Objective-This study evaluated the effects of cognitive remediation for improving cognitive performance, symptoms, and psychosocial functioning in schizophrenia.Method-A meta-analysis was conducted of 26 randomized, controlled trials of cognitive remediation in schizophrenia including 1,151 patients.Results-Cognitive remediation was associated with significant improvements across all three outcomes, with a medium effect size for cognitive performance (0.41), a slightly lower effect size for psychosocial functioning (0.36), and a small effect size for symptoms (0.28). The effects of cognitive remediation on psychosocial functioning were significantly stronger in studies that provided adjunctive psychiatric rehabilitation than in those that provided cognitive remediation alone.Conclusions-Cognitive remediation produces moderate improvements in cognitive performance and, when combined with psychiatric rehabilitation, also improves functional outcomes.Cognitive impairment is a core feature of schizophrenia, with converging evidence showing that it is strongly related to functioning in areas such as work, social relationships, and independent living (1, 2). Furthermore, cognitive functioning is a robust predictor of response to psychiatric rehabilitation (i.e., systematic efforts to improve the psychosocial functioning of persons with severe mental illness) (3), including outcomes such as work, social skills, and self-care (1,4,5). Because of the importance of cognitive impairment in schizophrenia, it has been identified as an appropriate target for interventions (6).Currently available pharmacological treatments have limited effects on cognition in schizophrenia (7,8) and even less impact on community functioning (9). To address the problem of cognitive impairment in schizophrenia, a range of cognitive remediation programs has been developed and evaluated over the past 40 years. These programs employ a variety of methods, such as drill and practice exercises, teaching strategies to improve cognitive functioning, compensatory strategies to reduce the effects of persistent cognitive impairments, and group discussions. Several reviews of research on cognitive rehabilitation in schizophrenia have been published (10-13). The general conclusions from these reviews have been that cognitive remediation NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript leads to modest improvements in performance on neuropsychological tests but has no impact on functional outcomes. However, these reviews were limited by the relatively small number of studies that actually measured psychosocial functioning, precluding any definitive conclusions about the effects of cognitive remediation on psychosocial adjustment or the identification of program characteristics that may contribute to such effects. The rationale for cognitive remediation is chiefly predicated on its presumed effects on psychosocial functioning and improved response to rehabilitation. Therefore, a critical examination of the effects of cognitive ...

This research assessed the lifetime prevalence of traumatic events and current posttraumatic stress disorder (PTSD) in 275 patients with severe mental illness (e.g., schizophrenia and bipolar disorder) receiving public mental health services in Concord and Manchester, New Hampshire, and Baltimore, Maryland. Lifetime exposure to traumatic events was high, with 98% of the sample reporting exposure to at least 1 traumatic event. The rate of PTSD in our sample was 43%, but only 3 of 119 patients with PTSD (2%) had this diagnosis in their charts. PTSD was predicted most strongly by the number of different types of trauma, followed by childhood sexual abuse. The findings suggest that PTSD is a common comorbid disorder in severe mental illness that is frequently overlooked in mental health settings.

Schizophrenia is a mental illness that is among the world's top ten causes of long-term disability. The symptoms of schizophrenia include psychosis, apathy and withdrawal, and cognitive impairment, which lead to problems in social and occupational functioning, and self-care. About 1% of the population is affected by schizophrenia, with similar rates across different countries, cultural groups, and sexes. The illness tends to develop between the ages of 16 and 30 years, and mostly persists throughout the patient's lifetime. The cause of schizophrenia is unknown, but evidence suggests that genetic factors, early environmental influences (eg, obstetric complications), and social factors (eg, poverty) contribute. No biological alterations are pathognomonic of schizophrenia, although several pathophysiological differences exist in a wide range of brain structures. Antipsychotic medications are the mainstay for managing schizophrenia. A range of psychosocial treatments are also helpful, including family intervention, supported employment, cognitive-behaviour therapy for psychosis, social skills training, teaching illness self-management skills, assertive community treatment, and integrated treatment for co-occurring substance misuse.

Although this paper originated as an effort of the Division 12 Task Force on Psychological Interventions, we are publishing it as individuals rather than representatives of the Division.

We describe different models of community care for persons with severe mental illness and review the research literature on case management, including the results of 75 studies. Most research has been conducted on the assertive community treatment (ACT) or intensive case management (ICM) models. Controlled research on ACT and ICM indicates that these models reduce time in the hospital and improve housing stability, especially among patients who are high service users. ACT and ICM appear to have moderate effects on improving symptomatology and quality of life. Most studies suggest little effect of ACT and ICM on social functioning, arrests and time spent in jail, or vocational functioning. Studies on reducing or withdrawing ACT or ICM services suggest some deterioration in gains. Research on other models of community care is inconclusive. We discuss the implications of the findings in terms of the need for specialization of ACT or ICM teams to address social and vocational functioning and substance abuse. We suggest directions for future research on models of community care, including evaluating implementation fidelity, exploring patient predictors of improvement, and evaluating the role of the helping alliance in mediating outcome.