Abstract
The objective of this case study was to assess the specific effect of cognitive remediation for schizophrenia on the pattern of cognitive impairments. Case A is a 33-year-old man with a schizophrenia diagnosis and impairments in visual memory, inhibition, problem solving, and verbal fluency. He was provided with a therapist delivered cognitive remediation program involving practice and strategy which was designed to train attention, memory, executive functioning, visual-perceptual processing, and metacognitive skills. Neuropsychological and clinical assessments were administered at baseline and after three months of treatment. At posttest assessment, Case A had improved significantly on targeted (visual memory and problem solving) and nontargeted (verbal fluency) cognitive processes. The results of the current case study suggest that (1) it is possible to improve specific cognitive processes with targeted exercises, as seen by the improvement in visual memory due to training exercises targeting this cognitive domain; (2) cognitive remediation can produce improvements in cognitive processes not targeted during remediation since verbal fluency was improved while there was no training exercise on this specific cognitive process; and (3) including learning strategies in cognitive remediation increases the value of the approach and enhances participant improvement, possibly because strategies using verbalization can lead to improvement in verbal fluency even if it was not practiced.
Highlights
Cognitive impairments are a core feature of schizophrenia with impairments in nearly every cognitive domain [1, 2]
To highlight specific cognitive deficits that are less visible in a larger sample, the present paper presents a case study of cognitive remediation in a patient with schizophrenia
We hypothesized that Case A would improve performance in the cognitive domains observed to be impaired at neuropsychological baseline and targeted by the CIRCuiTS program
Summary
Cognitive impairments are a core feature of schizophrenia with impairments in nearly every cognitive domain [1, 2]. A recent meta-analysis [2] demonstrated that patients with schizophrenia scored significantly lower than did controls across all cognitive tests and domains with largest impairments in processing speed and episodic memory [2, 3]. Verbal memory, and executive functioning have demonstrable prognostic value; that is, the degree of impairment predicts ability to achieve functional goals through treatment [7,8,9]. Episodic memory is one of the cognitive domains usually associated with poor social functioning [10]. Verbal fluency is generally considered as a measure of executive functions.
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