Targeting Cognition and Motivation in Coordinated Specialty Care for Early Psychosis

项目摘要 本研究的目的是将基于测量的精神病护理扩展到6个早期 明尼苏达州的精神病治疗小组，每个小组提供协调的专业护理，总共为200名 个人每年。我们的第一个目标是有效地部署有效的纵向结果的措施， 团队，实施最先进的信息学工具，并汇总汇总数据，以告知和支持 项目评估活动以及新颖的数据驱动分析。我们的第二个目标是 基于实践的研究项目旨在回答两个问题：1）结构化的个性化 反馈会议包括明确关注认知和积极行为，这对 利益相关者-服务使用者、家庭成员和初级临床医生？2)认知和动机 在真实世界环境中，使用为期12周的移动的 干预计划？ 我们的核心科学前提是，认知功能障碍和动机性行为受损， 在早期精神病中未得到满足的治疗需求。我们已经证明，听觉认知训练可以 在移动终端上成功地向患有早期精神分裂症的个体递送， 在干预结束后持续6个月的全球认知增益。我们还证明 社会认知训练的增加会促进动机行为的改善。更 最近，我们展示了一个为期12周的移动的数字健康指导和社交网络应用程序， 旨在针对早期精神病的动机行为， 自我报告的抑郁症、失败主义信念、自我效能感和改善动机/快乐的趋势 和阴性症状（与等待列表对照相比）。这些改进在重新进行时得到了保持， 在试验结束后3个月进行评估。根据这项工作和我们成功运行的经验， 我们的项目将通过协调专科护理团队，实现以下两个目标： 目的1：为200名早期精神病患者建立高度可靠的基于测量的精神病护理 每年6个临床团队;收集临床病例数据，以执行新的数据驱动轨迹 分析、预测建模和因果发现分析。 目的2：研究识别认知功能和动机行为的潜在益处， 明确进入护理的个人的治疗目标;研究明确的12周移动的干预 计划来实现这些目标。

PROJECT SUMMARY The purpose of this study is to expand measurement-based psychiatric care across 6 early psychosis treatment teams in Minnesota, each providing coordinated specialty care and in total serving 200 individuals per year. Our first goal is to efficiently deploy valid longitudinal outcome measures across each team, implement state-of-the-art informatics tools, and aggregate pooled data to inform and support program evaluation activities as well as novel data-driven analytics. Our second goal is to perform a practice-based research project designed to answer two questions: 1) Does a structured personalized feedback session that includes an explicit focus on cognition and motivated behavior provide benefit to stakeholders--service users, family members, and primary clinicians? 2) Can cognition and motivated behavior be addressed as key treatment goals within real-world settings, using a 12-week mobile intervention program? Our central scientific premise is that cognitive dysfunction and impaired motivated behavior are critical unmet therapeutic needs in early psychosis. We have shown that auditory cognitive training can be successfully delivered on a mobile device to individuals with early schizophrenia, resulting in significant gains in global cognition that endure 6 months after the end of the intervention. We have also demonstrated that the addition of social cognition training drives improvements in measures of motivated behavior. More recently, we demonstrated that a 12-week mobile digital health coaching and social networking app designed to target motivated behavior in early psychosis resulted in significantly greater improvements in self-reported depression, defeatist beliefs, self-efficacy, and a trend towards improved motivation/pleasure and negative symptoms (compared to a wait-list control). These improvements were maintained when re- assessed 3 months after the end of the trial. Based on this work and on our experience running successful coordinated specialty care teams, our project will address the following two aims: Aim 1: Establish highly reliable measurement-based psychiatric care for 200 early psychosis individuals per year across 6 clinical teams; Harness clinical encounter data to perform novel data-driven trajectory analyses, predictive modeling, and causal discovery analyses. Aim 2: Investigate potential benefits of identifying cognitive functioning and motivated behavior as explicit treatment targets for individuals entering care; Study a well-defined 12-week mobile intervention program to address these targets.