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Abstract
We aimed to evaluate in a sample of outpatients with schizophrenia (SCZ) the effectiveness of a cognitive remediation (CR) program (through the use of the Cogpack software) [computer-assisted CR (CACR)] in addition to standard therapy on cognitive outcomes as compared with that in a control active group (CAG) and to highlight a possible effect on social cognition (SC), metacognition, symptomatology, and real-world functioning. Of the 66 subjects enrolled, 33 were allocated to CACR and 33 to the CAG. Twenty-three patients in the CACR group and 25 subjects in the CAG completed at least 80% of the 48 prescribed CACR sessions, performed twice a week, for a total of 24 weeks of treatment. A significant time × group interaction was evident, suggesting that patients undergoing CACR intervention improved in specific metacognitive sub-functions (understanding others' mind and mastery), some cognitive domains (verbal learning processing speed, visual learning, reasoning, and problem solving) (h2 = 0.126), depressive symptoms, SC, awareness of symptoms, and real-world functioning domains (community activities and interpersonal relationships) more significantly than did patients undergoing CAG. The most noticeable differential improvement between the two groups was detected in two metacognitive sub-functions (understanding others' mind and mastery), in verbal learning, in interpersonal relationship, and in depressive symptomatology, achieving large effect sizes. These are encouraging findings in support of the possible integration of CACR in rehabilitation practice in the Italian mental health services.
Highlights
Thirty-three of these patients were allocated to computer-assisted CR (CACR) and 33 to the control active group (CAG)
Our study was aimed to assess the effectiveness of CACR vs. a CAG on specific cognitive, clinical, and functional domains in a sample of outpatients with SCZ
The CACR group was compared with an active experimental condition centered on non-specific elements of the remediation training, such as supportive therapist interactions and exposure to interesting computer activities
Summary
Cognitive deficits represent one of schizophrenia’s (SCZ’s) core features since they affect patients’ functioning and are related to high levels of functional disability [1,2,3,4].cognitive impairment attenuates the potential benefit of rehabilitation programs, such as supported employment and social skills training-, even when high-quality rehabilitation is provided [5,6,7].Cognitive Remediation in SchizophreniaSince cognitive deficits of patients with SCZ respond only moderately to pharmacotherapy [8], cognitive remediation (CR) techniques have received an increasing development in the last 15 years.At the Cognitive Remediation Experts Workshop (Florence, Italy, April 2010), CR has been defined as “a behavioral training based intervention that aims to improve cognitive processes (attention, memory, executive function, social cognition, or metacognition) with the goal of durability and generalization” [9].It has proved to be an evidence-based approach for ameliorating cognitive impairment in SCZ as confirmed in different meta-analytic studies [9,10,11,12], which show significant effect-size impact on cognition (0.45) and daily functioning (0.36) [9, 10].Wykes et al [9] found that cognitive outcomes improve with both drill-and-practice and strategic training; McGurk et al [10] corroborated that drill or practice training alone has a larger effect on memory and verbal learning, when associated with strategic training. At the Cognitive Remediation Experts Workshop (Florence, Italy, April 2010), CR has been defined as “a behavioral training based intervention that aims to improve cognitive processes (attention, memory, executive function, social cognition, or metacognition) with the goal of durability and generalization” [9]. Grynszpan et al [11] proved smaller effect sizes on verbal memory, working memory, attention/vigilance, and speed of processing and a significant medium effect size for social cognition (SC), while general cognition provides positive results. It appears that effects of CR programs are “non-specific”; targeted cognitive domains did not reach higher improvement than those that were not targeted
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