Cognitive Remediation for Schizophrenia
Condition: Schizophrenia
MeSH terms: Schizophrenia
Study type: Interventional

Summary: 
      The purpose of this study is to evaluate the efficacy of an innovative, computer driven
      cognitive rehabilitation program for unemployed veterans with schizophrenia.
    

Detailed description: 
      Schizophrenia leads to a striking array of negative outcomes, including profound deficits in
      the ability to fulfill desired and expected community roles. Chronic under employment and
      unemployment are among the most serious of these consequences. VA treats over 100,000
      veterans with schizophrenia spectrum disorders, the majority of whom are unable to work
      competitively and do not participate in VA vocational rehabilitation programs despite the
      fact that VA is committed to enhancing the ability of these veterans to work. Within VA, a
      major vehicle for helping veterans to become employed is the Compensated Work Therapy (CWT)
      program, yet in FY2001 only 800 of the roughly 14000 veterans treated in CWT had SMI
      diagnoses, and only a subset of those 800 had schizophrenia. A number of factors contribute
      to low participation in vocational rehabilitation and poor work outcomes, but recent data
      suggest that one of the most important is cognitive impairment. People with schizophrenia
      have significant deficits in multiple areas of neurocognition, including secondary and
      working memory, attention, and executive functioning. These impairments have been shown to
      play a major role in functional outcome, including the ability to benefit from rehabilitation
      and to work. As a result, there has been increasing interest in the potential for improving
      neurocognitive functioning via cognitive rehabilitation. While several programs have yielded
      promising data, currently there is no empirically validated approach.The purpose of this
      project is to evaluate the efficacy of an innovative, computer driven cognitive
      rehabilitation program we have developed: Computer Assisted Cognitive Remediation (CACR).
      Veterans with schizophrenia who are unemployed and not participating in vocational
      rehabilitation will be recruited and randomly assigned to one of two conditions: a) 36
      sessions of CACR; or b) 36 sessions of a manualized computer control condition (RC). The
      efficacy of CACR will be assessed on a range of outcome domains, including neuropsychological
      test, measures of every day and social problem solving, self-reported cognitive functioning
      and self-efficacy, and work readiness. All subjects will be referred to CWT at the conclusion
      of treatment and we will assess how many receive work assignments, and work performance (over
      3-months) of those who begin work. We hypothesize that CACR will be more effective than the
      control treatment in each domain.The results of this project could have important
      implications for treatment of veterans with schizophrenia. CACR is a manualized program that
      can be administered by BA level staff. If demonstrated to be efficacious, it could be
      disseminated throughout VA and have a beneficial impact on vocational outcomes and the
      quality of life of veterans with schizophrenia.
    

Intervention name(s): computer-assisted cognitive remediation (CACR); manualized computer control condition (RC).
Intervention type(s): Behavioral; Behavioral
Intervention description(s): 36 individual computer sessions with a staff clinician. computer activities consist of commercially available educational software designed for use in the classroom.; 36 sessions of a manualized computer control condition.
Other intervention name(s): CACR; RC
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: cognition; schizophrenia; treatment