Treating Thought Problems in Patients With Schizophrenia

This study will compare Cognitive Adaptation Training (CAT) to minimal schizophrenia treatment. This study will also determine whether the intensity of CAT can be reduced and still provide benefits to patients with schizophrenia.

Many schizophrenia patients have serious difficulties that affect their quality of life. Cognitive Adaptation Training (CAT) may improve adaptive functioning, quality of life, and rates of relapse in schizophrenia patients. CAT, which involves compensatory strategies or environmental supports, is tailored to each individual and is based on executive functioning levels and other factors.

Participants are randomly assigned to CAT, Minimal Environmental Supports (MES), or treatment as usual for 2 years. Participants receiving CAT will have a trained therapist make weekly visits to their home for 9 months. Over the following 3 months, the frequency of CAT visits will be slowly reduced to once a month. For the remaining 12 months of treatment, patients receive CAT only once a month.

Participants assigned to the MES group receive a generic set of supplies and equipment (calendar, alarm clock, watch, bus passes, etc.) at the beginning of the 2-year period. Each month, the supplies are replenished as necessary during the patient's scheduled clinic visit.

In all groups, assessments of adaptive function and quality of life occur at study start and at 3, 6, 9, 18, and 24 months.

• Behavioral: Cognitive Adaptation Therapy (CAT)
• Behavioral: Minimal Environmental Supports (MES)

• Active Comparator: Cognitive Adaptation Therapy
  Subjects receive Cognitive adaptation therapy as part of treatment for schizophrenia
  Intervention: Behavioral: Cognitive Adaptation Therapy (CAT)
• Active Comparator: Minimal Environmental Support
  Subjects receive minimal environmental support in schizophrenia treatment
  Intervention: Behavioral: Minimal Environmental Supports (MES)

Inclusion Criteria:

• DSM-IV diagnosis of schizophrenia or schizoaffective disorder
• Treatment with an atypical antipsychotic medication
• Stable living environment
• Able to read, understand, and complete rating scales and neuropsychological testing
• Willing to participate in psychosocial treatments for schizophrenia that may involve home visits

Exclusion Criteria:

• History of significant head trauma, seizure disorder, or mental retardation
• Alcohol or drug abuse that could interfere with participation in the study
• Treatment by an ACT team
• History of violence in the past year
• Score > 80 on the SOFAS
• Hospitalized in the past year