Augmenting Social Cognitive Intervention for Veterans with Schizophrenia

描述（由申请人提供）： 患有精神分裂症和情感障碍的退伍军人经历了高水平的残疾和不良的社区结果，这些不良的功能结果构成了一个主要的公共卫生问题。精神分裂症谱系障碍的治疗已经从根本上从关注症状减轻转向关注恢复和改善功能方面。这些疾病患者社区结果的必要改善不会仅仅通过更好地控制临床症状来实现。相反，有必要找到新的治疗方法，解决功能结果不佳的关键决定因素，包括社会认知。基本（非社会）认知和社会认知被认为是精神分裂症和情感障碍功能结局的关键决定因素。基本认知包括以下领域：学习和记忆，警惕/注意力，处理速度，推理和解决问题以及工作记忆。社会认知通常是指构成社会互动基础的心理活动，包括感知、解释、管理和对社会相关刺激（包括他人的意图和行为）产生反应。作为我们以前的优秀奖助金的一部分，我们已经开发了一个社会认知培训计划，并正在验证它。初步结果表明，该计划提高了社会认知和功能能力的测量性能。在这项研究中，我们将评估是否增加一个体内组件（在社区中发生的培训活动），以目前的社会认知干预促进泛化的培训效果，以社区的结果和主观满意度。在为期12周的培训计划中，将对社会认知和功能能力的结果进行检查，并在3个月的随访中评估受益的持久性。将在培训结束时和3个月随访时评估社区功能和主观满意度的泛化。我们将在5年的研究中招募105名患者，随机分配到训练组（社会认知干预与体内锻炼，社会认知干预无体内锻炼和对照）。受试者将在基线、6周（中点）、完成培训（12周）和3个月随访时接受评估。要想在精神分裂症和情感障碍患者中实现有意义的功能改善，需要了解如何提高训练计划的泛化能力。这项研究计划的最终目标是通过解决功能结果的决定因素来改善患有精神障碍的退伍军人的社区结果。

DESCRIPTION (provided by applicant): Veterans with schizophrenia and schizoaffective disorder experience high levels of disability and poor community outcome, and these poor functional outcomes constitute a major public health concern. The treatment of schizophrenia spectrum disorders has shifted fundamentally from a focus on symptom reduction to a focus on recovery and improving aspects of functioning. Needed improvements in community outcome for patients with these disorders will not occur simply through better control of clinical symptoms. Instead, it is necessary to find new treatments that address the key determinants of poor functional outcome, including social cognition. Both basic (non-social) cognition and social cognition are considered key determinants of functional outcome for schizophrenia and schizoaffective disorder. Basic cognition includes the domains of: learning and memory, vigilance / attention, speed of processing, reasoning and problem solving, and working memory. Social cognition generally refers to mental operations that underlie social interactions, including perceiving, interpreting, managing, and generating responses to socially relevant stimuli, including the intentions and behaviors of others. As part of our previous Merit grant, we have developed a training program for social cognition and are in the process of validating it. Initial results suggest that the program improves performance on measures of social cognition and functional capacity. In this study, we will evaluate whether adding an in vivo component (training activities that occur in the community) to the current social cognition intervention facilitates generalization of training effects to community outcome and subjective satisfaction. Outcome measures of social cognition and functional capacity will be examined during the 12 week training program, and durability of benefits will be assessed at a 3-month follow up. Generalization to community functioning and subjective satisfaction will be assessed at the end of training and at the 3-month follow up. We will enroll 105 patients across the 5 years of the study with random assignment to training group (social cognition intervention with in vivo exercises, social cognition intervention without in vivo exercises and control). Subjects will receive assessments at baseline, 6 weeks (mid-point), completion of training (12 weeks), and the 3-month follow up. Meaningful steps toward achieving improved functional outcome in schizophrenia and schizoaffective disorder require understanding how generalization of training programs can be enhanced. The ultimate goal of this research program is to improve community outcome for veterans with psychotic disorders by addressing the determinants of functional outcome.