Abstract

Pharmacological approaches to cognitive enhancement have received considerable attention but have not had considerable success in improving their cognitive and functional targets. Other intervention strategies, such as cognitive remediation therapy (CRT), have been shown to enhance cognitive performance but have not been found to improve functional outcomes without additional psychosocial interventions. Recently, several studies have attempted to enhance the effects of CRT by adding pharmacological interventions to the CRT treatments. In addition, as CRT has been shown to synergistically improve the effects of psychosocial interventions, the combination of pharmacological therapies aimed at cognition and psychosocial interventions may itself provide a promising strategy for improving functional outcomes. This review and commentary examines the current state of interventions combining CRT and psychosocial treatments with pharmacological augmentation. Our focus is on the specific level of effect of the pharmacological intervention, which could be enhancing motivation, training efficiency, or the consolidation of therapeutic gains. Different pharmacological strategies (e.g., stimulants, plasticity-inducing agents, or attentional or alertness enhancers) may have the potential to lead to different types of gains when combined with CRT or psychosocial interventions. The relative potential of these different mechanisms for immediate and durable effects is considered.

Highlights

  • Cognitive impairments are prominent in several neuropsychiatric conditions [1]

  • Pharmacological augmentation of cognitive remediation therapy (CRT) has been attempted and some success has been reported for certain study designs, primarily those using stimulant-like drugs

  • As social cognition is a critical component of social outcomes, there have been multiple attempts to train social skills

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Summary

INTRODUCTION

These impairments are functionally relevant and persistent over time and are minimally related to treatments for the illness [2] These impairments have spurred multiple treatment efforts spanning pharmacological, psychosocial, psychotherapeutic, and rehabilitation-based treatments. Pharmacological interventions may have the potential to synergistically combine with learning-based psychosocial treatments, much like the combination of these treatments with CRT training. The evaluation of pharmacological strategies focuses on the mechanism of action, duration of effect, and potential impact on learning-based interventions such as cognitive remediation or behavioral interventions. This evaluation necessitates a task analysis of CRT interventions, in terms of which cognitive processes are potentially important at different stages of the CRT participation process. While adherence to medication is clearly a participatory activity, the amount of effort expended, in clinical treatment studies where medication is prepacked and delivered to the participant, seems less than that required to train for ≥30 min on a cognitively demanding task, ≥2 times/week

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