The short-term impact of generic versus individualized environmental supports on functional outcomes and target behaviors in schizophrenia.
We examined the short-term efficacy of two treatments using environmental supports (e.g. signs, alarms, pill containers, and checklists) to improve target behaviors in individuals with schizophrenia. 120 participants were randomized into one of the following three treatment groups: 1) Cognitive Adaptation Training (CAT; a manual-driven set of environmental supports customized to individual cognitive impairments and behaviors, and established and maintained in participants' homes on weekly visits; 2) Generic Environmental Supports (GES; a generic set of supports given to patients at a routine clinic visit and replaced on a monthly basis); and 3) treatment as usual (TAU; standard follow-up provided by a community mental health center). Global level of functional outcome and target behaviors, including orientation, grooming and hygiene, and medication adherence, were assessed at baseline and 3 months. Results of an analysis of covariance indicated that patients in both CAT and GES had better scores on global functional outcome at 3 months than those in TAU. Results of Chi Square analyses indicated that patients in CAT were more likely to improve on target behaviors, including orientation, hygiene, and medication adherence, than those in GES. Irrespective of treatment group, individuals who were high utilizers of environmental supports were more likely to improve on target behaviors than individuals who were low utilizers of supports.
Velligan
Dawn I
DI
Department of Psychiatry, University of Texas Health Science Center at San Antonio, MSC 7792, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA. velligand@uthscsa.edu
Diamond
Pamela
P
Mueller
Janet
J
Li
Xueying
X
Maples
Natalie
N
Wang
Mei
M
Miller
Alexander L
AL
D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003072:Cognition Disorders / Q000175:diagnosis / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003155:Community Mental Health Centers; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012559:Schizophrenia / Q000175:diagnosis / Q000628:therapy*; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D012931:Social Environment; D012944:Social Support; D016896:Treatment Outcome
D014150:Antipsychotic Agents