Functional Rehabilitation of Older Patients With Schizophrenia

Not Applicable

Completed

• Conditions: Schizoaffective Disorder; Psychotic Disorders; Schizophrenia
• Interventions: Behavioral: Cognitive Behavioral Social Skills Training (CBSST); Behavioral: Goal Focused Supportive Contact (GFSC)

• Registration Number: NCT00237796
• Lead Sponsor: US Department of Veterans Affairs

Brief Summary

The primary purpose of this project is to evaluate the efficacy of a group therapy intervention, cognitive behavioral social skills training (CBSST), that teaches social functioning skills and cognitive-behavioral compensatory aids to older patients with schizophrenia. CBSST, therefore, targets the multidimensional deficits that lead to disability in aging veterans with severe mental illness.

Detailed Description

This is a randomized-controlled clinical trial comparing 2 treatment conditions: Goal focused supportive care (SC); and CBSST. Subjects (N=100) will be recruited, treated for 9 months and followed longitudinally for 9 months after treatment. A multidimensional evaluation of treatment outcome, including social functioning (primary outcome), neuropsychological functioning, cognitive insight, psychotic symptoms, and health services utilization, will be conducted at baseline, end of treatment (9-month follow-up), and 9 months post-treatment. 100 patients with schizophrenia or schizoaffective disorder will participate on a voluntary basis and will be paid $50.00 per assessment visit. Subjects will not be paid or given any incentive for treatment. The following inclusion/exclusion criteria will be used: (i) Voluntary informed consent for participation (given by the patient or conservator); (ii) Age 45 or older; (iii) DSM-IV-diagnosis (APA, 1994) of schizophrenia or schizoaffective disorder at any stage of illness; (iv) No prior exposure to SST or CBT in the past 5 years; (v) Level of care required at baseline does not interfere with outpatient group therapy participation (e.g., partial or inpatient hospitalization for psychiatric, or physical illness). We anticipate that we will be able to provide an empirically validated intervention that can be used by clinicians on multidisciplinary rehabilitation teams to reduce disability in aging patients with schizophrenia. The products from this research will be written research reports and a therapy manual and patient workbook to guide rehabilitation that can be disseminated (e.g., via the internet) to relevant clinicians.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study Start: 2005-02
• Study First Submitted: 2005-10-07
• Study First Submitted QC: 2005-10-07
• Study First Posted: 2005-10-12
• Primary Completion: 2009-01
• Study Completion: 2009-01
• Results First Submitted: 2014-11-19
• Status Verified: 2015-03
• Results First Submitted QC: 2015-03-23
• Last Update Submitted: 2015-03-23
• Results First Posted: 2015-04-06
• Last Update Posted: 2015-04-06

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 116

Inclusion Criteria

• 45 years of age and older
• DSM-IV diagnosis of Schizophrenia or Schizoaffective Disorder
• Fluent in speaking, reading, and writing English
• Physically and psychiatrically stable enough to undergo various assessments in this study

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Exclusion Criteria

Has not received Cognitive Behavioral Therapy (CBT) or Social Skills Training (SST) or Dialectical Behavioral Therapy (DBT) in the past 5 years

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
ARM 1	Cognitive Behavioral Social Skills Training (CBSST)	Cognitive Behavioral Social Skills Training (CBSST)
ARM 2	Goal Focused Supportive Contact (GFSC)	Goal Focused Supportive Contact (GFSC)

Primary Outcome Measures

Name	Time	Method
Independent Living Skills Survey (ILSS)	baseline, mid-treatment, end of treatment, mid-follow up, and follow up	The ILSS is a self-report measure in an interview format to assess everyday functioning in ten domains: Appearance and Clothing, Personal Hygiene, Care of Personal Possessions, Food Preparation/Storage, Health Maintenance, Money Management, Transportation, Leisure, Job Seeking, and Job Maintenance. Scale ranges from 0 to 1. Subscales are averaged to yield composite score. Higher scores represent higher level of functioning.

Secondary Outcome Measures

Name	Time	Method
Beck Anxiety Inventory (BAI)	baseline, mid-treatment, end of treatment, mid follow-up, and follow up	The Beck Anxiety Inventory is a self-report measure of anxiety that consists of 21 questions. Scores from individual items are summed to yield a total score. The total score ranges from 0-63. Higher scores represent greater severity of anxiety.
Comprehensive Module Test (CMT)	baseline, mid-treatment, end of treatment, mid-follow up, and follow up	The Comprehensive Module Test (CMT) is an assessment of CBSST skills acquisition in three domains: Communication Skills Test, Problem Solving Test, and Thought Challenging Test. The total CMT score ranges from 0-33. Higher total scores represent higher level of CBSST skills acquisition.
Positive and Negative Syndrome Scale (PANSS) - Positive Subscale	baseline, mid-treatment, end of treatment, mid follow-up, and followup	The PANSS is 30 item semi-structured clinical interview designed to assess positive and negative symptoms. Positive symptoms are rated on 7 domains: Delusions, Conceptual Disorganization, Hallucinatory Behavior, Excitement, Grandiosity, Suspiciousness/Persecution, and Hostility. Each domain in the positive symptom subscale is rated from 0 (absence of symptom) to 7 (extreme symptom severity). Total scores of the seven domains are summed to yield a total score range of 0 (Absence) to 49 (Extreme), where higher scores represent more severe positive symptoms.
The Scale for the Assessment of Negative Symptoms (SANS) - Diminished Motivation	baseline, mid-treatment, end of treatment, mid follow-up, and follow-up	The SANS is a 25 item semi-structured clinical interview designed to assess negative symptoms. There are 9 items that measure diminished motivation which consists of two domains: Avolition-Apathy and Anhedonia-Asociality. Each item is rated from 0 (Absent) to 5 (Severe). The total score is derived from the average of the Affective Flattening and Alogia global ratings (items #17 and #22).
Scale for the Assessment of Negative Symptoms (SANS) - Diminished Expression	baseline, mid treatment, end of treatment, mid follow-up, and follow up	The SANS is a 25 item semi-structured clinical interview designed to assess negative symptoms. The first 13 items measure diminished expression which consists of two domains: Affective flattening and Alogia. Each item is rated from 0 (Absent) to 5 (Severe). The total score is derived from the average of the Affective Flattening and Alogia global ratings (items #8 and #13).
Beck Depression Inventory-II (BDI-II)	baseline, mid-treatment, end of treatment, mid follow-up, and follow-up	The BDI-II is a self-report measure of depression that consists of 21 questions. The total scale ranges from 0-63. Scores from individual questions are summed to yield a total score. Higher scores represent greater severity of depression.

Trial Locations

Locations (1)

VA San Diego Healthcare System, San Diego; 🇺🇸 San Diego, California, United States