Cognitive remediation in schizophrenia: efficacy and effectiveness in patients with early versus long-term course of illness.

Early Interv Psychiatry 2014 Feb 24;8(1):32-8. Epub 2013 Jan 24.

Department of Psychology, Queen's University, Kingston, Ontario, Canada; Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada.

Aim: We examined the efficacy and effectiveness (transfer to functional competence and everyday functioning) of cognitive remediation in early-course (within 5 years of first episode) and long-term (more than 15 years of illness) schizophrenia.

Methods: Treatment lasted 12 weeks and included computerized exercises, strategic monitoring and methods to transfer cognition to behaviour. Assessments included a standard battery of neurocognition, performance-based measures of social and adaptive competence, and case manager ratings of real-world functional behaviour. Changes from baseline to post-treatment were examined with repeated measures analysis of variance and estimated premorbid intelligence and total months in hospital as covariates.

Results: The early-course group had larger improvements in measures of processing speed and executive functions, as well as larger improvements in adaptive competence and real-world work skills. Duration of illness was inversely associated with improvement in neurocognition and real-world work skills.

Conclusions: Treatment of cognitive impairments is feasible in both early-course and chronic schizophrenia, but the clinical meaningfulness and generalization to functioning appear to be more substantial when delivered early. Cognitive remediation should be considered a tool for early intervention in schizophrenia.

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http://dx.doi.org/10.1111/eip.12029DOI Listing
February 2014
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