Combining social cognitive treatment, cognitive remediation, and functional skills training in schizophrenia: a randomized controlled trial.

Maria B Iriarte,Aránzazu Iribarren,Pedro Sánchez,Javier Peña,Edorta Elizagarate,Miguel Gutiérrez,Naroa Ibarretxe-Bilbao,Natalia Ojeda,Maria A Garay

doi:10.1038/npjschz.2016.37

Abstract

This study examined the efficacy of an integrative cognitive remediation program (REHACOP) in improving cognition and functional outcome in patients with schizophrenia. The program combines cognitive remediation, social cognitive intervention, and functional skills training. Few studies have attempted this approach. One hundred and eleven patients diagnosed with schizophrenia were randomly assigned to either the cognitive remediation group (REHACOP) or an active control group (occupational activities) for 4 months (three sessions per week, 90 min). Primary outcomes were change on general neurocognitive performance and social cognition, including theory of mind (ToM), emotion perception (EP), attributional style, and social perception (SP). Secondary outcomes included changes on clinical symptoms (Positive and Negative Syndrome Scale) and functional outcome (UCSD Performance-Based Skills Assessment and the Global Assessment of Functioning). The trial was registered with clinicaltrials.gov (NCT02796417). No baseline group differences were found. Significant differences were found in the mean change between the REHACOP group and control group in neurocognition (), SP (), ToM (), EP (), negative symptoms (), emotional distress (), Global Assessment of Functioning (), and UCSD Performance-Based Skills Assessment (). The combination of cognitive remediation, social cognitive intervention, and functional skills training demonstrated statistically significant and clinically meaningful changes in neurocognition, social cognition, negative, and functional disability.

Highlights

Cognitive impairment has been considered a core feature of schizophrenia and it has been found in the prodomal phase of the disease[1] and in unaffected relatives of patients with schizophrenia.[2]
Differences in change scores between the REHACOP and control group were found in total neurocognitive score (Table 2), indicating that REHACOP improved compared with the control group
There were no significant differences in change scores between the two groups in positive symptoms, disorganization, or excitement symptoms. This randomized controlled trial evaluated the efficacy of the modified version of REHACOP, which combined cognitive remediation, social cognitive intervention, and functional skills training

Summary

Introduction

Cognitive impairment has been considered a core feature of schizophrenia and it has been found in the prodomal phase of the disease[1] and in unaffected relatives of patients with schizophrenia.[2]. Along with cognitive deficits,[2] social cognitive deficits[6] have been suggested as putative endophenotypes for schizophrenia. There is a large amount of evidence suggesting that cognitive deficits[7] and social cognitive deficits,[4] along with negative symptoms[8] are linked to functional outcome in schizophrenia. These results emphasize the importance of addressing cognition, social cognition, and negative symptoms in our treatments if our ultimate goal includes improving the functional outcome and quality of life of patients with schizophrenia.[9]

Methods

Results

Conclusion