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Efficacy of Repyflec Cognitive Remediation Group Training in Schizophrenia

Efficacy of Repyflec Cognitive Remediation Group Training in Cognition, Functional Outcomes and Psychiatric Symptoms of Outpatients With Schizophrenia.

Status
Completed
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01279070
Enrollment
62
Registered
2011-01-19
Start date
2006-09-30
Completion date
2011-03-31
Last updated
2013-08-23

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Indication for Modification of Patient Cognitive Status

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

BEHAVIORALRepyflec cognitive remediation training

Comparison of 32 Repyflec group sessions among 32 leisure group sessions where we stimulated non-specific cognitive perform.

Sponsors

Fundació Sant Joan de Déu
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No

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

MeasureTime frameDescription
Executive FunctionChange 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

MeasureTime frameDescription
Psychosocial FunctioningChange from baseline in social functioning scales at 16 weeksThe 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 SymptomsChange from baseline in psychiatric symptoms scales at 16 weeksThe 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

ArmCount
Leisure Group
Leisure group has got same number of sessions and timing than experimental group
28
Repyflec Training
Cognitive remediation treatment
34
Total62

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAcute exacerbation31
Overall StudyWithdrawal by Subject23

Baseline characteristics

CharacteristicRepyflec TrainingLeisure GroupTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
0 Participants0 Participants0 Participants
Age, Categorical
Between 18 and 65 years
34 Participants28 Participants62 Participants
Age Continuous39.6 years
STANDARD_DEVIATION 8.2
41.9 years
STANDARD_DEVIATION 6.7
40.6 years
STANDARD_DEVIATION 7.6
Region of Enrollment
Spain
34 participants28 participants62 participants
Sex: Female, Male
Female
11 Participants9 Participants20 Participants
Sex: Female, Male
Male
23 Participants19 Participants42 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
0 / 240 / 29
serious
Total, serious adverse events
0 / 240 / 29

Outcome results

Primary

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.

ArmMeasureGroupValue (MEAN)Dispersion
REPYFLEC Cognitive Remediation Group TrainingExecutive FunctionBADS Key search subscale (from 0 to 4)2.7 units on a scaleStandard Deviation 1.2
REPYFLEC Cognitive Remediation Group TrainingExecutive FunctionBADS total standardized score (from 12 to 129)99.5 units on a scaleStandard Deviation 14.5
Leisure & Socialization GroupExecutive FunctionBADS Key search subscale (from 0 to 4)1.7 units on a scaleStandard Deviation 1.3
Leisure & Socialization GroupExecutive FunctionBADS total standardized score (from 12 to 129)95.7 units on a scaleStandard Deviation 13.5
Comparison: To evaluate intervention efficacy on the BADS(Total score and Key search subtest),linear mixed-effects models were fitted using Restricted Maximum Likelihood (REML.An unstructured correlation matrix was used to account for correlation among several observations for each subject.The dependent variable comprised the measures at 16 weeks while the baseline value of the BADS,intervention group(REPYFLEC group vs Leisure group),time and the interaction term (time×treatment)were included as covariates.p-value: <0.0595% CI: [0.1, 0.7]Mixed Models Analysis
Primary

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.

ArmMeasureGroupValue (MEAN)Dispersion
REPYFLEC Cognitive Remediation Group TrainingExecutive FunctionBADS standardized total score (min.12-max.129)101.8 units on a scaleStandard Deviation 10.1
REPYFLEC Cognitive Remediation Group TrainingExecutive FunctionBADS Key search subscale (from 0 to 4)3 units on a scaleStandard Deviation 1.1
Leisure & Socialization GroupExecutive FunctionBADS standardized total score (min.12-max.129)94.5 units on a scaleStandard Deviation 14.7
Leisure & Socialization GroupExecutive FunctionBADS Key search subscale (from 0 to 4)1.7 units on a scaleStandard Deviation 1.4
Comparison: To evaluate intervention efficacy on the BADS(Total score and Key search subtest),linear mixed-effects models were fitted using Restricted Maximum Likelihood(REML).An unstructured correlation matrix was used to account for correlation among several observations for each subject.The dependent variable comprised the measures at 40 weeks while the baseline value of the BADS,intervention group(REPYFLEC group vs Leisure group),time and the interaction term (time×treatment)were included as covariates.p-value: <0.0595% CI: [0.1, 0.7]Mixed Models Analysis
Secondary

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

ArmMeasureGroupValue (MEAN)Dispersion
REPYFLEC Cognitive Remediation Group TrainingPsychiatric SymptomsPositive (from 7 to 49)11.5 units on a scaleStandard Deviation 2.9
REPYFLEC Cognitive Remediation Group TrainingPsychiatric SymptomsNegative (from 7 to 49)16.6 units on a scaleStandard Deviation 4.1
REPYFLEC Cognitive Remediation Group TrainingPsychiatric SymptomsGeneral Psychopathology (from 16 to 112)27.5 units on a scaleStandard Deviation 6
REPYFLEC Cognitive Remediation Group TrainingPsychiatric SymptomsPANSS Total score (min. 30-max. 210)55.6 units on a scaleStandard Deviation 10.6
Leisure & Socialization GroupPsychiatric SymptomsPANSS Total score (min. 30-max. 210)60.4 units on a scaleStandard Deviation 12.3
Leisure & Socialization GroupPsychiatric SymptomsPositive (from 7 to 49)12.8 units on a scaleStandard Deviation 3.5
Leisure & Socialization GroupPsychiatric SymptomsGeneral Psychopathology (from 16 to 112)30.1 units on a scaleStandard Deviation 6.1
Leisure & Socialization GroupPsychiatric SymptomsNegative (from 7 to 49)17.5 units on a scaleStandard Deviation 5.2
Comparison: To evaluate intervention efficacy on the PANSS, linear mixed-effects models were fitted using Restricted Maximum Likelihood (REML). An unstructured correlation matrix was used to account for correlation among several observations for each subject. The dependent variable comprised the measures at 16 weeks while the baseline value of the PANSS, intervention group (REPYFLEC group vs Leisure group), time and the interaction term (time×treatment) were included as covariates.p-value: <0.0595% CI: [0.01, 0.7]Mixed Models Analysis
Secondary

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

ArmMeasureGroupValue (MEAN)Dispersion
REPYFLEC Cognitive Remediation Group TrainingPsychiatric SymptomsPositive (from 7 to 49)12.9 units on a scaleStandard Deviation 3.3
REPYFLEC Cognitive Remediation Group TrainingPsychiatric SymptomsNegative (from 7 to 49)17.6 units on a scaleStandard Deviation 3.7
REPYFLEC Cognitive Remediation Group TrainingPsychiatric SymptomsGeneral Psychopathology (from 16 to 112)30.8 units on a scaleStandard Deviation 5.7
REPYFLEC Cognitive Remediation Group TrainingPsychiatric SymptomsPANSS Total score (min. 30- max. 210)61.4 units on a scaleStandard Deviation 9.5
Leisure & Socialization GroupPsychiatric SymptomsPANSS Total score (min. 30- max. 210)61.8 units on a scaleStandard Deviation 10.5
Leisure & Socialization GroupPsychiatric SymptomsPositive (from 7 to 49)14 units on a scaleStandard Deviation 4.8
Leisure & Socialization GroupPsychiatric SymptomsGeneral Psychopathology (from 16 to 112)30.8 units on a scaleStandard Deviation 5
Leisure & Socialization GroupPsychiatric SymptomsNegative (from 7 to 49)16.9 units on a scaleStandard Deviation 3.8
Comparison: To evaluate intervention efficacy on the PANSS, linear mixed-effects models were fitted using Restricted Maximum Likelihood (REML). An unstructured correlation matrix was used to account for correlation among several observations for each subject. The dependent variable comprised the measures at 40 weeks while the baseline value of the PANSS, intervention group (REPYFLEC group vs Leisure group), time and the interaction term (time×treatment) were included as covariates.p-value: <0.0595% CI: [0.01, 0.7]Mixed Models Analysis
Secondary

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.

ArmMeasureGroupValue (MEAN)Dispersion
REPYFLEC Cognitive Remediation Group TrainingPsychosocial FunctioningLSP Total Score (min. 39-max. 156)137.4 units on a scaleStandard Deviation 6.9
REPYFLEC Cognitive Remediation Group TrainingPsychosocial FunctioningSFS Total Score (min. 0-max. 223)108.8 units on a scaleStandard Deviation 17.6
Leisure & Socialization GroupPsychosocial FunctioningLSP Total Score (min. 39-max. 156)133.6 units on a scaleStandard Deviation 11.4
Leisure & Socialization GroupPsychosocial FunctioningSFS Total Score (min. 0-max. 223)105.9 units on a scaleStandard Deviation 19.3
Comparison: To evaluate intervention efficacy on the LSP, linear mixed-effects models were fitted using Restricted Maximum Likelihood (REML). An unstructured correlation matrix was used to account for correlation among several observations for each subject. The dependent variable comprised the measures at 16 weeks while the baseline value of the LSP, intervention group (REPYFLEC group vs Leisure group), time and the interaction term (time×treatment) were included as covariates.p-value: <0.0595% CI: [0.06, 0.6]Mixed Models Analysis
Secondary

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.

ArmMeasureGroupValue (MEAN)Dispersion
REPYFLEC Cognitive Remediation Group TrainingPsychosocial FunctioningLSP Total Score (min. 39-max. 156)135.7 units on a scaleStandard Deviation 7.7
REPYFLEC Cognitive Remediation Group TrainingPsychosocial FunctioningSFS Total Score (min. 0-max. 223)107 units on a scaleStandard Deviation 16.6
Leisure & Socialization GroupPsychosocial FunctioningLSP Total Score (min. 39-max. 156)132.9 units on a scaleStandard Deviation 12
Leisure & Socialization GroupPsychosocial FunctioningSFS Total Score (min. 0-max. 223)107.2 units on a scaleStandard Deviation 14.8
Comparison: To evaluate intervention efficacy on the LSP, linear mixed-effects models were fitted using Restricted Maximum Likelihood (REML). An unstructured correlation matrix was used to account for correlation among several observations for each subject. The dependent variable comprised the measures at 40 weeks while the baseline value of the LSP, intervention group (REPYFLEC group vs Leisure group), time and the interaction term (time×treatment) were included as covariates.p-value: <0.0595% CI: [0.09, 0.6]Mixed Models Analysis

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026