Abstract
Background: Schizophrenia is a disabling illness. Social cognition and interaction training (SCIT) seeks to improve patients’ social functioning by alleviating deficits in social cognition. SCIT has shown promise in improving social cognition in patients with schizophrenia, but has not yet been studied in Japan. Design: An assessor-masked, randomized, parallel-group clinical trial was conducted to compare the feasibility and efficacy of SCIT with treatment as usual (TAU). Setting: Participants were recruited from outpatient clinics at the National Center of Neurology and Psychiatry and four other hospitals in Japan. Participants: Seventy-two patients diagnosed with schizophrenia or schizoaffective disorder consented to participate in the trial. Procedure: Participants were randomly allocated to either a SCIT subgroup or a TAU subgroup. SCIT is a manual-based group intervention that is delivered in 20–24-h-long weekly sessions. Groups include two to three clinicians and four to eight patients. Hypotheses: We hypothesized that SCIT would be found to be feasible and that patients who were randomized to receive SCIT would exhibit improvements in social cognition. Results: Data from 32 participants in each subgroup were entered into analyses. The persistence rate in the SCIT subgroup was 88.9%, and the average attendance rate was 87.0%. Intrinsic motivation was significantly higher in the SCIT subgroup than the TAU group during the first half of the program. Mixed effects modeling of various outcome measures revealed no significant interaction between measurement timepoint and group in any measures, including social cognition, neurocognition, symptom severity, and social functioning. In the case of the social cognition measure, significant change was observed only in the SCIT subgroup; however, the interaction between timepoint and group failed to reach significance. In an exploratory subgroup analysis, a shorter duration of illness was found to be associated with significantly better improvement on the social cognition measure in the SCIT subgroup compared with the TAU subgroup. Conclusions: In terms of the primary objective, the relatively low dropout rate observed in the present study suggests that SCIT is feasible and well tolerated by patients with schizophrenia in Japan. This view is also supported by participants’ relatively high attendance and intrinsic motivation.
Highlights
Schizophrenia is a chronic, severe, and disabling illness that affects approximately 1% of individuals in the population, with onset usually during late adolescence or early adulthood [1]
Thirty-six patients were allocated to the Social cognition and interaction training (SCIT) subgroup and 36 to the treatment as usual (TAU) subgroup
The data from 32 SCIT subgroup and 32 TAU subgroup participants were submitted to statistical analyses (Figure 1)
Summary
Schizophrenia is a chronic, severe, and disabling illness that affects approximately 1% of individuals in the population, with onset usually during late adolescence or early adulthood [1]. It is characterized by a combination of positive, negative, and affective symptoms, but cognitive deficits, including impairment of neuro- and social cognitions, are the core symptoms that affect patients’ everyday lives. It has been pointed out that the variance in patients’ social and community functional outcomes can be explained by composite measures of neurocognition [2]. Pharmacological interventions have shown some ability to improve neurocognition, but their capacity to improve patients’ social and community functional outcomes is extremely limited [3]. SCIT has shown promise in improving social cognition in patients with schizophrenia, but has not yet been studied in Japan
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