Effectiveness of Psychosocial Treatment for Inpatients with Psychosis

描述(由申请人提供)：精神病住院患者的心理社会治疗的有效性精神病患者在急性疾病期间经常需要在住院医院环境中接受治疗，以进行危机管理和稳定。虽然这些患者经常接受有效的药物治疗，但在典型的医院环境中，向患者提供经验支持的心理社会干预措施是公认的缺乏。在住院期间提供高质量的心理社会治疗具有挑战性，因为住院时间短，医院单位普遍缺乏能够提供这些循证治疗的训练有素的治疗师。这种对医院心理社会治疗的未得到满足的需求是向患者传授应对策略的重要错失机会，这些应对策略可以加快康复时间，并影响出院后风险因素，包括精神病复发、不坚持治疗、自杀、慢性功能障碍和重新住院。接受与承诺疗法(ACT)是一种较新的认知行为方法，它结合了基于正念的创新策略，帮助患者更成功地应对精神病和其他症状，并实现与价值观一致的行为目标。ACT是迄今为止在美国短期精神病院实施的改善精神病患者急性和出院后结果的随机试验中显示出初步疗效的唯一一种特定疗法。然而，迫切需要适应最初的ACT方法，以促进在社区环境中的广泛实施。有必要使用一种更可行的、可由常规医院工作人员管理的团体分娩形式来修改该方法。目前R34提案的目的是使唯一有希望的精神病急性护理心理社会治疗在住院环境中实施，并对其有效性进行试点测试。更具体地说，我们建议通过在住院的精神病患者中进行公开试验(n=20)，进一步开发住院患者ACT的综合治疗手册(ACT-IN)。作为公开试验的一部分，W将实施和评估治疗忠诚度/能力措施和治疗师培训计划，以评估治疗在医院工作人员中的可实施性。为了为未来的大规模临床试验做准备，我们还将在住院的精神障碍患者样本(n=60)中进行随机对照初步研究，将ACT-IN与常规治疗进行比较，以估计出院时和4个月随访的相关治疗参数。在为未来的大规模临床试验做准备时，我们将评估干预的可行性和对包括消费者在内的多个利益相关者的可接受性。我们还将收集试点效果结果，包括急性精神症状、院后功能和再住院率。这项先导性研究将为一项全面的临床试验奠定基础，评估这种新型心理社会干预措施在改善高危住院精神病患者预后方面的有效性。

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.