"Food for Thought": Improving Cognition in People With Schizophrenia.

Abstract

We have known that cognitive difficulties are related to functional outcomes in schizophrenia for many years. However, we have only paid attention to potential treatments relatively recently, so implementation has been slow. This is a narrative review describing the development of cognitive remediation treatments to improve cognitive skills and their effects on functioning. It also reviews the types of cognitive remediation with some evidence on their effects. Models of treatment have now been clarified and have led to a landmark paper by cognitive remediation experts around the world on the ingredients of cognitive remediation to produce the most benefit. This expert judgement on good clinical practice was justified by a large meta-analysis that supported the extra benefit of the four ingredients: an active therapist, massed practice of cognitive skills, the teaching of cognitive strategies and additional rehabilitation to transfer skills to real life. Although there is evidence of efficacy and of the beneficial therapy ingredients there is little implementation of cognitive remediation, so the establishment of cognitive remediation into mental health services needs an implementation pathway.