Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
University of Massachusetts Boston, Boston, USA.
BMC Psychiatry. 2022 Sep 1;22(1):583. doi: 10.1186/s12888-022-04149-x.
Schizophrenia and related disorders are highly disabling and create substantial burdens for families, communities, and health care systems. Although pharmacological treatments can often lessen the psychotic symptoms that are a hallmark of schizophrenia, they do not lessen the social and cognitive deficits that create the greatest impediments to community engagement and functional recovery. This study builds on prior research on psychosocial rehabilitation by comparing the effectiveness of two treatments demonstrated as efficacious in improving social and community functioning, Cognitive Enhancement Therapy (CET) and a version of Social Skills Training (HOPES/SST).
The study uses a randomized cluster design in which a pair of clinicians at community- and hospital-based mental service centers deliver either CET or HOPES to at least one group of 6-8 eligible clients for 12 months. Clinicians are trained and then supervised weekly, with ongoing process measurement of treatment fidelity, attendance, satisfaction, and retention, and use of other services. Measures administered at baseline and at 6 and 12 months while in treatment, and then at 18 and 24 months after treatment include social adjustment, quality of life, social skills, positive and negative symptoms, and neuro- and social cognition. We hypothesize that CET will be associated with greater improvements than SST in both the primary outcome of community functioning and the secondary outcomes of neuro- and social cognition and social skills. Secondarily, we hypothesize that more cognitive impairment at baseline and younger age will predict more benefit from CET compared to HOPES.
Resource shortages endemic in mental health services and exacerbated by the pandemic highlight the importance of identifying the most effective approach to improving social and community functioning. We aim to improve understanding of the impact of two efficacious psychosocial treatments and to improve clinicians' ability to refer to both treatments the individuals who are most likely to benefit from them. We expect the result to be programmatic improvements that improve the magnitude and durability of gains in community functioning.
ClinicalTrial.gov NCT04321759 , registered March 25, 2020.
精神分裂症及相关障碍严重致残，并给家庭、社区和医疗保健系统带来巨大负担。虽然药物治疗通常可以减轻精神分裂症的典型精神病症状，但无法减轻社会和认知缺陷，这些缺陷是阻碍患者融入社区和康复的最大障碍。本研究在心理康复的先前研究基础上，比较了两种已被证明能有效改善社会和社区功能的治疗方法的疗效，即认知增强治疗（CET）和一种社会技能训练（HOPES/SST）版本。
该研究采用随机聚类设计，社区和医院精神服务中心的一对临床医生为至少一组 6-8 名符合条件的患者提供 CET 或 HOPES 治疗，为期 12 个月。临床医生接受培训并接受每周监督，同时进行治疗过程中的治疗一致性、出勤率、满意度和保留率以及其他服务的使用情况的持续测量。在基线和治疗 6 个月和 12 个月时以及治疗后 18 个月和 24 个月时进行评估的指标包括社会调整、生活质量、社会技能、阳性和阴性症状以及神经和社会认知。我们假设 CET 在社区功能的主要结果以及神经和社会认知和社会技能的次要结果方面的改善将优于 SST。其次，我们假设基线时认知障碍程度较高和年龄较小的患者将从 CET 中获益更多，而不是从 HOPES 中获益更多。
精神卫生服务中的资源短缺问题因大流行而加剧，突显了确定改善社会和社区功能最有效的方法的重要性。我们旨在提高对两种有效的心理社会治疗方法的影响的认识，并提高临床医生向最有可能从中受益的患者转诊这两种治疗方法的能力。我们预计结果将是改善计划，从而提高社区功能改善的幅度和持久性。
ClinicalTrials.gov NCT04321759，于 2020 年 3 月 25 日注册。
