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Cognitive remediation for individuals with psychosis: efficacy and mechanisms of treatment effects

Published online by Cambridge University Press:  08 September 2016

J. M. Fiszdon ,
K. H. Choi ,
M. D. Bell ,
J. Choi  and
S. M. Silverstein
J. M. Fiszdon*
Affiliation:
VA Connecticut Healthcare System and Yale University School of Medicine, Psychology Service (116B), 950 Campbell Avenue, West Haven, CT, USA
K. H. Choi
Affiliation:
Department of Psychology, Korea University, Seoul, Republic of Korea
M. D. Bell
Affiliation:
VA Connecticut Healthcare System and Yale University School of Medicine, Psychology Service (116B), 950 Campbell Avenue, West Haven, CT, USA
J. Choi
Affiliation:
The Institute of Living at Hartford Hospital, 200 Retreat Avenue, Hartford, CT, USA
S. M. Silverstein
Affiliation:
Rutgers University – Robert Wood Johnson Medical School Department of Psychiatry and University Behavioral Health Care, 151 Centennial Avenue, Piscataway, NJ, USA
*
*Address for correspondence: J. M. Fiszdon, VA Connecticut Healthcare System, Psychology Service (116B), 950 Campbell Avenue, West Haven, CT 06516, USA. (Email: [email protected])
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Abstract

Background

The popularity of cognitive remediation (CR) interventions for individuals with psychosis is in part based on the well-established link between cognition and functioning and the assumption that by targeting cognition, function can improve. While numerous trials have reported CR's efficacy, it is still not considered an evidence-based treatment. Importantly, little is known about the mechanisms through which it may affect functioning.

Method

In this study, we evaluated CR's proximal and distal effects, and examined potential mechanisms. A total of 75 individuals with psychotic disorders were randomized to a combination of strategy-based and drill-and-practice CR or wait-list control, with assessments of training task performance, neurocognition, functional capacity, symptoms and functioning conducted at baseline, end of the 2-month intervention, and 2-month follow-up.

Results

Compared with treatment as usual, CR was associated with large post-training improvements on training tasks targeting attention, visuospatial memory, and verbal learning and memory, with persisting group differences at the 2-month follow-up. These generalized to mostly large improvements on neuropsychological measures targeting visuospatial memory, verbal learning and memory, delayed verbal memory and verbal working memory. While there were no CR-associated improvements on measures of functional capacity, symptoms, or a self-report measure of independent living skills, there was an effect on an interviewer-rated measure of functioning (Quality of Life Scale), which appeared primarily driven by the Intrapsychic Foundations subscale. Finally, for those randomized to CR, there were significant, medium-sized correlations between training task improvement, neuropsychological improvement and functioning measures.

Conclusions

This suggests a complex, multifactorial relationship between CR, and cognitive and functional change.

Keywords

Cognitive remediationfunctioningmediationpsychosisschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 16 , December 2016 , pp. 3275 - 3289
Copyright
Copyright © Cambridge University Press 2016 

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