Treatment to Enhance Cognition in Bipolar Disorder
Condition: Bipolar Disorder; Psychosis
MeSH terms: Bipolar Disorder; Psychotic Disorders; Mental Disorders
Study type: Interventional

Summary: 
      The purpose of the present study is to evaluate a neuroplasticity-oriented, computer-based
      cognitive remediation treatment program in patients with bipolar disorder and its effects on
      cognitive deficits and community functioning compared to an active, computer-based control.
    

Detailed description: 
      Cognitive dysfunction is increasingly recognized as a major feature of bipolar disorder (BD),
      present by illness onset, persistent into euthymia, and associated with functional outcome.
      Deficits are qualitatively similar to those seen in schizophrenia (SZ), and may be
      quantitatively similar in some patient groups, e.g. in patients with a history of psychosis.
      Despite strong associations between cognitive impairment and functional outcomes in BD,
      treatment for these symptoms at present is inadequate. Pharmacotherapies do little to address
      cognitive symptoms, and may even worsen them. Psychosocial cognitive remediation (CR)
      treatments have been developed to target these symptoms and their functional correlates, and
      have shown early promise in patients with SZ in improving both neurocognition and community
      functioning. However, despite the overlap of neurocognitive deficits between patients with SZ
      and BD, no studies to date have extended neuroscience-based CR to patients with BD. The
      present study aims to assess the efficacy of CR treatment in patients with BD with a history
      of psychosis using a 70-hour CR paradigm compared to a dose-matched computer-based control.
      It is hypothesized that patients in the CR group will exhibit improvements in cognitive and
      community functioning compared to controls, which will persist during a 6-month durability
      phase. Additionally, putative mechanisms of functional change will be examined, including
      mediator effects of cognitive and clinical change on community functioning. 130 patients with
      BD with a history of psychosis recruited from the Psychotic Disorders Programs at McLean
      Hospital will be randomized into either the CR or computer control group. CR will be
      administered using the BrainWorks program, neuroscience-based training programs that have
      shown early promise in patients with SZ. Participants will be assessed on measures of
      clinical, cognitive, and community functioning at baseline, following the 70-hour treatment
      or control phase, and again 6 months later. Participants may opt to participate in an
      functional magnetic resonance imaging (fMRI) study at pre- and post-treatment; resting state,
      task-based and functional connectivity, and diffusion tensor imaging data will be collected
      to evaluate preliminary evidence of neurobiological changes after training versus control.
      Additionally, participants may opt in to participation in two tasks of reward sensitivity
      including the Probabilistic Reward task and Richard's Delay Discounting. These tasks are
      administered pre- and post-treatment to evaluate the role of reward in treatment response as
      well as the potential for CR to modulate reward processing. This project is in keeping with
      the NIH's stated strategic priorities for improving mental health outcomes in patients and
      strengthening the impact of National Institute of Mental Health (NIMH)-supported research on
      public health, with specific recommendations for broad implementation of effective
      psychosocial interventions.
    

Intervention name(s): BrainWorks; Computer Control
Intervention type(s): Behavioral; Behavioral
Intervention description(s): 13 programs targeting cognition in 4 separate domains: Auditory processing, visual processing, social cognition, and executive functioning. Games are imbedded in a format that is engaging and interactive. Animated characters serve as "directors" for each program, explaining the tasks in both verbal and written formats and providing feedback on each trial and overall after each activity. Users move systematically through the programs and can track their progress as the go. Each session includes activities from several different games to maintain interest and train a variety of skills; however, games are presented in the order of domains listed above (i.e. auditory, then visual, then social, and finally executive) to avoid stimulus interference during the training.; Sessions will involve generic computer games administered via the game interface "Sporcle." Sporcle is a game site that offers a collection of quiz-type activities available on line. The activities include typing, basic timed arithmetic (e.g. simple addition); picture identification (e.g. name the corporate logo; name the sitcom), and subject-based quizzes in areas like history (e.g. name the US presidents), geography (e.g. name the state capitals), and literature (e.g. book title fill-in-the-blank). An administrator can track the activity of subjects including when they logged in, which games they played and for how long, and what their accuracy was on each game. We will use a pre-developed game schedule that includes a mix of each type of game in each session, and ensures that subjects are playing the same games in the same order. This format was developed to mirror the treatment condition, as subjects are given a variety of specific games to play at each session.
Other intervention name(s): Sporcle
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Bipolar Disorder; Psychosis; Cognition; Cognitive Remediation