Improving Basic and Social Cognition in Veterans With Schizophrenia

Study Overview
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Brief Summary
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Veterans with schizophrenia and schizoaffective disorder experience very high levels of disability and poor community outcome. Further improvements in community outcome for patients with these disorders will not occur simply through better control of clinical symptoms. Instead, it will be necessary to find treatments that address the key determinants of poor functional outcome. Evidence strongly suggests that basic (non-social) cognitive and social cognitive deficits are among the key determinants of functional outcome for these illnesses. The primary goal of this 2-year pilot study is to implement and validate a new remediation program for social cognition that is appropriate for veterans with schizophrenia and schizoaffective disorder.

Detailed Description
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Veterans with schizophrenia and schizoaffective disorder experience very high levels of disability and poor community outcome. Further improvements in community outcome for patients with these disorders will not occur simply through better control of clinical symptoms. Instead, it will be necessary to find treatments that address the key determinants of poor functional outcome. Evidence strongly suggests that basic (non-social) cognitive and social cognitive deficits are among the key determinants of functional outcome for these illnesses. The primary goal of this 2-year pilot study is to implement and validate a new remediation program for social cognition that is appropriate for veterans with schizophrenia and schizoaffective disorder. We plan to recruit 72 patients over the 2 years of the study from the outpatient clinics at the VA Greater Los Angeles Healthcare System (VAGLAHS). They will receive baseline assessment that includes measures of social cognition, basic cognition, electrophysiology, functional capacity, clinical symptoms, community status, and demographics / clinical history. Follow up assessments will be administered at the mid-point of training (at 6 weeks) and end of training (at 12 weeks). Each follow up assessment will include measures of basic cognition, social cognition, electrophysiology, functional capacity, and clinical symptoms. The tester administering the assessments will be blind to treatment group. Subjects will be randomly assigned to one of four groups: 1) social cognitive training, 2) basic cognitive remediation, 3) a combined social cognitive and basic cognitive intervention, or 4) social skills training. All groups will meet in one-hour sessions held twice a week over the course of 12 weeks in small groups of 3-6. The Social Cognition Intervention (SCI) is a new 24-session, manualized intervention program specifically designed to improve emotion perception, social context processing, and theory of mind / attributional bias in veterans with schizophrenia and schizoaffective disorder. The Basic Cognitive Intervention (BCI) will involve computer-assisted training exercises. Each participant will work individually on a notebook computer. The combined intervention will cover the same content areas as the social cognitive and basic cognitive interventions, but will not go into as much detail as the separate intervention programs. The control condition will be facilitated discussion of current events. Treatment will be administered in a group format with three to six patients and a training coach.

Official Title
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Improving Basic and Social Cognition in Veterans With Schizophrenia

Conditions
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Schizoaffective Disorder, Schizophrenia

Intervention / Treatment
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* Behavioral: Cognitive remediation
* Behavioral: Social Cognitive skills training
* Behavioral: hybrid intervention
* Behavioral: skills training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients must be diagnosed with Schizophrenia, Schizoaffective Disorder, or Psychosis not otherwise specified according to Diagnosis and Statistical Manual-IV criteria. In addition, the subjects will meet the following criteria: Between 18 and 60 years of age Estimated premorbid intelligence quotient > 70 (based on reading ability) Understand spoken English sufficiently to comprehend testing procedures Clinically stable (e.g., no inpatient hospitalization in the 8 weeks prior to enrollment, no significant changes in medication in the 6 weeks prior to enrollment, and none anticipated for the 3 months of participation) Exclusion Criteria: No clinically significant neurological disease as determined by medical history No history of serious head injury (e.g., loss of consciousness longer than 1 hour) No physical, cognitive, or language impairment of such severity as to adversely affect the validity of data No evidence of drug or alcohol dependence in the past six months, and not intoxicated at time of testing The patients psychotic experiences can be explained solely by the use of drugs or alcohol

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Cognitive Remediation<br>cognitive remediation | Behavioral: Cognitive remediation<br>* Computer exercises in attention, memory, and speed of processing.<br>|
| Experimental: Social Cognitive Skills Training<br>social cognitive skills training | Behavioral: Social Cognitive skills training<br>* Group training on emotion perception, social perception, and understanding others' mental states.<br>|
| Active Comparator: Hybrid Intervention<br>combined social cognitive and cognitive remediation training | Behavioral: hybrid intervention<br>* A combination of the two groups listed above.<br>|
| Other: Skills Training<br>control training | Behavioral: skills training<br>* Skills training in how to identify symptoms of illness and medication side effects.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean Test Scores for Facial Emotion Identification. | This is a test of social cognition that measures the ability to identify the emotion shown in photos of still faces. The construct of interest is facial affect perception. It is an experimental measure and does not have norms or cut-offs. The range of accuracy scores is 0-56 with higher being better. | Assessments for end point (12 weeks). | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean Test Score From a Test of Functional Capacity (Ability to Perform Daily Activities). | This is a role play demonstration test that measures how well someone handles social communication in daily life. The scores reflect overall effectiveness and are the mean number scored across different social situations with a range of 0-5 with higher being better. There are no norms for this test. | Assessments at endpoint (12 weeks). | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cognition, Remediation, Schizophrenia, Social Cognition