Improving Negative Symptoms & Community Engagement in Veterans with Schizophrenia

改善负面症状

• 批准号: 9114880
• 负责人: MELANIE E. BENNETT
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9114880
• 关键词: Address; Affect; Affective; Aftercare; Anhedonia; Aphasia; Award; Behavior; Behavioral; Caregiver Burden; Clinical; Cognition; Cognitive; Cognitive Therapy; Communities; Control Groups; Data; Development; Disease; Educational process of instructing; Effectiveness of Interventions; Evidence based treatment; Expectancy; Failure; Feedback; Funding; Goals; Health; Health Personnel; Healthcare; Impairment; Individual; Intervention; Interview; Life; Maintenance; Manuals; Measures; Mental Health; Mental Health Services; Methods; Monitor; Motivation; Occupational; Outcome; Participant; Perception; Performance; Quality of life; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recovery; Recovery of Function; Rehabilitation therapy; Report (document); Research; Role; Sampling; Schizophrenia; Self Efficacy; Site; Source; Strategic Planning; Symptoms; Training; Veterans; Work; base; cognitive ability; effective intervention; effective therapy; efficacy testing; evidence base; expectation; experience; follow-up; functional outcomes; handbook; implementation trial; improved; innovation; interest; intrinsic motivation; pleasure; primary outcome; programs; psychosocial; psychotic symptoms; public health relevance; satisfaction; skills; skills training; social; social situation; social skills; success; symptomatic improvement; therapy design; therapy development; treatment strategy

DESCRIPTION (provided by applicant): Anticipated Impacts on Veteran's Healthcare: Negative symptoms are a central and enduring feature of schizophrenia and are related to pervasive deficits in residential independence, occupational functioning, and quality of life for veterans living with this illness. Currently ther is no effective treatment for this critical domain of the illness. As outlined in the VA Mental Health Strategic Plan, the development and implementation of strategies to enhance community functioning and promote recovery among veterans with schizophrenia is a VHA priority. This study will evaluate a tailored intervention package called Engaging in Community Roles and Experiences (EnCoRE) targeting negative symptoms in Veterans with schizophrenia. Project Background: Negative symptoms are distinct clinical features of schizophrenia that are major determinants of the poor community functioning and poor long-term outcome that characterize the disorder, as well as a major source of burden for caregivers. Recent reports document the lack of effective interventions that target the key clinical domains of negative symptoms and call for the development of interventions designed specifically to address this critical unmet treatment need. Our preliminary data on intervention development, negative symptom assessment, affective experience, and dysfunctional cognitions argues for an intervention that incorporates evidence-based treatment strategies to target affective- motivational deficits, behavioral skills deficits, and negative expectations of success as the key aspects of the illness that underlie motivation to engage in goal directed behavior. Project Objectives: This application is focused evaluating a tailored intervention package targeting negative symptoms in Veterans with schizophrenia who receive mental health services at 3 VAMCs. EnCoRE will include motivational, cognitive, and behavioral skills training strategies aimed at teaching individuals ways to (1) understand and overcome deficits in anticipatory pleasure, (2) increase intrinsic motivation for pleasant and goal directed activities, (3) reduce negative expectancies for success and performance, and (4) perform skillfully in new social situations. The primary objectives of this project are to (1) Train therapists and refine the EnCoRE manual in a preliminary trial with 10 Veterans with schizophrenia and negative symptoms; (2) Conduct a randomized clinical trial (RCT; n=108, medium effect, alpha=.05) to test the efficacy of EnCoRE in producing positive changes at post-treatment and 3-month follow-up on the primary outcomes of negative symptoms and social and community functioning; and (3) Examine qualitative interviews completed by Veterans who participated in EnCoRE and Mental Health Providers to determine aspects of EnCoRE that were perceived as more or less helpful, interesting, and valuable in order to inform a larger, multi-site implementation trial. Secondary objectives include assessing the modifying effects of cognitive ability and psychotic symptoms on intervention effectiveness, and examining recovery, self-efficacy, and program satisfaction. Project Methods: This project will include a period of training followed by an RCT with 108 participants. Participants will complete assessments at baseline, post-treatment, and 3-months. We will monitor fidelity, feasibility, and acceptability; study Veteran's experience in the program; measure symptom and functional outcomes; and evaluate potential moderators of outcomes.

描述（由申请人提供）： 对退伍军人医疗保健的预期影响：负面症状是精神分裂症的核心和持久特征，与住宅独立性，职业功能和生活质量的普遍缺陷有关。目前，对于这种疾病的关键领域，这是没有有效的治疗方法。如VA心理健康中所述 战略计划，制定和实施战略，以增强社区功能和促进精神分裂症的退伍军人的康复是VHA的优先事项。这项研究将评估一个量身定制的干预措施，称为“从事社区角色和经验（Encore），针对精神分裂症退伍军人的负面症状。项目背景：负面症状是精神分裂症的独特临床特征，这是社区功能较差的主要决定因素和表征该疾病的长期结局，也是护理人员负担的主要负担。最近的报告记录了缺乏针对负面症状的关键临床领域的有效干预措施，并呼吁开发专门针对这种关键未满足治疗需求的干预措施。我们有关干预发展，负面症状评估，情感经验和功能失调的认知的初步数据，主张一种干预措施，该干预措施纳入了基于证据的治疗策略，以针对情感动机缺陷，行为技能缺陷以及成功的负面期望，作为疾病的关键方面，这些疾病的关键方面是涉及有针对性行为的疾病动机的关键方面。项目目标：该应用程序是针对量身定制的干预软件包，该量子针对的是在3 VAMC中接受心理健康服务的精​​神分裂症的退伍军人的负面症状。 Encore将包括动机，认知和行为技能培训策略，旨在教个人（1）理解和克服预期愉悦中的缺陷，（2）增加内在动机，以进行愉快和目标有针对性的活动，（3）减少对成功和表现的负面预期，以及（4）在新的社交场合中巧妙地表现。该项目的主要目标是（1）在初步试验中，有10名具有精神分裂症和负面症状的退伍军人，并在初步试验中完善了本手册； （2）进行一项随机临床试验（RCT; n = 108，中等效应，α= .05），以测试Encore在治疗后产生积极变化的疗效和对负面症状以及社会和社区功能的主要结果的3个月随访； （3）研究由参加Encore和心理健康提供者的退伍军人完成的定性访谈，以确定被认为或多或少有用，有趣且有价值的连续性方面，以便为更大的多站点实施试验提供信息。次要目标包括 评估认知能力和精神病症状对干预效果的修改影响，并检查恢复，自我效能和程序满意度。项目方法：该项目将包括一段时间的培训，然后包括108名参与者的RCT。参与者将在基线，治疗后和3个月完成评估。我们将监控保真度，可行性和可接受性；研究退伍军人在该计划中的经验；测量症状和功能结果；并评估结果的潜在主持人。