Effects of Cognitive Remediation on Cognition in Young People at Clinical High Risk of Psychosis
Condition: Prodromal Schizophrenia
MeSH terms: Schizophrenia; Psychotic Disorders; Mental Disorders
Study type: Interventional

Summary: 
      Onset of psychotic disorders such as schizophrenia, typically occurs during late adolescence
      or early adulthood often resulting in chronic social and occupational disability. Deficits in
      cognition and functional outcome often precede the onset of full-blown psychosis although to
      a lesser degree than observed in schizophrenia. Recent progress in risk identification
      methodology has enabled reliable detection of persons who appear to be putatively prodromal
      for psychosis, that is, at clinical high risk (CHR) of developing a psychotic disorder. Since
      these CHR individuals already evidence cognitive deficits, which increase around the time of
      conversion, cognition is an excellent treatment target. Furthermore, there is clear evidence,
      in schizophrenia and in CHR samples, that deficits in cognition are related to poor
      functional outcome. Thus, treatments targeting cognition may consequently improve functional
      outcome. The primary aim of the project is to reduce cognitive deterioration and improve
      cognition among youths at CHR using cognitive remediation and to test the effectiveness of a
      new cognitive remediation program, the Brain Fitness program, in improving cognition of CHR
      individuals. A control treatment consisting of video games (VG) will be used. The primary
      hypothesis is that the BF group will have improved cognition at the end of treatment and 12
      months post baseline compared to the VG group. A secondary hypothesis is that improved
      cognition will be associated with improved functioning. This is a longitudinal, single blind,
      placebo controlled pilot trial of cognitive remediation in 36 CHR persons. Participants will
      be randomised to either the BF or VG program, which will be administered over a period of 3
      months. Assessments will occur at baseline, post treatment (3 months) and at 12 months after
      baseline. All subjects will be recruited in year 1 of the project and treatment will be
      completed by 15 months. The 40 hours of training will occur 4 days a week, for an hour each
      day, over a period of 10 -12 weeks.
    

Detailed description: 
      Participants were randomised to either the BFP or a control treatment consisting of
      commercial computer games (CG). Participants were not blind to group allocation but all
      cognitive and symptom raters were. The 40 hours of BFP or computer game activity was expected
      to occur 4 days a week, for an hour each day, over a period of 10-12 weeks. The primary
      outcome was cognitive function assessed using the MATRICS consensus cognitive battery MCCB)
      (Nuechterlein and others 2008). The secondary outcome was social and role functioning
      assessed with Global Functioning: Social and Role scales. All clinical and cognitive
      assessments using symptom, functioning and cognitive measures were performed at baseline,
      post-treatment (at 3 months) and at 9-month follow-up (i.e. 9 months post baseline or 6
      months after post-treatment assessment).
    

Intervention name(s): Cognitive Remediation Therapy; computer games
Intervention type(s): Other; Other
Intervention description(s): auditory computer games designed to improve the speed at which people react when they hear something and at which they process that information.; computer games that that consist of word puzzles
Other intervention name(s): Brain Fitness Program; Hoyle Puzzle and Board Games
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: schizophrenia prodrome; clinical high risk of psychosis