Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-31T17:23:05.941Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive Remediation and Functional Improvement in Schizophrenia: is it a Matter of Size?

Published online by Cambridge University Press:  10 November 2016

M. Bosia ,
M. Buonocore ,
M. Bechi ,
M. Spangaro ,
A. Pigoni ,
M. Croci ,
F. Cocchi ,
C. Guglielmino ,
L. Bianchi  and
E. Smeraldi
...Show all authors
M. Bosia
Affiliation:
Department of clinical neurosciences, IRCCS San Raffaele scientific institute, Milan, Italy Università Vita-Salute San Raffaele, Milan, Italy
M. Buonocore*
Affiliation:
Department of clinical neurosciences, IRCCS San Raffaele scientific institute, Milan, Italy
M. Bechi
Affiliation:
Department of clinical neurosciences, IRCCS San Raffaele scientific institute, Milan, Italy
M. Spangaro
Affiliation:
Department of clinical neurosciences, IRCCS San Raffaele scientific institute, Milan, Italy Università Vita-Salute San Raffaele, Milan, Italy
A. Pigoni
Affiliation:
Department of clinical neurosciences, IRCCS San Raffaele scientific institute, Milan, Italy
M. Croci
Affiliation:
Department of clinical neurosciences, IRCCS San Raffaele scientific institute, Milan, Italy
F. Cocchi
Affiliation:
Department of clinical neurosciences, IRCCS San Raffaele scientific institute, Milan, Italy
C. Guglielmino
Affiliation:
Department of clinical neurosciences, IRCCS San Raffaele scientific institute, Milan, Italy
L. Bianchi
Affiliation:
Department of clinical neurosciences, IRCCS San Raffaele scientific institute, Milan, Italy
E. Smeraldi
Affiliation:
Department of clinical neurosciences, IRCCS San Raffaele scientific institute, Milan, Italy Università Vita-Salute San Raffaele, Milan, Italy
R. Cavallaro
Affiliation:
Department of clinical neurosciences, IRCCS San Raffaele scientific institute, Milan, Italy
*
* Corresponding author. Tel.: +358 50 5928308. E-mail address:[email protected] (J.-P. Klemettilä).
Get access

Abstract

Background

Cognitive Remediation represents the best available tool to treat cognitive deficits in schizophrenia and evidence suggests an effect also on global functioning. However, the relationship between cognitive and functional improvement is not yet fully elucidated: do cognitive changes need to be of a definite size and/or encompass a certain number of domains in order to impact on daily functioning? This study aims to explore the role of cognitive improvement, evaluated both quantitatively and qualitatively through the use of Italian equivalent scores, on the daily functioning of patients. As secondary goal, the influence of demographic, clinical and neuropsychological variables on functional outcome was also systematically investigated.

Methods

One hundred subjects with a diagnosis of schizophrenia underwent 36 sessions of Cognitive Remediation and were evaluated at baseline and after the training with the Brief Assessment of Cognition in Schizophrenia and the Quality of Life Scale.

Results

A total of 70% of patients improved in at least one cognitive domain and over 50% obtained a normalized score. Among the clinical and neurocognitive factors examined, the only significant predictor of quality of life’s improvement was the proportion of cognitive functions that reached an equivalent score of “normal”.

Conclusions

This study suggests that improvements in daily functioning depend on the achievement of a cognitive profile as much as possible “normal”, harmonious and balanced, supporting the idea that a qualitative leap in cognition is needed in order to gain an advantage in real life activities.

Keywords

PsychosisQuality of LifeNeurocognitionRehabilitationDaily FunctioningEquivalent scores
Type
Original article
Information
European Psychiatry , Volume 40 , February 2017 , pp. 26 - 32
Copyright
Copyright © Elsevier Masson SAS 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

1

Authors Marta Bosia and Mariachiara Buonocore equally contributed to this work.

References

Kahn, R.S.Keefe, R.S.E.Schizophrenia is a cognitive illness: time for a change in focus. JAMA Psychiatry 2013; 70(10): 1107–1112CrossRefGoogle ScholarPubMed
Vita, A.Barlati, S.Bellani, M.Brambilla, P.Cognitive remediation in schizophrenia: background, techniques, evidence of efficacy and perspectives. Epidemiol Psychiatr Sci 2014; 23: 21–25CrossRefGoogle Scholar
Harvey, P.D.Keefe, R.S.Studies of cognitive change in patients with schizophrenia following novel antipsychotic treatment. Am J Psychiatry 2001; 158(2): 176–184CrossRefGoogle ScholarPubMed
Keefe, R.S.E.Cognitive deficits in patients with schizophrenia: effects and treatment. J Clin Psychiatry 2007; 68(Suppl. 1):8–13Google ScholarPubMed
Wykes, T.Spaulding, W.D.Thinking about the future cognitive remediation therapy – what works and could we do better?. Schizophr Bull 2011; 37(Suppl. 2):S80–S90CrossRefGoogle ScholarPubMed
Cavallaro, R.Anselmetti, S.Poletti, S.Bechi, M.Ermoli, E.Cocchi, F.et al.Computer-aided neurocognitive remediation as an enhancing strategy for schizophrenia rehabilitation Psychiatry Res 2009; 169: 191–196CrossRefGoogle ScholarPubMed
Kurtz, M.M.Neurocognitive rehabilitation for schizophrenia. Curr Psychiatry Rep 2003; 5: 303–310CrossRefGoogle Scholar
Hogarty, G.E.Medication adherence studies in schizophrenia. Am J Psychiatry 2004; 161(3): 581–582 [author reply 582–3]CrossRefGoogle Scholar
Mcgurk SR, Twamley EW, Sitzer DI, Mchugo GJ, Mueser KT. A meta-analysis of cognitive remediation in schizophrenia. Am J Psychiatry. 2007;164(12):1791-802.CrossRefGoogle Scholar
Fiszdon, J.M.Cardenas, A.S.Bryson, G.J.Bell, M.D.Predictors of remediation success on a trained memory task. J Nerv Ment Dis 2005; 193(9): 602–608CrossRefGoogle ScholarPubMed
Gomar, J.J.Valls, E.Radua, J.Mareca, C.Tristany, J.Del Olmo, F.et al.A multisite, randomized controlled clinical trial of computerized cognitive remediation therapy for schizophrenia Schizophr Bull 2015; 41(6):1387–96CrossRefGoogle Scholar
Bosia, M.Bechi, M.Marino, E.Anselmetti, S.Poletti, S.Cocchi, F.et al.Influence of catechol-O-methyltransferase Val158Met polymorphism on neuropsychological and functional outcomes of classical rehabilitation and cognitive remediation in schizophrenia Neurosci Lett 2007; 417: 271–274CrossRefGoogle Scholar
Amador, X.F.Strauss, D.H.Yale, S.Gorman, J.M.Awareness of illness in schizophrenia. Schizophr Bull 1991; 17(1): 113–132CrossRefGoogle Scholar
Mueser, K.T.McGurk, S.R.Schizophrenia. Lancet 2004; 363(9426): 2063–2072CrossRefGoogle ScholarPubMed
Smith, R.H.Gottesman, S.Hobbs, B.Lear, E.Kristofferson, D.Benton, D.et al.A mechanism for maintaining an up-to-date GenBank database via Usenet Comput Appl Biosci 1991; 7: 111–112Google ScholarPubMed
Choi, J.Medalia, A.Factors associated with a positive response to cognitive remediation in a community psychiatric sample. Psychiatr Serv 2005; 56: 602–604CrossRefGoogle Scholar
Fiszdon, J.M.McClough, J.F.Silverstein, S.M.Bell, M.D.Jaramillo, J.R.Smith, T.E.Learning potential as a predictor of readiness for psychosocial rehabilitation in schizophrenia. Psychiatry Res 2006; 143: 159–166CrossRefGoogle Scholar
Gooding, A.L.Saperstein, A.Mindt, M.R.Medalia, A.Predictors of treatment utilisation at cognitive remediation groups for schizophrenia: the roles of neuropsychological, psychological and clinical variables Neuropsychol Rehabil 2012 516–531CrossRefGoogle Scholar
Bosia, M.Zanoletti, A.Spangaro, M.Buonocore, M.Bechi, M.Cocchi, F.et al.Factors affecting cognitive remediation response in schizophrenia: the role of COMT gene and antipsychotic treatment. Psychiatry Res 2014; 217(1–2):9–14CrossRefGoogle ScholarPubMed
Kurtz, M.M.Seltzer, J.C.Fujimoto, M.Shagan, D.S.Wexler, B.E.Predictors of change in life skills in schizophrenia after cognitive remediation. Schizophr Res 2009; 107(2–3):267–274CrossRefGoogle ScholarPubMed
Vita, A.Deste, G.De Peri, L.Barlati, S.Poli, R.Cesana, B.M.et al.Predictors of cognitive and functional improvement and normalization after cognitive remediation in patients with schizophrenia Schizophr Res 2013; 150(1): 51–57CrossRefGoogle ScholarPubMed
Silverstein, S.M.Hatashita-Wong, M.Solak, B.A.Uhlhaas, P.Landa, Y.Wilkniss, S.M.et al.Effectiveness of a two-phase cognitive rehabilitation intervention for severely impaired schizophrenia patients Psychol Med 2005; 35(6): 829–837CrossRefGoogle ScholarPubMed
Fiszdon, J.M.Choi, J.Goulet, J.Bell, M.D.Temporal relationship between change in cognition and change in functioning in schizophrenia. Schizophr Res 2008; 105(1–3):105–113CrossRefGoogle Scholar
Bowie, C.R.Grossman, M.Gupta, M.Oyewumi, L.K.Harvey, P.D.Cognitive remediation in schizophrenia: efficacy and effectiveness in patients with early versus long-term course of illness. Early Interv Psychiatry 2014; 8(1): 32–38CrossRefGoogle ScholarPubMed
Anselmetti, S.Poletti, S.Ermoli, E.Bechi, M.Cappa, S.Venneri, A.et al.The Brief Assessment of Cognition in Schizophrenia. Normative data for the Italian population Neurol Sci 2008; 29(2): 85–92CrossRefGoogle ScholarPubMed
Capitani, E.Laiacona, M.The Italian Group for the Neuropsychological Study of Ageing Composite neuropsychological batteries and demographic correction: standardization based on equivalent scores, with a review of published data. J Clin Exp Neuropsychol 1997; 19(October 2015):795–809CrossRefGoogle ScholarPubMed
American Psychiatric Association DSM-IV. Diagnostic and statistical manual of mental disorders 4th ed. TR 2000 373–374Google Scholar
Kay, S.R.Fiszbein, A.Opler, L.A.The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 261–276CrossRefGoogle Scholar
Keefe, R.S.E.Goldberg, T.E.Harvey, P.D.Gold, J.M.Poe, M.P.Coughenour, L.The Brief Assessment of Cognition in Schizophrenia: reliability, sensitivity, and comparison with a standard neurocognitive battery. Schizophr Res 2004; 68(2–3):283–297CrossRefGoogle ScholarPubMed
Wechsler, D.The Wechsler intelligence scale for children 4th ed. 2004 153–190Google Scholar
Heinrichs, D.W.Hanlon, T.E.Carpenter, W.T.The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull 1984; 10: 388–398CrossRefGoogle ScholarPubMed
Marker, K.R.COGPACK. The cognitive training package manual. Marker Software 1987–2007 Heidelberg & LadenburgGoogle Scholar
Brenner, H.D.Roder, V.Hodel, B.et al.Integrated psychological therapy for schizophrenic patients 1994 Hogrefe & Huber Publishers Press SeattleGoogle Scholar
Roder, V.Brenner, H.D.Muller, M.et al.Development of specific social skills training programmes for schizophrenia patients: results of a multicentre study Acta Psychiatr Scand 2002; 105(5): 363–371CrossRefGoogle ScholarPubMed
Cohen, J.Statistical power analysis for the behavioral sciences 2nd ed. 1988 Lawrence Earlbaum Associates Hillsdale, NJGoogle Scholar
Davis, J.M.Chen, N.Dose response and dose equivalence of antipsychotics. J Clin Psychopharmacol 2004; 24(2): 192–208CrossRefGoogle ScholarPubMed
Scheu, F.Aghotor, J.Pfueller, U.Moritz, S.Bohn, F.Weisbrod, M.et al.Predictors of performance improvements within a cognitive remediation program for schizophrenia. Psychiatry Res 2013; 209(3): 375–380CrossRefGoogle Scholar
Twamley, E.W.Burton, C.Z.Vella, L.Compensatory cognitive training for psychosis: who benefits? Who stays in treatment?. Schizophr Bull 2011; 37(Suppl. 2):S55–S62CrossRefGoogle ScholarPubMed
Poletti, S.Anselmetti, S.Bechi, M.Ermoli, E.Bosia, M.Smeraldi, E.et al.Computer-aided neurocognitive remediation in schizophrenia: durability of rehabilitation outcomes in a follow-up study. Neuropsychol Rehabil 2010; 20: 659–674CrossRefGoogle ScholarPubMed
Medalia, A.Richardson, R.What predicts a good response to cognitive remediation interventions?. Schizophr Bull 2005; 31(4): 942–953CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.