Comparing the efficacy of interventions that use environmental supports to improve outcomes in patients with schizophrenia

Abstract

We examined the efficacy of 2 treatments using environmental supports (e.g. signs, alarms, pill containers, checklists) to improve functional outcomes in individuals with schizophrenia. 120 participants were randomized into one of 3 treatment groups 1) Cognitive Adaptation Training (CAT; supports customized to individual cognitive impairments and behaviors and maintained on weekly home 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). Functional outcomes, positive symptoms and motivation were assessed at baseline, 3, 6, 9, 18 and 24 months. After 9 months of intensive treatment with CAT, visits were decreased from weekly to monthly to examine whether treatment gains could be maintained. Results of a mixed effects regression model with repeated measures indicated a significant main effect of group (CAT>GES>TAU) with non-significant time and group by time interactions. Post-hoc analyses indicated that while individuals in CAT remained significantly better than those in TAU when treatment frequency was reduced, gains in CAT decreased to the level of those seen in GES. While group differences for positive symptoms were not significant, motivation improved in CAT and GES relative to TAU. The highest intensity treatment produced the best outcomes with respect to functioning. However, some improvements were seen with a relatively inexpensive, clinic-based treatment using a package of generic environmental supports.

Figures

Figure 1

Patient flow

Figure 2

Social and Occupational Functioning Scale Scores Over Time by Treatment Group Main Effect of Group F (2,106) = 22.61; p<.0001 main effect of time: f p treatment group x cat vs. tau and ges t="−6.57;" .0001 respectively>

Figure 3

Motivational Difficulties Subscale from the Negative Symptom Assessment Over Time by Treatment Group Main Effect of Group F (2,104) =5.41; p<.0058 main effect of time f p treatment group by interaction cat vs tau t ges>.30