Social cognition intervention program for psychosis in youth (SCIPPY) MRI study, Melbourne Neuropsychiatry Centre

Full description

Individuals suffering from a psychotic disorder show deficits in social cognition (thinking styles related to social interaction), and both social and functional disabilities that are severe, apparent early in the course of illness, and have serious detrimental effects on quality of life and rate of recovery. To date, treatment of psychosis has largely focused on symptomatic improvement, with the assumption that social and occupational functioning will subsequently improve. This is rarely the case. The early phase of psychotic illness, referred to as the critical period, is the most crucial in terms of limiting or even preventing the development of disability, with maximal levels of disability reached in the first 5 years after onset of illness. Furthermore, intervention can be more successful in young people with first episode psychosis (FEP), due to the greater brain plasticity associated with the ongoing neurodevelopment in this phase of life.

In the proposed randomised controlled trial, 96 participants will be recruited from the Early Psychosis Prevention and Intervention Centre of Orygen Youth Health, Melbourne, and randomised to either Social Cognition and Interaction Training (SCIT) or a control group program. Both groups will continue to receive treatment as usual. SCIT is the only intervention to successfully enhance both social cognition and social functioning in patients with schizophrenia, and focuses exclusively on the social-cognitive framework, with theory of mind (the mental capacity to infer one’s own and others’ mental states), emotion recognition (recognition of facial and vocal affect) and attributional style (tendencies in explaining the cause of events, to either the self, others or the environment) as the key social cognitive processes targeted for improvement, processes which ultimately drive social functioning, such as employment status, independent living and interpersonal relationships. This study extends the SCIT approach by applying it early in the course of illness, with the rationale that in this phase there is greater scope to reduce or prevent the onset of disability.

SCIT involves 10 weekly group meetings, where 2 training sessions (each lasting 45min-1 hour) will run every week on the same day (with lunch provided between sessions). The control group program will be matched for both time and duration and will involve fun achievable activities that encourage free socialisation with fellow group members. Social functioning, social cognitive, neurocognitive and psychopathology data will be collected at baseline, post-intervention and at 6 months post-intervention. Structural Magnetic Resonance Imaging data will be collected at baseline and 6 months post-intervention, to determine whether social cognitive deficits are related to structural brain abnormalities in FEP, and to investigate what impact SCIT has on brain morphology prospectively. We predict that participation in the SCIT group will lead to better social and occupational functioning, and this will be realised not only in test scores, but more importantly in increased in-role functioning such as attendance at work or school.

Time Period: 2009-present