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Cognitive deficits are prominent features of the ultra-high risk state for psychosis that are known to impact functioning and course of illness. Cognitive remediation appears to be the most promising treatment approach to alleviate the cognitive deficits, which may translate into functional improvements. This study systematically reviewed the evidence on the effectiveness of cognitive remediation in the ultra-high risk population. The electronic databases MEDLINE, PsycINFO, and Embase were searched using keywords related to cognitive remediation and the UHR state. Studies were included if they were peer-reviewed, written in English, and included a population meeting standardized ultra-high risk criteria. Six original research articles were identified. All the studies provided computerized, bottom-up-based cognitive remediation, predominantly targeting neurocognitive function. Four out of five studies that reported a cognitive outcome found cognitive remediation to improve cognition in the domains of verbal memory, attention, and processing speed. Two out of four studies that reported on functional outcome found cognitive remediation to improve the functional outcome in the domains of social functioning and social adjustment. Zero out of the five studies that reported such an outcome found cognitive remediation to affect the magnitude of clinical symptoms. Research on the effect of cognitive remediation in the ultra-high risk state is still scarce. The current state of evidence indicates an effect of cognitive remediation on cognition and functioning in ultra-high risk individuals. More research on cognitive remediation in ultra-high risk is needed, notably in large-scale trials assessing the effect of neurocognitive and/or social cognitive remediation on multiple outcomes.npj Schizophrenia (2017) 3:20 ; doi:10.1038/s41537-017-0021-9 INTRODUCTIONDuring the last two decades there have been a surge of studies into the putative prodromal phase of psychosis commonly termed "the ultra-high risk state for psychosis" (UHR) or "the clinical high risk state". This way of prospectively identifying individuals at heightened risk for psychosis serves as the foundation for intervention studies aimed at avoiding, ameliorating, or delaying progression to psychosis. Furthermore, initiating appropriate treatment as early as possible has the potential of improving both the clinical and functional heterogeneous outcome 1 of UHR individuals. 2 Cognitive deficits are prominent features of the UHR state that have received increased attention in the research field. The most recent meta-analysis on the subject found an overall impairment in neurocognition compared with healthy controls to have an effect size of Hedges' g = −0.34, 95% CI: −0.43 to −0.26, with the greatest impairments found in the domains of visual and verbal memory. 3 Moreover, evidence indicates that neurocognitive functioning can be predictive of transition to psychosis, as poorer neurocognitive functioning in the domains of verbal fluency, verbal and visual memory, an...

ObjectivePatients at ultra-high risk (UHR) for psychosis show significant impairments in functioning. It is essential to determine which factors influence functioning, as it may have implications for intervention strategies. This study examined whether social cognitive abilities and clinical symptoms are associated with functioning and social skills.MethodsThe study included 65 UHR patients and 30 healthy controls. Social cognitive function, social skills, and a broad range of functioning measures were assessed.ResultsThe UHR patients demonstrated significant decrements on The Awareness of Social Inferences Task total score (p = .046, d = .51), and on the CANTAB emotion recognition task total percent correct (p = .023, d = .54) displaying particular difficulties in negative affect recognition. The patients exhibited significant impairments in social skills measured with the High Risk Social Challenge (p˂.001, d = 1.05). Aspects of emotion recognition were associated with role functioning and social skill performance. The level of attributional bias was associated with overall functioning, and theory of mind ability was associated with self-reported functioning. Negative symptoms were associated with all measures of functioning (p ≤ .05).ConclusionSignificant impairments in social cognition and social skills were found in UHR patients. The patients' social cognitive function was associated with overall functioning and social skills. Negative symptoms appear to play an important role for functioning. Research is needed to investigate how the relations between social cognition, social skills and functioning develop from the UHR state to the stage of manifest illness. Research into how deficits in social cognition and social skills can be ameliorated in UHR patients is warranted.

In schizophrenia patients, cognitive functions appear linked to widespread alterations in cerebral white matter microstructure. Here we examine patterns of associations between regional white matter and cognitive functions in individuals at ultra‐high risk for psychosis. One hundred and sixteen individuals at ultra‐high risk for psychosis and 49 matched healthy controls underwent 3 T magnetic resonance diffusion‐weighted imaging and cognitive assessments. Group differences on fractional anisotropy were tested using tract‐based spatial statistics. Group differences in cognitive functions, voxel‐wise as well as regional fractional anisotropy were tested using univariate general linear modeling. Multivariate partial least squares correlation analyses tested for associations between patterns of regional fractional anisotropy and cognitive functions. Univariate analyses revealed significant impairments on cognitive functions and lower fractional anisotropy in superior longitudinal fasciculus and cingulate gyrus in individuals at ultra‐high risk for psychosis. Partial least squares correlation analysis revealed different associations between patterns of regional fractional anisotropy and cognitive functions in individuals at ultra‐high risk for psychosis compared to healthy controls. Widespread higher fractional anisotropy was associated with better cognitive functioning for individuals at ultra‐high risk for psychosis, but not for the healthy controls. Furthermore, patterns of cognitive functions were associated with an interaction‐effect on regional fractional anisotropy in fornix, medial lemniscus, uncinate fasciculus, and superior cerebellar peduncle. Aberrant associations between patterns of cognitive functions to white matter may be explained by dysmyelination.