Targeting Cognition and Motivation in Coordinated Specialty Care for Early Psychosis

项目总结 这项研究的目的是将基于测量的精神科护理扩展到6个早期 明尼苏达州的精神病治疗小组，每个小组提供协调的专门护理，总共为200人提供服务 每年的个人数量。我们的第一个目标是有效地部署有效的纵向结果度量 团队，实施最先进的信息学工具，并聚合池化数据以提供信息和支持 计划评估活动以及新颖的数据驱动分析。我们的第二个目标是执行 以实践为基础的研究项目旨在回答两个问题：1)结构化的个性化 反馈会议包括对认知和激励行为的明确关注，可为 利益相关者--服务使用者、家庭成员和初级临床医生？2)认知和激励 使用为期12周的移动电话，将行为作为现实世界环境中的关键治疗目标进行处理 干预计划？ 我们的中心科学前提是认知功能障碍和受损的动机行为 早期精神病的严重未得到满足的治疗需求。我们已经证明，听觉认知训练可以 在移动设备上成功地向早期精神分裂症患者传递，导致显著 全球认知方面的增长在干预结束后持续6个月。我们还展示了 社会认知训练的增加推动了动机行为测量的改进。更多 最近，我们展示了一款为期12周的移动数字健康指导和社交网络应用程序 旨在针对早期精神病的动机行为导致显著更大的改善 自我报告的抑郁，失败主义信念，自我效能感，以及动机/快乐改善的趋势 和阴性症状(与等待名单对照相比)。这些改进在重新部署时得以保持 在试验结束后3个月进行评估。基于这项工作和我们成功运行的经验 通过协调专业护理团队，我们的项目将实现以下两个目标： 目标1：为200名早期精神病患者建立高度可靠的以测量为基础的精神护理 每年跨越6个临床团队；利用临床遭遇数据执行新的数据驱动轨迹 分析、预测建模和因果发现分析。 目标2：调查识别认知功能和动机行为的潜在好处 明确进入护理的个人的治疗目标；研究明确的12周移动干预 计划来解决这些目标。

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.