Abstract
BackgroundEvidence is accumulating that cognitive remediation therapy (CRT) is an effective intervention for patients with schizophrenia or schizoaffective disorder. To date there has been no randomised controlled trial (RCT) cohort study of cognitive remediation within a forensic hospital. The goal of this study is to examine the effectiveness of a trial of cognitive remediation for forensic mental health patients with schizophrenia or schizoaffective disorder.MethodsAn estimated sixty patients will be enrolled in the study. Participants will be randomised to one of two conditions: CRT with treatment as usual (TAU), or TAU. CRT will consist of 42 individual sessions and 14 group sessions. The primary outcome measure for this study is change in cognitive functioning using the MATRICS Consensus Cognitive Battery (MCCB). Secondary outcomes include change in social and occupational functioning, disorganised symptoms, negative symptoms, violence, participation in psychosocial treatment and recovery. In addition to these effectiveness measures, we will examine patient satisfaction.DiscussionCognitive difficulties experienced by schizophrenia spectrum patients are associated with general functioning, ability to benefit from psychosocial interventions and quality of life. Research into the treatment of cognitive difficulties within a forensic setting is therefore an important priority. The results of the proposed study will help answer the question whether cognitive remediation improves functional outcomes in forensic mental health patients with schizophrenia or schizoaffective disorder. Forensic mental health patients are detained for the dual purpose of receiving treatment and for public protection. There can be conflict between these two roles perhaps causing forensic services to have an increased length of stay compared to general psychiatric admissions. Ultimately a focus on emphasising cognition and general functioning over symptoms may decrease tension between the core responsibilities of forensic mental health services.Trial RegistrationClinicalTrials.gov Identifier: NCT02360813. Trial registered Feb 4th 2015 and last updated May 1st 2015.
Highlights
Evidence is accumulating that cognitive remediation therapy (CRT) is an effective intervention for patients with schizophrenia or schizoaffective disorder
Forensic Mental Health Services (FMHS) provide treatment for a minority of people with mental illnesses such as schizophrenia who come into contact with law enforcement agencies as a consequence of their mental disorder, or who cannot be safely managed within another service and require specialised therapeutically safe and secure care and treatment for a period of time [1, 2]
It is possible to divert mentally ill patients charged with less serious offences to general psychiatric services especially when detention in prison would be detrimental to their health [3]
Summary
Evidence is accumulating that cognitive remediation therapy (CRT) is an effective intervention for patients with schizophrenia or schizoaffective disorder. The goal of this study is to examine the effectiveness of a trial of cognitive remediation for forensic mental health patients with schizophrenia or schizoaffective disorder. Forensic patients are often judged to have lacked mental capacity to form a criminal intent at the time of the offence. The dual role of providing treatment and public protection is codified in law as is the case for the Republic of Ireland’s Criminal Law (Insanity) Act (2006) section 11(2) [5]. Forensic mental health services have the dual role of treating and caring for the patient and representing their interests, whilst simultaneously protecting the public from further harm through involuntary detention and risk management [6, 7]
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