Contextualisation, cultural adaptation and pilot randomised controlled trial of compensatory cognitive training to improve cognition and functioning in young adults with first-episode psychosis in Nigeria
First-episode psychosis; Cognitive impairment in psychotic disorders; Schizophrenia spectrum and other psychotic disorders
Participants are randomly allocated in a 1:1 ratio to either a Compensatory Cognitive Training (CCT) intervention arm or an enhanced Recreational Therapy control arm using computer-generated block randomisation with allocation concealment by an independent statistician. Outcome assessors are blinded to group allocation. Intervention Arm: Culturally Adapted Compensatory Cognitive Training (CCT) Participants receive a culturally adapted, manualised Compensatory Cognitive Training programme delivered in small groups of 4–8 participants. The intervention is delivered once weekly for 12 consecutive weeks, with each session lasting approximately 60-90 minutes . CCT is delivered by trained psychiatric social workers under regular specialist supervision. The programme targets prospective memory, attention, learning and memory, and executive functioning using compensatory strategies, real-world skills training, and structured homework tasks. Participants receive mobile phone reminders and low-technology memory aids to support between-session practice. Fidelity is monitored using standardised checklists. Control Arm: Enhanced Recreational Therapy Participants receive structured group-based recreational therapy delivered once weekly for 12 consecutive weeks, matched to the intervention arm for session duration, frequency, facilitator contact time, group size, and incentives. Recreational therapy includes creative activities, physical exercise, leisure education, and group discussion but does not include any formal cognitive strategy training. Follow-up and Assessments All participants continue to receive routine clinical care at their treatment centres. Outcome assessments are conducted at baseline, 3 months, 6 months, and 12 months post-randomisation.
1. DSM‑5 diagnosis of a primary psychotic disorder (schizophrenia, schizophreniform, schizoaffective, delusional, brief psychotic, substance‑induced, or affective psychosis with psychotic features) with onset within the previous 5 years, confirmed using MINI 7.0 2. Age 18–30 years inclusive 3. Objective cognitive impairment documented on the Brief Assessment of Cognition in Schizophrenia (BACS), defined as composite score ≥0.5 SD below age/education‑adjusted norms 4. Fluent in English or Nigerian Pidgin sufficient to participate in group sessions and complete assessments 5. Mental capacity to provide informed consent and follow study procedures 6. Clinically stable (no psychiatric admission in previous 4 weeks; no major antipsychotic dose change in previous 2 weeks) 7. Receiving care at one of the participating hospitals
1. Dementia, intellectual disability or primary organic brain disorder 2. Traumatic brain injury with persistent cognitive sequelae or other neurological disease affecting cognition 3. Current substance dependence (excluding nicotine) 4. Severe comorbid medical illness preventing group attendance 5. High imminent suicide/homicide risk or acute agitation requiring intensive intervention 6. Very severe acute psychotic symptoms unsuitable for group participation 7. Residence outside facility catchment areas without reliable transport 8. Current participation in another cognitive intervention trial 9. Previous participation in formal cognitive remediation within past 12 months