness of this novel psychosocial intervention for improving outcomes in high-risk, hospitalized patients with psychosis.

描述（由申请人提供）：心理症患者心理疾病患者的心理社会治疗的有效性通常需要在急性疾病的住院医院环境中进行危机管理和稳定。尽管这些患者经常接受有效的药物治疗，但公认的缺乏典型医院患者提供的经验支持的社会心理干预措施。由于短期住院时间以及可以提供这些循证疗法的医院单位受雇的训练有素的治疗师，因此在住院期间提供高质量的社会心理治疗。这种对医院社会心理治疗的需求未满足，这是一个至关重要的错过的机会，可以教会患者应对策略，以加快恢复时间和影响入职后的危险因素，包括精神病复发，治疗不坚持，自杀，慢性功能障碍和再养老院化。接受和承诺疗法（ACT）是一种新的认知行为方法，结合了创新的基于正念的策略，可帮助患者更成功地应对精神病和其他症状，并实施价值观一致的行为目标。 ACT是迄今为止唯一在随机试验中显示出最初有效性的唯一特定疗法，用于改善精神病患者的急性和分期术后结局，而在美国的短期精神病医院实施，但是，在美国的短期精神病医院中实施，迫切需要适应原始ACT方法，以促进社区环境中的广泛实施。有必要使用更可行的团体交付格式来修改该方法，该格式可以由常规医院工作人员管理。当前R34提案的目的是适应唯一有望在住院环境和试点测试其有效性的急性急性心理社会心理治疗中。更具体地说，我们建议通过在住院的精神病患者中进行开​​放试验（n = 20），以进一步制定住院ACT（ACT）的综合治疗手册。作为公开试验的一部分，W将实施和评估治疗保真度/能力措施以及治疗师培训计划，以评估医院工作人员中治疗的可实施性。为了准备未来的大规模临床试验，我们还将在样本（n = 60）（n = 60）的患者中进行随机对照的试点研究，通过将ACT与往常进行比较，以便在出院和4个月后期进行相关治疗参数进行比较。为了准备未来的大规模临床试验，我们将评估干预措施对包括消费者在内的多个利益相关者的可行性。我们还将收集试点有效性结果，包括急性精神病症状，院后功能和重新住院率。这项试点研究将为一项全力以赴的临床试验奠定基础，该试验评估了这种新型社会心理干预措施的有效性，以改善高危住院患者的精神病患者的预后。