Targeting Cognition and Motivation in Coordinated Specialty Care for Early Psychosis

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PROJECT SUMMARY The purpose of this study is to expand measurement-based psychiatric care across 6 early psychosis treatment teams in Minnesota, each providing coordinated specialty care and in total serving 200 individuals per year. Our first goal is to efficiently deploy valid longitudinal outcome measures across each team, implement state-of-the-art informatics tools, and aggregate pooled data to inform and support program evaluation activities as well as novel data-driven analytics. Our second goal is to perform a practice-based research project designed to answer two questions: 1) Does a structured personalized feedback session that includes an explicit focus on cognition and motivated behavior provide benefit to stakeholders--service users, family members, and primary clinicians? 2) Can cognition and motivated behavior be addressed as key treatment goals within real-world settings, using a 12-week mobile intervention program? Our central scientific premise is that cognitive dysfunction and impaired motivated behavior are critical unmet therapeutic needs in early psychosis. We have shown that auditory cognitive training can be successfully delivered on a mobile device to individuals with early schizophrenia, resulting in significant gains in global cognition that endure 6 months after the end of the intervention. We have also demonstrated that the addition of social cognition training drives improvements in measures of motivated behavior. More recently, we demonstrated that a 12-week mobile digital health coaching and social networking app designed to target motivated behavior in early psychosis resulted in significantly greater improvements in self-reported depression, defeatist beliefs, self-efficacy, and a trend towards improved motivation/pleasure and negative symptoms (compared to a wait-list control). These improvements were maintained when re- assessed 3 months after the end of the trial. Based on this work and on our experience running successful coordinated specialty care teams, our project will address the following two aims: Aim 1: Establish highly reliable measurement-based psychiatric care for 200 early psychosis individuals per year across 6 clinical teams; Harness clinical encounter data to perform novel data-driven trajectory analyses, predictive modeling, and causal discovery analyses. Aim 2: Investigate potential benefits of identifying cognitive functioning and motivated behavior as explicit treatment targets for individuals entering care; Study a well-defined 12-week mobile intervention program to address these targets.