Cognitive Rehabilitation in Schizophrenia
| Status: | Completed |
|---|---|
| Conditions: | Cognitive Studies, Schizophrenia |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 65 |
| Updated: | 4/21/2016 |
| Start Date: | June 2004 |
| End Date: | October 2009 |
The Effects of Cognitive Rehabilitation on Function in Schizophrenia
The study will investigate the viability of two cognitive rehabilitation strategies to
improve functional outcomes for people with schizophrenia. Many people with schizophrenia
experience impairments in cognitive function which limit their abilities. These impairments
have been shown to precede the onset of illness and represent a vulnerability factor which
is exacerbated by emerging psychotic symptoms. These impairments affect a range of
functional domains including symptom severity, work function, symptom management, treatment,
and overall quality of life. Recognizing the link between cognitive impairment and function,
a few clinicals and researchers have attempted to remediate cognitive impairments by
providing cognitive retraining programs similar to those used in traumatic brain injured
patients or adaptive skills training. Cognitive retraining involves repetitive exercises to
increase elemental cognitive functions including memory, attention, psychomotor speed,
planning, and cognitive flexibility. Adaptive skill training involves didactic group
exercises in social skills, activities of daily living, and symptom management. Each
approach has demonstrated some rehabilitation benefits. This study will investigate the
effectiveness of a combination of these two approaches on outcomes in schizophrenia.
improve functional outcomes for people with schizophrenia. Many people with schizophrenia
experience impairments in cognitive function which limit their abilities. These impairments
have been shown to precede the onset of illness and represent a vulnerability factor which
is exacerbated by emerging psychotic symptoms. These impairments affect a range of
functional domains including symptom severity, work function, symptom management, treatment,
and overall quality of life. Recognizing the link between cognitive impairment and function,
a few clinicals and researchers have attempted to remediate cognitive impairments by
providing cognitive retraining programs similar to those used in traumatic brain injured
patients or adaptive skills training. Cognitive retraining involves repetitive exercises to
increase elemental cognitive functions including memory, attention, psychomotor speed,
planning, and cognitive flexibility. Adaptive skill training involves didactic group
exercises in social skills, activities of daily living, and symptom management. Each
approach has demonstrated some rehabilitation benefits. This study will investigate the
effectiveness of a combination of these two approaches on outcomes in schizophrenia.
Objective: Many people with schizophrenia experience impairments in cognitive function which
limit their abilities. These impairments affect a range of functional domains including
symptom severity, work function, symptom management, treatment, and overall quality of life.
Recognizing the link between cognitive impairment and function, a few clinicians and
researchers have attempted to remediate cognitive impairments by providing cognitive
retraining programs similar to those used in traumatic brain injured patients or adaptive
skills training. Cognitive retraining involves repetitive exercises to increase elemental
cognitive functions including memory, attention, psychomotor speed, planning, and cognitive
flexibility. Adaptive skill training involves didactic group exercises in social skills,
activities of daily living, and symptom management. This study investigates the
effectiveness of a combination of these two approaches on outcomes in schizophrenia. This
will be a three group randomized clinical trial investigating the effects of cognitive
rehabilitation on outcomes ranging from proximal (training tasks performance and
neuropsychological test performance), to more distal outcomes (treatment group performance
and quality of life ratings). We believe that the cognitive augmentation will have
significant impact on training task and neuro-psychological test performance and attenuated,
but significant effect on performance in the treatment groups. Finally, we hypothesize that
the combination of adaptive training and cognitive rehabilitation will have measurable
impact on the most distal outcomes such as daily living skills and quality of life. Method:
One hundred (100) individuals will be invited to participate in a 30-week program. After
informed consent is obtained and diagnosis established, participants will receive an
extensive assessment of neuropsychological, psychological and psychosocial functioning.
Participants will be randomly assigned to one of three conditions using a stratified
procedure based on cognitive test performance (this will ensure that there are similar
numbers of severely and less severely impaired participants in each condition). The three
conditions will be: (1) a usual care control group which is the Life Skills Development
Group (LSDG), (2) Individualized computer based cognitive rehabilitation (ICBCR) augmenting
the LSDG; and (3) Cognitive Remediation Therapy (CRT) with LSDG. Participants will be
compared on: (1) LSDG performance, (2) neuropsychological test performance and (3)
psychosocial functioning. Attendance in groups and remediation sessions will be compensated
at a rate of $5 per session. The key questions t be answered are which Cognitive
Rehabilitation strategy is more effective at improving cognitive function? Does Cognitive
Rehabilitation produce better performance in the Life Skills Development Group (LSDG)? Does
Life Skills Development Group augmented by Cognitive Rehabilitation produce better
psychosocial outcomes than the standard care control group?
limit their abilities. These impairments affect a range of functional domains including
symptom severity, work function, symptom management, treatment, and overall quality of life.
Recognizing the link between cognitive impairment and function, a few clinicians and
researchers have attempted to remediate cognitive impairments by providing cognitive
retraining programs similar to those used in traumatic brain injured patients or adaptive
skills training. Cognitive retraining involves repetitive exercises to increase elemental
cognitive functions including memory, attention, psychomotor speed, planning, and cognitive
flexibility. Adaptive skill training involves didactic group exercises in social skills,
activities of daily living, and symptom management. This study investigates the
effectiveness of a combination of these two approaches on outcomes in schizophrenia. This
will be a three group randomized clinical trial investigating the effects of cognitive
rehabilitation on outcomes ranging from proximal (training tasks performance and
neuropsychological test performance), to more distal outcomes (treatment group performance
and quality of life ratings). We believe that the cognitive augmentation will have
significant impact on training task and neuro-psychological test performance and attenuated,
but significant effect on performance in the treatment groups. Finally, we hypothesize that
the combination of adaptive training and cognitive rehabilitation will have measurable
impact on the most distal outcomes such as daily living skills and quality of life. Method:
One hundred (100) individuals will be invited to participate in a 30-week program. After
informed consent is obtained and diagnosis established, participants will receive an
extensive assessment of neuropsychological, psychological and psychosocial functioning.
Participants will be randomly assigned to one of three conditions using a stratified
procedure based on cognitive test performance (this will ensure that there are similar
numbers of severely and less severely impaired participants in each condition). The three
conditions will be: (1) a usual care control group which is the Life Skills Development
Group (LSDG), (2) Individualized computer based cognitive rehabilitation (ICBCR) augmenting
the LSDG; and (3) Cognitive Remediation Therapy (CRT) with LSDG. Participants will be
compared on: (1) LSDG performance, (2) neuropsychological test performance and (3)
psychosocial functioning. Attendance in groups and remediation sessions will be compensated
at a rate of $5 per session. The key questions t be answered are which Cognitive
Rehabilitation strategy is more effective at improving cognitive function? Does Cognitive
Rehabilitation produce better performance in the Life Skills Development Group (LSDG)? Does
Life Skills Development Group augmented by Cognitive Rehabilitation produce better
psychosocial outcomes than the standard care control group?
Inclusion Criteria:
- Clinical diagnosis of schizophrenia or schizoaffective disorder. Between the ages of
18-65. Stable medication regime (no changes in last 30 days)Minimum of 30 days since
last hospitalization. No hx of TBI
Exclusion Criteria:
- Current Substance abuse, no comorbid neurological disease
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