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Mechanisms of functional improvement in a 2-year trial of cognitive enhancement therapy for early schizophrenia

Published online by Cambridge University Press:  22 September 2010

S. M. Eack ,
M. F. Pogue-Geile ,
D. P. Greenwald ,
S. S. Hogarty  and
M. S. Keshavan
S. M. Eack*
Affiliation:
School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
M. F. Pogue-Geile
Affiliation:
Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
D. P. Greenwald
Affiliation:
Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
S. S. Hogarty
Affiliation:
Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
M. S. Keshavan
Affiliation:
Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
*
*Address for correspondence: S. M. Eack, Ph.D., University of Pittsburgh School of Social Work, 2117 Cathedral of Learning, Pittsburgh, PA 15260, USA. (Email: [email protected])
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Abstract

Background

Cognitive rehabilitation has emerged as an effective treatment for addressing cognitive impairments and functional disability in schizophrenia; however, the degree to which changes in various social and non-social cognitive processes translate into improved functioning during treatment remains unclear. This research sought to identify the neurocognitive and social-cognitive mechanisms of functional improvement during a 2-year trial of cognitive enhancement therapy (CET) for early-course schizophrenia.

Method

Patients in the early course of schizophrenia were randomly assigned to CET (n=31) or an enriched supportive therapy control (n=27) and treated for up to 2 years. A comprehensive neurocognitive assessment battery and the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT) were completed annually, along with measures of functioning. Mediator analyses using mixed-effects growth models were conducted to examine the effects of neurocognitive and social-cognitive improvement on functional change.

Results

Improvements over 2 years in neurocognition and the emotion management branch of the MSCEIT were found to be significantly related to improved functional outcome in early-course schizophrenia patients. Neurocognitive improvement, primarily in executive functioning, and social-cognitive change in emotion management also mediated the robust effects of CET on functioning.

Conclusions

Improvements in neurocognition and social cognition that result from cognitive rehabilitation are both significant mediators of functional improvement in early-course schizophrenia. Cognitive rehabilitation programs for schizophrenia may need to target deficits in both social and non-social cognition to achieve an optimal functional response.

Keywords

Cognitive rehabilitationcognitive remediationpsychosocial treatmentsocial cognition
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 6 , June 2011 , pp. 1253 - 1261
Copyright
Copyright © Cambridge University Press 2010

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