Title: 43. Cognitive Functioning in First-Episode Psychosis:_x000B_ Comparison of a 2-Year Coordinated Specialty Care Program to Community Care
Abstract: Background: Significant cognitive impairment is already seen in first-episode psychosis (FEP) and degree of impairment is a moderator of long-term outcomes. Does specialized FEP treatment improve cognitive functioning? The NIMH sponsored RAISE-ETP study allows comparison of NAVIGATE, a coordinated specialty care intervention designed for FEP, to Community Care (CC) in a randomized clinical trial. (RCT) Methods: The RCT was conducted at 34 sites in the United States. Seventeen sites were randomly assigned to provide NAVIGATE and 17 to provide CC. Four hundred four consenting participants age 15 to 45 years old, experiencing an FEP and had not received more than 6 months of antipsychotic medication entered the study. Treatment and assessment continued for up to two years. The Brief Assessment of Cognition in Schizophrenia (BACS) was administered at baseline, one and two years. Age and sex adjusted T-scores for the BACS Composite and six sub-tests (Verbal Memory, Digit Sequencing, Verbal Fluency, Token Motor, Symbol Coding and Tower of London) were calculated. Generalized estimating equations (GEEs) were applied to compare change in treatments between baseline, months 12 and 24 adjusting for within and between site variation. Results: The NAVIGATE and CC groups included 221 and 181 participants. The Group X Visit interactions was a statistically significant predictor of change in: Verbal Memory, Verbal Fluency, Symbol Coding, Tower of London and the Composite (P < .001 for all). For the NAVIGATE group, there was significant improvement at Month 12 and Month 24 for Verbal Memory, Digit Sequencing, Tower of London, and the Composite. For the CC group, there was a significant improvement at Month 12 and Month 24 for the Composite; and only at month 24 for the Tower of London. Conclusion: The results of this analysis suggest that NAVIGATE resulted in greater improvement in cognitive functioning in both an overall score and for specific components than did CC. NAVIGATE is a multi-component intervention, guided by manuals and supervision by a central team. NAVIGATE includes psychopharmacological treatment with antipsychotics and other psychotropic medications using an internet based decision support system, an individual psychotherapy called Individual Resiliency Training, family psychoeducation and supported employment and education. The role of individual components cannot be readily determined and further analyses will evaluate the effect of moderator variables such as duration of untreated psychosis, symptomatology and functioning at study entry. To date, pharmacologic treatments to improve cognition have not demonstrated efficacy. Cognitive remediation strategies, notably Cognitive Enhancement Therapy pioneered by Gerard Hogarty, has shown efficacy in FEP patients but to the best of our knowledge, this is the first RCT to show an effect of a broad FEP focused intervention on cognitive functioning.