Effectiveness of Psychosocial Treatment for Inpatients with Psychosis

描述（由申请人提供）：精神病住院患者的社会心理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，缺乏公认的药物支持的心理社会干预措施。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，医院单位普遍缺乏训练有素的治疗师，他们可以提供这些循证治疗。这种对医院心理社会治疗的未满足的需求代表了一个关键的错失机会，可以教会患者应对策略，加快康复时间并影响出院后的风险因素，包括精神病复发，治疗不依从性，自杀，慢性功能障碍和再住院。接受和承诺疗法（ACT）是一种较新的认知行为方法，它结合了创新的基于正念的策略，帮助患者更成功地科普精神病和其他症状，并实现价值观一致的行为目标。ACT是迄今为止唯一一种在美国短期精神病医院实施的随机试验中显示出初步疗效的特异性治疗方法，用于改善精神病患者的急性和出院后结局。有必要修改的方法，使用一个更可行的组交付格式，可以管理的日常医院工作人员。目前R34提案的目的是调整唯一有前途的精神病急性护理心理社会治疗，使其在住院患者中实施，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精神病患者中进行开放试验（n = 20），进一步制定住院患者ACT（ACT-IN）的综合治疗手册。作为开放试验的一部分，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。为了准备未来的大规模临床试验，我们还将在因精神障碍住院的患者样本（n = 60）中进行随机对照初步研究，通过比较ACT- IN与常规治疗，以估计出院和4个月随访时的相关治疗参数。在为未来的大规模临床试验做准备时，我们将评估干预措施对包括消费者在内的多个利益相关者的可行性和可接受性。我们还将收集试点的有效性结果，包括急性精神症状，住院后功能和再住院率。这项试点研究将为一项充分有效的临床试验奠定基础，该试验评估了这种新型心理社会干预对改善高危住院精神病患者结局的有效性。

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.