Schizophrenia is among the most serious and most expensive mental disorders in terms of direct treatment costs, loss of productivity, and expenditures for public assistance, with an estimated annual cost to society of over $62 billion. Almost two thirds of these costs come from patients'diminished capacity for learning, working, self-care, interpersonal relationships, and maintaining general living skills. While skills training interventions have been developed to address skills deficits in this population, patients typically do not consistently practice the skills they learn in therapy;potentially limiting the mastery of these important skills and ultimately the efficacy of these interventions. We previously compared a skills-training program for middle-aged and older patients with schizophrenia and found that patients did not regularly comply with homework assignments, thereby limiting functional gains. We have developed a new skills-training intervention, called the "Skills Training and Empowerment Program" (STEP) that incorporates communication technology (i.e., cellular phones) to help maximize compliance with homework and to improve generalization of skills to "real-world" settings. The primary goal of this study is to examine the efficacy of our STEP program for improving functional outcome in a sample of middle-aged and older patients with schizophrenia. We will also examine whether this intervention is successful for increasing homework compliance, which we believe is a key mechanism linking skills training to increases in functional outcome. To accomplish our aims, we will enroll 240 middle-aged and older adults with schizophrenia and randomly assign them to receive 6-months of our new STEP intervention or 6-months of our original skills training intervention, known as the FAST program. Participants in the STEP program will attend 12 group-based intervention sessions (120 minutes each) emphasizing training in 6 functional domains (e.g., communication skills, financial management, medication management). Participants will also receive cellular phones and will receive 24 cell-phone sessions (20 minutes each) emphasizing homework compliance and problem-solving barriers to compliance. FAST participants will receive 24 group- based sessions (120 minutes each) emphasizing the same 6 functional domains. Both groups will receive 6 months of booster sessions to reinforce functional gains. Group differences in functional outcomes will be determined based upon assessments made at baseline, 6-, 12-, and 18-months post-baseline.

Public Health Relevance

Schizophrenia is among the most serious and most expensive mental disorders in terms of direct treatment costs, loss of productivity, and expenditures for public assistance, with an estimated annual cost to society of over $62 billion. The primary goal of this study is to examine the efficacy of a technology-enhanced Skills Training and Empowerment Program (called STEP) for improving functional outcomes in a sample of middle- aged and older patients with schizophrenia. If successful, this program may help improve overall well-being and functioning in a population that is traditionally noted to have significantly diminished capacity for learning, working, self-care, interpersonal relationships, and maintaining general living skills.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH084967-05
Application #
8415880
Study Section
Special Emphasis Panel (ZMH1-ERB-F (02))
Program Officer
Niederehe, George T
Project Start
2009-07-01
Project End
2015-01-31
Budget Start
2013-02-01
Budget End
2015-01-31
Support Year
5
Fiscal Year
2013
Total Cost
$542,688
Indirect Cost
$187,790
Name
University of California San Diego
Department
Psychiatry
Type
Schools of Medicine
DUNS #
804355790
City
La Jolla
State
CA
Country
United States
Zip Code
92093
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Moore, Raeanne C; Davine, Taylor; Harmell, Alexandrea L et al. (2013) Using the repeatable battery for the assessment of neuropsychological status (RBANS) effort index to predict treatment group attendance in patients with schizophrenia. J Int Neuropsychol Soc 19:198-205
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Roepke, Susan K; Allison, Matthew; Von Kanel, Roland et al. (2012) Relationship between chronic stress and carotid intima-media thickness (IMT) in elderly Alzheimer's disease caregivers. Stress 15:121-9
Depp, Colin A; Mausbach, Brent T; Harmell, Alexandrea L et al. (2012) Meta-analysis of the association between cognitive abilities and everyday functioning in bipolar disorder. Bipolar Disord 14:217-26
Mausbach, Brent T; Depp, Colin A; Bowie, Christopher R et al. (2011) Sensitivity and specificity of the UCSD Performance-based Skills Assessment (UPSA-B) for identifying functional milestones in schizophrenia. Schizophr Res 132:165-70
Depp, Colin A; Cardenas, Veronica; Harris, Sara et al. (2011) Psychopathological and functional correlates of behavioral activation and avoidance in schizophrenia. J Nerv Ment Dis 199:861-5

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