Schizophrenia affects approximately 1.1% of U.S adults per year and is among the most
disabling psychiatric illnesses, due primarily to poor functioning related to cognitive
dysfunction. Negative (e.g. flattened affect, limited speech output, lack of motivation)
and cognitive symptoms (e.g. poor executive functioning, attention and working memory)
are by far the leading cause of social, occupational and educational disability and
functional impairment in patients with schizophrenia. Since the advent of antipsychotic
medications, Schizophrenia treatment has improved significantly with respect to positive
symptom control. However, there are limited resources for improving cognitive symptoms in
Schizophrenia, which remain disabling for most with the diagnosis. Cognitive remediation
and cognitive training programs have shown promise in improving these symptoms.
Specifically, adults with Schizophrenia show significant improvements in cognition after
participating in 2 weeks of computer based cognitive training. Functional capacity has
also been shown to improve with longer periods of computer-based cognitive training.
However, the effects of cognitive training alone may be most effective in the short-term.
Longer term effectiveness of cognitive training has yet to be shown.
There has been emergent interest in using neuromodulation for treatment of cognitive
decline in people with various illnesses including children with ADHD, adults with
schizophrenia and older adults with late life depression. Specifically, high frequency
(20Hz) rTMS applied to the dorsolateral prefrontal cortex (DLPFC) bilaterally has been
shown to improve working memory in patients with schizophrenia. By improving
neuroplasticity and working memory, rTMS could significantly improve effects of cognitive
training in patients with schizophrenia. Combination cognitive training and rTMS
treatment has been used in patients with depression with promising results. Previously,
the implementation of cognitive training programs in clinical settings was challenged by
the intensity of required patient engagement. However, our group and others have applied
computerized training programming that is accessible remotely, improving accessibility
and engagement. Thus, computerized training offers a feasible and scalable combination
with neuromodulation treatment. Here, we propose to test rTMS, in combination with a
computerized cognitive training program, to remediate cognitive dysfunction in
Schizophrenia and Schizoaffective Disorder in a pilot randomized clinical trial.
Aim: Conduct a randomized pilot and feasibility study of active versus sham rTMS combined
with computerized cognitive training program in adults with Schizophrenia or
Schizophreniform Disorders, comparing neurocognitive and functional outcomes between
groups.
1a) the investigators hypothesize favorable differences between groups in acute
improvement on neuropsychological executive functioning, as measured by the Screen for
Cognitive Impairment in Psychiatry (SCIP).
1b) The investigators hypothesize favorable differences between groups in daily
functioning as measured by the Canadian Objective Assessment of Life Skills (COALS) and
the WHO Disability Assessment Schedule (WHODAS) in participants receiving CrTMS compared
to controls.