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SchizophreniaNCT01312272

Does Acute Oxytocin Administration Enhance Social Cognition in Individuals With Schizophrenia?

A study testing Oxytocin in people with Schizophrenia, run by VA Greater Los Angeles Healthcare System at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Individuals with schizophrenia have been found to have deficits in social cognition, which is defined as the functions that are engaged during social interactions. Social cognition has been found to be critical in predicting multiple aspects of community functioning. Read more about this study

Who is it for?
Ages 18 to 55 years, men only
Conditions the study is for
Schizophrenia
What is being tested?
Oxytocin
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
24 participants
Where
1 siteUnited States
Study dates
Apr 2011to Aug 2012
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 55 years
  • Men only
  • No healthy volunteers
  • Adult

Who may be able to join

  • Veteran being treated in the Veterans Administration Healthcare System
  • Meet DSM-IV-TR criteria for Schizophrenia
  • At least 6 months since any hospitalization or substantial increase in level of care for an acute exacerbation of psychotic symptoms
  • At least 1 month since meeting the criteria for having a major depressive episode
  • At least 6 months since any behaviors suggesting any potential danger to self or others
  • Adherence to the regular administration of an antipsychotic medication (e.g., risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, paliperidone, iloperidone, asenapine, fluphenazine, haloperidol, loxapine, molindone, perphenazine, thiothixene, chlorpromazine, clozapine)
Show all 10Show fewer
  • Dose of antipsychotic medication not varying by more than 25% over the 3 months prior to study participation
  • No acute medical problems
  • Chronic medical conditions (e.g., hypertension, diabetes, dyslipidemia) consistently treated and stable for at least 3 months prior to study participation
  • Ability to provide signed informed consent and to cooperate with study procedures

Who cannot join

  • Documented history of mental retardation or severe learning disability
  • History of treatment with electroconvulsive therapy within 6 months prior to study participation
  • History of neurological or neuropsychiatric condition (e.g., stroke, severe traumatic brain injury, epilepsy, etc.)
  • Documented history of persistent substance abuse or dependence within 6 months prior to study participation
  • History of hyponatremia within the past 6 months
  • Allergic rhinitis or other inflammation of the nasal mucosa

Trial locations and contacts

1 site in 1 country.

United States1 site
  • West Los Angeles VA Healthcare Center

    Los Angeles, California, 90073

Other trials in United States

About this study

Individuals with schizophrenia have been found to have deficits in social cognition, which is defined as the functions that are engaged during social interactions. Social cognition has been found to be critical in predicting multiple aspects of community functioning. There are no currently available medications that have been consistently found to improve social cognition in individuals with schizophrenia. Oxytocin functions as a neurotransmitter that is thought to be involved in multiple aspects of social behavior and related emotions. In this study, we test the hypothesis that acute administration of intranasal oxytocin will improve social cognition in individuals with schizophrenia.

Read the detailed description

Schizophrenia is characterized by the presence of positive symptoms (delusions, hallucinations, disorganization of thought process and behavior) as well as negative symptoms (blunted affect, alogia, and avolition), neurocognitive deficits, and impaired social cognition. While positive symptoms can often respond well to antipsychotic medications, the latter symptoms are more difficult to treat. In this study, we will focus on social cognition, which is defined as the functions that are engaged during social interactions. Social cognition has been categorized into four main domains: theory of mind, social perception, attributional bias, and emotional processing. Social cognition in patients with schizophrenia has been found to be critical in predicting multiple aspects of community functioning. There are currently two broad approaches to improve social cognition in patients with schizophrenia: pharmacological and psychosocial interventions. While psychosocial interventions (training exercises to target improvement in domains of social cognition) have shown some benefit, their resultant improvements have been limited in their distribution across multiple domains as well as their generalization to improved functioning in the community. Pharmacological trials have yielded mixed results, and there are not any currently available medications that have been consistently found to improve social cognition in patients with schizophrenia2. One potential future therapeutic target for enhancing social cognition is the oxytocin system.

Oxytocin is a nine-amino acid peptide that, in addition to its role in the periphery for regulating lactation and uterine contractions, functions centrally as a neurotransmitter which is involved in multiple aspects of social behavior and related emotions. Specifically, it has been found to modulate emotion recognition, trust, eye contact, empathic accuracy, as well as envy and gloating. Given oxytocin's role in social functioning, in conjunction with the deficits in social functioning found frequently in individuals with schizophrenia, there have been several studies over the past three decades examining the oxytocin system in humans with schizophrenia and in rodent experimental models.

It has been found that individuals with schizophrenia do not show the same level of increase in oxytocin as normal controls in response to trust-related interpersonal interactions, and low plasma oxytocin predicted negative symptoms of schizophrenia. Additionally, it has also been found that plasma oxytocin levels predicted the ability of patients with schizophrenia to identify facial expressions. Finally, it has been found recently that sustained regular administration of intranasal oxytocin significantly reduced both positive and negative symptoms of schizophrenia. Thus, there is significant evidence supporting further research studying the effect of oxytocin on social cognition. It is not yet known if exogenous administration of oxytocin will have acute effects on neuropsychological measures of social cognition in individuals with schizophrenia, and this is the focus of this proposed pilot study.

The overall hypothesis guiding this study is that acute oxytocin administration will improve social cognition (as assessed by a composite score comprising two measures of "low level" social cognitive processes and two measures of "high level" social cognitive processes) in individuals with schizophrenia. Our primary goals are to assess the feasibility of this experimental paradigm and to generate pilot data and obtain estimates of effect sizes which can be used in planning future larger studies.

Conditions
Schizophrenia
Being tested
Oxytocin, Inactive placebo nasal spray
Keywords
Schizophrenia, Social Intelligence, Perception, Social, Oxytocin
Medical subject headings
Schizophrenia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • OxytocinDrug

    Oxytocin 40 units/ml nasal spray: use 5 sprays per nostril (40 IU total) one time

  • Inactive placebo nasal sprayDrug

    A placebo nasal spray will be prepared identically to the oxytocin nasal spray except lacking oxytocin. Its ingredients are mannitol, glycerin, and preserved water. It will be administered at 5 sprays to each nostril, one time.

Study groups in NCT01312272
Study groupRoleWhat they receive
Inactive nasal sprayPlacebo comparatorA placebo nasal spray will be prepared to be otherwise identical to the active treatment nasal spray except lacking oxytocin. The ingredients in the inactive nasal spray are mannitol, glycerin, and preserved water.
Receives: Drug: Inactive placebo nasal spray
Intranasal OxytocinExperimentalOxytocin nasal spray (40 units/ml) will be administered in a single intranasal dose of 40 IU. Its formula is: oxytocin 1 unit/mg mannitol trituration 0.2Gm + glycerin USP 0.1ml + preserved water 5ml.
Receives: Drug: Oxytocin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Social Cognition Composite Measure

    Our primary outcome measure will be a composite score created by calculating the mean of the four main social cognition measures assessed in this study (two "high-level" measures and two "low-level" measures). Because these measures are not on the same scale, we will first z-score (center and scale) each of the four measures at each time point using the baseline mean and standard deviation of the whole sample and then calculate the mean of the z-scores to create the composite social cognition score.

    Measured: Visit 2 (baseline), Visit 3 (1 week following, post-treatment)

Secondary outcomes (5)
  1. Theory of Mind Assessment (High Level Social Cognition)

    The Awareness of Social Inference Test (TASIT Part III: Social Inference - Enriched) will be administered to assess theory of mind.

    Measured: Visit 2 (baseline), Visit 3 (1 week following, post-treatment)

  2. Empathy

    Empathy was assessed using the Emotional Perspective Taking Task (EPTT) (Derntl et al., 2009). In this task, subjects are presented with 60 digital images depicting two individuals in a social interaction, with one individual's face masked. Subjects are asked to infer the emotional expression of the masked face, selecting between two choices. Scenes portray 5 basic emotions as well as neutrality and each image is displayed for 4 s each.

    Measured: Visit 2 (baseline), Visit 3 (1 week following, post-treatment)

  3. Social Perception Assessment (Low Level Social Cognition)

    We will assess social perception using the Half-Profile of Nonverbal Sensitivity (Half-PONS). Brief scenes are shown that include facial expressions, voice intonations, and/or body gestures. Subjects select a label that best describes the situation. The dependent measure is the total number of correct labels.

    Measured: Visit 2 (baseline), Visit 3 (1 week following, post-treatment)

  4. Facial Affect Recognition (Low Level Social Cognition)

    Participants are asked to identify facial expressions of emotion in still photographs from the standardized stimulus set developed by Ekman. The test includes digitized color photos of eight different posers displaying facial expressions of six basic emotions plus neutral expressions. On each trial, a photo and a list of the seven possible expressions are simultaneously presented on the screen. The participant verbally identifies the emotion he/she believes is correct and the experimenter enters the response. The dependent measure is the total number correct.

    Measured: Visit 2 (baseline), Visit 3 (1 week following, post-treatment)

  5. Positive and Negative Syndrome Scale (PANSS) for Schizophrenia Total Score

    This is a frequently used instrument, initially developed by Kay, Opler, and Fiszbein, that assesses 30 different symptoms (categorized into positive, negative, and general psychopathology) on a scale from 1 to 7, based on clinical interview. It will be used to compare the psychopathology between the two treatment groups.

    The maximum Total Score on the scale is 210 and the minimum score is 30, with higher values indicating more severe symptoms. The maximum scale of 210 is the sum of the scores from each symptom category (positive symptoms = range 7 to 49; negative symptoms = range 7 to 49; general psychopathology = range to 16 to 112).

    Our outcome measure refers to the change in the PANSS Total Score. A greater decrease on the scale indicates greater improvement in symptoms (e.g., a participant with a change score of -20 improved more on the PANSS than a participant with a change score of -5).

    Measured: Visit 2 (baseline), Visit 3 (1 week following, post-treatment)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted10 Mar 2011 (estimated)
  2. Study startApr 2011
  3. Primary completionAug 2012
  4. Study completionAug 2012

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Investigator, Outcomes assessor
Enrolment
24 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01312272
Sponsor's protocol ID
PCC 2011-020223
Status last verified
Mar 2014
First submitted
9 Mar 2011
Last updated
2 May 2014
Data monitoring committee
No

Publications

  • Bartz JA, Zaki J, Bolger N, Hollander E, Ludwig NN, Kolevzon A, Ochsner KN. Oxytocin selectively improves empathic accuracy. Psychol Sci. 2010 Oct;21(10):1426-8. doi: 10.1177/0956797610383439. Epub 2010 Sep 20. No abstract available.

    PubMed 20855907
  • Domes G, Heinrichs M, Michel A, Berger C, Herpertz SC. Oxytocin improves "mind-reading" in humans. Biol Psychiatry. 2007 Mar 15;61(6):731-3. doi: 10.1016/j.biopsych.2006.07.015. Epub 2006 Nov 29.

    PubMed 17137561
  • Feifel D, Macdonald K, Nguyen A, Cobb P, Warlan H, Galangue B, Minassian A, Becker O, Cooper J, Perry W, Lefebvre M, Gonzales J, Hadley A. Adjunctive intranasal oxytocin reduces symptoms in schizophrenia patients. Biol Psychiatry. 2010 Oct 1;68(7):678-80. doi: 10.1016/j.biopsych.2010.04.039. Epub 2010 Jul 7.

    PubMed 20615494
  • Goldman M, Marlow-O'Connor M, Torres I, Carter CS. Diminished plasma oxytocin in schizophrenic patients with neuroendocrine dysfunction and emotional deficits. Schizophr Res. 2008 Jan;98(1-3):247-55. doi: 10.1016/j.schres.2007.09.019. Epub 2007 Oct 24.

    PubMed 17961988
  • Guastella AJ, Mitchell PB, Dadds MR. Oxytocin increases gaze to the eye region of human faces. Biol Psychiatry. 2008 Jan 1;63(1):3-5. doi: 10.1016/j.biopsych.2007.06.026. Epub 2007 Sep 21.

    PubMed 17888410
  • Keri S, Kiss I, Kelemen O. Sharing secrets: oxytocin and trust in schizophrenia. Soc Neurosci. 2009;4(4):287-93. doi: 10.1080/17470910802319710. Epub 2008 Aug 1.

    PubMed 18671168
  • Kosfeld M, Heinrichs M, Zak PJ, Fischbacher U, Fehr E. Oxytocin increases trust in humans. Nature. 2005 Jun 2;435(7042):673-6. doi: 10.1038/nature03701.

    PubMed 15931222
  • Shamay-Tsoory SG, Fischer M, Dvash J, Harari H, Perach-Bloom N, Levkovitz Y. Intranasal administration of oxytocin increases envy and schadenfreude (gloating). Biol Psychiatry. 2009 Nov 1;66(9):864-70. doi: 10.1016/j.biopsych.2009.06.009. Epub 2009 Jul 29.

    PubMed 19640508
  • Webber MA, Marder SR. Better pharmacotherapy for schizophrenia: what does the future hold? Curr Psychiatry Rep. 2008 Aug;10(4):352-8. doi: 10.1007/s11920-008-0056-8.

    PubMed 18627675
  • Davis MC, Lee J, Horan WP, Clarke AD, McGee MR, Green MF, Marder SR. Effects of single dose intranasal oxytocin on social cognition in schizophrenia. Schizophr Res. 2013 Jul;147(2-3):393-7. doi: 10.1016/j.schres.2013.04.023. Epub 2013 May 12.

    PubMed 23676253

Questions about this trial

What is this clinical trial studying?

A study testing Oxytocin in people with Schizophrenia, run by VA Greater Los Angeles Healthcare System at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 2 May 2014. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 2 May 2014). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Social Cognition Composite Measure (time frame: Visit 2 (baseline), Visit 3 (1 week following, post-treatment)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01312272, which also lists 10 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 May 2014.

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