Cognitive Skills Training Using Computer for Patients With Severe Mental Illness

• Facial Emotional Discrimination Task (FEDT) and Facial Emotional Identification Task (FEIT) [ Time Frame: Week 0, and Week 12 (after compeltion of Cognitive Remediation) ] [ Designated as safety issue: No ]
• Personal and Social Performance Scale (PSP) [ Time Frame: Week 0, and Week 12 after completion of Cognitive Remediation ] [ Designated as safety issue: No ]
• Positive and Negative Syndrome Scale (PANSS) [ Time Frame: Week 0, Week 6 (Midpoint) and Week 12 after completion of Cognitive Remediation ] [ Designated as safety issue: No ]

The study is designed to evaluate the effectiveness of computerized cognitive skills training for improving memory and problem-solving skills in inpatients with schizophrenia.

Subjects are stable inpatients and outpatients with schizophrenia or schizoaffective disorder who are receiving atipsychotic medication at Manhattan Psychiatric Center.

Patients receive baseline assessments (MCCB-MATRICS; Personal and Social Performance Scale, FEDT/FEIT and PANSS) and then are assigned to Cognitive Remediation (CRT) using the COGPACK program, patients are then randomly assigned to a social cognition program (Mind Reader Interactive Guide to Emotions) for a period of 12 weeks. Following 12 weeks of treatment in either CRT + Mind Reader or CRT alone, assessments are repeated by raters.

Cognitive Remediation (CRT): CRT (COGPACK, Marker and Olbrich, 1998) consists of computerized practice tests for seven cognitive domains. There are 64 programs for testing and training, each with several variants for the domains of visuomotor skills, comprehension, reaction, vigilance, memory, language, and intellectual skills. Exercises in COGPACK can be edited and expanded. Patients attend 2 (45-minutes each) groups and 1 discussion group.

Social Cognition Training: Mind Reader (Baron-Cohen et al, 2004) is an interactive computerized program of emotions and mental states. It is based on a taxonomic system of 412 emotions and mental states, grouped into 24 emotion groups, and six developmental levels (from age 4 to adulthood). The emotions and mental states are organized systematically, according to the emotion groups and developmental levels. Patients assigned to Mind Reader attend 1 group per week.

Both the CRT and Mind Reader are administered in small groups of six to eight patients each.

• Schizophrenia
• Schizoaffective Disorder

• Behavioral: Computerized Cognitive Skill Training
  Behavioral: Cognitive Remediation 45 mins 2 times per week sessions of cognitive remediation (COGPACK) over twelve weeks.
  Other Name: Cognitive Remediation Therapy
• Behavioral: CRT and Social Cognition
  Mind Reading, The Interactive Guide to Emotions for one 45 minute session per week for 12 weeks.
  Other Name: Social Emotional Functioning

• Experimental: Computerized Cognitive Remediation
  Computerized Cognitive Remediation treatment using COGPACK.
  Intervention: Behavioral: Computerized Cognitive Skill Training
• Experimental: CRT + Social Cognition Training
  Two 45-minute sessions of Computerized Cognitive Remediation using COGPACK, one 45-minute discussion session, plus one 45 minute Mind Reader Interactive Guide to Emotions per week for 12 weeks.
  Intervention: Behavioral: CRT and Social Cognition

Inclusion Criteria:

1. Age 18 and above;
2. In- and out-patients;
3. DSM-IV diagnosis of schizophrenia (all subtypes) or schizoaffective disorder with illness duration >5 years;
4. Auditory and visual acuity adequate to complete cognitive tests;
5. Stable dose of oral atypical antipsychotic for at least 4 weeks;
6. Total PANSS score > 60;
7. Good physical health determined by physical examination from medical chart review;
8. Capacity and willingness to give written informed consent.
9. MMSE > 24

Exclusion Criteria:

1. Inability to read or speak English;
2. Documented disease of the central nervous system;
3. History of intellectual impairment pre-dating onset of symptoms of psychosis (e.g. mental retardation);
4. Clinically significant or unstable cardiovascular, renal, hepatic, gastrointestinal, pulmonary or hematological conditions;
5. HIV +;
6. Patients diagnosed with substance dependence;
7. Currently participating in another experimental study.