EPA-1033 – Cognitive adaptation training for outpatients with schizophrenia in integrated treatment

Abstract

Can Cognitive Adaptation Training (CAT) improve daily living due to impaired cognition and social cognition? Compared to a background population, most patients with schizophrenia have impaired cognition as well as impaired social cognition, giving problems in managing daily living and social contacts. Antipsychotic treatment can decrease cognitive impairment, even though it cannot eliminate the problem and cognitive remediation has only been shown to have a moderate effect on cognitive impairments. CAT is a treatment that circumvents cognitive impairments by rearranging the environment to support, prompt and sequence appropriate behaviours. CAT has shown promising results, including improved social functioning. As yet, no reports have appeared on the positive effect of CAT in combination with Assertive Community Treatment (ACT). The ACT treatment includes several supportive elements. Patients in ACT teams meet a specifically mental health worker in their own home, who has the opportunity to support and advise the patients. The low caseload allows for regular visits and the 14-hour crisis support gives a sense of security. Furthermore, the ACT mental health worker can assist patients in achieving sufficient material aid and services A trial comparing CAT+ACT versus ACT alone in regard to social functioning did not document differences. However the treatment as usual in this trial was more intensive than that in previous studies in regard to time spent with patients, in instructions in correct medication management, and adjusting the medication. Thus it is uncertain if some elements from CAT can make ACT more economically effective.