Improving Basic and Social Cognition in Veterans With Schizophrenia
Condition: Schizoaffective Disorder; Schizophrenia
MeSH terms: Schizophrenia; Psychotic Disorders
Study type: Interventional

Summary: 
      Veterans with schizophrenia and schizoaffective disorder experience very high levels of
      disability and poor community outcome. Further improvements in community outcome for patients
      with these disorders will not occur simply through better control of clinical symptoms.
      Instead, it will be necessary to find treatments that address the key determinants of poor
      functional outcome. Evidence strongly suggests that basic (non-social) cognitive and social
      cognitive deficits are among the key determinants of functional outcome for these illnesses.
      The primary goal of this 2-year pilot study is to implement and validate a new remediation
      program for social cognition that is appropriate for veterans with schizophrenia and
      schizoaffective disorder.
    

Detailed description: 
      Veterans with schizophrenia and schizoaffective disorder experience very high levels of
      disability and poor community outcome. Further improvements in community outcome for patients
      with these disorders will not occur simply through better control of clinical symptoms.
      Instead, it will be necessary to find treatments that address the key determinants of poor
      functional outcome. Evidence strongly suggests that basic (non-social) cognitive and social
      cognitive deficits are among the key determinants of functional outcome for these illnesses.
      The primary goal of this 2-year pilot study is to implement and validate a new remediation
      program for social cognition that is appropriate for veterans with schizophrenia and
      schizoaffective disorder.

      We plan to recruit 72 patients over the 2 years of the study from the outpatient clinics at
      the VA Greater Los Angeles Healthcare System (VAGLAHS). They will receive baseline assessment
      that includes measures of social cognition, basic cognition, electrophysiology, functional
      capacity, clinical symptoms, community status, and demographics / clinical history. Follow up
      assessments will be administered at the mid-point of training (at 6 weeks) and end of
      training (at 12 weeks). Each follow up assessment will include measures of basic cognition,
      social cognition, electrophysiology, functional capacity, and clinical symptoms. The tester
      administering the assessments will be blind to treatment group.

      Subjects will be randomly assigned to one of four groups: 1) social cognitive training, 2)
      basic cognitive remediation, 3) a combined social cognitive and basic cognitive intervention,
      or 4) social skills training. All groups will meet in one-hour sessions held twice a week
      over the course of 12 weeks in small groups of 3-6. The Social Cognition Intervention (SCI)
      is a new 24-session, manualized intervention program specifically designed to improve emotion
      perception, social context processing, and theory of mind / attributional bias in veterans
      with schizophrenia and schizoaffective disorder. The Basic Cognitive Intervention (BCI) will
      involve computer-assisted training exercises. Each participant will work individually on a
      notebook computer. The combined intervention will cover the same content areas as the social
      cognitive and basic cognitive interventions, but will not go into as much detail as the
      separate intervention programs. The control condition will be facilitated discussion of
      current events. Treatment will be administered in a group format with three to six patients
      and a training coach.
    

Intervention name(s): Cognitive remediation; Social Cognitive skills training; hybrid intervention; skills training
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): Computer exercises in attention, memory, and speed of processing.; Group training on emotion perception, social perception, and understanding others' mental states.; A combination of the two groups listed above.; Skills training in how to identify symptoms of illness and medication side effects.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Cognition; Remediation; Schizophrenia; Social Cognition