Cognitive Adaptation Training: Effectiveness in real-world settings and Mechanisms of Action (CAT-EM)

摘要 精神分裂症仍然是世界范围内最致残的疾病之一，其经济负担 仅2013财年就超过了1550亿美元。尽管有现有的药物和社区治疗， 许多被诊断为这种疾病的患者继续预后不佳，并努力恢复健康。猫是一只 使用环境支持进行心理社会治疗，如标志、警报、药丸容器、清单、 技术和财产的组织建立在一个人的家庭或工作环境中，以绕过 与精神分裂症相关的认知和动机困难，以及对功能性精神分裂症的支持习惯 促进复苏的行为。在一系列功效研究中，CAT改善了社会和职业 功能、症状和服药依从性，以及再住院率的降低。我们提出了一个集群 认知适应训练(CAT)与现有社区治疗的随机疗效比较试验 (CT)多个州的8个社区精神卫生中心的精神分裂症患者，包括 400人参加。这将是第一次大规模的CAT改善功能的有效性研究 在社区精神卫生中心(CMHC)可以看到精神分裂症患者的结果，那里的大多数人 对精神分裂症患者进行门诊跟踪治疗，并研究据称的作用机制 基于一个完整的理论模型。参与者将在基线以及6个月和12个月后进行评估 衡量功能和社区结果、服药依从性、症状、习惯养成和 自觉性、认知性和动机。猫的治疗将在6个月内每周进行一次，在3个月内每两周进行一次 在剩下的审判中每月一次。所谓的CAT的作用机制，包括旁路 认知功能障碍以改善功能结果，并绕过动机障碍以 本课程将考察如何自动养成习惯以改善功能结果。

Abstract Schizophrenia remains one of the most disabling conditions world-wide with an economic burden that exceeded $155 billion dollars in fiscal year 2013 alone. Despite existing medication and community treatment, many individuals with this diagnosis continue to have poor outcomes and struggle toward recovery. CAT is a psychosocial treatment using environmental supports such as signs, alarms, pill containers, checklists, technology and the organization of belongings established in a person's home or work environment to bypass the cognitive and motivational difficulties associated with schizophrenia, and support habits for functional behavior to promote recovery. In a series of efficacy studies, CAT improved social and occupational functioning, symptoms, and adherence to medication, and reduced rates of readmission. We propose a cluster randomized effectiveness trial comparing Cognitive Adaptation Training (CAT) to existing community treatment (CT) for individuals with schizophrenia in 8 community mental health centers across multiple states including 400 participants. This would be the first large-scale effectiveness study of CAT for improving functional outcomes for those with schizophrenia seen in community mental health centers (CMHCs) where the majority of those with schizophrenia are followed for outpatient care and to study the purported mechanisms of action based on an integrated theoretical model. Participants will be assessed at baseline and 6 and 12 months on measures of functional and community outcome, medication adherence, symptoms, habit formation and automaticity, cognition and motivation. CAT treatment will be weekly for 6 months, biweekly for 3 months and monthly for the remainder of the trial. Purported mechanisms of action for CAT including bypassing impairments in cognitive function to improve functional outcome and bypassing motivational impairments to create automatic habits to improve functional outcome will be examined.