Ignite Creation Date:
2024-05-06 @ 8:11 PM
Last Modification Date:
2024-10-26 @ 3:22 PM
Study NCT ID:
NCT06286202
Status:
RECRUITING
Last Update Posted:
2024-05-21
First Post:
2024-02-22
Brief Title:
Integrative Neuro-social Cognitive Strategy Programme for Instilling REcovery INSPIRE a Community-Based Cognitive Remediation Trial
Sponsor:
Singapore Institute of Technology
Organization:
Singapore Institute of Technology
Study Overview
Official Title:
Integrative Neuro-social Cognitive Strategy Programme for Instilling REcovery INSPIRE a Community-Based Cognitive Remediation Trial
Status:
RECRUITING
Status Verified Date:
2024-09
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Adults with serious mental illnesses such as schizophrenia and schizoaffective disorders often experience a range of cognitive difficulties such as memory problem solving difficulties that affect their ability to lead meaningful life roles Cognitive remediation is an intervention to address cognitive difficulties in this group of mental health service users Its implementation in less well-resourced community-based settings is less well-studied
Therefore the aims of the study are
To investigate the effects of cognitive remediation on various cognitive skills such as attention memory problem-solving facial expression recognition taking others perspectives etc for participants with schizophrenia or schizoaffective disorders in community mental health settings
To investigate if factors such as participants motivation for engagement and social interaction can affect changes in cognitive skills and functional ability
Participants in the treatment group will attend computer-based cognitive exercises to improve their cognitive skills They will also participate in group sessions facilitated by therapists to learn how to utilize strategies learned from the computer sessions in their daily lives Participants in the control group will attend the usual rehabilitation activities in their respective community-based psychiatric rehabilitation centers
This research study will compare the differences in their cognitive performance functional ability and recovery immediately after the intervention and 8 weeks later
Therefore the aims of the study are
To investigate the effects of cognitive remediation on various cognitive skills such as attention memory problem-solving facial expression recognition taking others perspectives etc for participants with schizophrenia or schizoaffective disorders in community mental health settings
To investigate if factors such as participants motivation for engagement and social interaction can affect changes in cognitive skills and functional ability
Participants in the treatment group will attend computer-based cognitive exercises to improve their cognitive skills They will also participate in group sessions facilitated by therapists to learn how to utilize strategies learned from the computer sessions in their daily lives Participants in the control group will attend the usual rehabilitation activities in their respective community-based psychiatric rehabilitation centers
This research study will compare the differences in their cognitive performance functional ability and recovery immediately after the intervention and 8 weeks later
Detailed Description:
Persons with severe mental illness such as schizophrenia and schizoaffective disorders often have difficulties integrating back to the community and many face the prospect of long-term institutionalisation when families could not manage them It is assumed that their inability to function is due to their mood and psychotic symptoms such as auditory hallucinations and persecutory delusions and paranoid thoughts However evidence has shown that neurocognitive impairment such as information processing memory problem solving coupled with social cognitive problems such as difficulty with emotion recognition perspective taking etc are the ones with more long-term impact on their functioning Green etal 2000 Tan 2009
Cognitive remediation is a form of intervention that addresses cognitive impairments of persons with psychiatric conditions in order to improve real-world functioning There are several approaches to cognitive remediation One of the well-studied cognitive remediation programmes is the Neuropsychological and Educational Approach to Remediation NEAR which consists of computer-assisted cognitive exercises followed by bridging sessions to generalise strategies learnt to daily living NEAR is conducted in groups of 5-8 clients and is facilitated by 1-2 therapists Medalia Revheim and Herlands 2009 It uses drill-and-practice rehearsal method to improve discrete cognitive skills as well as strategy-learning method to equip clients with strategies to overcome cognitive challenges in different functional scenarios NEAR has been implemented in inpatient wards supported housing settings and outpatient rehabilitation settings in United States and other countries largely with schizophrenia and schizoaffective disorders clients Medalia etal 2000 2003 2019 In Singapore cognitive remediation has been conducted in early psychosis intervention service with positive results Chong etal 2021
Meta-analyses of cognitive remediation has shown that while the rehearsal approach improves cognitive performance the strategy learning approach has a greater effect size on functional outcomes McGurk etal 2007 Wykes etal 2011 Deepening strategy learning in cognitive remediation is thus an important ingredient within cognitive remediation In occupational therapy practice the Multicontext Treatment Approach has been established as a credible and evidence-based framework on strategy learning Toglia etal 2011 2020 It utilises an over-arching metacognitive strategy approach that focuses on promoting self-awareness self-monitoring skills strategy generation and effective strategy use across a wide range of functional activities The therapist works closely with the service user to determine single or multiple strategies that can be applied across a broad range of occupations activities and tasks Toglia 2018 Thus incorporating the Multicontext Treatment Approach as a strategy learning framework within NEAR will enhance skills acquisition for persons with cognitive impairment and may yield better functional outcomes
In addition literature over the past decade has highlighted the overlapping constructs between neurocognition social cognition and negative symptoms in the pathway between symptomatology and functional outcomes Hajdúk etal 2021 Ventura etal 2009 Therefore integrated neuro and social cognitive remediation have been developed with some positive findings DeMare etal 2019 Tan etal 2018 Such interventions when contextualised to service users occupational context have been shown to improve social functioning and community independence Mueller etal 2015 Furthermore negative symptoms such as low motivation ie avolition appears to play a significant mediating role in the outcomes of cognitive remediation Lynch etal 2022 Therefore strategies to enhance motivation specifically the self-awareness and monitoring of motivation ie metamotivation have also been considered as part of strategy learning
In light of recent advancement in the research of cognitive remediation this study attempts to integrate current knowledge in the various therapeutic ingredients of cognitive remediation to deliver an adapted NEAR intervention that meets the needs of community-dwelling persons with schizophrenia and schizoaffective disorders The adapted NEAR intervention which comprises of computer-based cognitive exercises and bridging groups will be implemented in three community psychiatric rehabilitation centers namely 1 Anglican Care Center-Hougang 2 Anglican Care Center-Simei and 3 Anglican Care Center-Bukit Batok
1 To investigate the effects of cognitive remediation on
neurocognition measured by Brief Assessment of Cognition
social cognition measured by Bell Lysaker Emotion Recognition Task
functional outcomes Social and Occupational Functioning Assessment Scale and Canadian Occupational Performance Measure
2 To investigate the mediators for change eg motivation and negative symptoms in cognitive performance and functional outcomes
Cognitive remediation is a form of intervention that addresses cognitive impairments of persons with psychiatric conditions in order to improve real-world functioning There are several approaches to cognitive remediation One of the well-studied cognitive remediation programmes is the Neuropsychological and Educational Approach to Remediation NEAR which consists of computer-assisted cognitive exercises followed by bridging sessions to generalise strategies learnt to daily living NEAR is conducted in groups of 5-8 clients and is facilitated by 1-2 therapists Medalia Revheim and Herlands 2009 It uses drill-and-practice rehearsal method to improve discrete cognitive skills as well as strategy-learning method to equip clients with strategies to overcome cognitive challenges in different functional scenarios NEAR has been implemented in inpatient wards supported housing settings and outpatient rehabilitation settings in United States and other countries largely with schizophrenia and schizoaffective disorders clients Medalia etal 2000 2003 2019 In Singapore cognitive remediation has been conducted in early psychosis intervention service with positive results Chong etal 2021
Meta-analyses of cognitive remediation has shown that while the rehearsal approach improves cognitive performance the strategy learning approach has a greater effect size on functional outcomes McGurk etal 2007 Wykes etal 2011 Deepening strategy learning in cognitive remediation is thus an important ingredient within cognitive remediation In occupational therapy practice the Multicontext Treatment Approach has been established as a credible and evidence-based framework on strategy learning Toglia etal 2011 2020 It utilises an over-arching metacognitive strategy approach that focuses on promoting self-awareness self-monitoring skills strategy generation and effective strategy use across a wide range of functional activities The therapist works closely with the service user to determine single or multiple strategies that can be applied across a broad range of occupations activities and tasks Toglia 2018 Thus incorporating the Multicontext Treatment Approach as a strategy learning framework within NEAR will enhance skills acquisition for persons with cognitive impairment and may yield better functional outcomes
In addition literature over the past decade has highlighted the overlapping constructs between neurocognition social cognition and negative symptoms in the pathway between symptomatology and functional outcomes Hajdúk etal 2021 Ventura etal 2009 Therefore integrated neuro and social cognitive remediation have been developed with some positive findings DeMare etal 2019 Tan etal 2018 Such interventions when contextualised to service users occupational context have been shown to improve social functioning and community independence Mueller etal 2015 Furthermore negative symptoms such as low motivation ie avolition appears to play a significant mediating role in the outcomes of cognitive remediation Lynch etal 2022 Therefore strategies to enhance motivation specifically the self-awareness and monitoring of motivation ie metamotivation have also been considered as part of strategy learning
In light of recent advancement in the research of cognitive remediation this study attempts to integrate current knowledge in the various therapeutic ingredients of cognitive remediation to deliver an adapted NEAR intervention that meets the needs of community-dwelling persons with schizophrenia and schizoaffective disorders The adapted NEAR intervention which comprises of computer-based cognitive exercises and bridging groups will be implemented in three community psychiatric rehabilitation centers namely 1 Anglican Care Center-Hougang 2 Anglican Care Center-Simei and 3 Anglican Care Center-Bukit Batok
1 To investigate the effects of cognitive remediation on
neurocognition measured by Brief Assessment of Cognition
social cognition measured by Bell Lysaker Emotion Recognition Task
functional outcomes Social and Occupational Functioning Assessment Scale and Canadian Occupational Performance Measure
2 To investigate the mediators for change eg motivation and negative symptoms in cognitive performance and functional outcomes
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None