Cognitive Rehabilitation in Schizophrenia
Condition: Cognitive Impairment; Schizophrenia
MeSH terms: Schizophrenia; Cognitive Dysfunction
Study type: Interventional

Summary: 
      The study will investigate the viability of two cognitive rehabilitation strategies to
      improve functional outcomes for people with schizophrenia. Many people with schizophrenia
      experience impairments in cognitive function which limit their abilities. These impairments
      have been shown to precede the onset of illness and represent a vulnerability factor which is
      exacerbated by emerging psychotic symptoms. These impairments affect a range of functional
      domains including symptom severity, work function, symptom management, treatment, and overall
      quality of life. Recognizing the link between cognitive impairment and function, a few
      clinicals and researchers have attempted to remediate cognitive impairments by providing
      cognitive retraining programs similar to those used in traumatic brain injured patients or
      adaptive skills training. Cognitive retraining involves repetitive exercises to increase
      elemental cognitive functions including memory, attention, psychomotor speed, planning, and
      cognitive flexibility. Adaptive skill training involves didactic group exercises in social
      skills, activities of daily living, and symptom management. Each approach has demonstrated
      some rehabilitation benefits. This study will investigate the effectiveness of a combination
      of these two approaches on outcomes in schizophrenia.
    

Detailed description: 
      Objective: Many people with schizophrenia experience impairments in cognitive function which
      limit their abilities. These impairments affect a range of functional domains including
      symptom severity, work function, symptom management, treatment, and overall quality of life.
      Recognizing the link between cognitive impairment and function, a few clinicians and
      researchers have attempted to remediate cognitive impairments by providing cognitive
      retraining programs similar to those used in traumatic brain injured patients or adaptive
      skills training. Cognitive retraining involves repetitive exercises to increase elemental
      cognitive functions including memory, attention, psychomotor speed, planning, and cognitive
      flexibility. Adaptive skill training involves didactic group exercises in social skills,
      activities of daily living, and symptom management. This study investigates the effectiveness
      of a combination of these two approaches on outcomes in schizophrenia. This will be a three
      group randomized clinical trial investigating the effects of cognitive rehabilitation on
      outcomes ranging from proximal (training tasks performance and neuropsychological test
      performance), to more distal outcomes (treatment group performance and quality of life
      ratings). We believe that the cognitive augmentation will have significant impact on training
      task and neuro-psychological test performance and attenuated, but significant effect on
      performance in the treatment groups. Finally, we hypothesize that the combination of adaptive
      training and cognitive rehabilitation will have measurable impact on the most distal outcomes
      such as daily living skills and quality of life. Method: One hundred (100) individuals will
      be invited to participate in a 30-week program. After informed consent is obtained and
      diagnosis established, participants will receive an extensive assessment of
      neuropsychological, psychological and psychosocial functioning. Participants will be randomly
      assigned to one of three conditions using a stratified procedure based on cognitive test
      performance (this will ensure that there are similar numbers of severely and less severely
      impaired participants in each condition). The three conditions will be: (1) a usual care
      control group which is the Life Skills Development Group (LSDG), (2) Individualized computer
      based cognitive rehabilitation (ICBCR) augmenting the LSDG; and (3) Cognitive Remediation
      Therapy (CRT) with LSDG. Participants will be compared on: (1) LSDG performance, (2)
      neuropsychological test performance and (3) psychosocial functioning. Attendance in groups
      and remediation sessions will be compensated at a rate of $5 per session. The key questions t
      be answered are which Cognitive Rehabilitation strategy is more effective at improving
      cognitive function? Does Cognitive Rehabilitation produce better performance in the Life
      Skills Development Group (LSDG)? Does Life Skills Development Group augmented by Cognitive
      Rehabilitation produce better psychosocial outcomes than the standard care control group?
    

Intervention name(s): Cognitive Rehabilitation Therapy (CRT) + Skill Training (SDG); Individual Computer Based Cognitive Rehabilitation (ICBCR) and Skills Training (SDG); Skills Group (SDG)
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): CRT is a one on one cognitive skills training and Skill training is a group intervention to develop concrete skills of daily living.; ICBCR is a computerized cognitive skills training program and Skill training is a group intervention to develop concrete skills of daily living.; Skill training is a group intervention to develop concrete skills of daily living. This is augmented with the opportunity to receive up to 5 hours of individual staff contact.
Other intervention name(s): Standard care
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Cognitive Impairment; Rehabilitation