Addition of home-based cognitive retraining to treatment as usual in first episode schizophrenia patients: A randomized controlled study

Abstract

Objective:We examined the effectiveness of a 2-month-long home-based cognitive retraining program together with treatment as usual (TAU; psychoeducation and drug therapy) on neuropsychological functions, psychopathology, and global functioning in patients with first episode schizophrenia (FES) as well as on psychological health and perception of level of family distress in their caregivers.Materials and Methods:Forty-five FES patients were randomly assigned to either treatment group receiving home-based cognitive retraining along with TAU (n=22) or to control group receiving TAU alone (n=23). Patients and caregivers received psychoeducation. Patients and one of their caregivers were assessed for the above parameters at baseline, post-assessment (2 months) and at 6-months follow-up assessment.Results:Of the 45 patients recruited, 12 in the treatment group and 11 in the control group completed post-intervention and follow-up assessments. Addition of home-based cognitive retraining along with TAU led to significant improvement in neuropsychological functions of divided attention, concept formation and set-shifting ability, and planning. Effect sizes were large, although the sample size was small.Conclusions:Home-based cognitive retraining program has shown promise. However, further studies examining this program on a larger cohort with rigorous design involving independent raters are suggested.

Community-based psychosocial interventions for people with schizophrenia in low and middle-income countries: systematic review and meta-analysis

“…Across all included studies there were a total of 1580 participants with a median sample size of 101, ranging from 45 to 326. Five studies, reported in six papers, were conducted in China [ 35 – 40 ], two studies were conducted in India [ 41 , 42 ] and Iran [ 43 , 44 ], one study, reported in two papers, was conducted in South Africa [ 45 , 46 ], and one study was conducted in Turkey [ 47 ]. All studies were conducted in upper-middle income countries apart from the two studies based in India, which is classified by the World Bank as lower-middle income.…”

Systematic review of feasibility and acceptability of psychosocial interventions for schizophrenia in low and middle income countries

“…Fears of “gossip and ridicule” in the community were common in the collaborative community-based care programme in India [ 23 ]. An anecdotal report from another Indian study of home-based cognitive retraining suggested that high dropout rates could be due to families’ fear of stigma associated with attending the psychiatric hospital where the study was located [ 42 ].…”

Cognitive remediation in schizophrenia—The view from India

“…Intensive CR protocols available in developed countries are difficult to implement in India in view of the multiple ethnic groups, cultural practices and above all, a scarcity of mental health professionals. Thus, it is important to develop innovative CR approaches that can be implemented with brief training (Hegde et al, 2012). CR research in India is gathering momentum.…”

“…Hegde reported a 2 month home based CR program, based on a prior pilot study (Hegde et al, 2007, 2012). She developed booklet based tasks to be practiced weekly as an easier and cheaper alternative to one on one CR programs (n = 45 first episode schizophrenia patients, duration of illness less than two years, 12 subjects and 11 controls for final assessment) (Hegde et al, 2012).…”

“…She developed booklet based tasks to be practiced weekly as an easier and cheaper alternative to one on one CR programs (n = 45 first episode schizophrenia patients, duration of illness less than two years, 12 subjects and 11 controls for final assessment) (Hegde et al, 2012). While only half her subjects were employed, all the controls were in full time employment.…”