Enhancing Functional Outcomes in Schizophrenia Using a Novel mHealth Approach

描述（由申请人提供）：本项目的目标是完成移动的健康应用程序的开发和试点测试，以提高动机，从而改善近期发作（RO）精神分裂症患者的功能结局。动机障碍是精神分裂症的核心特征，可以说是决定患者参与和坚持有效治疗的能力的最重要因素，也是功能最强的预测因素，占心理社会结果方差的74%。以前的方法来改善精神分裂症的功能结果是有限的，在他们的疗效和高脱落率仍然是一个重要的问题。鉴于这一紧迫的公共卫生问题，必须采取创新办法。我们建议开发一种新的干预措施，PRIME（个性化实时干预动机增强），一个移动的应用程序，它将使用移动的软件的最新创新，以改善个人在疾病早期的功能结果。与传统治疗策略相比，PRIME需要更少的激励参与，同时也可以更高的频率使用（例如 心理治疗）。PRIME将在理论上基于动机行为的循证模型（期望值理论），并针对已知的动机缺陷，如奖励预测，行为激活和奖励学习。本项目将采用参与式设计策略，以提高PRIME在目标人群中的可行性和良好耐受性。经过一系列的焦点小组和现场测试，我们将进行一项小型的随机对照试验，以测试PRIME在三个关键领域改善动机行为的程度：社会，角色和健康功能，在一个月的时间内，相对于处于等待列表控制条件下的RO个体。这项研究将产生第一个为精神分裂症患者设计的移动的应用程序，同时也为动机障碍阻碍健康结果的其他健康状况带来希望。

DESCRIPTION (provided by applicant): The goal of this project is to complete the development and pilot testing of a mobile health app to improve motivation, thereby improving functional outcomes in individuals with recent-onset (RO) schizophrenia. Motivational impairment, a core feature of schizophrenia, is arguably the single most important factor in determining a patient's ability to engage in and adhere to effective treatment, and is the strongest predictor of functioning, accounting for 74% of the variance of psychosocial outcomes. Prior approaches to improve functional outcomes in schizophrenia are limited in their efficacy and high dropout rates remain a significant problem. In light of this pressing public health problem, an innovative approach is necessary. We propose to develop a new intervention, PRIME (Personalized Real-Time Intervention for Motivational Enhancement), a mobile app, which will use the latest innovations in mobile software to improve functional outcomes in individuals early in the course of illness. PRIME will require less motivational engagement while also being available at greater frequency than traditional therapeutic strategies would allow (e.g. psychotherapy). PRIME will be theoretically grounded in an evidence-based model of motivated behavior (Expectancy Value Theory) and target known motivational deficits, such as reward prediction, behavioral activation, and reward learning. This project will use a participatory desig strategy to enhance the likelihood that PRIME will be feasible and well tolerated in the target population. After a series of focus groups and field tests, we will conduct a small, randomized controlled trial to test the extent to which PRIME improves motivated behavior in three key domains: social, role, and health functioning, over a one-month period, relative to RO individuals in a wait-list control condition. This study will result in the first mobile app designed for individuals with schizophrenia, while also holding promise for other health conditions in which motivational impairments impede health outcomes.