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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2019.00589

The Feasibility and Efficacy of Social Cognition and Interaction Training for Outpatients with Schizophrenia in Japan: A Multicentre Randomised Clinical Trial

 Ayako Kanie1,  Akiko Kikuchi1, 2, Daisuke Haga3, Yuki Tanaka4, Akina Ishida4, Yuko Yorozuya4, Yasuhiro Matsuda5,  Tsubasa Morimoto5, Tomoharu Fukuoka6, Satoru Takazawa6, Kumiko Hagiya1, 7, Sachiyo Ozawa1, 7, Kazuhiko Iwata8, Emi Ikebuchi9,  Takahiro Nemoto4,  Kazuyuki Nakagome1, 7* and David Roberts10
  • 1Department of Cognitive Behavior Therapy, National Center of Neurology and Psychiatry (Japan), Japan
  • 2Department of Community Mental Health & Law, National Center of Neurology and Psychiatry (Japan), Japan
  • 3One more Toyonaka, Japan
  • 4Department of Neuropsychiatry, Faculty of Medicine, Toho University, Japan
  • 5Department of Psychiatry, Nara Medical University, Japan
  • 6Department of Psychiatry, Inuyama Hospital, Japan
  • 7National Institute of Mental Health, National Center of Neurology and Psychiatry (Japan), Japan
  • 8Osaka Psychiatric Medical Center, Japan
  • 9Department of Psychiatry, School of Medicine, Teikyo University, Japan
  • 10Department of Psychiatry, The University of Texas Health Science Center at San Antonio, United States

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, randomised, 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 hour-long weekly sessions. Groups include two to three clinicians and four to eight patients.
Hypotheses: We hypothesised that SCIT would be found to be feasible and that patients who were randomised 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 modelling 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.

Keywords: Social Cognition and Interaction Training, social cognition, Schizophrenia, Theory of Mind, Randomised clinical trial

Received: 28 Nov 2018; Accepted: 25 Jul 2019.

Copyright: © 2019 Kanie, Kikuchi, Haga, Tanaka, Ishida, Yorozuya, Matsuda, Morimoto, Fukuoka, Takazawa, Hagiya, Ozawa, Iwata, Ikebuchi, Nemoto, Nakagome and Roberts. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Kazuyuki Nakagome, National Center of Neurology and Psychiatry (Japan), National Institute of Mental Health, Kodaira, Tōkyō, Japan, nakagome@ncnp.go.jp