Minnesota Community-Based Cognitive Training in Early Psychosis

The purpose of this study is to perform a double-blind randomized controlled trial (RCT) in
young patients with recent-onset (RO) schizophrenia to target improvement in cognitive
functioning within real-world treatment settings. This study will be performed in the
University of Minnesota Department of Psychiatry's First Episode Psychosis Program with
specialized Early Intervention Services (EIS). The investigators will compare the effects of
web-based targeted cognitive training (TCT) vs. web-based general cognitive exercises (GCE),
both delivered via portable laptop computers. The investigators will examine the behavioral
and functional changes seen immediately after the intervention as well as at 6-month
follow-up, compared to a treatment as usual group (TAU). This will be the first study to
investigate cognitive enhancement for young RO schizophrenia patients in community mental
health settings, using scalable interactive neurotechnology, and the first to compare two
distinct cognitive training approaches. This study will generate high impact data on the
potential for targeted pre-emotion of the downward spiral of in cognitive and functional
disability that often characterizes psychotic illness. It will also generate valuable data on
the relative effects of two distinct cognitive training approaches in schizophrenia, each
derived from a very different theoretical rationale, providing much-needed information on the
efficacy of a targeted "distributed neural system" training model derived from systems
neuroscience vs. a "general cognitive stimulation" training model derived from
neuropsychological rehabilitation approaches.

The aims of this project are based on the current state of early psychosis research, as well
as the investigators' own experience successfully applying neuroscience-informed cognitive
training in schizophrenia. It is now abundantly clear that cognitive/neural system
dysfunction represents a significant risk factor for schizophrenia as well as a poor
prognostic indicator. Functional outcome in RO schizophrenia is predicted by level of
cognitive impairment and baseline cognitive reserve, and recent findings suggest that
specialized EIS programs focusing only on symptom reduction and psychosocial support may not
robustly improve long-term outcomes— indicating that critical treatment targets are not being
addressed at present in early psychosis interventions. Cognitive dysfunction and underlying
neural system inefficiency should therefore be one of the primary targets for pre-emptive
intervention in early psychosis. In this study, the investigators will determine whether this
goal can be achieved using cognitive training delivered via a portable computer, in order to
improve functional outcome in young individuals with RO schizophrenia.

Inclusion Criteria:

- Clinical diagnosis of schizophrenia, schizoaffective disorder, psychosis Not Otherwise
Specified (NOS), Unspecified Schizophrenia Spectrum Disorder, Schizophrenia Spectrum
Disorder, Specified, or schizophreniform disorder with onset of first psychotic
episode within the last 2 years.

- Good general physical health

- Between 18 and 35 years of age

- Is fluent and proficient in the English language

- No neurological disorder

- No substance dependence in the past 6 months as defined by DSM-IV criteria

- Currently enrolled in University of Minnesota First Episode Psychosis Program

- Achieved clinical stability, defined as outpatient status for at least one month prior
to study participation, stable doses of psychiatric medications for at least one month
prior to study participation

Exclusion Criteria:

- Unable to provide informed consent

- Presence of clinically significant substance abuse that is impeding the subject's
ability to participate in the study

- Prescribed benztropine, diphenhydramine, or high doses of clozapine (>500 mg po qd) or
olanzapine (to be determined on a case by case basis).