Despite improved pharmacological treatments for schizophrenia, patients continue to have difficulties functioning in the real world (e.g., medication management, communicating needs, establishing social networks, managing finances). These difficulties are likely compounded as persons with schizophrenia age (e.g., physical limitations, cognitive impairment), thus, making it more difficult to live in the community. As the proportion of older persons in the U. S. virtually explodes, so too will the proportion of older persons with schizophrenia, creating a drain on mental health and social service systems ill-equipped to serve them. There is a current paucity of studies on the effectiveness of rehabilitation programs for schizophrenia patients and none has been designed and tested with older patients. Thus, there is a clear need to develop effective rehabilitation programs sensitive to the deficits of older persons with schizophrenia. Psychosocial interventions which efficiently promote better symptom management, medication management, every day living skills, and psychosocial functioning are of particular importance in that they may reduce the chance that older patients with schizophrenia require hospitalization and long-term care while minimizing burden on health care systems. The goal of the proposed project is to test the efficacy of a skills training protocol, entitled Functional Adaptation Skills Training (FAST), designed to enhance daily functioning of older patients with schizophrenia. We will enroll 200 community dwelling patients over age 60 into a randomized, pretest, multiple posttest control group design study. Subjects will enroll in one of two time-equivalent interventions: Experimental treatment, a 24-session group intervention designed for older adults targeting 6 functional skill domains (i.e., financial management, social skills, communication skills, transportation, organization and planning, and medication management); or psychosocial placebo (a friendly support group). Treatment will be followed by six one-monthly maintenance sessions. Assessments are conducted at 6-, 12-, and 18-months post-baseline. A unique feature of the proposed study is the use of performance-based outcome measures which reduce problems associated with lack of insight common in schizophrenia. Data will allow us to determine short-term effects of our intervention, effectiveness of maintenance sessions, and post-intervention duration of treatment effects.
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