Individuals with schizophrenia demonstrate impairment in prospective memory (ProM), which describes the multifaceted ability to execute a future intention. Despite its clear implications for everyday functioning, the neuropsychological substrates and functional correlates of ProM impairment in schizophrenia remain poorly understood. In this study, the Memory for Intentions Screening Test (MIST), a standardized measure of ProM, was administered to 72 outpatients with schizophrenia or schizoaffective disorder as part of a comprehensive neuropsychological and psychiatric research evaluation. Results showed that ProM was positively correlated with standard clinical tests of attention, working memory, processing speed, learning, and executive functioning, but not delayed recall. In the context of multiple neuropsychological predictors, learning ability was the only domain that independently contributed to ProM. Importantly, better ProM was predictive of higher functional capacity (as measured by the UCSD Performance-Based Skills AssessmentBrief Version), above and beyond the variability explained by demographic and disease factors. Analysis of component processes revealed that event-based ProM, as well as no response (i.e., omission) and task substitution errors were the strongest predictors of everyday functioning. Overall, these findings suggest that ProM impairment in schizophrenia is associated with multiple cognitive substrates, particularly episodic learning deficits, and plays an important role in everyday living skills. Studies regarding the potential effectiveness of ProM-based remediation strategies to improve functional outcomes in schizophrenia are indicated.

The cognitive deficits of schizophrenia have a profound impact on everyday functioning and level of community integration for affected individuals. Cognitive training (CT) interventions may help improve these impairments. We developed and pilot tested a 12-week, group based CT intervention that focused on compensatory strategies and habit learning. Participants were randomly assigned to CT plus standard pharmacotherapy or standard pharmacotherapy (SP) alone and were assessed at baseline, three months (i.e., post-intervention), and at six months. Effect sizes were calculated comparing change in the CT group with change in the SP group. CT had medium to large positive effects on attention, learning, memory, executive functioning, functional capacity, negative symptoms, and subjective quality of life. Most effects became stronger at follow-up, but the effect on negative symptoms was not maintained. Immediately post-treatment, compared with SP subjects, CT participants reported fewer cognitive problems and greater use of cognitive strategies; many of these effects were maintained, but were generally weaker, at six-month follow-up. The initial effect sizes for this compensatory CT intervention suggest that it holds promise for improving cognitive performance, functional capacity, negative symptoms, and quality of life. It is proposed that CT emphasizing habit learning may result in long term changes in ability to function independently in the community.

Class Agenda 1. Introductions: program, instructors, and class members; hand out binders. 2. Course overview and expectations. 3. Provide handout on traumatic brain injury (TBI). 4. TBI and concussion education. 5. Introduce lifestyle strategies for managing symptoms. 6. Introduce and practice abdominal breathing. 7. Introduce the principles of cognitive training, including organization and calendar use. 8. Discuss goals for class. 9. Introduce home exercises and explain the first home exercise. 1. Introductions and distribute binders 2. Course overview and expectations This class will introduce a variety of mental strategies and external aids designed to help participants manage problems with memory, attention, and organization. 10-week course; one meeting per week. 2 hour classes with a break after the first hour and brief (2 minute) breaks every 30 minutes. Classes focus on improving cognitive abilities. You will apply your new skills to your most important real-life problems and goals. Feedback encouraged (questions, comments, suggestions, etc.). Expectations Class Binders: Please bring your class binders each week. Home Exercises: Each week, we will ask you to practice using various strategies and aids in your daily life. The more you practice, the better you'll get at using the strategies. Class Discussion: Each week, the class will have the opportunity to discuss ideas for managing common cognitive problems. You will also have the opportunity to discuss how the home exercises worked for you. Privacy and Respect: Please be courteous and respectful of one another. Help others find solutions. Be constructive when offering feedback. Personal information that is shared in the group is not to be discussed with members or persons outside of the group. Class Attendance and Participation: Please attend all classes. Please arrive on time. Please call instructors if you will be late or absent so we can plan accordingly. How common is TBI? 1.4 million cases/year. 14-20% of surviving combat casualties. What causes TBI? There are many ways people suffer traumatic brain injuries: Falling and hitting your head. Motor vehicle accidents/crashes. Getting assaulted or hit in the head with objects or weapons. Explosions or blasts. Rapid motion or shaking-acceleration or deceleration. Penetrating wounds like bullets. Not all traumatic brain injuries are obvious! You don't have to fracture your skull or bleed from the head to hurt your brain. How are TBI symptoms diagnosed? Neuroimaging tests often fail to detect injury. Neuropsychological testing is more sensitive. o May reveal memory or attention difficulties, or slowed processing. o These difficulties are often temporary. What are some common symptoms? "Post-concussion syndrome" = frequently co-occurring set of physical, cognitive, and psychosocial symptoms.