Mueser Kim T, Giuliano Anthony J, Goff Donald, Seidman Larry J
Massachusetts Mental Health Center Public Psychiatry Division of Beth Israel Deaconess Medical Center, Boston, MA.
Boston University Center for Psychiatric Rehabilitation, Boston, MA.
Am J Psychiatr Rehabil. 2016;19(1):62-74. doi: 10.1080/15487768.2015.1125401. Epub 2016 Mar 16.
Cognitive deficits are a major determinant of functional outcome in schizophrenia. A promising treatment involves teaching individuals to use cognitive adaptation strategies to minimize the functional impact of cognitive difficulties. We developed Family Directed Cognitive Adaptation (FCA) to train caregivers to help their relatives with schizophrenia use cognitive adaptations to improve living skills. The goal of this open pilot trial was to examine the feasibility of FCA. Ten adults with schizophrenia, each with at least one relative, participated in FCA and were evaluated at baseline, post-treatment, and 6-month follow-up. Domains assessed included adaptive functioning, psychiatric symptoms, school/work involvement, hospitalizations, family burden, and treatment satisfaction. Participants reported high levels of satisfaction with FCA, and all families completed the 16-session intervention. Relatives reported reduced burden at termination and follow-up. No participants were hospitalized during the treatment or follow-up period, and rates of work/school involvement increased from 30% at baseline to 50% at the end of treatment and follow-up. Individuals improved in negative symptoms and adaptive functioning over the course of treatment, but these gains were not maintained. This pilot provides preliminary support for the acceptability and feasibility of FCA, and points to the need to address the maintenance of treatment gains after termination.
认知缺陷是精神分裂症功能预后的主要决定因素。一种有前景的治疗方法是教导个体使用认知适应策略，以尽量减少认知困难对功能的影响。我们开发了家庭导向认知适应（FCA）方法，以培训照料者帮助他们患有精神分裂症的亲属运用认知适应来提高生活技能。这项开放性试点试验的目的是检验FCA的可行性。十名患有精神分裂症的成年人，每人至少有一名亲属，参与了FCA，并在基线、治疗后和6个月随访时接受评估。评估的领域包括适应性功能、精神症状、学校/工作参与度、住院情况、家庭负担和治疗满意度。参与者报告对FCA满意度很高，所有家庭都完成了16节的干预课程。亲属报告在干预结束和随访时负担减轻。在治疗或随访期间没有参与者住院，工作/学校参与率从基线时的30%增加到治疗结束和随访时的50%。个体在治疗过程中阴性症状和适应性功能有所改善，但这些改善并未持续。这项试点研究为FCA的可接受性和可行性提供了初步支持，并指出需要解决干预结束后治疗效果的维持问题。
