Effectiveness of Psychosocial Treatment for Inpatients with Psychosis

描述（由申请人提供）：精神病住院患者心理社会治疗的有效性精神病患者经常需要在急性疾病期间在住院医院进行治疗，以进行危机管理和稳定。虽然这些患者通常接受有效的药物治疗，但在典型的医院环境中，公认缺乏为患者提供的经验支持的社会心理干预措施。在住院期间提供高质量的社会心理治疗具有挑战性，因为住院时间短，而且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。这种对医院社会心理治疗的未满足需求，意味着错过了一个重要的机会，即教授患者应对策略，这些策略可以加快康复时间，并影响出院后的风险因素，包括精神病复发、治疗不依从性、自杀倾向、慢性功能损伤和再住院。接受和承诺疗法（ACT）是一种新的认知行为方法，它结合了创新的基于正念的策略，帮助患者更成功地应对精神病和其他症状，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院实施的随机试验中显示出改善精神病患者急性和出院后预后的初步疗效的特定疗法。然而，迫切需要对最初的ACT方法进行调整，以促进在社区环境中广泛实施。有必要修改方法，采用一种更可行的、可由医院常规工作人员执行的小组分娩形式。当前R34提案的目的是使唯一有希望的精神病急性护理心理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，我们建议通过在精神病住院患者中进行一项开放试验（n = 20），进一步开发一份综合治疗手册，用于住院患者的ACT （ACT- in）。作为公开试验的一部分，我们将实施和评估治疗保真度/能力措施和治疗师培训计划，以评估治疗在医院员工中的可实施性。为了准备未来的大规模临床试验，我们还将在精神病住院患者样本（n = 60）中进行随机对照试点研究，将ACT- in与常规治疗进行比较，以估计出院时的相关治疗参数和4个月的随访。为了准备未来的大规模临床试验，我们将评估该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、出院后功能和再住院率。这项初步研究将为一项全面的临床试验奠定基础，以评估这种新型心理社会干预对改善高危住院精神病患者预后的有效性。

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.