Cognitive Remediation Interventions in Schizoaffective Disorder: A Systematic Review.

Ester Lopez-Fernandez,Esther Jimenez,Benedikt Lorenz Amann,Anabel Martínez-Aran,Brisa Sole,Anna Gimenez,Caterina Del Mar Bonnín,Andrea Murru,Estela Salagre,Eduard Vieta,Iria Grande

doi:10.3389/fpsyt.2018.00470

Abstract

Background: Patients with schizoaffective disorder (SAD) suffer from cognitive impairment, which negatively influences their functionality. Cognitive remediation (CR) interventions have been shown to be effective in patients with schizophrenia (SZ) and bipolar disorder (BD), but evidence in SAD is limited so far. The aim of this study is to systematically review the published data on CR interventions, either in neurocognition or social cognition, in patients with SAD.Methods: We conducted a comprehensive, computerized literature search using terms related to CR interventions in psychotic and affective disorders, and particularly in SAD. Pubmed, Embase, and Web of Knowledge databases were used up to February 28th, 2018 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search returned 2672 articles of which four were finally selected meeting the inclusion criteria.Results: Cognitive Enhancement Therapy, computerized Cognitive Remediation Therapy and Cognitive Training showed positive results in subsamples of patients with SAD regarding neurocognition and functioning in comparable terms to patients with schizophrenia as well as in a greater extent in quality of life. Benefits in social cognition were also described when Social Cognition Interaction Training was considered in patients with SAD.Conclusions: CR interventions seem to improve neurocognition and social cognition in patients with SAD as well as functioning and quality of life. However, further randomized controlled trials on CR interventions with an optimized design focusing on selected sample of patients with SAD are imperative.

Highlights

Cognitive impairment is highly prevalent in several mental disorders, especially in those presenting with psychotic symptoms [1,2,3,4,5]
Records were reviewed using the following inclusion criteria: [1] Published studies about cognitive interventions targeted at improving cognitive skills, functioning, or quality of life which reported results about the sample or subsample of patients with schizoaffective disorder (SAD) with at least 2 timing outcomes measures; [2] number or proportion of cases diagnosed with SAD in the sample; [3] diagnoses of SAD according to DSM-III, DSM-III-R, DSM-IV, DSM-IV-TR, DSM-5, ICD-9, or ICD-10; [4] no language restrictions were applied in this review; [5] no comparator group was imperative
After excluding studies that did not include or describe the sample of patients with SAD and their outcomes, four papers were identified according to the inclusion criteria [54,55,56,57]

Summary

Introduction

Cognitive impairment is highly prevalent in several mental disorders, especially in those presenting with psychotic symptoms [1,2,3,4,5]. The most prevalent impaired cognitive domains in these patients are attention, processing speed, working memory, and problem solving [9,10,11]. Cognitive performance in BD declines in particular in the domains of attention, verbal learning and memory, and executive functions according to clinical severity and number of relapses [8, 13, 19]. Patients with schizoaffective disorder (SAD) suffer from cognitive impairment, which negatively influences their functionality. Cognitive remediation (CR) interventions have been shown to be effective in patients with schizophrenia (SZ) and bipolar disorder (BD), but evidence in SAD is limited so far. The aim of this study is to systematically review the published data on CR interventions, either in neurocognition or social cognition, in patients with SAD

Objectives

Methods

Results

Conclusion