Improving Negative Symptoms & Community Engagement in Veterans with Schizophrenia

描述(由申请人提供)： 对退伍军人医疗保健的预期影响：阴性症状是精神分裂症的核心和持久特征，与患有这种疾病的退伍军人在居住独立性、职业功能和生活质量方面普遍存在的缺陷有关。目前还没有有效的治疗方法来治疗这种疾病的这一关键领域。正如《退伍军人精神健康》中所概述的 根据《战略计划》，制定和实施加强社区功能和促进精神分裂症退伍军人康复的战略是VHA的一项优先事项。这项研究将评估一项针对患有精神分裂症的退伍军人的阴性症状的量身定制的干预方案，称为参与社区角色和体验(Encore)。项目背景：阴性症状是精神分裂症的明显临床特征，是社区功能不佳和长期结局差的主要决定因素，是该疾病的特征，也是照顾者负担的主要来源。最近的报告记录了缺乏针对阴性症状的关键临床领域的有效干预措施，并呼吁制定专门针对这一严重的未得到满足的治疗需求的干预措施。我们关于干预发展、负面症状评估、情感体验和功能障碍认知的初步数据表明，干预包括循证治疗策略，将情感动机缺陷、行为技能缺陷和对成功的负面期望作为疾病的关键方面，这些方面是参与目标导向行为动机的基础。项目目标：该应用程序重点评估针对精神分裂症退伍军人的阴性症状的定制干预方案，这些退伍军人在3个VAMC接受精神卫生服务。Encore将包括动机、认知和行为技能培训策略，旨在教个人如何(1)理解和克服预期快乐的缺陷，(2)增加愉快和目标导向活动的内在动机，(3)减少对成功和表现的负面预期，以及(4)在新的社交环境中熟练地表现。该项目的主要目标是：(1)对10名患有精神分裂症和阴性症状的退伍军人进行初步试验，培训治疗师并完善Encore手册；(2)进行随机临床试验(RCT；n=108，中等效果，α=0.05)，以测试Encore在治疗后和对阴性症状和社会和社区功能的主要结果的3个月随访中产生积极变化的疗效；以及(3)检查参与安可和精神健康提供者的退伍军人完成的定性访谈，以确定安可的哪些方面被认为或多或少有帮助、有趣和有价值，以便为更大规模的多地点实施试验提供信息。次要目标包括 评估认知能力和精神病性症状对干预效果的修正效果，并检查康复、自我效能和计划满意度。项目方法：该项目将包括一段时间的培训，然后是一个有108人参加的随机对照研究。参与者将在基线、治疗后和3个月时完成评估。我们将监测保真度、可行性和可接受性；研究退伍军人在该计划中的经验；测量症状和功能结果；并评估潜在的结果调节因素。

DESCRIPTION (provided by applicant): Anticipated Impacts on Veteran's Healthcare: Negative symptoms are a central and enduring feature of schizophrenia and are related to pervasive deficits in residential independence, occupational functioning, and quality of life for veterans living with this illness. Currently ther is no effective treatment for this critical domain of the illness. As outlined in the VA Mental Health Strategic Plan, the development and implementation of strategies to enhance community functioning and promote recovery among veterans with schizophrenia is a VHA priority. This study will evaluate a tailored intervention package called Engaging in Community Roles and Experiences (EnCoRE) targeting negative symptoms in Veterans with schizophrenia. Project Background: Negative symptoms are distinct clinical features of schizophrenia that are major determinants of the poor community functioning and poor long-term outcome that characterize the disorder, as well as a major source of burden for caregivers. Recent reports document the lack of effective interventions that target the key clinical domains of negative symptoms and call for the development of interventions designed specifically to address this critical unmet treatment need. Our preliminary data on intervention development, negative symptom assessment, affective experience, and dysfunctional cognitions argues for an intervention that incorporates evidence-based treatment strategies to target affective- motivational deficits, behavioral skills deficits, and negative expectations of success as the key aspects of the illness that underlie motivation to engage in goal directed behavior. Project Objectives: This application is focused evaluating a tailored intervention package targeting negative symptoms in Veterans with schizophrenia who receive mental health services at 3 VAMCs. EnCoRE will include motivational, cognitive, and behavioral skills training strategies aimed at teaching individuals ways to (1) understand and overcome deficits in anticipatory pleasure, (2) increase intrinsic motivation for pleasant and goal directed activities, (3) reduce negative expectancies for success and performance, and (4) perform skillfully in new social situations. The primary objectives of this project are to (1) Train therapists and refine the EnCoRE manual in a preliminary trial with 10 Veterans with schizophrenia and negative symptoms; (2) Conduct a randomized clinical trial (RCT; n=108, medium effect, alpha=.05) to test the efficacy of EnCoRE in producing positive changes at post-treatment and 3-month follow-up on the primary outcomes of negative symptoms and social and community functioning; and (3) Examine qualitative interviews completed by Veterans who participated in EnCoRE and Mental Health Providers to determine aspects of EnCoRE that were perceived as more or less helpful, interesting, and valuable in order to inform a larger, multi-site implementation trial. Secondary objectives include assessing the modifying effects of cognitive ability and psychotic symptoms on intervention effectiveness, and examining recovery, self-efficacy, and program satisfaction. Project Methods: This project will include a period of training followed by an RCT with 108 participants. Participants will complete assessments at baseline, post-treatment, and 3-months. We will monitor fidelity, feasibility, and acceptability; study Veteran's experience in the program; measure symptom and functional outcomes; and evaluate potential moderators of outcomes.