Brain Imaging, Cognitive Enhancement and Early Schizophrenia (BICEPS)
Schizophrenia, Schizoaffective Disorder
About this trial
This is an interventional treatment trial for Schizophrenia focused on measuring Early Course Schizophrenia, Cognitive Enhancement Therapy, Enriched Supportive Therapy
Eligibility Criteria
Inclusion Criteria:
Patients will be included if they have:
- a diagnosis of schizophrenia or schizoaffective disorder verified by the SCID (in our data patients with both conditions respond similarly to CET);
- duration since first psychotic symptom of < 10 years;
- stable positive symptoms based on medical record review and SCID for at least 2 months;
- are currently maintained on and compliant with prescribed antipsychotic medication;
- age 18-55 years;
- significant social and cognitive disability based on the Cognitive Style and Social Cognition Eligibility Interview utilized in previous CET studies;
- current IQ >= 80; and
- the ability to read (sixth grade level or higher) and speak fluent English. This is a study of early course schizophrenia, not first-episode schizophrenia. A duration of illness since first psychotic symptom of < 10 years is adequate to define the early phase of the illness, particularly given that the average duration of untreated psychosis is a year or more. Eligibility criteria regarding IQ are justified from previous experience with CET indicating that individuals with severe mental incapacity are better served with less cognitively advanced programs.
Exclusion Criteria:
In order to avoid confounders likely to affect cognition and limit response to cognitive rehabilitation, we will exclude those with:
- significant neurological or medical disorders that may produce cognitive impairment (e.g., seizure disorder, traumatic brain injury);
- persistent suicidal or homicidal behavior;
- a recent (within the past 3 months) history of substance abuse or dependence; and
- any MRI contraindications such as ferromagnetic objects in the body.
Sites / Locations
- Beth Israel Deaconess Medical Center
- Massachusetts Institute of Technology
- Massachusetts General Hospital
- University of Pittsburgh
- Western Psychiatry Institute and Clinic
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Cognitive enhancement therapy
Enriched Supportive Therapy
Cognitive Enhancement Therapy (CET) consists of approximately 60 hours of computer-assisted neurocognitive training in attention, memory, and problem-solving; and 45 social-cognitive group sessions that employ in vivo learning experiences to foster the development of social wisdom and success in interpersonal interactions. CET begins with 3 months of weekly 1-hour neurocognitive training in attention, after which patients begin the weekly 1.5-hour social-cognitive groups. Neurocognitive training then proceeds concurrently with the socialcognitive groups
Enriched Supportive Therapy is an individual approach that includes the established principles of supportive therapy previously tested by our group, which are "enriched" by selected practice principles from the effective Personal Therapy. These manualized supportive therapeutic practices include active listening, correct empathy, appropriate reassurance, basic psychoeducation, including computer-based educational programs, reinforcement of health-promoting initiatives, the provision of case management, and reliance on the advocacy and advice of the therapist in times of crisis.