Role of Executive Function in Response to a Problem Solving Based Psychoeducational Intervention in Adolescents with Psychosis: The PIENSA Trial Revisited.

Francisco Camino,Ana Ruíz-Sancho,Carmen Moreno,Marta Rapado-Castro,Maria Mayoral,Celso Arango

doi:10.3390/jcm8122108

Abstract

An improvement in negative symptoms and a reduction in the number of visits to the emergency department have been reported in a problem solving based psychoeducational group intervention (PE) for adolescents with psychosis relative to a nonstructured group (NS). One of the factors that may play a role on the response to PE treatment is executive function (EF), a crucial cognitive domain for problem-solving performance. We aimed to examine the role of EF in response to PE treatment versus an NS group. We examined the associations between changes in cognition and in clinical/functional variables within each treatment group using Spearman-ranked and partial correlation analyses. A total of 22 individuals (mean age: 16.3) were randomized to PE (N = 10) and NS (N = 12). We found an association between improvements in EF performance and a reduction in positive symptoms (rs = –0.756, p = 0.030 for semantic fluency), reduction in negative symptoms (r = 0.758, p = 0.029 for semantic; rs = –0,733, p = 0.025 for verbal fluency), and reduction in the number of visits to the emergency department (r = –0,743, p = 0.035 for semantic fluency) in the PE group. No associations were found in the NS group. Our results suggest that EF may play a role in the specific improvements observed in the PE group. This may have implications in the development of new areas of clinical intervention focusing on the role of cognitive functioning in response to psychosocial treatments in psychosis.

Highlights

Continued beneficial effects in clinical and functional outcomes have previously been reported for participants in a nine-month problem solving based psychoeducational group intervention (PE) for adolescents with psychosis and their families, at the end [2] and two years after the intervention [3], relative to a nonstructured group intervention (NS)
We found an improvement in negative symptoms and a reduction in the number of visits to the emergency department in the group of adolescents with psychosis who participated in psychoeducational (PE) treatment compared to the nonstructured (NS) group at the end of the intervention [2]
Our own previous studies in an independent group of adolescents with psychosis have shown that executive functioning performance is altered at the time of the first episode [8], and, function in this cognitive domain improves at follow-up, the degree of the impairment relative to healthy controls remains stable over the first two years of the illness [9,10]

Summary

Introduction

Continued beneficial effects in clinical and functional outcomes have previously been reported for participants in a nine-month problem solving based psychoeducational group intervention (PE) for adolescents with psychosis and their families (i.e., the PIENSA program [1]), at the end [2] and two years after the intervention [3], relative to a nonstructured group intervention (NS). Executive function involves the orchestration of high-order cognitive processes that are necessary to deliberately solve a problem and/or to respond to the demands of daily life [4]. Deficits in these core processes have consistently been shown in early psychosis [5,6,7]. Our own previous studies in an independent group of adolescents with psychosis have shown that executive functioning performance is altered at the time of the first episode [8], and, function in this cognitive domain improves at follow-up, the degree of the impairment relative to healthy controls remains stable over the first two years of the illness [9,10]. Executive impairments can interfere with the ability to understand and internalize the information and skills trained in specific psychotherapies for psychosis and, prevent applying them in everyday life [25]

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