Skills Training and Empowerment Program for Middle-Aged and Older Patients with P

描述(申请人提供)：就直接治疗费用、生产力损失和公共援助支出而言，精神分裂症是最严重和最昂贵的精神疾病之一，估计每年给社会造成的成本超过620亿美元。其中近三分之二的成本来自患者学习、工作、自我照顾、人际关系和维持一般生活技能的能力减弱。虽然已经开发了技能培训干预措施来解决这一人群的技能缺陷，但患者通常不会始终如一地练习他们在治疗中学到的技能，这可能会限制对这些重要技能的掌握，并最终限制这些干预措施的有效性。我们之前比较了一项针对中老年精神分裂症患者的技能培训计划，发现患者没有定期遵守家庭作业，从而限制了功能增长。我们开发了一种新的技能培训干预措施，称为“技能培训和赋权计划”(STEP)，它结合了通信技术(即移动电话)，以帮助最大限度地遵守家庭作业，并提高技能在“现实世界”环境中的普适性。这项研究的主要目标是检验我们的STEP计划在改善中老年精神分裂症患者样本功能结果方面的有效性。我们还将研究这种干预措施是否成功地提高了作业遵从性，我们认为这是将技能培训与提高功能结果联系起来的关键机制。为了实现我们的目标，我们将招募240名患有精神分裂症的中老年患者，并随机分配他们接受为期6个月的新步骤干预或最初的技能培训干预，即FAST计划。STEP计划的参与者将参加12次以小组为基础的干预会议(每次120分钟)，重点是6个功能领域的培训(例如，沟通技能、财务管理、药物管理)。参与者还将收到手机，并将接受24次手机通话(每次20分钟)，强调遵守作业和解决遵守规定的障碍。快速参与者将接受24次基于小组的会议(每人120分钟)，强调相同的6个功能领域。这两组人都将接受为期6个月的强化训练，以加强功能上的进步。根据基线、基线后6个月、12个月和18个月时的评估，确定两组患者功能结果的差异。

DESCRIPTION (provided by applicant): Schizophrenia is among the most serious and most expensive mental disorders in terms of direct treatment costs, loss of productivity, and expenditures for public assistance, with an estimated annual cost to society of over $62 billion. Almost two thirds of these costs come from patients' diminished capacity for learning, working, self-care, interpersonal relationships, and maintaining general living skills. While skills training interventions have been developed to address skills deficits in this population, patients typically do not consistently practice the skills they learn in therapy; potentially limiting the mastery of these important skills and ultimately the efficacy of these interventions. We previously compared a skills-training program for middle-aged and older patients with schizophrenia and found that patients did not regularly comply with homework assignments, thereby limiting functional gains. We have developed a new skills-training intervention, called the "Skills Training and Empowerment Program" (STEP) that incorporates communication technology (i.e., cellular phones) to help maximize compliance with homework and to improve generalization of skills to "real-world" settings. The primary goal of this study is to examine the efficacy of our STEP program for improving functional outcome in a sample of middle-aged and older patients with schizophrenia. We will also examine whether this intervention is successful for increasing homework compliance, which we believe is a key mechanism linking skills training to increases in functional outcome. To accomplish our aims, we will enroll 240 middle-aged and older adults with schizophrenia and randomly assign them to receive 6-months of our new STEP intervention or 6-months of our original skills training intervention, known as the FAST program. Participants in the STEP program will attend 12 group-based intervention sessions (120 minutes each) emphasizing training in 6 functional domains (e.g., communication skills, financial management, medication management). Participants will also receive cellular phones and will receive 24 cell-phone sessions (20 minutes each) emphasizing homework compliance and problem-solving barriers to compliance. FAST participants will receive 24 group- based sessions (120 minutes each) emphasizing the same 6 functional domains. Both groups will receive 6 months of booster sessions to reinforce functional gains. Group differences in functional outcomes will be determined based upon assessments made at baseline, 6-, 12-, and 18-months post-baseline.