A Pharmaco-imaging Approach to Predicting Social Functioning and Clinical Responses to Oxytocin Administration in Schizophrenia

Phase 2

Terminated

Brief Summary: Schizophrenia has a devastating and disproportionate effect on veterans compared to the general US population. Some of the most disabling symptoms, such as low motivation, difficulty expressing emotions, and decreased ability to infer the mental states of others, cause poor social functioning. This means that veterans with schizophrenia have trouble navigating interpersonal interactions and building meaningful relationships in the community. Unfortunately, current antipsychotic medications typically only improve positive symptoms but fail to improve social functioning deficits, which are strong predictors of poor quality of life and functional outcomes. Oxytocin, a peptide found in the brain, plays an important role in social behavior and is known to moderate affiliation, stress, and learning across taxa. In this study, the investigators will test whether oxytocin could be an effective treatment for social functioning deficits in schizophrenia. The investigators will examine changes in brain activation to understand how oxytocin affects behavior and to predict which individuals may benefit from oxytocin treatment.

Detailed Description: The study uses a combined within- and between-subject placebo-controlled study design. After screening, participants will be randomized into two study arms for the fMRI phase of the study. In each study arm, participants will complete a placebo-controlled, within-subject, pharmaco-fMRI paradigm with one of two possible dosages of oxytocin (20 or 40IU) and placebo. In the fMRI scanner, they will complete two well-validated theory of mind tasks: the false belief task and the person description task. Following the fMRI phase of the study, participants will be randomized to receive the same dosage of oxytocin the participant received in the fMRI phase, or placebo, twice daily for 3 weeks. Before and after the three weeks of drug administration, participants will be assessed for social functioning, social ability, negative symptoms, and theory of mind. More participants will be randomized to receive chronically administered oxytocin than placebo to maximize the study's power to test the investigators' hypothesis that acute oxytocin-induced increases in right temporo-parietal junction activity will be positively correlated with improvements in social functioning (primary outcome), social ability, negative symptoms, and theory of mind over three weeks of oxytocin administration.

Recruitment & Eligibility

Inclusion Criteria

Veteran
age 18-70
a diagnosis of schizophrenia, schizophreniform, schizoaffective, or brief psychotic disorder determined by the Structured Clinical Interview for DSM-5
no medication changes or psychiatric hospitalizations in the past month
SFS modified raw score of no more than 75

Exclusion Criteria

substance use disorder in the past month, except mild to moderate cannabis use disorder
illness affecting the nasal passages
significant neurological/medical disorder
pacemakers
extensive dental work
claustrophobia
deafness
inability to read
currently participating in a psychosocial intervention targeting social functioning deficits
currently taking high dose testosterone or estrogen/progesterone
inability to complete VOT

Arm && Interventions

Group	Intervention	Description
Placebo	Placebo	Saline
Intranasal Oxytocin	Oxytocin	Dosages of oxytocin: 20IU or 40IU.

Primary Outcome Measures

Name	Time	Method
Social Functioning Score	From the baseline visit in the chronic OT administration portion of the study design to after three weeks of oxytocin administration	The Social Functioning Scale is a 79-item semi-structured interview based assessment that includes \[a global summary score (primary outcome) as well as seven subscales (secondary outcomes): social engagement, interpersonal communication, independence, competence, recreation, prosocial, and employment.\] A mean of the subscale scores provides overall score of social functioning. Each subscale score is transformed into a standard distribution with a mean of 100 and standard deviation of 15 for comparability and interpretation. Higher scores indicates a high level of functioning.

Secondary Outcome Measures

Name	Time	Method
CAINS Score (clinical assessment interview for negative symptoms)	From the baseline visit in the chronic OT administration portion of the study design to after three weeks of oxytocin administration	Negative symptoms will be assessed with the CAINS, comprising two subscales reflecting the negative symptom factors: The 9-item Motivation and Pleasure subscale (each item is scored from 0 no impairments to 4 severe deficit) captures experiential negative symptoms by assessing motivation, behavior, and pleasure derived from social, vocational, and recreational activities over the past week. The MAP total score therefore ranges from 0-36. The 4-item Expression subscale (each item is scored from 0 no impairment to 4 severe deficit) captures both non-verbal (face, posture) and verbal expressivity (output, prosody). The EXP total score ranges from 0 to 16 (higher scores indicate greater severity of symptoms). The CAINS has excellent convergent and divergent validity.

Locations (2): VA Greater Los Angeles Healthcare System, West Los Angeles, CA
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West Los Angeles, California, United States
San Francisco VA Medical Center, San Francisco, CA
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San Francisco, California, United States