Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-20T17:41:41.089Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive remediation therapy for schizophrenia: what is it and does it work?

Published online by Cambridge University Press:  13 June 2014

Gary Donohoe ,
Heike Schmidt  and
Ian H Robertson
Gary Donohoe*
Affiliation:
Department of Psychiatry and Institute of Neuroscience, St James's Hospital, Dublin 8, Ireland
Heike Schmidt
Affiliation:
Department of Psychiatry, School of Medicine, Trinity College Dublin
Ian H Robertson
Affiliation:
School of Psychology and Institute of Neuroscience, Trinity College, Dublin 2, Ireland
*
*Correspondence E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Impaired cognition is a core feature of schizophrenia (SZ) that precedes, accompanies, and often outlasts a patient's clinical symptoms. The success of new generation antipsychotics, as well as their failure to ameliorate the persistent disabilities associated with the disorder are well documented. Consequently, a number of psychosocial and cognitive interventions have been developed to address specific aspects of disability not adequately alleviated by medication.

Among these, interventions adapted from the acquired brain literature that target cognitively based disability (cognitive remediation therapy; CRT) have received significant empirical support both for ameliorating specific deficits in memory, attention and executive function, and improving real world outcome. CRT strategies have focused either on providing drill-based training aimed at increasing capacity or providing behavioural strategies for compensating for cognitive deficits, or a mixture of both. Nonetheless, these interventions have varied widely and several questions remain.

This review provides a brief overview of cognitive remediation therapies in psychosis, discusses evidence for its success, and outlines a number of questions that remain about its implementation. Given the current unavailability of cognitive remediation as part of standard care in Irish mental health services, we conclude by describing one such intervention developed within our clinical research group and the questions we hope to address in making this programme more widely available to Irish patients.

Type
Review
Information
Irish Journal of Psychological Medicine , Volume 28 , Issue 4 , December 2011 , pp. 217 - 221
Copyright
Copyright © Cambridge University Press 2011

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.Ustun, TB. Multiple-informant ranking of the disabling effects of different health conditions in 14 countries. The Lancet 1999; 354(9173): 111–115.CrossRefGoogle ScholarPubMed
2.Behan, C, Kennelly, B, O'Callaghan, E. The economic cost of schizophrenia in Ireland: a cost of illness study. Ir J Psychol Med 2008; 25(3): 80–87.CrossRefGoogle Scholar
3. Central Statistical Office (2002) and the National Disability Authority's (NDA, 2005). Disability and Work cited in Schizophrenia Ireland's Economic report to Irish Minister for Health ‘Time to act, 2006 Pre-budget submission’. (http://www.sirl.ie/other/repository_docs/58.pdf).Google Scholar
4.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. Schiz Res 2004; 72(1): 5–9.CrossRefGoogle ScholarPubMed
5.Hyman, SE, Fenton, WS. Medicine. What are the right targets for psychopharmacology? Sci 2003; 299(5605): 350–351.Google ScholarPubMed
6.Keefe, RS, Vinogradov, S, Medalia, Aet al.Report From the Working Group Conference on Multisite Trial Design for Cognitive Remediation in Schizophrenia. Schiz Bull 2010 Mar 1 [epub ahead of print]. doi: 10.1093/schbul/sbq010Google Scholar
7.Wykes, T. Cognitive remediation therapy needs funding. Nature 2010; 468(7321): 165–166.CrossRefGoogle ScholarPubMed
8.Kurtz, M M. Neurocognitive rehabilitation for schizophrenia. Curr Psych Rep 2003; 5(4): 303–10.CrossRefGoogle ScholarPubMed
9.Delahunty, A, Morice, R. The Frontal Executive Program. A Neurocognitive Rehabilitation Program For Schizophrenia (2nd ed). New South Wales Department of Health: Albury, NSW, Australia, 1993.Google ScholarPubMed
10.Wykes, T, Reeder, C, Corner, J, Williams, C, Everitt, B. The Effects of Neurocognitive Remediation on Executive Processing in Patients With Schizophrenia. Schiz Bull 1999; 25(2): 291–307.CrossRefGoogle ScholarPubMed
11.Rossell, SL, David, AS. Improving performance on the WCST: variations on the original procedure. Wisconsin Card Sorting Test. Schiz Res 1997; 28(1): 63–76.CrossRefGoogle ScholarPubMed
12.Kern, RS, Wallace, CJ, Hellman, SG, Womack, LM, Green, MF. A training procedure for remediating WCST deficits in chronic psychotic patients: an adaptation of errorless learning principles. J Psych Res 1996; 30(4): 283–94. doi:10.1016/0022-3956(96)00028-3CrossRefGoogle ScholarPubMed
13.Young, DA, Freyslinger, MG. Scaffolded instruction and the remediation of Wisconsin Card Sorting Test deficits in chronic schizophrenia. Schiz Res 1995; 16(3): 199–207.CrossRefGoogle ScholarPubMed
14.Wexler, BE, Bell, MD. Cognitive remediation and vocational rehabilitation for schizophrenia. Schiz Bull 2005; 31(4): 931–941.CrossRefGoogle ScholarPubMed
15.Hamera, E, Rempfer, M, Brown, C. Performance in the ‘real world’: update on test of grocery shopping skills (TOGSS). Schiz Res 2005; 78(1): 111–112.CrossRefGoogle ScholarPubMed
16.Jaeggi, SM, Buschkuehl, M, Jonides, J, Perrig, WJ. Improving fluid intelligence with training on working memory. Proc Nat Acad Sci USA 2008; 105(19): 6829–6833.CrossRefGoogle ScholarPubMed
17.Klingberg, T, Fernell, E, Olesen, PJet al.Computerized training of working memory in children with ADH D – a randomized, controlled trial. J Am Acad Child Adol Psych 2005; 44(2): 177–186.CrossRefGoogle Scholar
18.McNab, F, Varrone, A, Farde, Let al.Changes in cortical dopamine D1 receptor binding associated with cognitive training. Sci 2009; 323(5915): 800–802. doi: 10.1126/science.1166102CrossRefGoogle ScholarPubMed
19.Green, MF. What are the functional consequences of neurocognitive deficits in schizophrenia? Am J Psych 1996; 153(3): 321–30.Google ScholarPubMed
20.Kurtz, MM, Seltzer, JC, Fujimoto, M, Shagan, DS, Wexler, BE. Predictors of change in life skills in schizophrenia after cognitive remediation. Schiz Res 2009; 107(2-3): 267–274.CrossRefGoogle ScholarPubMed
21.Greenwood, KE, Landau, S, Wykes, T. Negative symptoms and specific cognitive impairments as combined targets for improved functional outcome within cognitive remediation therapy. Schiz Bull 2005; 31(4): 910–921.CrossRefGoogle ScholarPubMed
22.Fisher, M, Holland, C, Merzenich, MM, Vinogradov, S. Using neuroplasticity-based auditory training to improve verbal memory in schizophrenia. Am J Psych 2009; 166(7): 805–11.CrossRefGoogle ScholarPubMed
23.McGurk, SR, Twamley, EW, Sitzer, DI, McHugo, GJ, Mueser, KT. A meta-analysis of cognitive remediation in schizophrenia. Am J Psych 2007; 164: 1791–1802.CrossRefGoogle ScholarPubMed
24.Wykes, T, Huddy, V. Cognitive remediation for schizophrenia: it is even more complicated. Curr Op Psych 2009; 22(2): 161–167.CrossRefGoogle ScholarPubMed
25.Dickinson, D, Tenhula, W, Morris, Set al.A randomized, controlled trial of computerassisted cognitive remediation for schizophrenia. Am J Psych 2010; 167(2): 170–180.CrossRefGoogle ScholarPubMed
26.Eack, SM, Greenwald, DP, Hogarty, SSet al.Cognitive enhancement therapy for early-course schizophrenia: effects of a two-year randomized controlled trial. Psych Serv 2009; 60(11): 1468–1476.CrossRefGoogle ScholarPubMed
27.Adcock, RA, Dale, C, Fisher, Met al.When top-down meets bottom-up: auditory training enhances verbal memory in schizophrenia. Schiz Bull 2009; 35(6): 1132–1141.CrossRefGoogle ScholarPubMed
28.Donohoe, G, Robertson, IH. Can specific deficits in executive functioning explain the negative symptoms of schizophrenia? A review. Neurocase 2003; 9(2): 97–108.CrossRefGoogle ScholarPubMed
29.Wykes, T, Reeder, C, Landau, S, Matthiasson, P, Haworth, E, Hutchinson, C. Does age matter? Effects of cognitive rehabilitation across the age span. Schiz Res 2009; 113(2-3): 252–258.CrossRefGoogle ScholarPubMed
30.Bell, MD, Zito, W, Greig, T, Wexler, BE. Neurocognitive enhancement therapy with vocational services: work outcomes at two-year follow-up. Schiz Res 2008; 105(1-3): 18–29.CrossRefGoogle ScholarPubMed
31.Wykes, T, Huddy, V, Cellard, C, McGurk, SR, Czobor, P. A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am J Psych 2011 May; 168(5): 472–85.CrossRefGoogle ScholarPubMed
32.Klingberg, T. Training and plasticity of working memory. Trends Cog Sci 2010; 14(7): 317–324. doi:10.1016/j.tics.2010.05.002CrossRefGoogle ScholarPubMed
33.Medalia, A, Choi, J. Cognitive remediation in schizophrenia. Neuropsychol Rev 2009; 19(3): 353–364. doi: 10.1007/s11065-009-9097-yCrossRefGoogle ScholarPubMed
34.Silverstein, SM. Bridging the gap between extrinsic and intrinsic motivation in the cognitive remediation of schizophrenia. Schiz Bull 2010; 36(5): 949–56.CrossRefGoogle Scholar
35.Wykes, T, Brammer, M, Mellers, Jet al.Effects on the brain of a psychological treatment: cognitive remediation therapy: functional magnetic resonance imaging in schizophrenia. Br J Psych 2002; 181: 144–52.Google ScholarPubMed
36.Bosia, M, Bechi, M, Marino, Eet al.Influence of catechol-O-methyltransferase Val 158 Met polymorphism on neuropsychological and functional outcomes of classical rehabilitation and cognitive remediation in schizophrenia. Neurosci Letters 2007; 417(3): 271–4. Epub 2007 Mar 2. PubMed PMID: 17383818.CrossRefGoogle Scholar
37.Greenwood, K, Hung, CF, Tropeano, M, McGuffin, P, Wykes, T. No association between the Catechol-O-Methyltransferase (COMT) val 158 met polymorphism and cognitive improvement following cognitive remediation therapy (CRT) in schizophrenia. Neurosci Lett 2011 Jun 1; 496(2): 65–9.CrossRefGoogle Scholar