Cognitive remediation for individuals with psychosis: efficacy and mechanisms of treatment effects
| Autor: | Steven M. Silverstein, Jimmy Choi, Morris D. Bell, Kee-Hong Choi, Joanna M. Fiszdon |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Neuropsychological Tests Verbal learning Spatial memory 03 medical and health sciences 0302 clinical medicine Memory Activities of Daily Living Task Performance and Analysis medicine Humans Attention Applied Psychology Spatial Memory Working memory Neuropsychology Cognition Middle Aged Verbal Learning medicine.disease Cognitive Remediation 030227 psychiatry Psychiatry and Mental health Psychotic Disorders Cognitive remediation therapy Schizophrenia Female Schizophrenic Psychology Psychology Neurocognitive 030217 neurology & neurosurgery Clinical psychology |
| Zdroj: | Psychological Medicine. 46:3275-3289 |
| ISSN: | 1469-8978 0033-2917 |
| Popis: | BackgroundThe popularity of cognitive remediation (CR) interventions for individuals with psychosis is in part based on the well-established link between cognition and functioning and the assumption that by targeting cognition, function can improve. While numerous trials have reported CR's efficacy, it is still not considered an evidence-based treatment. Importantly, little is known about the mechanisms through which it may affect functioning.MethodIn this study, we evaluated CR's proximal and distal effects, and examined potential mechanisms. A total of 75 individuals with psychotic disorders were randomized to a combination of strategy-based and drill-and-practice CR or wait-list control, with assessments of training task performance, neurocognition, functional capacity, symptoms and functioning conducted at baseline, end of the 2-month intervention, and 2-month follow-up.ResultsCompared with treatment as usual, CR was associated with large post-training improvements on training tasks targeting attention, visuospatial memory, and verbal learning and memory, with persisting group differences at the 2-month follow-up. These generalized to mostly large improvements on neuropsychological measures targeting visuospatial memory, verbal learning and memory, delayed verbal memory and verbal working memory. While there were no CR-associated improvements on measures of functional capacity, symptoms, or a self-report measure of independent living skills, there was an effect on an interviewer-rated measure of functioning (Quality of Life Scale), which appeared primarily driven by the Intrapsychic Foundations subscale. Finally, for those randomized to CR, there were significant, medium-sized correlations between training task improvement, neuropsychological improvement and functioning measures.ConclusionsThis suggests a complex, multifactorial relationship between CR, and cognitive and functional change. |
| Databáze: | OpenAIRE |
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