Enhancing Functional Outcomes in Schizophrenia Using a Novel mHealth Approach

描述(申请人提供)：该项目的目标是完成移动健康应用程序的开发和试点测试，以提高动机，从而改善新近发病的(RO)精神分裂症患者的功能结果。动机障碍是精神分裂症的一个核心特征，可以说是决定患者进行和坚持有效治疗的能力的最重要因素，也是功能的最强预测因子，占心理社会结果变量的74%。以前改善精神分裂症功能结果的方法在有效性上是有限的，高辍学率仍然是一个严重的问题。鉴于这一紧迫的公共卫生问题，有必要采取创新的方法。我们建议开发一种新的干预措施，Prime(针对动机增强的个性化实时干预)，这是一款移动应用程序，它将使用移动软件中的最新创新来改善个人在疾病病程早期的功能结果。Prime需要更少的激励性参与，同时也比传统治疗策略允许的频率更高(例如 心理治疗)。PRIME将在理论上建立在基于证据的激励行为模型(期望值理论)的基础上，并针对已知的动机缺陷，如奖励预测、行为激活和奖励学习。该项目将使用参与式设计战略，以提高Prime在目标人群中可行并被很好地容忍的可能性。经过一系列焦点小组和实地测试后，我们将进行一项小型随机对照试验，以测试Prime在一个月的时间内，相对于处于等待名单控制条件下的RO个人，在三个关键领域：社交、角色和健康功能方面改善动机行为的程度。这项研究将导致第一个为精神分裂症患者设计的移动应用程序，同时也有望用于其他动机障碍阻碍健康结果的健康状况。

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.