Predictors of Remediation Success on a Trained Memory Task

Department of Psychiatry, Yale University, New Haven, Connecticut, United States
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 10/2005; 193(9):602-8. DOI: 10.1097/
Source: PubMed


Cognitive remediation has led to improvements for some but not all individuals with schizophrenia. The goal of the current investigation was to determine which variables predicted response to cognitive remediation training. In a sample of 58 patients with DSM-IV schizophrenia or schizoaffective disorder, normalization of performance on a trained memory task was selected as the criterion for successful remediation. The contribution of demographic, symptom, treatment process, and cognitive variables in predicting successful remediation was examined using a series of logistic regressions. A final regression evaluated the combined contribution of these variables. From among patients who were impaired before training, 43% reached normal levels of performance. Measures of attention, immediate verbal memory, hostility, and latency between last training and assessment were retained in the final step of the regression, resulting in 83% classification accuracy. Findings suggest that in addition to cognitive factors, motivational and training variables also significantly affect remediation outcomes.

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Available from: Joanna M Fiszdon
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    • "Executive functions are known to be widely impaired in patients with schizophrenia (Heinrichs and Zakzanis, 1998; Gopal and Variend, 2005) and are a specific target of cognitive remediation (Wykes et al., 2007; Vita et al., 2011a,b; Gharaeipour and Scott, 2012). Our finding is in line with the intuitive notion as well as experimental evidence that better baseline cognitive performance may be associated with greater effectiveness of cognitive remediation (Fiszdon et al., 2005; Medalia and Richardson, 2005; Kurtz et al., 2009). More specifically, there is consistent evidence that better baseline performance in the executive function domain could facilitate the application of specific rehabilitation strategies used in cognitive remediation interventions such as Cognitive Remediation Therapy (Velligan et al., 2006). "
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    ABSTRACT: Although the efficacy of cognitive remediation interventions has been demonstrated in several experimental studies on schizophrenia, few studies have investigated the predictors of response to such interventions. We were interested in determining what factors contribute to a positive outcome after cognitive rehabilitation and whether different factors are associated with different degrees of improvement in cognitive and real-world functioning in individual patients after cognitive remediation. The study sample consisted of 56 patients with schizophrenia who had completed a 6-month cognitive remediation intervention and showed different cognitive and functional outcomes. Measures of cognitive and functional amelioration after cognitive remediation were analyzed in relation to patients' clinical, neuropsychological and functional variables at baseline using logistic regression analysis. Lower antipsychotic intake at baseline predicted cognitive improvement, whereas lower antipsychotic intake, severity of specific symptoms, and higher neurocognitive functioning (particularly executive functions and verbal memory) at baseline were associated with cognitive normalization after remediation treatment. Functional improvement was predicted by lower patient age and type of cognitive remediation intervention, whereas functional normalization was related to lower baseline antipsychotic intake and, at a trend level, to higher executive functioning and type of cognitive remediation intervention. Cognitive remediation could be more effective in younger, less disorganized, and cognitively less impaired patients, who take a smaller amount of antipsychotics. The predictive role of lower antipsychotic dosage on cognitive and functional outcome after remediation suggests either that patients with less severe illness could gain better advantage from cognitive remediation interventions or that high dose or complex antipsychotic therapy may limit the effectiveness of such interventions.
    Full-text · Article · Aug 2013 · Schizophrenia Research
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    • "A recent meta-analysis has shown that cognitive remediation therapy (CRT) indeed improves both cognition and more distal outcomes such as social functioning, work, and self-esteem (Wykes et al., 2011). The predictors of a successful response to CRT have only recently begun to be investigated (Fiszdon et al., 2005; Kurtz et al., 2009; Medalia and Richardson, 2005; Wykes et al., 2009). These have concentrated mostly on participant characteristics. "
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    ABSTRACT: Cognitive remediation therapy (CRT) for schizophrenia has been effective in improving cognitive and global functioning outcomes. It is now important to determine what factors maximize benefit. The quality of relationship--or working alliance--between clients and therapists may be one such factor that improves outcome. To investigate this, 49 individuals with schizophrenia were recruited into a naturalistic study of the impact of CRT on work and structured activity outcomes. Participant's cognitive skills, severity of symptoms, and social skills were assessed at baseline. Both client and therapist working alliance ratings were gathered early in therapy. After controlling for depression, clients who rated the alliance more favorably stayed in therapy longer and were more likely to improve on their main target complaint but notably not on working memory performance or self-esteem. Therapist's ratings of the alliance were not associated with memory outcome. These findings indicate that working alliance is important for client satisfaction with therapy.
    Full-text · Article · Jul 2012 · The Journal of nervous and mental disease
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    • "This milder profile of deficits in those at risk for psychosis is promising for treatment in two ways. First, there is evidence that neurocognitive and symptom improvement may be more likely in individuals whose impairments are minimal, rather than severe or profound (Fiszdon et al., 2005; Medalia and Richardson, 2005). Second, if the magnitude of response to treatment for individuals at high risk resembles that of chronic schizophrenia patients, which is often approximately 0.5 standard deviation units (Harvey and Keefe, 2001), the milder baseline profile in the high-risk individuals makes it likely that post-treatment functioning would be closer to normal performance. "
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    ABSTRACT: Improving neurocognitive abilities is a treatment priority in schizophrenia, however, pharmacological efforts to enhance deficits after illness onset have resulted in quite modest results that are of questionable clinical meaningfulness. Individuals at clinical risk for psychosis demonstrate neurocognitive impairments intermediate to the level of deficits observed in schizophrenia and normative performance, suggesting that a similar magnitude of improvement might result in more clinically meaningful change. In this study, we examined neurocognitive changes after six months of treatment in adolescents with clinical signs of risk for psychosis.
    Full-text · Article · Feb 2012 · Schizophrenia Research
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