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Subproject III (Prof. Weisbrod)

Complex Problem Solving Training in Schizophrenic Patients

There exists an apparent gap between our knowledge about the predictive value of basic cognitive functions for functional outcome in schizophrenia and our understanding how basic cognitive dysfunction translates into daily life failure. Accordingly, there is a wealth of cognitive training programs available for schizophrenia, but there have been few systematic evaluations investigating how cognitive training improves real-world functioning and which aspects of training are of specific importance. In the framework of the BMBF-supported collaboration we address the role of complex problem solving and planning as intermediate cognitive constructs between basic cognition and real-world functioning, which is also a promising target for training interventions.

In this observer-blind randomized controlled trial we will compare a complex problem solving training package (Plan-A-Day) with standard basic cognitive training (CogPack) in schizophrenic patients. Main objectives are (1) to assess the impact of a problem solving training on functional capacity, (2) to investigate the neural effects of complex problem solving training via EEG, (3) to determine which basic cognition factors determine training success. Primary efficacy endpoint is Functional Capacity assessed by the Osnabrücker-Arbeitsfähigkeitsprofil. Key secondary endpoints are complex problem solving performance on Plan-a-Day, basic cognition performance and EEG coherence in a planning task.

The training intervention will include 10 sessions of 45 minutes over two weeks. Main inclusion criteria are diagnosis of schizophrenic or schizoaffective Disorder (DSM IV), remitted positive symptoms (PANSS positive all <4), clinical stability, age 18-45 years, native German speaker, verbal IQ > 80. Main exclusion criteria are concurrent Axis-I disorder, drug abuse during last 6 months and neurological or medical conditions potentially affecting cognition. The study is non-invasive, non-pharmacological and contains no known risks for participants. The intensity of training is similar to interventions usually offered in clinical settings, so that it is unlikely to lead to re-exacerbation of symptoms. Sample size will be n of 100 patients allocated to the trial, requiring screening of an estimated n of 300. The study will be conducted at the Department of Psychiatry, SRH Klinikum Karlsbad-Langensteinbach, where about 200 patients with schizophrenia or schizo-affective disorder are admitted per year. Overall trial duration is two years.