Cognitive remediation for schizophrenia: it is even more complicated

Abstract

Attempts to remediate the cognitive difficulties of people with a diagnosis of schizophrenia have shown efficacy; however, existing treatment studies display huge variation, frustrating efforts to determine how best to apply this treatment tool. This review summarizes findings of induced cognitive change in schizophrenia, with reference to the remediation method, the presence of accompanying treatment(s), how cognitive change generalizes and its value. Although there is strong evidence that cognitive change can be induced in schizophrenia, there is little evidence for the superiority of any treatment approach. Furthermore, remediation is most effective when in combination with other treatments, such as vocational training. Cognitive rehabilitation can be cost-effective and is valued by patients. A number of studies show generalization of positive outcomes beyond cognitive variables, with more focused treatment associated with less generalization. Induced cognitive change does not necessarily need to be large to facilitate functional outcomes. Instead, opportunities to apply newly acquired cognitive skills and strategies in the real world are vital. The next generation of studies need to compare different treatments using specific and more general measures of cognitive outcome. These may then throw light on their mechanisms of action. The results of these more sophisticated studies will allow therapists to tailor treatments to individuals to maximize gain for patients.