Cognitive Adaptive Training for Improving Medication Adherence, Symptoms, and Function in People With Schizophrenia
Condition: Schizophrenia
MeSH terms: Schizophrenia
Study type: Interventional

Summary: 
      This study will compare the effectiveness of three treatments in improving medication
      adherence, symptoms, and function in people with schizophrenia.
    

Detailed description: 
      Schizophrenia is a chronic and severely disabling mental disorder. People with schizophrenia
      may experience hallucinations, delusions, disordered thinking, movement disorders, social
      withdrawal, and cognitive deficits. Antipsychotic medications have been effective in
      alleviating many of the symptoms of schizophrenia and improving the lives of people with the
      disease. It is well established, however, that poor adherence to antipsychotic medications
      can lead to relapse and rehospitalization. Cognitive deficits often contribute to treatment
      nonadherence by compromising patients' capacity to establish routines for taking medication.
      Cognitive adaptation training (CAT) is a treatment approach designed to alter the physical
      environment of individuals with schizophrenia to compensate for cognitive deficits and
      improve adaptive function. For example, various environmental supports, such as signs,
      checklists, and electronic devices, are used to remind patients to take their medication.
      Studies have shown that CAT's support system led to better treatment outcomes than those
      produced by standard care in people with schizophrenia. This study will compare the
      effectiveness of two CAT treatments versus standard treatment in improving medication
      adherence, symptoms, and function in people with schizophrenia.

      After providing a blood sample, participants in this single-blind study will be randomly
      assigned to Full-CAT, Pharm-CAT, or treatment as usual for 9 months. Participants receiving
      treatment as usual will not receive CAT support. Full-CAT will entail a comprehensive use of
      environmental supports to improve multiple areas of adaptive functioning. Pharm-CAT will
      provide support for medication adherence only. Participants assigned to one of the two CAT
      groups will receive weekly treatments in their homes. All participants will report to the
      study site once every 3 months to assess medication adherence, symptomatology, and adaptive
      functioning. Participants will be interviewed by the study physician for 2 to 3 hours at each
      visit. A member of the study staff will also visit each participant's home at a random,
      unannounced time once every 3 months to obtain a blood sample. Follow-up visits will occur 3
      and 6 months following the end of treatment.
    

Intervention name(s): Cognitive Adaptation Training; Pharm-Cognitive Adaptation Training; Treatment as usual
Intervention type(s): Behavioral; Behavioral; Other
Intervention description(s): Environmental supports for all independent living skills; Environmental supports for medication and appointment adherence; Medication follow-up and limited case management provided by local community mental health authority
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Schizoaffective Disorder; Medication Adherence