Augmenting hospitalization for SMI by targeting interpretation bias

项目摘要 NIMH战略目标4规定，“慢性残疾...严重精神疾病(SMI)...要求 快速反应。“大约4.1%的美国成年人口符合精神障碍SMI的标准 与严重的功能障碍有关。即使在有效的情况下，药理学和心理学 治疗通常会使患有SMI的患者出现残留症状、损害，并面临再次发作的风险 住院和自杀。住院后的一个月是一个特别危险的时期；因此，增加 可以在短暂住院期间加速改善的治疗，以及为门诊患者提供桥梁的治疗 迫切需要护理。因此，我们建议开发一种加强精神科医院护理的方法(称为“I- 变化“)，可在出院后在家中继续。I-改变目标解释偏差， 倾向于消极地解决模棱两可的情况。口译偏差是一种公认的认知方式 易患精神病，并与情绪调节不良、沉思、症状有关 严重性和自杀意念。例如，在我们的精神病院样本中，对 入院治疗反应的差异解释了28%，并预测自杀意念在 出院，入院时控制思维。尽管一些现有的治疗方法针对的是这种机制， 最值得注意的是认知行为疗法(CBT)，它们要求个人能够认识到他们的 自动解释，并使用复杂的技术重新评估它们。患有SMI的个人 出现严重到需要住院治疗的症状通常是难以治疗的，并可能 在应用这些技术时会遇到特别困难。因此，更有效和更有效地 有效地吸引这一目标。在过去的14年里，PI制定并验证了一项培训任务， 利用重复和反馈来强化更健康的解释风格。计算机提供的版本的 任务可以被SMI人群接受，并且在患者中导致比安慰剂任务更好的治疗反应 在基线时表现出解释偏差的人。我们寻求将这项任务开发成个性化的智能手机 提供干预。我们将利用智能手机技术来提高技能获得和推广能力 通过提高用户参与度并提示患者在设定的时间完成一次会议，以确保足够的 疗程的剂量和间隔。我们将进行开放试验(n=16)和随机对照试验(n=)以确定靶点 参与度(改善口译偏差)，评估交付I- 在部分医院出院期间和出院后的变化，并检查临床结果(全球 改进、运作)与口译的变化有关。我们预计i-Change将改变解释 偏见，是SMI患者可以接受的，与症状相比，导致更大的整体改善 跟踪控制。结果将支持全功率R01有效性试验。

Project Summary NIMH Strategic Objective 4 states that the “chronic disability ... of Serious Mental Illnesses (SMI)...demands a rapid response.” Approximately 4.1% of the adult US population meets the criteria for SMI, a mental disorder associated with significant functional impairment. Even when effective, pharmacologic and psychological treatments often leave individuals with SMI with residual symptoms, impairment, and at risk for re- hospitalization and suicide. The month following hospitalization is a particularly risky time; thus, augmentation treatments that can speed up improvement during brief hospital stays, as well as provide a bridge to outpatient care are urgently needed. Thus, we propose to develop an augmentation to psychiatric hospital care (called “I- Change”) that can be continued at home following discharge. I-Change targets interpretation bias, the tendency to resolve ambiguous situations negatively. Interpretation bias is a well-established cognitive vulnerability for psychopathology and is associated with poor emotion regulation, rumination, symptom severity, and suicidal ideation. For example, in our psychiatric hospital sample, interpretation bias upon admission accounted for 28% of the variance in treatment response, and predicted suicidal ideation at discharge, controlling for ideation at admission. Although some existing treatments target this mechanism, most notably Cognitive Behavioral Therapy (CBT), they require individuals to be able to recognize their automatic interpretations and use complex techniques to reappraise them. Individuals with SMI who are experiencing symptoms acute enough to require hospitalization are often treatment refractory and may experience particular difficulty applying these techniques. It is therefore critical to more efficiently and effectively engage this target. Over the past 14 years, the PI has developed and validated a training task that utilizes repetition and feedback to reinforce a healthier interpretive style. The computer-delivered version of the task was acceptable to an SMI population and led to better treatment response than a placebo task in patients who exhibited interpretation bias at baseline. We seek to develop this task into a personalized smart-phone delivered intervention. We will harness smart-phone technology to enhance skill acquisition and generalization by improving user engagement and prompting patients to complete a session at set times to ensure adequate dosage and spacing of sessions. We will conduct an open trial (n = 16) and RCT (n = 64) to confirm target engagement (improvement in interpretation bias), evaluate the feasibility and acceptability of delivering I- Change during and following discharge from a partial hospital, and examine clinical outcomes (global improvement, functioning) related to changes in interpretation. We expect that I-Change will shift interpretation bias, be acceptable to patients with SMI, and lead to greater global improvement compared to a Symptom Tracking control. Results will support a fully-powered R01 effectiveness trial.