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

精神分裂症是最严重和最昂贵的精神障碍之一，就直接治疗费用，生产力损失和公共援助支出而言，估计每年社会成本超过620亿美元。这些费用中几乎有三分之二来自患者学习、工作、自我照顾、人际关系和维持一般生活技能的能力下降。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，从而限制了功能的获得。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），其中包括通信技术（即，移动电话），以帮助最大限度地遵守家庭作业，并提高技能的泛化到“现实世界”的设置。本研究的主要目的是检查我们的STEP程序的有效性，以改善功能的结果在一个样本的中年和老年精神分裂症患者。我们还将研究这种干预是否能成功地提高家庭作业的依从性，我们认为这是将技能培训与功能结果增加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年和老年人，并随机分配他们接受6个月的新STEP干预或6个月的原始技能培训干预，称为FAST计划。STEP计划的参与者将参加12个基于小组的干预会议（每个120分钟），强调6个功能领域的培训（例如，沟通技巧、财务管理、药物管理）。与会者还将收到手机，并将收到24个手机会议（每个20分钟），强调家庭作业的遵守和解决问题的遵守障碍。FAST参与者将接受24个基于小组的会议（每个120分钟），强调相同的6个功能域。两组都将接受6个月的强化训练，以加强功能性增益。将根据基线、基线后6个月、12个月和18个月进行的评估确定功能结局的组间差异。

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.