Compensating for Cognitive Deficits in Schizophrenia

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Many schizophrenia outpatients demonstrate significant impairment in role functioning, poor quality of life and high rates rehospitalization. Recent research has shown that neurocognitive deficits predict community outcomes for these patients. In a series of studies, we showed that Cognitive Adaptation Training (CAT) -a manual-driven set of compensatory strategies (signs, checklists, electronic devices) designed to bypass specific neurocognitive deficits -significantly improved adaptive functioning, quality of life, and rates of relapse in schizophrenia patients compared to control conditions. Significant questions remain: Is CAT superior to a minimal set of generalized compensatory strategies (e.g. pillboxes, calendars) that could be given to virtually all patients? Can the intensity and therefore the cost of CAT treatment be substantially reduced while maintaining gains in important functional outcomes? We plan to address these questions in a sample of 120 medicated schizophrenia patients randomly assigned for a period of two years to one of three treatment groups: 1) CAT, 2) Minimal Environmental Supports, 3) Treatment as usual. Following an initial 9 months of treatment, the intensity of CAT will be reduced to an economically viable level over the next 3 months and be continued at this lower intensity for the next 12 months. Comprehensive assessments will be obtained at study entrance and at 3, 6, 9, 18, and 24 months. Primary outcome variables will include measures of adaptive function and quality of life. Repeated measures analyses of covariance, with pretreatment scores used as covariates, will be utilized to examine group differences on functional outcomes at 9, 12, and 24 months. We hypothesize that at the end of 9 months, patients in CAT and minimal supports will have better functional outcomes than patients in standard treatment, and the gains in functionality and quality of life for patients in CAT will be maintained when the treatment is provided at an economically viable level that would be suitable for use in existing treatment delivery systems.