The objective of this career development award is to provide the applicant with the necessary training, practical experience, and knowledge to become a successful independent investigator in the development and assessment of innovative mobile health interventions to target the motivational impairments of schizophrenia. The applicant will build towards this goal in several phases over the course of the award period, culminating in a pilot, randomized controlled trial that compares two intervention strategies, relative to a wait-list control condition, aimed at enhancing functional outcomes in recent-onset schizophrenia. In addition, the applicant will: 1) develop expertise in the neurocognitive and behavioral mechanisms that contribute to impaired motivation in schizophrenia;2) learn how to conduct clinical trial in schizophrenia;3) develop expertise in the development and implementation of novel mobile health interventions;and 4) acquire necessary skills in advanced statistical methods. The two aims of the research plan are: 1) To test the feasibility and acceptability of a Personalized Real- Time Intervention for Motivation Enhancement (PRIME);this intervention for young individuals with schizophrenia aims to improve psychosocial functioning by increasing their aspiration to initiate and attain health-promoting goals (i.e., to target their wanting deficits), and a combination of PRIME and a computer- based Plasticity-Assisted Cognitive Remediation (PACR) program;which will target higher order cognitive processes associated with goal persistence (learning deficits), 2) The applicant will conduct a pilot randomized clinical trial comparing the potential efficacy of PRIME and PRIME + PACR, relative to participants in a wait-list control condition. The outstanding research environment at the University of California, San Francisco, as well as the candidate's exceptional mentoring team, will support her achievement of the project and career development goals. The results of the research will serve as pilot data for an R01 study that further investigates the most robust of the approaches for improving motivation, and examines the ways in which enhancing motivational deficits improves treatment engagement for young people with schizophrenia and improves their clinical and functional outcomes.

Public Health Relevance

This project will result in the development of a personalized intervention strategy to improve motivation for treatment engagement and functional outcomes in individuals with schizophrenia. Motivational impairment is arguably the single most important factor that determines a patient's ability to engage in and adhere to effective treatment. By enhancing motivation, schizophrenia patients would be able to engage more fully with treatment and develop full and productive lives. This study may also pave the way forward for other health conditions in which motivational impairments impede health outcomes.

National Institute of Health (NIH)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Interventions Committee for Adult Disorders (ITVA)
Program Officer
Hill, Lauren D
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University of California San Francisco
Schools of Medicine
San Francisco
United States
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Fisher, Melissa; Loewy, Rachel; Carter, Cameron et al. (2015) Neuroplasticity-based auditory training via laptop computer improves cognition in young individuals with recent onset schizophrenia. Schizophr Bull 41:250-8
Schlosser, Danielle A; Fisher, Melissa; Gard, David et al. (2014) Motivational deficits in individuals at-risk for psychosis and across the course of schizophrenia. Schizophr Res 158:52-7