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      The Feasibility and Efficacy of Social Cognition and Interaction Training for Outpatients With Schizophrenia in Japan: A Multicenter Randomized Clinical Trial

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          Abstract

          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, randomized, 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-h-long weekly sessions. Groups include two to three clinicians and four to eight patients.

          Hypotheses: We hypothesized that SCIT would be found to be feasible and that patients who were randomized 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 modeling 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.

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          Most cited references35

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          What does the PANSS mean?

          Despite the frequent use of the Positive and Negative Syndrome Scale (PANSS) for rating the symptoms of schizophrenia, the clinical meaning of its total score and of the cut-offs that are used to define treatment response (e.g. at least 20% or 50% reduction of the baseline score) are as yet unclear. We therefore compared the PANSS with simultaneous ratings of Clinical Global Impressions (CGI). PANSS and CGI ratings at baseline (n = 4091), and after one, two, four and six weeks of treatment taken from a pooled database of seven pivotal, multi-center antipsychotic drug trials on olanzapine or amisulpride in patients with exacerbations of schizophrenia were compared using equipercentile linking. Being considered "mildly ill" according to the CGI approximately corresponded to a PANSS total score of 58, "moderately ill" to a PANSS of 75, "markedly ill" to a PANSS of 95 and severely ill to a PANSS of 116. To be "minimally improved" according to the CGI score was associated with a mean percentage PANSS reduction of 19%, 23%, 26% and 28% at weeks 1, 2, 4 and 6, respectively. The corresponding figures for a CGI rating "much improved" were 40%, 45%, 51% and 53%. The results provide a better framework for understanding the clinical meaning of the PANSS total score in drug trials of schizophrenia patients with acute exacerbations. Such studies may ideally use at least a 50% reduction from baseline cut-off to define response rather than lower thresholds. In treatment resistant populations, however, even a small improvement can be important, so that a 25% cut-off might be appropriate.
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            Estimation of premorbid IQ in individuals with Alzheimer's disease using Japanese ideographic script (Kanji) compound words: Japanese version of National Adult Reading Test.

            The National Adult Reading Test (NART) is widely used as a measure of premorbid IQ of the English-speaking patients with dementia. The purpose of the present study was to develop a Japanese version of the NART (JART), using 50 Japanese irregular words, all of which are Kanji (ideographic script) compound words. Reading performance based on JART and IQ as measured by the Wechsler Adult Intelligence Scale-Revised (WAIS-R) was examined in a sample of 100 normal elderly (NE) persons and in 70 age-, sex-, and education-matched patients with Alzheimer's disease (AD). The NE group was randomly divided into the NE calculation group (n=50) and the NE validation group (n=50). Using the NE calculation group, a linear regression equation was obtained in which the observed full-scale IQ (FSIQ) was regressed on the reading errors of the JART. When the regressed equation computed from the NE calculation group was applied to the NE validation group, the predicted FSIQ adequately fit the observed FSIQ (R2=0.78). Further, independent t-tests showed that the JART-predicted IQs were not significantly different between the NE and AD groups, whereas the AD group performed worse in the observed IQs. The reading ability of Kanji compound words is well-preserved in Japanese patients with AD. The JART is a valid scale for evaluating premorbid IQ in patients with AD.
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              Social cognition as a mediator variable between neurocognition and functional outcome in schizophrenia: empirical review and new results by structural equation modeling.

              Cognitive impairments are currently regarded as important determinants of functional domains and are promising treatment goals in schizophrenia. Nevertheless, the exact nature of the interdependent relationship between neurocognition and social cognition as well as the relative contribution of each of these factors to adequate functioning remains unclear. The purpose of this article is to systematically review the findings and methodology of studies that have investigated social cognition as a mediator variable between neurocognitive performance and functional outcome in schizophrenia. Moreover, we carried out a study to evaluate this mediation hypothesis by the means of structural equation modeling in a large sample of 148 schizophrenia patients. The review comprised 15 studies. All but one study provided evidence for the mediating role of social cognition both in cross-sectional and in longitudinal designs. Other variables like motivation and social competence additionally mediated the relationship between social cognition and functional outcome. The mean effect size of the indirect effect was 0.20. However, social cognitive domains were differentially effective mediators. On average, 25% of the variance in functional outcome could be explained in the mediation model. The results of our own statistical analysis are in line with these conclusions: Social cognition mediated a significant indirect relationship between neurocognition and functional outcome. These results suggest that research should focus on differential mediation pathways. Future studies should also consider the interaction with other prognostic factors, additional mediators, and moderators in order to increase the predictive power and to target those factors relevant for optimizing therapy effects.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                23 August 2019
                2019
                : 10
                : 589
                Affiliations
                [1] 1Department of Cognitive Behavior Therapy, National Center of Neurology and Psychiatry , Kodaira, Japan
                [2] 2Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry , Kodaira, Japan
                [3] 3One More Toyonaka , Toyonaka, Japan
                [4] 4Department of Neuropsychiatry, Toho University School of Medicine , Ota-ku, Japan
                [5] 5Department of Psychiatry, Nara Medical University School of Medicine , Kashihara, Japan
                [6] 6Department of Psychiatry, Inuyama Hospital , Inuyama, Japan
                [7] 7National Center of Neurology and Psychiatry Hospital , Kodaira, Japan
                [8] 8Osaka Psychiatric Medical Center , Hirakata, Japan
                [9] 9Department of Psychiatry, Teikyo University School of Medicine , Itabashi-ku, Japan
                [10] 10Department of Psychiatry, University of Texas Health Science Center at San Antonio , San Antonio, TX, United States
                Author notes

                Edited by: Simon Surguladze, King’s College London, United Kingdom

                Reviewed by: Hernando Santamaría-García, Pontifical Javeriana University, Colombia; Petr Bob, Charles University, Czechia

                *Correspondence: Kazuyuki Nakagome, nakagome@ 123456ncnp.go.jp

                This article was submitted to Social Cognition, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2019.00589
                6715766
                31507463
                843810f5-3db7-47a8-a416-b0e5f6d1664e
                Copyright © 2019 Kanie, Kikuchi, Haga, Tanaka, Ishida, Yorozuya, Matsuda, Morimoto, Fukuoka, Takazawa, Hagiya, Ozawa, Iwata, Ikebuchi, Nemoto, Roberts and Nakagome

                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.

                History
                : 28 November 2018
                : 25 July 2019
                Page count
                Figures: 2, Tables: 6, Equations: 1, References: 47, Pages: 11, Words: 6804
                Categories
                Psychiatry
                Original Research

                Clinical Psychology & Psychiatry
                social cognition and interaction training,social cognition,schizophrenia,theory of mind,randomized clinical trial

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