Cognitive Remediation for Schizophrenia

NCT ID: NCT00261794

Last Updated: 2010-01-06

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 90 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2004-11-30
• Study Completion Date: 2007-09-30

Brief 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.

Conditions

Schizophrenia

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

1

computer-assisted cognitive remediation (CACR)

Group Type: EXPERIMENTAL

computer-assisted cognitive remediation (CACR)

Intervention Type: BEHAVIORAL

36 individual computer sessions with a staff clinician. computer activities consist of commercially available educational software designed for use in the classroom.

2

computer-based cognitive activity

Group Type: ACTIVE_COMPARATOR

manualized computer control condition (RC).

Intervention Type: BEHAVIORAL

36 sessions of a manualized computer control condition.

Interventions

computer-assisted cognitive remediation (CACR)

36 individual computer sessions with a staff clinician. computer activities consist of commercially available educational software designed for use in the classroom.

Intervention Type: BEHAVIORAL

manualized computer control condition (RC).

36 sessions of a manualized computer control condition.

Intervention Type: BEHAVIORAL

Other Intervention Names

CACR; RC

Eligibility Criteria

Inclusion Criteria

1. Current DSM-IV diagnoses of schizophrenia or schizoaffective disorder

2. Stable clinical course and antipsychotic treatment on a new generation antipsychotic other than clozapine and/or a dose of first generation antipsychotic equivalent to 10 mg. or less of haloperidol for one month prior to enrollment

3. Age between 18 and 64 years

4. Voluntary consent after receiving full information about the study

Exclusion Criteria

1. Documented history of neurological disorder or significant head trauma with extended loss of consciousness

2. Physical limitations (e.g., with hearing or vision) that would interfere substantially with the use of computer-based exercises

3. Current treatment with a first generation antipsychotic medication at a dose equivalent to more than 10 mg. of haloperidol

4. Current treatment with benztropine mesylate at a daily does greater than 4 mg

5. Current treatment with trihexyphenidyl at a daily dose greater than 15 mg

6. Current treatment that combines benztropine mesylate with trihexyphenidyl

7. Current treatment with diphenhydramine

8. Current competitive employment or participation (current or within past 3 months) in a program designed to secure competitive employment (e.g., CWT)

9. Mini Mental Status Examination (MMSE) score of less than 23

10. Diagnosis of current Substance Dependence according to DSM-IV criteria

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 64 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

US Department of Veterans Affairs

FED

Sponsor Role: lead

Responsible Party

Department of Veterans Affairs

Principal Investigators

Alan S. Bellack, PhD

Role: PRINCIPAL_INVESTIGATOR

VA Maryland Health Care System, Baltimore

Locations

VA Maryland Health Care System, Baltimore

Baltimore, Maryland, United States

Countries

United States

References

Bellack AS, Gold JM, Buchanan RW. Cognitive rehabilitation for schizophrenia: problems, prospects, and strategies. Schizophr Bull. 1999;25(2):257-74. doi: 10.1093/oxfordjournals.schbul.a033377.

Reference Type: RESULT

PMID: 10416730 (View on PubMed)

Bellack AS. Skills training for people with severe mental illness. Psychiatr Rehabil J. 2004 Spring;27(4):375-91. doi: 10.2975/27.2004.375.391.

Reference Type: RESULT

PMID: 15222149 (View on PubMed)

Dickinson D, Tenhula W, Morris S, Brown C, Peer J, Spencer K, Li L, Gold JM, Bellack AS. A randomized, controlled trial of computer-assisted cognitive remediation for schizophrenia. Am J Psychiatry. 2010 Feb;167(2):170-80. doi: 10.1176/appi.ajp.2009.09020264. Epub 2009 Dec 15.

Reference Type: RESULT

PMID: 20008941 (View on PubMed)

Other Identifiers

D3153R

Identifier Type: -

Identifier Source: org_study_id