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。这些患者中有许多人的认知功能受损严重，以至于他们从心理干预中获益甚少，如果不引入新的认知增强干预措施，他们几乎没有机会重返社区。此外，在最近人口普查减少之后，许多从州立医院出院的病人也有注意力问题，这妨碍了他们充分参与和受益于心理社会干预的能力。只要这些患者从治疗中获益的能力有限，他们仍然没有穿衣服，就可以被认为有更高的复发和再住院风险。使这一问题更加复杂的是，目前的认知康复干预措施无法改善具有最严重注意力问题的精神分裂症患者的注意力功能。对于这些患者，行为导向的注意力塑造程序在几个小规模的研究中证明了有效性。然而，由于缺乏一个用户友好的，标准化的格式来提供这种干预，导致其几乎完全不使用学术研究中心以外。因此，拟议的研究旨在借鉴那些率先使用塑造技术来改善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的手动治疗干预中，沿着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格式，然后通过一系列试点治疗组在三个地点进行完善：康奈尔大学威尔医学院，林肯区域中心和夏威夷州立医院。此外，将收集并汇总关于注意力功能、组内技能获得和行为学的治疗相关变化的数据。该项目的预期成果包括：1）开发一套用户友好的材料，以促进将注意力塑造干预传播到现实世界; 2）收集有关其有效性的初步数据;以及3）生成功效和受试者变异性的估计值，可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.