Indication for Modification of Patient Cognitive Status
Conditions
Keywords
Schizophrenia, Cognitive remediation, Group training, Executive function, Social functioning
Brief summary
The purpose of this study was to develop an integrative intervention for schizophrenia taking into account previous efficacious therapies. Thus, our aim was to evaluate the efficacy of our cognitive remediation group training: Problem Solving and Cognitive Flexibility training (REPYFLEC), focused to improve neurocognition and functioning in schizophrenia patients. We hypothesized that training executive function and metacognition would allow us to achieve improvements in neurocognition, functioning and psychiatric symptoms of patients with schizophrenia.
Interventions
Comparison of 32 Repyflec group sessions among 32 leisure group sessions where we stimulated non-specific cognitive perform.
Sponsors
Study design
Eligibility
Inclusion criteria
* Diagnosis of schizophrenia or schizoaffective disorder * More than 2 years illness duration * Literate * Mini Mental Status Examination score over 24 * Global Assessment of Functioning scores between 40 and 70
Exclusion criteria
* Current acute illness exacerbation * Mental Retardation * Neurological disorder which impairs cognition * Currently participating in social skills training or cognitive remediation * Change of antipsychotic medication one month before the trial or during the 40 study weeks * Diagnosis of alcohol or drug dependence within 6 months of trial commencement.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Executive Function | Change from baseline in executive function at 16 weeks (post-treatment) | Behavioral Assessment of the Dysexecutive Syndrome (BADS). This scale evaluates cognitive flexibility, inhibition of impulsive responses, planning and organization, working memory and time-estimation capacity. All subscales (Rule shift cards, Action Program, Key search, Temporal judgment, Zoo map and Six elements) were administered. We used subscales raw scores which run from 0 to 4. The subscales' raw score is summarized and converted to standardized total score which run (min. 12-max. 129). A higher score indicates better performance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Psychosocial Functioning | Change from baseline in social functioning scales at 16 weeks | The Spanish validation of the Life Skills Profile (LSP)was used. This scale measures functionality in daily life activities such as self-care, social behavior and autonomy. Raw scoring was used for the various subscales which are summarized for the total (min. 39-max. 156) with a higher score indicating a better result. The 5 subscales are: Self-care, Non-turbulence, Social contact, Communication and Responsibility. We used the Spanish validation of the Social Functioning Scale (SFS)for measuring social behavior and relationships, autonomy, employment-occupation and leisure. Raw scoring was used for each subscale and for total score (min. 0-max. 223) with a higher score indicating a better result. All 7 subscales were administered: social engagement/ withdrawal, interpersonal behavior, independence-competence, independence-performance, pro-social activities, recreation and employment/ occupation. |
| Psychiatric Symptoms | Change from baseline in psychiatric symptoms scales at 16 weeks | The Spanish validation of the Positive and Negative Syndrome Scale (PANSS) was used for measuring positive, negative and general symptomatology. Total raw scoring obtained through the sum of the raw scores for each subscale was considered (min. 30-max. 210) with a score of 30 representing an absence of psychiatric symptoms. |
Countries
Spain
Participant flow
Recruitment details
Recruitment started on January 2007 and finished on May 2010. We have worked in different outpatient Rehabilitation Centers and we incorporated experimental and control group as a part of their rehabilitation planning. We have worked in 6 different centers.
Participants by arm
| Arm | Count |
|---|---|
| Leisure Group Leisure group has got same number of sessions and timing than experimental group | 28 |
| Repyflec Training Cognitive remediation treatment | 34 |
| Total | 62 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Acute exacerbation | 3 | 1 |
| Overall Study | Withdrawal by Subject | 2 | 3 |
Baseline characteristics
| Characteristic | Repyflec Training | Leisure Group | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 34 Participants | 28 Participants | 62 Participants |
| Age Continuous | 39.6 years STANDARD_DEVIATION 8.2 | 41.9 years STANDARD_DEVIATION 6.7 | 40.6 years STANDARD_DEVIATION 7.6 |
| Region of Enrollment Spain | 34 participants | 28 participants | 62 participants |
| Sex: Female, Male Female | 11 Participants | 9 Participants | 20 Participants |
| Sex: Female, Male Male | 23 Participants | 19 Participants | 42 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 24 | 0 / 29 |
| serious Total, serious adverse events | 0 / 24 | 0 / 29 |
Outcome results
Executive Function
Behavioral Assessment of the Dysexecutive Syndrome (BADS). This scale evaluates cognitive flexibility, inhibition of impulsive responses, planning and organization, working memory and time-estimation capacity. All subscales (Rule shift cards, Action Program, Key search, Temporal judgment, Zoo map and Six elements) were administered. We used subscales raw scores which run from 0 to 4. The subscales' raw score is summarized and converted to standardized total score which run (min. 12-max. 129). A higher score indicates better performance.
Time frame: Change from baseline in executive function at 16 weeks (post-treatment)
Population: The sample size required was calculated according to the main study objective which consisted of achieving an improvement in social functioning according to the Living Skills Profile (LSP) scale. It was estimated that a sample of 27 patients per group would have a power of 80% at a significance level of 5% to detect these differences.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| REPYFLEC Cognitive Remediation Group Training | Executive Function | BADS Key search subscale (from 0 to 4) | 2.7 units on a scale | Standard Deviation 1.2 |
| REPYFLEC Cognitive Remediation Group Training | Executive Function | BADS total standardized score (from 12 to 129) | 99.5 units on a scale | Standard Deviation 14.5 |
| Leisure & Socialization Group | Executive Function | BADS Key search subscale (from 0 to 4) | 1.7 units on a scale | Standard Deviation 1.3 |
| Leisure & Socialization Group | Executive Function | BADS total standardized score (from 12 to 129) | 95.7 units on a scale | Standard Deviation 13.5 |
Executive Function
Behavioral Assessment of the Dysexecutive Syndrome (BADS) (Wilson et al., 1996). This scale evaluates cognitive flexibility, inhibition of impulsive responses, planning and organization, working memory and time-estimation capacity. All subscales (Rule shift cards, Action Program, Key search, Temporal judgement, Zoo map and Six elements) were administered. We used subscales raw scores which run from 0 to 4. The subscales' raw score is summarized and converted to standardized total score which run (min. 12-max. 129). A higher score indicates better performance.
Time frame: Change from baseline in executive functioning at 40 weeks
Population: The sample size required was calculated according to the main study objective which consisted of achieving an improvement in social functioning according to the Living Skills Profile (LSP) scale. It was estimated that a sample of 27 patients per group would have a power of 80% at a significance level of 5% to detect these differences.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| REPYFLEC Cognitive Remediation Group Training | Executive Function | BADS standardized total score (min.12-max.129) | 101.8 units on a scale | Standard Deviation 10.1 |
| REPYFLEC Cognitive Remediation Group Training | Executive Function | BADS Key search subscale (from 0 to 4) | 3 units on a scale | Standard Deviation 1.1 |
| Leisure & Socialization Group | Executive Function | BADS standardized total score (min.12-max.129) | 94.5 units on a scale | Standard Deviation 14.7 |
| Leisure & Socialization Group | Executive Function | BADS Key search subscale (from 0 to 4) | 1.7 units on a scale | Standard Deviation 1.4 |
Psychiatric Symptoms
The Spanish validation of the Positive and Negative Syndrome Scale (PANSS) was used for measuring positive, negative and general symptomatology. Total raw scoring obtained through the sum of the raw scores for each subscale was considered (min. 30-max. 210) with a score of 30 representing an absence of psychiatric symptoms.
Time frame: Change from baseline in psychiatric symptoms scales at 16 weeks
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| REPYFLEC Cognitive Remediation Group Training | Psychiatric Symptoms | Positive (from 7 to 49) | 11.5 units on a scale | Standard Deviation 2.9 |
| REPYFLEC Cognitive Remediation Group Training | Psychiatric Symptoms | Negative (from 7 to 49) | 16.6 units on a scale | Standard Deviation 4.1 |
| REPYFLEC Cognitive Remediation Group Training | Psychiatric Symptoms | General Psychopathology (from 16 to 112) | 27.5 units on a scale | Standard Deviation 6 |
| REPYFLEC Cognitive Remediation Group Training | Psychiatric Symptoms | PANSS Total score (min. 30-max. 210) | 55.6 units on a scale | Standard Deviation 10.6 |
| Leisure & Socialization Group | Psychiatric Symptoms | PANSS Total score (min. 30-max. 210) | 60.4 units on a scale | Standard Deviation 12.3 |
| Leisure & Socialization Group | Psychiatric Symptoms | Positive (from 7 to 49) | 12.8 units on a scale | Standard Deviation 3.5 |
| Leisure & Socialization Group | Psychiatric Symptoms | General Psychopathology (from 16 to 112) | 30.1 units on a scale | Standard Deviation 6.1 |
| Leisure & Socialization Group | Psychiatric Symptoms | Negative (from 7 to 49) | 17.5 units on a scale | Standard Deviation 5.2 |
Psychiatric Symptoms
The Spanish validation of the Positive and Negative Syndrome Scale (PANSS) was used for measuring positive, negative and general symptomatology. Total raw scoring obtained through the sum of the raw scores for each subscale was considered (min. 30-max. 210) with a score of 30 representing an absence of psychiatric symptoms.
Time frame: Change from baseline in psychiatric symptoms scales at 40 weeks
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| REPYFLEC Cognitive Remediation Group Training | Psychiatric Symptoms | Positive (from 7 to 49) | 12.9 units on a scale | Standard Deviation 3.3 |
| REPYFLEC Cognitive Remediation Group Training | Psychiatric Symptoms | Negative (from 7 to 49) | 17.6 units on a scale | Standard Deviation 3.7 |
| REPYFLEC Cognitive Remediation Group Training | Psychiatric Symptoms | General Psychopathology (from 16 to 112) | 30.8 units on a scale | Standard Deviation 5.7 |
| REPYFLEC Cognitive Remediation Group Training | Psychiatric Symptoms | PANSS Total score (min. 30- max. 210) | 61.4 units on a scale | Standard Deviation 9.5 |
| Leisure & Socialization Group | Psychiatric Symptoms | PANSS Total score (min. 30- max. 210) | 61.8 units on a scale | Standard Deviation 10.5 |
| Leisure & Socialization Group | Psychiatric Symptoms | Positive (from 7 to 49) | 14 units on a scale | Standard Deviation 4.8 |
| Leisure & Socialization Group | Psychiatric Symptoms | General Psychopathology (from 16 to 112) | 30.8 units on a scale | Standard Deviation 5 |
| Leisure & Socialization Group | Psychiatric Symptoms | Negative (from 7 to 49) | 16.9 units on a scale | Standard Deviation 3.8 |
Psychosocial Functioning
The Spanish validation of the Life Skills Profile (LSP)was used. This scale measures functionality in daily life activities such as self-care, social behavior and autonomy. Raw scoring was used for the various subscales which are summarized for the total (min. 39-max. 156) with a higher score indicating a better result. The 5 subscales are: Self-care, Non-turbulence, Social contact, Communication and Responsibility. We used the Spanish validation of the Social Functioning Scale (SFS)for measuring social behavior and relationships, autonomy, employment-occupation and leisure. Raw scoring was used for each subscale and for total score (min. 0-max. 223) with a higher score indicating a better result. All 7 subscales were administered: social engagement/ withdrawal, interpersonal behavior, independence-competence, independence-performance, pro-social activities, recreation and employment/ occupation.
Time frame: Change from baseline in social functioning scales at 16 weeks
Population: The sample size required was calculated according to the main study objective which consisted of achieving an improvement in social functioning according to the Living Skills Profile (LSP) scale. It was estimated that a sample of 27 patients per group would have a power of 80% at a significance level of 5% to detect these differences.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| REPYFLEC Cognitive Remediation Group Training | Psychosocial Functioning | LSP Total Score (min. 39-max. 156) | 137.4 units on a scale | Standard Deviation 6.9 |
| REPYFLEC Cognitive Remediation Group Training | Psychosocial Functioning | SFS Total Score (min. 0-max. 223) | 108.8 units on a scale | Standard Deviation 17.6 |
| Leisure & Socialization Group | Psychosocial Functioning | LSP Total Score (min. 39-max. 156) | 133.6 units on a scale | Standard Deviation 11.4 |
| Leisure & Socialization Group | Psychosocial Functioning | SFS Total Score (min. 0-max. 223) | 105.9 units on a scale | Standard Deviation 19.3 |
Psychosocial Functioning
The Spanish validation of the Life Skills Profile (LSP)was used. This scale measures functionality in daily life activities such as self-care, social behavior and autonomy. Raw scoring was used for the various subscales which are summarized for the total (min. 39-max. 156) with a higher score indicating a better result. The 5 subscales are: Self-care, Non-turbulence, Social contact, Communication and Responsibility. We used the Spanish validation of the Social Functioning Scale (SFS)for measuring social behavior and relationships, autonomy, employment-occupation and leisure. Raw scoring was used for each subscale and for total score (min. 0-max. 223) with a higher score indicating a better result. All 7 subscales were administered: social engagement/ withdrawal, interpersonal behavior, independence-competence, independence-performance, pro-social activities, recreation and employment/ occupation.
Time frame: Change from baseline in social functioning scales at 40 weeks
Population: The sample size required was calculated according to the main study objective which consisted of achieving an improvement in social functioning according to the Living Skills Profile (LSP) scale. It was estimated that a sample of 27 patients per group would have a power of 80% at a significance level of 5% to detect these differences.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| REPYFLEC Cognitive Remediation Group Training | Psychosocial Functioning | LSP Total Score (min. 39-max. 156) | 135.7 units on a scale | Standard Deviation 7.7 |
| REPYFLEC Cognitive Remediation Group Training | Psychosocial Functioning | SFS Total Score (min. 0-max. 223) | 107 units on a scale | Standard Deviation 16.6 |
| Leisure & Socialization Group | Psychosocial Functioning | LSP Total Score (min. 39-max. 156) | 132.9 units on a scale | Standard Deviation 12 |
| Leisure & Socialization Group | Psychosocial Functioning | SFS Total Score (min. 0-max. 223) | 107.2 units on a scale | Standard Deviation 14.8 |