Abstract

Therapeutic intervention early in the course of schizophrenia may positively influence the outcome of this illness. The Environmental and Personal Indicators of Course in Schizophrenia (EPICS) treatment program at WPIC has developed a disorder-relevant rehabilitation of cognitive deficits (CET) found to be highly effective in chronic schizophrenic outpatients. Improvements in these cognitive deficits may reflect improved structural and functional integrity of the PFC and related structures. The Center for the Neuroscience of Mental Disorders (CNMD) at WPIC prospectively investigates PFC function in first-episode schizophrenia using structural and functional MRI and MRS. In this study, CNMD and EPICS investigators collaboratively seek to determine the efficacy of CET in ameliorating specific cognitive, structural and functional brain abnormalities in early course schizophrenia. We predict that CET will be more effective than enriched supportive psychotherapy (EST) in differentially improving behavioral and neurobiological dysfunctions in schizophrenia that compromise """"""""executive"""""""" cognitive functions, specifically the structural and functional integrity of the PFC. We also predict that a relatively preserved PFC integrity will be associated with a better response to CET. A series of early course schizophrenic patients, stabilized on an atypical antipsychotic will be randomized to CET or EST. Cognitive and functional outcomes will be assessed before, and following 1 and 2 years of psychosocial treatment and maintenance antipsychotic treatment. In a subset of these patients, an integrated neuroimaging study will be conducted before and one year after the CET or EST. If successful, the study will provide the first evidence of neurobiological remediation, and possible mechanisms and site(s) of action, for cognitive rehabilitation in early schizophrenia. An understanding of the cerebral correlates of improvement (or lack thereof) in cognition and behavior might guide development of future cognitive rehabilitation strategies for schizophrenia.

  Funding Agency

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH060902-03
Application #
6615756
Study Section
Special Emphasis Panel (ZRG1-BBBP-6 (04))
Program Officer
Heinssen, Robert K
Project Start
2001-08-15
Project End
2006-07-31
Budget Start
2003-08-01
Budget End
2004-07-31
Support Year
3
Fiscal Year
2003
Total Cost
$603,081
Indirect Cost

  Institution

Name
University of Pittsburgh
Department
Psychiatry
Type
Schools of Medicine
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213

  Publications

Eack, Shaun M; Newhill, Christina E; Keshavan, Matcheri S (2016) Cognitive Enhancement Therapy Improves Resting-State Functional Connectivity in Early Course Schizophrenia. J Soc Social Work Res 7:211-230
Keshavan, Matcheri S; Mehta, Urvakhsh Meherwan; Padmanabhan, Jaya L et al. (2015) Dysplasticity, metaplasticity, and schizophrenia: Implications for risk, illness, and novel interventions. Dev Psychopathol 27:615-35
Keshavan, Matcheri S; Vinogradov, Sophia; Rumsey, Judith et al. (2014) Cognitive training in mental disorders: update and future directions. Am J Psychiatry 171:510-22
Eack, Shaun M; Mesholam-Gately, Raquelle I; Greenwald, Deborah P et al. (2013) Negative symptom improvement during cognitive rehabilitation: results from a 2-year trial of Cognitive Enhancement Therapy. Psychiatry Res 209:21-6
Wojtalik, Jessica A; Eack, Shaun M; Keshavan, Matcheri S (2013) Structural neurobiological correlates of Mayer-Salovery-Caruso Emotional Intelligence Test performance in early course schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 40:207-12
Wojtalik, Jessica A; Eack, Shaun M; Pollock, Bruce G et al. (2012) Prefrontal gray matter morphology mediates the association between serum anticholinergicity and cognitive functioning in early course schizophrenia. Psychiatry Res 204:61-7
Eack, Shaun M; Hogarty, Gerard E; Greenwald, Deborah P et al. (2011) Effects of Cognitive Enhancement Therapy on Employment Outcomes in Early Schizophrenia: Results From a Two-Year Randomized Trial. Res Soc Work Pract 21:32-42
Lewandowski, Kathryn E; Eack, Shaun M; Hogarty, Susan S et al. (2011) Is cognitive enhancement therapy equally effective for patients with schizophrenia and schizoaffective disorder? Schizophr Res 125:291-4
Keshavan, Matcheri S; Eack, Shaun M; Wojtalik, Jessica A et al. (2011) A broad cortical reserve accelerates response to cognitive enhancement therapy in early course schizophrenia. Schizophr Res 130:123-9
Eack, S M; Pogue-Geile, M F; Greenwald, D P et al. (2011) Mechanisms of functional improvement in a 2-year trial of cognitive enhancement therapy for early schizophrenia. Psychol Med 41:1253-61

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