Hostname: page-component-5cf477f64f-h6p2m Total loading time: 0 Render date: 2025-04-05T13:01:18.089Z Has data issue: false hasContentIssue false
  • English
  • Français

Integrating psychopharmacology and cognitive remediation to treat cognitive dysfunction in the psychotic disorders

Published online by Cambridge University Press:  23 July 2013

Alice Medalia ,
Lewis A. Opler  and
Alice M. Saperstein
Alice Medalia*
Affiliation:
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA
Lewis A. Opler
Affiliation:
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA
Alice M. Saperstein
Affiliation:
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA
*
*Address for correspondence: Alice Medalia, PhD, Columbia University Medical Center, 710 West 168 Street, NI-12, New York, NY 10032, USA. (Email [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Cognitive deficits are a prominent and enduring aspect of schizophrenia, which pose a significant barrier to achieving functional goals. The most promising intervention for treating cognitive impairment is cognitive remediation (CR), a behaviorally based therapy associated with medium effect sizes for cognitive and functional outcomes. However, there is a sizeable group of nonresponders whose CR outcomes become limited when the therapeutic approach fails to address individual differences in baseline cognition, motivation variables, and the extent to which CR offers opportunities for generalization. This speaks to a need to develop cognitive interventions that are both personalized and scalable. Emerging data suggest that specific pharmacological agents have the potential to enhance and accelerate behaviorally based CR effects. This article will review the rationale and preliminary evidence to support combining CR and pharmacotherapy. We will review crucial aspects of cognitive interventions that offer the most promise for improving not only cognitive outcomes, but also for enhancing improvement in real-world functioning. Finally, we will address methodological issues to be considered for future research on combined pharmacological and CR interventions.

Keywords

Cognitionpsychosiscognitive remediationcognitive enhancers
Type
Review Articles
Information
CNS Spectrums , Volume 19 , Issue 2 , April 2014 , pp. 115 - 120
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Hoff, AL, Svetina, C, Shields, G, etal. Ten year longitudinal study of neuropsychological functioning subsequent to a first episode of schizophrenia. Schizophr Res. 2005; 78(1): 27–34.Google Scholar
2. Keefe, RS, Eesley, CE, Poe, MP. Defining a cognitive function decrement in schizophrenia. Biol Psychiatry. 2005; 57(6): 688–691.Google Scholar
3. Green, MF. What are the functional consequences of neurocognitive deficits in schizophrenia? Am J Psychiatry. 1996; 153(3): 321–330.Google ScholarPubMed
4. Wykes, T, Huddy, V, Cellard, C, etal. A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am J Psychiatry. 2011; 168(5): 472–485.CrossRefGoogle ScholarPubMed
5. McGurk, SR, Twamley, EW, Sitzer, DI, etal. A meta-analysis of cognitive remediation in schizophrenia. Am J Psychiatry. 2007; 164(12): 1791–1802.CrossRefGoogle ScholarPubMed
6. Kurtz, MM, Richardson, CL. Social cognitive training for schizophrenia: a meta-analytic investigation of controlled research. Schizophr Bull. 2011; 38(5): 1092–1104.CrossRefGoogle ScholarPubMed
7. Hooker, CI, Bruce, L, Fisher, M, etal. Neural activity during emotion recognition after combined cognitive plus social cognitive training in schizophrenia. Schizophr Res. 2012; 139(1–3): 53–59.Google Scholar
8. Subramaniam, K, Luks, TL, Fisher, M, etal. Computerized cognitive training restores neural activity within the reality monitoring network in schizophrenia. Neuron. 2012; 73(4): 842–853.Google Scholar
9. Eack, SM, Hogarty, GE, Cho, RY, etal. Neuroprotective effects of cognitive enhancement therapy against gray matter loss in early schizophrenia: results from a 2-year randomized controlled trial. Arch Gen Psychiatry. 2010; 67(7): 674–682.CrossRefGoogle ScholarPubMed
10. Nemeth, D, Janacsek, K. The dynamics of implicit skill consolidation in young and elderly adults. J Gerontol B Psychol Sci Soc Sci. 2011; 66: 15–22.Google Scholar
11. Spaulding, WD, Sullivan, M, Poland, J. Treatment and Rehabilitation of Severe Mental Illness. New York: Guilford Press; 2003.Google Scholar
12. Hogarty, GE, Flesher, S. Practice principles of cognitive enhancement therapy for schizophrenia. Schizophr Bull. 1999; 25: 693–708.Google Scholar
13. Medalia, A, Revheim, N, Herlands, T. Cognitive Remediation for Psychological Disorders. New York: Oxford University Press; 2009.Google Scholar
14. Wykes, T, Reeder, C. Cognitive Remediation Therapy for Schizophrenia: Theory and Practice. London: Brunner Routledge; 2005.Google Scholar
15. Harvey, PD. Pharmacological approaches to cognitive enhancement. In: Harvey PD, ed. Cognitive Impairment in Schizophrenia. New York: Cambridge University Press; 2013.Google Scholar
16. Valenzuela, MJ, Matthews, FE, Brayne, C, etal. Multiple biological pathways link cognitive lifestyle to protection from dementia. Biol Psychiatry. 2012; 71(9): 783–791.Google Scholar
17. Woolett, K, Maguire, EA. Acquiring “the knowledge” of London's layout drives structural brain changes. Curr Biol. 2011; 21(24): 2109–2114.Google Scholar
18. Goff, DC, Hill, M, Barch, D. The treatment of cognitive impairment in schizophrenia. Pharmacol Biochem Behav. 2011; 99(2): 245–253.Google Scholar
19. Gray, JA, Roth, BL. Molecular targets for treating cognitive dysfunction in schizophrenia. Schizophr Bull. 2007; 33(5): 1100–1119.CrossRefGoogle ScholarPubMed
20. Hahn, B, Gold, JM, Buchanan, RW. The potential of nicotinic enhancement of cognitive remediation training in schizophrenia. Neuropharmacology. 2013; 64: 185–190.Google Scholar
21. Ibrahim, HM, Tamminga, CA. Treating impaired cognition in schizophrenia. Curr Pharm Biotechnol. 2012; 13(8): 1587–1594.Google Scholar
22. D'Souza, DC, Radhakrishnan, R, Perry, E, etal. Feasibility, safety, and efficacy of the combination of D-serine and computerized cognitive retraining in schizophrenia: an international collaborative pilot study. Neuropsychopharmacology. 2013; 38(3): 492–503.CrossRefGoogle ScholarPubMed
23. Gottlieb, JD, Cather, C, Shanahan, M, etal. D-Cycloserine facilitation of cognitive behavioral therapy for delusions in schizophrenia. Schizophr Res. 2011; 131(1–3): 69–74.CrossRefGoogle ScholarPubMed
24. Goff, D, Gottleib, J, Cather, C. Pilot studies of D-cycloserine enhancement of CBT & cognitive remediation in schizophrenia. Schizophr Bull. 2013; 39(suppl 1): S332.Google Scholar
25. Marder, SR. Oxytocin and social cognition training in schizophrenia. Schizophr Bull. 2013; 39(suppl 1): S316.Google Scholar
26. Multnomah Community Ability Scale User's Manual. Portland, OR: Network Ventures, Inc.; 2004.Google Scholar
27. Medalia, A, Choi, K, Jock, W, Herlands, T. Community based skills coaching facilitates functional improvement in people with schizophrenia. Schizophr Bull. 2013; 39(suppl 1): S300.Google Scholar
28. Keefe, RSE, Vinogradov, S, Medalia, A, etal. Report from the Working Group Conference on Multisite Trial Design for Cognitive Remediation in Schizophrenia. Schizophr Bull. 2011; 37(5): 1057–1065.Google Scholar
29. Marder, SR, Fenton, W. Measurement and treatment research to improve cognition in schizophrenia: NIMH MATRICS initiative to support the development of agents for improving cognition in schizophrenia. Schizophr Res. 2004; 72: 5–9.Google Scholar
30. Keefe, R, Siu, C, Fox, K, etal. Test-retest characteristics of the MATRICS Consensus Cognitive Battery in a 20-site schizophrenia clinical trial of R3487/MEM3454 versus placebo. Schizophr Bull. 2009; 35: 358–359.Google Scholar
31. Keefe, RS, Harvey, PD, Goldberg, TE, etal. Norms and standardization of the Brief Assessment of Cognition in Schizophrenia (BACS). Schizophr Res. 2008; 102(1–3): 108–115.Google Scholar
32. Bowie, CR, Leung, WW, Reichenberg, A, etal. Predicting schizophrenia patients’ real-world behavior with specific neuropsychological and functional capacity measures. Biol Psychiatry. 2008; 63(5): 505–511.Google Scholar
33. Green, MF, Nuechterlein, KH, Kern, RS, etal. Functional co-primary measures for clinical trials in schizophrenia: results from the MATRICS Psychometric and Standardization Study. Am J Psychiatry. 2008; 165(2): 221–228.Google Scholar
34. Mausbach, BT, Moore, R, Bowie, C, etal. A review of instruments for measuring functional recovery in those diagnosed with psychosis. Schizophr Bull. 2009; 35(2): 307–318.Google Scholar
35. Velligan, DI, Diamond, P, Glahn, DC, etal. The reliability and validity of the Test of Adaptive Behavior in Schizophrenia (TABS). Psychiatry Res. 2007; 151: 55–166.Google Scholar
36. Bowie, CR, McGurk, SR, Mausbach, B, etal. Combined cognitive remediation and functional skills training for schizophrenia: effects on cognition, functional competence, and real-world behavior. Am J Psychiatry. 2012; 169: 710–718.Google Scholar
37. Franck, N, Duboc, C, Sundby, C, etal. Specific vs general cognitive remediation for executive functioning in schizophrenia: a multicenter randomized trial. Schizophr Res. 2013; 147(1): 68–74.Google Scholar
38. Medalia, A, Saperstein, A. The role of motivation for treatment success in schizophrenia. Schizophr Bull. 2011; 37(suppl 2): S122–S128.CrossRefGoogle Scholar