Article

Computer-assisted cognitive remediation therapy: Cognition, self-esteem and quality of life in schizophrenia

Authors:
  • Hospital Clínic de Barcelona; University of Barcelona
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Abstract

Quality of life (QoL) is an important outcome in the treatment of schizophrenia. Cognitive deficits have an impact on functional outcomes. Cognitive remediation therapy is emerging as a psychological intervention that targets cognitive impairment, but the effect of computer-assisted cognitive remediation on neuropsychology and social functioning and wellbeing remains unclear. The aim of the current study is to investigate the neurocognitive outcomes of computer-assisted cognitive remediation (CACR) therapy in a sample of schizophrenia patients, and to measure the quality of life and self-esteem as secondary outcomes. Sixty-seven people with schizophrenia were randomly assigned to computer-assisted cognitive remediation or an active control condition. The main outcomes were neuropsychological measures and secondary outcomes (self-esteem and quality of life). Measurements were recorded at baseline and post-treatment. The CACR therapy group improved in speed of processing, working memory and reasoning and problem-solving cognitive domains. QoL and self-esteem measures also showed significant improvements over time in this group. Computer-assisted cognitive remediation therapy for people with schizophrenia achieved improvements in neuropsychological performance and in QoL and self-esteem measurements.

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... Assessing the clinical effectiveness of a DPI 17 50,54,55,[69][70][71][72][73][74][75][76][77][78][79][80][81][82] Technological acceptance 7 48,49,54,77,81,83,84 Feasibility of DPIs 5 54,74,81,85,86 Understanding users' perspectives of the DPI 3 53,71,87 Cost-effectiveness 1 78 Methods of the studies N References RCT 10 55,69,70,[74][75][76][77][78][79]85 Pre-post design 5 48,50,54,72,86 Case-control 4 48,[82][83][84] Cohort (retro/pro) 1 80 Cross-section 1 49 Case study 2 73,81 Qualitative or mixed methods 7 48,50,53,71,72,86,87 Abbreviations: DPI, digital psychological intervention; RCT, randomized controlled trial. Trauma-and stressor-related disorders 5 48,54,70,71,83 Substance use and addictive disorders 3 70,71,83 Schizophrenia spectrum and other psychotic disorders 2 71,75 Somatic symptom disorders 2 69,84 Bipolar and related disorders 1 71 Personality disorders 1 71 Other disorders 1 71 Psychological interventions (based on APS) N References ...
... Assessing the clinical effectiveness of a DPI 17 50,54,55,[69][70][71][72][73][74][75][76][77][78][79][80][81][82] Technological acceptance 7 48,49,54,77,81,83,84 Feasibility of DPIs 5 54,74,81,85,86 Understanding users' perspectives of the DPI 3 53,71,87 Cost-effectiveness 1 78 Methods of the studies N References RCT 10 55,69,70,[74][75][76][77][78][79]85 Pre-post design 5 48,50,54,72,86 Case-control 4 48,[82][83][84] Cohort (retro/pro) 1 80 Cross-section 1 49 Case study 2 73,81 Qualitative or mixed methods 7 48,50,53,71,72,86,87 Abbreviations: DPI, digital psychological intervention; RCT, randomized controlled trial. Trauma-and stressor-related disorders 5 48,54,70,71,83 Substance use and addictive disorders 3 70,71,83 Schizophrenia spectrum and other psychotic disorders 2 71,75 Somatic symptom disorders 2 69,84 Bipolar and related disorders 1 71 Personality disorders 1 71 Other disorders 1 71 Psychological interventions (based on APS) N References ...
... Assessing the clinical effectiveness of a DPI 17 50,54,55,[69][70][71][72][73][74][75][76][77][78][79][80][81][82] Technological acceptance 7 48,49,54,77,81,83,84 Feasibility of DPIs 5 54,74,81,85,86 Understanding users' perspectives of the DPI 3 53,71,87 Cost-effectiveness 1 78 Methods of the studies N References RCT 10 55,69,70,[74][75][76][77][78][79]85 Pre-post design 5 48,50,54,72,86 Case-control 4 48,[82][83][84] Cohort (retro/pro) 1 80 Cross-section 1 49 Case study 2 73,81 Qualitative or mixed methods 7 48,50,53,71,72,86,87 Abbreviations: DPI, digital psychological intervention; RCT, randomized controlled trial. Trauma-and stressor-related disorders 5 48,54,70,71,83 Substance use and addictive disorders 3 70,71,83 Schizophrenia spectrum and other psychotic disorders 2 71,75 Somatic symptom disorders 2 69,84 Bipolar and related disorders 1 71 Personality disorders 1 71 Other disorders 1 71 Psychological interventions (based on APS) N References ...
Article
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In recent years, despite significant progress in digital psychological interventions (DPIs), the prevalence of psychological issues among young adults remains a concern. While research on the feasibility and effectiveness of DPIs is extensive, there's a growing recognition of the need for a sociotechnical approach to enhance user engagement. This review aims to highlight the importance of integrating diversity, especially sociodemographic characteristics, into DPI design and implementation. The review meticulously examined literature from six academic databases focused on DPIs tailored for users aged 12 to 26, spanning the period between 2009 and 2019. The data extraction process specifically targeted biosocial factors such as gender and ethnicity, as well as sociocultural elements like remoteness and labor force status among users. Among the initial pool of 879 articles, a refined selection of 25 underwent detailed analysis. Intriguingly, 14 of these studies did not treat sociodemographic factors as independent variables, leaving only 11 that did. Notably, gender and ethnicity emerged as the most frequently studied factors, with remoteness and labor force considerations receiving comparatively less attention. Despite the acknowledged importance of user engagement in DPI effectiveness, the review highlights a critical gap: insufficient consideration of young adults' sociodemographic characteristics in intervention design and implementation. Therefore, the findings strongly support further mixed-method studies to fully understand the complex social factors influencing user engagement with DPIs. Closing this gap will undoubtedly refine and optimize DPIs to better meet the diverse needs of young adults dealing with psychological challenges.
... In one study of tornado-effected adolescents, users were given the option to complete different modules or opt out when they were symptomless . In another study, the therapist selected different games within a DPI and their difficulty according to the user's success rate (Garrido et al., 2013). Such a strategy could also be developed so it personalizes in real-time using artificial intelligence (Boucher et al., 2021;D'Alfonso, 2020) or modified by clinicians or users. ...
... Segmented personalization was evident in the way in which content was personalized (see previous section). DPIs were personalized based on users' ethnicity (African-American, Latino, Indigenous, Norwegian) (Bansa et al., 2018;Høifødt et al., 2013;Shepherd et al., 2018), gender (sexual minority groups) (Lucassen et al., 2015), age (children, adolescents or young adults), mental disorders (schizophrenia, depression, anxiety, and PTSD) (Garrido et al., 2013;Høifødt et al., 2013;Price et al., 2015;Ruggiero et al., 2015;Thew et al., 2019), and physical diseases (cancer, chronic pain) (Law et al., 2017;Li et al., 2011). However, we did not find any DPI with the cognitive-based and whole-person methods of personalization. ...
... al., 2017;Bansa et al., 2018;Baumeister et al., 2015;Brabyn et al., 2016;Bunnell et al., 2017;Garnefski et al., 2011;Garrido et al., 2013;Høifødt et al., 2013;Law et al., 2017;Li et al., 2011;Lillevoll et al., 2014;Lungu & Sun, 2016;Reid et al., 2011;Ruggiero et al., 2015;Schueller et al., 2019;Staples et al., 2019 Qualitative or mixed methods 7 28Agyapong et al., 2016;Lucassen et al., 2015;Neal-Barnett et al., 2019;Price et al., 2015;Shepherd et al., 2018;Spates et al., 2013; Stjerneklar et al.Bansa et al., 2018;Lillevoll et al., 2014; al., 2019; Stjerneklar et al., 2018; Thew et al., 2019 Cost-effectiveness 1 Ã Brabyn et al., 2016 Consumers' perspective or acceptance 10 Ã Agyapong et al., 2016; Baumeister et al., 2015; Bunnell et al., 2017; Høifødt et al., 2013; Lucassen et al., 2015; Lungu & Sun, 2016; Price et al., 2015; Schueller et al., 2019; Shepherd et al., 2018; Thew et al., 2019 Clinical effectiveness 17 Ã Agyapong et al., 2016, 2017; Brabyn et al., 2016; Garnefski et al., 2011; Garrido et al., 2013; G omez et al., 2019; Høifødt et al., 2013; Law et al., 2017; Li et al., 2011; Lillevoll et al., 2014; Neal-Barnett et al., 2019; Reid et al., 2011; Ruggiero et al., 2015; Schueller et al., 2019; Spates et al., 2013; Staples et al., 2019; Thew et al., 2019 Personalization in DPI DPI was personalized 11 44 Bansa et al., 2018; G omez et al., 2019; Høifødt et al., 2013; Law et al., 2017; Li et al., 2011; Lucassen et al., 2015; Neal-Barnett et al., 2019; Price et al., 2015; Ruggiero et al., 2015; Shepherd et al., 2018; Stjerneklar et al., 2018 DPI was not personalized 5 20Agyapong et al., 2016;Brabyn et al., 2016;Lillevoll et al., 2014;Schueller et al., 2019; Thew et al.et al., 2017;Baumeister et al., 2015;Bunnell et al., 2017;Garnefski et al., 2011;Garrido et al., 2013;Lungu & Sun, 2016;Reid et al., 2011;Spates et al., 2013;Staples et al., 2019 Delivery methods of DPIs Online 13 ÃBansa et al., 2018;Baumeister et al., 2015;Brabyn et al., 2016;Bunnell et al., 2017;Høifødt et al., 2013;Law et al., 2017;Lillevoll et al., 2014;Lungu & Sun, 2016;Price et al., 2015;Ruggiero et al., 2015;Staples et al., 2019;Stjerneklar et al., 2018;Thew et al., 2019 Mobile 6 Ã Agyapong et al., 2016, 2017Brabyn et al., 2016;Neal-Barnett et al., 2019;Reid et al., 2011; al., 2019 Desktop 4 Ã Garnefski et al., 2011; Garrido et al., 2013; Shepherd et al., 2018; Spates et al., 2013 Games 3 Ã G omez et al., 2019; Lucassen et al., 2015; Shepherd et al., 2018 Virtual reality 2 Ã G omez et al., 2019; Li et al., 2011 Ã The percentages are not calculated because of multiple instances of overlapped items in one study (e.g., cost-effectiveness and clinical effectiveness in one study, or mobile and desktop delivery methods in one study). ...
Article
Personalized digital psychological interventions (DPI) seek to provide solutions tailored to user requirements. DPI Personalization has been found to increase user engagement which can improve treatment outcomes. Recognizing different dimensions of personalization (content, method, and the actor/s doing the personalization), this research reviewed past studies of personalized DPIs for young adults. Identifying the dimensions of DPI personalization that have been studied is an important step in enhancing personalization, which subsequently can increase low user engagement and therefore enhance treatment of mental health. A structured literature review searched six academic databases with adjusted search phrases and included participants' age (18-26 years), publication years (2010-2019), and language (English). Out of 879 collected articles, 25 relevant articles were analyzed using a framework to extract details of personalization. The analysis revealed low rates of studies on personalization of DPIs in this age group. Personalization dimensions were mostly evident in content (75%), using segmented personalisation (91%) by providers (83%), not users. This gap suggests further studies on DPI personalization are warranted. Future research must focus more on co-design and collecting users' personal, social, and technical preferences to enhance personalization quality. This can provoke young people's engagement through smarter and real-time personalization based on user characteristics and preferences to enhance usage and achieve better clinical outcomes.
... The design of the CACR program is based on current research evidence. First, the program use computerized training programs that promote the motivation of participants (Contreras et al., 2016a;Garrido et al., 2013). CACR programs use game like designs and multimedia activities, which is a stimulating form of learning (Grynszpan et al., 2011;Rass et al., 2012). ...
... From meta-analyses and reviews, there are wide variations in the effect size of computer-assisted cognitive remediation on cognitive functioning domains. The effect sizes reported could range from low to medium (d = 0.25 to 0.65) for different cognitive domains (Barlati et al., 2013;Galletly and Rigby, 2013;Garrido et al., 2013;Genevsky et al., 2010;Wykes et al., 2011). The repeated-measures design used in this study had two groups (an experimental group and a control group), and there were two repeated measures over time. ...
... Last, the feedback from the therapists and research participants indicated that the characteristics of the trainer made an impact on the effectiveness of training, through enhancing the motivation of participants (Garrido et al., 2013). This finding echoes the results of a qualitative study by Contreras et al. (2016aContreras et al. ( , 2016b, which highlighted that trainers who were supportive, adaptive, and instructive were instrumental in achieving better training outcomes in CR. ...
Article
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Background: People with psychosis have a range of neuropsychological impairments that impact their functional abilities and rehabilitation outcomes. We designed a Computer-Assisted Cognitive Remediation (CACR) program to help young people with psychosis to restore their cognitive function. The program combines the drill-and-practice approach and the strategic approach to remediation, with sixteen sessions of computerized cognitive training, two sessions of psychoeducation, and four session of coaching on applying cognitive skills to daily life. Method: This was a randomized, single-blind, controlled study in which the outcomes of the CACR program were compared with outcomes of a treatment-as-usual (TAU) control group. Pre-intervention and post-intervention measures were compared. Results: When compared with the control group, the intervention group had significant increases in their MCCB neurocognitive composite scores, and specifically in the areas of verbal learning and speed of processing at posttest. They also had significant increases in their secondary outcome measures of mental well-being and perceived occupational competence. There were no significant differences in functional status between the two groups at post-test. Conclusions: The CACR program was effective in improving overall cognitive function and in the specific domains of verbal learning, speed of processing, and effect sizes were small. Participants also experienced positive changes in mental well-being and perceived competence.
... Positive associations between neurocognitive performance and QoL have also been found (Addington and Addington, 2008;Alessandrini et al., 2016;Savilla et al., 2008), and authors have suggested that neurocognitive dysfunction may have a bearing on self-esteem (Hesse et al., 2015;Lysaker et al., 2007) and on measures of well-being (Garrido et al., 2013). However, CRT is time-consuming, and concerns have been raised about its costs (Owen et al., 2010). ...
... All patients recruited in this follow-up study had previously participated in a study (Garrido et al., 2013) of 67 patients with schizophrenia confirmed by Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I; First et al., 1997) and followed at the Department of Mental Health of Consorci Sanitari de Terrassa, Catalonia, Spain. Patients were aged 18-55 years, had an estimated IQ of 85 or above according to the Vocabulary subtest (Wechsler Adult Intelligence Scale-III; WAIS-III), a Global Assessment of Functioning score (GAF; Endicott et al., 1976) of 40 or higher and had received a stable Participants who completed assessment post-treatment n = 31 ...
... As expected after randomization, the CACR group and the active control group showed similar baseline results for clinical variables and primary and secondary outcomes (n=67). Descriptive data for cognitive, QoL and self-esteem variables at baseline were previously reported by Garrido et al. (2013). In the follow-up study (n=33) more than three-quarters of the sample were male (78.8%, n=26) and the mean age was 34.0 years (SD=8.27); ...
Article
The durability of computer–assisted cognitive remediation (CACR) therapy over time and the cost-effectiveness of treatment remains unclear. The aim of the current study is to investigate the effectiveness of CACR and to examine the use and cost of acute psychiatric admissions before and after of CACR. Sixty-seven participants were initially recruited. For the follow-up study a total of 33 participants were enrolled, 20 to the CACR condition group and 13 to the active control condition group. All participants were assessed at baseline, post-therapy and 12 months post-therapy on neuropsychology, QoL and self-esteem measurements. The use and cost of acute psychiatric admissions were collected retrospectively at four assessment points: baseline, 12 months post-therapy, 24 months post-therapy, and 36 months post-therapy. The results indicated that treatment effectiveness persisted in the CACR group one year post-therapy on neuropsychological and well-being outcomes. The CACR group showed a clear decrease in the use of acute psychiatric admissions at 12, 24 and 36 months post-therapy, which lowered the global costs the acute psychiatric admissions at 12, 24 and 36 months post-therapy. The CACR is durable over at least a 12-month period, and CACR may be helping to reduce health care costs for schizophrenia patients.
... Its effectiveness is enhanced when provided in a context (formal or informal) that provides support and opportunity for extending to everyday functioning" (1). Computer-assisted cognitive remediation (CACR) has the advantage of being economic by lowering the global health care costs (2) and enhancing productivity outcomes (3). Furthermore CACR can be adaptive, repeated infinitely, provide incentives and be tailored to specific cognitive domains (4,5). ...
... Cognitive deficits appeared with a frequency of 86% in divided attention, 85% in response inhibition, 81% in selective attention, 66% in working memory, 59% in alertness, and FIGURE 1 | Schedule of the study. 1 Four sessions per week, additional one transfer session (individual benefits and motivation, problem solving strategies, transfer to real world functioning). 2 Alertness, divided attention, selective attention, planning, working memory, inhibition. 3 Three main deficits out of the six subdomains, depending on individual results of neuropsychological performance at T1. 44% in planning. ...
Article
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Computer-assisted cognitive remediation (CACR) is an economical, adjustable, and effective treatment for individuals with schizophrenia. The current randomized controlled study examined whether an individualized or generic exercise plan in CACR is superior in patients with multiple cognitive deficits compared to treatment-as-usual (TAU). Fifty-nine inpatients diagnosed with schizophrenia were randomly assigned to 1) TAU, 2) TAU plus an individualized exercise plan in CACR, or 3) TAU plus a generic exercise plan in CACR. Neuropsychological performance, psychopathology, and functional outcome were assessed at baseline and post-treatment. The results show a medium to large training effect for all neuropsychological performance measures. Contrary to our expectations the neuropsychological improvement over time did not differ between groups. Self-reported depression, global level of functioning, and activity and participation functioning showed a significant improvement from baseline to post-treatment. However no further group, time, or interaction effects for other psychopathology and functional outcome could be demonstrated. Possible implications for clinical use of CACR and future studies are discussed.
... • Qualité de vie : perception plus négative de la qualité de vie en raison des difficultés relationnelles 40 . ...
... • Serait associée à une augmentation de l'estime de soi, telle qu'étudiée auprès d'une population souffrant de schizophrénie ayant bénéficié d'une thérapie par remédiation cognitive 40,46 ; ...
Book
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Trousse d'information abordant le développement de difficultés neuropsychologiques, les facteurs de risque et de protection au développement de telles difficultés, ainsi que les conséquences possibles lorsque des difficultés neuropsychologiques ne sont pas prises en charge.
... Our results highlight the importance of screening for depression and cognitive impairment in all older adults with schizophrenia or schizoaffective disorder and the potential important value of interventions targeting depression and cognitive impairment for improving QoL. For example, cognitive remediation therapy (Garrido et al., 2013;Wykes et al., 2011), social skill therapy (Almerie et al., 2015;Mueller et al., 2013), cognitive behavioral therapy (Dixon et al., 2010;Granholm et al., 2005) and antidepressants such as selective serotonin reuptake inhibitor Zisook et al., 2009) have shown benefits to improving cognition (Goff et al., 2011;McGurk et al., 2007), mood (Bark et al., 2003;Bartels et al., 2014;Cohen et al., 2015;Dixon et al., 2010;Granholm et al., 2013;Kasckow et al., 2010;Zisook et al., 2009) and quality of life (Cohen et al., 2011;Garrido et al., 2013;Kasckow et al., 2010;Zisook et al., 2009). Prior research (Cohen et al., 2015) has also suggested that physical activity, which is associated with cognitive improvement and depression alleviation, may also improve QoL (Leutwyler et al., 2014a(Leutwyler et al., , 2014b. ...
... Our results highlight the importance of screening for depression and cognitive impairment in all older adults with schizophrenia or schizoaffective disorder and the potential important value of interventions targeting depression and cognitive impairment for improving QoL. For example, cognitive remediation therapy (Garrido et al., 2013;Wykes et al., 2011), social skill therapy (Almerie et al., 2015;Mueller et al., 2013), cognitive behavioral therapy (Dixon et al., 2010;Granholm et al., 2005) and antidepressants such as selective serotonin reuptake inhibitor Zisook et al., 2009) have shown benefits to improving cognition (Goff et al., 2011;McGurk et al., 2007), mood (Bark et al., 2003;Bartels et al., 2014;Cohen et al., 2015;Dixon et al., 2010;Granholm et al., 2013;Kasckow et al., 2010;Zisook et al., 2009) and quality of life (Cohen et al., 2011;Garrido et al., 2013;Kasckow et al., 2010;Zisook et al., 2009). Prior research (Cohen et al., 2015) has also suggested that physical activity, which is associated with cognitive improvement and depression alleviation, may also improve QoL (Leutwyler et al., 2014a(Leutwyler et al., , 2014b. ...
Article
Background: Little is known about the respective effects of depression and cognitive impairment on quality of life among older adults with schizophrenia spectrum disorder. Methods: We used data from the Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia or schizoaffective disorder (N = 353). Quality of life (QoL), depression and cognitive impairment were assessed using the Quality of Life Scale (QLS), the Center of Epidemiologic Studies Depression scale and the Mini-Mental State Examination, respectively. We used structural equation modeling to examine the shared and specific effects of depression and cognitive impairment on QoL, while adjusting for sociodemographic characteristics, general medical conditions, psychotropic medications and the duration of the disorder. Results: Depression and cognitive impairment were positively associated (r = 0.24, p < 0.01) and both independently and negatively impacted on QoL (standardized β = -0.41 and β = -0.32, both p < 0.01) and on each QLS quality-of-life domains, except for depression on instrumental role and cognitive impairment on interpersonal relations in the sensitivity analyses excluding respondents with any missing data. Effects of depression and cognitive impairment on QoL were not due to specific depressive symptoms or specific cognitive domains, but rather mediated through two broad dimensions representing the shared effects across all depressive symptoms and all cognitive deficits, respectively. Limitations: Because of the cross-sectional design of this study, measures of association do not imply causal associations. Conclusions: Mechanisms underlying these two broad dimensions should be considered as important potential targets to improve quality of life of this vulnerable population.
... Interestingly, Puig et al. [138] demonstrated significant improvements in verbal memory and executive functions, with medium-to-large effect sizes in a sample of fifty adolescents diagnosed with early-onset schizophrenia. Moreover, CR integrated within a supported education setting demonstrated interesting outcomes in specific areas of functioning and mental health [139] and CR was also shown to exert a significant effect on both disorganization and negative symptoms [140]. ...
... 3) The number of female participants was very low Garrido et al., 2013 Crosssectional study ...
Article
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Results: Increasing utilization of diverse types of atypical antipsychotic drugs (AAPDs), e.g. clozapine-type serotonin (5-HT)2A and weak dopamine (DA) D2 antagonist, amisulpride, a D2/D3/5-HT7 antagonist, and cariprazine, a D3 partial agonist with additional neurotransmitter targets, is occurring as their advantages in efficacy, especially for cognitive impairment and mood symptoms, and side effects is becoming appreciated. Typical APDs, e.g. haloperidol, are diminishing in favor because of their EPS, especially, tardive dyskinesia (T D) and appreciation that reducing D2 receptor stimulation is not the only means to treat psychosis. Some of the mechanisms inherent in various AAPDs, e.g. 5-HT2A inverse agonism, and D3 receptor partial agonism, are now recognized as effective treatments for psychosis. A new focus on treating the cognitive impairment associated with schizophrenia (CIAS) has emerged via mechanisms such as stimulation of acetyldraline receptor with muscarinic and nicotinic receptor agonists, but demonstrating their efficacy in trials is proving elusive. Pharmacogenetic strategies which may lead to personalized treatment of schizophrenia is emerging but has not yet succeeded in being widely reimbursable. Transcranial stimulation and cognitive enhancement therapy are more common but more evidence for their efficacy is needed. Conclusion: The heterogeneity of the pathophysiology of the various domains of schizophrenia require a diversity of treatments that are best met by the expert use of AAPDs at the current time. Pharmacogenetic efforts are consistent with new evidence that multiple genes are involved in the risk for schizophrenia and the effectiveness of AAPDs.
... This aligns with the subjective reports from participants in the focus groups, who identified cognitive deficits as a major concern. These findings underscore the potential value of behavioral training-based interventions, particularly cognitive remediation therapy, in mitigating cognitive difficulties and promoting recovery [39,40]. However, access to such therapies remains limited, especially in low-income settings where availability lags behind that of middle-and high-income regions [41]. ...
Article
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The comprehensive and brief International Classification of Functioning, Disability and Health (ICF) core sets for schizophrenia, based on the World Health Organization (WHO) framework, aim to describe the functioning of individuals with schizophrenia. The objective of this study was to identify the most common problems faced by these individuals and validate the ICF core sets. Eight focus groups were conducted, recorded, and transcribed verbatim. The linking process involved two independent coders identifying meaningful units and linking agreed-upon concepts to the ICF categories. Data saturation was defined as the point at which no new categories emerged from additional focus groups. The 37 participants in this study represented the WHO regions of Africa, South-East Asia, the Western Pacific, and Europe. The focus groups confirmed the relevance of all ICF core set categories, with an additional 21 s-level categories being proposed in at least six of the eight focus groups. In this study, the ICF core sets for schizophrenia were validated from the perspective of individuals. However, several second-level categories not currently included in the ICF core sets also emerged. To ensure that the ICF core sets are truly international in scope, the potential relevance of these categories should be investigated further.
... 21,22 Moreover, in people with schizophrenia, computer-based cognitive interventions have led to improvements in neuropsychological performance, quality of life, and self-esteem. 23 Hence, treating the cognitive area can bring benefits in other areas as well. ...
Article
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Objective: The aim of this study was to evaluate and compare the impressions of older adults with mild dementia/MCI (mild cognitive impairment) and people with schizophrenia towards the usability of GRADIOR (version 4.5) and their user experience (UX) with this computerized cognitive rehabilitation program. Methods: The impressions towards the usability of GRADIOR and the UX of 41 older adults with mild dementia/MCI and 41 people with schizophrenia were obtained using the User Experience Questionnaire. Results: Older adults with dementia/MCI had more positive impressions than people with schizophrenia. Both agreed that its quality was lower in Dependability. Conclusion: GRADIOR meets users’ needs and preferences but needs improvements to ensure they feel more in control when interacting with it. For people with schizophrenia, other aspects of usability and UX need improvement. Usability and UX evaluation allow the verification of technological acceptability and functionality, and to identifying specific improvements for each user group.
... The Measurement And Treatment Research to Improve Cognition in Schizophrenia (MATRICS) group identified seven domains of cognition impaired in people with schizophrenia (PWS). 1 These are associated with worse functional and clinical outcomes. [2][3][4][5] Even if there is no conclusive evidence about the effect of antipsychotic medication on cognition, there is promising evidence that adjunctive pharmacological 6-10 and psychosocial [11][12][13] interventions can mitigate the impact of cognitive difficulties in PWS. However, these interventions are not offered routinely. ...
... In this study, BACS motor speed and verbal fluency showed significant positive correlations with positive automatic thoughts. Garrido et al. (2013) reported improvements in self-esteem and neurocognition in schizophrenia patients treated with cognitive remediation therapy (CRT). Taken together with the results of the present study, it is possible that neurocognition correlates with positive selfperception and thinking and that improving neurocognition may be effective in improving positive self-perception and thinking. ...
Article
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This study investigated the relationships between negative and positive automatic thoughts and clinical variables in patients with schizophrenia. The participants included 36 patients with schizophrenia (male = 16; female = 20; age = 42.86 ± 9.40) who were outpatients in the Department of Psychiatry at Tokushima University Hospital. We used the Automatic Thoughts Questionnaire-Revised (ATQ-R), Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), and Brief Assessment of Cognition in Schizophrenia (BACS) to assess negative and positive automatic thoughts, positive and negative symptoms, depressive symptoms, and neurocognition, respectively. Spearman rank correlation coefficients were calculated to determine the relationships between negative and positive automatic thoughts and clinical variables. No relationship was observed between negative and positive automatic thoughts. Negative automatic thoughts were related to depressive symptoms. Positive automatic thoughts were related to neurocognition. We therefore surmise that each automatic thought might have different clinical features and outcomes, and should therefore be treated accordingly.
... Economic studies assessing cost effectiveness of the rehabilitation methods, would hopefully convince policy makers and stakeholders to have cognitive rehabilitation programs reimbursed by public health insurance. There are a few studies that have succeeded to demonstrate the cost effectiveness of cognitive rehabilitation interventions, compared with traditional psychosocial ones (Garrido et al. 2013;Patel et al. 2010;Yamaguchi et al. 2017). Expanding the implementation of cognitive remediation programs could bring results not only beneficial and relieving for patients, families, and society, but also, in a broad sense, life saving. ...
Chapter
Objective: Antipsychotic drugs constitute the basis of schizophrenia therapy; however, available pharmaceutical agents lack efficacy for treating the cognitive deficits caused by the illness. The aim of the present work is to present current data regarding cognitive rehabilitation of schizophrenia, providing information and guidance to health professionals. Method: A literature search was conducted in the PubMed and Google Scholar Databases from inception up to 1/9/2022. Relevant articles were explored for factors affecting cognitive function, including genetics, psychopathology, time in the course of the illness, and drug therapy. Characteristics and outcome of cognitive rehabilitation programs are briefly presented. Results: A total of 562 relevant articles were retrieved, 39 of which were selected for the review. Factors contributing to a favorable outcome are young age, early phase of disease, symptomatic control of hostility and conceptual disorganization, lack of negative symptoms, management of drug side effects, and cognitive and cortical reserve. Some evidence for a procognitive effect seems to exist for atypical antipsychotics, clozapine, aripiprazole, memantine, modafinil, d-serine, and cycloserine. The Val/Val polymorphism of the COMT gene seems to be associated with worse outcome. Specific remediation strategies include programs such as Cognitive Enhancement Therapy (CET), Cognitive Adaptation Training (CAT), and RehaCom Cognitive Therapy Software, among others, all employing a range of techniques, from paper-and-pencil to computer-assisted, bottom-up, or top-down approaches, and varying neurocognitive targets. Conclusion: Cognitive symptoms, closely related to functional impairment, still remain a therapeutic challenge. Cognitive rehabilitation strategies are as yet the only treatment modality offering cognitive improvement to patients who struggle to recover.
... The meta-analysis included 58 studies, Bell, Fiszdon, Greig, Wexler, and Bryson (2007), Bell, Zito, Greig, and Wexler (2008), Bellucci, Glaberman, and Haslam (2003), Bryce et al. (2018), Cavallaro et al. (2009), Choi et al. (2018, Contreras, Tan, Lee, Castle, and Rossell (2018), d 'Amato et al. (2011), Eack et al. (2009), Fisher, Holland, Merzenich, and Vinogradov (2009), Fisher, Holland, Merzenich, and Vinogradov (2010), Fisher, Mellon, Wolkowitz, and Vinogradov (2016, Fisher et al. (2015), Fiszdon, Kurtz, Choi, Bell, and Martino (2016), Garety et al. (2015), Garrido et al. (2013), Gottlieb et al. (2017), Greig, Zito, Wexler, Fiszdon, and Bell (2007) ...
Article
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Background: Technology-based interventions (TBIs) are a useful approach when attempting to provide therapy to more patients with psychosis. Methods: Randomized controlled trials of outcomes of TBIs v. face-to-face interventions in psychosis were identified in a systematic search conducted in PubMed/Ovid MEDLINE. Data were extracted independently by two researchers, and standardized mean changes were pooled using a three-level model and network meta-analysis. Results: Fifty-eight studies were included. TBIs complementing treatment as usual (TAU) were generally superior to face-to-face interventions (g = 0.16, p ≤ 0.0001) and to specific outcomes, namely, neurocognition (g = 0.13, p ≤ 0.0001), functioning (g = 0.25, p = 0.006), and social cognition (g = 0.32, p ≤ 0.05). Based on the network meta-analysis, the effect of two TBIs differed significantly from zero; these were the TBIs cognitive training for the neurocognitive outcome [g = 0.16; 95% confidence interval (CI) 0.09-0.23] and cognitive behavioral therapy for quality of life (g = 1.27; 95% CI 0.46-2.08). The variables educational level, type of medication, frequency of the intervention, and contact during the intervention moderated the effectiveness of TBIs over face-to-face interventions in neurocognition and symptomatology. Conclusions: TBIs are effective for the management of neurocognition, symptomatology, functioning, social cognition, and quality of life outcomes in patients with psychosis. The results of the network meta-analysis showed the efficacy of some TBIs for neurocognition, symptomatology, and quality of life. Therefore, TBIs should be considered a complement to TAU in patients with psychosis.
... La rehabilitación cognitiva ha demostrado no solo una mejora en el desempeño funcional, sino que también en la calidad de vida reportada por los pacientes 82 . Sin embargo, existen resultados contradictorios en cuanto a la intervención psicofarmacológica -por ejemplo en el uso de antipsicóticos como la quetiapina-que ha demostrado mejorar aspectos subjetivos de la disfunción cognitiva así como su desempeño en las pruebas, pero esto no se ve reflejado en sus puntajes de calidad de vida 83 . Por otra parte, intervenciones dirigidas hacia la rehabilitación de la cognición social -como intervenciones psicosociales-han demostrado no solo una recuperación de estos aspectos de la cognición, sino también un aumento en todos los subdominios de calidad de vida 84 ...
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Schizophrenia is a chronic mental illness that affects 0.3-0.7% of the population and is characterized by a spectrum of differentiated symptoms in each patient. Cognitive symptoms have impacts on patients functioning and their possible integration into society, namely cognitive disability has negative effects on Quality of Life. This relationship has been studied with heterogeneous methods, causing controversial results as predictors of Quality of Life cannot be identified in a straightforward way. Identifying predictors of Quality of Life is relevant given that it represents the subjective well-being of the patient beyond the usual outcomes for medicine and psychiatry, such as morbidity or disability. In this project we analyze the impact of cognitive dysfunction on the subjective Quality of Life in 26 outpatients with stable schizophrenia. For this, we used the MCCB instrument to assess cognition, both in its Overall Composite and in its 7 Cognitive Domains. In order to assess Quality of Life, we used the WHOQOL-Bref scale in both its average score and its 4 dimensions. We postulate that cognitive alterations would have negative effects on the subjective Quality of Life and that evaluating it as the Overall Composite it will exceeded statistically in its correlation with the subjective Quality of Life in comparison to the Cognitive Domains. Negative correlations were observed for Attention/Vigilance and positive and of greater magnitude for Social Cognition in relation to the average Quality of Life as well as for its Mental Health dimension. It is unknown what factors could mediate the inverse relationship between neurocognition and subjective Quality of Life in this type of patients. The multiple linear regression models were able to explain the variability of the subjective Quality of Life in their average score by 27%, while for the Mental Health dimension this increases up to 32%. The other five cognitive domains and the other three dimensions of Quality of Life did not show significant associations. In conclusion, we recommended studying the Quality of Life in its dimensions and cognition in its domains in order to clarify with more precision its relationship. We encourage incorporating and expanding the research of the repercussions of the Social Cognition in longitudinal rehabilitation studies, having the subjective Quality of Life as an outcome
... These completion rates are comparable with some studies (15,(28)(29)(30) and in contrast with other ones conducted so far (31), showing a higher attrition rate. Nevertheless, the present study adopted several measures to sustain adherence, mostly by strengthening the relationship with the therapist that has been shown to have a fundamental role in ensuring participants' completion of the training modules (32) and providing social cues to improve patients' self-esteem and motivation, supporting the use of strategies, motivation, or reinforcement and helping to develop metacognition, which is thought to be a key component for improving transfer from cognitive change to functional development (33,34). Indeed, supportive, adaptive, and instructive trainers are thought to be a key ingredient of CACR programs and ultimately what makes them a therapeutic tool rather than a common "brain training, " being instrumental in achieving better training outcomes in CR (34,35). ...
Article
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We aimed to evaluate in a sample of outpatients with schizophrenia (SCZ) the effectiveness of a cognitive remediation (CR) program (through the use of the Cogpack software) [computer-assisted CR (CACR)] in addition to standard therapy on cognitive outcomes as compared with that in a control active group (CAG) and to highlight a possible effect on social cognition (SC), metacognition, symptomatology, and real-world functioning. Of the 66 subjects enrolled, 33 were allocated to CACR and 33 to the CAG. Twenty-three patients in the CACR group and 25 subjects in the CAG completed at least 80% of the 48 prescribed CACR sessions, performed twice a week, for a total of 24 weeks of treatment. A significant time × group interaction was evident, suggesting that patients undergoing CACR intervention improved in specific metacognitive sub-functions (understanding others' mind and mastery), some cognitive domains (verbal learning processing speed, visual learning, reasoning, and problem solving) (h² = 0.126), depressive symptoms, SC, awareness of symptoms, and real-world functioning domains (community activities and interpersonal relationships) more significantly than did patients undergoing CAG. The most noticeable differential improvement between the two groups was detected in two metacognitive sub-functions (understanding others' mind and mastery), in verbal learning, in interpersonal relationship, and in depressive symptomatology, achieving large effect sizes. These are encouraging findings in support of the possible integration of CACR in rehabilitation practice in the Italian mental health services.
... This system of classification is necessary and has been widely used in other fields. Besides, it has provided a common framework with a fundamental knowledge of preventive strategy for health care professionals, clinicians and policymakers (Garrido et al., 2013;Hill et al., 2017). As discussed above, the evidence presented so far supports the idea that CCBT may play a prominent role in the primary prevention of depression, and this may be accelerated by the emergence of cutting-edge technology (Sijbrandij et al., 2016). ...
Article
Background: It is necessary to develop effective preventive interventions before depression established to alleviate depressive symptoms or delay the onset of depression. In this study, we employed Bayesian network meta-analysis to identify the optimal psychosocial intervention approach for preventing depressive symptoms in children and adolescents. Methods: We searched publication databases and conference abstracts, from time of their inception through April 2019 without language restriction, for randomized controlled trials that compared the efficacy of various psy-chosocial intervention approaches. We extracted the mean and standard deviation values between baseline and the last observation, and calculated the change score in depression. We also assessed ranking probability by surface under the cumulative ranking curve using a 95% credible interval. Results: A total of 27 randomized controlled trials, involving 5,976 participants aged between 7 to 18 years, were included in our analyses. Analysis of various valid assessment instruments indicated that computer cognitive-behavioral therapy [standard mean difference (SMD =-1.82)], cognitive-behavioral therapy (SMD =-1.54) and interpersonal psychotherapy (SMD =-1.29) were statistically superior to wait-list group. Among the approaches , computer cognitive-behavioral therapy had the highest probability of being the best intervention, based on improvement from baseline to the end of the intervention (SUCRA = 90.47%, CrI: 0.55, 1.00). Limitations: The results herein may not apply to other cultures and ethnic minorities because about half of the studies included in our analysis were conducted in the United States. Conclusions: Computer cognitive-behavioral therapy was the most recommended intervention to accompany the depression among children and adolescents according to our Bayesian network meta-analysis results.
... If the cognition-sQOL relationship is indeed indifferent to oQOL levels, it would suggest that improved cognition in CRT does only influence functioning [16]. Consequently, improvements in sQOL associated with CRT [48] would not be due to better functioning or cognition, but may instead be linked to other CRT-related factors such as increased socialisation and beliefs about self-worth and capability [49]. Indeed, there is evidence to suggest that improvements in daily living self-efficacy, a concept linked to sQOL, is not exclusively associated with cognitive improvement from CRT [50]. ...
Article
Cognitive impairment is characteristic of schizophrenia but the nature and severity often differ between patients and the relationship with subjective quality of life (sQOL) is inconsistent. This study sought to better characterise the cognition-sQOL relationship in schizophrenia by 1) examining associations between factor analysis-derived cognitive domains and sQOL, 2) investigating if these domains independently predicted sQOL, and 3) exploring if clinical, demographic and functional variables moderated any significant relationships. 47 schizophrenia/schizoaffective disorder patients and 48 healthy controls were assessed. QOL was measured using the Lehman’s QOL Interview. Composite scores were created to represent objective QOL and sQOL, and factor analysis was used to determine cognitive domains from 14 cognitive tasks. Three cognitive domains were derived: visuospatial planning, verbal linguistic and inhibition switching. Tasks comprising the verbal linguistic cognitive domain were significantly associated with and predicted sQOL. Moderation analyses revealed that the direction of this relationship differed between patients and healthy controls, and may be moderated by positive symptom severity in patients. In conclusion, meaning-based (e.g. verbal-linguistic) cognitive abilities may be most closely related to sQOL in schizophrenia. Symptomatology may also impact this relationship, with worsening sQOL among those with more intact verbal-linguistic processing and persistent positive symptoms. These patients may therefore be at greater risk for poor sQOL, but may be more motivated and capable of engaging in and benefiting from offered psychosocial interventions.
... Quality of life encompasses physical health, psychological state, level of independency, social relationship, and relationship between all the above mentioned factors [15]. There have been individual studies to show effectiveness of mindfulness-based cognitive therapy [16], antipsychotic medication [17], computer assisted cognitive remediation [18], drug adherence [19], supported employment [14] and family intervention [20] in improving the quality of life of persons with mental illness. The above intervention studies detail on how individually biological, psychosocial and social interventions helped to improve the quality of life of a person. ...
Article
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The quality of life of a person with psychiatric disability is often determined by illness outcomes, personal journey of recovery, coping with the illness, family support, and successful integration into the community. Biopsychosocial factors either hamper or improve the quality of life of a person with psychiatric disability. To depict the usefulness of the biopsychosocial approach of assessment and intervention in improving the quality of life of a patient with mental illness in India. Case study method using the Biopsychosocial approach. Biopsychosocial approach of assessment and intervention helped in understanding the medical and psychosocial circumstances existing in the patient and his family. This helped in providing appropriate interventions such as psychoeducation about the illness, managing patient’s problematic behaviour, improving patient’s functionality, and ensuring regularity in follow up thus eventuating enhanced quality of life. Mental health professionals can use the biopsychosocial approach of assessment and intervention to gain a comprehensive understanding of the patient and his/her community needs and provide appropriate interventions to help improve the quality of life of a patient suffering from psychiatric disability.
... Although there is no specific treatment available, based on these results, an intervention oriented toward cognitive rehabilitation can be suggested. As shown in previous studies, this intervention could improve performance in cognitive domains and therefore also improve functionality (Garrido et al., 2013;Olivier et al., 2015;Penadés et al., 2006). ...
Article
Background: Functional impairment is a defining feature of psychotic disorders. A range of factors has been shown to influence functioning, including negative symptoms, cognitive performance and cognitive reserve (CR). However, it is not clear how these variables may affect functioning in first-episode psychosis (FEP) patients. This 2-year follow-up study aimed to explore the possible mediating effects of CR on the relationship between cognitive performance or specific clinical symptoms and functional outcome. Methods: A prospective study of non-affective FEP patients was performed (211 at baseline and 139 at follow-up). CR was entered in a path analysis model as potential mediators between cognitive domains or clinical symptoms and functioning. Results: At baseline, the relationship between clinical variables or cognitive performance and functioning was not mediated by CR. At follow-up, the effect of attention (p = 0.003) and negative symptoms (p = 0.012) assessed at baseline on functioning was partially mediated by CR (p = 0.032 and 0.016), whereas the relationship between verbal memory (p = 0.057) and functioning was mediated by CR (p = 0.014). Verbal memory and positive and total subscales of PANSS assessed at follow-up were partially mediated by CR and the effect of working memory on functioning was totally mediated by CR. Conclusions: Our results showed the influence of CR in mediating the relationship between cognitive domains or clinical symptoms and functioning in FEP. In particular, CR partially mediated the relationship between some cognitive domains or clinical symptoms and functioning at follow-up. Therefore, CR could improve our understanding of the long-term functioning of patients with a non-affective FEP.
... Interventions which focus directly on improving self-esteem have been developed and evaluated in service users with psychosis (Garrido et al., 2013;Laithwaite et al., 2007) and members of the general population who experience subclinical symptoms of psychosis (Lincoln, Hohenhaus & Hartmann, 2013). As far as we are aware, besides the group CBT for a self-esteem feasibility study (Akande et al., n.d.), such interventions have yet to be trialled in UHR populations. ...
Article
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Aim Low self‐esteem (LSE) has been reported among individuals with psychosis and is hypothesized to act as a risk and maintenance factor for the disorder. However, the extent to which LSE also characterizes individuals deemed at ultra‐high risk (UHR) for psychosis (who present features consistent with the prodromal phase of illness), has yet to be quantified using meta‐analysis. This is important given that LSE is a potentially modifiable target for early intervention services aiming to reduce the risk of psychosis transition in this population. Methods We searched Medline, Embase, PsycINFO and Web of Science Core Collection for studies examining self‐esteem in UHR and healthy individuals. Random‐effects models were used to examine group differences in self‐esteem (Hedges'g) with exploratory meta‐regression analyses employed to investigate the effect of study characteristics (mean age of UHR group, the proportion of male participants in the UHR group and study quality) on standardized mean differences. Results Six studies were eligible for inclusion. Significant differences in self‐esteem were observed, with individuals at UHR showing reduced self‐esteem relative to healthy controls (g = −1.33 [−1.73 to −0.94] P < .001).However, there was evidence of substantial heterogeneity (I² = 75%). Exploratory meta‐regression analyses indicated a significant effect of the mean age of the UHR group on effect sizes (B = −0.26, P = .02). Conclusions UHR youth present with lower levels of self‐esteem than healthy individuals, a difference that appears to be more pronounced with advancing age. We discuss clinical implications and provide recommendations for future studies.
... Schizophrenia spectrum disorders (SZ) are characterised by social and community dysfunction (Couture et al., 2006;Garrido et al., 2013). In addition to positive and negative symptoms like hallucinations, delusions and anhedonia, difficulty in navigating the social world has a substantial impact on daily-life functioning (Couture et al., 2006;Fett et al., 2011;Velthorst et al., 2016). ...
Article
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This study examined the feasibility and effectiveness of an interactive smartphone application that aimed to improve daily-life social functioning and symptoms in schizophrenia spectrum disorders (SZ) with Experience Sampling Method (ESM) derived personalised feedback.Two groups of outpatients with a diagnosis of SZ were included (one receiving ESM-derived personalised feedback (n = 27) and one without feedback (n = 23)) and used the interactive smartphone application for three weeks. Main outcomes were momentary symptoms and social functioning, as assessed by ESM questionnaires. Additionally, feasibility and user-friendliness of the application were assessed. Theresponse rate was 64% for the ESM questionnaires. In the feedback group, participants indicated that on 49% of the ESM days %they acted on at least one personalised feedback prompt per day. Momentary psychotic symptoms significantly decreased over time only in the feedback group. Momentary loneliness and questionnaire-assessed psychotic symptoms decreased over time, irrespective of feedback. Participants evaluated the SMARTapp as user-friendly and understandable. Momentary personalised feedback may impact momentary psychosis in daily life. Feelings of loneliness and questionnaire-based measured psychotic symptoms may be more responsive to non-specific effects of daily-life self-monitoring, not requiring specific feedback. Ecological momentary interventions offer opportunities for accessible and effective interventions in SZ.
... Another study by Moore et al. [24] showed that the use of aerobic exercise and recreational therapy programs had the ability to prevent or reduce the problems and needs of these patients and subsequently increased their chances of social reintegration. Garcia et al., [25] posited that recreation and the community play a role in enhancing the daily functioning of patients with schizophrenia, whereas Garrido et al., [26] stated that to improve the quality of life in patients with schizophrenia, active treatment for negative symptoms, psychological distress and resistance should be recommended. In addition, Gallagher et al., [8] have asserted in their study that since CBT includes elements of cognitive rehabilitation therapy, it is considered an effective cure alongside drug therapy in the treatment of schizophrenic patients, and can thus be applied as an effective intervention for schizophrenic patients in Iran. ...
... CARC has been used with promising results in many studies to assist with the drill-and-practice aspect of the therapy. Garrido et al. (2013), for instance, compared the effect of CARC on the neuropsychological measures and secondary outcomes (quality of life and self-esteem) of patients diagnosed with schizophrenia. The findings showed an improvement in speed of processing, working memory and problem-solving as well as significant improvement in quality of life and self-esteem in patients who underwent CARC. ...
... Cogpack, PSSCogRehab, Rehacom) for CRT has increased. [21][22][23][24][25] Computer-assisted CRT helps motivate participants by providing immediate feedback that is individualized through adjustment of difficulty levels such as speed and complexity. Table 1 summarizes previous meta-analyses that compiled the results of several randomized controlled trials (RCT) of CRT in patients with schizophrenia. ...
Article
Patients with schizophrenia experience cognitive impairments that relate to poorer social functioning even after amelioration of positive symptoms. Pharmacological treatment and cognitive remediation are the two important therapeutic approaches for cognitive impairment in schizophrenia. Cognitive remediation therapy (CRT) for schizophrenia improves cognitive functioning and induces neuroplasticity. However, different approaches and durations of CRT and different neuroimaging devices have led to variable results in meta‐analyses. The objective of this review is to explore the impact of CRT on neurobiology. Several studies have provided evidence of increased activation in the frontal brain regions, such as the prefrontal cortex, anterior cingulate cortex, and parietal and occipital regions during working memory or executive function tasks after CRT. Two studies have shown alterations in resting‐state connectivity between the prefrontal cortex and temporal regions. Two studies have reported that CRT induces changes in gray matter volume in the hippocampus. Further, one study observed that patients who had received CRT exhibited elevated fractional anisotropy values in the basal ganglia. We conclude that neuroimaging studies assessing CRT in patients with schizophrenia showed functional, structural, and connectivity changes that were positively correlated with cognitive improvements despite heterogeneous CRT approaches. Future studies that combine multiple modalities are required to address the differences, effects of intrinsic motivation, and pharmacological augmentation of CRT. Further understanding of the biological basis might lead to predictions of the CRT response in patients with schizophrenia and contribute to identification of schizophrenic patients for future interventions. This article is protected by copyright. All rights reserved.
... CARC has been used with promising results in many studies to assist with the drill-and-practice aspect of the therapy. Garrido et al. (2013), for instance, compared the effect of CARC on the neuropsychological measures and secondary outcomes (quality of life and self-esteem) of patients diagnosed with schizophrenia. The findings showed an improvement in speed of processing, working memory and problem-solving as well as significant improvement in quality of life and self-esteem in patients who underwent CARC. ...
Article
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Purpose The purpose of this paper is to describe the components, structure and theoretical underpinnings of a cognitive remediation intervention that was delivered within a supported education program for mental health survivors. Design/methodology/approach In total, 21 participants enrolled in the course Strengthening Memory, Concentration and Learning (PREP 1033 at George Brown College (GBC)) with the diagnosis of depression, anxiety, PTSD, ED and substance use disorder were included in the research. After a baseline assessment, participants completed 14 week cognitive remediation training (CRT) protocol that included six essential components that were integrated and implemented within the course structure of the supported education program at GBC. This was followed by a post-training assessment. Findings Analysis of the participants’ performance on CRT protocol using computerized games showed little significant progress. However, the research found a positive change in the self-esteem of the participants that was statistically significant and the findings also aligned with the social and emotional learning framework. Research limitations/implications One of the limitations in the research was the use of computer-assisted cognitive remediation in the form of the HappyNeuron software. The value and relevance of computer assisted needs are to be further examined. It seems that the implementation of the course that explicitly address cognitive challenges creates a supportive environment can be helpful. Practical implications Despite the mixed results and the few limitations associated with the CRT intervention reported in the research, the study offers reminders of the complexity of cognitive remediation and all the factors involved that need to be taken into consideration. Social implications This research created explicit space for addressing some of the implicit assumptions about the cognitive abilities when in post-secondary education. Originality/value This work is based on author’s previous work on cognitive remediation research within the supported education setting.
... Lo que es más, la falta de efecto sobre la autoestima podría deberse a la estabilidad del constructo. Los hallazgos obtenidos, sin embargo, difi eren de los que Garrido et al. (2013) encontraron, referentes a mejoras estadísticamente signifi cativas sobre la cv y la autoestima mediante el uso de un programa de rehabilitación cognitiva que aplicaba técnicas asistidas por ordenador. Pudiera ser que el mayor número de sesiones y la prolongación de la intervención en el tiempo fueran las razones por las cuales encontraron dichas mejoras. ...
Article
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For some years there has been considerable interest in using virtual reality for rehabilitation in schizophrenia, although there is little evidence of its usefulness. The aim of this study was to evaluate the efficacy of an intervention through Nintendo Wii® to improve cognitive domains, self-esteem and quality of life. 40 patients were randomized into two groups: experimental and control. A statistically significant improvement in cognitive domains was found, especially in working memory. Results in quality of life and self-esteem have not obtained statistical significance, though a large effect size appeared. Long-term studies are needed to test the efficacy of virtual reality systems on quality of life and self-esteem, as changes in these constructs may develop in a relatively longer time.
... The trials under this category are related to ICT-based prevention, screening and treatment in the area of mental health. Moreover, studies involve abnormalities in cognitive processes [51][52][53], depression and anxiety [54][55][56][57][58][59][60][61]. It also includes trials related with addictions, such as smoking [62][63][64][65], alcohol use [66,67] and drugs [68]. ...
Article
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Background: The application of Health Information Technologies (HITs) can be an effective way to advance medical research and health services provision. The two-fold objective of this work is to: (i) identify and review state-of-the-art HITs that facilitate the aims of evidence-based medicine and (ii) propose a methodology for HIT assessment. Methods: The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Furthermore, we consolidated existing knowledge in the field and proposed a Synthesis Framework for the Assessment of Health Information Technology (SF/HIT) in order to evaluate the joint use of Randomized Controlled Trials (RCTs) along with HITs in the field of evidence-based medicine. Results: 55 articles met the inclusion criteria and refer to 51 (RCTs) published between 2008 and 2016. Significant improvements in healthcare through the use of HITs were observed in the findings of 31 out of 51 trials-60.8%. We also confirmed that RCTs are valuable tools for assessing the effectiveness, acceptability, safety, privacy, appropriateness, satisfaction, performance, usefulness and adherence. Conclusions: To improve health service delivery, RCTs apply and exhibit formalization by providing measurable outputs. Towards this direction, we propose the SF/HIT as a framework which may help researchers to carry out appropriate evaluations and extend their studies.
... Based on these results, an intervention oriented toward cognitive rehabilitation can be suggested (56) in patients with a low CR. As shown in previous studies, this intervention could improve performance in cognitive domains and therefore also improve functionality (57)(58)(59). Specifically, in order to address the needs of patients with low CR, cognitive rehabilitation treatments will need to be 'enriched' by adding some pro-cognitive pharmacological agents (60,61) or using more sophisticated approaches like the action-based cognitive remediation treatment (62). ...
Article
Objective Cognitive reserve (CR) refers to the brain's capacity to cope with pathology in order to minimize the symptoms. CR is associated with different outcomes in severe mental illness. This study aimed to analyze the impact of CR according to the diagnosis of first‐episode affective or non‐affective psychosis (FEP). Method A total of 247 FEP patients (211 non‐affective and 36 affective) and 205 healthy controls were enrolled. To assess CR, common proxies have been integrated (premorbid IQ; education–occupation; leisure activities). The groups were divided into high and low CR. Results In non‐affective patients, those with high CR were older, had higher socioeconomic status (SES), shorter duration of untreated psychosis, and a later age of onset. They also showed greater performance in most cognitive domains. In affective patients, those with a greater CR showed a higher SES, better functioning, and greater verbal memory performance. Conclusion CR plays a differential role in the outcome of psychoses according to the diagnosis. Specifically, in order to address the needs of non‐affective patients with low CR, cognitive rehabilitation treatments will need to be ‘enriched’ by adding pro‐cognitive pharmacological agents or using more sophisticated approaches. However, a functional remediation therapy may be of choice for those with an affective psychosis and low CR.
... Described improvements are consistent with reviews concluding that CR may enhance cognitive test performance and support greater functioning in outcomes distal to the training targets (i.e., social interaction; Medalia & Saperstein, 2013;Paquin, Wilson, Cellard, Lecomte, & Potvin, 2014;Wykes et al., 2011). This study also provides further support that outcomes dependent on internal evaluations, such as perceived competence, subjective quality of life and self-esteem, are responsive to learning-based interventions in people with schizophrenia (Bowie et al., 2017;Cavallaro et al., 2009;Garrido et al., 2013). ...
Article
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Objective: Cognitive remediation (CR) is a promising method of improving cognitive functioning in people with schizophrenia. Nevertheless, the lived experience of participation, and whether this differs from computer game (CG) playing control conditions, remains poorly understood. This study aimed to qualitatively compare the experience of participating in these 2 interventions. Method: Forty-two outpatients with schizophrenia or schizoaffective disorder completed a qualitative survey with 7 open-ended questions after completing 10 weeks of CR (n = 22) or CG (n = 20). An iterative and inductive thematic analysis was used to identify and tally reoccurring codes and facilitate their organization into overarching themes. Results: Four high-order themes summarized the data: (a) Perceived benefits; (b) Experience of group; (c) Operation of group; and (d) Suggestions for improvement. Participation was described as enjoyable with similar levels of social and intrinsic benefits reported by study completers in both CR and CG groups. CR completers were more likely to report improvements in memory and everyday functioning as well as greater opportunities to acquire new cognitive skills and experience personal and cognitive challenge. CR completers also described the pursuit of shared goals with other peers. Conclusions and implications for practice: CR and CG share qualitative benefits in schizophrenia. CR may, however, offer a supportive environment where participants can encounter and surmount personal challenges, learn new abilities that may be functionally relevant and experience team-based success. These benefits may be unique to CR and contribute to increases in self-efficacy, which could bridge the gap between capacity and real world functioning in schizophrenia. (PsycINFO Database Record
... Consistent evidence from randomized controlled trials demonstrates significant, durable improvements in cognition and daily functioning in people with schizophrenia [11][12][13][14][15][16] with additional evidence indicating that cognitive gains translate to improvements that impact quality of life. 17 Cognitive remediation is linked to improvement in social functioning, psychiatric symptoms, and vocational outcomes. [18][19][20][21][22] Further, emerging evidence indicates that CR programs are effective for first episode psychosis [23][24][25] and for people with affective disorders. ...
Article
Introduction With the increasing enthusiasm to provide cognitive remediation (CR) as an evidence-based practice, questions arise as to what is involved in implementing CR in a large system of care. This article describes the first statewide implementation of CR in the USA, with the goal of documenting the implementation issues that care providers are likely to face when bringing CR services to their patients. Methods In 2014, the New York State Office of Mental Health set up a Cognitive Health Service that could be implemented throughout the state-operated system of care. This service was intended to broadly address cognitive health, to assure that the cognitive deficits commonly associated with psychiatric illnesses are recognized and addressed, and that cognitive health is embedded in the vocabulary of wellness. It involved creating a mechanism to train staff to recognize how cognitive health could be prioritized in treatment planning as well as implementing CR in state-operated adult outpatient psychiatry clinics. Results By 2017, CR was available at clinics serving people with serious mental illness in 13 of 16 adult Psychiatric Centers, located in rural and urban settings throughout New York state. The embedded quality assurance program evaluation tools indicated that CR was acceptable, sustainable, and effective. Conclusions Cognitive remediation can be feasibly implemented in large systems of care that provide a multilevel system of supports, a training program that educates broadly about cognitive health and specifically about the delivery of CR, and embedded, ongoing program evaluation that is linked to staff supervision.
... Another study by Moore et al. [24] showed that the use of aerobic exercise and recreational therapy programs had the ability to prevent or reduce the problems and needs of these patients and subsequently increased their chances of social reintegration. Garcia et al., [25] posited that recreation and the community play a role in enhancing the daily functioning of patients with schizophrenia, whereas Garrido et al., [26] stated that to improve the quality of life in patients with schizophrenia, active treatment for negative symptoms, psychological distress and resistance should be recommended. In addition, Gallagher et al., [8] have asserted in their study that since CBT includes elements of cognitive rehabilitation therapy, it is considered an effective cure alongside drug therapy in the treatment of schizophrenic patients, and can thus be applied as an effective intervention for schizophrenic patients in Iran. ...
Article
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Schizophrenia is a psychiatric condition that has detrimental outcomes on an individual’s thinking, understanding and feelings. However, it not only affects one’s actions and emotions, but also, and quite specifically, creates an avenue for such antisocial behavior as seclusion. Hence, it is important to highlight the necessary requirements for the recovery of schizophrenic patients and subsequently delve deeper into the signs and symptoms of schizophrenia itself, especially among patients who have been confined to psychiatric care for too long. The aim of this study was to determine the effects of recreation therapy on smoking as well as the positive-negative symptoms of schizophrenia among patients who have reached the chronic stage of this condition. Essentially, this was a semi-experimental study with one pretest and one posttest. 50 patients under psychiatric care, aged between 30 to 50 years, were selected and then equally divided into the control and experimental groups. The instruments for this research were the Anderson questionnaire and the smoking cigarette questionnaire, the latter being created by the researcher. Data were analyzed using descriptive and inferential statistics. To evaluate the hypothesis of research, this study relied on a covariance analysis. Based on the results, it can be said that there were significant (p ≤ 0.05) differences between the control and experimental groups related to smoking as well as the positive-negative symptoms of schizophrenia. It shows that 4 months of recreation therapy was able to decrease the prevalence of smoking (19.9%), in addition to the positive symptoms (18.3%) and negative symptoms (14.7%) of schizophrenia within the experimental group. It is hoped that the results of this study will encourage the use of recreation therapy as a practical and non-pharmacological form of treatment for patients with chronic schizophrenia.
... Overall, participants across both groups experienced improvements in their self-esteem, quality of life and social relationships. This is consistent with previous quantitative cognitive remediation research reporting improved intrinsic social functioning (Garrido et al., 2013;Huddy et al., 2012;Medalia and Saperstein, 2013), and more recent qualitative data describing associated cognitive remediation psychosocial-occupational benefits from participants' personal experiences (Contreras et al., 2016a(Contreras et al., , 2016b. This highlights the broader psychosocial benefits of participation for people with schizophrenia in structured group-based therapies. ...
Article
Approaches to cognitive remediation (CR) that address sensory perceptual skills before higher cognitive skills, have been found to be effective in enhancing cognitive performance in schizophrenia. To date, however, most of the conducted trials have concentrated on auditory processing. The aim of this study was to explore whether the addition of visual processing training could enhance standard cognitive remediation outcomes in a schizophrenia population. Twenty participants were randomised to either receive 20h of computer-assisted cognitive remediation alone or 20h of visual processing training modules and cognitive remediation training. All participants were assessed at baseline and at the end of cognitive remediation training on cognitive and psychosocial (i.e. self-esteem, quality of life) measures. At the end of the study participants across both groups improved significantly in overall cognition and psychosocial functioning. No significant differences were observed between groups on any of the measures. Of potential interest, however, was that the Cohen's d assessing the between group difference in the rates of change were moderate/large for a greater improvement in Visual Learning, Working Memory and Social Cognition for the visual training plus cognitive remediation group. On the basis of our effect sizes on three domains of cognition, we recommend replicating this intervention with a larger sample.
... Garrido et al. 50 assessed the effectiveness of another computer-assisted cognitive remediation (CACR) program. The aim of this program is to train attention span, working memory, and executive functions (reasoning and problem-solving). ...
Article
Cognitive impairment is a core aspect of schizophrenia. Studies have postulated that it is the basis of the disease as evidenced by its independent and persistent quality and its relation to prognosis. Research on cognitive deficits in psychotic disorders has led to the development of intervention strategies for the cognitive rehabilitation of these patients. Attention, working memory, and executive functions are among the most widely affected functions and are closely related to the functionality of these patients. This work aims to study the effectiveness of cognitive rehabilitation targeting attention, executive functions, and working memory in people diagnosed with a psychotic disorder (mostly schizophrenia). An exhaustive search in PubMed and PsycINFO was conducted up to January 2016. All research papers that were included studied a therapeutic technique to improve one or more of the aforementioned functions in patients over age 16 years diagnosed with psychotic disorder. Studies with methodological diversity were included, which were afterwards organized by levels of evidence. Thirty-four papers were studied, from which we can conclude that cognitive rehabilitation of the aforementioned cognitive functions brings about improvements in cognition. As a result of the influence of cognitive rehabilitation on other variables such as social functioning and symptoms of the disease, the results are promising.
... Some researchers have used puzzles (e.g., Tower of Hanoi), while others have used neuropsychological tests (e.g., the Wisconsin Card Sorting Test; Bell, Bryson, Greig, Corcoran, & Wexler, 2001;Young & Freyslinger, 1995). In recent years there has also been the increasing use of computer software programs for cognitive remediation (Garrido et al., 2013;Kurtz, Seltzer, Shagan, Thime, & Wexler, 2007;Lee, 2013;Rass et al., 2012). ...
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Objective: Cognitive impairment is common in schizophrenia, and is associated with poor psychosocial functioning. Previous studies had inconsistently shown improvement in cognitive functions with cognitive remediation therapy. This study examined whether cognitive remediation is effective in improving both cognitive and social functions in schizophrenia in outpatient settings that provide learning-based psychiatric rehabilitation. This study is the first randomized controlled trial of cognitive remediation in Japan. Method: Study participants were individuals with schizophrenia from 6 outpatient psychiatric medical facilities who were randomly assigned either a cognitive remediation program or treatment as usual. The cognitive remediation intervention includes Cognitive training using computer software (CogPack; Japanese version) administered twice a week and a weekly group over 12 weeks and was based on the Thinking Skills for Work program. Most study participants were attending day treatment services where social skills training, psychoeducation for knowledge about schizophrenia, group activities such as recreation and sport, and other psychosocial treatment were offered. Cognitive and social functioning were assessed using the Brief Assessment of Cognition in Schizophrenia (BACS) and Life Assessment Scale for Mentally Ill (LASMI) at pre- and postintervention. Results: Of the 60 people with schizophrenia enrolled, 29 were allocated to the cognitive remediation group and 31 were allocated to the treatment as usual group. Processing speed, executive function, and the composite score of the BACS showed significantly greater improvement for the cognitive remediation group than the treatment as usual group. In addition, there was significant improvement in interpersonal relationships and work skills on the LASMI for the cognitive remediation group compared with the treatment as usual group. Changes from pretreatment to posttreatment in verbal fluency and interpersonal relationships were significantly correlated, as well as changes in attention and work skills. Conclusions and Implications for Practice: The present findings showed that providing cognitive remediation on addition to psychiatric rehabilitation contributed to greater improvement in both cognitive and social functioning than psychiatric rehabilitation alone. Cognitive remediation may enhance the efficacy of psychiatric rehabilitation improving social functioning.
... According to the self-reporting of psychosocial measures, participants experienced additional improvements in their selfesteem, quality of life, and social relationships. This is consistent with recent research that reports CR has potential in enhancing intrinsic social functioning (Garrido et al., 2013;Huddy, Reeder, Kontis, Wykes, & Stahl, 2012;Medalia & Saperstein, 2013). ...
Article
Despite advances in the treatment of people with severe mental illness (SMI), access to work for this community still remains a challenge. Cognitive remediation (CR) is an intervention that can improve employment outcomes, especially when offered alongside employment support. This pilot study aimed to determine whether CR enhances vocational outcomes for job seekers participating in an innovative vocationally oriented psycho-educational program implemented in Australia. Fourteen participants with SMI were enrolled in Health Optimisation Program for Employment (HOPE) and attended 20 sessions of CR. Assessments were performed at baseline, post-CR, and 3 months follow-up. Individuals were assessed on a number of occupational and psychosocial variables (e.g., hours of paid and unpaid work, self-esteem, quality of life, social relationships), in addition to undertaking the MATRICS Consensus Cognitive Battery. There was no increase in hours of paid work for those in employment, but 46% of the group initiated tertiary studies between baseline and 3-month follow-up. There was a trend towards a significant increase in number of volunteer hours, with 31% of individuals having initiated a non-paid activity at the end of the CR. As predicted, cognition improved over time as did psychosocial outcomes in the areas of self-esteem, quality of life and social relationships. Consistent with previous studies, CR improved psychosocial and cognitive functioning. While employment benefits were not found, promising outcomes were reported on volunteering and educational participation. This pilot suggests there may be potential for combining CR with HOPE to enhance vocation-related participation and potential employability of job seekers with SMI in Australia. Given these preliminary findings, a further clinical trial with appropriate control group and sample size is required to validate the effectiveness of HOPE+CR.
Article
Background and Hypothesis Cognitive difficulties significantly burdened people with schizophrenia (PWS). However, cognitive assessment is often unavailable in low- and middle-income counties (LMICs) due to a lack of validated and culturally adapted cognitive assessment tools. In this study, we developed and evaluated a culturally sensitive cognitive battery for PWS in Ethiopia. Study Design This study was conducted in three phases. First, we selected appropriate tests through an instrument selection procedure and created a new battery. Then, we rigorously adapted the tests using culturally competent procedures, including cognitive interviewing and expert meetings. Finally, we tested the new battery in 208 PWS and 208 controls. We evaluated its psychometric properties using advanced statistical techniques, including Item Response Theory (IRT). Study Results The Ethiopian Cognitive Assessment battery for Schizophrenia (ECAS) was developed from three different batteries. Participants reported tests were easy to complete, and the raters found them easy to administer. All tests had good inter-rater reliability, and the composite score had very high test-retest reliability (ICC = 0.91). One-factor structure better represented the data with excellent internal consistency (α = .81). ECAS significantly differentiated PWS from controls with 77% sensitivity and 62% specificity at a Z-score ≤0.12 cut-off value. IRT analysis suggested that the battery functions best among moderately impaired participants (difficulty between −0.06 and 0.66). Conclusions ECAS is a practical, tolerable, reliable, and valid assessment of cognition. ECAS can supplement current assessment tools in LAMICs for PWS and can be used to measure cognitive intervention outcomes.
Article
Individuals with schizophrenia often experience poor psychosocial outcomes and self-stigma. This study aimed to investigate the effect of compensatory cognitive training (CCT) on self-esteem, self-efficacy, quality of life, and self-stigma in schizophrenia. Forty-six participants with schizophrenia were randomly assigned to intervention (CCT group, n = 24) or treatment as usual (TAU group, n = 22). The Rosenberg Self-Esteem Scale (RSES), the General Self-Efficacy Scale (GSES), the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4), and the Internalized Stigma of Mental Illness Scale (ISMIS) were administered at pretest (T0), posttest (T1), and 1-month follow-up (T2). A significant result was found at T2 in the SQLS-R4 score between CCT and TAU groups ( P = 0.001). A significant result was also noted at T2 in the ISMIS score ( P = 0.004). These findings show that CCT contributes to improvement in quality of life and self-stigma in individuals with schizophrenia. Accordingly, CCT may enhance the effectiveness of psychiatric rehabilitation programs. [ Psychiatr Ann . 2023;53(10):473–481.]
Article
: This systematic review aimed to evaluate the efficacy of Cognitive Behavioral Therapy (CBT), META Cognitive Therapy (MCT), Metacognitive Training (MCTR), Metacognitive Reflection and Insight Therapy (MERIT), of various rehabilitation programs and of recovery programs in schizophrenia. Medline/Pubmed was searched for studies published in English from January 2010 to August 2018, which were screened against inclusion criteria by two reviewers. The methodological quality of the included studies was evaluated by two independent raters, which are the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies and the fidelity criteria. The study included 41 RCTs and 12 case studies with n = 3,059 persons with schizophrenia. Cognitive Behavioral Therapy (CBT) proved to be superior in terms of the improvement of primary and secondary outcomes. MCT decreased positive symptoms and improved metacognitive capacity and insight. MCTR reduced positive symptoms and socially disruptive behavior. MERIT improved metacognitive capacity and insight. Rehabilitation programs were efficacious in the improvement of cognition, symptoms, and functional outcome. The recovery programs enhanced illness-management knowledge, attitudes toward medication and insights related to negative symptoms. It is recommended to combine the above evidence based psychotherapeutic interventions. Limitations of this systematic review are discussed toward the end of the essay. Some important factors have to be considered in the future have been mentioned.
Article
Background Executive deficits are a core characteristic of schizophrenia. Yet, the origin of these impairments remains unclear as they may be caused by processing slowing. This issue is of particular interest for aging insofar as cognitive aging is also associated with a decline in executive functioning and a slowing of processing speed. As schizophrenia patients’ life expectancy increases, a better understanding of the origin of older patients’ cognitive deficits becomes essential so that healthcare can be adapted to suit them. This study aims to determine whether processing speed mediates how schizophrenia affects executive functions and whether these relationships are moderated by age. Methods Sixty-two schizophrenia patients (27 women) and 62 healthy comparison subjects matched for age (range: 18–76 years), gender and education performed neurocognitive tests to evaluate their executive functions (shifting, updating, inhibition and access) and processing speed. Results Processing speed mediated the effect of schizophrenia on the four specific executive functions, and age moderated this mediation for shifting, updating and access, but in different ways. Age moderated the effect of processing speed on shifting, the direct effect of schizophrenia on access, and both the effect of processing speed and the direct effect of schizophrenia on updating. Conclusions This research highlights the need to evaluate processing speed routinely during therapeutic follow-up, as it is easy and simple to assess and appears to be at the heart of the cognitive deficits in schizophrenia. Finally, processing speed abilities yield information about the evolution of cognition with aging in schizophrenia.
Article
Aim Cognitive remediation is an evidence‐based intervention targeting the common and disabling cognitive deficits in people with psychosis. Findings from efficacy studies and meta‐analyses show that cognitive remediation produces medium to large effects on cognition in both chronic and first episode patients. However, clinical availability of this treatment remains scarce, reflecting a major gap between science and practice. Here we describe the development of a cognitive remediation programme in an outpatient first episode psychosis clinical service, and preliminary feasibility and acceptability outcomes. Methods Based on evidence from efficacy trials and assessment within the clinic of perceived benefits and barriers, we developed a CR programme that involved both internet‐based computer training exercises and a weekly in‐person therapy group. Outcomes were assessed based on data from three consecutive 12‐week group series. Feasibility outcomes included adoption, fill, cost, and utilization; tolerability outcomes were based on user survey and focus group feedback. Results We found evidence of feasibility including good adoption, fill, utilization, and cost. We also found good tolerability and satisfaction based on feedback from a user survey and focus groups, with more than 80% of respondents reporting high overall satisfaction with the programme and subjective cognitive and functional improvements. Conclusions The present report provides preliminary evidence that cognitive remediation can be translated into real world clinical practice for first episode psychosis. Systematic evaluation of implementation and dissemination of cognitive remediation is needed, and has the potential to improve access to cognitive health interventions for people with psychosis.
Article
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This systematic review aimed to evaluate the efficacy of Cognitive Behavioral Therapy (CBT), META Cognitive Therapy (MCT), Metacognitive Training (MCTR), Metacognitive Reflection and Insight Therapy (MERIT), of various rehabilitation programs and of recovery programs in schizophrenia. Medline/Pubmed was searched for studies published in English from January 2010 to August 2018, which were screened against inclusion criteria by two reviewers. The methodological quality of the included studies was evaluated by two independent raters, which are the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies and the fidelity criteria. The study included 41 RCTs and 12 case studies with n = 3,059 persons with schizophrenia. Cognitive Behavioral Therapy (CBT) proved to be superior in terms of the improvement of primary and secondary outcomes. MCT decreased positive symptoms and improved metacognitive capacity and insight. MCTR reduced positive symptoms and socially disruptive behavior. MERIT improved metacognitive capacity and insight. Rehabilitation programs were efficacious in the improvement of cognition, symptoms, and functional outcome. The recovery programs enhanced illness-management knowledge, attitudes toward medication and insights related to negative symptoms. It is recommended to combine the above evidence based psychotherapeutic interventions. Limitations of this systematic review are discussed toward the end of the essay. Some important factors have to be considered in the future have been mentioned.
Article
Objective: Empowerment is an important component of many recovery-oriented treatments for people diagnosed with psychosis. Cognitive Enhancement Therapy (CET) is an efficacious rehabilitation program targeting social and neuro- cognition, but secondary recovery benefits are unknown. The purpose of this exploratory study was to examine experiences of empowerment among CET participants. Method: Semi-structured interviews were conducted with 16 participants diagnosed with psychotic disorders. Interview transcripts were analyzed by three independent coders using thematic analysis. Results: Four themes consistent with empowerment theory emerged: (1) Peer support; (2) Optimism and control over the future; (3) Power; and (4) Self-esteem. Conclusions: Findings from this exploratory study suggest that experiences of empowerment are a measurable component of CET. Findings highlight opportunities to measure and target empowerment within cognitive rehabilitation and other recovery-oriented interventions.
Article
Well-being is a critical outcome in the recovery from psychosis and the prevention of symptoms. Previous reviews of the effectiveness of psychological interventions have focused on psychotic symptoms and general psychopathology, not recognising well-being as an essential outcome. This study conducted a meta-analysis of the effects of psychological interventions on the well-being and quality of life (QoL) of people with schizophrenia and analysed some critical moderating factors. A systematic literature search was conducted yielding 12986 published reports, 2043 of which were clinical trials. After a detailed review, 36 articles were included in the analyses. Measures of related concepts, well-being and quality of life were included in the present meta-analysis to reflect the current state of the literature and to ensure the representativeness of RCTs that have evaluated the effect of psychological interventions on the extent to which people with schizophrenia experience a good life. Our findings reflect a significant, small, treatment effect on the outcomes of well-being. Subgroup analysis also suggested a significant moderating effect when the primary aim of the intervention was well-being. These findings suggest that symptom or functional improvement does not necessarily lead to an improvement in well-being and would imply the need to focus specifically on those. We recommend psychological interventions that target well-being as a complementary strategy in mental health promotion and treatment. In addition, we stress the need to include well-being outcome measure in RCT as well as to clearly identify the different domains of well-being being measured.
Article
Results: The research site averaged almost triple the number of referrals as the clinical sites. Over nine months 46.51% of clinic referrals were enrolled in the CR program whereas 64.29% of research referrals were enrolled. Clinical site utilization averaged 70.53% while research site utilization averaged 90.47%. At the clinical sites, 97% of respondents reported CR was an excellent or good experience. There was high treatment fidelity for program structure and content across sites. Conclusions: This comparison of CR in clinical and research sites highlights the decrease in referrals, enrollment and utilization that occurs when a program moves from a highly controlled setting to the real world. Still, the acceptability, fill rates and utilization indicated that CR can be successfully implemented in large scale, geographically diverse, publically funded clinic settings.
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Background Randomized trials evaluating electronic Media (eMedia) delivery of interventions are increasingly frequent in mental health. Although a number of reviews have reported efficacy of these interventions, none has reviewed the type of eMedia interventions and quality of their description. We therefore decided to conduct a survey of eMedia-delivered interventions for schizophrenia. Methods We surveyed all relevant trials reliably identified in the Cochrane Schizophrenia Group’s comprehensive register of trials by authors working independently. Data were extracted regarding the size of the trial, interventions, outcomes and how well the intervention was described. Results eMedia delivery of interventions is increasingly frequent in trials relevant to the care of people with schizophrenia. The trials varied considerably in sample sizes (mean =123, median =87, range =20–507), and interventions were diverse, rarely evaluating the same approaches and were poorly reported. This makes replication impossible. Outcomes in these studies are limited, have not been noted to be chosen by end users and seem unlikely to be easy to apply in routine care. No study reported on potential adverse effects or cost, end users satisfaction or ease of use. None of the papers mentioned the use of CONSORT eHealth guidelines. Conclusion There is a need to improve reporting and testing of psychosocial interventions delivered by eMedia. New trials should comply with CONSORT eHealth guidance on design, conduct and reporting, and existing CONSORT should be updated regularly, as the field is constantly evolving.
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Towards the provision of medical research and eHealth services, several Health Information Technology (HIT) platforms are blended with communication and software technologies (i.e. mobile and Web applications, wireless sensor networks, Internet of Things and cloud computing). However, an important research issue is whether and to what degree these technologies are efficiently and effectively integrated into medical practice. Accordingly, this study reviews recent literature on HITs that employ RCTs, which are acknowledged as a reliable solution by the community of health stakeholders. Furthermore, it examines the research efforts in the field and evaluates the relevant functionalities. The literature search strategy was based on PRISMA 2009 Checklist and the CONSORT-EHEALTH Checklist that are two standard methodologies for systematic reviews in Evidence Based Medicine and Health Information Technologies. The analysis of the studies included was performed according to the Cochrane Risk of Bias Assessment Tool. The sources considered in this research include the most common clinical trial registries and academic electronic databases. The studies considered were conducted from 2008 until 2016. The authors considered RCTs having published their results in at least one article. As a result, 55 articles from 42 different journals are considered in this review. The benefits of the HIT delivered interventions are clearly presented in the outcomes of the relevant studies. Significant improvements were observed in the findings of 31 trials from a total of 51 (60.78%) including the acceptance, satisfaction, reliability, usefulness, safety, effectiveness and financial benefit of HITs. The results of this review reveal that HIT and eHealth interventions achieve at least equally reliable and safe outcomes compared with the usual support methods of healthcare. Significantly encouraging results are noticed in interventions employing HIT over several healthcare fields.
Article
The purpose of this paper is to analyze the relationship between self-esteem, symptomatology, cognitive functioning and self-reported cognitive deficits in patients with schizophrenia, and evaluate the effectiveness of a Mind Training Program specifically designed to work self-esteem through cognitive exercises in these patients. The 83 patients with schizophrenia who participated were assessed with the Scale of Positive and Negative Syndrome, the Rosenberg Self-Esteem Scale and the "MATRICS Battery". Subsequently, 40 of these patients were randomized to one of two experimental groups: one that was trained for 10 weeks with a "Mind Training Program" and another that received no training. The results indicate the existence of a negative correlation between self-esteem and self-reported cognitive deficits, so that patients with higher self-esteem have a lower perception of their cognitive deficits. On the other hand, the Mind Training program was not effective in improving symptoms, cognition and self-esteem of these patients.
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Cognitive deficits are stable features of schizophrenia that are linked to functional outcome. Cognitive remediation approaches have been proven successful in ameliorating these deficits, although effect sizes vary considerably. Whether cognitive deficits are serious predictors of clinical outcome is less clear. Sixty patients suffering from schizophrenia were included in our sample, thirty of them received computer-assisted cognitive training, and thirty received occupational therapy. For a subsample of 55 patients, who could be traced over a period of five years after the end of the cognitive remediation intervention, time until first relapse and time in psychosis were determined retrospectively from their medical records. Cognitive remediation significantly improved problem solving, memory and attention with high effect sizes. Employment status, a post test verbal memory performance measure and a measure of executive functioning outperformed all other measures in the prediction of time to relapse, while allocation to treatment group outperformed all other variables in the prediction of both cognitive measures. Cognitive remediation of neurocognitive deficits thus makes sense in a twofold fashion: It enhances cognition directly and positively acts on clinical course indirectly via improved neurocognition.Trial registrationGerman Clinical Trials Register: DRKS00004880.
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Cognitive impairment is a core symptom in schizophrenia that has a significant impact on psychosocial func-tion, but shows a weak response to pharmacological treatment. Consequently, a variety of cognitive remediation strategies have been evaluated to improve cognitive function in schizophrenia. The efficacy of computer-based cognitive remediation as a stand-alone intervention on general measures of neuropsychological function remains unclear. We tested the effectiveness of biweekly training using computerized cognitive remediation programs on neuropsychological and event-related potential outcome measures. Schizophrenia patients were randomly assigned to cognitive remediation training (N = 17), active control (TV-watching; N = 17), or treatment-as-usual (N = 10) groups for ten weeks and run in parallel. Cognitive and ERP measures revealed no differential improvement over time in the cognitive remediation group. Practice effects might explain change over time on several cognitive measures for all groups, consistent with studies indicating task-specific improvement. Computer-assisted cognitive remediation alone may not be sufficient for robust or generalized effects on cognitive and electrophysiological measures in schizophrenia patients.
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Quality of life (QOL) has been recognized as a crucial domain of outcome in schizophrenia treatment, and yet its determinants are not well understood. Recent meta-analyses suggest that symptoms have only a modest relationship to QOL (Eack SM, Newhill CE. Psychiatric symptoms and quality of life in schizophrenia: a meta-analysis. Schizophr Bull. 2007;33:1225-1237). Individuals with schizophrenia show 1-2 SD deficits on measures of elementary neurocognition, and links between these deficits and objective measures of community functioning (eg, employment and independent living) are well established. While objective measures of community functioning and measures of QOL would appear to be closely related, studies investigating the ability of neurocognitive variables to predict QOL in individuals with schizophrenia have yielded conflicting results. One potential explanation for opposing findings in the schizophrenia literature is the interchangeable use of objective and subjective indices of QOL. This study used quantitative methods of meta-analysis to clarify the relationship between neurocognitive determinants of objective QOL (ie, observable, clinician-rated) and subjective QOL (ie, patient satisfaction) separately in individuals with schizophrenia. A total of 20 studies (10 objective and 10 subjective) consisting of 1615 clients were aggregated from relevant databases. Weighted effect size analysis revealed that there were small-moderate relationships (d ≤ 0.55) between crystallized verbal ability, working memory verbal list learning, processing speed, and executive function and objective indices of QOL. In contrast, results revealed either nonsignificant or inverse relationships for the vast majority of neurocognitive measures and measures of subjective QOL. Moderating variables and implications for future research and treatment development are discussed.
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Cognitive remediation is frequently based on computerized training methods that target different cognitive deficits. The aim of this article was to assess the efficacy of computer-assisted cognitive remediation (CACR) in schizophrenia and to determine whether CACR enables selective treatment of specific cognitive domains. A meta-analysis was performed on 16 randomized controlled trials evaluating CACR. The effect sizes of differences between CACR and control groups were computed and classified according to the cognitive domain assessed. The possible influences of four potential moderator variables were examined: participants' age, treatment duration, weekly frequency, and control condition type. To test the domain-specific effect, the intended goal of each study was determined and the effect sizes were sorted accordingly. The effect sizes of the cognitive domains explicitly targeted by the interventions were then compared with those that were not. CACR enhanced general cognition with a mean effect size of 0.38 [confidence interval (CI) 0.20-0.55]. A significant medium effect size of 0.64 (CI 0.29-0.99) was found for Social Cognition. Improvements were also significant in Verbal Memory, Working Memory, Attention/Vigilance and Speed of Processing with small effect sizes. Cognitive domains that were specifically targeted by the interventions did not yield higher effects than those that were not. The results lend support to the efficacy of CACR with particular emphasis on Social Cognition. The difficulty in targeting specific domains suggests a 'non-specific' effect of CACR. These results are discussed in the light of the possible bias in remediation tasks due to computer interface design paradigms.
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Individuals with schizophrenia have consistently been found to exhibit cognitive deficits, which have been identified as critical mediators of psychosocial functional outcomes. Recent reviews of cognitive remediation (CRT) have concluded that these deficits respond to training. This multi-site community study examined 40 individuals with schizophrenia who underwent cognitive remediation using the Neuropsychological Educational Approach to Remediation(1) (NEAR). Assessments using the same neuropsychological tests and measures of psychosocial outcome were made at four time points: baseline, before start of active intervention, end of active intervention and 4 months after end of active intervention. Dose of antipsychotic medication remained constant throughout the study period. After participating in NEAR, individuals showed significant improvements in verbal and visual memory, sustained attention and executive functioning. This effect persisted 4 months after the treatment ceased. The average effect size was mild to moderate. Social and occupational outcomes also improved from baseline to post-treatment, which persisted 4 months later. Our findings replicate those of previous studies that suggest that NEAR is effective in improving cognition in individuals with schizophrenia in a naturalistic and ecologically valid setting. Further it extends such findings to show a generalisation of effects to social/occupational outcomes and persistence of effects in the short term.
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We analyzed the psychometric properties of the Positive and Negative Syndrome Scale (PANSS) in a sample of 100 DSM-III-R schizophrenic patients. Our findings coincided with the results of Kay's group in the following points: (1) the PANSS scores were normally distributed; (2) the positive and negative scales showed good interrater reliability; (3) positive and negative syndromes are independent constructs; (4) the positive and negative scales held a high concurrent validity in relation to the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms; and (5) although positive and negative syndromes showed factorial validity, they were not sufficient to account for the whole of the schizophrenic symptoms. Unlike Kay's group, we found a modest internal consistency of the positive scale, indicating that it is composed of several independent components. The data suggest that the distinction between positive and negative symptoms is an oversimplification, and that schizophrenic symptoms can be better conceptualized as composed of, at least three dimensional syndromes: positive, disorganized, and negative.
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The purpose of the present study was to examine the relationship between neurocognitive deficits and self-reported quality of life in order to examine whether neurocognitive impairment interferes with any aspects of quality of life for patients with schizophrenia. Forty-two outpatients with stable chronic schizophrenia were assessed for neurocognitive deficits using a computerized test battery, and all patients completed a version of the Sickness Impact Profile (SIP) to assess their quality of life across a variety of domains. The neurocognitive assessment tests revealed significant deficits compared with normal control subjects, particularly with respect to impaired iconic memory and frontal functioning. Patients reported that their quality of life was compromised. Despite the substantiation of marked neurocognitive deficits and reduced quality of life, correlations between neurocognitive deficits and quality of life were largely nonsignificant or very weak. Symptom expression, however, particularly with regard to general psychopathology on the Positive and Negative Syndrome Scale (PANSS), was significantly associated with quality of life. These results suggest that neurocognitive deficits in schizophrenia, while often profound, appear to have little direct impact on the patient's perceived quality of life.
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A meta-analysis of 128 studies examined the effects of extrinsic rewards on intrinsic motivation. As predicted, engagement-contingent, completion-contingent, and performance-contingent rewards significantly undermined free-choice intrinsic motivation (d = -0.40, -0.36, and -0.28, respectively), as did all rewards, all tangible rewards, and all expected rewards. Engagement-contingent and completion-contingent rewards also significantly undermined self-reported interest (d = -0.15, and -0.17), as did all tangible rewards and all expected rewards. Positive feedback enhanced both free-choice behavior (d = 0.33) and self-reported interest (d = 0.31). Tangible rewards tended to be more detrimental for children than college students, and verbal rewards tended to be less enhancing for children than college students. The authors review 4 previous meta-analyses of this literature and detail how this study's methods, analyses, and results differed from the previous ones.
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Efforts to remediate the problem-solving deficits of patients with schizophrenia have met with circumscribed success. This could be viewed as a sign of the immutability of the deficit or, alternatively, as a reflection of the inefficacy of the training techniques used. This study examined the feasibility of using problem-solving teaching techniques developed within educational psychology for remediating the problem-solving deficits of inpatients with schizophrenia spectrum disorders. These techniques rely on intrinsic motivation and task engagement, which are promoted through contextualization, personalization, and control of learning activities. A sample of 54 patients who demonstrated problem-solving and memory deficits on psychometric testing were randomly assigned to a problem-solving group, a memory training group, or a control group. Patients who received ten sessions of problem-solving remediation showed significantly more improvement on the outcome measure that assessed problem-solving skills required for independent living. Patients who received ten sessions of memory training did not improve on problem-solving measures. These results suggest that patients with schizophrenia spectrum disorders are responsive to problem-solving training techniques that promote intrinsic motivation and task engagement.
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In a multisite study, the authors examined the construct validity and utility of a brief self-report Satisfaction With Life scale, an expanded 21-item version of one of the earliest measures of subjective satisfaction with life used with individuals with serious and persistent mental illness. The Satisfaction With Life scale measures satisfaction in four domains: living situation, social relationships, work, and self and present life. Satisfaction With Life scale data were gathered from consumers receiving community treatment at two sites in Los Angeles (N=166 and N=172, respectively) and one in Wisconsin (N=146). A confirmatory factor analysis of a hypothesized four-factor structure using data from the pooled Los Angeles samples revealed that several items were less than optimal indicators of the underlying domain. On the basis of an analysis of each item, the Satisfaction With Life scale was reduced to 18 items, and the factor structure and factor loadings of the revised scale were cross-validated with data from the Wisconsin sample. The 18-item scale was further validated by testing hypotheses regarding the relationship between the instrument's four domains, or subscales, and clinically important life conditions of clients in the areas of symptoms, living and employment situations, and social relationships. The findings provided excellent support for the construct validity of the 18-item Satisfaction With Life scale, which assesses an individual's subjective satisfaction with his or her current life in the four domains: living situation, social relationships, work, and self and present life. The brief, easily completed 18-item Satisfaction With Life scale is a useful tool in evaluation research for assessing the subjective satisfaction with life of adults with serious mental illness.
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An overview is provided of the set of articles included in this special issue of Schizophrenia Bulletin that were derived from the final meeting of the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) program. These essays summarize the presentations and discussions of the MATRICS New Approaches Conference that examined the future needs of the field for a coordinated research effort to improve the preclinical and clinical science required to optimize new cotreatments for the cognitive deficits in patients with schizophrenia. Specific priorities for a research agenda involving collaborations among academic, industrial, and governmental participants are addressed.
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Quality of life (QoL) has been recognized as an important outcome of schizophrenia treatment, yet the determinants of QoL for individuals with schizophrenia are not well known. Research has consistently found psychiatric symptoms to be negatively related to QoL, however, findings concerning the strength of these relationships have been mixed, making it difficult to determine the degree to which such symptoms are related to poor QoL. This research presents a systematic meta-analysis of studies examining the relationship between psychiatric symptoms and QoL in schizophrenia, in an effort to elucidate the determinants of QoL for this population. A total of 56 studies were extracted from literature searches of relevant databases for empirical reports published between 1966 and 2005 examining the relationship between positive, negative, and/or general psychiatric symptoms and QoL. Weighted effect size analyses revealed small relationships between psychiatric symptoms and QoL, with general psychopathology showing the strongest negative associations across all QoL indicators. Moderator analyses indicated that variation in effect sizes could be accounted for by differing operationalizations of QoL, study design, sample, and participant treatment setting. In particular, positive and negative symptoms were more strongly related to poor QoL among studies of schizophrenia outpatients, whereas general psychopathology showed a consistent negative relationship with QoL across all study samples and treatment settings. Implications for future research and treatment development are discussed.
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Quality of life (QOL) is considered an important outcome in the treatment of schizophrenia, but the determinants of QOL are poorly understood in this population. Furthermore, previous studies have relied on combined measures of subjective QOL (usually defined as life satisfaction) and objective QOL (usually defined as participation in activities and relationships). We examined separately the clinical, functional, and cognitive predictors of subjective and objective QOL in outpatients with schizophrenia. We hypothesized that better subjective QOL would be associated with less severe negative and depressive symptoms, better objective QOL, and greater everyday functioning capacity, and that better objective QOL would be associated with less severe negative and depressive symptoms, better cognitive performance, and greater functional capacity. Participants included 88 outpatients with schizophrenia or schizoaffective disorder who completed a comprehensive series of assessments, including measures of positive, negative, and depressive symptoms; performance-based functional skills; a neuropsychological battery; and an interview measure of subjective and objective QOL. In the context of multiple predictor variables, more severe depressive symptoms and better neuropsychological functioning were independent predictors of worse subjective QOL. More severe negative symptoms predicted worse objective QOL. Functional capacity variables were not associated with subjective or objective QOL. Treatments to improve QOL in schizophrenia should focus on negative symptoms and depressive symptoms.
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This study evaluated the effects of cognitive remediation for improving cognitive performance, symptoms, and psychosocial functioning in schizophrenia. A meta-analysis was conducted of 26 randomized, controlled trials of cognitive remediation in schizophrenia including 1,151 patients. Cognitive remediation was associated with significant improvements across all three outcomes, with a medium effect size for cognitive performance (0.41), a slightly lower effect size for psychosocial functioning (0.36), and a small effect size for symptoms (0.28). The effects of cognitive remediation on psychosocial functioning were significantly stronger in studies that provided adjunctive psychiatric rehabilitation than in those that provided cognitive remediation alone. Cognitive remediation produces moderate improvements in cognitive performance and, when combined with psychiatric rehabilitation, also improves functional outcomes.
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The consensus cognitive battery developed by the National Institute of Mental Health's (NIMH's) Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative includes 10 independently developed tests that are recommended as the standard battery for clinical trials of cognition-enhancing interventions for schizophrenia. To facilitate interpretation of results from the MATRICS Consensus Cognitive Battery using a common scaling across tests, normative data were obtained from a single representative U.S. community sample with the battery administered as a unit. The MATRICS Consensus Cognitive Battery was administered to 300 individuals from the general community at five sites in differing geographic regions. For each site, recruitment was stratified by age, gender, and education. A scientific survey sampling method was used to help avoid sampling bias. The battery was administered in a standard order to each participant in a single session lasting approximately 60 minutes. Descriptive data were generated, and age, gender, and education effects on performance were examined. Prominent age and education effects were observed across tests. The results for gender differed by measure, suggesting the need for age and gender corrections in clinical trials. The MATRICS Consensus Cognitive Battery components were co-normed, with allowance for demographic corrections. Co-norming a battery such as the MATRICS Consensus Cognitive Battery, comprising tests from independent test developers each with their own set of norms, facilitates valid interpretation of test scores and communication of findings across studies. These normative data will aid in estimating the magnitude of change during clinical trials of cognition-enhancing agents and make it possible to derive more directly interpretable composite scores.
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Background Cognitive deficits are a major determinant of social and occupational dysfunction in schizophrenia. In this study, we determined whether neurocognitive enhancement therapy (NET) in combination with work therapy (WT) would improve performance on neuropsychological tests related to but different from the training tasks.Methods Sixty-five patients with schizophrenia or schizoaffective disorder were randomly assigned to NET plus WT or WT alone. Neurocognitive enhancement therapy included computer-based training on attention, memory, and executive function tasks; an information processing group; and feedback on cognitive performance in the workplace. Work therapy included paid work activity in job placements at the medical center (eg, mail room, grounds, library) with accompanying supports. Neuropsychological testing was performed at intake and 5 months later.Results Prior to enrollment, both groups did poorly on neuropsychological testing. Patients receiving NET + WT showed greater improvements on pretest-posttest variables of executive function, working memory, and affect recognition. As many as 60% in the NET + WT group improved on some measures and were 4 to 5 times more likely to show large effect-size improvements. The number of patients with normal working memory performance increased significantly with NET + WT, from 45% to 77%, compared with a decrease from 56% to 45% for those receiving WT.Conclusions Computer training for cognitive dysfunction in patients with schizophrenia can have benefits that generalize to independent outcome measures. Efficacy may result from a synergy between NET, which encourages mental activity, and WT, which allows a natural context for mental activity to be exercised, generalized, and reinforced.
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Background: Consistent evidences suggest that poor functional outcomes in schizophrenia are associated with deficits in executive functions (EF). As result cognitive training, remediation and/or rehabilitation (CR) programs have been developed and many theories, methods and approaches have emerged in support of them. This article presents a systematic review of randomized controlled trials (RCT), including EF rehabilitation interventions, with a focus on methodological issues and evidences of EF improvements. Method: Electronic databases (Medline, Web of Science, PsycINFO and Embase) were searched for articles on schizophrenia, EF and cognitive rehabilitation terms. The methodological quality of each article was measured by 5-point JADAD scale. Results: A total of 184 articles were initially identified, but after exclusion criteria, 30 RCT remained in this review. A proportion of 23% of studies scored higher than 4 points in JADAD scale, 40% scored 3 points, 33% scored 2 points and one study scored only 1 point. The average length of interventions was approximately 80 h distributed around 3.42 h/week. Conclusion: The reviewed articles corroborate the literature pointing that CR could be a promising therapeutic option for cognitive deficits in schizophrenia. In general, CR could improve cognitive domains and social adjustment either using computerized or paper-and-pencil programs. Additionally, CR combined with cognitive behavioral therapy and/or group sessions is particularly effective. In this paper, we also speculated and discussed optimal doses of treatment and the differences regarding modalities and approaches.
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Most research establishing the relationship between cognition and functioning in schizophrenia has been conducted cross-sectionally, leaving unanswered the question of whether there is a predictive relationship between temporal change in cognition and temporal change in functioning. In the present study, we used longitudinal mixed models to examine the relationship between change in cognition and change in Quality of Life (QLS), as measured over three time-points spanning a 12-month period, for 151 schizophrenia outpatients participating in work therapy with or without cognitive remediation. Memory and executive function changes were significant predictors of improved QLS total. Whereas the relationship between memory and QLS total was in the expected direction, with improvements in memory associated with improvements in QLS, the relationship between executive function and QLS was negative, with QLS improvements associated with declines in executive function. Similar patterns were found for individual QLS domains. Finally, there were positive cross-sectional relationships between QLS and hours worked as well as gender (female gender associated with better QLS). Lag models supported these results. Differences between these findings and previous studies are discussed along with functional assessment issues and the potential moderators of the relationship between cognitive change and functioning.
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