Cognitive Adaptation Training: Effectiveness in real-world settings and Mechanisms of Action (CAT-EM)

认知适应训练：现实环境中的有效性和行动机制（CAT-EM）

基本信息

批准号：
10405566
负责人：
Dawn Irene Velligan
金额：
$ 41.81万
依托单位：
UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10405566
关键词：
Acute Adaptive Behaviors Adherence Ambulatory Care Attention Awareness Behavior Bypass Caring Cognition Cognitive Communities Community Mental Health Centers Conscious Country Diagnosis Direct Costs Economic Burden Educational Background Effectiveness Electronics Goals Habits Health Home Home environment Impaired cognition Impairment Individual Intention Intervention Lead Maintenance Measures Mediating Memory Motivation Occupational Outcome Outpatients Participant Persons Pharmaceutical Preparations Population Process Public Health Randomized Recovery Schizophrenia Series Services Symptoms Technology Theoretical model Time Training Training Support Visit Work base cognitive function cost cost effectiveness effectiveness study effectiveness testing effectiveness trial efficacy study functional disability functional outcomes hospital readmission improved improved functioning improved outcome medication compliance pill professional atmosphere psychosocial randomized effectiveness trial readmission rates response social theories treatment duration trial comparing

项目摘要

Abstract Schizophrenia remains one of the most disabling conditions world-wide with an economic burden that exceeded $155 billion dollars in fiscal year 2013 alone. Despite existing medication and community treatment, many individuals with this diagnosis continue to have poor outcomes and struggle toward recovery. CAT is a psychosocial treatment using environmental supports such as signs, alarms, pill containers, checklists, technology and the organization of belongings established in a person's home or work environment to bypass the cognitive and motivational difficulties associated with schizophrenia, and support habits for functional behavior to promote recovery. In a series of efficacy studies, CAT improved social and occupational functioning, symptoms, and adherence to medication, and reduced rates of readmission. We propose a cluster randomized effectiveness trial comparing Cognitive Adaptation Training (CAT) to existing community treatment (CT) for individuals with schizophrenia in 8 community mental health centers across multiple states including 400 participants. This would be the first large-scale effectiveness study of CAT for improving functional outcomes for those with schizophrenia seen in community mental health centers (CMHCs) where the majority of those with schizophrenia are followed for outpatient care and to study the purported mechanisms of action based on an integrated theoretical model. Participants will be assessed at baseline and 6 and 12 months on measures of functional and community outcome, medication adherence, symptoms, habit formation and automaticity, cognition and motivation. CAT treatment will be weekly for 6 months, biweekly for 3 months and monthly for the remainder of the trial. Purported mechanisms of action for CAT including bypassing impairments in cognitive function to improve functional outcome and bypassing motivational impairments to create automatic habits to improve functional outcome will be examined.

抽象的精神分裂症仍然是世界范围内最残疾的条件之一，经济负担仅在2013财政年度，就超过了1550亿美元。尽管有药物和社区治疗，许多患有这种诊断的人继续取得差的结果，并为康复而奋斗。猫是使用环境支持的社会心理治疗，例如标志，警报，药丸容器，清单，技术和物品的组织在一个人的房屋或工作环境中建立以绕过与精神分裂症相关的认知和动机困难，以及支持功能的习惯行为促进康复。在一系列疗效研究中，猫改善了社会和职业功能，症状和对药物的依从性，以及降低的再入院率。我们提出了一个集群比较认知适应训练（CAT）与现有社区治疗的随机有效性试验（CT）针对多个州的8个社区心理健康中心的精神分裂症患者 400名参与者。这将是CAT提高功能的首次大规模有效性研究大多数人在社区心理健康中心（CMHC）中看到的精神分裂症的人的结果在患有精神分裂症的人中，接受门诊护理并研究所谓的作用机理基于综合理论模型。参与者将在基线和6个月和12个月的时间进行评估功能和社区结果，药物依从性，症状，习惯形成和自动性，认知和动机。猫治疗将每周进行6个月，每两周持续3个月，剩下的审判每月一次。据称猫的作用机制，包括绕过认知功能的损害以改善功能结果并绕开动机障碍将检查自动习惯以改善功能结果。