To examine if a cognitive remediation program could be a positive supplement to a psychoeducational treatment program for adolescents with early onset psychosis.
Twenty-six subjects, randomly assigned to cognitive remediation (n = 14) or control group (n = 12), were assessed on cognitive, clinical, psychosocial and behavioural measures.
No significant between-group differences in pre- and post-treatment scores were found. This may be due to low statistical power. Exploratory within-group analyses showed that the training group improved on five of the 10 cognitive, and three of the five functioning outcome measures, while the control group improved on three of the cognitive, and one functioning outcome variable.
Based on these results we cannot conclude that the addition of this cognitive remediation program, yields better results than psychoeducation alone. However, within-group analyses indicate that on specific cognitive functions, as well as on some functioning outcome measures, the remediation program may have a positive effect.
"On the other hand, there are great expectations for the nonpharmacological treatment of cognitive rehabilitation. Cognitive remediation has been indicated to improve neuropsychological functioning (Krabbendam and Aleman, 2003; Twamley et al., 2003; McGurk et al., 2007; Wykes et al., 2011; Ikezawa et al., 2012), although not all (Ueland and Rund, 2004; Dickinson et al., 2010). However, little research has been conducted on the effects of cognitive rehabilitation on brain function (Wykes et al., 2002; Haut et al., 2010; Bor et al., 2011; Subramaniam et al., 2012). "
[Show abstract][Hide abstract] ABSTRACT: The regional neuronal changes taking place between before and after cognitive rehabilitation are still not characterized in schizophrenia patients. In addition, it is not known whether these regional changes are predictive or correlated with treatment response. We conducted a preliminary quasi-experimental study to investigate the effects of a Neuropsychological Educational Approach to Cognitive Remediation (NEAR), one of the cognitive remediation therapies, on neurocognitive functioning assessed by the Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS-J), and on prefrontal and temporal hemodynamic responses during working memory (WM) task (2-back, letter version) using 52-channel near-infrared spectroscopy (NIRS). We assessed 19 patients with schizophrenia or schizoaffective disorder twice with an interval of 6 months. Moreover, taking into consideration the possible practice effect, we assessed 12 control patients twice with an interval of 6 months. The NEAR group, in comparison with the control group, showed significant improvement in two subcomponents of BACS-J, that is, motor speed and executive function along with the composite scores. The NEAR group also showed a significant increase in brain activation in the bilateral cortical regions associated with WM, and in comparison with the control group the between-group differences were restricted to the right frontopolar area. In addition, the amount of enhancement in some cognitive subcomponents was positively correlated with the magnitude of an increase in hemodynamic response during WM task predominantly in the right hemispheres. These findings suggest that neurocognitive deficits in schizophrenia and their neural dysfunction may be improved by NEAR, and NIRS may be a useful tool to assess the changes of the neural activity underlying the improvement of neurocognitive functioning elicited by neurocognitive rehabilitation.
Schizophrenia Research 03/2014; 153(1-3). DOI:10.1016/j.schres.2014.01.031 · 3.92 Impact Factor
"First study on cognitive remediation in adolescents in the early course of psychosis was conducted by Ueland and Rund . This randomized controlled study demonstrated that a cognitive remediation program might have beneficial effects for some specific aspects of cognition and possibly an indirect effect on measures of functional outcome in this group of patients. "
[Show abstract][Hide abstract] ABSTRACT: Objectives. This study is aimed to review the current scientific literature on cognitive remediation in schizophrenia. In particular, the main structured protocols of cognitive remediation developed for schizophrenia are presented and the main results reported in recent meta-analyses are summarized. Possible benefits of cognitive remediation in the early course of schizophrenia and in subjects at risk for psychosis are also discussed. Methods. Electronic search of the relevant studies which appeared in the PubMed database until April 2013 has been performed and all the meta-analyses and review articles on cognitive remediation in schizophrenia have been also taken into account. Results. Numerous intervention programs have been designed, applied, and evaluated, with the objective of improving cognition and social functioning in schizophrenia. Several quantitative reviews have established that cognitive remediation is effective in reducing cognitive deficits and in improving functional outcome of the disorder. Furthermore, the studies available support the usefulness of cognitive remediation when applied in the early course of schizophrenia and even in subjects at risk of the disease. Conclusions. Cognitive remediation is a promising approach to improve real-world functioning in schizophrenia and should be considered a key strategy for early intervention in the psychoses.
"Each of the completed trials will be described with a specific focus on functional outcome. In a small RCT, Ueland and Rund [123, 124] investigated whether 30 hours of individual neurocognitive remediation could enhance functional outcomes in inpatient adolescents (aged 12–18) with early-onset psychosis already receiving comprehensive psychoeducational treatment. Participants were randomized to receive cognitive remediation (n = 14) or treatment as usual (TAU; n = 12). "
[Show abstract][Hide abstract] ABSTRACT: Improving functional outcome, in addition to alleviating psychotic symptoms, is now a major treatment objective in schizophrenia research. Given the large body of evidence suggesting pharmacological treatments generally have minimal effects on indices of functioning, research has turned to psychosocial rehabilitation programs. Among these, neurocognitive and social cognitive interventions are at the forefront of this field and are argued to target core deficits inherent to the schizophrenia illness. However, to date, research trials have primarily focused on chronic schizophrenia populations, neglecting the early psychosis groups who are often as severely impaired in social and occupational functioning. This theoretical paper will outline the rationale for investigating adjunctive cognitive-based interventions in the early phases of psychotic illness, critically examine the current approach strategies used in these interventions, and assess the evidence supporting certain training programs for improving functional outcome in early psychosis. Potential pathways for future research will be discussed.
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