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A randomized controlled trial of cognitive remediation and long-acting injectable risperidone after a first episode of schizophrenia: improving cognition and work/school functioning

Published online by Cambridge University Press:  28 September 2020

Keith H. Nuechterlein Open the ORCID record for Keith H. Nuechterlein [Opens in a new window] ,
Joseph Ventura ,
Kenneth L. Subotnik ,
Denise Gretchen-Doorly ,
Luana R. Turner ,
Laurie R. Casaus ,
John Luo ,
Michael L. Boucher ,
Jacqueline N. Hayata  and
Morris D. Bell
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Keith H. Nuechterlein*
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA Department of Psychology, University of California, Los Angeles, USA
Joseph Ventura
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
Kenneth L. Subotnik
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
Denise Gretchen-Doorly
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
Luana R. Turner
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
Laurie R. Casaus
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
John Luo
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
Michael L. Boucher
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
Jacqueline N. Hayata
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
Morris D. Bell
Affiliation:
Department of Psychiatry, Yale University, New Haven, CT, USA
Alice Medalia
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
*
Author for correspondence: Keith H. Nuechterlein, Ph.D., E-mail: [email protected]
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Abstract

Background

Cognitive deficits at the first episode of schizophrenia are predictive of functional outcome. Interventions that improve cognitive functioning early in schizophrenia are critical if we hope to prevent or limit long-term disability in this disorder.

Methods

We completed a 12-month randomized controlled trial of cognitive remediation and of long-acting injectable (LAI) risperidone with 60 patients with a recent first episode of schizophrenia. Cognitive remediation involved programs focused on basic cognitive processes as well as more complex, life-like situations. Healthy behavior training of equal treatment time was the comparison group for cognitive remediation, while oral risperidone was the comparator for LAI risperidone in a 2 × 2 design. All patients were provided supported employment/education to encourage return to work or school.

Results

Both antipsychotic medication adherence and cognitive remediation contributed to cognitive improvement. Cognitive remediation was superior to healthy behavior training in the LAI medication condition but not the oral medication condition. Cognitive remediation was also superior when medication adherence and protocol completion were covaried. Both LAI antipsychotic medication and cognitive remediation led to significantly greater improvement in work/school functioning. Effect sizes were larger than in most prior studies of first-episode patients. In addition, cognitive improvement was significantly correlated with work/school functional improvement.

Conclusions

These results indicate that consistent antipsychotic medication adherence and cognitive remediation can significantly improve core cognitive deficits in the initial period of schizophrenia. When combined with supported employment/education, cognitive remediation and LAI antipsychotic medication show separate significant impact on improving work/school functioning.

Keywords

Cognitive trainingfunctional outcomelong-acting injectable antipsychotic
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 8 , June 2022 , pp. 1517 - 1526
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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