Cognitive rehabilitation in psychiatry

Abstract

Cognitive impairments in mental disorders are common, poorly recognized, and largely unaddressed despite their significant impact on daily life functioning. Today, the treatment of psychiatric disorders goes beyond only symptom management and emphasizes optimizing functional abilities. Cognitive Rehabilitation or Cognitive Remediation(CR) is the nonpharmacological intervention that has received attention over the last few decades and is steadily emerging as a potentially strong tool to manage cognitive issues that impact functional outcomes. A large body of research has studied role of CR in schizophrenia populations, and the role in other disorders is now being explored. This review looks at the various studies from across the globe and in India to understand the types of programs, their theoretical underpinnings, imaging data, and efficacy of CR. There is considerable heterogeneity across studies in terms of methods, materials, and approaches, and it is challenging to identify the key active ingredients that ensure success. Overall, the meta-analysis studies have identified strategy coaching by an expert therapist and use of CR in conjunction with psychosocial and vocational programs as important factors to ensure best results. Despite promising results in enhancing cognition across most studies, generalization and transfer of this improvement to real-life functioning still remains elusive. Other moderators that can possibly influence outcomes such as motivation factors, therapist-patient relationship, personal goals of the patient and families, and the socioeconomic milieu of the patient need to be studied more extensively in the future studies to develop a comprehensive model of cognitive rehabilitation.