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Psychosocial Therapy and Risperidone Treatment in Work Performance in Recent-Onset Schizophrenia

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT00333177
Recruitment Status : Completed
First Posted : June 2, 2006
Results First Posted : March 26, 2020
Last Update Posted : March 26, 2020
Sponsor:
Collaborators:
National Institute of Mental Health (NIMH)
Janssen Scientific Affairs, LLC
Information provided by (Responsible Party):
Keith Nuechterlein, Ph.D., University of California, Los Angeles

Brief Summary:
This study will determine the effectiveness of various combinations of psychosocial therapy and risperidone treatment in improving work or school performance in people with first-episode schizophrenia.

Condition or disease Intervention/treatment Phase
Schizophrenia Behavioral: Cognitive remediation training (CT) Behavioral: Healthy behavior training (HBT) Drug: Risperidone, administered orally (Oral Ris) Drug: Risperidone, administered via injection (RLAI) Phase 4

Detailed Description:

Schizophrenia is a chronic, severe, and disabling brain disorder. People with schizophrenia often experience hallucinations, delusions, thought disorders, and movement disorders. These symptoms make it difficult to maintain a job, participate in school, and keep up self-care. Proper treatment of first-episode schizophrenia may increase the chances of controlling disease progression on a long-term basis. Antipsychotic medications, such as risperidone, and psychosocial treatments, such as cognitive enhancement training and health behavior training, are common, effective treatments for schizophrenia. This study will determine the effectiveness of various combinations of psychosocial therapy and risperidone treatment in improving work or school performance in people with first-episode schizophrenia.

Participants in this open label study will be randomly assigned to receive one of the following four combinations of an antipsychotic medication and a psychosocial treatment: cognitive enhancement training plus oral risperidone; cognitive enhancement training plus long-acting injectable risperidone; health behavior training plus oral risperidone; or health behavior training plus long-acting injectable risperidone. Cognitive enhancement training will entail 2 hours per week of computer-assisted training targeted at improving attention, memory, and problem-solving skills. Additionally, participants will attend a weekly 1-hour group meeting to learn how to apply these skills to work and school situations. Health behavior training will involve 3 hours per week of relaxation training, nutrition education, and physical exercise to enhance wellness. Participants assigned to receive oral risperidone will receive their medication in pill form at the dosage determined to be optimal by the study psychiatrist. Participants assigned to receive injectable risperidone will be given one injection every 2 weeks. Dosages will start at 25 mg per injection and will be adjusted as needed.

Treatment will continue for 1 year following dosage stabilization, which typically occurs 2 to 3 months following study entry. For the first 6 months, participants assigned to receive health behavior training will attend study visits once a week and participants assigned to receive cognitive enhancement training will attend study visits once a week. For the final 6 months, all participants will attend study visits twice weekly. At each visit, participants will receive their assigned psychosocial treatment; attend group therapy; meet with a case manager for counseling and assessment of symptoms, work functioning, and social functioning; and meet with a psychiatrist to monitor medication response. Additional cognitive and health behavior measures will be taken every 6 months to assess treatment effectiveness.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 92 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Developmental Processes in Schizophrenic Disorders: Cognitive Remediation, Medication Adherence, and Work Outcome in Recent-Onset Schizophrenia
Study Start Date : March 2006
Actual Primary Completion Date : January 2013
Actual Study Completion Date : January 2013

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Schizophrenia
Drug Information available for: Risperidone

Arm Intervention/treatment
Experimental: Cog Remediation, risperidone injection
Participants will receive cognitive remediation training plus risperidone, administered via injection.
Behavioral: Cognitive remediation training (CT)
Cognitive remediation training includes computerized cognitive training plus learning skills group.

Drug: Risperidone, administered via injection (RLAI)
Risperidone in injectable form every 2 weeks, starting with 25 mg and adjusted as needed
Other Name: Risperdal Consta

Active Comparator: Healthy Behavior Training, risperidone injection
Participants will receive health behavior training plus risperidone, administered via injection.
Behavioral: Healthy behavior training (HBT)
Healthy behavior training includes group skills training in nutrition, exercise, and relaxation.

Drug: Risperidone, administered via injection (RLAI)
Risperidone in injectable form every 2 weeks, starting with 25 mg and adjusted as needed
Other Name: Risperdal Consta

Experimental: Cog Remediation, oral risperidone
Participants will receive cognitive remediation training plus risperidone administered orally.
Behavioral: Cognitive remediation training (CT)
Cognitive remediation training includes computerized cognitive training plus learning skills group.

Drug: Risperidone, administered orally (Oral Ris)
Oral risperidone at dosage judged optimal by treating psychiatrist
Other Name: Risperdal

Active Comparator: Healthy Behavior Training, oral risperidone
Participants will receive health behavior training plus risperidone administered orally.
Behavioral: Healthy behavior training (HBT)
Healthy behavior training includes group skills training in nutrition, exercise, and relaxation.

Drug: Risperidone, administered orally (Oral Ris)
Oral risperidone at dosage judged optimal by treating psychiatrist
Other Name: Risperdal




Primary Outcome Measures :
  1. Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) [ Time Frame: Measured at baseline and 12 months ]
    Values presented here are the changes in MCCB Overall Composite T scores from baseline to 12 months, with higher values representing better outcome. Raw test scores are used to generate T-scores and then the seven MCCB domains are combined to generate an Overall Composite T score. MCCB Overall Composite T scores have a mean in the general population of 50 with a standard deviation of 10. Thus, a positive change of 5 T scores is an improvement of half a standard deviation.

  2. Work/School Functioning (Global Functioning Scale: Role) [ Time Frame: Baseline to 6 months ]
    Change in role functioning from baseline to the 6 month point (rated on a scale from 1= Extreme Role Dysfunction to 10 = Superior Role Functioning) is presented here.

  3. Average Medication Non-adherence [ Time Frame: Averaged over study participation (up to 12 months) ]
    5-point scale (1 = best adherence, 5= nonadherent) based on pill counts, Medication Event Monitoring System (MEMS) cap readings, plasma assays, and psychiatrist judgements for oral risperidone and timing of injections for long-acting injectable risperidone. Averaged over medication study participation.

  4. Work/School Functioning (Global Functioning Scale: Role) [ Time Frame: Baseline to 12 months ]
    Changes in role functioning from baseline to 12 months. Ratings on a 10-point scale with 10 being best.


Secondary Outcome Measures :
  1. Work Behavior Inventory (WBI) Quality of Work/School Performance [ Time Frame: Baseline to 1 year ]
    Change in rating on quality of work/school performance based on patient, employer, and/or teacher reports. The Quality of Work rating at baseline was subtracted from the same rating at 12 mos. Higher scores are better outcome.

  2. Maintenance of Work/School Attendance [ Time Frame: 12 months ]
    Modified Work Section of the Social Adjustment Scale (SAS) was used to calculate the total number of weeks in school or competitive work. Range of possible values is 0 to 52, with higher numbers being better outcome.

  3. Exacerbation or Relapse of Psychotic Symptoms [ Time Frame: Occurence after randomization and until end of study participation (up to 12 mos.) ]
    Dichotomous measure: Presence of any of 3 psychotic relapse or exacerbation categories scored from the Brief Psychiatric Rating Scale (BPRS) occurring after randomization and until end of study participation (up to 12 months post baseline). BPRS was administered every two weeks throughout study participation.

  4. Retention in Treatment [ Time Frame: 12 months ]
    Days after randomization that a participant continued to receive at least the assigned CT or HBT psychosocial treatment. If a participant needed to end the assigned medication condition (RLAI vs. Oral Ris), they continued in the psychosocial treatment so this outcome focused on the days in the assigned psychosocial treatment. Possible range is 1 to 365, with higher being a better outcome.

  5. Awareness of Illness, as Assessed by the Scale to Assess Unawareness of Mental Disorder, Revised Version (SUMD-R) [ Time Frame: 12 months after randomization ]
    Rating scale based on clinician's interview of patient to determine level of lack of awareness of having a mental disorder. Range is from 1 (Aware) to 5 (Unaware), so lower scores indicate better outcome.

  6. Change in Motivation for Work/School [ Time Frame: Baseline to 12 months ]
    The Work Motivation scale is a factor score from the Work Personality Profile. The Work Personality Profile is a set of ratings based on interviewing the participant. Scores at each occasion can range from 8 to 32, with higher indicating better motivation. Scores reported here are changes from baseline to 12 months, which could range from -24 to 24 with higher being better.

  7. Change in Coping Strategies [ Time Frame: Baseline to 12 months ]
    Coping Response Inventory, which rates extent to which active coping strategies were used after a significant stressful life event. Range of possible scores is 1 to 4. Higher scores are better.



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years to 45 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Diagnosis of schizophrenia, schizoaffective disorder (depressed type), or schizophreniform disorder
  • First major episode of psychotic symptoms occurred within 2 years prior to study entry

Exclusion Criteria:

  • Neurological disorder or injury (e.g., encephalitis, epilepsy, traumatic brain injury)
  • Mental retardation (e.g., premorbid intelligence quotient (IQ) less than 70)
  • Significant alcohol or substance use during last 6 months
  • Unable to complete research measures in English
  • Any condition that may make risperidone use medically inadvisable

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00333177


Locations
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United States, California
Semel Institute for Neuroscience and Human Behavior at UCLA
Los Angeles, California, United States, 90095
Sponsors and Collaborators
University of California, Los Angeles
National Institute of Mental Health (NIMH)
Janssen Scientific Affairs, LLC
Investigators
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Principal Investigator: Keith H. Nuechterlein, PhD University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Keith Nuechterlein, Ph.D., Prinicipal Investigator, University of California, Los Angeles
ClinicalTrials.gov Identifier: NCT00333177    
Other Study ID Numbers: R01MH037705-06 ( U.S. NIH Grant/Contract )
R01MH037705 ( U.S. NIH Grant/Contract )
DAHBR AD-P ( Registry Identifier: WHO ICTRP )
First Posted: June 2, 2006    Key Record Dates
Results First Posted: March 26, 2020
Last Update Posted: March 26, 2020
Last Verified: March 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by Keith Nuechterlein, Ph.D., University of California, Los Angeles:
Schizoaffective Disorder, Depressed Type
Schizophreniform Disorder
First-Episode Schizophrenia
Supported Employment
Cognitive Remediation
Health Behavior Training
Antipsychotic Medication
Additional relevant MeSH terms:
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Schizophrenia
Schizophrenia Spectrum and Other Psychotic Disorders
Mental Disorders
Risperidone
Serotonin Antagonists
Serotonin Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs
Antipsychotic Agents
Tranquilizing Agents
Central Nervous System Depressants
Psychotropic Drugs
Dopamine Antagonists
Dopamine Agents