Shaping Attention in treatment--Refractory Schizophrenia

描述(申请人提供)：尽管药物治疗取得了进展，但仍有许多难治性精神分裂症患者留在州立医院。其中许多患者的认知能力受到严重损害，因此他们从心理社会干预中获益甚微，如果不采用新的增强认知的干预措施，他们重返社区的机会也微乎其微。此外，最近人口普查减少后从公立医院出院的许多患者也存在注意力问题，使他们无法充分参与心理社会干预并从中受益。只要这些患者从治疗中获益的有限能力保持不变，就可以认为他们复发和再次住院的风险更高。使这个问题更加复杂的是，目前的认知康复干预措施无法改善患有最严重注意力问题的精神分裂症患者的注意力功能。对于这类患者，面向行为的注意力塑造程序在几项小规模研究中证明是有效的。然而，由于缺乏一种用户友好的标准化格式来提供这种干预，导致它几乎完全不在学术研究中心之外使用。因此，这项拟议的研究试图借鉴那些率先使用整形技术来提高治疗难治性精神分裂症患者注意力的研究人员的专业知识，以便将这些技术整合到标准化、机械化的治疗干预中，并附带培训录像带和治疗师忠诚度评估措施。拟议的项目将开发这种标准化的治疗提供形式，然后通过在三个地点的一系列试点治疗小组来完善它：康奈尔大学威尔医学院、林肯地区中心和夏威夷州立医院。此外，还将收集和汇集与治疗相关的注意力功能变化、分组技能获取和症状学方面的数据。该项目的预期结果包括：1)开发一套用户友好的材料，以促进将注意力塑造干预措施传播到现实世界环境；2)收集关于其有效性的初步数据；以及3)产生功率和受试者变异性的估计，作为设计大规模对照治疗研究的基础。

DESCRIPTION (provided by applicant): Despite pharmacologic treatment advances, there are many treatment-refractory schizophrenia patients remaining in state hospitals. Many of these patients are sufficiently cognitively impaired that they benefit little from psychosocial interventions and have little chance of returning to the community without the introduction of novel cognition-enhancing interventions. Moreover, many patients who have been discharged from state hospitals in the wake of recent census reductions also have attentional problems that preclude their ability to fully engage in, and benefit from, psychosocial interventions. Such patients can be considered at heightened risk for relapse and rehospitalization as long as their limited ability to benefit from treatment remains undressed. Compounding this problem is the inability of current cognitive rehabilitation interventions to improve attentional functioning in schizophrenia patients with the most severe attentional problems. For such patients, behaviorally oriented attention shaping procedures have demonstrated effectiveness in several small-scale studies. However, the lack of a user-friendly, standardized format for the delivery of this intervention has led to its almost complete nonuse outside of academic research centers. Therefore, the proposed study seeks to draw on the expertise of those investigators who have pioneered the use of shaping techniques to improve attention in treatment-refractory schizophrenia patients, in order to integrate these techniques into a standardized, manualized treatment intervention, along with an accompanying training videotape and therapist fidelity evaluation measure. The proposed project would develop this standardized treatment delivery format, and then refine it through a series of pilot treatment groups at three sites: Weill Medical College of Cornell University, Lincoln Regional Center, and Hawaii State Hospital. In addition, data would be collected and pooled regarding treatment-related changes in attentional functioning, skill acquisition in groups, and symptomatology. The expected results of this project include: 1) the development of a user-friendly set of materials to facilitate dissemination of the attention shaping intervention to real-world settings; 2) the collection of preliminary data on its effectiveness; and 3) the generation of estimates of power and subject variability which can serve as the foundation from which to design a large-scale controlled treatment study.